Good afternoon, everyone. My name is Dee Binder. I'm part of the Professional Development Committee. We made it! Woo! Successful 2024 Annual Congress. Get your CE. I'm not going to go into a big long thing here, September 9th. I'm going to spend more time here to introduce fabulous colleagues. Okay? I'm going to read because I don't want to mess it up. Dr. Randy Cornelius. Okay. Stacey Yancy. Dr. Cornelius is a CRNA for RDC Anesthesia and AANA's Region 6 Director. Ms. Yancy is a clinical practitioner in multiple settings. She's AANA's Region 4 Director. No, she's not a student. Thank you guys for doing this so much. Thank you. Thank you. It's so good to be here. So today, me and Stacey are going to be talking about Army anesthesia being all you can be. That was a slogo, a recruiting motto that the Army had. This is not to take any offense to the other services, but this is just to focus on the Army. If anyone in the audience has served in our military or is currently serving in any branch, please stand up and be recognized. Recognize our service. Thank you. Thank you. Thank you so much for your service. So this is our conflict of interest. RDC has no financial relationships with any commercial interests related to the content of this activity. Now the fun part. I, Randy Cornelius, am a member of the United States Army Reserves. Presentation today is in no part of my official duties as a member of the United States Army Reserves. The views presented are mine and do not necessarily represent the views of the Department of Defense or its components. This presentation has been approved by my higher command, the Medical Readiness Training Command Public Affairs Office, and the United States Army Recruiting Command. After this presentation, a representative from the United States Army, Captain Tweekly, will be outside to answer any questions, if anybody has any questions about joining the Army. And luckily, we will not be discussing any off-label drug use during this presentation. These are our learner outcomes, and I'll let Stacey take over. Thank you so much, Randy. And I would just like to thank Randy for asking me to join him during this presentation. He has a presentation very similar to this that he gives by himself, but he knew that I was researching Civil War nurse anesthetists and asked me to join him. So thank you so much for including me in this. So I am so excited to be here to talk to you about historic Army nurse anesthetists. Now before we get started with the very earliest nurse anesthetists that we know of, I'd like to give you a little bit of historical background. So we know that Ether Day, the first public demonstration of surgical anesthesia, was on October 16, 1846. The very first military use of anesthesia that we know of was during the Mexican-American War in 1847. We also know by 1849, the U.S. military kept ether and chloroform in stock. So and then after the Civil War, the Army Medical Department wrote a six-volume history of the Medical and Surgical Department of the war, and it's documented in this history that no less than 80,000 surgeries were performed with anesthesia. They also recorded about 300 surgeries that they knew of that did not have anesthesia. And the ones that did not have anesthesia were usually on the front lines, they were very urgent or emergent, and they ran out of ether and chloroform, and they had to be done anyway. So a lot of people have this vision in their head of Civil War surgery being extremely brutal, people biting on leather straps or biting the bullet. And we know that that is not accurate. You know, a few times it did happen because they ran out, but that wasn't the majority of the time. So we know that anesthesia was given during this time. Who was giving it? We have some records that surgeons would induce the patient, you know, they'd put the rag soaked with ether or chloroform over their face, induce the patient, and then come to the other side of the table and do the amputation. We also have records where they ask an assistant to do it. And that assistant could have been a convalescing soldier, another physician, or a nurse. And right now we know of three nurses that it's documented that they gave anesthesia. The first one is Mary Newcomb. Mary Newcomb was born in New York, and she was living in Effingham County, Illinois by the time the Civil War was starting. Her husband volunteered for the Army, and he was in the 11th Infantry, the 11th Illinois Infantry. She followed him to where he was stationed at Birds Point, Missouri. And early in the war, in one of the early battles in the Western Theater, he was injured. He was shot in the chest, and she was taking him home to care for him. She was with him right after his injury. Nine days after his injury, he died. They didn't make it home for her to care for him at home. They were still traveling. But his last words to her were, Mary, go home, or go back and take care of those boys. They need you. And so she did. She served as a volunteer nurse in the Civil War until it ended. Now right after the Battle of Shiloh in Tennessee, Mary Newcomb found herself on a hospital ship on the river right there outside of Shiloh. And she met a young man who had a shattered arm that was becoming gangrenous, and he needed an amputation at the shoulder to save his life. Now I'm going to read her words now from her memoir. He had suffered very much and was very pale and weak. The arm had to be taken off near the shoulder, and everyone said he would never live through the operation. I stood by the table and gave him brandy and ether and applied cold cloth to his forehead till he was quite unconscious, and three doctors commenced the operation. It was quickly over, and not a groan escaped the boy. Now the Battle of Shiloh took place on April 6th and 7th, 1862, and this makes Mary Newcomb the very first nurse that we know of so far to give anesthesia. Now Catherine Lawrence, you've probably heard about Catherine Lawrence. She was also born in New York. She was orphaned at age 14, and she began working as a seamstress to provide for herself after the death of her parents. She later became a schoolteacher. And in 1861, she enlisted as an Army nurse, and according to her book, she entered City Hospital in New York for military nursing training. And this was a big deal because at the time, nurses weren't formally trained. A lot of physicians weren't formally trained, if we're going to be honest, and so this was one of the earliest training programs for nurses. Now she served at several different hospitals throughout the war, and in August of 1862, she was at Armory Square Hospital in Washington, D.C., and the Second Battle of Bull Run started right outside of town, and her little hospital became an amputation hospital. She wrote in her book that the very worst cases were kept there, and the less serious cases were sent on to other hospitals. She wrote in her book about how busy they were and how men just kept coming from the front just constantly. And in one short little sentence, she says, I also tied arteries and gave chloroform. That was it, no more details, that's all you get. So that, and since the Battle of Bull Run took place on August 28th through the 30th, this makes Katherine Lawrence the second nurse we know of to give anesthesia. Now Clara Barton, do I have to introduce Clara Barton? She is probably the most famous American nurse and the founder of the American Red Cross, and I have to give Randy some credit and maybe an apology because he said to me, why don't you look up Clara Barton? She probably gave anesthesia. And I said, Randy Cornelius, if she gave anesthesia, we would already know about it. It would be on the front page of the AANA Journal, and we would know. And he said, just look into it. And I said, okay, I will. So he was right. He was right. I'm sorry. One for the guys. Right. Just one. That's the only time he's ever been right. We'll take it. We've known each other four years. I'll give it to him. So Clara Barton, her father had served as a captain in the Army, and he was involved in a lot of the campaigns in the Michigan Territory. And he taught her military tactics and how to shoot a gun. She was apparently a really great shot with a revolver, and she reminisced that he raised her more like a son than like a daughter. And so when the war broke out, she wanted to be a nurse. And she was too independent to join as a nurse. She didn't want people telling her exactly what to do. So what she started doing was gathering supplies from her local community and donating them to hospitals. That really didn't scratch the itch she had. You know, in her heart, she knew that she was going to be a nurse. She knew that she was going to be a nurse. She knew that she was going to be a nurse. It didn't scratch the itch she had. You know, in her heart, she wanted to be on the front lines. And so she went to meet the quartermaster in Washington, D.C., and convinced him to give her a pass to the front lines. So she had the ability to go to her community, gather supplies, and then put them in her wagon and take them to the front lines, where she would serve as a nurse and distribute these supplies. You have probably heard of the Battle of Antietam. If you haven't, it is the single bloodiest day in American military history. Over 12,000 Union soldiers were wounded or killed this day. Over 10,000 Confederate soldiers wounded or killed. It was awful. And Clara Barton was there with her wagon full of supplies. And she slept in her wagon the night before the fighting started. Amongst the troops. At 3 a.m., the shooting started. And at dawn, she took her field glass and looked at the front lines. And she looked, and with all the military training her father had given her, she said, that's where I will be needed first. That's where the fighting is going to be worse. The worst. And so she ran back to her wagon, drove her wagon to where she thought the fighting would be the worst. And there was an old farmhouse there. And one of her surgeon friends who she had met at previous battles was already there taking care of patients. And so she started unloading her wagon and got to work. And the fighting was about an eighth of a mile from where this farmhouse stood. And it kept inching closer and closer and closer. At one point, she was kind of in the lawn outside of the house. And she was bent down, giving a drink of water to a wounded soldier, and a bullet tore through the arm of her dress and killed the man she was giving the water to. It got even closer, though. It got even closer that all of the male surgeons and assistants who were there helping ran away, except for the chief surgeon, because he was in the middle of an operation. And so she runs up to him. She's the only other person left. And she says, can I assist you? And he says, can you stand it? She said, oh, yes, I can. And so she gave that patient chloroform and held him firmly on the table so that the surgeon could finish the operation. Now, later, the fighting moved further away. And the male surgeons and assistants came back. But the chief surgeon did not want to work with them. He wanted to work with Clara. And so she worked by his side until dawn. And the only reason they could work until dawn was because she brought candles in her wagon. She was the only one who thought that they would need those. So these are the three earliest nurses that we know of so far who gave anesthesia. All three were fiercely independent and served on the front lines and wherever they were needed to care for wounded soldiers. And I hope that I will find more of these women so I can share their stories with you. I want to switch gears a little bit and talk about some amazing nurse anesthetists from World War I. Now, this is just 50 years after the American Civil War. And 50 years is seeming shorter and shorter to me as I get older. I don't know about you guys. Not very long after, but technology had advanced so much. Instead of what you think of as in the Civil War, World War I, there were machine guns and bombs falling from planes and mustard gas and trench warfare. And if you think about trench warfare, what is the first thing that pops up out of the trench when you're looking over the sides? There were so many facial and head injuries in World War I that people wouldn't have survived in the Civil War. But thankfully, in World War I, the technology for medicine had also advanced. We had x-rays. Blood transfusions were becoming a thing. And germ theory was widely recognized. Surgeons washed their hands before surgery now. Instruments were sterilized. We were discussing the causes of shock. They didn't really know that there were multiple causes of shock, but they were getting there this time. Anesthesia was also evolving. Nitrous oxide was championed as safer for patients in shock than ether and chloroform. There was now the drop ether method instead of just smothering people with a rag coated in ether. And medical professionals were beginning to specialize, including our predecessors, the nurse anesthetists. Now, World War I started in 1914, but the U.S. didn't declare war until 1917. Now, the American ambassador to France, Myron Herrick, who was from Ohio, Jeff Moultra, asked George Creil, who was also from Ohio, he was a prominent surgeon at Lakeside Hospital, he asked him if he would come and help the wounded French soldiers. Now, Creil told him, sure, I would love to come, but I would be useless without my staff. And so he volunteered to bring a team, and he would also recruit from other major hospitals in the United States to bring teams of volunteers as well. Now, this system of rotating hospital units worked so well at the American Ambulance that Creil, major hospitals, the Red Cross, and the Army Medical Department started planning to use this system if the United States entered the war. Now, these hospital units would be the foundation of the American military medical system during the war. Now, I'm going to turn it over to Randy. So let's talk about one of the nurse anesthetists that Dr. Creil used. That's Agatha Hodgins. Yes. Born in 1877 in Toronto, Canada. Had to make sure we get that geography right. Not Toronto, United States. She's Canadian. But she trains in Boston. In 1900, she goes to work at the Lakeside Hospital in Cleveland, which is now known as the Cleveland Clinic. But in 1908, Dr. Creil asked her to be his personal nurse anesthetist. She trained on rabbits and dogs. And I've only done anesthetic on one dog, so she has more skill than I do in this. But as Stacy alluded to, in 1914, the Lakeside Unit, the hospital, functions at the American Ambulance Hospital in Nuit, France. And then it was called the Lakeside Unit in Transportation and Triage. They were the first American unit to go to combat. Again, this is before the United States enters the war. And we get mentioned that there was three nurse anesthetists. According to Watchful Care, Agatha Hodgins says there were three nurse anesthetists. Herself and two others. However, in Thatcher's book, in the book of History of Anesthesia, there's only mention of two. Agatha and a Mabel Linton. So we're very unsure about who this third anesthetist is. But what does Agatha do? She introduces the oxygen nitrous technique, achieving wild acclaim. She demonstrated that nitrous gas solution was very conducive to preventing the shock worse. She has to work at the front lines with an anesthetizing apparatus, hazardly transported there in the trenches. But three months later, in 1915, Lakeside is replaced by the Harvard Unit, with a Dr. Harvey Cushing. He's not well-known in it either, but yes. So Dr. Kreil and Mabel Linton go back to the United States. Agatha stays on for an extra month to teach the nitrous gas technique to other soldiers in that unit, et cetera. But with this, like Stacey alluded to, it helped develop the base hospital concept. It also recommended it had to be staffed by physicians, nurse anesthetists, and nurses. And it was our precursor to what the Army had field hospitals in World War II. Agatha comes back. The United States enters the war, but she does not go back to Europe. But instead she does, she goes back and teaches at Lakeside. But she was busy teaching. And she did other things. She made a contribution for anesthesia into the war. Her and a co-founder of the Ohio Chemical Company, Dr. Graham Clark, designed the Ohio Monovalve Gas Machine. I had a picture of Stacey with it in our archives, but Stacey said they wouldn't let her unravel it from the bubble wrap. It was just one of several machines used during the war, but in a U.S. military report in 1923, it was said to be the most satisfactory machine because it gave a constant pressure of nitrous oxide, which is no surprise because Agatha said it. The importance of a constant amount during the anesthetic. So even though she wasn't there, her gas machine was helping to save lives. But what are some of her other accomplishments? 1915, she formalized the Lakeside Hospital School of Anesthesia. 1926, she presented at the Alumni Association of Lakeside Hospital School of Anesthesia the idea of forming a national organization. 1929, excuse me, we began our Constitution and Bylaws for national organization. On June 17th, 1931, a meeting is called of representative nurse anesthetists resulting in the organization of the National Association of Nurse Anesthetists, then called NANA, then changed the American Association of Nurse Anesthetists and now known as the American Association of Nurse Anesthesiology. That is our birthday. And Agatha, as hopefully everybody should know, is our first president of our association. And the Agatha Hodgins Award for Outstanding Accomplishment was established in 1975 to recognize individuals whose foremost dedication to excellence has furthered the art and science of nurse anesthesia, our highest award. Thank you. Right now, I have the honor of talking to you about Ann Penland. Now, Ann is a native of Asheville, North Carolina. She's my people, but she went to nursing school at Presbyterian Hospital in New York, and she was an anesthetist there when World War I started. Now, she went to France with the Presbyterian Unit, and they were one of the first hospital units to go over there. Now, we declared war on April 6th, 1917, and she was on a ship headed for Ports Unknown on May 14th. Now, the Presbyterian Unit replaced British physicians and nurses at Base Hospital No. 2 in Étretat, France. Now, the anesthetist that she relieved was a physician, and he was very interested to meet her because people had been teasing him about being replaced by a woman, and they were calling her the female anesthetist. Now, in July, Ann's Base Hospital provided surgical teams to assist the British front during this huge push in Belgium. Now, these surgical teams consisted of a surgeon, an anesthetist, a nurse, and an orderly. And Ann, and they sent two teams, so they sent eight people to the British Base Hospital, or sorry, British Casualty Clearing Station 47, and Ann was one of the two anesthetists that went. And these casualty clearing stations would be about the equivalent of an American evacuation hospital. Now, Major Darragh was the surgeon that she would be with during her time here, and he was a surgeon that she used to work with in New York as well. Now, remember, the American Army isn't really over here yet. This is just a few months after we declared war. Our Army is still being recruited and trained and transported over here. So she is working with the British Medical Department, and she is caring for wounded British soldiers. And she was the first nurse anesthetist that these British physicians had ever seen. And she writes in her journal about the British medical officers being very suspicious of a nurse giving anesthesia because they had never seen one before. Now, here is her journal entry from August 10th, 1917. And here, she gives a whole lot of credit to the surgeon that she worked with for sticking up for her. But I've also found another record of this in the history of the U.S. Army Nurse Corps. It was described a little bit differently. I'm gonna read it to you. When her team arrived at the front, a British medical officer queried Major Darragh, the American surgeon, but where is your anesthetist? Major Darragh indicated, Miss Penland, but often there are eight or 10 patients at once, big chaps, and they struggle. Wait and see, promised the American surgeon. Now, during a lull in the work which followed, the British officer came back to Major Darragh, praised Miss Penland's work, and concluded, but she always seems to draw the quiet, peaceful chaps. Come and see, said the American surgeon. And they approached the table where Miss Penland was anesthetizing a broad-shouldered Tommy who seemed inclined to fight the ether. Miss Penland leaned over and murmured soothingly, there, dear, it won't hurt you a bit. There, there, and at the sound of her low, distinctly feminine Southern voice, the Tommy looked up in surprise, then grinned with perfect confidence, and went under without a struggle. So, it's the voice, it's the voice. So successful was her work that the British decided to train their own nurses for this service. And here is a copy of a letter that was written to Anne that was published in the American Journal of Nursing. It was written to her in November of 1917, and it's basically just letting her know that due to her influence, they decided to train their own nurses in anesthesia. And I have found a record of about 200 British, Australian, and South African nurses who were trained in anesthesia during World War I because of Anne Penland's influence. Now, in Anne's journal, she didn't talk a whole lot about anesthesia. She was used to giving it, right? So, that wouldn't have been the most noteworthy thing that she experienced while she was over there. But she did talk about one particular patient. So, this is Anne on the left, and Lieutenant Revere Osler on the right. Revere Osler's father was William Osler, who is widely considered to be the father of modern medicine. At the time of World War I, he was the dean of Oxford Medical School. And on August 29th, Revere Osler was injured, and he was brought to Casualty Clearing Station 47 in extreme shock. He had shrapnel wounds in his chest and his abdomen. Now, there were a lot of famous American surgeons at the front at this time, and they were all called to come and help. Harvey Cushing, George Kreil, they were just down the road. An ambulance brought them to CCS 47. And before Revere was taken back to the operating room, he was told, your father's friends are here. And he gave a faint smile. Now, Anne writes in her journal that Brewer and Darragh were the operating surgeons, George Kreil was giving a blood transfusion, and Harvey Cushing held his fingers on Revere's pulse through the whole surgery. And she writes, and I gave a few drops of ether. So here is this woman, this nurse from North Carolina, giving anesthesia for the most famous surgeons from America in the middle of nowhere in Belgium, trying to save the life of the son of the father of modern medicine. And everybody in that room trusted her to do her job. There were physician anesthetists at that Casualty Clearing Station. They weren't called in to replace her. Everyone trusted her to do her job. Now, you can Google Revere Osler and read about this story. Kreil, Brewer, and Cushing all wrote about it. And they write about each other. They write about their connection to William Osler and how he trained them. But nobody mentions Anne Penland giving the anesthesia. If she had not written it down in her own journal, we would have never known. It is so easy to be left out of history, y'all. If we don't tell our own story, no one else will. Yeah. Thank you. Now, this is Anne Penland's record of her service. If she hadn't left a diary, if others hadn't published letters written to her, or their own diaries of her teachings, we have a diary of one of her Australian students about her teaching. This is all we even know about her. There's nothing about her being an anesthesia specialist or how she served with Casualty Clearing Station 47 or how she convinced the British Army Medical Department to train other nurses in anesthesia. But who knows what other stories are out there that we just haven't found yet because we have records like this and we need to dig a little deeper. And remember, if you don't tell your own story, nobody else will. And if you ever find yourself in Asheville, North Carolina, take a walk downtown and Anne Penland has a historical marker right outside of the library. And the day it was dedicated, four AA&E presidents were there. Because if we don't tell our own story, nobody else will. Now, there's another nurse anesthetist that I'd like to tell you about whose travels are very similar to Anne's. Her name is Gertrude Gerard. She was a graduate of Peter Bent Brigham School of Nursing in Boston in 1915. And then she was trained by a physician to give anesthesia. Now, Dr. Harvey Cushing, who we've talked a lot about, the father of modern neurosurgery, I don't know who the father of pre-modern neurosurgery is, but she became his personal anesthetist. And they went over with the Harvard unit in 1917 about the same time as Anne Penland. And like Anne and her surgical team, they were pulled from their base hospital to serve at the front lines at Casualty Clearing Station 46. They were about six miles apart. And I'm not sure if Gertrude and Anne ever met. Now, I haven't found a journal from Ms. Gerard, but Harvey Cushing kept a journal. There's a published version that's been edited down for size, but in the original that's kept in the Yale archives, he has an entry about her. Now, he was doing up to eight cranial surgeries a day in this tent hospital in Belgium. And Gertrude was always his anesthetist. And he wrote, they think I am killing Ms. Gerard. She does double work, anesthetist and instruments too. Moreover, like me, she has no regular schedule of hours. And not only was she in the OR, she was cleaning instruments. She was going to the wards with him to give anesthesia while he did complex painful dressing changes. And at the end of the war, Gertrude Gerard, as well as the three other nurse anesthetists that we know of who served with the Harvard unit, received the British Royal Red Cross for their service with the Casualty Clearing Stations. Now, Gertrude Gerard, she went home after the war and she became the chief anesthetist at Brigham Hospital. When Harvard medical students would go through their surgery rotation, she would teach them about anesthesia. She was also the only nurse anesthetist for the neurosurgery service. And she did all of the neurosurgery cases at that hospital, including the pediatric cases. And she served as the chief anesthetist there until the hospital decided to replace the nurse anesthetist with physicians in 1946. You'll never take our profession for granted. Sophie Winton was born and raised in Minnesota and trained in anesthesia at Swedish Hospital in Minneapolis. She volunteered to serve in the army as a nurse in 1918. And she already had five years of experience and a record of over 10,000 anesthetics without a fatality when she joined. And why did she join? It was the patriotic thing to do. If you ever meet a military CRNA, you will always find out we do things for others. We volunteer. Quick side note, I was in a military course, met a person from our human resource command, and she goes, oh, you're one of those nurse anesthetists. I was like, yeah, is there a problem? And she goes, yeah, when this war kicked off, meaning Operation Enduring Freedom, she goes, you guys came out of the woodwork to volunteer to go overseas to provide anesthesia. I was like, yeah, I guess that's a bad thing that our profession would volunteer to go over because you'd struggle to find other people. You'd have to take them kicking and dragging. She was assigned with a pioneering physician anesthetist named James Guathami. She gave anesthesia from June till November. The first three months were chloroform, entirely ruling made to use ether because of death related to chloroform. She was assigned to the mobile hospital number one in the Chateau Thierry area of France. She often gave as many as 25 to 30 anesthetics a day. I get tired doing 16 cataracts. You can't imagine that. But interestingly, she wrote that at times she would have to pour either the ether or the chloroform on her finger to know how much amount she was giving because she couldn't use light. That was for the surgeon. And the only monitor she was utilizing was the patient's respirations. Sophie ends up going back to California. She becomes a partner in a private dental clinic. California, when it comes, when she goes there, is not a friendly place for nurse anesthetists. If you listen to Sandy Ouellette's presentation a couple days ago on the history of the Dagmar Nelson, she still went out. She was asked to please come out. She was welcomed by a guy named Dr. George W. G.W. Olson, also from the University of California, who was a doctor at the University of California, G.W. Olson, also from Minneapolis. But like I said, Sophie never practiced in a California hospital. She was not a hospital employee. She got paid for services. She helped advance the field of dental anesthesia, opened outpatient plastic surgery clinics in California, helped form the California Associated Nurse Anesthetist, and was actually their first president. So kudos to Kana. And in 1984, she was awarded our highest recognition, the Agatha Hodgins Award for Outstanding Accomplishment, at the age of 97. But she also played a significant part in supporting uprights of other nurses anesthetists to work. So we're gonna pivot real quick. We're gonna talk about Dagmar Nelson and Dr. Vern Hunt. Dr. Vern Hunt was formerly of the Mayo Clinic, where Dagmar Nelson trained and worked for 10 years. Dr. Hunt goes out to Los Angeles and is practicing. He has an incident where a young, healthy individual dies of asphyxiation during a minor procedure, and Dr. Hunt is not happy about it. He asked Dagmar Nelson to please come out to California and provide anesthesia to his group, with preference for him, Dr. Hunt. This time this is going on, the California State Board of Medical Examiners adopted a resolution in 1928, basically stating that the administration of anesthetics by persons not licensed under the Medical Practice Act constitute a violation of the act. Physicians sought an injection to restrain permanently from administering the anesthesia. They take Dagmar Nelson to court, saying she's practicing medicine. It goes to court, trial lasts 12 days. The courts ruled in favor of Dagmar Nelson, because they said, she is not practicing medicine, she's administering an anesthetic that was ordered by the physician. What does this have to do with Sophie Winton? Sophie Winton gave financial support for Dagmar Nelson. Nana was only two years old. Our association did not have the funds to help support Dagmar Nelson. She couldn't work during that time. Thank you. All right, the last nurse anesthetist from World War I that I'd really like to talk to you about is Grace Anderson. She was trained by the nurse anesthetist at the Mayo Clinic, and she joined the Army Nurse Corps in November of 1917. In December, she was sent to Camp Pike in Arkansas for military training and to wait for transport to Europe. While she was there, she was asked to train other nurses in anesthesia, so that when they got over there, they would be able to help give anesthesia as well. Now, after waiting stateside for nine months because transports were not available for a while, Grace finally arrived in Europe in August of 1918, and she served as the chief anesthetist for this hospital in Vichy, France. Now, I wanted to tell you about this particular hospital because they specialized in head injuries. They had neurosurgeons there, they had neurosurgeons, neurologists, and a new specialty was forming, plastic surgeons were there. Now, Grace worked with all of these people, and she was the chief anesthetist, and she wrote home in some letters that have been published about what great work they were doing, especially for men who had lost their entire lower jaw. Now, this next part is a little bit graphic. I don't expect it to bother a group of CRNAs, but just wanted to warn you. This is an example of the facial injuries that Grace, and really all of these women, would have been dealing with. But I wanted to really emphasize that Grace Anderson was the chief anesthetist at this particular hospital that specialized in these cases because in a lot of the books that I've been reading about World War I, the medical advances, a lot of these sources are saying that a specialist in anesthesia was needed for these cases, and that plastic surgery is one of the reasons that physicians started to give anesthesia. I partially agree. I do think sharing an airway, and doing a case like this, you need a specialist. We already had specialists. We had nurse anesthetists who specialized in this. And Grace Anderson was the chief of anesthesia at a hospital that specialized in this. I just wanted to remind you that these nurse anesthetists were doing anesthesia for battlefield trauma, neurosurgery, complicated facial plastics, and everything else that was thrown at them during their time in Europe. And now I'm gonna turn it over to Randy because he said I talk too slow to get through everything. He's gonna finish this up. So this is Colonel Mildred Irene Clark. She joins the Army Nurse Corps in 1938, trains at Jewish Hospital in Philadelphia under a person we might have heard of named Hilda Solomon. She completes her training in 1940 and gets orders to the horrible place called Hawaii. Dream job. But while on her trip, she decides she's gonna go up to Mayo to learn the use of a new drug called Pentothal from Florence McQuillan and also another well-known anesthesiologist named John Lunding. But what was her impact? She was stationed at Schofield Army Hospital at Schofield Barracks on December 7th, 1941. She shared the anesthesia workload and call with one other nurse anesthetist. She gets tasked to set up an anesthesia program following our guidelines to prepare nurses as anesthetists in Hawaii for duty in the Pacific. 1947, she's sent to Korea and serves as the chief nurse of the 24th Corps. Shortly after, gets reassigned to General Douglas MacArthur's staff in Japan as the chief nurse of the Far East Command. July 1949, she's the only nurse in Korea and she was the only nurse on 25 June, 1950 when North Korea invaded South Korea. And she was tasked with a surgeon of the Far East Command to rapidly put first the two hospitals immediately to deploy to Korea, the 8054th and the 8055th Mass. In both of these units, we're having nurse anesthetists in our units. But she's not just done there. 1963 to 1967, she is the chief of the Army Nurse Corps. You're the boss of all the nurses in the Army, but she's the first nurse anesthetist to hold this. You're gonna start seeing, you guys have been catching common themes. Female nurse anesthetist, first leaders. We're a certain personality, aren't we? And that tradition still continues to this day. We are a certain breed of individual. What I'm thankful for though, is she went bat to bat for me. As I said, I'm an Army reservist, nurse anesthetist. Back in that day, I would have not been able to join the United States Army as an officer and serve as a nurse. I would have had to serve as a medic. Colonel Clark fought for males to come in to serve as nurses. Additionally, then she also went to bat to have that the nurses have the same rank as what's called a star, a general officer. You think that's minor, but it's not. Because when you're going in to have meetings with individuals, if you do not have the same rank as those others in that meeting, you might as well be sitting at the kids' table at Thanksgiving versus sitting with the adults. It brought up the equality for females to have that fight. In your upper left corner, Phyllis Arnold-Lacobucci. She's from Minneapolis, Minnesota. You have Ann Mueller. She was from Gorgas, Alabama. And she was a chief nurse on an island called Corridor. Doris Kehoe was in charge of anesthesia department at a hospital in Pacific California. And Denny Wilmans was from Culpeper, Virginia. She was actually in the Army, but married another Army person, so then had to resign her commission. Because back then, you could not be married and serve as a nurse in the United States Army. We've come a long way. But unfortunately, her husband died during the conflict, so then she did come back and join the Army. What's their story? They were Army CRNAs taken prisoner on Corridor by the Japanese. They were not among 22 nurses that were evacuated at the last minute. In May 1942, they were interned at the Santo Thomas internment camp in Manila. It took them three years to finally be liberated by the United States military. Throughout the imprisonment, they continued to provide nursing and anesthesia services for fellow prisoners at the prison hospital, despite the severely limited access to drugs and equipment. So just to put this in perspective, this is what the Philippines looked like. Early on in the war, we lost the Philippines. We had to evacuate General Douglas MacArthur to get him out and get him to Australia, because if he would have been captured, we probably would have lost the Pacific. But this little bitty island called Corridor is where everybody went and tried to hold out. They were holding out to wait for more forces to come, but it didn't happen. That's the camp. You can read more about them by a book called We, Band of Angels. It tells the story of all those nurses in captivity. It brings to light that it's the first time females were ever taken prisoner. This is a picture of what they looked like in the hospital in those islands, or down in the basements. This is Colonel Ruth Satterfield. She joins the Army Nurse Corps in 1940, and she modernized the education process for Army and civilian nurse anesthesia programs. First nurse ever to be appointed consultant to the Army Surgeon General, and she holds that from 1961 to 1968. During that tenure, she kind of opens up the Army anesthesia programs. From 1968 to 1981, she served as our education consultant. In 1975, she is awarded the Agatha Hodgins Award for Outstanding Accomplishment, becoming the first recipient. We don't have a lot of stories from Korea. We just haven't been able to find them yet. We're gonna kind of fast forward and get to Vietnam. In 1968, we have 330 Army CRNAs on duty. 108 of those are needed in Vietnam alone. So CRNAs are now having to begin to do a second tour. These weren't just quick. These were, you were there for a year, come back. The Army Nurse Corps usually would send our lower-ranking officers, lieutenants all the way up to majors, but now they're gonna have to start sending higher-ranking CRNAs, our lieutenant colonels, our colonels who had never been there. Oftentimes, Army CRNAs were outranking the chief nurses of those hospitals, and most definitely we are outranking the anesthesiologists. This is Lieutenant Kenneth Schumacher. He's from Mount Vernon, Illinois. He goes to school for anesthesia in St. Joseph Hospital School of Anesthesia in Lancaster, Pennsylvania. Graduates in 66, drafted in 1966, and is shipped to Vietnam in 67. What he really wanted to do is he wanted to go to medical school, but he couldn't afford it. He also had a plan that he was gonna do anesthesia school first, and then send his wife to anesthesia school. This is Lieutenant Jerome Olmsted from Clintonville, Wisconsin. In 1966, he graduated from St. Francis School of Anesthesia in La Crosse, Wisconsin. Now May 30th, 1967, he's serving in Vietnam. What's their story? They're serving with the 67th EVAC Hospital in a town area called Quy Nhon. They volunteered to help go up to an area in Pleiku to help out the 71st EVAC Hospital. They knew we were having a big push. They were gonna have a lot of casualties coming in. They served with former ANA President Ron Lester. He was our president from 2002 to 2003. They were up there for two weeks helping out. Their transport plane taking them back to Quy Nhon crashed and kills them. They were killed in the crash amongst some other nurses. There's their panel markers on the Vietnam Wall. They became the first Army Nurse Corps male soldiers to die in conflict, probably also making them the first nurse anesthetists. I think we wouldn't have to introduce Ira Gunn, but we kind of have to. There's a lot of stories we gotta talk about Ira. She joins, this is what's amazing, from 1948 to 51, she simultaneously worked towards a nursing diploma at Lily Jolly School of Nursing in Houston and a Master's of Letters in Nursing at the University of Houston. I could barely get through one degree. In 1952, she joins the Army and serves 18 months total in Korea during the conflict as a nurse, not as a nurse anesthetist. In 1955, she joins the Army Nurse Anesthesia Program. In 65, she's sent to Triplett, which is in Hawaii, to set up a nurse anesthesia program, and she established a cooperative program with Triplett and the University of Hawaii School of Nursing, which led to the first graduate-level anesthesia program. ANA did not mandate master's-level training until 1998. She serves as a consultant to the Army Surgeon General for nurse anesthesia, but she retires in 1973 from the military. But she's not done. In August 1974, the U.S. Department of Health, Education, and Welfare announced an enacting major changes to the accreditation criteria. January 1975 is the deadline for the ANA to submit a petition outlining compliance with the new criteria. Ira Gunn is hired to be a consultant to work as a project manager and tasked to work with writing the petition. She identified nine major tasks to ensure compliance. The first being major revision of an organizational structure of ANA to ensure no conflict of interest and to assure autonomy in the decision-making for the accreditation and the certification of the bodies. Our counterparts, the ASA, files a formal challenge to the ANA's right to accredit nurse anesthesia schools. Why would they do that? They wanted to control our education. If you control somebody's education, you control their practice, which luckily we were able to successfully defend this. What also was in this is this new criteria precipitated a major revision in the ANA bylaws. In 1975, members voted to approve creation of a new council. I really was hoping that wouldn't have been a contentious business meeting, but I think we understood what had to happen. And for this, Ira Gunn is called the architect of the ANA council structure. She was involved with director and reimbursement for the CRNAs. In 1983, a prospective payment system, legislation was passed in an attempt to control rising Medicare costs. It provided that all services by providers other than those with authorized payments under Medicare Part B would be bundled in the hospital diagnosis-related group payment. This had huge economic disincentives for hospitals and physician anesthesiologists to utilize this. Her work in analyzing, writing, and defending our position to congressional and administration leaders ensured success and laid the groundwork for our victory in the passage on the Omnibus and Budget Reconciliation Act of 1986, which gave direct reimbursement for CRNAs. She was an expert witness for three antitrust case. October 2nd, 1985, Bond v. NME Hospitals, United States Court of Appeals, Ninth Circuit Court ruled nurse anesthetists have the standing to sue under federal antitrust law for anticompetitive practices excluding them from the market for anesthesia services. The biggest, though, was she also helped for Olds v. St. Peter's Hospital, the only antitrust case won by a CRNA. If you wanna hear their stories, listen to episodes 69 and 70 in the Beyond the Mask podcast. She was a major contributor to writing of the ANA's amicus curiae brief to the U.S. Supreme Court on the Jefferson Parish Hospitals v. Hyde case. We weren't involved with this. CRNAs were not named in the case. But even though, like I said, we weren't involved, the lower court's attempts to understand and describe any relevant economics, which involves CRNAs, since one of the, was one of the justifications given by the hospital for entering into the exclusive contract was it permitted greater use of the CRNAs. The appellate court saw the role of CRNAs as a crucial issue. A lot of misinformation about us was used. Also very interesting in this court case was the ASA entered into record that they formed in 1937, not 1910 like they claim now. The 1910 that they're claiming is when the Long Island Society of Anesthesia was formed. So I look at it as if you enter proof to the courts that you formed in 1937, you knew that you said you formed in 1937. So we are still older than the American Society of Anesthesiology. She was an advocate for basic healthcare as a human right. She advocated for collaboration with physicians and other nurse practitioners in areas where our interests were converged. But she was the first to argue that a physician-controlled healthcare really restricted access to care. In 1981, she was inducted in as the fellow of the American Academy of Nursing, becoming the first CRNA to ever do that. A little trivia question. In 2003, she was named a living legend in nursing, the highest honor of fan. That's a picture of her receiving that award. In 1983, she was given the Agatha Hodgins Award for Outstanding Accomplishment. That's a picture with her and Patricia Fleming. And in 2000, we established the Ira Gunn Award, and she was our first recipient. But just think of all that she did. Ira Gunn actually wanted to go to medical school, but she realized as a female at that time that was not gonna happen. So I just kind of, I gave a shiver, because if she'd gone into medical school, where would we be? This is Jack Neary. Jack graduated from Army's Anesthesia School in 1970, and he does a couple tours in Vietnam. But he also started the co-founder's partners for the Nurse Anesthesiology Pain Education Seminars, also known as NAEPS. He gets the, in 2000, he does the Alice McGaugh Clinical Anesthesia Practitioner of the Year. In 2009, he's awarded the Agatha Hodgins Award for Outstanding Accomplishment, posthumously. He's kind of also related to this individual. His name's W. Keith Barnhill. Everybody just calls him Keith. Keith graduates from the Army Anesthesia Program. Oh, to backtrack, Jack Neary actually was trained by Ira Gunn. I got told that by Keith Barnhill. But Keith finishes his training in 1991. In 1999, he does a certificate in Pain Management, Special Studies from the American Academy of Pain Management. In 2001, he's mentored by Mary B. G. And in 2001, he's mentored by Father Jeremiah Loke, who's a Russian Orthodox priest and a CRNA, and Jack Neary. They're starting to do chronic pain. Again, Keith is a co-founder of the NAEPS program. NAEPS was the courses that would teach CRNAs how to do chronic pain management. And I have the tames that the NAEPS was from 2002 to 2010. 2010, we renamed NAEPS to the Jack Neary Pain Course in honor of Jack Neary. Keith still serves as a consultant to the ANA on pain-related subjects. You wanna catch me afterwards? I'll talk about his involvement in the Iowa Board of Nursing Public Health Fluoroscopy Court Mass. But Keith was a subject matter expert on CMS Multiparity Descanate Disciplinary Task Force. He was the one CRNA amongst 11 physicians, and it's the first time they ever used a CRNA. When Keith got done talking and having his discussions with them, the MAC providers realized that CRNAs need to be involved with chronic pain. We are doing it right. This is Bruce Schoneboom. He graduates from the Army Anesthesia Program in 1991, earns a PhD in neuroscience from the Uniformed Services University, also known as U-SHOES. And he used to be the program director. Do you wanna have a nice, interesting story? Go talk to Adrian Hartnick. Because in 2006, Bruce leaves to go to Afghanistan to command a hospital unit. Adrian was his assistant program director, and so Adrian had to take over the program from him. But Bruce served as our chief learning officer, and he worked with academia to transition all those pain management courses, workshops, to actual fellowships, working with the COA and NBCRNA to accredit the program. So now instead of just workshops, we are being fellowship trained, thanks to the work that Bruce Schoneboom did. But in 2018, he represented the ANA as on a 29-person task force confirmed by Health and Human Services in conjunction with the Department of Defense, Veteran Affairs, and the Office of National Drug Control Policy to address acute and chronic pain relative to the opioid crisis. He ensured that the task force final report acknowledged that services for pain management is not a physician thing, and that CRNA's training in pain management was accurately reflected. They almost left us out, but thanks to Colonel Bruce Schoneboom, they kept us in. Any questions? All right, thank you guys for coming to the last session of Annual Congress. We're the closers, Randy. We are. I think you have something else to announce, don't you? Yes, I do. So Randy and I, and one other CRNA, are working on a book about Army CRNA. So if you have anything that you would like to share, or if you have served in the Army and would like to share your story with us, we would love to hear it. Not sure when this will come out, but we've been working on it for a little while. Yes. All right, thank you so much. Thank you guys.

Army anesthesia

nurse anesthetists

military history

Mary Newcomb

Katherine Lawrence

Clara Barton

Agatha Hodgins

legal battles

CRNAs book project