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You may live without water for a few days and without food for a few weeks. But without air, you will suffer brain damage within a few minutes and die after 9 minutes or more. Respiratory therapists, also known as respiratory care practitioners, evaluate, treat, and care for patients with breathing disorders.
In evaluating patients, therapists test the capacity of the lungs and analyze the oxygen and carbon dioxide concentration and potential of hydrogen (pH), a measure of the acidity or alkalinity level of the blood. To measure lung capacity, therapists have patients breathe into an instrument that measures the volume and flow of air during inhalation and exhalation. By comparing the reading with the norm for the patient's age, height, weight, and sex, respiratory therapists can determine whether lung deficiencies exist. To analyze oxygen, carbon dioxide, and pH levels, therapists draw an arterial blood sample, place it in a blood gas analyzer, and relay the results to a physician.
Respiratory therapists treat all sorts of patients, be they premature infants whose lungs are not fully developed or elderly people whose lungs are diseased. They provide temporary relief to patients with chronic asthma or emphysema and emergency care for heart failure, stroke, drowning, or shock victims. Respiratory therapists most commonly use oxygen or oxygen mixtures, chest physiotherapy, and aerosol medications. Therapists may place an oxygen mask or nasal cannula on a patient and set the oxygen flow at the level prescribed by a physician to increase a patient's concentration of oxygen. Therapists also connect patients who cannot breathe on their own to ventilators which deliver pressurized air into the lungs. They insert a tube into a patient's trachea, or windpipe; connect the tube to the ventilator; and set the rate, volume, and oxygen concentration of the air entering the patient's lungs. Therapists regularly check on patients and equipment. If the patient appears to be having difficulty or if the oxygen, carbon dioxide, or pH level of the blood is abnormal, they change the ventilator setting according the doctor's order or check equipment for mechanical problems. In homecare, therapists teach patients and their families to use ventilators and other life support systems. They visit several times a month to inspect and clean equipment and ensure its proper use and make emergency visits if equipment problems arise.
Respiratory therapists perform chest physiotherapy on patients to remove mucus from their lungs to make it easier for them to breathe. For example, during surgery, anesthesia depresses respiration, so this treatment may be prescribed to help get the patient's lungs back to normal and prevent congestion. Chest physiotherapy also is used on patients suffering from lung diseases, such as cystic fibrosis, that cause mucus to collect in the lungs. Therapists place patients in positions to help drain mucus, thump and vibrate patients' rib cages, and instruct them to cough.
Respiratory therapists also administer aerosols-generally liquid medications suspended in a gas that forms a mist which is inhaled and teach patients how to inhale the aerosol properly to assure its effectiveness.
Therapists are increasingly working under the supervision of nurses and are being asked to perform tasks that fall outside of their traditional role. They are expanding into cardiopulminary procedures like electrocardiograms and stress testing, but also perform other tasks like drawing blood samples from patients. They also keep records of the materials used and charges to patients. Some therapists teach or supervise other respiratory therapy personnel.
Respiratory therapists generally work between 35 and 40 hours a week. Because hospitals operate around the clock, therapists may work evenings, nights, or weekends; they spend long periods standing and walking between patients' rooms. In an emergency, they work under a great deal of stress. Gases used by respiratory therapists are potentially hazardous because they are used and stored under pressure. However, adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of injury. As with many health occupations, respiratory therapists run a risk of catching infectious diseases. Careful adherence to proper procedures minimizes this risk as well.
Respiratory therapists held about 73,000 jobs in 1994. About 9 out of 10 jobs were located in hospitals in departments of respiratory care, anesthesiology, or pulmonary medicine. Durable medical equipment rental companies, home health agencies, and nursing homes accounted for most of the remaining jobs.
Formal training is necessary for entry to this field. Training is offered at the postsecondary level by hospitals, medical schools, colleges and universities, trade schools, vocational-technical institutes, and the Armed Forces. Some programs prepare graduates for jobs as respiratory therapists; other, shorter programs lead to jobs as respiratory therapy technicians. In 1994, 275 programs for respiratory therapists were accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) of the American Medical Association (AMA). Another 174 programs offered CAAHEP-accredited preparation for respiratory therapy technicians.
Formal training programs vary in length and in the credential or degree awarded. Most of the CAAHEP-accredited therapist programs last 2 years and lead to an associate degree. Some, however, are 4-year bachelor's degree programs. Technician programs last about 1 year, and award certificates. Areas of study for respiratory therapist programs include human anatomy and physiology, chemistry, physics, microbiology, and mathematics. Technical courses deal with procedures, equipment, and clinical tests.
More and more therapists receive on-the-job training, allowing them to administer electrocardiograms and stress tests, as well as draw blood samples from patients.
Therapists should be sensitive to patients' physical and psychological needs. Respiratory care workers must pay attention to detail, follow instructions, and work as part of a team. Operating complicated respiratory therapy equipment requires mechanical ability and manual dexterity.
High school students interested in a career in respiratory care are encouraged to take courses in health, biology, mathematics, chemistry, and physics. Respiratory care involves basic mathematical problem-solving. An understanding of basic chemical and physical principles is also important. Computing medication dosages and calculating gas concentrations are just two examples of the need for knowledge of science and mathematics.
Thirty-eight States license respiratory care personnel. The National Board for Respiratory Care offers voluntary certification and registration to graduates of CAAHEP-accredited programs. Two credentials are awarded to respiratory care practitioners who satisfy the requirements: Certified Respiratory Therapy Technician (CRTT) and Registered Respiratory Therapist (RRT). All graduates-those from 2- and 4-year programs in respiratory therapy, as well as those from 1-year technician programs-may take the CRTT examination first. CRTT's who meet education and experience requirements can take a separate examination, leading to the award of the RRT.
Individuals who have completed a 4-year program in a nonrespiratory field, but have college level courses in anatomy, physiology, chemistry, biology, microbiology, physics, and mathematics, can become a CRTT after graduating from an AMA accredited 1- or 2-year program. After they receive 2 years of clinical experience, they are eligible to take the registry exam to become an RRT.
Most employers require that applicants for entry level or generalist positions hold the CRTT or are eligible to take the certification examination. Supervisory positions and those in intensive care specialties, usually require the RRT (or RRT eligibility).
Respiratory therapists advance in clinical practice by moving from care of "general" to "critical" patients, whom have significant problems in other organ systems such as the heart or kidneys. Respiratory therapists, especially those with 4-year degrees, may also advance to supervisory or managerial positions in a respiratory therapy department. Respiratory therapists in home care and equipment rental firms may become branch manager. Others leave the occupation to work as sales representatives or as equipment designers for equipment manufacturers.
Job opportunities are expected to remain good. Employment of respiratory therapists is expected to increase much faster than the average for all occupations through the year 2005 because of substantial growth of the middle-aged and elderly population, a development that will heighten the incidence of cardiopulmonary disease.
The elderly are the most common sufferers from respiratory ailments and cardiopulmonary diseases such as pneumonia, chronic bronchitis, emphysema, and heart disease. As their numbers increase, the need for respiratory therapists will increase as well. In addition, advances in treating victims of heart attacks, accident victims, and premature infants (many of whom may be dependent on a ventilator during part of their treatment) will require the services of respiratory care ractitioners. Rapid growth in the number of patients with AIDS also will boost demand because lung disease often accompanies AIDS.
Opportunities are expected to be highly favorable for respiratory therapists having cardiopulmonary care skills and experience working with infants.
Very rapid growth is expected in home health agencies, equipment rental companies, and firms that provide respiratory care on a contract basis.
Median annual earnings for respiratory therapists who worked year round full time in 1994 were $30,212. The middle 50 percent earned between $24,544 and $34,996. The lowest 10 percent earned less than $18,200; the top 10 percent, more than $43,420.
According to the the University of Texas Medical Branch, median annual salary, based on a 40-hour week and excluding shift and area differentials, for respiratory therapists in hospitals and medical centers was about $30,888 in October 1994. The average minimum annual salary was $25,978 and the average maximum was $38,233.
Respiratory therapists, under the supervision of a physician, administer respiratory care and life support to patients with heart and lung difficulties. Other workers who care for, treat, or train people to improve their physical condition include dialysis technicians, registered nurses, occupational therapists, physical therapists, and radiation therapy technologists.
Information concerning a career in respiratory care is available from:
American Association for Respiratory Care, 11030 Ables Ln., Dallas, TX 75229.
Information on gaining credentials as a respiratory therapy practitioner can be obtained from:
The National Board for Respiratory Care, Inc., 8310 Nieman Rd., Lenexa, KS 66214.
For the current list of CAAHEP-accredited educational programs for respiratory therapy occupations, write to:
Joint Review Committee for Respiratory Therapy Education, 1701 W. Euless Blvd., Suite 300, Euless, TX 76040.
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