Respiratory Solutions

Ubiquitous RT!

• By Tim H Gordon
• Oct 01, 2009

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.

This article originally appeared in the Respiratory Management October 2009 issue of HME Business.