If you were to ask your conventional healthcare clinician or
provider about what respiratory therapists do and where to
find them, you would probably get an answer like, “They manage
ventilators in the intensive care units of my local hospital.” Yet,
the nature of pulmonary pathophysiology works against this
narrow perspective because our need to breathe does not discriminate
based on time or place. And this physiological reality underlies
the true breadth of practice that our respiratory therapists
deliver. From the moment of birth for the hypoxic premature
newborn, to the emotional challenges presented by end-of-life
care, to everything that can occur in between, we find the respiratory
therapist in every healthcare-related venue.
The “machine-oriented” view of respiratory therapists, historically
identified as “oxygen orderlies and technicians, inhalation
technicians and technologists,” is understandable given the history.
The origins of respiratory therapy date to the 1940s, when some
forward-thinking oxygen technicians began working with physicians
who were addressing acute lung disease. Over the last 50
years, the need for respiratory therapy in all cycles of life and
points of care has steadily expanded the boundaries and demands
for respiratory care.
Today’s respiratory therapists marry their legacy of mechanical
knowledge with equally important physiological and psychological
capabilities to serve our respiratory care needs at all ages, levels of
function and locations.
Perhaps because ventilatory support is so often a life or death
affair at the beginning and end of life, the respiratory therapist
seems most prominent at these times. But if we look deeper, in
between these mortal circumstances, we readily see the role of the
respiratory therapist as an educator to patients and their families,
nurses, physicians and pharmacists—a key member of the healthcare
team that teaches patients and their families how to manage
chronic lung disease.We see the respiratory therapist as a teacher
to students of all ages, as they show parents how to deliver nebulizer
treatments to their young children, then teach those same
parents how to deliver inhaler treatments to the children who are not quite so young anymore; coach maturing youngsters on how
to transition from mask to mouthpiece for both nebulizers and
valved holding chambers; and, eventually, teach the children
themselves to self-administer inhaler treatments.
Because ventilatory support is so
often a life or death affair at the
beginning and end of life, the
respiratory therapist seems most
prominent at these times.
And, once our children are no longer children, but have passed
into the vast expanse we call adolescence, the respiratory therapist
must not only teach, but cajole and persuade our emotional
teens to maintain their adherence to what many perceive as socially embarrassing medication regimens. Whether addressing
the challenges of asthma, COPD, sleep apnea or home ventilation,
the respiratory therapist’s role goes broader and deeper than
simply that of device management.
Even within the hospital itself, the role of respiratory therapists
is more expansive than is commonly (mis) perceived. The scope of
their work stretches well beyond managing ventilators in the ICU
or delivering aerosol treatments on the floor. They are engaged in
are critical contributors within asthma clinics, conduct smoking
cessation programs, draw blood and analyze blood gases, assist
with ECMO procedures and deliver surfactant directly to infants’
underdeveloped lungs. They perform hands-on chest physiotherapy
to effect mucous clearance, and even conduct low-impact
aerobic classes for rehabilitation with patients who suffer from
chronic lung problems.
Both inside and outside the confines of the hospital, we
encounter respiratory therapists as critical first responders, vital
members of rapid response teams, and hospital transport teams.
Understanding the broad range of experience and capabilities
that respiratory therapists bring to the healthcare table, it is no
surprise that the respiratory therapist’s role continues to adapt to
the changing circumstances of people who need help breathing.
Two timely issues are already thrusting respiratory therapists into
the center of today’s healthcare stage. First, we have the H1N1
virus.We can be sure that as the concern about and impact of the
virus accelerates in the coming fall and winter season that our
respiratory therapists will be central to caring for those of us who
become afflicted.
Second, we have the ongoing healthcare debate in America.
And, with home health care presented as a common, careenhancing,
cost-reducing theme in the debate, it is no surprise
that we see increasing attention given to the role of respiratory
therapists in the home environment, where respiratory therapists
already deliver both care and education.With this in mind, the
AARC is addressing respiratory therapists’ increasing outpatient
impact with its Medicare Respiratory Therapist initiative. The
AARC is seeking to establish a benefit category under Part B
Medicare to reimburse physician-practice-based respiratory therapist
outpatient services when delivered under the general supervision
of a physician (services currently limited as “incident to a
physician’s care”). This initiative, if passed by Congress, will allow
respiratory therapists to continue to go more readily wherever
their patients need them, to provide the life-saving care they have
always delivered.
From the youngest preemie trying to grab on to life, to the
dignity associated with end of life, we rely on our respiratory therapists
to keep those breaths coming.
Tim H Gordon would like to express his appreciation
to Mike West, RRT, Clinical Manager, Philips Respironics Respiratory
Drug Delivery, for his inspiration and assistance with this article.
