Just to expand on the low value of trauma, the military has surgeons supervise CRNAs in battlefield hospitals. Soldiers have few comorbidities, so the cookbook is a secure airway and transfusion to keep up with bleeding. Repeat.
More or less exactly this. Tube, blood/volume, air evac.
I did residency at a military hospital and saw very, very little trauma. I had to count things like elderly hip fractures as "trauma" to meet case log numbers.
🙂 Then I went to a small Navy hospital and did no trauma at all. Almost zero trauma at a community hospital where I was moonlighting. Then they deployed me to a Role 3 trauma center in Kandahar where we had multiple serious trauma patients almost every day. Mostly IED blast injuries, lots of traumatic amputations. Some vehicle accidents and occasional GSWs. It took me about 20 minutes to get up to speed on that kind of trauma anesthesia. I did get a week or so of "trauma refresher" lectures before deploying. Trauma is just not that complicated.
Most deployed military CRNAs who are "supervised" by surgeons are mostly at echelon 2 facilities. (Very forward, small, surgical/resuscitation teams. Typically a dozen or fewer people, no holding capacity, damage control surgery and near-immediate air evac.)
The next step up (role 3 facilities) in those areas are generally far more completely staffed and have anesthesiologists.
A great deal of battlefield trauma overflies those role 2 tents straight for the role 3 centers.
The amount of independent work military CRNAs do is vastly, vastly overstated. It's a big part of AANA propaganda, but they're not nearly as independent as they pretend to be. Even at the CONUS hospitals where they are "independent" they're doing the cases that get triaged to them by whichever anesthesiologist is making the schedule.
