Respiratory therapy

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Respiratory Therapy is categorized as an allied health profession in the United States and Canada. Formerly there was distinction between Certified Respiratory Therapy Technicians (CRTT) and Registered Respiratory Therapists (RRT), but in the United States, all Respiratory Care Practitioners (RCP) are now called Therapists, either Certified Respiratory Therapists (CRT) or Registered Respiratory Therapists (RRT). Respiratory Therapists (RTs) 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. RTs are specialists in airway management, mechanical ventilation, blood acid/base balance, and critical care medicine. RTs work closely with other medical disciplines such as physicians, nurses, speech therapists and physical therapists etc.

1 Roles and Responsibilities
2 Certification, Education, and Training
3 History
4 Regulatory Bodies and Professional Societies in the United States
5 External links

[edit] Roles and Responsibilities

- Respiratory Therapists (RTs) can be found in hospital intensive care units ICU's, emergency rooms (ER), operating rooms (OR), delivery rooms, and medical flight teams. 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 assisting in tracheostomy and bronchoscopy procedures. RTs may also provide an important role in the homecare environment. The homecare RT role is different from the hospital RT role in that there are fewer technical resources available. A homecare RT 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.

[edit] Certification, Education, and Training

- All Respiratory Therapists are required to complete a minimum of 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 degree programs as well as Master's degree programs offered by some schools. Therapist holding Bachelor Degrees can go on to earn Masters degrees 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 Providence .

Canada
In Canada, credentialing is governed by the Canadian Board for Respiratory Care (CBRC) or also known as Le Conseil Canadien Des Soins Respiratoires (CCSR). Therapists obtain the Registered Respiratory Therapist (RRT) credential by successfully completing the written and clinical simulation parts of the 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 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.[1] Other exams that RT's are eligible to take include Certified Pulmonary Function Technologist (CPFT), and Registered Pulmonary Function Technologist (RPFT). Some RTs go on to 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).

[edit] History

- Respiratory Therapy has grown considerably through the past four decades. There was a time when Respiratory Therapists were on-the-job trained technicians, with little formal education. 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. They were initially titled Inhalation Therapists. 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 who work in a variety of settings.

[edit] 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 NBRC [2]. The American Association for Respiratory Care [3] is only professional organization in the United States specifically for Respiratory Care Practitioners.

- In order to be considered for admission to a respiratory therapy program, a strong high school background (typically grades of B+ or higher) in science and math at the senior matriculation level is usually required. The program of study varies from one school to another, but all programs include the following:

- Courses in anatomy, physiology, pathophysiology, pharmacology, chemistry, physics, microbiology, hemodynamics, mechanical ventilation, statistics, healthcare law, and medical ethics are required. Pass marks are usually set high. These studies relate to all body systems. Extra focus is spent on the respiratory, cardiovascular, neurological and renal systems.

- Class sizes are usually small and offer classroom as well as clinical "hands-on" experiences. Some schools offer online courses. Many applicants already hold science degrees. Traditionally there is a measurable attrition rate due to a student's failure to meet expected performance standards. Most of the schools do not allow multiple rewrites of failed exams. The material from the entire program must be mastered, applied and retained. There is no "cook book" practice. RTs must think quickly under stressful situations and make the proper life-or-death decisions. RTs function as a patient advocate, as well as a staff, physician and patient resource. RTs function as a member of the health care team.