crtt

Respiratory therapy

Respiratory Therapy is categorized as 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. All schools in the United States are two year Associate Degree programs or four year Baccalaureate 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 as a Respiratory Care Practitioner (RCP). RCPs 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. RCPs are specialists in airway management, mechanical 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 Care Practitioners (RCPs) 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. They are cardiopulmonary specialists with vast training in both heart and lung function. 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 RCPs 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. RCPs may also provide an important role in the homecare environment. The homecare RCP role is different from the hospital RCP role in that there are fewer technical resources available. A homecare RCP 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 RCPs would benefit from hospital-based clinical experience before engaging in homecare work.

Certification, Education, and Training

All Respiratory Therapists are required to complete 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 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).

History

- Respiratory Therapy is a subset of anesthesia and 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 personnel who assist the physician and teach registered nurses in assessing and treating patients.

Invasive skills that RCP's must master include, but are not limited to; intubation, other advanced airway placement, arterial-line insertion, Cardiac Catheter advancement, intra-venous line insertion, Tracheostomy re-cannulation, naso-tracheal suction, and ABG's. These skills require a great deal of practice to master.

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 Repiratory Care (AARC) is the only professional organization in the United States specifically for Respiratory Care Practitioners.

- Admission to a Respiratory Therapy program is quite competitive, and includes:

- 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 extensive 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. RCPs must think quickly under stressful situations and make the proper life-or-death decisions. Respiratory Therapist's function as a patient advocate, as well as a staff, physician and patient resource. RCPs function as a pivotal member of the health care team offering much needed guidance and patronage to the registered nurse.