A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respiratory therapists graduate from a college or university with a degree in respiratory therapy and have passed a national board certifying examination. The National Board for Respiratory Care (NBRC) is responsible for credentialing as a certified respiratory therapist (CRT), or registered respiratory therapist (RRT) in the United States. The Canadian Society of Respiratory Therapists and provincial regulatory colleges administer the RRT credential in Canada.
The American specialty certifications of respiratory therapy include CPFT and RPFT (certified or registered pulmonary function technologist), ACCS (adult critical care specialist), NPS (neonatal/pediatric specialist), and SDS (sleep disorder specialist).
Respiratory therapists may work in hospitals, laboratories, sleep labs, and home care (specifically durable medical equipment and home oxygen).
Respiratory therapists are specialists and educators in many areas including cardiology, pulmonology, and sleep therapy. Respiratory therapists are clinicians trained in advanced airway management; establishing and maintaining the airway during management of trauma, and intensive care.
Respiratory therapists initiate and manage life support for people in intensive care units and emergency departments, stabilizing, treating and managing pre-hospital and hospital-to-hospital patient transport by air or ground ambulance.
In the outpatient setting, respiratory therapists work as educators in asthma clinics, ancillary clinical staff in pediatric clinics, and sleep-disorder diagnosticians in sleep clinics. They also serve as clinical providers in cardiology clinics and cath-labs, as well as working in pulmonary rehabilitation.
Clinical practice
Respiratory therapy includes a variety of treatments to help with breathing and support the heart's work. Giving oxygen and drugs to ease breathing are two examples. Respiratory therapists also do patient assessments.
Intensive care and operating room Respiratory therapists educate, assist in diagnosing, and treat people who have heart and lung problems. Specialized in both cardiac and pulmonary care, respiratory therapists often collaborate with specialists in pulmonology and anaesthesia in various aspects of clinical care of patients. Respiratory therapists play a vital role in both medicine and nursing, such as the initiation and maintenance of mechanical ventilation.
Outpatient clinical practice Respiratory therapists are also primary clinicians in conducting tests to measure lung function and teaching people to manage asthma, chronic obstructive pulmonary disorder among other cardiac and lung functions.
Internationally, respiratory therapists that provide lung function testing are termed respiratory scientists, but in North America, they may be called a respiratory therapist.
Home-health care Outside of clinics and hospitals, respiratory therapists often manage home oxygen needs of patients and their families, providing around the clock support for home ventilators and other equipment for conditions like sleep apnea.
In the clinic or outpatient setting respiratory therapists assist with diagnosis and serve as an educator for patients with cardiac and respiratory illness. In the United States, respiratory therapists with certification as registered respiratory therapists evaluate and treat patients with a great deal of autonomy under the direction of a pulmonologist. In facilities that maintain critical care transport teams, respiratory therapists are a preferred addition to all types of surface or air transport.
Public education Respiratory therapists are found in schools as asthma educators, working with teachers and coaches about childhood symptoms of asthma and how to spot an emergency. In the United States, legislation has been unsuccessfully introduced several times to allow respiration therapists certified as asthma specialists with registered respiratory therapist certification to prescribe and manage previously diagnosed respiratory patients in physician clinics. In sleep clinics, respiratory therapists work with physicians in the diagnosis of sleep-related illnesses. Respiratory therapists in the United States are migrating toward a role with autonomy similar to the extension of the physician like the physician assistant. Respiratory therapists are frequently utilized as complete cardiovascular specialists to place and manage arterial accesses, along with peripherally-inserted central catheters.
Credentialing and licensure United States and Canada In the United States and Canada, respiratory therapists are healthcare practitioners who, after receiving their education, complete a credentialing process and become a certified respiratory therapists (CRTs) or registered respiratory therapists (RRTs).
After satisfactorily completing the required examinations and being added to a registry, the practitioner is then eligible to apply for a license to practice in the region governed by their respective licensing body.
In the United States, specialist respiratory therapists are clinicians who hold National Board for Respiratory Care specialty credentials, which may include neonatal/pediatric specialist (CRT-NPS or RRT-NPS), adult critical care specialist (RRT-ACCS), sleep disorder specialist (CRT-SDS or RRT-SDS), and pulmonary function technologist (CPFT or RPFT). The NBRC's RRT-ACCS examination is the newest NBRC examination: it was introduced in 2012.
In the United States, one must obtain a degree in respiratory care and must then sit for the board exams to become a RRT. RRT is issued by the National Board for Respiratory Care after passing the Therapist Multiple-Choice Examination NBRC-TMC and Clinical Simulation Examination NBRC-CSE examinations. Eligibility for the NBRC-CSE examination is based on scoring high enough on the NBRC-TMC, and holding at least an Associate of Science in Respiratory Care. Professional credentials denoted as a certified asthma educator (AE-C) may also be earned by passing the National Asthma Educator Certification Board (NAECB) exam.
In some parts of Canada, one may practice as a provisional respiratory therapist after graduating, until writing and passing the CBRC exam. The RRT certification is granted through examination by the Canadian Society of Respiratory Therapists.
Scope of practice The registered respiratory therapist is typically governed by their medical director for clinical services and their licensing body for laboratory, rehabilitation and home-health services.Kacmarek RM, Durbin CG, Barnes TA, Kageler WV, Walton JR, O'Neil EH. Creating a vision for respiratory care in 2015 and beyond. Respir Care 2009;54(3):375-389. They are trained in cardiology and pulmonology medicine. The registered respiratory therapist is prepared didactically and clinically to perform advanced procedures and emergency management.Barnes TA, Gale DD, Kacmarek RM, Kageler WV. Competencies needed by graduate respiratory therapists in 2015 and beyond. Respir Care 2010;55(5):601-616. Actual scope of practice varies by region and institution.American Association for Respiratory Care. AARC 2009 respiratory therapist human resource study. Irving, Texas: AARC; June 2009.
International respiratory care Except for the United States and Canada, very few countries have a dedicated professional role for respiratory health. In these countries, respiratory care is provided by physiotherapists, nurses and physicians that have chosen to specialize in this field. In many countries this recognition is in a transition stage. In 2011, a journal from China claimed that hospitals in Beijing, China had begun a recruitment drive to acquire respiratory therapists for their intensive care units, where previously nurses were the only clinicians.
Canada Upon graduation from an accredited school of respiratory therapy, the graduate is then eligible to write the national exam administered by the Canadian Board for Respiratory Care.
Success on this examination will then allow the respiratory therapist to register with any licensing body in Canada. Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Quebec and Saskatchewan are the Canadian provinces with provincial licensing bodies; in these provinces, it is illegal to practice the profession of respiratory care without first being licensed as a full or provisional member with the provincial licensing body.
These provinces are so-called regulated provinces. In some provinces, one may work provisionally upon graduating, until writing and passing the exam. In all other jurisdictions, the licensing body for the profession of respiratory care is the Canadian Society for Respiratory Therapy.
Registration as a full member with the CSRT is compulsory for respiratory therapists living in non-regulated provinces, and optional for respiratory therapists living in regulated provinces. Registration with the provincial regulatory body or the CSRT (in non-regulated provinces) confers the title of registered respiratory therapist (RRT). Canada and the United States recognize each of their cardio-pulmonary education structure as equal; however, a qualifying exam must be written in order to practice in either nation.
There is pressure for the program to become a degree, in the way that other therapies (physical therapy, occupational therapy) now require a master's degree or greater. However, in some places such as Alberta, Canada, the cardio-pulmonary coursework is only offered at technical schools that are unable to grant a formal degree.
France Respiratory therapy is a sub-specialty of physical therapy in France.World Confederation for Physical Therapy. Federation Francaise des Masseurs Kinesitherapeutes Reeducateurs Respiratory care as a specialty is regulated by the Fédération Française des Masseurs Kinésithérapeutes Rééducateurs.
Germany The German Respiratory Society first issued a resolution to develop the dedicated respiratory therapist (RT) role in 2004 as a means to increase the quality of patient care, delegate physician duties and respond to the observed increase in respiratory conditions and diseases. In 2006, a year-long pilot training program was offered to established nurses and physiotherapists.Karg O, Bubulj C, Esche B, Geiseler J, Bonnet R, Mäder I. [The Respiratory Therapist]. Pneumologie. 2008;62(11):685-9. Researchers report that significant additional work is necessary to define and position the role of the respiratory therapist within the current healthcare system.Karg, O., Bubulj, C., Esche, B., Geiseler, J., Bonnet, R., Mader, I., 2008. Karg, O., Bonnet, R., Magnussen, H., Kohler, D., 2008
Italy In Italy, the title of respiratory therapist can be acquired by earning a master's degree in respiratory therapy. It consists of lessons and various internships throughout Italian hospitals.
Philippines In the Philippines, respiratory therapists are clinicians who have been awarded at minimum a Bachelor of Science in Respiratory Care degree. Licenses to practice respiratory care are regulated by the Professional Regulatory Board of Respiratory therapy and Professional Regulation Commission which was established and is legally maintained by the Philippine Respiratory Therapy Act (Republic Act No. 10024).
United Arab Emirates