respiratory therapy

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Respiratory Therapy is an allied health profession in the United States and Canada. In the United States there are currently two levels of respiratory therapist, the Certified Respiratory Therapist (CRT) and the Registered Respiratory Therapist (RRT), both credentials offered by the National Board for Respiratory Care (NBRC). The formerly entry level CRTT (Certified Respiratory Therapy Technician) credential is now recognized as the CRT designation for entry level therapists once the individual has taken the National Board's Certification Exam. Most schools in the United States are two year Associate Degree programs or four year Baccalaureate Programs, with a few Masters Degree Programs. Graduates become Registry Eligible, qualified to take the National Registry Exam. Respiratory Therapists in the United States are licensed individually by each state. They specialize in the assessment and treatment of respiratory and cardiovascular pathologies. These include chronic lung problems (e.g., asthma, bronchitis, emphysema, COPD), and more acute multi-systemic problems stemming from other pathological conditions such as heart attacks, stroke, or trauma, as well as complications at birth. They are specialists in airway management, mechanical (artificial) ventilation, and pulmonary hygiene. RCPs work closely with other medical professionals such as physicians, nurses, speech therapists and physical therapists.

Roles and Responsibilities

Respiratory Therapists (RTs) can be found in hospital intensive care units (ICU), as well as pediatric and neonatal units (NICU / PICU), emergency rooms (ER), operating rooms (OR), delivery rooms, acute care areas, and medical flight teams. RTs work with the sickest patients in the hospital. Airway management, ventilator management, pulmonary hygiene, and patient assessment (including assessment of acid-base balance via arterial blood gas measurement) are the main clinical services provided by RT. Skills and responsibilities may include vascular access for intravenous lines (IV), arterial line insertions for arterial blood gas (ABG), and performing endotracheal intubation. They are an essential part of the Code Blue (Cardiac Arrest) team. Some RTs are specially trained in helping in the operating room (OR), high-risk deliveries, intra-aortic balloon pump management, extracorporeal membrane oxygenation (ECMO), chest tube and central line insertion, pulmonary function testing (PFT), and Clinical Exercise Stress Testing. Other roles include tracheostomy and bronchoscopy procedures. RTs play an important role in the homecare environment. Homecare is different from the hospital, because there are fewer resources available. A homecare RTs must rely more on clinical assessment and experience-related decision making when evaluating patients. It is not uncommon for homecare RTs to have hospital based work experience prior to becoming a homecare RT.

Certification, Education, and Training

All RTs are required to complete at least an Associate's Degree program supported by one of the following: the Committee on Accreditation for Respiratory Care (CoARC), its predecessor the Joint Review Committee for Respiratory Therapy Education (JRCRTE), the Commission on Accreditation of Allied Health Education Programs (CAAHEP), or in Canada by the Council o­n Accreditation for Respiratory Therapy Education (CoARTE). There are four and five year Bachelor's degree programs as well as Master's degree programs. A Therapist holding a Bachelor's Degree can go on to earn a Master's degree in health related fields such as MPH, as well as Doctoral degrees such as a PhD, or EdD. After graduation, the therapist must then take a national exam and obtain proper licensure for their state or province .

Canada
In Canada, credentialing is governed by the Canadian Board for Respiratory Care (CBRC), also known as Le Conseil Canadien Des Soins Respiratoires (CCSR). Therapists obtain the Registered Respiratory Therapist (RRT) credential by successfully completing the written Canadian Society of Respiratory Therapists (CSRT) Certification Examination.

United States
In the US, a two-tiered system exists that is administered by the National Board for Respiratory Care (NBRC). Passing the primary certification exam makes the practitioner a Certified Respiratory Therapist (CRT). Subsequently, a written registry exam and a separate clinical simulation exam must be taken. All graduates as of 2005 are required to pass both the written and clinical simulation portions of the registry exam, becoming an RRT. A further examination for Neonatal/Pediatric Specialist may be taken, allowing RTs to be designated Neonatal-Pediatric Specialists (CRT-NPS or RRT-NPS). CRT status with one year experience in Neonatal or Pediatric Respiratory Care following Certification, or RRT status, is required for eligibility to take the NPS exam.[1] Other exams that RTs are eligible to take include Certified Pulmonary Function Technologist (CPFT) and Registered Pulmonary Function Technologist (RPFT). Some RTs become sleep study technicians and obtain the credential of Registered Polysomnographic Sleep Technologist (RPSGT), which is governed by the Board of Registered Polysomnographic Technologists (BRPT).

History

- Respiratory Therapy as known today did not exist 50 years ago. The field has grown greatly since a few oxygen tank technicians began meeting with doctors concerned with lung disease in Chicago, Illinois in the 1940s. This group named itself the Inhalational Therapy Association ("ITA") in 1946. They gradually put together a series of classes for people administering medical gases to patients. In December, 1950, 31 members of the Association were issued certificates for attending 16 lectures. This was the first certification of "inhalation therapists." (Burton, pp. 5-6) It was an on-the-job training system for so-called "oxygen jockies". They had little formal education, but did have a desire to do their jobs better and help patients in the process.

In 1953 the American College of Chest Physicians agreed to sponsor the ITA. By this year the ITA was holding an annual convention, with attendees from 14 states and Canada. In 1954 they changed the name to American Association of Inhalation Therapists, electing a board of directors. They elected Sister Borromea as president and appointed Jimmy Young as executive director. By this time the AAIT was putting out a monthly Bulletin, and state chapters began to form. (Burton p. 7)

During the next few years better equipment and more advanced therapy techniques were introduced. Those practicing in the profession began to adopt the title "inhalation therapist." Their main function was to ensure safe oxygen use, to administer intermittent positive pressure breathing (IPPB) treatments, to perform cardiopulmonary resuscitation (CPR), and to operate negative pressure (iron lung) ventilators.

Alvin Barach, a leader in discovering the role oxygen therapy played in breathing and health, led a group in publishing in 1950 "Minimum Standards for Inhalation Therapy." In 1957 the New York delegation to the AMA's House of Delegates introduced a resolution to develop schools of inhalation therapy, and soon after some schools were set up. In 1960 Articles of Incorporation were filed with the State of Illinois for the American Registry of Inhalation Therapists. Twelve examinees were registered in 1961. In 1972 the Association changed its name to the American Association of Respiratory Therapy, and this was later changed to the American Association of Respiratory Care. By 1983 about 16,000 respiratory therapists had been registered. (Burton, pp. 9-10). About 1969 the organization devised a system for credentialing entry-level practitioners, which became the National Board of Respiratory Care's system of certifying technicians.

With the advent of positive pressure mechanical ventilators, the more widespread hospital provision of neonatal and pediatric care, more sophistocated pulmonary function testing (PFT), a need for thoroughly trained clinical practitioners presented itself.

Over the years "respiratory technicians" have evolved to being college and University trained clinicians. Respiratory therapy skills and procedures include (but are not limited to): managing mechanical ventilation (invasive and non-invasive), intubation and placement of other airways, arterial line insertion, cardiac catheter advancement, tracheostomy recannulation, nasotracheal suction, drawing and interpreting arterial blood gases, pulmonary waveform analysis, inhaled medication delivery, oxygen delivery (via nasal canula and various mask devices), managing a variety of aerosol therapy devices, performing pulmonary function tests.

Regulatory Bodies and Professional Societies in the United States

- In the United States respiratory therapy is regulated by the individual states. All states except for Hawaii and Alaska require licensure by the individual state, including the District of Columbia and Puerto Rico. Others accept the accreditation granted by the National Board for Respiratory Care (NBRC). The American Association for Respiratory Care (AARC) is the only professional organization in the United States specifically for Respiratory Care Practitioners.

- A Respiratory Care program includes:

- Courses in anatomy, physiology, pathophysiology, pharmacology, chemistry, physics, microbiology, hemodynamics, mechanical ventilation, diagnostics, therapeutics, health care law, and medical ethics are required. These studies relate to all body systems. Curriculum includes advanced study of Gas physics, respiratory, cardiovascular, neurological and renal systems.

- Admission into a program is quite competitive. Class sizes are usually small and offer classroom as well as extensive clinical "hands-on" experiences. Many applicants already hold science degrees. Most programs suffer a substantial attrition rate due to fairly difficult curriculum. The material from the entire program must be mastered, applied and retained. Respiratory therapists must think quickly under stressful situations and make the proper life-or-death decisions.

Sources

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (March 2009)

• 1. George Burton & John Hodgkin, Respiratory Care: A Guide to Clinical Practice, 1984, 1071 pp., JB Lippincott, Philadelphia.

• 2. Egans Guide for Respiratory Practitioners

External links

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• Advance for Respiratory Care Practitioners
• Advance for Managers of Respiratory Care
• RT Space, Global Community for Respiratory Therapist
• Respiratory Care & sleep disorder
• American Association for Repiratory Care (AARC)
• National Board for Respiratory Care (NBRC)
• Canadian Respiratory Therapist Job Profile — analysis of job outlook and wage information for Canada.
• Critical Care News is a peer-to-peer forum for intensive care clinicians throughout the world to share experiences in ventilation therapies with each other.
• United States Occupational Outlook Handbook for Respiratory Therapists — Job outlook and wage information for The United States
• Canadian Society of Respiratory Therapists (CSRT)
• RT Magazine (bimonthly professional publication)
• RT Corner (Educational Site for RT's and Nurses)
• RESPIRATORY CARE: The Science Journal of the American Association for Respiratory Care (AARC)
• Respiratory Care Forum