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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 .
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Encyclopedia
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 . 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. Essentially making all graduates Registry Eligible (able 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 blood acid/base balance. 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, and medical flight teams. RT's most often work with the sickest patients in the hospital. Airway and ventilator management as well as clinical assessment including acid-base balance are the main clinical roles provided by a respiratory therapist. Their roles also 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 may also provide an important role in the homecare environment. The homecare RTs role is different from the hospital RTs role in that there are fewer technical resources available. A homecare RTs must rely more on clinical assessments and experience-related decision making when evaluating the patient's current condition. Because of the potential for professional isolation and with limited collaborative assistance available, homecare RTs would benefit from hospital-based clinical experience before engaging in homecare work..
Certification, Education, and Training
All Respiratory Therapists are required to complete at least an Associate's Degree program supported by the Committee on Accreditation for Respiratory Care (CoARC), or its predecessor the Joint Review Committee for Respiratory Therapy Education (JRCRTE), or accredited by 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 offered by some schools. 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). First a certification exam can be taken, and if passed, the therapist is designated a Certified Respiratory Therapist (CRT). After that, a written registry exam and a separate clinical simulation exam can be taken, and if passed, will earn the designation of Registered Respiratory Therapist (RRT). Also, further examination for Neonatal/Pediatric Specialist may be taken allowing RT's to be designated as 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. Other exams that RT's are eligible to take include Certified Pulmonary Function Technologist (CPFT), and Registered Pulmonary Function Technologist (RPFT). Some RTs also 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, the first certification of "inhalation therapists." (Burton, pp. 5-6) This was an on-the-job training system for so-called "oxygen jockies" with little formal education, but 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 and showed attendees from 14 states and Canada. In 1954 they changed the named to American Association of Inhalation Therapists, elected 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 personnel who mainly administer inhaled medications. Skills that Respiratory therapists must master include, but are not limited to; intubation, other advanced airway placement, arterial-line insertion, Cardiac Catheter advancement, tracheostomy re-cannulation, naso-tracheal suction, Blood Gas (drawing and interpretation), Waveform analysis, Inhaled medication delivery, other aerosol therapy devices, mechanical ventilation (invasive and non-invasive) among others.
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 . The 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, healthcare law, and medical ethics are required. Pass marks are usually set high, though the courses are not particularly challenging when compared to other curricula in the hard sciences. 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 of the schools do not allow multiple rewrites of failed exams, although this tends not to be a problem since the majority of the material merely requires rote memorization. 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
- 1. George Burton & John Hodgkin, Respiratory Care: A Guide to Clinical Practice, 1984, 1071 pp., JB Lippincott, Philadelphia.
External links
- — analysis of job outlook and wage information for Canada.
- — Job outlook and wage information for The United States
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