Tending the breath


The Report: October / November 2009 vol.30 num.3



From the first inspiration of a newborn baby, to the last exhalation of a person at the end of life, breathing defines our existence.

Accordingly, respiratory therapists can be an integral part of every step of this journey. It is no wonder, then, that respiratory therapist Brian Herzke finds his job both exciting and profound. It is also no wonder that this profession has grown and expanded in scope since its inception.

Brian Herzke
Respiratory Therapist
Vancouver General Hospital

In the spectrum of health care providers, respiratory therapy is a relatively new profession: it evolved in the 1950s during the polio epidemic, when the first mechanical ventilators were invented. At that time, respiratory -technicians" maintained oxygen cylinders for these machines, but had little interaction with the patients they supported. These days, the role has expanded to include technical, therapeutic and diagnostic care in both community and acute care settings.

-We are the ABCs ... we manage the airway, provide breathing and assist with circulation," Herzke said. -We are a part of the cardiac arrest team and the trauma team; we are also involved with the assessment and treatment of patients with severe respiratory distress," he said.

-We treat and educate asthmatics; we work in the intensive care unit as well as the cardiac surgery unit for both neonates and adults. We practice in the emergency department as well as assist with transports both in and out of the hospital environment." The scope of an RT seems to grow every day.

-We treat sleep disorders such as sleep apnea, and we are getting more involved with rehabilitation and community care. Youll find RTs at GF Strong working with patients and families on how to manage life on a ventilator outside of a hospital setting."

Respiratory therapists are essential almost everywhere in the health care system. This becomes clear when Herzke describes his current position as a member of the critical care outreach team (CCOT) at Vancouver General Hospital. This medical emergency team is comprised of a critical care RT, a critical care nurse, and a physician. The team will respond to calls from anyone or anywhere in the hospital when a patient exhibits early warning signs of impending distress or deterioration. This medical SWAT team provide preventative care management of those patients at high risk of critical illness.

-Anyone can call us ... a nurse, a doctor, a physiotherapist ... if they think a patient is deteriorating to the point of requiring critical care," he said. -Often, we can be at the bedside sooner than the physicians to support the primary care team members, and we assist with getting things started. Then, after the patient is stabilized, we follow up with feedback to the patients primary care team," Herzke explained. This feedback helps improve the overall care for all patients through support, collaboration and effective communication.

Further, the CCOT members are effective in leadership and mentoring for other health care professionals, some of whom do not have a critical care background. This shared partnership capitalizes on the educational strengths of respiratory therapists. -Our goal is to try and prevent intensive care admission when possible ... or facilitate it when it is required. When patients do need intensive care, we want to shorten length of stay with healthier results."

Response from the staff on the wards has been overwhelming, he said. -We are inundated with thank yous for helping, supporting and teaching," Herzke said.

-When the critical care outreach team first started, wed be called in when there was a code blue and someone was in cardiac arrest and about to die. Now, we are called before that happens, and we are better equipped to save someone. Our motto is ‘call early ... call often.\

Sometimes respiratory therapists are involved in scenarios where their actions and decisions can be described as being life saving. -Nothing is more satisfying than saving a life," Herzke said. -I can remember specific people where I have felt I had a big hand in giving them more life. Had I not been there, they might not have survived the event."

RTs provide expertise through their understanding of mechanical ventilation, or life support. This complex intervention requires years of training to optimize the care and management of a critically ill patient. RTs can often suggest or implement life saving ventilation strategies.

In the emergency department, RTs work with patients suffering from asthma and chronic obstructive pulmonary disease. -The greatest thing about being in the emergency department is successfully caring for a patient with chronic airway disease," he said. -The patients are often admitted scared and unable to breathe