In Harm's Way
A staple of military care for more than a century, CRNAs who serve in the armed forces tend to a variety of patients and injuries in settings around the world

By Scott Williams
April 1, 2004

They may be the most unheralded heroes in military history. Most outside the medical profession are unfamiliar with their work. Yet the military depends upon them to treat casualties from the frontlines to military hospitals back home.

They’re certified registered nurse anesthetists and they’ve provided the bulk of anesthesia to American troops in the war against Iraq, as well as during the first Gulf war.

Throughout U.S. military history, nurse anesthetists have provided the bulk of anesthesia services, beginning as far back as World War I, said Ira Gunn, MLN, CRNA, a retired Army nurse anesthetist from El Paso, Texas.

“Nurse anesthetists do a good job and they’re more accessible to the military services,” said Gunn, who at 76 has become a historian on military nurse anesthetists.

Nurses became involved in administering anesthesia—discovered in 1846—from almost the very beginning, when the Mayo brothers began training them to administer it in the late 1800s, Gunn said.

“It started pretty much with individual surgeons getting a nurse and training that nurse to do anesthesia and then that nurse training more nurses,” she said.

The U.S. military branches began training nurse anesthetists at the beginning of the 20th century. By the time World War II started, there were 287 fully trained anesthesiologists in the United States and 17 times as many nurse anesthetists, Gunn said.

“So nurse anesthetists became the primary provider of anesthesia in World War II,” she said. Nurse anesthetists outnumbered anesthesiologists in Vietnam by a 4-to-1 ratio, Gunn said, and that ratio has continued to hold up throughout the military branches.

Commanding presence

The American Association of Nurse Anesthetists, founded in 1931, reported that the Pentagon released statistics in May that indicate that 364 CRNAs and 77 anesthesiologists were deployed as part of the recent war against Iraq. By October, those numbers had dropped to 167 CRNAs and 46 anesthesiologists deployed from all military branches.

Why do CRNAs outnumber anesthesiologists to such a great degree in military service?

“The income as a military officer isn’t very attractive to anesthesiologists,” Gunn said, “and [many] nurse anesthetists get training in the military service.”

That’s how Maj. Adrienne Hartgerink, MSN, CRNA, RN, received her training as a nurse anesthetist. Hartgerink, 38, is a 16-year veteran of the U.S. Air Force and is stationed at Langley Air Force Base in Virginia.

She began her Air Force career as a registered nurse in the intensive care unit at Langley’s hospital. After eight years, she decided she wanted a new challenge and the ability to make decisions on her own.

“As a nurse anesthetist, you have a lot of autonomy, a lot of independent practice, and I like the excitement of it, too,” she said. “I like the OR setting in general. I find it fascinating, so that’s kind of what drew me to it.”

To become a nurse anesthetist, she attended the Uniformed Services University of the Health Sciences in Bethesda, Md., where she met her future husband, Brad, a nurse anesthetist in the U.S. Navy. The military paid for her and her husband’s schooling and paid them a salary while they attended school, she said.

In return for her 27 months of schooling, Hartgerink had to give the military
4 1/2 years of service, including a five-month stint in the Philippines in 2002. Her husband has been deployed five times.

In the Philippines, Hartgerink for the most part treated people injured in common, everyday accidents such as automobile crashes. However, a terrorist bomb that killed four and wounded 25 also brought in burn and shrapnel victims.

Maj. J. Benjamin Campbell, a CRNA from Hot Springs, Ark., had a similar experience in Iraq. Campbell, a member of the Army Reserve for 18 years, recently spent 90 days in Baghdad, and in 2002 served with his wife, Lt. Col. Mary Jane Campbell, as the sole anesthesia providers at Eagle Base in Bosnia.

He, too, treated victims from car bombs and other explosives planted by terrorists after the occupation. Injured terrorists tended to be taken elsewhere, he said, although they often treated Iraqi soldiers held in detention centers.

“We mostly seemed to get the innocent bystanders, the ones who were blown up in car bombs or were working with us and got caught in the crossfire,” Campbell said. “We treated as many Iraqis as we did American soldiers. We had the soldiers, but if in the course of any engagement an Iraqi was wounded, we were responsible for their care, too.”

Challenging conditions

Maj. Steve McColley, a CRNA from Salt Lake City and a member of the U.S. Army Reserve since 1990, also served in Iraq recently. He was deployed last March as part of the 20-person 934th Forward Surgical Team.

The FST was assigned to the Second Brigade of the Third Infantry Division and traveled all over Iraq to treat the injured. The FST members often ended up closer to the action than they would have preferred.

“We were not only right next to [the frontlines], at one time we actually got in front of the lines,” McColley said.

The FST would follow the Second Brigade. Once the fighting began, the FST members would stop, set up their tents and wait for nightfall. That’s when the casualties would begin to come in and surgery would commence.

McColley, 46, said injuries included shrapnel, gunshot wounds and injuries from hand grenades, land mines and fragmentation bombs. The FST operated on American soldiers, prisoners of war and men, women and children from the civilian population.

“The lion’s share of who we operated on were Iraqi prisoners of war and some civilians,” he said. “We treated everybody who came in our door. We turned no one away.”

McColley said keeping dust out of the operating rooms was one of the biggest problems they faced. They also had problems with their generator.

“Our problem was our generator went out on us and if the generator went out we had to use headlights and we didn’t have piped-in oxygen,” he said. “We had oxygen concentrators that ran off electricity and if we ran out, we didn’t have any backup oxygen source.”

Campbell said serving in Iraq was the hardest thing he has ever done. The environment is hostile, the heat is oppressive and there are few, if any, amenities. “You have to change your whole way of life,” he said. “There’s nothing there you’re accustomed to, so you have to learn to live differently and function differently.”

Hartgerink’s job at Langley is a lot like nurse anesthetist jobs anywhere. She provides anesthesia for knee surgeries, gallbladder surgeries and administers epidurals to grateful women in labor.

“I would say the best part of my job is being able to take the pain away,” she said. “We have a lot of babies named after us.”

The worst part? The hours.

“We work a lot of long hours and nights and weekends and holidays,” Hartgerink said. “People still have babies and get sick at all hours of the night.”

Despite their military record, most people still don’t understand how much nurse anesthetists have contributed to the country.

“It’s amazing that most people don’t know about us,” Campbell said. “But we’re the silent majority, we’re the backbone.”

Campbell and McColley both put more lucrative private practices on hold in order to serve their countries. Both said they consider it an honor to serve their country and don’t regret joining the reserves.

“There wasn’t one person who didn’t want to go,” McColley said, referring to his unit. “Everybody wanted to be there. We wanted to help out people who were over there. It was something that we volunteered for, and if they asked us to go again, we certainly would.”

Contact Scott Williams at scottwilliams21@msn.com.