Respiratory therapists, also known as respiratory care practitioners, evaluate, treat, and care for patients with deficiencies or abnormalities of the cardiopulmonary (heart/lung) system by either providing temporary relief from chronic ailments or administering emergency care where life is threatened. They are involved with the supervision of other respiratory care workers in their area of treatment. Respiratory technicians have many of the same responsibilities as therapists; however, technicians do not supervise other respiratory care workers.
Working under a physician’s direction, these workers set up and operate respirators, mechanical ventilators, and other devices. They monitor the functioning of the equipment and the patients’ response to the therapy and maintain the patients’ charts. They also assist patients with breathing exercises, and inspect, test, and order repairs for respiratory therapy equipment. They may demonstrate procedures to trainees and other health care personnel. Approximately 118,000 respiratory therapy workers are employed in the United States.
History of Respiratory Therapist and Technician Career
In normal respiration, the chest muscles and the diaphragm (a muscular disk that separates the chest and abdominal cavities) draw in air by expanding the chest volume. When this automatic response is impaired because of illness or injury, artificial means must be applied to keep the patient breathing and to prevent brain damage or death. Respiratory problems can result from many conditions. For example, with bronchial asthma, the bronchial tubes are narrowed by spasmodic contractions, and they produce an excessive amount of mucus. Emphysema is a disease in which the lungs lose their elasticity. Diseases of the central nervous system and drug poisoning may result in paralysis, which could lead to suffocation. Emergency conditions such as heart failure, stroke, drowning, or shock also interfere with the normal breathing process.
Respirators, or ventilators, are mechanical devices that enable patients with cardiorespiratory problems to breathe. The iron lung was designed in 1937 by Philip Drinker and Louise A. Shaw, of the Harvard School of Public Health in Boston, primarily to treat people with polio. It was a cylindrical machine that enclosed the patient’s entire body, except the head. This type of respirator is still in use today. The newer ventilators, however, are small dome-shaped breastplates that wrap around the patient’s chest and allow more freedom of motion. Other sophisticated, complex equipment to aid patients with breathing difficulties includes mechanical ventilators, apparatuses that administer therapeutic gas, environmental control systems, and aerosol generators.
Respiratory therapists and technicians and their assistants are the workers who operate this equipment and administer care and life support to patients suffering from respiratory problems.
The Job of Respiratory Therapists and Technicians
Respiratory therapists and technicians treat patients with various cardiorespiratory problems. They may provide care that affords temporary relief from chronic illnesses such as asthma or emphysema, or they may administer life-support treatment to victims of heart failure, stroke, drowning, or shock. These specialists often mean the difference between life and death in cases involving acute respiratory conditions, as may result from head injuries or drug poisoning. Adults who stop breathing for longer than three to five minutes rarely survive without serious brain damage, and an absence of respiratory activity for more than nine minutes almost always results in death. Respiratory therapists carry out their duties under a physician’s direction and supervision. Technicians typically work under the supervision of a respiratory therapist and physician, following specific instructions. Therapists and technicians set up and operate special devices to treat patients who need temporary or emergency relief from breathing difficulties. The equipment may include respirators, positive-pressure breathing machines, or environmental control systems. Aerosol inhalants are administered to confine medication to the lungs. Respiratory therapists often treat patients who have undergone surgery because anesthesia depresses normal respiration, thus the patients need some support to restore their full breathing capability and to prevent respiratory illnesses.
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 gender, 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 watch equipment gauges and maintain prescribed volumes of oxygen or other inhalants. Besides monitoring the equipment to be sure it is operating properly, they observe the patient’s physiological response to the therapy and consult with physicians in case of any adverse reactions. They also record pertinent identification and therapy information on each patient’s chart and keep records of the cost of materials and the charges to the patients.
Therapists instruct patients and their families on how to use respiratory equipment at home, and they may demonstrate respiratory therapy procedures to trainees and other health care personnel. Their responsibilities include inspecting and testing equipment. If it is faulty, they either make minor repairs themselves or order major repairs.
Respiratory therapy workers include therapists, technicians, and assistants. Differences between respiratory therapists’ duties and those of other respiratory care workers’ include supervising technicians and assistants, teaching new staff, and bearing primary responsibility for the care given in their areas. At times the respiratory therapist may need to work independently and make clinical judgments on the type of care to be given to a patient. Although technicians can perform many of the same activities as a therapist (for example, monitoring equipment, checking patient responses, and giving medicine), they do not make independent decisions about what type of care to give. Respiratory assistants clean, sterilize, store, and generally take care of the equipment but have very little contact with patients.
Respiratory Therapist and Technician Career Requirements
To prepare for a career in this field while you are still in high school, take health and science classes, including biology, chemistry, and physics. Mathematics and statistics classes will also be useful to you since much of this work involves using numbers and making calculations. Take computer science courses to become familiar with using technical and complex equipment and to become familiar with programs you can use to document your work. Since some of your responsibilities may include working directly with patients to teach them therapies, take English classes to improve your communication skills. Studying a foreign language may also be useful.
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. The Committee on Accreditation for Respiratory Care (CoARC) has accredited more than 400 programs nationwide. A listing of these programs is available on CoARC’s Web site, http://www.coarc.com/ . To be eligible for a respiratory therapy program, you must have graduated from high school.
Accredited respiratory therapy programs combine class work with clinical work. Programs vary in length, depending on the degree awarded. A certificate program generally takes one year to complete, an associate’s degree usually takes two years, and a bachelor’s degree program typically takes four years. In addition, it is important to note that some advanced-level programs will prepare you for becoming a registered respiratory therapist (RRT), while entry-level programs will prepare you for becoming a certified respiratory therapist (CRT). RRT-prepared graduates will be eligible for jobs as respiratory therapists once they have been certified. CRT-prepared graduates, on the other hand, are only eligible for jobs as respiratory technicians after certification. The areas of study for both therapists and technicians cover human anatomy and physiology, chemistry, physics, microbiology, and mathematics. Technical studies include courses such as patient evaluation, respiratory care pharmacology, pulmonary diseases, and care procedures.
There are no standard hiring requirements for assistants. Department heads in charge of hiring set the standards and may require only a high school diploma.
Certification and Licensing
The National Board for Respiratory Care (NBRC) offers voluntary certification to graduates of CoARC-accredited programs. The certifications, as previously mentioned, are registered respiratory therapist (RRT) and certified respiratory therapist (CRT). You must have at least an associate’s degree to be eligible to take the CRT exam. Anyone desiring certification must take the CRT exam first. After successfully completing this exam, those who are eligible can take the RRT exam. CRTs who meet further education and experience requirements can qualify for the RRT credential.
Certification is highly recommended because most employers require this credential. Those who are designated CRT or are eligible to take the exam are qualified for technician jobs that are entry-level or generalist positions. Employers usually require those with supervisory positions or those in intensive care specialties to have the RRT (or RRT eligibility).
More than 40 states regulate respiratory care personnel through licensing or certification. Requirements vary, so you will need to check with your state’s regulatory board for specific information. The NBRC Web site provides helpful contact information for state licensure agencies at http://www.nbrc.org/Pages/Default.aspx .
Respiratory therapists must enjoy working with people. You must be sensitive to your patients’ physical and psychological needs because you will be dealing with people who may be in pain or who may be frightened. The work of this occupational group is of great significance. Respiratory therapists are often responsible for the lives and well being of people already in critical condition. You must pay strict attention to detail, be able to follow instructions and work as part of a team, and remain cool in emergencies. Mechanical ability and manual dexterity are necessary to operate much of the respiratory equipment.
Exploring Respiratory Therapist and Technician Career
Those considering advanced study may obtain a list of accredited educational programs in respiratory therapy by writing to the American Association for Respiratory Care at the address listed at the end of this article. Formal training in this field is available in hospitals, vocational-technical institutes, private trade schools, and other non-collegiate settings as well. Local hospitals can provide information on training opportunities. School vocational counselors may be sources of additional information about educational matters and may be able to set up interviews with or lectures by a respiratory therapy practitioner from a local hospital.
Hospitals are excellent places to obtain part-time and summer employment. They have a continuing need for helpers in many departments. Even though the work may not be directly related to respiratory therapy, you will gain knowledge of the operation of a hospital and may be in a position to get acquainted with respiratory therapists and observe them as they carry out their duties. If part-time or temporary work is not available, you may wish to volunteer your services.
More than four out of five respiratory therapy jobs were in hospital departments of respiratory care, anesthesiology, or pulmonary medicine. The rest are employed by oxygen equipment rental companies, ambulance services, nursing homes, home health agencies, and physicians’ offices. Many respiratory therapists (13 percent, as opposed to 5 percent in other occupations) hold a second job.
Graduates of CoARC-accredited respiratory therapy training programs may use their school’s placement offices to help them find jobs. Otherwise, they may apply directly to the individual local health care facilities.
High school graduates may apply directly to local hospitals for jobs as respiratory therapy assistants. If your goal is to become a therapist or technician, however, you will need to enroll in a formal respiratory therapy educational program.
Many respiratory therapists start out as assistants or technicians. With appropriate training courses and experience, they advance to the therapist level. Respiratory therapists with sufficient experience may be promoted to assistant chief or chief therapist. With graduate education, they may be qualified to teach respiratory therapy at the college level or move into administrative positions such as director.
Respiratory therapists earned a median salary of $43,140 in 2004, according to the Occupational Outlook Handbook. The lowest 10 percent earned less than $32,220, and the highest 10 percent earned more than $57,850. Median annual earnings of respiratory therapy technicians were $36,740 in 2004. Salaries ranged from less than $24,640 to more than $52,280.
Hospital workers receive benefits that include health insurance, paid vacations and sick leave, and pension plans. Some institutions provide additional benefits, such as uniforms and parking, and offer free courses or tuition reimbursement for job-related courses.
Respiratory therapists generally work in extremely clean, quiet surroundings. They usually work 40 hours a week, which may include nights and weekends because hospitals are in operation 24 hours a day, seven days a week. The work requires long hours of standing and may be very stressful during emergencies.
A possible hazard is that the inhalants these employees work with are highly flammable. The danger of fire is minimized, however, if the workers test equipment regularly and are strict about taking safety precautions. As do workers in many other health occupations, respiratory therapists run a risk of catching infectious diseases. Careful adherence to proper procedures minimizes the risk.
Respiratory Therapist and Technician Career Outlook
Employment growth for respiratory therapists is expected to grow at a faster than average rate through 2014, despite the fact that efforts to control rising health care costs has reduced the number of job opportunities in hospitals.
The increasing demand for therapists is the result of several factors. The fields of neonatal care and gerontology are growing, and there are continuing advances in treatments for victims of heart attacks and accidents and for premature babies.
Employment opportunities for respiratory therapists and technicians should be very favorable in the rapidly growing field of home health care, although this area accounts for only a small number of respiratory therapy jobs. In addition to jobs in home health agencies and hospital-based home health programs, there should be numerous openings for respiratory therapists in equipment rental companies and in firms that provide respiratory care on a contract basis.