From 1993-2008 Steve Wooden, CRNA, DNP, serviced 12 hospitals in rural Nebraska. To save on travel time, Wooden attained a pilot's license and traveled by airplane. He has tallied over 400,000 miles in his career.
I was one of the two who graduated from the University of Nebraska Medical Center Nurse Anesthesia program in 1982. After graduation, my classmate and I decided to open a private anesthesia practice. Initially, we were able to negotiate contracts with four rural hospitals in Nebraska – the timing was good because Nebraska had just passed legislation that required a Certified Registered Nurse Anesthetist (CRNA) or physician to administer anesthesia. It was a challenge to get some of these hospitals to shift their focus to modern anesthesia – some hospitals even had unlicensed people administering drip ether.
It took several years to bring each hospital up to standards. For that reason, we often had to bring drugs and equipment with us. Luckily, the hospital that serviced the community I was a part of was willing to support my efforts, but there were limitations. I had to purchase my own monitors and guarantee payment to the hospital for any of the anesthesia drugs I used.
Because of the large area we covered and the need to be readily available for emergency situations, I decided flying was the best means of transportation for me. I was able to save on both travel time and cost. Flying can also be safer than traveling by car – if all the rules are followed. The weather can change in an instant, but with good training and proper planning, there is always another alternative.
The first 10 years of practice were the most challenging. I probably took off an average of one week per year. We realized the need to expand our territory to get a larger caseload, but also to consolidate individual practices in the region. After contacting and contracting with a few area CRNAs, our staff grew to six. This made it possible to service several more hospitals and allowed for more vacation time.
I have had the opportunity to be a part of some remarkable cases through my career. I have delivered a few babies when the physician couldn’t make it in time and I even had one baby named after me. I have worked on countless emergency situations, but one involving a cowboy and cattle medication is my most memorable emergency.
The patient had accidentally injected himself with a fatal dose of cattle medication – according to poison control. He arrived at the emergency room with a faint heartbeat and only supported respirations. The physician in charge had consulted with both the university and poison control, but nobody had a clue what to do except continue cardiopulmonary resuscitation (CPR). The medication was a veterinary drug and was not listed as a benzodiazepine. It had a similar molecular structure to benzodiazepine, which I was familiar with. Fortunately, a new drug had just been released that reversed the effects of benzodiazepines called Romazicon. I suggested trying it, but I did not receive much support. After asking, “What do we have to lose?” the emergency room (ER) physician told me to go ahead. Within a minute, the patient sat up on the ER cart and started talking. Everyone was shocked! We supported him through the night with additional doses of Romazicon and close monitoring, and he recovered without any complications. The family and patient told me many times how grateful they were, and how lucky the hospital was to have a CRNA on staff. My education as a CRNA, and my ability to get to the remote hospital quickly by air, were both instrumental factors in this positive outcome.
I could write a book on the exciting cases I have had in my career, but more importantly, I have never had an anesthetic-related death, any serious complications, or a lawsuit.
Flying has allowed me to be more active with my practice and professional interests than I could ever have been if I had not flown. I lived 200 miles away from the closest commercial airport, and it was impractical for me to volunteer for any professional activities outside of my local community. With an airplane, I was not only able to reach hospitals and, in turn, my patients more quickly, I was able to become very active in the American Association of Nurse Anesthetists (AANA), the Nebraska regulatory boards, and the National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA). I feel so fortunate that I decided to get a pilot’s license and have been able to use it so effectively in my practice and professional life. I have seen the United States from a vantage point that few people get to see – between 500 and 8,000 feet above ground. I would encourage anyone who has an interest in flying to pursue it. Flying is so much like anesthesia. You want to plan well, make small changes well in advance of a problem to avoid a “crash,” and always have a Plan B.
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