1. The oxygen period
With the increased use of therapeutic oxygen in the 1920s arose a profession. Yet as with anything new in the medical industry, the rise would be slow in the making. First our work would be added to the already exorbitant tasks of nurses. They were responsible for setting up large, bulky oxygen tents and operating and maintaining them for the duration of there use, and then cleaning them between patients. They were also responsible for lugging from room to room large oxygen tanks and timing how long they were in use to make sure they were changed before they became empty. This job was complicated because regulators were primitive and without gauges.
As better oxygen equipment became available it was made of rubber and vinyl and needed to be maintained while in use and cleaned between patients. From what I hear the rubber would stick to patient's faces, so there was a need to remove the masks from their faces every few hours to make sure they didn't become permanently attached or break down the skin on the face. If they weren't directly doing this task, they had to delegate the responsibility to nursing assistants or anyone else up to the task. All this work became overwhelming for nurses, who had to do all this added work plus their other nursing duties.
By the 1940s the task of lugging around oxygen tanks and maintaining this equipment was delegated to male nursing assistants and a profession was born. The initial name of these professionals was inhalation therapists and they were members of a profession called inhalation therapy. Actually they were often poorly trained in respiratory therapy, so they were simply handy folks with on the job training and were simply referred to as ancillary staff. They were glorified nursing assistants. Yet organizations were formed, education of these folks greatly improved, and the profession of respiratory therapy was born.
Yet during the 1940s oxygen was piped into the walls of more and more hospitals around the United States, and there was fear among the young profession that they would soon be out of a job. That fear gave rise to the hypoxic drive theory
2. The iron lung period
Yet first we must delve into the era of the iron lung. The first half of the century there were epidemics of poliomyelitis which paralyzed and knocked out the drive to breathe for many young victims. What was needed was a device to keep these kids alive while the disease ran its course. Such a device made it's way into circulation with the invention of the Drinker and Shaw Respirator in 1928. It was an iron lung that was exorbitantly expensive, complicated, noisy and heavy. It greatly added to the tasks of nurses and may even have become overwhelming for them. This was another reason for the rise of the respiratory therapy profession. Someone was needed to set up, monitor, lug, and clean oxygen equipment, yet someone was also needed to set up, monitor, lug and clean iron lungs. The new Emerson Respirator that was invented in 1931 made this job a little better, yet these devices continued to be a major responsibility. We were thus titled tank jockeys, although not so much because iron lungs were sometimes called tanks, but because we lugged around oxygen tanks.
Yet then came the poliomyelitis vaccine. During the late 1950s and early 1960s the vaccine was given to millions of kids. After a polio epidemic in the early 1950s there weren't any more. Their was a fear that this vaccine would not just wipe out a crippling and deadly disease, it would wipe out their job. Yet it didn't. Just as the vaccine was being invented so too was the Bird Mark 7.
3. The IPPB period
The scope of this profession also advanced as bronchodilator therapy advanced. In the 1920s there were primitive glass nebulizers, but by the 1930s nebulized aerosol therapy became increasingly popular. The 1950s brought nasal catheters, oxygen partial rebreathers, non rebreathers, nasal rubber masks, medication aerosolized nebulizers made of glass, modern bronchodilators such as Isuprel, mucolytics such as mucomyst and Alevair, and ethyl alcohol for treating pulonary edema.
Perhaps the most important advancement in
Yet then came along the
Yet during the 1970s insurance companies started questioning the need for all these expensive IPPB therapies. Likewise, studies were done that showed IPPB aerosolized medication distributed 35 percent less medicine to the lungs than the less expensive nebulizer therapy would . Studies also showed that less expensive incentive spirometers were much more effective for post operative patients than IPPB therapy. Soon the IPPB period of respiratory therapy would
4. The Nebulizer/ DRG Period
So as IPPB therapy was slowly eliminated and quickly replaced with nebulizers. By the 1990s
We could simply justify this period being called the nebulizer period for not for the intervention of the government
Hospitals decided that due to the complicated respiratory therapists performed they would still be needed. Yet if that wasn't enough, the National Board of Respiratory Care would continue to push for the need for respiratory therapists by assuring we graduated with an exceptional education. Knowledgeable respiratory therapists would be on demand. The idea was that instead of RTs being seen and treated as ancillary staff (which we still were even though we weren't) we would be seen as part of the team of professionals adept at treating the patient through the critical thinking process and professional experience and knowledge. Yet as our knowledge grew, old
The Health Maintenance Organization Act of 1973 made it so hospitals would only receive a flat fee for each patient admitted. This meant that for hospitals to make a profit they had to limit therapies given, and this made all respiratory therapy procedures debt procedures or losses. So at this time there was a fear that many of the tasks RTs did would be phased away or given back to nurses. Yet the profession lived on. Again, with all the emphasis of cutting costs, many government agencies, and hospital organizations, are looking for ways to cut costs. With bronchodilator medicine no longer a high risk therapy, there's no longer to have a babysitter during a treatment.
5. The current/ future period:
Yet the profession will survive. Surely doctors and nurses can intubate, and lab can draw ABGs, and nurses and patients themselves can do breathing treatments. Yet we RTs will always be needed to take care of, initiate and monitor complex respiratory equipment such as BiPAPs and microprocessor ventilators, and to make sure CPR is done correctly. Our services will also be needed to educate the community about such diseases as asthma and COPD. Our wisdom is a wisdom that has yet to be tapped into in this area, yet legislatures are presently considering legislation that would allow reimbursement for RT services outside hospitals and outside the realms of a doctors care. This is the future of our profession. We will evolve from simple task doers to thinkers and educators. We will educate and treat patients outside hospitals, teach them how to stay healthy, and keep them from requiring the services of a hospital.
So the role of RT continues to grow, and the profession lives on. I would imagine in the future a fear might develop when baby boomers die off, and their children die off, and there are very few people left who smoke cigarettes. Deep into the future there may be a day when people take better care of themselves, and medicine has the ability to cure diseases and replace old and tattered hearts, kidneys and lungs. Perhaps lung diseases will someday be eliminated altogether. When this time comes, there will be a fear that there will be nothing left for RTs to do. Yet the profession will evolve once again, new technologies will be developed, new wisdom, and the scope of practice of RTs will change as noted in the above paragraph.
There have been many times in the past where RTs feared their jobs would be phased out. Yet, despite these fears, the profession lives on. The profession of RT will continue to live on because we play a vital role in the care of the patient. We work with -- we do not assist -- nurses and doctors. We are a well, respected and vital part of the patient care team.
References for this post:
- Glover, Dennis W, "The History of Respiratory Therapy," 2010, Bloomington, Indiana.(this is where I obtained much of my history of respiratory therapy. I highly recommend reading this book.)
- Giordano, Sam P., "Respiratory Drug Delivery: What if?", AARC Times, August 2011,