On Air/À l’affiche · 2018-08-30 · Spring 2008, Volume 44 (1) Printemps 2008, Numéro 44 (1) Features/Sommaire Medical Simulation Part Three Filtered Gases President’s Message

Spring 2008, Volume 44 (1)Printemps 2008, Numéro 44 (1)

Features/Sommaire■ Medical Simulation Part Three

■ Filtered Gases

■ President’s MessageMot du président

■ Message from the Executive Director

On Air/À l’affiche■ Algonquin SIM Lab

■ RT Week Winners

■ Membership Renewals

Conference PreliminaryProgram Highlights 2008

The jour na l fo r re sp i ra to ry hea l thprofes s iona l s in Canada

La revue des professionnels de la santérespiratoire au Canada

PUBLICATIONS MAIL AGREEMENT NO. 40012961REGISTRATION NO. 09846 RETURN UNDELIVERABLE CANADIAN ADDRESSES TO CSRT102 – 1785 Alta Vista DriveOttawa ON K1G [email protected]

Alveolar Avengers — Winners of the Great Ventilator Race

Table of ContentsOn Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5À l’affiche

President’s Message . . . . . . . . . . . . . . . . . .11Mot du président

CSRT News . . . . . . . . . . . . . . . . . . . . . . . . . .13Nouvelles de la SCTR

Special Interests . . . . . . . . . . . . . . . . . . . . .18Intérêts spéciaux

Conference 2008 . . . . . . . . . . . . . . . . . . . . .20

Conference Registration Form . . . . . . . . .23

Scientific News . . . . . . . . . . . . . . . . . . . . . .27

The CJRT acknowledges the financial support of the Government ofCanada, through the Publications Assistance Program (PAP), toward ourmailing costs.

Spring 2008 Canadian Journal of Respiratory Therapy — www.csrt.com 3

CSRT membership inquiries /Questions concernant l’adhésion à la SCTR :

102 – 1785 Alta Vista Dr.,

Ottawa, Ontario, K1G 3Y6

1-800-267-3422

[email protected]

www.csrt.com

Canadian Journal ofRespiratory Therapy

Revue canadienne de lathérapie respiratoire

Official Journal of the CSRTRevue officielle de la SCTR

CSRT Board Representative / Représentant du Conseild’administration de la SCTR Patty Wickson, RRT

Managing Editor / Directrice de la rédactionRita Hansen

Chair Editorial Committee Amy Reid, RRT

President CSRT / Présidente, SCTRRobert Leathey, B.Ed., RRT

The Canadian Journal of Respiratory Therapy (CJRT)(ISSN 1205-9838) is produced for RRT: The CanadianJournal of Respiratory Therapy, Inc., by the GraphicCommunications Department, Canadian PharmacistsAssociation and printed in Canada by Tri-Graphic Printing.Publications mail registration no. 40012961. CJRT is pub-lished 5 times a year (in February, May, July, October andDecember); one of these issues is a supplement publishedfor the Annual Educational Forum of the Canadian Societyof Respiratory Therapists (CSRT).

La Revue canadienne de la thérapie respiratoire (RCTR)(ISSN 1205-9838) est produite pour le compte de RRT :The Canadian Journal of Respiratory Therapy, Inc., par Communications graphiques de l’Association despharmaciens du Canada et imprimée au Canada par Tri-Graphic Printing. Courrier de publications no 09846. La RCTR paraît cinq fois l’an (en février, mai, juillet, octo-bre et décembre); un de ces numéros constitue un sup-plément publié pour le compte du Forum éducatif annuelde la Société canadienne des thérapeutes respiratoires(SCTR).

Advertiser’s Index

CSRT Conference . . . . . . . . . . . . . . . . . . . . . . . . . IFC

RCE Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Dymedso . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC

GE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OBC

Table of contents table des matières

Cover Photo — RT Week 2007Winners of the Great Ventilator Relay are members of the AlveolarAvengers team, L-R: Tricia Zwarich, Dave Reid, Cheryl Rogers, TerryWright, Oommen Thomas, from the University of Alberta Hospital. The race, part of RT Week 2007 activities raised over $5,000 for theAlberta Lung Association.

4 Printemps 2008 Revue canadienne de la thérapie respiratoire — www.csrt.com

It is with some degree of hesitation that I com-pose the introduction to this issue of the CJRT, asit will be my last. I have recently accepted a posi-tion with the Canadian Association of PaediatricHealth Centres, and will be leaving the CSRT.

As I mention later in this issue, it has been anhonour and a privilege to hold this position. I put a lot of heart,soul, blood, sweat and tears, into this organization, but I havereceived much more in return.

This issue comes at a very important time of year, as membershiprenewal is just around the corner. This is always a somewhatstressful time for the staff and Board of Directors, as this is the timeof year where the membership makes it’s ultimate judgement ofour work through the decision to be a member or not. In the timeI’ve spent here, I’ve had the pleasure of seeing that numbers goup every year. The CSRT is more relevant and important to theprofession now than it has ever been. Discussions on healthcarereform are happening at every level, and it is very important thatyour perspective is brought to the table.

The Board of Directors, staff, volunteers, and other contributorswork extremely hard to ensure that the CJRT and other offeringsfrom the CSRT help meet the ever-changing needs of respiratorytherapists.

This issue also comes at a time where preparation for the NationalConference begins to ramp up. We have a great slate of speakersand the folks in Saskatoon are prepared to showcase all thatSaskatoon has to offer. There is some preliminary information onthe event later in this issue.

This issue has some great articles. Some of our profession’s cur-rent challenges are in relation to finding clinical placements forour students, the role of simulation in training students, and therole of simulation in maintaining/training our current RRTs. Thisissue includes the final in a series of articles related to issues insimulation, plus an article on the incredibly advanced sim lab atAlgonquin College. No more practicing ABGs on oranges! We alsohave the results from our dedicated members that participated inthe RT Week 2007 Contest.

Thank you, again, for giving me the opportunity to be a part ofthe CJRT and of the CSRT. It has been a fantastic four years.

Sincerely,Doug Maynard, BSc, RRT, MBAExecutive Director, CSRT

Dans ce numéroC’est avec une certaine hésitation que je rédige l’introduction duprésent numéro de la RCTR puisqu’il s’agit de ma dernière. Ayantrécemment accepté un poste à l’Association canadienne des cen-tres de santé pédiatriques, je quitte la SCTR.

Suite à la page 26

Design and production / Conception et productionCanadian Pharmacists Association / Association des pharmaciens du Canada

Marketing and Advertising Sales / Marketing et publicitéKeith Health Care Inc.Mississauga 905 278-6700, fax 905 278-4850Montréal 877 761-0447, fax 514 624-6707

Classified Advertising / Annonces classéesCSRT102 – 1785 prom. Alta Vista Dr.Ottawa ON K1G 3Y6800 267-3422 or fax 613-521-4314

Subscriptions / Abonnements

Annual subscriptions are included in annual membership to theCSRT. Subscription rate for 2008 for other individuals and institu-tions within Canada is $50. International orders are $60 Cdn. AllCanadian orders are subject to 5% GST / 15% HST as applicable.Requests for subscriptions and changes of address: MemberService Centre, CSRT, 102 - 1785 Alta Vista Dr., Ottawa ON K1G3Y6.

L’abonnement annuel est compris dans la cotisation des mem-bres de la SCTR. Le tarif annuel d’abonnement pour les non-mem-bres et les établissements au Canada est de 50 $. Les commandesinternationales sont 60 $ Canadien. La TPS de 5% ou la TVH de15% est ajoutée aux commandes canadiennes. Veuillez faire par-venir les demandes d’abonnement et les changements d’adresseà l’adresse suivante: Centre des services aux membres, SCTR, 102- 1785 prom. Alta Vista, Ottawa ON K1G 3Y6.

Once published, an article becomes the permanent property ofRRT: The Canadian Journal of Respiratory Therapy, Inc., andmay not be published elsewhere, in whole or in part, withoutwritten permission from the Canadian Society of RespiratoryTherapists, 102 - 1785 Alta Vista Dr., Ottawa ON K1G 3Y6. / Dèsqu’un article est publié, il devient propriété permanente de RRT:The Canadian Journal of Respiratory Therapy, Inc., et ne peutêtre publié ailleurs, en totalité ou en partie, sans la permission dela Société canadienne des thérapeutes respiratoires, 102 - 1785prom. Alta Vista, Ottawa ON K1G 3Y6.

All editorial matter in CJRT represents the opinions of theauthors and not necessarily those of RRT: The Canadian Journalof Respiratory Therapy, Inc., the editors or the publisher of thejournal, or the CSRT. / Tous les articles à caractère éditorial dansle RCTR représentent les opinions de leurs auteurs et n’engagentni le RRT: The Canadian Journal of Respiratory Therapy, Inc., niles rédacteurs ou l’éditeur de la revue, ni la SCTR.

RRT : The Canadian Journal of Respiratory Therapy Inc.assumes no responsibility or liability for damages arising fromany error or omission of from the use of any information oradvice contained in the CJRT including editorials, articles,reports, book and video reviews letters and advertisements. /RRT : The Canadian Journal of Respiratory Therapy, Inc. déclinetoute responsabilité civile ou autre quant à toute erreur ou omis-sion, ou à l’usage de tout conseil ou information figurant dans leRCTR et les éditoriaux, articles, rapports, recensions de livres etde vidéos, lettres et publicités y paraissant.

All prescription drug advertisements have been cleared by thePharmaceutical Advertising Advisory Board. / Toutes les annoncesde médicaments prescrits ont été approuvées par le Conseil con-sultatif de publicité pharmaceutique.

About This Issue

CJRT welcome RCTR bienvenue


OnAir À l’afficheAlgonquin College State-of-the-Art SIM LabAnita Gallant, Coordinator, Respiratory Therapy, Algonquin College

Le laboratoire de simulation de pointe du collège AlgonquinLe Collège Algonquin à Ottawa dessert 16 000 étudiants àtemps plein et près de 40 000 étudiants à temps partiel. LaFaculty of Health, Health, Public Safety and CommunityStudies prodigue une éducation en soins de santé par l’en-tremise de nombreux programmes. L’énoncé de notre missionest le suivant :

Être le leader canadien de la prestation d’occasions novatricesde simulation en favorisant un apprentissage multidisciplinairechez les étudiants dans le domaine des services de santé etcommunautaires.

Le Collège Algonquin est voué à assurer l’excellence des pro-grammes de formation en soins de santé. Pour atteindre cetobjectif, l’administration du Collège, le corps professoral et lepersonnel de soutien travaillent ensemble en vue d’être desleaders de la formation qui est conforme aux normes les plusélevées en matière de soins de santé prodigués à la population.Parmi les programmes offerts à divers niveaux, passant du cer-tificat à la formation de cycle supérieur, notons le préposé aux

Suite à la page 24

Algonquin RT student Akhilesh Patel, practices his skills on anadvanced Human Patient Simulator in the Allied Health Simulation Centre

Algonquin College in Ottawa, serves 16,000 full-time andalmost 40,000 part-time students. The Faculty of Health,Public Safety and Community Studies provides health careeducation in several programs. Our Mission Statement is:To be the Canadian leader in delivering innovative simula-tion opportunities while promoting multidisciplinary learn-ing for students in health and community services.

Algonquin College is committed to providing excellence inhealth care training programs. To achieve this goal, theCollege administration, faculty and support staff worktogether to be leaders in education that meets the highestof standards to provide health care for the public. The pro-grams range from certificate to post diploma levels andinclude offerings such as Personal Support workers,Polysomnography, Bachelor of Science in Nursing,Respiratory Therapy, Paramedic program, Advanced CareParamedic program, Critical Care Nursing, and AnesthesiaAssisting.

Faculty of Health, Public Safety and Community StudiesMission Statement:

To be the Canadian leader in delivering innovative simula-tion opportunities while promoting multidisciplinary learn-ing for students in health and community services.

To achieve the goals for current and future health educa-tion needs, the College initiated a multiphase project:

Phase I of these plans was completed in 2004. It focusedon the renovation of existing labs and the installation ofnew equipment to better facilitate clinical simulation.Upon the completion of this Phase, the College had reno-vated space for the paramedic programs, respiratory therapy program and various nursing related programs.The paramedic space provides facilities to simulate domi-cile, vehicular and community care access of patientsneeding first responder care. The respiratory therapy spaceprovides facilities to simulate pulmonary function testing,non-invasive cardiac diagnostics, polysomnopgraphy studies, basic care beds and critical care unit beds. Thenursing spaces provide facilities to provide care in thehome, long term care units, basic hospital care units andcritical care units.

Phase II of the College plan was completed in fall 2005.This involved building a new Allied Health SimulationCentre. This centre offers leading edge facilities for healthcare training. It includes functional hospital care units thatinclude:

Continued on page 9

New Brunswick RT students Lynn Lagace, Christine Collin, Charles Bois,Lise Cormier, Genevieve Lemieux, Patrick Dugas, show off some of their RT Booth props.

On Air À l’affiche


Again this year, we encouraged peopleto take pictures of their activities andsubmit descriptions to the CSRT forentry into a contest. We had a greatresponse from people interested in shar-ing their stories.

First PrizeThe winners of the RT Week 2007 con-test are from the University of AlbertaHospital (UAH) in Edmonton, Alberta:

Organizing Team: Julie Mitchell (TeamLead), Samantha Sampson, Carla Keller.Volunteers for Booth: Don Hrycun,Michelle Hathaway, Murray Sampson,Tricia Zwarich, Dan Lee, Tim Wozniak

The team from UAH had a comprehen-sive display set up for the full RT Week,including some classic items such as theexcised pig lung/ventilator display, theintubation mannequin and general infor-mation about the practice of respiratorytherapy. The display also had a sectionfocusing on non-invasive ventilation.

Throughout the week the group heldsocial functions, had daily trivia ques-tions and prizes, and a “What is it?”contest.

To cap it off the group held the “GreatVentilator Relay”. This event was afundraising challenge between UAH/Stollery and the other sites within theCapital Health Authority, in Edmonton.The event is a ventilator relay and therecipient of the fundraising efforts wasthe Alberta Lung Association. The sitesthat have accepted the challenge includ-ed the Royal Alexandria Hospital, GreyNuns Hospital and the NAIT RT studentclass.

The GREAT VENTILATOR RELAY requiredeach site to assemble a team of RRTsthat pushed a “dressed” ventilator over

a relay course while completing tasks ofdaily activity for the RRT.

The goal for each site was to raise a min-imum of $1000.00 in pledges and comeup with a theme for their team that willhelp to promote public awareness forthe profession of respiratory therapy.Prizes were awarded for the best dressedventilator and the team that raised themost money.

In total, the event raised over $5,000 forthe Alberta Lung Association, with theunofficial winners of the race being theAlveolar Avengers from the University ofAlberta Hospital.

Second PrizeSecond place goes to a strong entryfrom the crew from New Brunswick,lead by Janice Langis. Participantsincluded Pam Hayward, Justin Morris,Patrick Dugas, Lise Cormier, DanyDurand, Lynn Lagace, GenevieveLemieux, Nicole Boudreau, ChristineCollin, and Charles Bois.

This group represents the Beausejour and the South-East Regional HealthAuthorities, as well as the Collège communautaire du Nouveau-Brunswick(C.C.N.B.)/Université de Moncton RTProgram.

This group had a very comprehensiveone-day display, located in the HighfieldSquare Shopping Centre in Moncton, NB. The display highlighted asthma,COPD, non-invasive ventilation, includ-ing demonstrations of various pieces ofequipment. The display included twosets of excised lungs, one appearing tobe healthy, and the other appearing tobe diseased, possibly as a result of smok-ing. If those lungs came from a pig, I would strongly suggest a porcine

smoking cessation program be estab-lished in New Brunswick!

From their photos they obviously werehaving a great time at their display,enjoying the opportunity to interact withsome of the “healthy individuals” in thecommunity, and also having the oppor-tunity to work with people from otherregions. Janice reported, “The winningpoint was the networking between RTsfrom two different health authoritiesplus the RT students. We rarely get achance to work with our neighbors!We’re hoping to start a new tradition.”We agree that this would be a great tra-dition to start.

Third PrizeThird place goes to a student groupfrom Fanshawe College, in London, ON.Last year’s contest winners were alsofrom Fanshawe College, so it’s good tosee a strong tradition building there.

This group was lead by Amanda Henein,and included Kaley Nelson, Mary LizGabra, Stephanie Rotella, AmandaSmith, Amanda Henein, Neena Sandu,Anil Charron, Denis Z, Laura Van Bomel.

This group established a very large dis-play at the college. The group hadnumerous training tools, a variety ofmannequins, excised lungs and muchmore.

Thank you to all of the RTs that partici-pated in this past RT Week. This is a veryimportant event as we struggle to be recognized for the significant role that we play in the healthcare system.Congratulations to all of the participantsin this year’s contest. The winners havecertainly pushed the limits for RT Weekand have raised the bar for Week 2008contestants.

Respiratory Therapy Week: The WinnersRT Week 2007 received a great response from the

membership. There was lots of participation across the

country, with many creative ideas being used to inform the

public and our healthcare colleagues of what it is that RTs do.



La semaine de la thérapie respiratoire : les gagnants

Les membres de la SCTR d’un bout à l’autre du pays ont participé en grand nombre à la Semaine de la TR 2007.

Ils ont fait preuve d’une gamme d’idées créatrices visant à informer le public, et nos collègues du domaine des soins de santé,

du rôle des TR.

Comme par les années passées, nousavons encouragé les gens à prendre desphotos et à soumettre une descriptionde leurs activités à la SCTR dans le cadred’un concours. Plusieurs personnes ontrépondu à l’appel et ont partagé leursexpériences.

Premier prixLes gagnants du concours de la Semainede la TR 2007 proviennent du Universityof Alberta Hospital (UAH) à Edmonton,en Alberta :

Équipe d’organisation : Julie Mitchell (chefd’équipe), Samantha Sampson, CarlaKeller. Bénévoles au kiosque : Don Hrycun,Michelle Hathaway, Murray Sampson,Tricia Zwarich, Dan Lee, Tim Wozniak

L’équipe du UAH a installé un kiosquebien conçu, pendant la durée de laSemaine de la TR, qui comprenait desobjets classiques tels le poumon de porcexcisé branché à un ventilateur, le man-nequin d’intubation et des renseigne-ments généraux sur la pratique de lathérapie respiratoire. Le kiosque mettaitégalement en vedette la ventilation non-effractive.

Tout au long de la semaine, le groupe aorganisé des activités sociales, des ques-tions anecdotiques quotidiennes assor-ties de prix et un concours « Qu’est-ceque c’est? »

Pour couronner le tout, le groupe a tenule « Grand relais de ventilateur ». Ils’agissait d’une activité de financemententre le UAH/Stollery et les autres sitesau sein de la Capital Health Authority àEdmonton. L’activité consistait en unrelais de ventilateur et les fonds amassésont été remis à la Alberta LungAssociation. Les sites qui ont accepté derelever le défi sont le Royal AlexandriaHospital, le Grey Nuns Hospital et laclasse d’étudiants de TR du NorthernAlberta Institute of Technology (NAIT).

Le GRAND RELAIS DE VENTILATEURexigeait que chaque site forme uneéquipe de TRA qui devait pousser unventilateur « habillé » sur un parcours derelais tout en effectuant une série detâches quotidiennes d’un TRA.

L’objectif pour chaque site était d’a-masser un minimum de 1 000,00 $ enpromesses de dons et de créer un thèmequi sensibilise la population vis-à-vis dela profession de la thérapie respiratoire.Des prix ont été décernés à l’équipeayant le ventilateur le mieux vêtu et àcelle qui a amassé le plus d’argent.

Au total, l’activité a amassé au-delà de 5 000 $ au profit de la Alberta LungAssociation. Les gagnants non officielsde la course sont les Alveolar Avengersdu University of Alberta Hospital.

Deuxième prixLa deuxième place a été accordée à l’ex-cellente soumission de l’équipe duNouveau-Brunswick menée par JaniceLangis et dont les participants incluaientPam Hayward, Justin Morris, PatrickDugas, Lise Cormier, Dany Durand, LynnLagace, Genevieve Lemieux, NicoleBoudreau, Christine Collin et Charles Bois.

Ce groupe représente les régiesrégionales de la santé Beauséjour etSouth-East Regional Health Authority,ainsi que le Collège communautaire duNouveau-Brunswick (C.C.N.B.)/ Programme de TR de l’Université de Moncton.

Le groupe a monté un kiosque très bienconçu au centre d’achats HighfieldSquare Shopping Centre à Moncton quitraitait d’asthme, de MPOC et de venti-lation non-effractive, dont des démon-strations d’équipement divers. Entreautres, le kiosque exposait deux pairesde poumons excisés, dont l’une paraissait en santé et l’autre malade,possiblement par suite de tabagisme. Si ces poumons provenaient de porcs, je recommande fortement qu’un

programme porcin d’abandon du tabacsoit créé au Nouveau-Brunswick!

D’après leurs photos, il est évident que legroupe s’est amusé, profitant de l’occa-sion d’interagir avec les « personnes ensanté » de la communauté et de travailleravec des gens des autres régions. SelonJanice : « Le clou de la journée s’est avéréle réseautage entre les TR de deux dif-férentes régies de la santé et les étudiantsde TR. Nous avons rarement la chance de travailler avec nos voisins! Noussouhaitons établir une nouvelle tradition. »Nous sommes d’accord qu’il s’agiraitd’une excellente tradition à créer.

Troisième prixLa troisième place a été remportée parun groupe d’étudiants de FanshaweCollege à London, en Ontario. Notonsque les gagnants de l’an dernier prove-naient également de Fanshawe College.Voilà une belle tradition qui s’installedans cet établissement.

Le groupe, mené par Amanda Henein,comprenait Kaley Nelson, Mary Liz Gabra,Stephanie Rotella, Amanda Smith,Amanda Henein, Neena Sandu, AnilCharron, Denis Z et Laura Van Bomel.

L’énorme kiosque que l’équipe a installéau collège mettait en vedette unegamme d’outils de formation, de man-nequins, de poumons excisés, et plusencore.

Merci à tous les TR qui ont participé àl’édition 2007de la Semaine de la TR. Ils’agit d’une activité très importante dansle contexte actuel de la lutte que nousmenons en vue d’être reconnus pour lerôle critique que nous jouons au sein dusystème de soins de santé. Félicitations àtous les participants au concours decette année. Les gagnants ont réussi àrepousser les limites de la Semaine de laTR et ont rehaussé les attentes pour lesconcurrents de 2008.


Did you ever wish you had the perfect job, that awesomehouse, a great car or extra cash in the bank? Do you everfind yourself working your fingers “to the bone” to feel likeyou are getting somewhere? What about talk of cut-backs,people calling in sick, working with too little staff or without-dated equipment? The reality is that we are always goingto be challenged somewhere, sometime. How we react toour work environment and the pressures we put on ourselveshas an impact on the quality of care we give and the type ofprofessionals we become.

Someone once said I was “the RT with the dream job”. I hada good laugh when I first heard that. But the more I thinkabout it the more it rings true. I was listening to a fascinat-ing story told by an RT who is now in his fifth decade work-ing in health care. He has done other jobs, but the majorityof his health care career has been in respiratory therapy. Hestarted as an “oxygen orderly” and changed titles and roleswith the times. His passion for this profession is very evidentin the way he tells his stories and relives the events as herelays them. I find this inspiring. To find somebody who hasbeen doing this job twice as long as I have and still has thefire burning in him as he talks about how things havechanged over time, makes me a little curious about what liesahead. Where will this profession take us over the next tento fifteen years (that’s about when I should be ready toretire)?

I was encouraged to get involved with the CSRT Board ofDirectors two years ago. Joining this board has been veryrefreshing and has given me perspective that I would neverhave gained had I chosen to stay in my own familiar littleworld.

This past winter I went ice fishing in Northern Ontario with acouple of great guys who I have known for a number ofyears. This was my first experience at ice fishing. Spendingtwo whole days in the sun and sleeping under a tarp on arock beach at the edge of a frozen lake at -29oC was an amaz-ing experience.One really appreciates a strong heart andgood lungs when he can haul a loaded toboggan four kminto the bush from the highway, seemingly up hill all the way.Stress test anyone?

Because we do have the “dream job” — my colleague and Icrossed off the outpatient schedule one Friday afternoon inJuly — writing in “team-building session”. We went sailingwith our internist on his boat. For us, getting outdoors, suck-ing in the fresh air and leaving the hospital, town and mari-na two hours behind us added much needed perspective inour hectic world. “Breathing life into healthcare” as screenedon the back of my shirt has a whole new meaning now.

The included photos are about getting away, stepping back.We are enjoying ourselves with those we meet along theway. The harder we work, the more we need to play. Everychoice leads somewhere. I have learned to be much moreeffective when I have taken the time to explore the positivein the many things that I do. Get out there and enjoy your-self — take some of that advice we are always giving to ourpatients. I read somewhere recently that “to never fail is tonever have tried”. You won’t believe how much differencedoing something out of the usual can make in your life, untilyou try it. Trust me, we all have “dream jobs” when we’reready to be the dreamer.

Respiratory Therapist— a Dream JobDan McPhee, RRT, Treasurer, CSRT Board of Directors

Thérapeute respiratoire : un emploi de rêveVous arrive-t-il de souhaiter avoir l’emploi parfait, unesuperbe maison, une magnifique voiture ou davantage d’ar-gent à la banque? Vous arrive-t-il de vous épuiser à unetâche pour avoir l’impression d’avancer? Et qu’en est-il descompressions budgétaires, des gens qui téléphonent se dis-ant malades, de l’obligation de travailler avec trop peu depersonnel ou avec de l’équipement périmé? La réalité esttelle que nous serons toujours confrontés à des défis dans unmilieu donné, à un moment donné. Notre façon de réagir ànotre milieu de travail et aux pressions que nous nous créonsa une incidence sur la qualité des soins que nous prodiguonset sur le genre de professionnel que nous sommes.

Une personne m’a déjà dit que j’étais « le TR avec l’emploide rêve ». J’ai bien ri en entendant cela, mais plus j’y pense,plus je me rends compte que c’est vrai. J’écoutais une his-toire fascinante racontée par un TR à sa cinquième décenniede travail dans le milieu des soins de santé. Bien qu’il aitoccupé d’autres postes, c’est dans le domaine de la thérapierespiratoire qu’il a passé la majorité de sa carrière. À sesdébuts, il était « préposé à l’équipement d’oxygène » et avecle temps, il a assumé d’autres titres et fonctions. Sa passion

Suite à la prochaine page


Dan McPhee and Judy Kerr (RPN/CRA) participating in a nauticalteam-building session



Algonquin College State-of-the-Art SIM Lab

Continued from page 5

■ An operating room suite with six sink scrub room and asterile supply area

■ Three critical care/trauma units

■ Nine advanced care beds

All units have piped gas, drop-down power walls andmounted monitors and X-ray viewers.

To complement the facilities, the College made major invest-ments into equipment that would not only reflect standardsin related professional skills, but provide realistic patientinteraction. This fosters learning and troubleshooting.Equipment has a range for all learners and patient popula-tions, including such things as:

■ Radiant warmers and incubators

■ Fluid administration and monitoring units

■ Mechanical ventilators

■ Anesthesia machine

■ Airway care mannequins for intubation, tracheostomy andbronchoscopy (with video bronchoscopes).

■ Patient mannequins manikins range from neonatal toadult and from basic to Laerdaol’s Sim Man models, theEmergency Care Simulator (ECS) and Noel (which can sim-ulate the delivery of a baby)

■ An advanced Human Patient Simulator (HPS) for criticaland anesthesia care that “breathes”, using oxygen and“producing” carbon dioxide relative to ventilation. It alsorecognizes drugs and fluids that are administered. The simulator then alters its’ response according to therapy provided by students and the protocols used bythe faculty controller

■ Models that allow intravenous and arterial line insertion,as well as “blood” sampling

The feature that makes the learning experience optimal isthat the simulation units are monitored with cameras andsound. They can be monitored from a concealed controlroom, a debriefing room and may also be monitored by offcampus sites with web links. There is the possibility to dovideo conferencing to all education centres and health carecentres that have this capability. This allows real time edu-cation to off campus sites. The cameras can zoom in suffi-ciently to allow visualization of waveforms on ventilators assettings are changed. This allows the professor/technician tomonitor student activity indirectly and also record practiceand evaluation sessions for review. Students may use thisfeature to observe and critique team practice sessions, learn-ing not only skill techniques, but how timing affects careand the codependence of team members in the provision ofeffective care. Students can also review their individualrecorded skills performance in an effort to identify strengths

Continued on page 24

Suite de la dernier pagepour la profession est très évidente par sa façon de raconterses anecdotes et de revivre les événements à mesure qu’il lesrelate. Pour moi, il est édifiant de rencontrer une personnequi occupe ce poste depuis deux fois plus longtemps quemoi et qui est encore passionné par les changements qui sesont multipliés avec le temps. Cela nourrit ma curiosité parrapport à ce qui nous attend. Où la profession nous mènera-t-elle d’ici les dix ou quinze prochaines années (soit, lemoment ou je serai prêt à envisager ma retraite)?

Il y a deux ans, j’ai été encouragé à m’impliquer au sein duConseil d’administration de la SCTR. En plus de s’avérer trèsrafraîchissante, mon implication m’a donné une perspectiveque je n’aurais jamais connue si j’avais choisi de rester dansmon petit monde familier.

L’hiver dernier, je suis allé, pour la première fois, à la pêchesur la glace dans le Nord de l’Ontario avec quelques copainsque je connais depuis longtemps. Quelle expérience extra-ordinaire que de passer deux jours complets au soleil et dedormir sous une toile, à une température de -29oC, sur unlit de roches au bord d’un lac gelé! C’est lorsqu’on traîne untoboggan chargé sur quatre km dans la forêt, ayant l’im-pression de toujours monter la colline, que l’on appréciesincèrement un cœur fort et de bons poumons. On passe àl’épreuve d’effort?

Puisque nous avons « l’emploi de rêve », mon collègue etmoi avons rayé l’horaire des patients externes par un ven-dredi après-midi de juillet, pour y inscrire « séance dedéveloppement de l’esprit d’équipe ». Nous sommes allésfaire de la voile avec notre interniste. Le fait de sortir dehors,de respirer l’air frais, de quitter l’hôpital, et de s’évader de laville pendant quelques heures nous a donné une nouvelleperspective, combien nécessaire dans notre monde mouve-menté. Le slogan « Les TR insufflent la vie dans les soins desanté », imprimé à l’arrière de mon t-shirt, revête désormaisun tout nouveau sens.

Les photos que vous apercevez ont pour thème l’évasion etle recul. Nous prenons le temps de nous amuser avec lespersonnes que nous croisons sur notre chemin. Plus on tra-vaille fort, plus on a besoin de s’amuser. Chacun de noschoix mène quelque part. J’ai appris à être beaucoup plusefficace lorsque je prends le temps d’explorer l’aspect posi-tif des multiples tâches que j’accomplis. Sortez et amusez-vous : prenez ce conseil que nous donnons constamment ànos patients. Récemment, j’ai lu quelque part : « Ne jamaiséchouer signifie ne jamais avoir essayé. » Jusqu’à ce quevous ne l’essayiez, vous ne pourrez croire à quel point uneactivité hors de l’ordinaire peut faire une énorme différencedans votre vie. Croyez-moi : nous avons tous « l’emploi derêve », du moment que nous sommes prêts à rêver un peu.

Thérapeute respiratoire : un emploi de rêve


CSRT News nouvelles de la SCTR

Farewell from the Executive Director

I have learned more about respirato-ry therapy, about our healthcare col-leagues and about the healthcaresystem in general, than I could pos-sibly of have imagined. I’ve had theopportunity to travel to a number ofdifferent cities and provinces tomeet RTs from coast to coast tocoast. I have made some greatprofessional contacts. I have madesome great friends. Respiratory ther-apy is as much a family as it is a pro-fession, and I was always amazed bythe camaraderie within the profes-sion that I witnessed as I traveledaround.

One thing I never got used to wasthe way people treated the CSRTExecutive Director. RTs, membersand non-members alike, treated mewith an uncanny level of respect.Members often mistakenly attributedan unwieldy amount of authorityand privilege to this position, whilenon-members would sheepishlyadmit their non-member status whilestaring at their shoes. All the while, Ijust considered myself the guy athead office that signed the pay-checks of the staff that did the realwork. I guess I did a little more thanthat, but the CSRT would not benearly the strong organization that itis without the support of the headoffice staff. I want to thank Sylvia,Rita, Tracy, Pam, Dana, Sandie, Anneand Andrea, for making it a pleasureto come to the office every day, fordoing the great work that made melook good, and for always listeningto my wild tales of what it’s reallylike to be an RT.

I would also like to thank the CSRTExecutive Committee of 2003 fortaking a chance on an inexperi-enced, newly-minted MBA graduate,and for giving me this opportunity.Jim Winnick, Daniel Pare, BrentKitchen and Kevin DeJong were allinstrumental in any success that mayhave been attributed me. Not for justgiving me the opportunity, but alsofor their guidance, mentorship, sup-port, friendship, and for theirpatience.

In parting, I would like to also thankthe CSRT members. I was alwayssurprised when people approachedme at conferences or called me onthe phone regarding something thatI had written in the CJRT or said at aconference. I was mostly surprisedby the fact that they were payingattention to me, but also (whetherthey agreed or disagree with me) bythe passion with which they debatedand discussed the various issues.

It’s great to see that kind of passionin our profession and that enthusi-asm is needed now more than ever.The healthcare human resourceenvironment is becoming increas-ingly competitive. We compete withother professions to encourage stu-dents to go into respiratory therapy.We compete with our colleagues forour proper role on the healthcareteam. We compete for public andprivate money to fund our projects,and to staff and resource our RT departments. We often have the dis-advantage of being smaller in num-bers than other professions, but we

clearly make up for that in pride inwhat we do and who we are. It isthe CSRT that gives us the opportu-nity to rally our small numbers intoa powerful force, and to give you,the individual RT, the stage uponwhich to express your opinion,share your ideas, and show yourpride in being a respiratory thera-pist.

When I started telling people that Ihad accepted my new position,many people immediately saw thegreat opportunity to have a respira-tory therapist with a position in anorganization such as CAPHC. Otherswere disappointed that I was “leav-ing respiratory therapy.” I was ini-tially, sort of offended by that com-ment, as I at no time consideredmyself to be leaving respiratory ther-apy. As I move on, I will not forgetthat first and foremost, I am a respi-ratory therapist. My career as an RTis what gave me these opportunitieswith the CSRT and with CAPHC. Iwill always be a proud CSRT mem-ber. I will take every opportunity tolet people know that I am incrediblyproud and honoured to, at one timehave been, the Executive Director ofthe Canadian Society of RespiratoryTherapists.

Thank you again, for giving me thisopportunity!

Sincerely,Doug Maynard, BSc, RRT, MBA

Being a proud RT, it has been a great honour, to hold the position

of Executive Director with the Canadian Society of Respiratory

Therapists. It is with deep sadness that I announce that I am

leaving the CSRT to accept an opening with the Canadian

Association of Paediatric Health Centres.Doug Maynard


Moving away from our long-estab-lished role as a quasi-regulator hasnot been easy for many to under-stand. Doug has helped get our mes-sage out effectively as we slowly seemore provinces gain licensure. I’msure that as a respiratory therapist hewill continue to speak on behalf ofthe profession as often as possible inhis new capacity. Best of luck toyou, Doug.

So here it is the beginning of a newyear. With Doug’s news, I have justreturned from a quick trip to Ottawain order to speak to the staff andalong with Dan McPhee, ourTreasurer, get the ball moving inputting together an interim plan forthe office organization and a recruit-ment strategy.

Getting to Ottawa was a lot more“exciting” than it should have been.Due to the holiday season, it wasquite a chore finding a flight out butDana Taylor, our AdministrativeAssistant, was able to book a flightout of Moncton. Normally this wouldnot have posed a problem at all. Justover an hour’s drive from Saint John,this was less time than what it wouldhave taken me to travel fromBrampton to the airport in Torontoback when I lived in Ontario. I hadn’tcounted on the weather though andhere in the Maritimes, you alwayscheck the weather! When I retiredfor the night we barely had anysnow left from the Christmas thaw,so it was quite a shock to wake upto almost 20 cm of the fluffy whitestuff at 0300. Undaunted, I clearedoff the car and tried to get out of the

driveway only to get stuck twice.Eventually I made it to the road butit was more than obvious that I was-n’t going to get any further. I freedthe car one last time, was able to getthe car back in the driveway andwent back to bed hoping that themorning would be better.

Later it was rather obvious that theweather hadn’t gotten better. In spiteof the predictions, the region wasgetting a major storm. A check withthe airline found my 0615 flight wasnow delayed until 1500. At 1000 thetown plow came by and very nicelydeposited a four-foot pile of snow atthe end of the driveway. At 1130 our“plow guy” finally came by andcleared the way for me to get out.Armed with a fresh mug of coffeeand a snack I took off and headeddown the Trans-Canada Highway toMoncton. The first part of the tripwas a breeze. I’ve been in worsedriving conditions in Montreal,Ottawa and London when I livedthere. Little did I know just howwrong my optimism would be.

As I approached Moncton it becamea little too apparent that the plowshad been called off the highway.Crawling along behind an eighteenwheeler, we barely reached 20km/hr. Eventually I was rewarded bythe sight of the airport. Pulling up tothe entrance I ran inside to confirmmy booking. The flight was still on,but further delayed until 1700. Great,no problem, this would give me timeto get the car parked. I had to waitfor a plow to clear the area since asmall pickup was blocking the

entrance. A nice guy with a hugeplow offered to clear my way andwith that I was able to park and thenstruggle through the mounting snowdrifts back to the terminal building.

As I overcame the last of the driftsand entered the building I had asense of real accomplishment. I hadovercome a storm that made all ofmy previous storm driving memoriesto shame. I had made it to the air-port and was finally going to get onmy way. Fat chance of that! As Imade my way to the check-in count-er they announced that the flightwas cancelled. I was not going any-where that day. Eventually, after anight in a local hotel, a couple moredelayed flights and backed up air-ports I finally got to Ottawa.

Not that any of this tale will be ofany interest to any of you, but if youhad any thoughts that the Presidentof this illustrious Society lived in lux-ury and traveled in style, you’re sowrong! As a volunteer, myself andthe rest of the Board do all of this forthe simple reason that we care aboutour profession. There is no grandpayout or luxury accommodation,just economy flights with narrowseats. And if you think that travelingto Las Vegas and Orlando to attendthe AARC annual meetings soundsexotic, think again. When I went toLas Vegas they lost my bags andother than stepping out of the shut-tle bus and taking a five minute walkone evening, I never left the hotel inOrlando or even saw where thetheme parks were.

Continued on page 17

Message from the President

Rob Leathley

I’d like to start off this edition of my message by wishing CSRT

Executive Director Doug Maynard all the best in his new position.

After four years with the CSRT, Doug has decided to move on to the

Canadian Association of Pediatric Health Centres. Among his many

accomplishments, Doug has been instrumental in assisting the Board

with the implementation of its new Strategic Plan.

President’s message mot du président


Tout d’abord, j’aimerais souhaiter lemeilleur des succès à DougMaynard, directeur général de laSCTR, dans son nouveau poste.Après quatre ans à la SCTR, Doug adécidé de se joindre à l’Associationcanadienne des centres de santépédiatriques. Parmi ses nombreuxaccomplissements, Doug a prêté une assistance précieuse au Conseild’administration lors de la mise enœuvre de son nouveau Planstratégique. L’éloignement, de la partde la SCTR, de son rôle de quasi-organisme de réglementation, établide longue date, n’était pas facile àexpliquer. Doug nous a aidé à com-muniquer notre message avec effi-cacité à mesure que les provincesprennent en main l’autorisation del’exercice de la profession. Je suisconvaincu qu’en qualité dethérapeute respiratoire, il continueraà parler au nom de la professionaussi souvent que possible dans l’ex-ercice de ses nouvelles fonctions.Bonne chance, Doug.

Nous voici au début d’un nouvel an.Par suite des nouvelles de Doug, j’aieffectué un court voyage à Ottawapour parler au personnel et élaborer,avec Dan McPhee, notre trésorier, unplan provisoire relatif à l’organisa-tion du bureau ainsi qu’une stratégiede recrutement.

Le voyage à Ottawa s’est avéré beau-coup plus « excitant » qu’il n’aurait dûl’être. En raison du temps des Fêtes,il n’a pas été facile d’obtenir un volmais Dana Taylor, notre adjointeadministrative, a réussi à réserver un vol à partir de Moncton.Normalement, cela n’aurait poséaucun problème. À un peu plusd’une heure de Saint John, cela pre-nait moins de temps que de voyagerde Brampton à l’aéroport à Toronto àl’époque où je vivais en Ontario. Parcontre, je n’avais pas pensé à lamétéo et dans les Maritimes, il fauttoujours vérifier la météo! En mecouchant ce soir-là, il ne restait pra-tiquement plus de neige après ledégel de Noël. Ce fut donc tout unchoc d’en découvrir près de 20 cm en

me réveillant à 0300. Loin de medécourager, j’ai nettoyé l’auto et tentéde sortir de mon entrée, restant pris àdeux reprises. Je me suis éventuelle-ment rendu jusqu’à hauteur de la rue,pour constater que je n’irais pas plusloin. Ayant réussi à ramener l’autodans l’entrée, je suis retourné mecoucher en souhaitant que tout aillemieux dans quelques heures.

Mais plus tard, la météo était loin des’être amélioré. En dépit des prévi-sions, la région était en proie à unetempête majeure. Un appel au trans-porteur aérien a confirmé que monvol de 0615 était reporté à 1500. À1000, le chasse-neige de la ville adéposé un banc de neige de quatrepieds au bout de mon entrée en pas-sant, et notre préposé au déneige-ment est venu tout nettoyer à 1130afin que je puisse sortir. Armé d’unbon café et d’une collation, j’aiemprunté la Transcanadienne endirection de Moncton. Au début,tout s’est bien passé et je me suis ditque j’avais encouru de pires condi-tions routières à Montréal, à Ottawaet à London lorsque j’y avais vécu.J’étais loin de me douter que monoptimisme était mal fondé.

Près de Moncton, il m’est devenutrès évident que les chasse-neigeétaient hors circulation. Je suivaisune remorque et nous roulions àpeine à 20 km/h. J’ai éventuellementété récompensé par la vue de l’aéro-port. En arrivant, je suis tout de suiteallé confirmer ma réservation. Bienque le vol ne soit pas annulé, il étaitmaintenant reporté à 1700. Bon, j’au-rais donc tout le temps voulu pourgarer ma voiture. J’ai dû attendrequ’un chasse-neige nettoie le sta-tionnement puisqu’un petit camionbloquait la route. Finalement, ungentil homme avec un gros chasse-neige a offert de me frayer unchemin et grâce à lui, j’ai réussi àgarer ma voiture pour ensuite com-battre les amoncellements de neigejusqu’à l’entrée de l’aérogare.

En pénétrant dans l’édifice, j’airessenti une énorme satisfaction.

J’avais combattu une tempête qui ne se comparait aucunement à mesexpériences passées. Je m’étaisrendu à l’aéroport et j’allais finale-ment partir. Pas de danger! Alors queje me dirigeais vers le comptoird’enregistrement, on annonça que levol était annulé. Je n’irais nulle partce jour-là. Éventuellement, aprèsune nuit dans un hôtel local,quelques vols encore reportés et desaéroports bondés, je me suis finale-ment rendu à Ottawa.

Ce récit ne revête peut-être aucunintérêt pour vous, mais si vouscroyiez que le président de cetteillustre société vivait et voyageaitluxueusement, détrompez-vous! Enqualité de bénévole, je fais toutesces choses, comme l’ensemble duConseil d’administration d’ailleurs,simplement parce que j’ai à cœurnotre profession. Il n’y a pas de grosboni, ni d’hébergement de luxe,mais plutôt des vols en classeéconomique aux sièges étroits. Et sivous croyez qu’il est exotique de se rendre à Las Vegas et à Orlandopour participer aux réunionsannuelles de l’AARC, repensez-y.Lorsque je suis allé à Las Vegas, mesbagages ont été perdus et à Orlando,outre une marche de cinq minutesun soir, je n’ai pas quitté l’hôtel nimême vu l’emplacement des parcsthématiques.

Exotique? Non. Deux ans à titre deprésident ont signifié deux voyagesen Alberta, un à Las Vegas, un àOrlando, deux à Toronto, deux àMontréal et quatre à Ottawa. Un par-cours incroyable? Oui. Je n’y chang-erais rien. J’ai eu l’occasion de tra-vailler avec les meilleurs au pays. J’airencontré des centaines de nouvellesconnaissances et je me suis liéd’amitié avec des gens de partoutsur la terre qui sont, eux aussi, pas-sionnés par la thérapie respiratoire.J’ai beaucoup changé grâce aux per-sonnes autour de moi. Si voussouhaitez vivre une parcelle de cetteexpérience, impliquez-vous. Portez-vous bénévole pour travailler au

Suite à page 17

Mot du président

President’s message mot du président


It is a stressful time for all partiesinvolved. However, in today’s litigioussociety, it is a brutal fact that the likeli-hood that becoming involved in a mal-practice suit is no longer a remote pos-sibility. The fact that you can be suedfor an alleged action or non action isthere — however, you can use somesimple risk management techniques toavoid or reduce your liability.

Risk management is a systematicapproach to identifying, assessing,understanding, acting on, and com-municating risk issues. Following arethe steps in Risk Management.

1. Identify and Analyze LossExposures (What could happen)

2. Examine Alternative RiskManagement Techniques(Purchase an Insurance Policy vs.Risk Your Own PersonalFinances Should You Be Sued)

3. Select Risk ManagementTechniques (Ways to MinimizeYour Liability)

4. Implement Techniques (InitiateYour Procedures To MinimizeYour Risk and Purchase YourOwn Individual Insurance)

5. Monitor Results

What can you do to minimize yourrisk?

■ Keep well documented records

■ Ensure that you are only providing professional serviceswithin your scope of practice

■ Report any incident that may giverise to a suit to your supervisorand your insurance provider

■ Always act professionally and portray a professional image

■ Review your Code of Ethics andScope of Practice

■ Ensure that you have adequateprotection should you be sued —i.e. a professional liability insur-ance policy through your employ-er complemented by your ownindividual professional liabilityinsurance policy

Although employers may cover youfor your rendering or failure to ren-der your professional services, youshould consider complementingtheir coverage with your own policy.Consider:

■ Disciplinary actions against you

■ Your own policy looks out foryour best interests

■ Your own insurance policy is notemployer specific — it “follows”you wherever you provide services in Canada (i.e. contractemployee, volunteer work, etc.)

■ The limit of coverage you purchase is your own limit andyou are not “sharing” limits withother health care professionals

■ You have an opportunity to havea copy of your policy to ensurecoverage is appropriate

■ The deductible you pay for yourown insurance is minimal (if atall)

Risk is a fact of life. There is a riskwhen crossing the street. There is arisk in purchasing a home. There isa risk when providing professionalservices. You want to ensure thatyou minimize your risk as much aspossible and transfer as much risk asyou can to an insurance policy.

CSRT sponsors a professional liabili-ty insurance program exclusive tomembers. For more information,please visit www.csrt.com.

Managing Your Risk As A RespiratoryTherapistMary-Ann Hamel, Senior Vice President, Marsh Canada Limited


Mary-Ann Hamel

Thousands of Canadians struggle with breathing everyday for a variety of reasons.

Respiratory Therapists play a vital role in caring for these individuals and while

doing so, open themselves up to liability. No one enjoys being involved in a lawsuit

or being made to account for alleged professional infractions.

CSRT PROFESSIONAL DEVELOPMENT

WORKSHOP

March 20, 200812:00 to 1:00 PM EST

Patient Safety: Mark Daly, RRT

The workshop will be accessible via a combinationof web-based and teleconfer-encing services.

For more information contactPam Hicks, [email protected] orcall 800-267-3422 ex 26 orcheck the CSRT website atwww.csrt.com



Au contraire, il s’agit d’événementsstressants pour toutes les partiesimpliquées. Compte tenu de l’épo -que contentieuse actuelle, la proba-bilité de se voir impliqué dans unepoursuite pour faute professionnellene constitue pas une possibilitévague. La possibilité d’être actionnépour une action ou une inactionalléguée est très réelle. Par contre, ilexiste des techniques simples degestion des risques qui servent àréduire ou à éliminer votre respons-abilité civile.

La gestion des risques est uneapproche systématique qui englobel’identification, l’évaluation, la com-préhension et la communication desenjeux liés aux risques, ainsi que lesactions posées pour y palier. Ellecomporte les étapes suivantes :

1. Identifier et analyser les exposi-tions à une perte (ce qui pourraitarriver)

2. Étudier les diverses techniquesde gestion des risques (souscrireune police d’assurance c. risquervos finances personnelles dansl’éventualité d’une poursuite)

3. Choisir les techniques de gestiondes risques (les façons de réduirevotre responsabilité civile)

4. Mettre les techniques en œuvre(initier vos procédures en vue de réduire les risques; souscrirevotre propre assurance individuelle)

5. Évaluer les résultats

Qu’est-ce que vous pouvez fairepour réduire les risques?

■ Tenir des dossiers bien documentés

■ S’assurer de ne prodiguer que lesservices professionnels quirelèvent de votre champ d’exercice

■ Communiquer à votre superviseuret à votre fournisseur d’assurancetout incident qui risque d’entraîner une poursuite

■ Toujours se comporter de façonprofessionnelle et projeter uneimage professionnelle

■ Passer en revue votre Code dedéontologie et votre Champ d’exercice

■ S’assurer d’avoir une protectionadéquate dans l’éventualité d’unepoursuite, c.-à-d. une police d’assurance responsabilité professionnelle offerte par votreemployeur ainsi que votre proprepolice d’assurance responsabilitéprofessionnelle individuelle

Bien que l’employeur puisse couvrirl’exécution ou l’inexécution de vosservices professionnels, il y a lieu desonger à compléter cette couvertureà l’aide de votre propre police.Songez à ce qui suit :

■ les mesures disciplinaires intentéescontre vous

■ votre propre police protège vosmeilleurs intérêts

■ votre propre police d’assurance nese limite pas à un employeur : ellevous « suit » là où vous prodiguezdes services au Canada (employéscontractuels, bénévolat, etc.)

■ la limite de la couverture que voussouscrivez est votre propre limite :vous ne « partagez » pas les limitesavec d’autres professionnels de lasanté

■ vous avez l’occasion de conserverune copie de votre police afin devous assurer que la couverture estconvenable

■ la franchise que vous devez payerest minime (ou inexistante)

Le risque fait partie de la vie. Vousprenez un risque en traversant larue, en achetant une maison et enprodiguant des services profession-nels. Il faut s’assurer de réduire lesrisques autant que possible et detransférer la plus grande part derisque possible vers une police d’as-surance.

La SCTR commandite un programmed’assurance responsabilité profes-sionnelle à l’intention exclusive de ses membres. Pour un complé-ment d’information, consultez lewww.csrt.com.

La gestion des risques pour le thérapeuterespiratoireMary-Ann Hamel, Vice-présidente directrice, Marsh Canada Limitée

Mary-Ann Hamel

Chaque jour, pour toutes sortes de raisons, des milliers de Canadiens ont du mal à

respirer. Les thérapeutes respiratoires jouent un rôle critique vis-à-vis des soins qu’ils

prodiguent à ces personnes, s’exposant par le fait même à la responsabilité civile

Les poursuites et l’obligation de rendre des comptes relatifs à des allégations

d’infractions professionnelles ne sont pas une partie de plaisir.



Hello everyone. Spring will be arriving shortly and with it comes membership renewal time!

Why renew with CSRT?At CSRT, our members are our great-est resource. It is extremely impor-tant, in this growing world of multi-disciplinary healthcare practitioners,that the voice of respiratory thera-pists is powerful and is at the fore-front of the discussions regardinghealthcare in Canada. Join or renewwith the CSRT and be part of thatvoice. Please keep your eyes openfor your renewal packages and/oran e-mail regarding renewal in thecoming weeks.

You will notice in your renewalpackage, the renewal forms havechanged significantly. For the RRTmembership renewal form, there is avery in-depth profile that we wouldgreatly appreciate you filling out inits entirety. Although we encourageyou to renew your membership on-line, please download the actualMembership Profile Form from thewebsite or fill out the form that youreceive in the mail. Any data collect-ed will adhere to CSRT’s PrivacyPolicy and will be used for statisticalpurposes only.

There are significant improvementsin our professional liability insuranceprogram for the 2008–2009 member-ship year. By request, we haveworked closely with our insurancebroker to receive improvedenhancements to the insurance pro-gram, including a second option thatwill provide $5-million coverage andgreater coverage for legal defencereimbursement costs. The moremembers we have enrolled in theprogram, the better the premiumsand policy enhancements that wecan offer our members.

Risk management is one of the areasin your career that should remain instrong focus. What better way is

there to protect your career, than tobe adequately covered by liabilityinsurance in the event that a suit isbrought against you?

Our spring educational workshopsdealt with risk management in yourprofession. The workshops thatwere held are:

■ Risk Management — ProtectingYourself and Your Practice —January 30, 2008, Brent Kitchen, RRT

■ Liability Insurance — What YouNeed to Know — February 12,2008, Mary-Ann Hamel, SeniorVice President, Marsh CanadaLimited. Mary-Ann has also written an article on RiskManagement for this issue of theJournal.

We are providing a Patient Safetyworkshop — March 20, 2008 from12:00 – 1:00 ET, with Mark Daly.Please visit www.csrt.com for moreinformation and how to register.

In December, I attended the Canad -ian Institute for Health Infor mation(CIHI) conference, entitled “HealthHuman Resources 2007: ConnectingIssues and People”. Over 350 dele-gates from many areas of the health-care industry including governmentagencies, professional and regulato-ry organizations, hospital administra-tors and many different types ofhealth care professionals attended.This conference highlighted theimportance of collecting very con-cise and consistent data in order tohave a clear picture of many aspectsof a profession. CIHI has been col-lecting data for a very long time fordoctors and nurses, but not the dif-ferent therapy groups. CIHI releasedresults from data collected and cre-ated a report entitled “Workforce

Trends of Occupational Therapists inCanada, 2006” in December 2007.CIHI is currently work ing with thePharmacists, Physi o therapists, MedicalLaboratory Tech nologists and Me -dical Radiation Technologists to cre-ate similar databases and plans tohave workforce reports created overthe next several years. AlthoughCIHI will not be using our data atthis point in time, we have decidedto set up our database using similardata sets and methodology used forthe other therapy groups in order tocollect consistent and more repre-sentative data.

It was also very evident whileattending this conference that it isextremely important to have thevoice of respiratory therapistsstrongly heard amongst all of thoseother voices.

Please join the CSRT — help strengthenour voice… .

Thank you for your continued support and we look forward to providing you with the best servicespossible.

Membership RenewalsTracy Taylor, Director of Operations and Membership Services

The CSRT office staff wear many hats toserve you better.



Bonjour! Le printemps qui arrive à grands pas signale la période de renouvellement des adhésions!

Pourquoi renouveler votreadhésion à la SCTR?À la SCTR, les membres constituentnotre plus grande ressource. Comptetenu de la croissance du nombre deprofessionnels pluridisciplinaires, ilest de toute importance que la voixdes thérapeutes respiratoires soitforte et au premier plan des discus-sions portant sur les soins de santé auCanada. Votre adhésion/renouvelle-ment d’adhésion à la SCTR vous per-met de faire partie de cette voix.Surveillez l’arrivée de votre trousse derenouvellement par la poste au coursdes prochaines semaines et/ou votrecourriel pour une annonce à cet effet.

Parlant de la trousse, vous remar-querez que des changements impor-tants ont été apportés aux formu-laires. En particulier, le formulaire derenouvellement d’adhésion à laSCTR comporte un profil détaillé.Nous apprécierions grandement quevous preniez le temps nécessaire àle remplir au complet. Bien quenous vous encouragions à renouvel-er votre adhésion en ligne, nousvous demandons de télécharger leFormulaire de profil du membre àpartir du site Web ou encore de rem-plir le formulaire que vous recevrezpar la poste. Tous les renseigne-ments recueillis se conformeront à laPolitique sur la protection de la vieprivée de la SCTR et servirontuniquement à des fins statistiques.

D’importantes améliorations ont étéapportées à notre programme d’as-surance responsabilité profession-nelle pour l’année d’adhésion 2008-2009. À la demande populaire, nousavons travaillé de près avec notrecourtier d’assurance afin d’améliorerle programme, notamment enajoutant une deuxième option quifournit une couverture de 5 millionsde dollars et en améliorant la couver-

ture des frais de défense juridique.Plus de membres s’inscrivent au programme, plus les primes sontavantageuses et les améliorationssont nombreuses.

Le domaine de la gestion des risquesdoit constituer l’un des points demire de votre carrière. Quellemeilleure façon y a-t-il de protégervotre carrière que de vous assurerd’avoir une couverture adéquate enmatière d’assurance responsabilitédans l’éventualité qu’une poursuitesoit intentée contre vous?

Les ateliers éducatifs tenus au print-emps traitaient de gestion des ris -ques au sein de la profession :

■ Risk Management — ProtectingYourself and Your Practice (La gestion des risques : pourvotre protection et celle de votrepratique) — le 30 janvier 2008,Brent Kitchen, TRA

■ Liability Insurance — What YouNeed to Know (L’assuranceresponsabilité : Ce qu’il fautsavoir) — le 12 février 2008,Mary-Ann Hamel, Vice-présidentedirectrice, Marsh Canada Limitée.Mary-Ann a également rédigé unarticle portant sur la gestion desrisques pour le présent numéro.

Nous offrons un atelier sur laSécurité du patient (Patient Safety)le 20 mars 2008 de 12 h 00 à 13 h 00HE, avec Mark Daly. Consultez lewww.csrt.com pour un complémentd’information ou pour vous inscrire.

En décembre dernier, j’ai participé àla conférence de l’Institut canadiend’information sur la santé (ICIS) intitulée « Ressources humaines de la santé 2007 : Des enjeux et desgens ». Au-delà de 350 délégués deplusieurs domaines de l’industrie dessoins de santé y ont participé, y

compris des représentants d’agencesgouvernementales et d’organismesprofessionnels et de réglementation,des administrateurs d’hôpitaux etune riche gamme de professionnelsde la santé. La conférence soulignaitl’importance de recueillir des don-nées très concises et cohérentes afinde dresser une image nette deplusieurs aspects d’une profession.L’ICIS recueille depuis très long -temps des données à l’intention desmédecins et des infirmières, maisnon des différents groupes dethérapeutes. L’ICIS a publié les résul-tats des données recueillies et arédigé, en décembre 2007, un rap-port intitulé « Tendances de la maind’œuvre chez les ergothérapeutes auCanada, 2006 ». L’Institut travailleprésentement avec les pharmaciens,physiothérapeutes, technologues delaboratoire médical et technologuesen radiation médicale en vue decréer des bases de données sem-blables et il prévoit créer des rap-ports sur la main d’œuvre au coursdes quelques prochaines années.Bien que l’ICIS n’utilise pas nos don-nées à l’heure actuelle, nous avonsdécidé de créer notre base de don-nées en fonction d’ensembles dedonnées et de méthodologies sem-blables à ceux qui sont utilisés pard’autres groupes de thérapeutes afinde recueillir des données cohérenteset davantage représentatives.

Lors de cette conférence, l’impor-tance de veiller à ce que la voix des thérapeutes respiratoires soitclairement entendue parmi toutes lesautres voix m’a paru très évidente.

Renforcez notre voix... adhérez à laSCTR.

Merci de votre soutien continu. Nousnous employons à vous offrir lesmeilleurs services possibles.

Services aux membresTracy Taylor, Directrice des opérations et des services aux membres



Enhanced CSRT Professional LiabilityInsuranceThere are now two options to choose from.

We have negotiated a decrease in the premiums and an increase in thecoverage for Disciplinary Defense costs for Option 1 and Option 2 hasbeen added in order to provide coverage for those members whorequire $5M coverage in liability.

Option 1: Basic Professional Liability Insurance: $2M/incident — $4M aggregate ($67 + applicable taxes)

■ Disciplinary Defense — $25K/Incident — $100K aggregate

■ Criminal Defense Reimbursement — $100K/incident — $100K aggregate

Option 2: Basic Professional Liability Insurance: $5M/incident — $5M aggregate ($110 + applicable taxes):

■ Disciplinary Defense — $25K/Incident — $50K aggregate

■ Criminal Defense Reimbursement — $50K/incident — $100K aggregate

There have been several other additions/enhancements to the program.See your renewal package or visit www.csrt.com.

President’s message continued from page 10

Exotic, no; two years asPresident has meant two tripsto Alberta, one to Las Vegas,one to Orlando, two to Tor -onto, two to Montreal and fourto Ottawa. An incredible jour-ney, yes. I would not havechanged this for anything. Ihave had a chance to workwith some of the best thiscountry has to offer. I have methundreds of new people andmade new friends with peoplefrom around the world whoare also passionately interestedin respiratory therapy. I havebeen profoundly changed bythose around me. If you wantto feel even the smallest bit ofthis, get involved. Volunteer towork on one of our manycommittees or put your nameforward for one of the electedpositions. You have nothing toloose. Even if you don’t obtainthe position you seek, otheropportunities will presentthem selves. Just get involved,you too will be profoundlychanged.

Rob Leathley, B.Ed., RRTCSRT President

Mot du présidentsuite de la page 11

sein d’un de nos nombreuxcomités ou soumettez votrecandidature pour un despostes élus. Vous n’avez rien à perdre. Même si vousn’obtenez pas le poste con-voité, d’autres occasions seprésenteront. Mais impliquez-vous et vous serez changé pro-fondément, vous aussi.

Rob Leathley, B.Ed., TRAPrésident de la SCTR

CSRTCorporateMembers

All-Can Medical Inc.Bayer Healthcare Cardinal HealthCarestream MedicalFisher & PaykelIkariaInstrumentationLaboratoryKEGO HealthcareMasimo Canada

ProResp/ProHealthO-Two MedicalTechnologies RC EducationalConsulting ServicesRespanSummit TechnologiesVitalaire


Special interest

Canada’s First Research Practice CouncilTracy Seaman BA, RRT, Instructor, Dalhousie School of Health Sciences, Halifax, NS

The aim of the Research PracticeCouncil (RPC) is to highlight bestpractices in clinical researchthroughout the local research com-munity. Although there are manypractice councils at the CapitalDistrict Health Authority (CDHA) theRPC is the first council specificallydeveloped to represent researchstaff. The focus is not on a certaindiscipline or clinical practice issue,but strictly on the practice of patient-centered research. Within the coun-cil, much has already been learnedabout the scope and diversity ofresearch at CDHA. This has helpedto build bridges among the disci-plines and also raise awarenessabout the safe and proper conductof clinical trials.

The CDHA is the largest health carecentre east of Montreal and clinicalresearch trials take place throughout30 of the centre’s major disciplinesin Halifax, Nova Scotia and sur-rounding areas . The research teamlead by principal investigatorsincludes research coordinators, labo-ratory technicians, diagnostic imag-ing technologists, pharmacy techni-cians along with many other hospitalpersonnel.

Due to the diversity and clinicalbackgrounds of the research staff acouncil was started in 2005 to sup-port this multidisciplinary group.Current and past council member-ship includes clinicians with variousbackgrounds; nursing, occupationaltherapy, engineering, clinical nutri-tion, pharmacy and respiratory

therapy. Other council membersinclude the research educator andhuman resources manager forresearch services.

Although the council has evolvedover the past years, the overall goalof the council remains the same; toassist research employees in the res-olution of practice issues that mayarise during the completion of clini-cal trials at Capital Health. The hopeis to document these issues and touse them as possible educationaltools in the future; to learn from thepast.

Council Terms of Reference outlinethe following responsibilities:

■ To provide a framework fordefining and addressing researchpractice issues for a multitude ofdisciplines

■ To define and clarify roles ofresearch staff and to collaboratewith the Research EducationCommittee, the Research PolicyAdvisory Council and theWorkplace Safety Team regardingresearch practice

■ To facilitate continuing competence through professionaleducation and development

■ To interact and consult asrequired with other Capital Health councils and committeesregarding practice issues

■ To serve as a resource for recognizing research excellence

■ To establish mechanisms for theevaluation and effectiveness ofthe Council

The council has successfully com-pleted a framework for resolution ofpractice issues and a guidance docu-ment to accompany it. This frame-work assists research staff to clarifywhether an identified issue is a safe-ty issue, a research practice issue, aprofessional practice issue or not,and then guide staff to the appropri-ate personnel to help them further.The council has also awarded edu-cational scholarships on behalf ofResearch Services the past 3 years;each year the Research Star Awardhas been awarded to a deservingresearch staff member who has beennominated by colleagues or peersdue to their commitment to researchexcellence and dedication to theresearch community. The councilhas also shared developments withthe research community throughLunch and Learn sessions andthrough the internet as part of theResearch Services web access.

Since this is the first such council (tothe author’s knowledge) in Canada ithas been a challenging and educa-tional endeavor to be a part of.Recently, council members have putactual practice issues through theframework to help with their resolu-tion. One issue involved safety andthe mumps outbreak in Nova Scotiathis past year. The use of the frame-work helped a research staff mem-ber decide what was the mostappropriate manner to deal with themumps concern in their area withprimary importance on patient (i.e.clinical trial participants) and CDHAstaff safety. The framework workedwell for this situation which gave

“A practice council is a group of professional(s)…who participate in, and are accountable for, making

organizational decisions about discipline-specific as well as interdisciplinary practice standards and

protocols. The overall goal of a practice council is the delivery of safe, competent and ethical quality

care for patients and their families”.


Intérêts spéciaux

Canada’s First ResearchPractice Council Continued

council members positive reinforcement that all the pastyears work was well worth the time and effort involved toget this council off the ground!

As an inaugural member of the RPC and a registered respira-tory therapist (RRT) it was important for the author to be apart of this council in order to represent the RRTs in practiceand also to be involved in the framework and developmentof the council from the ground up. It has also been a reward-ing and educational experience to work together on councilprojects with a diverse group of dedicated and caring healthcare professionals. Research is just one of the many areas ofadvancement of RRTs in Canada and councils such as theRPC can ensure that RRTs have a voice in this and other suchcommunities within the health care system.

What are RRTs doing in research at CapitalHealth?There are currently over 300 research employees at CapitalHealth taking part in more than 1300 clinical trials. Themajority of these trials involve experimental pharmaceuticalproducts but there are many non-pharmacological trials aswell.

Within the Department of Medicine, the Division ofRespirology conducts various research projects, includingclinical trials, each year. Staff Respirologist Dr. PaulHernandez is the research director for the division andemploys 2 full time RRTs and 1 part-time RRT as researchcoordinators. Dr. Hernandez is an associate professor ofMedicine at Dalhousie University and is a member of theCanadian Thoracic Society including the COPD GuidelinesCommittee.

Pharmaceutical trials in the areas of chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, pul-monary hypertension, pulmonary fibrosis and palliative careare currently taking place in the Division of Respirology.Non-pharmaceutical trials in COPD and asthma include inte-grative clinical respiratory and exercise physiology andassessment of interventions such as lung surgery and patienteducation.

The author is a part time research coordinator in the Division ofRespirology and full time educator of Respiratory Therapy at theSchool of Health Sciences (SHS) at Dalhousie University, Halifax,Nova Scotia.

References1. Capital District Health Authority. Practice Councils in Capital Health.

Date unknown.2. Capital District Health Authority. Research Homepage,

http://www.cdha.nshealth.ca/default.aspx?page=SubPage&cate-gory.Categories.1=81&centerContent.Id.0=5295. Last updated6/29/2007. Accessed December 29, 2007.

3. Capital District Health Authority. Research Practice Council, Termsof Reference, December 2007, page 1.

March 2 – 7, 2008Anaesthesiologists, 14thWorld CongressCape Town, South Africawww.wca2008.com/

March 3 – 11, 2008American Academy ofAllergy Asthma andImmunologyPhiladelphia, PAwww.aaaai.org/

April 9 – 12, 2008International Society forHeart & LungTransplantation, 28thAnnual Meeting &Scientific SessionsBoston, MAwww.ishlt.org/meetings/futureMeetings.asp

April 19–22, 200818th European Congressof Clinical Microbiologyand Infectious DiseasesBarcelona, Spainwww.akm.ch/eccmid2008/

April 30 – May 4, 200840th Annual Meeting ofthe Society for ObstetricAnesthesia andPerinatology Chicago, ILwww.soap.org/default.htm

May 16 – 21, 2008International Conferenceof the American Thoracic SocietyToronto, ONwww.thoracic.org/

May 22 – 25, 2008Canadian Society ofRespiratory TherapistsAnnual RespiratoryTherapy ConferenceSaskatoon, SKwww.csrt.com

June 13 – 17, 2008CanadianAnesthesiologists'Society, 65th Annual MeetingHalifax, NSwww.siicsalud.com/scripts/congresos.php/cc008189

June 18 – 21, 200816th World Congress in CardiologyNice, Francewww.cardiostim.fr

June 26 – 30, 2008CAS 65th AnnualMeetingVancouver, BC www.cas.ca/

July 13 – 15, 2008Pain, 2008 WorldCongressLondon, Englandwww.kenes.com/neuropathic2008

October 2 – 5, 2008American ThyroidAssociation, 79th Annual MeetingChicago, IL

October 4 – 8, 2008European RespiratorySociety Annual CongressBerlin, Germanywww.dev.ersnet.org/

October 18 – 22, 2008American Society ofAnesthesiologists, 2008 Annual MeetingOrlando, FLwww.asahq.org/

October 19 – 22, 2008Canadian Association of Paediatric HealthCentres, 2008 AnnualMeetingOttawa, ONwww.siicsalud.com/scripts/congresos.php/cc017845

October 25 – 20, 2008American College of Chest Physicians, 74th Annual ScientificAssemblyMiami, FLwww.siicsalud.com/scripts/congresos.php/cc008221

October 25 – 29, 2008Canadian CardiovascularSociety, 2008 AnnualScientific Sessions &ExhibitionToronto, ONwww.siicsalud.com/scripts/congresos.php/cc011836

October 27 – 31, 2008American College ofEmergency Physicians,2008 Scientific AssemblyChicago ILwww.siicsalud.com/scripts/congresos.php/cc017850

Calendar of Events

CSRT Conference

Saskatoon, SKMay 22–25, 2008

Thank you to our sponsors

Please join us in beautiful Saskatoon

THURSDAY, MAY 22, 2008

Leadership Congress 8:00 AM – 5:00 PM

Educator’s Congress8:00 AM – 5:00 PM

CSRT Complimentary Wine and Cheese ReceptionOpening of Exhibits6:00 AM – 9:00 PM

FRIDAY May 23, 2008

Exhibitor’s Breakfast7:30 to 8:30 AM

Keynote Speaker: Dr. Richard Heinzl,Doctors Without Borders9:00 – 10:00 AM

Airway Olympics Sputum CupChallenge3:00 PM – 5:00 PM

Fun Night — Saskatoon Social Multi-Cultural Evening Plains Indians Pow Wow — UkrainianDancers, Ethnic Finger Foods Sponsored by Roxon and Carestream

SATURDAY, May 24, 2008

Poster and Paper Presentations and Breakfast7:30 – 8:30 AM

RTs on Trial — Is Your PracticeDefendable Under CrossExamination?”9:00 – 11:00 AM

CSRT AGM3:30 – 5:30 PM

CSRT President’s Banquet and Awards 6:00 PM

SUNDAY, May 25, 2008

Keynote Speaker: Dr. John Fleetham“Sleep Disordered Breathing in

Adults”9:00 – 10:00 AM

Keynote Speaker: Libby Groff“The Gender Lens: Issues inRespiratory Disease”10:00 – 11:00 AM

Keynote Speaker: Dr. Alana Barmby,Saskatoon Naturopathic Health andWellness Centre, 11:00 AM – 12:00 PM

Conference Highlights

Early BirdRegistration

Deadline April 15, 2008


THURSDAY, MAY 22, 2008

Leadership Congress — Gallery C 8:00 AM – 4:00 PM

Educator’s Congress — Gallery B9:00 AM – 5:00 PM

JOIN US!6:00 – 9:00 PMCSRT ComplimentaryWine and Cheese ReceptionOpening of Exhibits

FRIDAY MAY 23, 2008

EXHIBITORS’ BREAKFAST — Salon A & B7:30 – 8:30 AM

OPENING REMARKS — Salon C & D8:30 – 9:00 AM

TRUDELL AWARDSPresentation of the 2007 Trudell Awards to students whoobtained the highest mark as a first-time writer of theCSRT-approved national Certification Examination.

9:00 – 10:00 AMKeynote Speaker: Dr. Richard HeinzlDoctors Without Borders

10:00 – 11:00 AMKeynote Speaker — TBA

LUNCH, EXHIBIT HALL — Salon A & B11:00 AM – 12:30 PM

BREAKOUT SESSION ONEA = Neonatal/Pediatrics B = AnesthesiaC = Sleep Disorders D = Critical CareE = Leadership

12:30 – 1:30 PM

MODULE A Gallery A“Discovering the Earliest Origins of Health andDisease: Pediatric Solutions to Health Care Crises”Dr. Alan Rosenberg, Professor, Department of Pediatrics,College of Medicine, University of Saskatchewan,Director, Section of Pediatric Rheumatology, University ofSaskatchewan Chair, Pediatric Research, University ofSaskatchewan, SK

MODULE B Gallery C “Obstetric Anesthesia Emergencies”Dr. David C. Campbell, MD, MSc, FRCPC, Professor andChairman Department of Anesthesiology, PerioperativeMedicine and Pain Management, University of Saskatch -ewan and Saskatoon Health Region and Director of Ob ste -tric Anesthesia, Royal University Hospital, Saskatoon, SK

BREAKOUT SESSION TWO 1:30 – 2:30 PM

MODULE A Gallery A “The Science Behind the NRP 2006 Changes”Dr. Koravangattu Sankaran, Neonatal-Perinatal Medicine,Department of PediatricsRoyal University Hospital, Saskatoon, SK

MODULE E Gallery B “Productivity and Benchmarking” Dr. Douglas Laher, BSRT, RRT, MBA, Director, RespiratoryCare, Fairview, Cleveland, OH

MODULE E Gallery C “Respiratory Therapy as a Profession — Are We on the Right Path?”Randy Baker, PhD, RRT Associate Professor, Chair,Department of Respiratory TherapyMedical College of Georgia, Augusta, GA

BREAK — Salon A & B2:30 – 3:00 PM

BREAKOUT SESSION THREE Gallery B3:00 – 4:00 PM

Airway Olympics Sputum Cup Challenge — Can you Beat Six Seconds? — 3:00 – 5:00 PMPre-registration is required — See Registration DeskRick Paradis RRT, BAdms.; Charge Therapist O.R.,Respiratory Therapy Department/ Anesthesia, MountSinai Hospital, Toronto, ON

MODULE A Gallery A “Fetal Inflammatory Response Syndrome”Dr. Thierry Lacaze, MD, PhD, FRCPC, Edmonton to be theDirector of the Women and Children’s Health ResearchInstitute after 10 years of neonatal research at theUniversity of Paris

MODULE D Gallery C “A Code Doesn’t Occur Out of the Blue — A Primer on Rapid Response Teams”Stuart F. Reynolds, M.D, Assistant Professor of Medicine,Staff Intensivist, Toronto General Hospital; Director,International Critical Care Fellowship Program, UniversityHealth Network & Mount Sinai Hospitals, Physician Lead,Critical Care Response Team Project, Ontario Ministry ofHealth and Long Term Care, Toronto General Hospital,Toronto, ON

Conference 2008


Conference 2008

BREAKOUT SESSION FOUR 4:00 – 5:00 PM

MODULE Gallery BAirway Olympics FINALS

MODULE A Gallery A “Neonatal & Pediatric Chest X-ray Interpretation”Dr. Sheldon Wiebe, Department of Medical Imaging,Royal University HospitalSaskatoon, SK

MODULE C Gallery C “NAVA”Dr. C. Sinderby MSc, PhD

FRIDAY FUN NIGHT Join us at the Odeon Theatre for a Multi-CulturalEvening. Plains Indians Pow Wow — Ukrainian DancersEthnic Finger Foods SPONSORED BY ROXON AND CARESTREAM

SATURDAY, May 24, 2008

POSTER AND PAPER PRESENTATIONS & BREAKFASTSalon A & B7:30 – 8:30 AM

OPENING REMARKS — Salon C & D8:30 – 9:00 AM

SUMMIT AWARDSummit Award presentation recognizes an RT who exem-plifies excellence in patient care, education or research.

Salon C & D9:00 – 11:00 AM “RTs on Trial”Reginald Watson, QC, B.A., LL.B.Twenty-seven years of practice in Civil Litigation,Insurance, Health, Personal Injury; Balfour Moss Barristers& Solicitors, Regina, SK

LUNCH — Salon A & B11:00 – 12:30 PM

BREAKOUT SESSION ONE 12:30 – 1:30 PM

MODULE A Gallery A “NeoNatal Surfactant Therapy”Dr. Thierry Lacaze, MD, PhD, FRCPC, Director of theWomen and Children's Health Research Institute, tenyears neonatal research at the University of Paris

MODULE D Gallery B “Methamphetamine/OverdoseDr. Jon Witt, MD, CCFP(EM), Emergency Department,Royal University Hospital, Saskatoon, SK

MODULE C Gallery C“Oral Appliances and/or CPAP: Current TreatmentConcepts Including Combination and AlternativeProtocols”Dr. Leslie Dort, Departement of Surgery, University ofCalgary, Calgary, AB

BREAKOUT SESSION TWO 1:30 – 2:30 PM

MODULE A Gallery A“How To Avoid Hurting the Baby You Are Trying To Save”Evan Richards, RT, Clinical Services Director, Salt LakeCity, UT

MODULE C Gallery B“In-line Ventilator Applications”Linda Dean, RRT; Irvine, CA

MODULE E Gallery C — TBA

BREAK — Salon C & D2:30 –3:00 PM

CSRT ANNUAL GENERAL MEETING — Salon C & D3:30 – 5:30 PM

CSRT President’s Banquet and Awards Gallery A, B, C and Gallery Ste A6:30 PM

SUNDAY, May 25, 2008

CONTINENTAL BREAKFAST — Salon A & B7:30 – 8:30 AM

8:30 – 9:00 AM — Opening Remarks

9:00 – 10:00 AM “Sleep Disordered Breathing in Adults”Keynote Speaker: Dr. John FleethamProfessor of Medicine at the University of BritishColumbia, Chair, Canadian Thoracic Society Sleep ApneaCommittee, Vancouver, B.C.

10:00 – 11:00 AM “The Gender Lens: Issues in Respiratory Disease”Keynote Speaker: Libby Groff, R.R.T., B.H.A Manager Ambulatory Cardio-Pulmonary, WCHProfessional Leader, Respiratory Therapy, Women’sCollege Hospital & Sunnybrook Health Sciences Centre,Toronto, ON

11:00 AM – 12:00 PMKeynote Speaker: Dr. Alana Barmby, SaskatoonNaturopathic Health and Wellness Centre, Saskatoon, SK

12:00 – 12:30 — Closing Remarks

Send in your form with payment by April 15, 2007 the early-bird registration deadline to receive most economical fees. Advance registration and payment is due by May 13, 2007. After this date, please register on-site. On-line registration by MC or Visa is available at www.csrt.com

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Please note: Sharing of name badges is not permitted Pre-Conference EventsLeadership Congress Members $75 $85 $95

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Full Friday May 23 Saturday May 24 Sunday May 25

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and weaknesses to improve the carethey give in a variety of therapeuticprotocols.

The combination of the variety ofequipment and patient interactionsimulations provides a realistic hospi-tal setting with events that canprogress from basic to life threaten-ing. This fosters critical thinking anddecision making by students in a“safe” setting. Additionally, studentscan be offered clinical situations thatoccur infrequently in their hospitalclinical practicum, but exposure tothe experience is needed;, such as:

■ Burn and multiple system trauma

■ Tension pneumothorax

■ Malignant hyperthermia

■ Acute infective respiratory illnessprotocols

■ Mass casualty

■ Advanced cardiac care

The health programs are currentlylooking at scheduling plans thatwould allow interprofessional train-ing with the students. Students willwork in real health care teams to sim-ulate total patient care from firstresponder through admissions toward or critical care. Interaction of avariety of health care learners ishoped to build a stronger team forthe public. Students will learn notonly to provide profession specifictherapy, but how to optimize andintegrate all aspects of care to bestmeet patient needs. By working withteam members they gain an appreci-ation of how individual roles comple-ment each other. They learn not onlyfrom faculty but each other, just asworkers in hospitals learn from col-leagues to build their knowledge andskills. The team members that prac-tice together will improve timing,efficiency and reduce error possibili-ties. Team work improves communi-cation and interpersonal skills.Debriefing as a team promotes criti-cal thinking on a total care basis.Both faculty and students have foundsimulation an effective and positive

way to learn and look forward to roleplaying within the team approach.Algonquin College is looking forwardto the implementation of Phase III ofthe plan for health education.Planning is underway and mayinclude:

■ Simulated emergency care unitswith mock land and air transportpatient receiving areas

■ Simulated diagnostic units withpossible patient clinics forPolysomnography, PulmonaryDiagnostics, non-invasive CardiacDiagnostics, as well as Asthmaand COPD education

■ Simulated X-ray orEchocardiography units

■ Integrated training with all aspectsof community care, from firstresponders, home/communitycare, acute/critical care, rehabilita-tion care, diagnostics, and emer-gency/disaster training

Algonquin College has invested morethan 2-million dollars for the comple-tion of Phases I and II. It is hoped thatfunding to start Phase III will be forth-coming soon and building renovationsare hoped to start within three to fiveyears. It is an exciting time for every-one and the goal to provide excellencein education to all our students so thatthey will serve the community withoptimal care is the driving forcebehind this project. It is the hope foreveryone involved in this project;,from physical resource engineers,administrators and faculty to stay onthe cutting edge of health care educa-tion for our local, national and globalcommunity. It will not only be theentry level students that benefit, butenhanced learning will cascade out tocontinuing education and/ or retrain-ing for health care workers in regionaland distant centres.

On Air à l’affiche

Algonquin College State-of-the-Art SIM Lab Continued from page 9

Le laboratoire de simulation de

pointe du collège AlgonquinSuite de la page 5

services de soutien à la personne, lapolysomnographie, le baccalauréat ensciences infirmières, la thérapie respira-toire, le programme d’ambulancier para -médical, le programme avancé d’ambu-lancier paramédical, les soins infirmiersintensifs et l’assistance en anesthésie.

Énoncé de mission de la Faculty ofHealth, Health, Public Safety andCommunity Studies :

Être le leader canadien de la prestationd’occasions novatrices de simulation enfavorisant un apprentissage multidisci-plinaire chez les étudiants dans ledomaine des services de santé et com-munautaires.

Afin d’atteindre ces buts liés aux besoinséducatifs actuels et futurs, le Collège ainitié un projet polyphasé :

La Phase I, complétée en 2004, consistaità rénover les labos existants et à installerde nouveaux équipements afin derehausser la simulation clinique. Par lasuite, le Collège a rénové les espacesréservés aux programmes d’ambulanciersparamédicaux, au programme dethérapie respiratoire et à divers pro-grammes liés aux sciences infirmières.L’espace réservé aux programmes d’am-bulanciers paramédicaux renferme desinstallations qui simulent l’accès à domi-cile, automobile et communautaire auxpatients qui exigent les soins d’un sec-ouriste. L’espace dédié à la thérapie res-piratoire renferme des installations quisimulent l’exploration fonctionnelle respi-ratoire, le diagnostic cardiaque non-effractif, les études en polysomnogra-phie, les soins hospitaliers et les soinsintensifs. L’espace dédié aux sciencesinfirmières prévoit des installations envue de prodiguer des soins à domicile, delongue durée, de base et intensifs.

La Phase II, soit la construction d’un nou-veau Centre de simulation de soinsparamédicaux (Allied Health SimulationCentre), a été complétée à l’automne2005. Ce centre offre des installations depointe pour la formation en soins desanté. On y retrouve des unités hospital-ières fonctionnelles, dont :

■ une salle d’opération avec une sallede lavage des mains équipée de sixéviers et une aire de fournituresstériles

■ trois unités de soins intensifs/trauma-tologie

■ neuf lits de soins avancés

Chaque unité est munie de gaz canalisé,d’étalages muraux déroulants ainsi que

Suite à prochaine page


de moniteurs et de négatoscopes montés.

Pour complémenter les installations, leCollège a investi des sommes consid-érables dans l’équipement afin qu’ilreflète les normes liées aux compétencesprofessionnelles connexes et qu’il perme-tte une interaction réaliste avec le patient,favorisant ainsi l’apprentissage et ledépannage. Il existe une gammed’équipement à l’intention de tous lesapprenants et de toutes les populationsde patients, par exemple :

■ des tables à infrarouges radiantes etdes incubateurs

■ des unités d’administration de liquideset de surveillance

■ des ventilateurs mécaniques

■ des appareils d’anesthésie par inhalation

■ des mannequins de soins respiratoirespour les intubations, trachéostomies et bronchoscopies (avec vidéobroncho-scopes)

■ une gamme de mannequins-patientsde néonatal à adulte à partir du modèle de base jusqu’au SimMan deLaerdal, au Simulateur de soins d’urgence (ECS) et à Noel (qui peutsimuler l’accouchement d’un bébé)

■ un Human Patient Simulator (HPS)avancé pour les soins intensifs etanesthésiques qui « respire » à l’aided’oxygène et qui « produit » dudioxyde de carbone relativement à laventilation. Il reconnaît également lesmédicaments et les liquides qui sontadministrés et il modifie sa réaction enfonction de la thérapie prodiguée parl’étudiant et du protocole privilégié parle professeur

■ des modèles qui permettent l’insertiond’intraveineuses et de cathétersartériels ainsi que les prélèvements « sanguins »

La surveillance des unités de simulation àl’aide de caméras et de haut-parleursoptimise l’apprentissage. Elle peut êtreeffectuée à partir d’une salle de com-mande dissimulée, d’une salle d’objectiva-tion ou encore de sites hors campus àl’aide de liens Internet. Il est possible detenir des vidéoconférences avec tout cen-tre d’éducation et de soins de santé munide cette capacité, ce qui permet la forma-tion en temps réel dans des sites horscampus. La capacité de zoom descaméras permet de visualiser les représen-tations oscillographiques des ventilateurslorsque les paramètres sont modifiés. Celapermet au professeur/technologue de sur-

veiller l’activité de l’étudiant indirecte-ment et d’enregistrer les sessions de pra-tique et d’évaluation aux fins de révision.Grâce à cette caractéristique, l’étudiantpeut observer et critiquer les sessions depratique pour acquérir des compétenceset constater l’incidence de la synchronisa-tion vis-à-vis des soins et de la codépen-dance des membres de l’équipe de soinslors de la prestation de soins efficaces. Ilpeut également passer en revue son ren-dement individuel en matière de compé-tences évaluées dans le but d’identifierses forces et ses faiblesses et d’améliorerles soins qu’il prodigue au sein d’unegamme de protocoles thérapeutiques.

La combinaison d’une variété d’équipe -ments et de simulations d’interactionsavec les patients crée un milieu hospitalierréaliste où les événements peuventévoluer et constituer un danger de mort.Cela favorise la pensée critique chez l’étu-diant et la prise de décisions dans unmilieu « sécuritaire ». De plus, l’étudiantpeut vivre des situations cliniques qui seproduisent rarement lors des stages clin-iques en milieu hospitalier, mais dont l’exposition est nécessaire, par exemple :

■ les brûlures et les traumatismes multiviscéraux

■ le pneumothorax suffocant

■ l’hyperthermie maligne

■ les protocoles liés aux atteintes respiratoires infectieuses aiguës

■ les soins à un grand nombre de blessés

■ les soins cardiaques avancés

Les programmes de santé étudientprésentement la planification d’horairespermettant une formation interprofes-sionnelle. Les étudiants travailleront ausein de véritables équipes de soins desanté afin de simuler l’ensemble des soinsaux patients, à partir du secouriste jusqu’àl’admission et à l’unité hospitalière ou auxsoins intensifs. L’interaction d’une gammed’apprenants des soins de santé estsouhaitée en vue de créer des équipesmieux rodées. Ainsi, l’étudiant apprendranon seulement à prodiguer la thérapie liéeà sa profession, mais également commentoptimiser et intégrer tous les aspects dessoins afin de combler les besoins dupatient. En travaillant avec les membresd’une équipe, il vient à apprécier la com-plémentarité des rôles individuels. Les étu-diants apprennent non seulement de leurprofesseur, mais entre eux, tout commeles professionnels en milieu hospitalier enapprennent de leurs collègues afin de par-faire leurs connaissances et leurs compé-tences. Les membres de l’équipe qui

pratiquent ensemble améliorent la syn-chronisation et l’efficacité et réduisent lapossibilité d’erreurs. Le travail d’équiperehausse la communication et leshabiletés interpersonnelles, alors que l’objectivation en équipe favorise la pen-sée critique liée aux soins dans leurensemble. Les professeurs et les étudiantssont d’avis que la simulation constitue unmoyen d’apprentissage efficace et positifet ils ont hâte d’incorporer les jeux de rôleau travail en équipe.

Le Collège Algonquin anticipe la mise enœuvre de la Phase III du plan lié à la for-mation en soins de santé. La planificationde cette phase est en cours et pourracomprendre :

■ des unités de soins d’urgence simuléesavec des aires de réception de patientsqui arrivent par transport terrestre etaérien

■ des unités de diagnostic simulées avec la possibilité de cliniques depolysomnographie, de diagnostic pul-monaire, de diagnostic cardiaque non-effractif et une composante d’éduca-tion en matière d’asthme et de MPOC

■ des unités de radiographie et d’échocardiographie simulées

■ une formation qui englobe tous lesaspects des soins communautaires, ycompris les soins de secouristes, les soinsà domicile/communautaires, les soins decourte durée/intensifs, les soins deréadaptation, le diagnostic et la forma-tion en matière d’urgences/de désastres.

Le Collège Algonquin a investi au-delà de2 millions de dollars en vue de terminerles Phases I et II. Il est souhaité que lefinancement permettant d’entamer laPhase III se matérialisera bientôt et que lesrénovations aux immeubles com-menceront d’ici trois à cinq ans. Il s’agitd’une période stimulante pour tous lesintervenants. L’objectif d’assurer l’excel-lence de la formation à tous nos étudiantsafin qu’ils puissent offrir des soins opti-maux à la communauté constitue l’élé-ment moteur de ce projet. L’espoir collec-tif des gens impliqués à ce projet, soit lesingénieurs de ressources matérielles,administrateurs et professeurs, est dedemeurer à la fine pointe de la formationen soins de santé pour le bien de notrecommunauté locale, nationale et globale.Ce ne sont pas que les étudiants débu-tants qui en bénéficieront : l’améliorationde l’apprentissage se répercutera sur leperfectionnement permanent et/ou lerecyclage des professionnels de la santédans des centres régionaux ou éloignés.

On Air à l’affiche

Le laboratoire de simulation de pointe du collège AlgonquinSuite de la dernier page


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CJRT welcome RCTR bienvenue

Dans ce numéro Suite de la page 4

Tel que je le mentionne ailleurs dans ce numéro,ce fut à la fois un honneur et un privilège d’occu-per ce poste. J’y ai mis beaucoup de cœur, d’âme,de sang, de sueurs et de larmes, mais en retour,j’en ai retiré beaucoup plus.

Ce numéro coïncide avec une importante périodede l’année, soit le renouvellement des adhésions. Ils’agit toujours d’une période quelque peu stres-sante pour le personnel et le Conseil d’administra-tion puisque c’est à ce moment-ci de l’année queles membres rendent le jugement ultime de notretravail en décidant d’adhérer ou non. Pendant monséjour à la SCTR, j’ai eu le plaisir de constater quenos effectifs augmentent chaque année. La Sociétéest plus pertinente et importante que jamais pourla profession. Des discussions portant sur laréforme des soins de santé ont lieu à tous lesniveaux et il est très important que votre perspec-tive soit représentée.

Le Conseil d’administration, le personnel, lesbénévoles et les autres collaborateurs travaillenttrès fort en vue de s’assurer que la RCTR et lesautres produits de la SCTR comblent les besoins enévolution des thérapeutes respiratoires.

Ce numéro coïncide également avec le lancementdes préparatifs en vue du congrès national. Nousdisposons déjà d’une liste impressionnante de con-férenciers et les gens de Saskatoon sont prêts àmettre en évidence tout ce dont leur ville a à offrir.Des renseignements préliminaires sur le congrèssont publiés dans ce numéro.

Vous trouverez d’excellents articles dans cesquelques pages. Parmi les défis actuels auxquelsnotre profession est confrontée, notons l’identifica-tion de stages cliniques pour nos étudiants, le rôlede la simulation vis-à-vis de la formation des étu-diants et le rôle de la simulation vis-à-vis de la for-mation et du recyclage des TRA actuels. Le présentnuméro contient le premier d’une série d’articlestraitant des enjeux liés à la simulation, de mêmequ’un article sur le labo de simulation à la finepointe de la technologie du Collège Algonquin.Finie l’époque où il fallait pratiquer la GSA sur desoranges! Nous publions également les résultats desnombreux membres dévoués qui ont participé auConcours de la Semaine de la TR 2007.

Merci encore une fois de m’avoir permis de fairepartie de la RCTR et de la SCTR. Ces quatredernières années ont été superbes.

Doug Maynard, TRA, MBADirecteur général

Michener AccrediationThe Michener Institute of Applied Health Sciences hosted theaccreditation team at their facility in October for their accred-itation site visit. A large thank-you goes out to the programreview team consisting of Michael Bachynsky, Debbie Cain,Joe MacPherson and Jo-Ann Aubut for all their hard work.The CoARTE council has awarded The Michener Institute fullaccreditation status.

If anyone has any questions about the CoARTE accreditationprocess, or is interested in participating on a program reviewteam, please contact Pam Hicks, Accreditation and EducationCoordinator at [email protected], or (800) 267-3422 ext 26.

Agrément du Michener InstituteEn octobre, le Michener Institute of Applied Health Sciences aaccueilli l’équipe chargée de l’agrément qui procédait à la visitede site aux fins d’agrément. Un merci particulier est adressé àl’équipe de révision de programme formée de Michael Bachynsky,Debbie Cain, Joe MacPherson et Jo-Ann Aubut pour leur travaild’arrache-pied. Le Michener Institute s’est vu accorder le statutd’agrément complet par le Conseil du CAFTR.

Toute personne ayant des questions au sujet du processus d’a-grément du CAFTR, ou intéressée à participer à titre de membred’une équipe de révision de programme, est priée de joindre PamHicks, coordonnatrice du Programme d’agrément et d’éducation,à l’adresse [email protected] ou au 800-267-3422, poste 26.


Case-crossover study in northernAlberta, Canada.Paul J Villeneuve, Li Chen, Brian H Roweand Frances Coates

Environmental Health 2007,6:40doi:10.1186/1476-069X-6-40

Published: 24 December 2007

Background: Recent studies haveobserved positive associations betweenoutdoor air pollution and emergencydepartment (ED) visits for asthma.However, few have examined the possibleconfounding influence of aeroallergens,or reported findings among very youngchildren.

Methods: A time stratified case-crossoverdesign was used to examine 57,912 EDasthma visits among individuals two yearsof age and older in the census metropoli-tan area of Edmonton, Canada betweenApril 1, 1992 and March 31, 2002. Dailyair pollution levels for the entire regionwere estimated from three fixed-site mon-itoring stations. Similarly, aeroallergen lev-els on a daily basis were estimated usingrotational impaction sampling methodsfor the period between 1996 and 2002.Odds ratios and their corresponding 95%confidence intervals were estimated usingconditional logistic regression with adjust-ment for temperature, relative humidityand seasonal epidemic of viral related res-piratory disease.

Results: Positive associations for asthmavisits with outdoor air pollution levelswere observed between April andSeptember, but were absent during theremainder of the year. Effects werestrongest among young children. Namely,an increase in the interquartile range ofthe 5-day average for NO2 and CO levelsbetween April and September was associ-ated with a 50% and 48% increase,respectively, in the number of ED visitsamong children 2–4 years of age(p<0.05). Strong associations were alsoobserved with these pollutants amongthose 75 years of age and older. Ozoneand particulate matter were also associat-ed with asthma visits. Air pollution riskestimates were largely unchanged afteradjustment for aeroallergen levels.

Conclusions: Our findings, taken togeth-er, suggest that exposure to ambient lev-els of air pollution is an important deter-minant of ED visits for asthma, particular-ly among young children and the elderly.

Survival of bronchiectatic patientswith respiratory failure in ICUAbdulaziz H. Alzeer, MohammedMasood, Syed Jani Basha and Shaffi A. Shaik

BMC Pulmonary Medicine 2007,7:17doi:10.1186/1471-2466-7-17


Background: The outcome of patientswith bronchiectasis during and after theirstay in the intensive care unit (ICU) hasseldom been reported in the literature.Managing these patients in the ICU canbe challenging because of the complexnature of their disease. This study aims toidentify the in-hospital and long-term out-come of patients with bronchiectasis andrespiratory failure (RF) in ICU.

Methods: A retrospective study was car-ried out by studying all bronchiectaticpatients admitted to the medical ICU forRF over a 10-year period (1995-2004).

Results: The mean (+/- standard devia-tion) age of 35 patients was 63.5 +/- 11.7years and APACHE score was 22.3 +/- 7.3.The 4-year mortality was 60%. Amongthe variables observed, age > 65 years(relative risk(RR):4.15; 95% confidenceinterval(CI): 3.2-5.1), APACHE II score >24(2.61, 95%CI 1.7-3.5), intuba-tion(2.81, 95%CI 1.9-3.7), inotropic sup-port (2.86, 95%CI 2.0-3.7), Home-O2(4.0, 95%CI 2.7-5.2) and activity index(4.05, 95%CI 2.8-5.3) were associatedwith diminished survival in univariateanalysis by Cox regression. By long ranktest, survival probabilities were significant-ly low at these strata. Multivariate analysisof Cox proportional hazard modelshowed that age > 65 years (RR: 5.4,95% CI 1.88-15.68); activity index (RR:4.82, 95% CI 1.39-16.64); and inotropicsupport (RR: 3.84, 95% CI 1.46-10.06)were independently associated withreduced survival.

Conclusion: The decreased survival ofICU patients was associated with age >65 years, activity index (bedridden orwheelchair-bound) and use of inotropicsupport.

Withdrawal of inhaled corticosteroids in people withCOPD in primary care: a randomised controlled trialAklak B Choudhury, Carolyn M Dawson,Hazel E Kilvington, Sandra Eldridge, Wai-Yee James, Jadwiga A Wedzicha,Gene S Feder and Chris J Griffiths

Respiratory Research 2007,8:93doi:10.1186/1465-9921-8-93


Background: Guidelines recommendinhaled corticosteroids (ICS) for patientswith severe chronic obstructive pul-monary disease (COPD). Most COPDpatients are managed in primary care andreceive ICS long-term and irrespective ofseverity. The effect of withdrawing ICSfrom COPD patients in primary care isunknown.

Methods: In a pragmatic randomised,double-blind, placebo-controlled trial in 31practices, 260 COPD patients stoppedtheir usual ICS (median duration of use 8 years) and were allocated to 500mcgfluticasone propionate twice daily(n=128), or placebo (n=132). Follow-upassessments took place at three monthlyintervals for a year at the patients’ prac-tice. Our primary outcome was COPDexacerbation frequency. Secondary out-comes were time to first COPD exacerba-tion, reported symptoms, peak expiratoryflow rate and reliever inhaler use, and lungfunction and health related quality of life.

Results: In patients randomised to place-bo, COPD exacerbation risk over one yearwas RR: 1.11 (CI: 0.91-1.36). Patients tak-ing placebo were more likely to return totheir usual ICS following exacerbation(placebo: 61/128 (48%); fluticasone:34/132 (26%), OR: 2.35 (CI: 1.38-4.05).Exacerbation risk whilst taking ran-domised treatment was significantlyraised in the placebo group 1.48 (CI:1.17-1.86). Patients taking placebo exac-erbated earlier (median time to first exac-erbation: placebo (days): 44 (CI: 29-59);fluticasone: 63 (CI: 53-74), log rank 3.81,P=0.05) and reported increased wheeze.In a post-hoc analysis, patients with mildCOPD taking placebo had increased exac-erbation risk RR: 1.94 (CI: 1.20-3.14).

Conclusions: Withdrawal of long-termICS in COPD patients in primary careincreases risk of exacerbation shortenstime to exacerbation and causes symptomdeterioration. Patients with mild COPDmay be at increased risk of exacerbationafter withdrawal. Trial Registration:ClinicalTrials.gov NCT00440687

Abstracts

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In recent years, the filtration ofexpired gases has become a standardof care for ventilated patients as ameans of infection control. Manualventilation bags have also been iden-tified as a source of colonization.1,2

Therefore, as part of an effective per-sonnel and environmental protectionstrategy from respiratory aerosols, ourinstitution filters the exhaled gases ofthe bag-valve device. However, thisdoes raise an interesting point whenreferring to the pediatric and neona-tal patient populations. This equip-ment set up description assumes thatthe most appropriate bacterial andviral filter has been chosen, knowingthat there are hazards associated withuse. A few of these hazards areaddressed by EG Lawes (2003), andthere are many citations available thataddress product specific properties toaid in decision making.

The point of most clinical signifi-cance in these patient populations isthe degree of mechanical deadspacethe filter would impose,3 as standardapplication of the HMEF (heat andmoisture exchanger filter) is betweenthe endotracheal tube (ETT) and themanual resuscitator. This is evennoted as being clinically significant inadult patient populations, as itincreases minute volume demands.4

The compressible volume of theHMEF available in our institution is49 milliliters.5 (DAR, Hygrobac S,Tyco). Alternately available is a bac-terial-viral filter with no humidifica-tion properties (DAR, Barrierbac S,Tyco), which adds 35 milliliters ofdead space.5 To a clinician wellversed in pediatric and neonatal crit-ical care, these volumes are concern-ing, as they can be larger than thetidal breath of a small patient, andcause re-breathing of carbon diox-ide. In choosing a filter, low dead-

space is an important factor.6 Wedescribe a set up that eliminates thismechanical dead space entirely.

Both neonatal and pediatric inten-sive care units in our institution usea flow inflating bag-valve device ofthe Jackson Rees type, which is:patient connection-fresh gas source-pressure monitoring-body-reservoirof 500 or 1000 mL, depending onpatient weight. (Figure A.). The bac-terial-viral filter (DAR, Barrierbac “S”,Tyco) is placed distal to the fresh gassource, and proximal from the pres-sure monitoring port. (Figure B.). Inthis way the fresh gas sourceremains closest to the patient con-nection, ensuring that no re-breath-ing of carbon dioxide occurs.

We selected a bacterial-viral filter thathas no humidification properties foruse on pediatric/neonatal manualresuscitators in our institution. Therationale for this is three-fold. Firstly,adequately humidifying the smallpediatric/neonatal patient’s inspiredgases with an HMEF is difficult, giventhat an HMEF functions by addingmoisture and warmth to inspiredgases by collecting humidity fromexpired gases. This is a volume andtime dependent process, i.e.) thesmaller a patient’s tidal volumes, thelonger the HMEF will need tobecome fully saturated. It has beencited that this warm up time can take12 minutes.3 Secondly, the place-ment of the HMEF in line with thebag-valve device is downstream fromthe fresh gas supply. This means thatthroughout the expiratory phase,

fresh, dry gas flows over the HMEF,causing cooling and evaporation ofthe moisture and heat that has beencollected from exhaled gases. Andthirdly, the use of the bag-valvedevice is limited to short time peri-ods, ie.) emergent situations, asdepartment protocols dictate theventilator circuit be broken as infre-quently as possible.

References1. Weber, DJ. et al. (1990) Manual

Ventilation Bags as a Source forBacterial Colonization of IntubatedPatients. American Review RespiratoryDiseases 142: 892-894

2. Van Der Zwet, WC. et al. (2000)Outbreak of Bacillus cereus Infections ina Neonatal Intensive Care Unit Traced toBalloons Used in Manual Ventilation.Journal of Clinical Microbiology, Vol 38,No. 11: 4131-4136

3. Luchetti, M. et al.(1999) Evaluation ofthe Efficiency of Heat and MoistureExchangers during Pediatric Anes -thesia. Pediatric Anesthesia, 9, 39-45

4. Campbell, S. et al (2000) The Effects ofPassive Humidifier Dead Space onRespiratory Variables in Paralyzed andSpontaneously Breathing Patients.Respiratory Care, 45:3, 306-312

5. Dar product listing (Jul 2007) found on:http://www.nellcor.com/prod/List.aspx?S1=AIR&S2

6. Monrigal, JP, and Granry, JC. (1997)The Benefit of Using a Heat andMoisture Exchanger During ShortOperations in Young Children.Pediatric Anesthesia 7, 295-300

7. Lawes, EG. (2003) Hidden hazards anddangers associated with the use of HME/filters in breathing circuits. Their effect ontoxic metabolite production, pulse oximetryand airway resistance. British Journal ofAnaesthesia 91: 249-264

Description of Filtering Exhaled Gases with aFlow Inflating Bag-Valve Device: For Pediatricand Neonatal ApplicationsEsther Weathers, David Stone and Don Granoski, Respiratory Therapy DepartmentUniversity of Alberta and Stollery Children’s Hospitals

Scientific news

Figure A Figure B


Scientific news

The Future of SimulationThis is an exciting time for MedicalSimulation! As we outlined, in part-one of this series, there are manyarguments in favour of Simulation,and numerous educators, cliniciansand administrators have becomestrong advocates. A number of cen-tres have subsequently developedsustainable simulation programs- byapplying many of the principles thatwe outlined in part-two. The cutting-edge of simulation now appears tobe evidence-based simulation, col-laborative simulation and develop-ing the science of simulation. Thiswill be the focus of this third andfinal manuscript.

Growing InfrastructureLocal simulation initiatives remainvery important, but widespread col-laborations can now promote thedevelopment of national standards,national advocacy, and multi-centretrials- in addition to the straightfor-ward exchange of ideas. To facilitatecollaboration, national organizationsnow exist such as the Society forSimulation in Healthcare (SSIH)1, theCritical Care Education Network(formerly the Canadian ResuscitationInstitute (CRI)2, and the Society inEurope for Simulation Applied toMedicine (SESAM)3.

The SSIH hosts the annual“International Meeting on Simulationin Healthcare” and now administersa peer-reviewed journal, called“Simulation in Healthcare”. This hassignificantly raised the expectationsfor authors to undertake evidence-based simulation research. This is instark contrast to erstwhile manu-scripts that were typically merelydescriptive: describing what hadbeen tried and how it had been con-ceived.

Instead of each simulation centrecreating its own scenarios locally,efforts have been made by groups,such as the CRI, to develop

Part Three: Medical Simulation What Medical Simulation Programs are Available.P.G. Brindley MD FRCPC,1,2,3 G. I. Suen MD FRCPC,2 J. Drummond RRT,2

1. Regional Simulation Program, Capital Health,Edmonton

2. Division of Critical Care Medicine, University ofAlberta, Edmonton.

3. Canadian Resuscitation Institute

Correspondence to: Peter G. Brindley MD FRCPCAssistant Professor, University of AlbertaProgram Director Critical Care MedicineAttending Physician, Critical Care MedicineMedical Lead for Patient Simulation, Capital HealthVice-President Canadian Resuscitation Institute4H1.22 University of Alberta Hospital,8840-112th St, Edmonton AlbertaEmail [email protected] 780-407-8822Fax 780-407-6018

Acknowledgements: To the Respiratory Therapists ofthe Capital Health Region, Alberta for your dedicationand caring.

Key words: Medical education • medical simulation •communication skills • crisis resource management

Conflicts of interest: None. Dr Brindley is the MedicalLead for Patient Simulation for Capital Health, Albertaand Vice-president for the non-profit CanadianResuscitation Institute.

Background: This manuscript is part-three of a three-part series on Medical Simulation. Part-one addressedthe “why” of Simulation, namely, why MedicalSimulation offers novel opportunities to improve edu-cation, continuing-competency, and patient safety.Part-two focused on the “how” of simulation, namely,how to design, implement, and maintain a viable pro-gram. Part-three will now cover the “what”, namelywhat the future directions are likely to be, what sort ofprograms are currently available, and what evidencesupports their implementation.

Definitions: Our definition of “Medical Simulation”means any technique, “low-tech” or “high tech”, thatattempts to realistically recreate clinical situations andallow training with minimum patient risk. In this way itresembles the “war-games” of the military or “flightsimulators” of aviation. Medical training has alwaysinvolved graduated acceptance of decision-makingand supervised practice. Equally, examinations havelong included actors. As such, medical training hasalways incorporated a degree of simulation of realpractice. What has changed is the explosion of avail-able technology; the principles of adult education, thefocus on patient safety, and the expectation of proofvia research. Simulation is therefore a huge topic. Wehope to offer a concise introduction.

Introduction

“See one, do one,

teach one…

just not on my Mom”


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marketable courses. This centralizedeffort should raise the quality ofSimulation as it usually involves anin-depth needs-assessments (e.g.studying what areas ought to beaddressed; what are the deficienciesin the current curriculum; what arethe needs of learners), taking painsto incorporate principles of adulteducation and psychology (e.g.encouraging self-directed learning,bilateral exchange of ideas betweenfacilitator and trainee; courses thatare easily modifiable based uponfeedback), and developing metricsto analyze participant satisfaction. Evidence-based programs now exist.A few of these are outlined in orderto provide practical examples ofwhat is possible. What follows is farfrom exhaustive, but may help thoseeager to see how they too can pro-vide unique opportunities for educa-tion, patient safety, healthcare-work-er safety, and meaningful research.

Acute Critical EventsSimulationThe Acute Critical Events Simulation(ACES) program was designed bythe CRI.4 ACES originated with thegoal of improving patient safety fol-lowing the identification of recurrenterrors during resuscitation. This twoday course was designed by facultyfrom across Canada to aid with theacquisition of knowledge and proce-dural skills, but especially behaviorsand communication. It has beendelivered to hundreds of candidatesin both urban and regional settings,and successfully modified for MDs,RNs, and RTs.

Evaluations have consistently beenvery favorable. Analysis of a Likert-scale questionnaire (0 to 5, with 5representing strongly agree) issuedto the first 50 participants found anoverall rating of 4.38 (95% CI, 4.12-4.65) in 2002 and 4.44 (95% CI, 4.3-4.59) in 2003. Participants also feltthat ACES was very useful, withscores of 4.33 (95% C.I 4.01-4.67) for2002 and 4.37 (95% C.I 4.19-4.55) for 2003. Comparing evaluationsfrom one year to the next alsodemonstrated how the course couldbe easily modified using a needs-

assessment beforehand and feed-back afterwards.4 ACES is one of thefirst courses to focus on CrisisResource Management (CRM) skillsand as such offers a unique andimportant supplement to otherexcellent life support courses.

Simulating Telephone CallsIn Canada, large distances and lowpopulation density means frequenttransport of acutely-ill patients to asingle urban centre. A great deal ofcare is coordinated by telephone,but communication skills are rarelyaddressed. As such, acute-care tele-conference calls have been simulat-

ed to help participants develop the“verbal-dexterity” and problem-solv-ing abilities required to care for theacutely-ill. Of note, very littleresearch has been done regardinghow best to transition care from onegroup to another (for example frompre-hospital to the emergency room)or how to safely transport unstablepatients across enormous distances.In addition, this strategy providesmany of the putative benefits ofHigh-Fidelity Simulation but withminimal cost or logistics. Whilelargely descriptive in nature, qualita-tive evaluation suggested the exer-cise was extremely well received,the exercise was deemed realistic,

Figure 1: Simulation of Severe Acute Respiratory Distress Syndrome (SARS) Photo: Dr. Peter Brindley/Dr Randy Wax

Figure 2: The Acute Critical Events Simulation Course Photo: CRI Critical Care Education Network


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and that mistakes mirrored those inreal-practise. All participants felt thisstrategy was superior to didactic ses-sions, and complementary to clinicalexperience. Simulated calls withinthe same hospital could be per-formed just as easily, and plans areunder way to train both referringand receiving staff using thismethod.5

Simulating Transportationof the Acutely IllWright et al.6 performed a uniquestudy assessing the feasibility of pro-viding high fidelity simulation in anair ambulance helicopter. Due tocost limitations, the simulation wasperformed while the helicopter wasrunning at flight idle, rather than infull flight. Despite this limitation,they were able to simulate the noiseand vibration present during flightwhich has profound implicationswhen trying to resuscitate patients.As they described in detail, alarmscan be missed and monitors can be blurred, making the helicopterenvironment particularly difficult towork in.6

Twelve residents completed the sim-ulations and all reported animproved awareness of the chal-lenges faced in such environments.All residents agreed that the simula-tion was educational and should be

used for future training.6 One caneasily imagine other difficult scenar-ios that healthcare workers mightfind themselves working in, such asin the back of an ambulance, or con-fined spaces such as elevators.Optimizing transportation remains apoorly studied area, but one withenormous potential.

Simulating DisasterResponseHigh-fidelity simulation has beenused as a method of developing(and refining) complex hospital pro-tocols and disaster plans. These rec-ommendations are often extensivelydiscussed beforehand, but then filedaway in policy binders, and rarelypracticed. Without testing and re -fine ment, experience suggests theywill not be properly applied duringthe chaos of an evolving crisis.Equally, it is not appropriate to learnthrough “trial-and-error” when theconsequence of “error” could be toworsen an already desperate situa-tion. Furthermore, while patient-safety is finally receiving long overdue attention, similar attentionis needed for “healthcare workersafety”. Overall, a good example ofthese challenges, and opportunities,was the outbreak of severe acuterespiratory syndrome (SARS) in2002–3.

Abrahamson, Canzian and Brunetused Simulation to develop andteach the resuscitation of cardiacarrest patients with SARS.7 This syn-drome presented new paradigms in care delivery and, as such, previ-ously entrenched treatment methodswere not applicable. For example,hospital workers needed to re-trainnot to vigorously bag ventilatepatients or risk dispersing the SARSvirus. Furthermore, workers neededto learn how to put on a personalprotective suit (PPS) before theycould start.

Intubation of the SARS patientrequired a PPS in order to mitigateexposure and transmission. How -ever, this seriously hampered com-munication and procedural dexteri-ty. As Abrahamson et al. note,Simulation “provided insights thathad not been considered in earlierphases of development”.7 Expressedanother way, if you plan in a board-room, you will typically come upwith boardroom solutions! They hadinitially timed individuals at 1½ to2½ minutes to don the suits anddesigned their protocols around thisassumption. However, during simu-lation, when an entire team had togown up, the time to don the suitsincreased dramatically to 3 ½ to 5 ½minutes. Using results from the actu-al simulation, they revised their pro-tocol and corrected unanticipatederrors in infection control. Impres -sively, these authors were able totrain 275 health care workers withintwo weeks in this new protocol: afeat that would have been difficultwithout using Simulation. SARStherefore represents an excellentexample of how Simulation offersopportunities for patient safety.These same opportunities existwhether for training in mass casual-ty, avian flu, or just another “disas-trous day” in an overcrowded emer-gency room.

Use of Simulation in Clinical TrialsSimulation offers unique opportuni-ties to improve the development ofclinical trial protocols. Furthermore,

Figure 3: The Acute Critical Events Simulation Course Photo: CRI Critical Care Education Network


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once developed, researchers need tobe confident that bedside staff willduplicate these complex protocolsprecisely. If a protocol is violated itmay mean that a patient’s data can-not be used. This decreases the sta-tistical power of the study, delays itscompletion, and wastes resourcesand money. Experience has alsosuggested that study outcomes canbe significantly different based uponwhether the first few patients areincluded or excluded (likely becauseof early mistakes adhering to thestudy protocol). Significantly, thisalso raises ethical concerns regard-ing how appropriate it is to performtrials if the first few candidates areexposed to risks. In fact, minimizingharm and striving for equipoise (thebelief that benefit and harm areequal for all study participants) is afundamental requirement for studyapproval. Overall, Simulation offersa way to protect the rights of studyparticipants, at the same time asoptimizing the study’s statisticalpower, and protecting the investiga-tors’ scarce resources.

Wright et al.8 describe using a highfidelity simulator when designing acomplex clinical trial in which multi-ple medications were given at pre-cise times for patients undergoingcoronary bypass surgery. As with theSARS resuscitation study, Wrightfound unanticipated problems withtheir protocol during simulation, thatlikely would not have been foundotherwise. They were able to train48 research coordinators and furtherrefine their protocol before anypatients were actually subjected toexperimentation.8

Rapid Response TeamTrainingBusy medical staff often failure torecognize when inpatients showearly clinical deterioration.9-10

Equally concerning, even whendeterioration is recognized, health-care workers often fail to initiatetreatment or access help10-11 There islittle doubt that, for many acuteillnesses, outcome is far better withearly intervention compared to

waiting for full cardiovascular col-lapse.9-12 However, there is equallystill considerable debate as to thebest way to institutionalize rapidresponse.10-11 Different jurisdictionshave implemented different rapidresponse teams. These teams differbased upon their composition (e.g.whether an MD or RT is the firstresponder) and its activation trig-gers. In Canada, by far the mostcommon model is the MedicalEmergency Team (MET).11

In theory, MET is activated whenhospital inpatients display predeter-mined aberrant vital signs. METoften consists of a physician, respi-

ratory therapist, and nurse. Theseprofessionals must be able to worktogether in an efficient and collegialway despite varied and stressful sit-uations and disparate training.Equally, despite numerous patientscompeting for their attention, wardnurses are expected to remember toactivate MET in a timely manner.Medical Simulation has thereforebeen recommended as a way to trainall of the personnel involved inthese calls.

DeVita et al.13,14 designed a curricu-lum utilizing High FidelitySimulation which focused on devel-oping multidisciplinary team skills

Figure 4: Routine Multi-Disciplinary Operating-Room Simulation

Figure 5: Use of Simulation to Train Multidisciplinary Rapid Response Teams


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during medical crises. A total of 138individuals were trained including21 respiratory therapists, 48 physi-cians, and 69 critical care nurses.Following this training, simulatedsurvival (following predeterminedcriteria for death) increased from 0%to 89%. A similar Medical OutreachProgram has been developed by theCRI, and has trained healthcareworkers throughout the Province ofOntario (following generous govern-ment support).2 These initiativessuggest that Simulation has enor-mous potential to help in both triageand resuscitation.

While few would argue with theidea of responding rapidly, the current research has not shown an unequivocal benefit following MET implementation.9 Simulationresearch may offer insights as towhy not. It may also be invaluableregarding how best to introduce ini-tiatives such as MET, and in under-standing the complexities of hospitalculture within which the MET mustfunction. Overtime, Simulation mayhelp to finesse rapid response, indi-vidualize programs for different hos-pitals, or even suggest alternativestrategies. Simulation has a vital, andcurrently underutilized, role in thistopical debate.

Barriers to Simulation (andhow to overcome them)Dr. David Gaba, a renown championfor Medical Simulation has empha-

sized that, despite many putativebenefits, widespread Simulation iscurrently the exception in health-care.15 Furthermore, due to cost andtime constraints, most training pro-grams that do use Simulation exposetrainees only a few times per year.For Simulation to be truly acceptedand effective, sessions must happenroutinely and be “fully integrated intothe routine fabric of health care deliv-ery”.15 In fact, the more that Simu -lation becomes integrated into every-day practice, the greater the supportit is likely to garner. In this way par-ticipants will increasingly regardSimulation as a normal (non-puni-tive) part of working in healthcare.

Those already in clinical practice (asopposed to trainees) are currentlyeven less likely to be required toparticipate in Simulation. This is instark contrast to other professionssuch as the airline industry whichmandates regular Simulation fromthe newest employee through to seasoned veterans. As such, senior clinicians need to lead byexample. In the current voluntarysystem, this means requesting simu-lation experience. Otherwise quality-improvement, and patient-safety, isunlikely to be seen as a system-wideimperative. Equally, for those re-entering clinical practice or changingroles for example from trainee toindependent practitioner Simulationoffers a way to smooth the transitionand offer reassurance.

Numerous comparisons exist be -tween healthcare and other profes-sions that long-ago mandatedSimulation. Therefore, it is quite rea-sonable to mandate Simulation train-ing in healthcare. In fact, increasing-ly, this appears to be a necessarystep towards promoting its accept-ance. For example, courses such asAdvanced Cardiac Life Support(ACLS®) and Advanced Trauma LifeSupport (ATLS®) have been mandat-ed for years. Few healthcare workersappear to object to these courses.Similarly, hospitals have been per-forming mock fire-drills for decades.As such, it seems no different to per-form “mock-codes” and “mock trau-mas”, and to do so using the hospi-tal’s overhead announcement sys-tem. Overall, healthcare’s inertia isincreasingly difficult to defend.Understanding its causes is anotherimportant step forward.

Savoldelli et al.16 surveyed 154 anes-thesiologists to determine barriers toSimulation. Ninety percent of staffphysicians reported at least onepotential reason. These included“lack of time”, “lost income”, and“lack of training opportunities”.Notably, however, a significant addi-tion barrier for staff physicians was“performance anxiety”. Approx -imately one quarter of respondentsreported fearing the judgments ofpeers and worried about a stressfulor intimidating environment in thesimulator.16 Therefore, medical edu-cators must take great care that par-ticipants feel safe to learn…and safeto learn from mistakes.

Simulation ResearchLord Kelvin stated that if knowledgecould not be expressed “in numbers”then it was “meagre and unsatisfacto-ry”. This “Kelvin’s Curse” 17 compli-cates quantitative-research of qualita-tive-skills such as communication andteamwork. Of note, whether didacticlecturing is beneficial has never beenheld to similar scrutiny, nor haveother professions demanded proofbefore mandating widespread simula-tion. The skills addressed throughSimulation are not “meagre” or unimportant, as we know that

Figure 6: The Critical Care Education Network (criedunet.ca): A National CollaborationCommitted to Increasing Medical Education and Simulation)Photo: CRI Critical Care Education Network


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communication and teamwork to beone of the greatest causes of preventa-ble medical error (see Part One).However, advocates need to acceptthat traditional research methods andexpectations may not apply.Simulation proponents should acceptthat applications for research grantsmay compete poorly against tradition-al research. Strategies therefore includeensuring multidisciplinary input andapproaching novel funding agencies,as well as dogged persistence.

Simulation outcomes tend to bequalitative in nature (e.g. is a studentable to run a resuscitation more effi-ciently; can a coworker function bet-ter within a multidisciplinary team).These outcomes, while vital, are dif-ficult to express in numerically.Furthermore, following the “scientif-ic method” means accepting thatresearch may or may not ultimatelydemonstrate a benefit. In short, itmay never be conclusively proventhat simulators significantly improveclinical outcome.

An intriguing question is that, givenall of the potential benefits ofMedical Simulation (and the lack ofany obvious downside), just whatlevel of proof is needed. Regardlessmost simulation research does notreach the level expected of tradition-al research. For example, in a reviewof over 670 articles covering 34 years, McGaghie et al. identifiedthat only 5% of simulation researchpublications met or exceeded mini-mum quality standards.18 Instead,many proponents have focusedupon arguments such as the aviationindustry mandates regular simulationtraining for pilots entrusted with pas-senger’s lives, and therefore medicalstaff, entrusted with a patient’s lives,should be no different. Equally ifSimulation was instead a pharma-ceutical agent, with this much poten-tial to improve outcome and no clearside effects, practitioners woulddemand widespread access. Thesecommon sense arguments are worthmaking, but cannot be confusedwith definitive data or proof.

We may indeed be approaching astate where Medical Simulation will

become accepted based upon itswidespread acceptance and its “facevalidity”. However, it must be appre-ciated that data is a very powerfulally whenever we are looking tomandate change or redirect funding.Competition for resources is fierce,and without research it will be hard-er for administrators to secure fundsfor Simulation, or for educators todemand its widespread application. In short, Simulation is almost cer-tainly here to stay, but how rapidlyaccepted or widely integrated itbecomes will be influenced uponhow well it grows into a scientificdiscipline. The challenge ahead isclear; whether we will rise to it willrepresent the next chapter in theevolving story of Medical Simulation.

SummaryThe number of simulation programs isincreasing rapidly. Furthermore, thereis an increased emphasis upon collab-oration, incorporating principles ofadult education, and demanding simulation research. High qualityMedical Simulation now covers thegamut from programs designed toimprove acute resuscitation and triage,to improving communication, toimproving pandemic planning, andimproving clinical trials. There is aneed for higher quality evidence-based research if Medical Simulation isto reach its potential. However, signif-icant research challenges have yet tobe systematically addressed. Obstaclesremain but the opportunities are sim-ply too great not to persevere.

References1. Society for Simulation in Health Care.

Available at: www.ssih.org/public/.Accessed Jan 04, 2008.

2.Critical Care Education Network/Canadian Resuscitation Institute.Available at: www.criedunet.ca/en/por-tal. Accessed Jan 04, 2008.

3. Society in Europe for SimulationApplied to Medicine. Available at:www.sesam.ws/. Accessed Jan 04,2008.

4. Brindley P, Neilipovitz D, Kim J, CardinalP. The Acute Critical Events Simulation(ACES) Program. A Novel CanadianEducational Initiative to Improve Careof the Critically Ill. Critical Care Rounds2005;6(2):1-6.

5. Brindley P. Novel technique for criticalcare training. CMAJ 2007;176(1):68.

6. Wright SW, Lindsell CJ, Hinckley WR,Williams A, Holland C, Lewis CH, et al.High fidelity medical simulation in thedifficult environment of a helicopter:feasibility, self-efficacy and cost. BMCMed Educ 2006; Oct 5;6:49.

7. Abrahamson SD, Canzian S, Brunet F.Using simulation for training and tochange protocol during the outbreakof severe acute respiratory syndrome.Crit Care 2006;10(1):R3.

8. Wright MC, Taekman JM, Barber L,Hobbs G, Newman MF, Stafford-SmithM. The use of high-fidelity humanpatient simulation as an evaluative toolin the development of clinical researchprotocols and procedures. ContempClin Trials 2005; 26(6):646-59.

9. Hillman K, Chen J, Cretikos M, BellomoR, Brown D, Doig G, for the MERITStudy Investigators. Introduction of themedical emergency team (MET) system:a cluster-randomised controlled trial.Lancet 2005; Jun 18-24;365(9477):2091-7.

10. Devita MA, Bellomo R, Hillman K,Kellum J, Rotondi A, et al. Findings ofthe first consensus conference onmedical emergency teams. Crit CareMed. 2006;34(9):2463-78

11. DeVita MA, Smith GB. Rapid responsesystems: Is it the team or the systemthat is working? Crit Care Med 2007Sep;35(9):2218-9.

12. Brindley PG, Markland DM, Mayers I,Kutsogiannis DJ. Predictors of survivalfollowing in-hospital adult cardiopul-monary resuscitation. CMAJ 2002;Aug 20; 167(4):343-8.

13. DeVita MA, Schaefer J, Lutz J,Dongalli T, Wang H. Improving med-ical crisis team performance. Crit CareMed 2004 32: S61-65.

14. DeVita MA, Schaefer J, Lutz J,Dongalli T, Wang H. Improving med-ical emergency team (MET) perform-ance using a novel curriculum and acomputerized human patient simula-tor. Qual Saf Health Care. 2005;14(5):326-31

15. Gaba DM. The future vision of simula-tion in health care. Qual Saf HealthCare 2004;13 Suppl 1:i2-10.

16. Savoldelli GL, Naik VN, Hamstra SJ,Morgan PJ. Barriers to use of simula-tion-based education. Can J Anaesth2005;52(9):944-50.

17. Wears RL. Patient satisfaction and thecurse of Kelvin. Ann Emerg Med2005;46(1):11-2.

18. McGaghie WC, Issenberg SB, PetrusaER, Scalese RJ. Effect of practice onstandardised learning outcomes insimulation-based medical education.Med Educ 2006; Aug;40(8):792-7.

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On Air/À l’affiche · 2018-08-30 · Spring 2008, Volume 44 (1) Printemps 2008, Numéro 44 (1) Features/Sommaire Medical Simulation Part Three Filtered Gases President’s Message