RTSO Airwaves Winter 2014

8/13/2019 RTSO Airwaves Winter 2014

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Winter 20

RTSO Airwaves



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Greetings and welcome to the Winter 2014 edition ofthe RTSO Airwaves. I would like to take this opportunity

to again thank Dave McKay and Elisabeth Biers for all

of their hard work to put together another exciting issue. As well, I’d like to acknowledgethose of you who have in this issue or in the past, contributed to Airwaves. Its evolution is

both reective of the growth of the RTSO and of the bond that again holds our profession

together across the province.

I hope everyone had a happy and healthy holiday season and on behalf of the RTSO

Board of Directors and our front ofce management team, I would like to wish everyone aprosperous 2014.

Please take some time to review some of the fantastic work your RTSO Board is doing toadvance our professional interests via various special interest groups. These groups includ

the Leadership Committee, the Research Committee, Student Affairs, Professional Advocacand the Community RT interest group. Some of the work that is done by these teams ishighlighted in this issue of the RTSO Airwaves.

As you know, the 2014-2015 membership campaign is well on its way. The RTSO ispleased to offer a new membership program that includes full RTSO membership plus

membership in the Ontario Lung Association’s Ontario Respiratory Care Society. Also

included is personal liability, errors and omissions insurance; access to an ADVANCED

PRACTICE BURSARY PROGRAM and opportunities for membership in any of the special

RTSO

Airwaves

www.rtso.ca

P RESIDENT ' S M ESSAGE FROM

R OB B RYAN A-EMCA, RRT, AA

Winter 2014

TSO Airwaves Winter 2014



interest groups listed in the previous paragraph. Further, you are now able to purchase you

membership online as well as register for education events and other programs with theintroduction of PayPal to the RTSO website. Contact the RTSO ofce for more information

Save the Date: On October 4, 2014, the RTSO is organizing a ZOMBIE RUN –

UNDEAD, UNLEASHED at Downsview Park in Toronto. You’ve got to be part of this event

You can check it out at www.undeadunleashed.com . We hope to attract 1500 to 3000runners, who will then be chased by Zombies over a 5 km obstacle course. There are

plenty of opportunities to be a runner, a zombie, a corporate sponsor or most importantly,

a volunteer. This will be an all day fundraising event with food, drinks and good times that

will provide memories that will last a lifetime. Proceeds will support respiratory therapyresearch, Respiratory Therapy without Borders and the Kiwanis Club. See the Zombie run

article in this issue for more details.

The RTSO has been the profession’s voice, advocate and provincial professional associatio

for Respiratory Therapists in Ontario since 1972. Many of the past RTSO administrations

have inuenced and contributed greatly to an array of Ministry of Health and Long TermCare (MoHLTC) health care policies that have shaped the practice landscape of Respirator

Therapy as you see it today. Some of the initiatives the RTSO has taken part of in past

helped form the home oxygen program, advocated for the practice of Respiratory Therapyto be part of the Regulated Health Professions Act (RHPA) which developed the Respirator

Therapy Act (RTA) and assisted the Critical Care Secretariat’s ofce (now known as Critica

Care Services Ontario) during both the SARS and H1N1 endemics, to name a few. We

are pleased that you continue to support the RTSO and your profession through yourmembership as every name on our list strengthens our voice.

We believe that 2014 will be an exciting year for the Respiratory Therapy profession in

Ontario as we are celebrating twenty years of self-regulation; a proud achievement indeed

Since the introduction of the RHPA and the Respiratory Therapy Act in 1994 that thenled to the establishment of the College of Respiratory Therapists of Ontario (CRTO), our

practice and professional creditability has ourished. We have seen tremendous growth in

our role and scope in our pursuits to provide expert and compassionate cardio-respiratory

care. Our expertise and knowledge is well understood and respected by our peers, the keystakeholders in our provincial healthcare system and most importantly by our patients,

their families and their loved ones. The evolution of Respiratory Therapy as a self-regulateprofession has allowed RRTs to step out from the shadows of our delegators and take

responsibility for our own professional path, scope and role.

At this time, the RTSO would like to congratulate the CRTO on twenty years of excellence

in patient advocacy and offer a sincere thank you for providing the profession with a solid

regulatory framework while nurturing a patient-centered culture that has helped shape ou

P RESIDENT ' S M ESSAGE FROM R OB B RYAN A-EMCA, RRT, AA

RTSO Airwaves Winter 2



practice, raise our credibility amongst our peers and secure the public trust over the pasttwo decades.

The past twenty years has seen the RRT become a key contributor and collaborator in the

delivery of healthcare to the neonatal, pediatric and adult patient populations in all clinicasettings. We are champions of best practice in advanced cardio-respiratory therapies and

technologies; resuscitation; acute illness management; chronic lung disease prevention,management and counselling as well as experts to enable the transition of patients withcomplex respiratory conditions who may require advanced and/or applied respiratory

technologies back to their homes. We have also seen the evolution of advanced practice

roles such as RRT Anaesthesia Assistants, rapid response team members and transportmedicine specialists. We are homecare specialists, diagnosticians, educators, scientists,

patient and lung health advocates, healthcare administrators and professional practice

leaders. More and more RRTs are being relied upon as a clinical resource for all healthcar

professionals by developing, guiding and teaching evidence-based respiratory care. Wesave lives and improve health, wellness and the quality of living for millions.

As we look to the future, the role of Respiratory Therapy will continue to evolve and

expand as we increase our presence in the community and out-of-hospital clinical care

settings, ensuring all Ontarians will have access to our specialized knowledge, skill, uniquexpertise and abilities. Through our Professional (RTSO) and Regulatory (CRTO) bodies,

RRTs will continue to be key collaborators and contributors to the MoHLTC mandate, as it

continues to reshape healthcare delivery in Ontario.

As you can see, these are exciting times for the RTSO and the practice of RespiratoryTherapy in Ontario. If you are interested in volunteering with the RTSO, please contact theRTSO head ofce at [email protected] and for the interim, enjoy another great edition of the

RTSO Airwaves!

Rob Bryan A-EMCA, RRT, AA

P RESIDENT ' S M ESSAGE FROM R OB B RYAN A-EMCA, RRT, AA




Editor - Dave McKay, RRTLayout/Design - Elisabeth BiersOpinions expressed in RTSO Airwaves do not necessarily representhe views of The RTSO. Any publication of advertisements does

not constitute ofcial endorsement of products and/or services.

RTSO Airwaves is a publication of

and may not be copied or duplicated in full or in partwithout prior permission.

Lucy Bonanno MBA, MA, CAE, CHEExecutive Director, Summerville Family Health Team

Management's CornerPage 59

Robert Bryan A-EMCA, RRT, AAPresident - RTSO

Ryan's Law - Open Letter to Premier WynnePage 21

Madonna Feronne, RRT, CRECoordinator ARGI/PCAP

Focus on Community CareRRTs Forging New Paths for the ProfessionPage 38

Mike Keim, RRTNick Keim, RRT

All in the FamilyNick's Story / Mike's StoryPage 30

Jenn Lewis, RRT Spotlight on Jenn LewisPage 46

Annette Lievaart, RRT The Road to KenyaPage 25

Carole Madeley, RRT, CRE, MAppSc(RespSc),Director, Respiratory Health Programs,Ontario Lung Association

To Go Where No Man (or Woman) HasGone BeforePage 14

Dave McKay, RRTRTSO Director, RTSO Airwaves Editor

Pioneers of Endotrachael IntubationPage 49

Ivan Nicoletti, RRT, Care Coordinator, The Erie St. Clair CCAC

Focus on Community CareStrengthening Community CarePage 41

Mika Nonoyama, RRT, PhDRTSO Director

RRT PerspectiveStrengthening Community CarePage 56

Amy Reid, RRT, FCSRT, CRECoordinator ARGI/PCAP

Focus on Community CareRRTs Forging New Paths for the Profession

Page 38Allyson SnellingCommunications Officer at Muskoka AlgonquinHealthcare

Welcome to Respiratory Therapy at MuskokAlgonquin HealthcarePage 16

Thank YouTo Our Contributors




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RTSO Committee Update

Leadership The RTSO has many committees that encourage

members to join and provide their input and

insight. The Leadership Committee focuses oncurrent topics that are relevant to RT Leaders

throughout Ontario. These topics include

professional practice, education, advances inequipment, and addressing the changes that are

occurring on the Ministry level and its impact

towards RT’s. Currently, the Leadership Committeemeets once a month to discuss these topics via the Ontario

TeleHealth Network. However, the RTSO has identied this as an

area of improvement as not all RT’s have access to the OTN. Assuch, we are working with Citrix to setup an RTSO “Go To Meetings”

account. With access to this service, RT’s will be able to join in the

meetings from anywhere by accessing a PC, Mac, iPhone, iPad, or andevice with an Android operating system. Additionally, we are workin

to establish a Leadership micro-site as an adjunct to the RTSO Websitewith a goal to share and distribute documents and information.

A project that the Leadership Committee is currently involved in is

the Canadian Institute of Health Information (CIHI) review of the RTworkload measurements. We are all aware that different sites collect

RT workload measurements in different ways throughout Ontario. The

collection of RT workload can be completed based on the electronicmedical records, or recorded on spreadsheets based on the RT’s

recollection of their daily workload with more formal data collection

programs like GRASP. Even though the data is collected differently, it isbenchmarked to the CIHI standards, however this has resulted in both

positive and negative results at different sites. In addition to the way we

are collecting the data, we are also aware that the data we are currentlycollecting is no longer truly representative of what we, as RT’s, do and as

such we need to voice our inputs at this point in the redevelopment process

Kyle Davies , RRT Leadership Chair



Ginny Myles CRE, BHA (HoRTSO Directo

Community

Committee Co-

We always welcome new members and now with the ability to connect

with everyone on multiple platforms it’s easier than ever. So please join the

RTSO, sign up for the Leadership committee, and have your voice and yourinput heard. For those interested in becoming involved with the Leadership

Committee please contact me at [email protected]

I look forward to meeting all of you and hearing your input,

Kyle Davies

Community RT As a special interest group of the RTSO, we are a dedicated

group of respiratory therapists (RTs) who are working in or havean interest in RT community-based care. Community-based

care includes RTs that are working in hospital-based programs;

respiratory homecare companies; Community Care AccessCentres (CCACs); primary care (including Family Health Teams (FHT))

and research.

A gap in respiratory care support exists in the community/home setting.

Several reports, generated within Ontario1-5 have conrmed this. These

reports recommend that RT services be implemented or expanded inthe community setting. These statistics are also conrmed by the many

personal stories related by respiratory therapists and the patients/clients

who are directly affected by this gap.

The mandate of our interest group is to advocate for and establish eligibleRTs in the community and home setting, beginning with our valuable

role in managing mechanical ventilation, oxygen therapy and complex

airway patients and chronic respiratory disease management. Our goal isto have funding for these positions to be provided by the Ministry of Health

and Long Term Care (MoHLTC), similar to nursing and other allied health

professions.

Committee Reports - Leadership / Community RT


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The MoHLTC has recently recognized the value that community-based RTs

bring to primary care by listing their services in the Guide to InterdisciplinarProvider Compensation (http://www.health.gov.on.ca/en/pro/programs/fh

docs/fht_inter_provider.pdf ).

Here is an excerpt from a letter to Family Health Teams from Phil Graham

Manager of Family Health Teams & Related Programs:

Ontario’s Family Health Teams (FHTs) are making signicant progress in

expanding access to quality, comprehensive primary health care program

and services across the province that are based on the needs of patients

and communities. From time to time we hear from you that parameters

set by the ministry can raise barriers in delivering these person-centred

programs and services. Although work is on-going to address a numbe

of these barriers, the purpose of this message is to inform you of an

interim step of allowing FHTs more exibility to provide patients with

the care they need, where they need it.

Effectively immediately, the ministry is expanding the types of

professions that are eligible to provide services within the FHT. This

expansion includes: Chiropractors, Physiotherapists and Respiratory

Therapists. This is in addition to Physician Assistants, who were added

at the beginning of the scal year. These are explained below:

Registered Respiratory Therapists:

The integration of Registered Respiratory Therapists in a Family Health

Team can bring specialized expertise in a wide range of therapies and

diagnostic services related to lung health to the interprofessional team.

Registered Respiratory Therapists can make meaningful contributions

to chronic disease management programs offered by FHTs, particularly

chronic respiratory disease, in addition to disease prevention and health

promotion. Several Registered Respiratory Therapists are working in FHT

through involvement in the Primary Care Asthma Program and various

COPD initiatives but this change formalizes this arrangement to facilitate

broader inclusion.

In addition to the work in primary care, the RTSO and the CRTO, incollaboration with Ontario CCACs developed a Respiratory Therapy service

schedule – a step that will allow billing for RT services as ordered by

Committee Reports - Community RT




attending physicians; upon request of the family and/or patient or as a result

of a recognized clinical requirement by the CCAC case manager. Since thisschedule was nalized, progress has been made toward formal RT services in

the community. However, the level of awareness, understanding and demand

within the community and the public still needs enhancement to elevate toa conscious level. We strive for the public to have an equal awareness of RT

services should their needs warrant it, as they already do regarding otherhealthcare professions.

The RTSO is establishing a dedicated Community RT Committee

including expert members to advocate for high quality respiratory therapycare in the primary care setting. A teleconference meeting is being

planned for February 2014. If you wish to become involved, please

contactGinny Myles via [email protected] or Mika Nonoyama via

[email protected].

References:1. Bayliss M, et al. College of Respiratory Therapists of Ontario's

Optimizing Respiratory Therapy Services: A Continuum Of Care

from Hospital to Community. Toronto: HealthForce Ontario -Optimizing Use of Health Providers’ Competencies Fund 2008/09

Final Report; 2010.2. Chronic Ventilation Strategy Task Force. Final Report: The Ministry of

Health & Long-term Care; 2006 June 30.

3. Long-term Ventilation Service Inventory Program. Final summary

report: The Ministry of Health & Long-term Care; 2008 July 31.4. Ontario Spinal Cord Injury Solutions Alliance. Position Paper. Living

fully in Ontario communities. People with spinal cord injuries &

disease who use respiratory supports: Canadian Paraplegic AssociationOntario & Ontario Neurotrauma Foundation; 2008 August.

5. Long-Term Ventilation Strategy Development for Ontario. Long-TermVentilation Strategy Development for Ontario Progress Report: Toronto

Central Local Health Integration Network; 2007 June 28.

6. Guide to Interdisciplinary Health Provider Compensation. Family HealthTeams Advancing Family Health Care. Updated October 2013 Version

3.3. http://www.health.gov.on.ca/en/pro/programs/fht/docs/fht_inter_ provider.pdf

Committee Reports - Community RT



Research Committee Committee Reports - Research & Educaction

0 RTSO Airwaves Winter 2

Interested in research? Involved in quality improvementinitiatives? Participating in a program that needs to demonstrateits value? Then the RTSO’s Research Committee will likely be

able to provide information and/or support to help you succeedin your efforts!

Our main goal is to help build research and evaluation capacityamong our members, capitalizing on our specialized bodyof knowledge, skills and ability which improves respiratoryhealth for all Ontarians. Living in an era of evidence-based

healthcare, who better to demonstrate and evaluate the benets orneed for improvements of respiratory interventions than respirator

therapists?

Over the past two years, the RTSO Research Committee has:• Included poster presentations reecting member researchand program activity along with a research-focused session aspart of the annual RTSO Inspire Education Forum providingopportunities for presenters to both share and ne-tune theirlearning• Established funding awards to help support RRT advanced

practice education and knowledge translation activities• Provided regular contributions to Airwaves to share members’experience and insight related to their personal involvement withresearch and evaluation activities• Initiated a dedicated research section of the RTSO website withadditional information and resources added on a regular basis• Initiated a research network for members across Ontario topromote collaboration and networking opportunities that will enhanc

research as well as evaluation skills and activities to benet ourpatients.

With RRT representation from across the province, the six membersof the committee and our Clinical Scientist are motivated and excitedabout advancing our agenda! We look forward to RTSO membersbecoming involved in the Network and Committee activities. Formore information, please contact the chairperson, Nancy Garvey RRT,MAppSc. through the RTSO ofce at [email protected] .

Nancy Garvey RRT, MAppSc.

Research Chair



The Respiratory Therapy Society of Ontariotakes great p leasure to announce that the

APOCALYPSE HAS ARRIVED!


For those of you who may have aninterest in “spreading the infection” for achange, the RTSO is eager to announcewhat will be our biggest fundraising effortto date. On October 4th 2014, the RTSOwill host the city of Toronto’s very rstZombie Run which is “suitable for theft, the unft and the ugly!”

The Undead: Unleashed Zombie Run will be hosted at Downsview Park and isassured to be an adventure unmatchedby any other 5K run. You can participatein this event as an individual or as a team. You can also sign upto be an event volunteer or if you desire, crawl out of whateverhole you eternally rest in and participate as Zombie. People whochoose to participate in this run are generally those who simply want

to live an active, healthy lifestyle and have as much fun as possibledoing it. Let’s face it; most of us are busy so training time is precious.Therefore, it’s really tough to nd the time to work out for a marathonbut not so with this 5K event. You can work up to it quickly with littleor no training. The best part of this event is that it is not a timed run…it’s a survival run!

The convenience of

the Zombie 5K is asnap. You arrive atthe race, warm upfor 10 to 20 minutes,race for 40 to 60minutes maximum,cool down, replenishwith food and drinkthen head home in



The Apocalypse Has Arrived

12 RTSO Airwaves Winter

your new race t-shirt. That’s only if youhaven’t been devoured by the horde ofZombies that have been unleashed.

In a 5K, you feel like you’re really racinbut you really aren’t unless you are oneof those elite athletes who is always

at the front of the pack. That is whywe put zombies out to capture you.Racing the occasional 5K is an excellentness booster. It will elevate your maxVO2 and improve form and efciencybut when you add in Zombies, it just

becomes a little bit more fun. By the way, did you recognize the parthat there will be Zombies chasing you? Speed alone won’t save you

in this race. Runners will have to navigate a series of challengingobstacles and escape the horde of the undead waiting to claim themas one of theirown.

The RTSO isembarkingon promisingdevelopments as

the organizationstrives to ndinnovative waysto further thestrategic goalsset forth by theBoard of Directors. As your professional association, we continue tomove forward with several professional advocacy projects and we strive

to develop new engagement strategies to put our profession and ourorganization at the forefront of the healthcare community. Through ourfundraising efforts, we endeavour to support advanced practice bursaryprograms and initiatives focused of Respiratory Therapist driven research.We also embrace partnerships with like-minded organizations to raisefunds for common healthcare concerns. Charitable organizations involvedin the RTSO Zombie Run 2014 include the Kiwanis Club, who will directtheir proceeds to programs attempting to eliminate maternal and neonataltetanus as well as Respiratory Therapists Without Borders, who have taken



The Apocalypse Has Arrived


our profession globallyby championing andmentoring neonatalto adult respiratorycare in third worldcountries.

At this time, we arecalling out to theRTSO communityto help spread theword about thisexciting event

slated for October 4th 2014. We need your participation and/oryour support to maximize the success that this event will provide to

our organization. Watch out for further details, as we launch whatwill be our largest fundraiser to date. As well, we hope to makethis one of the greatest running events that the city of Torontohas ever hosted because as the Undead: Unleashed Zombie Runslogan says “Dead last is not an option!”

For more information on the ZombieRun, we invite you to visitwww.unleashedundead.com .



To Go Where No Man (or Woman)Has Gone Before!

I have been an RRT for 32 years, and I have had theopportunity to work in most areas of our profession,including research. Research – where I had not gonebefore - all started when I was doing my Mastersprogram. The program introduced me to critical reviewskills and research methods and guided me in myrst research study as the principal investigator. Thatexperience led to other research opportunities as well aprofessional opportunities.

One of the coolest research projects underway is theConsumer Access to Personal Health Information forAsthma Self-Management, which is an electronicapplication (app) for asthma management known as“breathe”. It is unique because it is the only asthmaapp in Canada that integrates with the patient/physicia

and their electronic medical record. It will also be the largestasthma app study in the world recruiting 400 participants in arandomized controlled trial. With funding by Canada Health Infoway (CHI) and sponsored bythe Ontario Lung Association, breathe is a novel web application(app) to enhance asthma self-monitoring and self-management.breathe was developed in collaboration with University HealthNetwork’s Centre for Global eHealth Innovation, clinical expertsfrom University of Western Ontario/London Health Science Centreand Queen’s University/Kingston General Hospital. Human-factorsmethodology and user-centered design principles were utilized in thedevelopment of breathe features which include symptom tracking;access to clinically approved personal asthma action plans; planchange indicators; environmental factors display and data visualizatioI had the opportunity to be part of the clinical development team and continue today to be on the Project Lead team, the Steering Committeeand the Benets/Evaluation (BE) team. The primary and secondaryhypotheses focus on health outcomes and appropriateness of care. Toview a short video of breathe go to www.on.lung.ca/Breathe-App

Submitted by Carole Madeley RRT,

CRE, MAppSc(RespSc),

Director, Respiratory

Health Programs, Ontario

Lung Association



Another cool innovative study I have been involved with is Dr. Samir Gupta’swiki-based asthma action plan development protocol, whichwas the development stage for the electronic Asthma Action PlanSystem (eAAPS) tool. I was a part of the research team for thatproject and had input into the action plan development process.I also helped to test the wiki tool and provided links forrecruitment of allied health professionals for the study itself.

Furthermore, I am a knowledge-user in the ongoing eAAPSstudy and have been an integral member of the eAAPSteam over the past 3 years, providing invaluable feedbackin system design, recruitment strategies and alignment withother Ontario Lung Association projects.

In 2009 – 2010, I collaborated on a team with Dr. Lisa Cicutto,PhD, CAEat the University of Toronto on a study titled “Perspectives of the End Usersof Asthma Action Plans.” The purpose of the study was to identify the

end user’s perspective of an asthma action plan regarding its ease of use,condence levels in implementation and its ability to meet the needs ofvarying developmental groups. We worked in partnership with the PrimaryCare Asthma Program (PCAP) sites with the study itself being funded by theGovernment of Ontario’s Asthma Plan of Action (APA). I coordinated thestudy in collaboration with researchers from the U of T, who conducted andled the research. The study involved conducting a mail out survey to patientswith asthma in the PCAP sites.

For my Masters program, I was the Principal Investigator in “A comparisonstudy of the outcomes of respiratory rehabilitation sessions using varied lengthsand frequency in a randomized clinical trial”. The study objectives were toinvestigate different program formats (lengths) via comparison of identicaloutcomes (health-related quality of life and functional exercise capacity)to determine the best length and frequency of a respiratory rehabilitationprogram for the management of clients suffering with Chronic ObstructivePulmonary Disease (COPD). Forty-nine COPD patients met the study criteriaand consented to be randomized and participate. In conclusion, the programswith greater frequency had more signicantly improved outcomes, howeverall frequencies of programs had some benets over time. The use of supportgroups, maintenance exercise programs, telephone counseling and home basedprograms need further research and evaluation.

Research can be challenging, rewarding, interesting and it extends yourknowledge ‘to go where you have never gone before!’

To Go Where No Man (or Woman) Has Gone Before



Submitted by: Allyson Snelling

Welcome to Respiratory Therapy aMuskoka A lgonquin Healthcare


The role of the Registered RespiratoryTherapist (RRT) at Muskoka AlgonquinHealthcare (MAHC) is as diverse as itis rewarding. Working in the heart ofMuskoka’s cottage country, the RRT is animportant member of the interprofessional

care team at MAHC’s two communityhospital sites: the Huntsville DistrictMemorial Hospital Site in Huntsville and th

South Muskoka Memorial Hospital Site inBracebridge.

Nestled into a backdrop of lakes,trees and rock, Bracebridge andHuntsville are just two of the towns

in the Muskoka region, a four-season destination and a vacationer’splayground. Generally, MAHC servica population of roughly 60,000people, but that gure triples in thesummer with the arrival of the touristseason. The organization providesambulatory care, 24-hour emergencyrooms, surgical services and inpatien

care with an operating budget of approximately $73 million andclose to 700 staff, 85 active physicians and over 300 volunteers.

MAHC employs a team of front-line respiratory therapists whosupport inpatient and outpatient care and provide services rangingfrom diagnostic testing to intensive care management. “OurRRTs love it here in Muskoka,” says Noreen Chan RRT, who is themanager of the department for both sites. “They not only enjoycoming to work every day, but also seize every opportunity to take

advantage of what the Muskoka region has to offer.”



RRTs at MAHC see large numbersof vacationers and correspondingtrauma volumes. The RRT is a highlyrespected member of the traumateam and is responsible for stabilizingpatients and monitoring high-riskpatients during transports. In addition,

ventilation hours at MAHC have beensteadily increasing and exceeded5,000 hours in 2013. They provide24/7 on-call coverage and supporta variety of interprofessional teamson a day-to-day basis including nuclear medicine and as a partner inthe cardiac rehabilitation program. Beyond bedside care, these RRTsalso maintain some of the roots from where the profession evolved bymanaging the medical gases used in the hospitals, from inventory and

quality control to educating others in the handling and use of thesecompressed gases. This knowledge and expertise is invaluable tosmaller sites like ours.

This dedicatedbut small groupof professionals isalso committed toleadership support

by participating onmedical committeessuch as Emergency,Internal Medicine,Surgical Services,and Family Medicine.MAHC’s RRT teammembers will alsosupport a new Rapid

Response Team that willbe initiated in the NewYear.

In 2013, the cardio-respiratory department ledthe launch of a smokingcessation program forinpatients to support

smoking cessation efforts

Welcome to Respiratory Therapy at Muskoka Algonquin Healthcare

Muskoka Algonquin Healthcare Registered RespiratoryTherapists (from left) Madison Wright, DarrenBrownrigg and Jodie Evans with the pulmonaryfunction test equipment. Missing from photo is

Judy Nault (nee McRae).TSO Airwaves Winter 2014



and improve long-term quit rates locally. There was good reasonfor introducing a smoking cessation support program as Simcoe-

Muskoka’s smoking rate is 22%, which is ve per cent higher than thprovincial rate, according to Noreen.

“One of the RRTs played a leadership role in establishing andcoordinating a smoking cessation task force to introduce and roll outthe program across the hospitals,” she said. “The RRTs also embracedthe chance to speak passionately about what they do as expertspokespeople in local media coverage.”

Since implementation, the RRTs have a formal role in the programwhere they perform the initial smoking cessation consult and givethe patient an opportunity to partake in the program, which providespharmacotherapy, education and follow-up support upon discharge.

“What is most important is that the RRTs also identied their crucial rolein educating their colleagues and building the understanding that everyhealthcare professional at MAHC can inuence smoking cessation just basking a simple question about tobacco use. Research has shown us tha

the more tobacco users are reminded or asked about their smoking historor cessation goals, the more they will consider or attempt quitting,” Noreeelaborated.

The good work of our RRTs also extends beyond the hospital walls as onesupports a healthy lifestyle through tness and healthy eating coachingwhile another works with the local Family Health Team in their respiratoryeducation clinic.



Muskoka AlgonquinHealthcare RegisteredRespiratory Therapists(from left) AprilPinkerton with aventilator, Paul Shisko

and Laura Speelmanwith the Neopuffresuscitator fornewborns.



For many years, MAHChas provided our RRTswith opportunities forprofessional growth. Thishas resulted in benets forthe patient – the RRT is theprimary care support in the

Pacemaker Clinic; RRTsperform echocardiographs– and as a healthcareprofessional – MAHC hasrecognized the benetsof a department stafngmodel with RRT-trainedleadership. Noreen, asan RRT, has managed

portfolios beyond cardio-respiratory, such asSurgical Services, MedicalDevice Reprocessing,and Diagnostic Imaging.Further, HaroldFeatherston, our ChiefExecutive of Diagnostics,Ambulatory and Planning advanced into senior management from a

front-line position as an RRT. In his role, he supports the profession byparticipating on a variety of regional committees and contributing tostrategic initiatives.

With the healthcare agenda focused on Quality Based Procedures suchas Chronic Obstructive Pulmonary Disease and Congestive Heart Failure,the province is looking at increased demand for the RRT’s expertise. It isa great time to be an RRT! Being an RRT in the Muskoka region is just anadded bonus!

Allyson Snelling is the Communications officer at Muskoka Algonquin Healthcare.



Good Catch AwardDarren Brownrigg,RRT, receivedMuskoka AlgonquinHealthcare’s “GoodCatch Award” for

August 2013 whenhe discovered andreported criticalequipment missingfrom the intubationboxes. This resultedin an improved

process to ensurethat all criticalequipment required

in a critical situationis available to theclinical staff. Darrenreceived his awardfrom Bev McFarlane,Chief Quality &Nursing Executive.

MAHC’s diagnostic services by the numbers• Holters (24-, 48-, and 72-hour monitoring) (~980 /yr)• Blood pressure monitoring (~110 /yr)• Echocardiograms at SMMH Site (~450 /yr)• Breathing tests: pulmonary function and spirometry (~1,500 /yr)• Home oxygen assessments (~210 /yr)• Cardiac stress testing (~950 /yr)• Pacemaker clinic at HDMH Site (follow 300 patients, twice a year)

*MAHC is part of the North Simcoe Muskoka Local Health Integration Network



Your RTSO membership now gives youMORE

The Ontario Respiratory Care Society (ORCS) is aninterdisciplinary section of The Lung Association for healthcare professionals involved in respiratory care.

The ORCS provides members with educationalopportunities, funding of research and post-graduateeducation in the eld of respiratory care, information

dissemination related to respiratory health and lung disease as well as access to Lung Associationresources. In addition, the ORCS provides health professional expertise to the Ontario Lung Association.

The ORCS provides full day and evening educational seminars throughout Ontario organized by theirseven regional groups and an annual Better Breathing Conference held in Toronto.

Full details available at www.on.lung.ca.

One low annual RTSO membership fee now gives you..• Professional Errors & Liability Insurance

• Access to the Research bursary fund through the Advanced Education Practice Award

• Stethoscope Discount Program

• Research and Education Committee Networking

• Discounted Rates on RTSO Educational Programs

• Employment listings on the RTSO web site

• Membership in the Ontario Respiratory Care Society (ORCS) and all of the benets they have to oer• Subscription to RTSO Airwaves Newsletter

• Leadership networking

• Regular updates of pertinent information aecting Respiratory Therapy in Ontario

• Government Representation on Matters of Interest to the Profession

• College of Respiratory Therapists of Ontario Representation

Together you have...The opportunity to help improve the quality of respiratory care in Ontario plus Networking opportunities with others involved in respiratory care

What are you waiting for?

Application form available now at www.rtso.ca



Ryan Gibbons was a 12-year-old small-town Ontario boy who had hopesand dreams like any other child his age. Tragically, on October 9th, 2012,Ryan endured a status asthmatic attack while at school that led to respiratorycollapse and his eventual death. Unfortunately, throughout Ontario, schoolboard policies vary regarding chronic disease management and the responsesnecessary during the critical events that may occur in relation to them.

Jeff Yureck, a pharmacist and the Progressive Conservative Member ofProvincial Parliament for Elgin-Middlesex-London has sponsored a privatemembers bill (Bill 135) to create legislation that would allow students to carryrescue medications on their person. This movement has commonly becomeknown as Ryan’s Law.

Many school boards do not allow students to carry their rescue devices(inhalers, epi-pens, glucagon kits, etc.) and instead centrally locate thesemedications somewhere in the school. In many cases, this does not provideimmediate access when necessity is critical, especially when students areoutside of the classroom and the school itself. This can be resolved if Ryan’sLaw receives its nal passing on February 18, 2014.

The following is a letter written by the RTSO Board of Directors to the

Honourable Kathleen Wynne, Premier of Ontario, advocating for her ofceand all Members of the Provincial Parliament to support this tremendouslyimportant bill.

Ryan's Law



http://slidepdf.com/reader/full/rtso-airwaves-winter-2014 24/6422 RTSO Airwaves Winter

Kathleen WynnePremier of Ontario

Dear Premier,

The Respiratory Therapy Society of Ontario (RTSO) is the professionalassociation that advocates for and represents the practice of RegisteredRespiratory Therapists (RRT) in the Province of Ontario. We are the voice ofthe profession.

The role of the RTSO is to promote leadership and professional growthfor all Respiratory Therapists. In addition, the RTSO supports programsin research, education and patient care as it pertains to cardio-respiratoryhealth. Our desire is to work in a holistic, collaborative and coordinated

effort with all parties and like-organizations partaking in cardio-respiratorycare. Further, our mandate is to ensure that the public, the provincialgovernment and the Ministry of Health and Long Term Care are aware of thecontributions that our members make to ensure excellence in health caredelivery throughout Ontario.

Respiratory Therapists are also one of the key care providers to theindividual diagnosed with asthma who comes through the door ofmost Ontario hospitals. We are the clinicians who provide therapeutic

interventions to patients in respiratory crisis in the Emergency Department.We also manage the life-supporting technology that may become necessaryto sustain life when transfer to the Critical Care Unit is required and weprovide follow-up care during the recovery phase on a medical unit. Weare also the educators, at the bedside and in clinics, both in hospital andin primary care. Our goal is to enhance the knowledge of every individualwho suffers from a chronic lung disease, promote ownership of their illnessand develop strategies of self-management with them, to enable a full andproductive life; one without the burdens that often result from living with a

respiratory-related illness, such as asthma.

While preventative measures are the goal of effective asthma management,when an acute asthma exacerbation does strike, it is often without warning.Early intervention is vital and as such, it is imperative that a comprehensiveasthma management plan be instituted in all Ontario schools. Ryan’s Law(Bill 135) sponsored as a private member’s bill by Jeff Yurek, ProgressiveConservative MPP for Elgin-Middlesex-London is the rst step, as it will

protect children who live with asthma, by enabling them to carry their rescue

medications while at school.

160-2 County Court Blvd, Suite 440

Brampton, ON L6W 4V1

Tel: 647-729-2717/Fax: 647-729-2715

Toll Free: 1-855-297-3089

E-Mail: [email protected]

www.rtso.ca


http://slidepdf.com/reader/full/rtso-airwaves-winter-2014 25/64TSO Airwaves Winter 2014

The early use of a rescue inhaler can be the difference between proactivemanagement and preventable death. In fact, it is estimated that 80% ofasthma-related deaths are preventable. Unfortunately, present school boardpolicies regarding management of chronic diseases and treatment of acuteepisodes of these illnesses dramatically varies throughout the province. Asa result, many children are still at risk in an environment where they shouldbe safe. Fortunately, the legislation of Ryan’s Law, which posthumously

refers to Ryan Gibbons, who succumbed to respiratory failure as a result ofan asthma attack while at school in October 2012, would lessen the risk ofsimilar tragedies in every Ontario school.

Further, the RTSO supports the movement of the Ontario Lung Associationto enact a province-wide asthma policy within schools that would:

• Outline strategies to reduce the risk of exposure to asthma triggers

• Develop a communication plan for the dissemination of information on

asthma • Initiate regular school board member training on recognizing and

managing asthma

• Institute a requirement that every school principal maintain a le

for students with asthma which includes an individualized asthma

management plan that has been developed in collaboration with the

pupil’s health-care provider

At one time or another, every Respiratory Therapist has provided care to a

child suffering from an acute exacerbation of their asthma. Unfortunately, toomany of the practitioners of our profession have also had the heartrendingexperience of witnessing the often preventable death that can result fromasthma. It is the hope of our membership, that you and all Members of theProvincial Parliament will recognize the importance and value of Ryan’s Lawand offer full support to ensure its passing. By doing so, every parent of achild diagnosed with asthma and every healthcare provider who treats apatient suffering with asthma in Ontario will be undeniably grateful.

Respectfully,

Robert Bryan A-EMCA, RRT, AAPresidentRespiratory Therapy Society of Ontario

-2-



Somewhere I took a turn off the “this iswhat normal people do” road, even thoug

I started on the normal road after graduat

from the Northern Alberta Institute ofTechnology (NAIT) in 2008 by working at

the Misericordia Hospital in Edmonton as

a staff Respiratory Therapist (RT). Howeveafter a few years of work, I began to

look for something else. I knew of some

RTs who had worked in the United ArabEmirates and Saudi Arabia and while thatlooked interesting, I hoped to nd a new

destination, something completely differe

My wants were directing me to somewhere that I could build a newbridge and then carry something over it to make a difference. As we

my faith is important to me and I wanted to be able to go somewhe

where I could live out and share my Christian beliefs with others

who held their faith in the same regard. For those reasons, I started togather information regarding mission work. In fact, I spent hours on

the internet e-mailing various agencies and hospitals around the worllooking for a place where I could serve.

After several dead-ends, I nally received a response from a hospitalin Kenya. Tenwek Hospital, a large rural mission hospital believed that

they could provide me with the opportunity that I was seeking. So, with

a cloud of dust following behind me, off I went to spend six months

in Africa, from October 2010 to March 2011. At the time, I think myfriends and family thought this was just a short detour off the road of

normal but after returning to Canada, I spent quite a bit of time doingsome extensive soul searching. It was during this time, that I discovered

Respiratory Therapists without Borders (RTWB). I was excited to meet like

minded people and joined their Board in hopes of helping others nd theown opportunities. This bond, with other RTs seeking a similar need to giv

something back also further engrained my own want and desires, so I mad

the decision to return to Kenya – this time for 2 years.

The Road to Kenya, Afric

ubmitted by nnette Lievaart , RRT



So now here I am, sitting with my pager on my hip (like always),

surrounded by lush tea elds and the sound of rain on my roof. I arrivedin Kenya in January 2013 but before being able to work independently

at the hospital, I had some things to do rst. Foremost was to get my

license to practice here.Through much footwork

by fellow missionaries andstaff here in Kenya, welearned that the Kenyan

Society of Physiotherapists

would license me. I wasthe rst RT that they had

licensed and it was indeed

an interesting process. In

January, I spent four weeksdoing practicums, paired

with physiotherapists (PTs) at various hospitals inNairobi. It was a great exposure to health care in Kenya

from the basic government-run hospital to the top of

the line, private hospital. While I was paired with PTs,

I did spend some time in Intensive Care Units doingchest physiotherapy but I was not allowed to touch the

ventilators. Much of the day was spent walking patients,

tting corsets, doing passive exercises, etc. This wascertainly not the critical care experiences that I was

used to, but at the end of the month, I was done and

was given my licence.

My practicum was then followed by 3 months of Swahililanguage instruction. English and Swahili are the two

ofcial languages of Kenya, however Swahili is the language of the

people and it is great to be able to (or attempt to) communicate in thelanguage of the people, especially living in rural Kenya where not all havelearned English.

Unfortunately, it wasn’t until May that I was nally able to arrive at Tenwek

and start working as a clinician. In some ways my job is very similar to

that of an RT in Canada – I manage and wean ventilated patients, assesspatients in distress, look at x-rays, provide oxygen therapy, and do asthma

education and health teaching. However, in many other ways, my work is

The Road to Kenya, Africa


Physio Certic

Being a

student -learningwith theinterns




very different. I am the only RT in a

300-bed hospital; the only hospital i

a large area that provides ICU care,CT scans, and complex surgeries. W

have two ICUs giving us a total of

thirteen critical care beds. I have sixventilators that currently work, and a

few home-quality BiPAP machines fonon-invasive support. However, beinthe only RT, it is necessary that I do

things differently. I cannot be there

every time a patient codes, needs aventilator, a blood gas or suctioning.

These responsibilities are shared

between me, the physicians and the

nurses.

Since an RT has a unique knowledge set, I also provide educationfor these same doctors and nurses. Some of this education takes

place via formal lectures but much of it is situational. Teaching

opportunities come up spontaneously when someone is baggingtoo fast at a code, or a patient is asynchronous with a ventilator or

when a child with bronchiolitis needs BiPAP. Through these events,

I have also learned that most people here, like many RTs in Canada,

tend to be visual or hands-on learnersas comprehension is much better when

something is demonstrated or done ratherthan lectured. Some things I have introduce

to enhance education or understanding

during my tenure thus far include – theuse of non-invasive ventilation, weaning

of ventilated patients, lung protective

strategies when ventilating ARDS patients,maintenance of ETT tubes and other basicrespiratory therapies.

In addition to the normal activities, I also have some responsibilities that

are not standard for an RT. I have learned how to and regularly ll the

O2 cylinders, I programed our new (to us) ICU monitors so they wouldstop beeping all of the time and I regularly attempt to x and maintain ou

ventilators. Aside from working in a different hospital where I see different


The ICU

Learning froma radiologist- a short termvisitor atTenwek




diseases, have different (old) equipment and am

the only RT, I also have the challenge of living in a

different culture and being on the opposite side of theworld from my family.

Just to give you a taste of what I do here, this iswhat an average day looks like. I leave my house at

0655 to head up to the hospital, a nice short walk,where I then participate in 0700ICU rounds with the surgeons. As

there are no other RTs here, I don’t

get a shift report so each morningcan be a surprise – who went on a

ventilator last night; who coded; who

got admitted, etc. Surgical rounds are

generally quick – sometimes too quickwhere they barely mention the fact

that the patient is ventilated and thecare plans that go along with it.

After Surgical-ICU rounds, I have a chance to look at the rest of mypatients and gure out what their diagnosis is and what other rounds

I need to be at. Tenwek trains interns, family practice residents and

surgical residents so every morning at 0800 there is a training session

and the topic of discussion is always something new, from malaria toaortic enteric stulas. From 0900 to 1000, I attempt

to round with the Medicine, Paediatric and OB teams.Based on what I may have seen earlier in the day, I try

to attend the ICU rounds that have the sickest patients

but on more than one occasion I have stood betweentwo teams, trying to listen to them both so I know what

the care plans are.

After rounds are nished, my day is much less

scheduled and this is my chance to get some work

done. I ip through charts and gure out what plansare, I wean patients, help the nurses with ETT ties,

show a nurse how to give MDIs to a vented patient,

etc. Once I am happy with the condition of the ICUpatients, I do “my rounds” by following up on patients I know or get my

exercise by walking over to casualty (ER) to see what is going on. The other


Below: A peds

patient on bipap

Above -

Rounds

with Mothe inter

Left:

Rounds





day I walked in as they were just nishing an intubation of a patient whohad attempted suicide by ingesting pesticides – sadly all too common here

I took over “bagging” the patient as we do not have a ventilator in the ER

while the staff worked on getting a bed in one of our ICUs. Once the bedand vent were ready, we went down the ramp (no elevators) and got the

patient settled. After any sentinel event where I feel I am needed, I try to

maintain a continuation of my rounds checking up on the babies in thenursery and patients in the various wards, helping out where I can. Thes

rounds usually ll the rest of my day with no two days ever being alike

There are other unique challenges to work here, as Tenwek provides

care in a resource-limited setting. I have between four to six ventilato

that work and as the only ICU available for a few million people,we must think before we use a ventilator. If a patient does not have

a reasonable chance of successful weaning from the ventilator in

a few days, they simply do not goon it. This practice at times has

been heartbreaking as in the case

of a young man with Guillan-Barrewho did not go on the ventilator,

but rather succumbed to his illness.

Other difculties that arise fromworking in a resource-limited settin

include things such as a lack of

appropriate medications, decreased

laboratory capabilities or the absencof basic medical equipment and

supplies, to name just a few.

Tenwek Hospital has many North

American visitors and as a whole, the staff is quite welcoming. Morewelcoming than I would be if every week there was a new physician

telling me what to do. As well, coming in as an RT has been aninteresting experience for all, trying to gure out what I do and how thawill t into the care already provided at the hospital. For the most part,

the majority of the staff is very thankful for the help and expertise that

an RT can provide but I tend to struggle with nding a balance between

educating and doing. I cannot function as an RT does in Canada and doeverything because when I am gone, they will have lost those skills. On

the other hand, when the staff is busy and don’t have time for learning, me

doing is helpful in the moment.

Below: Playing

"Spoons", cardgame with the

Interns





Kenya is a beautiful country where many people come to vacation. I have

explored some of its offerings by going on safari and enjoying the beach

at the coast. I have also taken a few side trips doing day hikes or visitingfriends in other parts of the country. However, most of my time is spent

within the community at Tenwek, just living a simpler life. Evenings are

spent like many of yours, catching up on e-mailsand staying in touch via Facebook or phone calls.

We regularly have games of volleyball or get

together for an evening, playing cards or boardgames. Things take more time here; so life takes a

different pace although I still feel like my to-do list

is never ending.

Tenwek itself is a four hour drive from Nairobi and

the culture is very rural. Most of the staff at thehospital comes from a farming background and

many still have small farms that they grow tea,

beans, corn and cabbage to provide extra incomeand/or food for their families. Everyone has a

cell phone but very few have computers. It is still

common to see people walking with rewood ontheir head and donkeys pulling carts. For Kenyans relationships are

highly valued. I am still working on getting into the habit of greeting

everyone, every morning and always with a handshake. As an RT, who

works everywhere in the hospital, this practice can be quite a feat, as itrequires a lot of names to be remembered as well as a lot of hands to be

shaken. Being a training institution, the staff members of our hospital are

an imported culture from a variety of global locales. As such, they areoften very westernized and just like me they miss movie theaters, take

out and fast internet speeds.

Despite all of the challenges that I have faced, l love the work I am doinghere and I look forward to my remaining year and a half in Kenya. If youhave enjoyed hearing about my experiences, you are welcome to view my

blog www.respiratorykenya.blogspot.com and if you have any questions,

please don’t hesitate to send me an e-mail at [email protected]. I do miss

my friends and my family but Kenya is currently my home and I wouldn’thave it any other way.

Annette giving

blood



All in the FamilyNick’s Story A s the son of Mike Keim, a well-

known practitioner within the

community of Respiratory Therapy

(RT) in Ontario, I have often beenasked how I became interested in th

profession. My name is Nick Keim

and I’d like to be frank and say thatit wasn’t a completely straight road

getting here.

My dad would always talk highly about his profession and what a great career

was and often suggested to my brother and I, that we should consider pursing

a similar path. To be honest, in the beginning, I wasn’t always interested inhealthcare or having a career in any medical eld. I always thought hospita

were a place that should be avoided at all costs and besides, they always ha smell to them that I didn’t particularly like.

In grade nine, my high school timetabled a “Take Your Kid to Work” day,

and my dad offered the option for me to spend the day with him, so Ithought, why not? At the time, he was working at St. Joseph’s Hospital

in London, Ontario. I didn’t have the strongest understanding of what

my dad actually did but I knew that as a Registered RespiratoryTherapist (RRT) he worked with patients who had respiratory-related

illnesses such as asthma and emphysema. However, I didn’t really

understand the details of what that meant. As it turned out, I followseveral RRTs around St. Joseph’s Hospital that day which raised

my awareness of his role and I got to see different areas that RRTs

worked in, such as the PFT labs, NICU, and Labour and Deliveryalso got the chance to intubate a mannequin which I learned wa

a common procedure RRTs regularly needed to do.

Nick and Mike Keim

Submitted by:

Nick Keim , RRT Mike Keim , RRT



At the end of the day, I sat beside another student whose parent

had brought them in for the day as well, and we both experienced

what nasal prongs were like while I waited for Dad to nishhis work. Whether it was simply the experience or the oxygen

enriching the blood that owed to my brain, I now had a greater

appreciation of what my dad did for a living.

On completion of the “Take Your Kid to Work” day, I still wasn’t

hooked on wanting to become a Respiratory Therapist. Instead, aftergraduating from high school, I entered an apprenticeship, working as a

general carpenter for a company called John & David Baer Construction.

I renovated commercial and residential buildings, as well as xed leakybasements. At rst, I really enjoyed constructing things with my own hands

and seeing the nished product. In fact, I found this to be very satisfying but

as the winter months came along, the work slowed down which resulted in

smaller paycheques. Subsequently, I soon realized that general carpentry wasno longer my dream career. I did enjoy building and creating things with my

own hands, but I began to see general carpentry asmore of a hobby than an actual career for me.

As a result, I had to re-evaluate what I wanted to do.I looked back to when I worked in a cafeteria at a

small rural healthcare facility called Four Counties

Hospital. Four Counties is a fourteen-bed hospitalwith a small emergency department. My job in the

cafeteria was to help prepare meals for the staff,

visitors and patients within the hospital, along withcleaning the dishes. I enjoyed this job. I enjoyed

the satisfaction of working with the patients and the

nurses. I was able to provide some level of care, justby being friendly and talking to the patients while I

dropped off their tray of food. This experience made me recognize that

working in a hospital wasn’t all that bad and as far as the smells wereconcerned, I could get used to them.

It was then that I started to think about a career in healthcare.Because of my workplace experience with my dad, I had some

understanding of the role that RRTs played on a healthcare team.

I also had some understanding of what nurses did since mymother is a Registered Nurse (RN) at the same hospital where

I had worked as cafeteria staff. She too, talked highly about

Nick Keim

All In the Family - Nick's Story




her profession. Consequently, both my parents continued to remind

me that if I decided to pursue a career in either, the path would beextremely rewarding. When I nally realized the truth in what they sa

I entered the Pre-Health Sciences program at Fanshawe College, which

was a one year certicate course that helped students advance into the

highly competitive healthcare programs. I graduated from the programwith honours and throughout that year, I had time to evaluate what I was

going to do. At the same time, my parents continued to talk in depth aboueach of their careers while providing me with lots of advice and informatio

Still unsure of what route I was going to take, I decided to apply to bothprograms at Conestoga and Fanshawe Colleges. I was accepted into the RT

program at both schools as well as nursing at Conestoga College but made

my nal decision to go with the RT program at Conestoga. I chose Conestogabecause I liked the fact that the program was shorter than the one at Fanshawe

which would enable me to start my career sooner. I chose Respiratory Therapyover nursing due to the fact that I preferred the idea of being highly specialized i

cardio-respiratory care as well as having taken in interest in the technical aspect omechanical ventilation.

Throughout school, I worked hard to study and understand the theories of

Respiratory Therapy. At times, the program was difcult, especially memorizing

the equations and understanding the different concepts of mechanical ventilatiobut having my dad there to get me through these times was of great benet. I

would call him in the evenings while working on the homework that I didn’tunderstand to seek out his assistance. He would happily go through the vario

concepts with me and helped enhance my understanding of them. Sometimewould email him my assignments which he would gladly review and then of

honest, constructive feedback and suggestions. Having him as a resource, w

an absolute benet.

When I went home for weekends and holidays (since they lived near Lond

and I lived in Kitchener) Dad would want to talk about what I was learninat school. Inevitably, the conversation would then turn to “shop talk”, as

my mom would often describe the interactions at our dinner table. My dwould always get excited about what we were talking about. Sometime

would have to remind him that I was only a rst year student and that

conversation was way over my head. As I continued through school a

became more knowledgeable in respiratory care, the talks at the dinntable became even more interesting because I could better relate to m

dad about all things respiratory. We talked about how excited I was




complete the theory portion of school and begin my clinical rotations.Consequently, I would often call my dad to tell him the exciting things

hat I was doing at the Hamilton General Hospital (HGH). I loved being

able to put everything that I learned at school into practice.

n July of 2012, while still a student in my clinical year, my girlfriend anddecided to go camping at Long Point Provincial Park. One evening, we

decided to head into Port Dover to get some dinner. While waiting to be

eated out on the patio, I heard a mother’s cry for help on the beach, “HELP!HELP! My child is choking!” I ran down to the beach and explained to her

hat I was a Student Respiratory Therapist and that I could help her child. As

he told me that her child was choking on a gum ball; I quickly took a listenand could still hear her breathing past the obstruction. Panicked bystanders were

macking the child on the back trying to dislodge the gum ball, which didn’t

work. I coached her along and said, “You need to try to cough” and with a few

trong efforts, she managed to cough the gum ball out on her own. She began tocry, much to her mother’s relief who repeatedly expressed her appreciation and

hanks. After this event, I felt pretty good about myself, having been able to put the

kills that I had learned into practice at a critical time.

Helping this child was a pivotal moment for me. I already knew that I likedRespiratory Therapy but this event made me realize that I could easily do this for

he rest of my life. For the remainder of my courses and clinical placement, I

worked hard and became very passionate with regards to the direction that my

uture held until I successfully completed my schooling and graduated withhonours in December, 2012.

Right after graduating, I began an earnest search for a job in the eld. I knew

hat I wanted to start my career in a hospital because of the experiences that I

had had throughout my clinical rotations at HGH. After a few failed interviewattempts, I once again approached my dad and he assisted me with my

nterviewing skills which aided me to land a great job working casually at

HGH. My plan now is to do whatever is necessary to enhance my growthas a Respiratory Therapist. Every shift offers new and different experiences,

continued learning, and personal satisfaction. I greatly appreciate how my

dad helped me reach the tough decision of what I wanted to do for the rest

of my life and looking back, I wouldn’t change a thing.





All In the Family - Mike's Story

4 RTSO Airwaves Fall

S o now what am I going to do? I just concluded a disturbing conversati

with my geology lab instructor. He was a graduate student, who in a tenminute conversation regarding my personal academic choice, that of a deg

in honours biology, reafrmed that the end result for me would be working

a lab, … for the rest of my life. He was attempting to convince me that geolowas where the exciting opportunities were. While geology was not a desired

option for me, what he did achieve that day was to raise personal doubts abou

whether I would enjoy the eventual outcome of my current academic choice. Ileft the lab that day not sure what to do.

Later that week between classes, I foundmyself, with mild curiosity, flipping through

a Fanshawe College career pamphlet. I came

across a course titled Respiratory Technology(today Therapy). It described the developmen

of a new profession in an area of rapidly

expanding knowledge and mechanical deviceHealthcare’s historical bedside model of

doctors and nurses could no longer “do it

all.” New advances in respiratory care would

require specifically trained individuals whowould become an integral part of a respirator

healthcare team. Now that sounded exciting.

The following September, I found myself sitting in a classroom with thirty

other RRT hopefuls, getting all excited about bubble bottles and medicalgas cylinder labeling. This was all new to me and I appreciated that it was

preparing me for a career, one that got more exciting with each new concI was introduced to by the dedicated, passionate instructors who clearlyenjoyed what they were doing. Their enthusiasm was contagious. It was

September, 1975 and I had no idea what experiences were ahead of me

simply knew that this felt right.

My last day as a student was on a Friday and on the following Monday

morning; I began my orientation as a staff member at St Joseph’sHospital in London, Ontario. My rst leader clearly communicated

Mike Keim

Mike's Story




that he trusted his team of therapists as knowledgeable, accountable

professionals capable of making sound, ethical decisions during theprovision of their care. Subsequently, he did not manage the team’s

patient care delivery but rather he managed resources and allowed us

to make personal decisions how to best provide the necessary care. Ifelt empowered by his trust and determined that given the opportunity, it

would be how I would one day like to inspire graduate therapists.

Ten years into my career, a close friend who had known me all my life (not

an RRT), commented, “Mike, Respiratory Therapy has turned into everything

you had hoped it would, right?” His comment was true, as I had been aclinical therapist, a clinical instructor and at that time was participating in

the exciting and expanding role of RRTs in neonatal care. I was enjoying each

opportunity. Subsequent years also provided the opportunity to work withthe development of a new model in London which was composed of a non-

physician based paediatric/neonatal transport team. Following that, provincialbudget pressures inuenced my career choices and led me to an exciting ve yearsin Chatham as manager/clinical therapist, then back to St Joseph’s in London, as

professional practice leader/educator/coordinator and currently with ORNGE air

medical transport as an educator.

Early in my career, a colleague encouraged me to get involved in what was then

the local chapter of the Respiratory Therapy Society of Ontario (RTSO). Fromthat beginning, I was interested in organizing education opportunities. This

earlier interest has continued and I currently maintain a role with the RTSO in

a leadership capacity. In addition, my interest in education has also led to agreater than 25 year relationship with the Ontario Respiratory Care Society

(ORCS), the professional branch of the Ontario Lung Association. I am

presently the chair of the provincial education committee and a member ofthe local regional ORCS education committee.

Throughout all of these events, life was always unfolding for my wife Nancy

and I. We had our rst son, Chris, in 1984 and at that time, I was theclinical instructor for Fanshawe College’s students rotating at St. Joseph’s.

The students were completing case studies related to infants in our level 3NICU. One month before Nancy’s due date, reading through these infant

case studies, I began thinking that there were no “normal” births and

became a bit apprehensive about what that would look like for Nancyand our new child. Chris and, six years later, his brother Nick were

both at risk of acquiring Group B strep and subsequently both spent

a number of days in the NICU, … “my” NICU. Fortunately, both ofTSO Airwaves Winter 2014




them arrived with birth weights exceeding 4300 grams and each lookedhuge in comparison to their pre-term, less than 1500 gram neighbours.

Thinking back, I guess as a dad, I might naturally have hoped that

one son might follow in my career footsteps. However, that was never

an expectation of either Chris or Nick. So when Nick announced oneevening over dinner that he did not wish to continue in his carpentry

apprenticeship, but rather was going to apply that spring, to pre-health

sciences at Fanshawe College, he had my attention. He went on to state

that he might apply to nursing or Respiratory Therapy. I was surprised, as hehad not shown any interest in healthcare before, but I did nd myself secret

hoping that he would choose Respiratory Therapy. It isn’t that nursing isn’t a

great career; after all Nancy is a nurse who loves her work, but a RespiratoryTherapist, now that’s a cool job and one I innately knew Nick would nd a

passion for.

As Nick’s knowledge of the theory and application of respiratory care developed

I was pleased to see that this excited him as well. I especially appreciated gettingthat call in the evening of “Dad can you help me, what does this mean?” or “Coul

you read over my assignment, does it make sense?”

When Nick and I were asked to share our thoughts as parent and child, both

being Respiratory Therapists, I must say that the words attered and proud came

to mind. Flattered that Nick chose Respiratory Therapy, perhaps in part becausehe witnessed how I have enjoyed my career and proud because he is a young

man of integrity and purpose, the very same reason that I am proud of my

son Chris. To be a parent is an awesome privilege, to have a child becomea meaningful contributor to their community is very satisfying, to have one

follow in your footsteps and choose your career path is a bonus.

I think again of what my good friend said “Mike, respiratory therapy has

turned into everything you had hoped it would, right?” After thirty-six

years, I can still easily say yes, at so many levels.




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T he eld of Respiratory Therapy is rapidly evolving from a largelytechnical method to a multifaceted systemic approach. Part of this

rapid evolution is a result of the advances made through ARGI (Asthma

Research Group Inc), founded by Dr. Christopher Licskai in 2004.

Asthma Research Group (ARGI) is a not-for-prot organization that

integrates Certied Respiratory Educator (CRE)/Registered RespiratoryTherapist (RRT) leaders with community based physicians. Together

they make use of the Canadian Institute of Health Research (CIHR)

knowledge-translation (KT) framework to contribute to multi-levelhealth system innovations, to facilitate guideline implementation, an

to improve health outcomes in community primary care practices.

ARGI has proven that asthma educators are of great asset to patients

and to the health care system as a whole. ARGI is now a Regional

Respiratory Care Program which provides Chronic ObstructivePulmonary Disease (COPD) education, smoking cessation services,

air quality health information, as well as support for other respiratory

diseases. This past year, ARGI was recognized and awarded anHonourable Mention for the Minister’s Medal Honouring Excellence in

Health Quality and Safety .

The heart of the ARGI program lies with the dedicated CRE/RRT’s

who provide timely, patient centered, evidence-based care within amulti-disciplinary team. The CREs/RRTs are considered experts withrespect to guideline implementation and patient education. They

deliver standardized, individual care within a Quality Improvement (QI)

framework, including a robust benets evaluation process that keeps thepatient as the centre of the focus.

Collaborative partnerships have also facilitated the growth of the program.One major collaborative partner is the University of Windsor. CREs/

RRTs within the ARGI framework provided extensive input to computer8 RTSO Airwaves Winter 2

Focus on Community Care RRTs Forging New P aths for the Professio

Submitted by adonna Ferrone RRT, CRE

Amy Reid RRT, FCSRT, CRE



programming experts to support the development

of an invaluable electronic, point-of-care,

evidence-based, clinical information system (CIS).This system is upgraded on a regular basis to

remain guideline and evidence based compliant

for asthma, COPD and “TEACH” (TrainingEnhancement in Applied Cessation Counselling

and Health) tobacco counselling. Indicators based

on rigorous research protocol are integrated intothe system for ongoing outcome and performance

measurement. Reports are generated for all

sites. CIS standardizes the patient encounter,provides decision support, integrates information

technology, and captures and transmits system

and health quality indicators. CIS includes a

regional administrative infrastructure to facilitatestaff scheduling and continuing education. It has

also been adapted for use in the Community CareAccess Centre (CCAC) COPD initiative.

Additional strategic collaborative partnerships have been formed withprimary healthcare teams (Family Health Teams (FHT), Community

Health Centres (CHC), Nurse Practitioner-led Clinics (NPLC), solo

practices), CHC COPD rehab program, hospitals, CCAC, Windsor-Essex Public Health Unit, Ontario Lung Association (OLA), as well

as a community COPD expert panel. Each of these partnerships has

been implemented through the utilization of Local Health IntegrationNetworks (LHINs) and Family Health Teams.

A great source of pride for ARGI is their commitment to rigorousevaluation and research. ARGI is striving to improve the quality of care

and the quality of life for its patients. The CREs/RRTs are at the core of

implementation and execution of two research based initiatives: ConsumerAccess to Personal Health Information for Asthma Self-Management –

Smart phone Breathe APP; and, COPE with COPD Randomized Control

Trial.

The Smartphone Breathe App, funded by Health Canada and the Ontario

Lung Association, is an innovative patient self-management tool whichincludes air quality measure and recommendations for feasibility and

improvement in asthma control. At present, Canada Health Infoway is

Madonna Ferron


Focus on Community Care - RRTs Forging New Paths for the Profession



funding a larger initiative including a TELUS personal health record and linkto primary care.

COPE with COPD is a trial designed to develop and evaluate a diagnostic

and treatment pathway for the management of COPD in primary care.

Standards are based on national guidelines and application is focusedon patient self-management. Pathway objectives include implementing

a process that identies and/or conrms a diagnosis of COPD inindividuals at risk, implementing interdisciplinary care that include

comprehensive disease education, and engaging patients withCOPD in self-management. A secondary project objective

is to introduce an electronic tool that standardizes the

intervention, permits study evaluation, and can be integratedinto practice. This tool will provide ongoing outcome repor

to participating physicians after study completion.

Clearly, collaborative partnerships are of great importance

for ARGI. These partnerships further the role of the RRT/

CRE and improve patient quality of life. ARGI uses an integrated organization approach that

facilitates transitions between hospital, emergency

department, and community healthcareorganizations with a focus on empowering patients through

collaborative self-management.

We would like to formally recognize all members of this illustrious

group: Dr. C. Licskai, Dave Nadalin, Zofe Roberts, Colleen MacDonaldErin Simic, Josie Stapleton, Barbara Veigli, Nena Stojic, Patty Paraschak,

Melissa Fisk, Madonna Ferrone, and Amy Reid.

With this dedicated team of CREs/RRTs, the patients will prosper, as will

the communities and programs that they continue to serve.


Focus on Community Care - RRTs Forging New Paths for the Profession

Amy Reid



TSO AirwavesWinter 2014

Respiratory Therapists at theErie St. Clair CCACStrengthening Community Care

T he need to strengthen home and community care has become more

and more evident as the health care system continues to be challenged

by an aging population and an increased burden of chronic conditions.To address some of these challenges, the Erie St. Clair Community Care

Access Centre (CCAC) has taken an innovative approach by formulatinginterdisciplinary care teams and now further expanding them to includeRegistered Respiratory Therapists (RRTs).

Funded by the Ministry of Health and Long-Term Care (MoHLTC), the

CCAC is an organization that coordinates home and community care for

patients, by providing them with resources and acting as the contact point

for access to community health and social services.

Respiratory Therapists working within the CCAC system are very uniqueand non-traditional. The Erie St. Clair CCAC has been a provincial leader

by having RRT services as a critical component within their specialized

care teams, who support patients through care transitions, while alsoattempting to ll an identied need within the community setting.

Respiratory Therapists at the CCAC work in various capacities, including

management, within program development, as CCAC Care Coordinators andas frontline staff that provide direct respiratory care to patients.

The Erie St. Clair region has a higher prevalence of chronic disease andof hospitalization rates when compared to the rest of the province. The

increased urgent and emergent health care resource utilization is costly

to both patient quality of life and health care dollars. As more complexpatients are discharged into the community, it was envisioned that the

RRT with advanced knowledge and skills in respiratory disease could play

a significant role within the interdisciplinary team and further strengthencommunity care provision.

Submitted by Ivan Nicoletti RRT,Care Coordinator



As Respiratory Therapists working for theCCAC, we have had great opportunities to

be involved in patient-focused initiatives

that improve the health and well-being ofpatients with respiratory disease. CCAC

RRTs are members of and signicant

contributors to several chronic diseaseworking groups, the local primary care

council and have also worked closely with

the Erie St. Clair Local Health Integration

Network (ESC LHIN) and communitypartners in the development of patient car

pathways. The development of these care

pathways is a re-design of the current healcare state and an extension of health care

provider roles that will maximize patient engagement, improve care accessand patient ow across all levels of the health care system.

An Example of Care CollaborationThe development of a community-wide integrated Chronic Obstructive

Pulmonary Disease (COPD) program is a direct example of one of the care

pathways that was developed. It is a multidisciplinary, integrated health

team approach between the Erie St. Clair CCAC, the Erie St. Clair LHIN,

Community Health Centres and Family Health Teams within the counties ofSarnia-Lambton and Chatham-Kent (regionalization of the program is curren

in progress with further expansion into Windsor-Essex). The partnership brintogether clinical leadership and community care experience that ensures tha

comprehensive support is provided, with the overall focus of improving care

and the quality of life for individuals with COPD. Respiratory Therapists playprominent role within the model of care.

Using an innovative e-tool, the RRT conducts comprehensive assessments,

provides education around self-management, reviews medications and properinhaler technique, performs clinical interventions and collaborates with the

primary care providers for the development of patient self-management actionplans. Patients are then connected to Community Health Centres or Family

Health Teams for ongoing follow-up, maintenance and other supportive treatme

options that include pulmonary rehabilitation and smoking cessation services. Toutcome of this collaboration is a patient-focused service that is streamlined and

coordinated.

Respiratory Therapists at the Erie St. Clair CCAC - Strengthing Community Ca

Roslynn Walpole and Ivan Nicoletti



“Patient feedback to date has been very positive. By the

time I leave a patient’s home the most common comment

I hear is that they have learned much more then they

knew before; especially when it comes to understanding

their disease and using their medications properly. It is

very gratifying to be able to spend quality time with a

patient one-on-one in their home, and in my experienceto achieve effective teaching and meaningful support, the

RRT requires time to build a relationship with the patient.

In order to improve their health, the majority of patients

are willing to participate in additional chronic disease

management education and undergo an exercise program

as well.” – Mario Aquilina, CCAC RRT, CRE

The Multi-faceted Role of the CCAC RRT The role of the CCAC Respiratory Therapist has been expanded and is

responsible for leading multidisciplinary biweekly rounds whereby COPDcases are discussed to ensure that optimal care and management is achieved.

The team consists of community nurses, an occupational therapist, a

community pharmacist, a registered dietitian and a respirologist. This teamapproach integrates the unique skills and knowledge of multiple health care

professionals and reduces the potential risk for uncoordinated and conicting

treatment plans.

The CCAC RRTs are also part of the Palliative Care Consultative Team (PCCT)

and are consulted on a regular basis to support palliative patients within theirhome environment. For many patients, the home is the preferred setting to

discuss disease management, prevention strategies, lifestyle changes and end-

of-life care. Having a team of health care providers including RRTs in thehome allows for an assessment of the environment and the need for additional

referrals, as most of these patients have multiple comorbidities.

RRTs have been a welcomed addition by all team members and care

coordinators alike.

“The RRT provides a unique perspective and can offer advocacy, health teaching

and counseling to our patients in relation to ALS, BiPAP/CPAP and COPD

management. The RRT not only teaches the patient, but teaches our entire team

of professionals. It is a wonderful partnership. We are truly collaborative in that

we have developed a mutual respect for each other's knowledge and expertise

Respiratory Therapists at the Erie St. Clair CCAC - Strengthing Community Care

Mario Aquilina



Respiratory Therapists at the Erie St. Clair CCAC - Strengthing Community Ca

and can learn from one another and work together to provide optimal care to ou

mutual patients” -Jon Ann Meko, CCAC Nurse Practitioner.

Looking Ahead Having this larger community presence and collaborating with many of our

community partners and stakeholders has lead us to be involved with Health

Quality Ontario’s (HQO) Expert Advisory Panel on Post-Acute Community-Based Care for COPD Patients and in preliminary discussions around an ESC

LHIN Long Term Ventilation Pilot Project. We are also currently looking

at building capacity within our Telemedicine program by expanding intoTelehomecare and perhaps the role of the RRT will be enhanced further.

Within Erie St. Clair, the CCAC RRT will be engaged in the new local Health

Link project working to improve patient coordination and information

sharing, with the goal of patients receiving faster care, spending less time

waiting for services and being supported by a multi-disciplinary team ofhealth care providers at all levels of the health care system. The CCAC RRT

with respiratory care expertise, will be involved in informing the health

link project within Erie St. Clair, but also are contributing to important workinvolving chronic diseases and patient outcomes.

Submitted by Mika Nonoyama

PhD, RRT Ontario Lung Health Alliance Breakfastat Queen's Park

On November 26, 2013, the Ontario LungHealth Alliance hosted an education andawareness event for Members of ProvincialParliament. We were lucky enough tohear about the importance of lung healthinvestment from speakers including theHonourable Deb Matthews (Minister ofHealth and Long-Term Care), Christine Elliott(PC Health Critic), France Gelinas (NDPHealth Critic) and Dr. John Granton (Chair-Elect of the Ontario Lung Association Boardof Directors). MPPs were invited to browsedisplays from Alliance organizations and wersent away with Breathers United goody bags



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Spotlight on

Jenn Lewis , RRT

L ife tends to take us in many different direction

Some paths end where we expect them to, while

others lead us on a completely different journey

than we originally anticipated. While the uncertain

within our mind often leads us to question at those

times if we are following the right path, once we

arrive at our destination, we only then recognize thit is where we were truly meant to be.

My whole experience started a few years ago, after I rst discovered Internationa

Children’s Heart Foundation (ICHF); a medical non-prot organization that has

become, quite literally, close to my heart. ICHF sends volunteer medical teams

including Respiratory Therapists (!) – around the world to help save the lives o

children born with congenital heart defects (CHD) in developing countries. A

a former CHD kid myself (I had open-heart surgery in my early teens), I was

eager to get involved. However, having only ever worked within adult patie

populations, my lack of pediatric experience prevented me from sending in

my resume. Undeterred, I continued to investigate other ways that I could

possibly be of assistance.

One day, while visiting their website, I came across a mention of ICH

receiving donated medical equipment from various hospitals. It was

then that the proverbial light-bulb went off above my head. We are

indeed blessed in this part of the world to continually have newermodels of equipment available to us but, as we all know, some

of that replaced or ‘phased out’ equipment that has been retired

still works perfectly well. So, several questions began to race

through my mind. What exactly did we do with it all? Did we

do anything? Had anyone considered donation as an option? A

a result, I started sending out emails within the community of

hospitals where I work (Hamilton Health Sciences, or “HHS”)

asking these very questions.6 RTSO Airwaves Winter 2



Spotlight on Jenn Lewis, RRT

This led to an email I received about a year later informing me

that nineteen ventilators (three Servo 900s and sixteen Servo

300s models) had been taken out of circulation. While they were

all still fully functional, they were no longer supported for parts

or repairs by the manufacturer and therefore, could no longer be

used by our facility. I was asked if there were any organizations that

I knew of that would want them and my reply was that I would ndsome who did.

As it worked out, ICHF was thrilled to hear about the Servo 300s and a

hospital in Kenya (connected to me through physician friends who have

served in Africa) were specically interested in the Servo 900s. The 900s

were the easier project to pursue since there were only three of them. They

needed to be delivered to Samaritan’s Purse headquarters in North Carolina,

who would then take them the rest of the way to Kenya. Samaritan’s Purse is

a non-denominational, humanitarian organization that offers medical support

to and meets the emergency needs of crisis areas throughout the world whether

the need be a result of disease, famine, poverty, disaster or war. To enable my

delivery to them, my parents suggested that we simply pack the three ventilators

up in their SUV and drive them down to North Carolina. I like road trips, so I

got the paperwork for the border and that’s exactly what we did. We even got a

tour of the Samaritan’s Purse World Medical Mission warehouse while we were

there. It is lled with countless donated medical equipment and supplies that

can be shipped all over the world. It was truly inspiring!

After that, the next step was to get the remaining sixteen ventilators to

ICHF’s warehouse in Tennessee. It was far too big of a shipment (over

720kg!) to pack up in my parents’ SUV; this time we were going to

need some professional help. Therefore, I started investigating various

shipping companies and requested price estimates from each. I think

it’s important for me to note that ICHF offered to cover the costs of

shipping but I told them I’d like to attempt to fundraise instead. It wasa decision that certainly landed me some raised eyebrows. However,

ICHF approximates it costs about $2000 for every cardiac surgery

they perform on a child and I couldn’t escape the thought that the

shipment might cost the same amount. I really wanted ICHF to

incur no costs for countless amounts of donated or, at least, as

little as possible. We had to try, right?




Unfortunately, the price estimates that I received from several

shipping companies ran from $2500 to $3000. I then decided

to apply for some “charitable” transports (aka, free) but to my

disappointment was not accepted. Eventually (or in retrospect), I

discovered the blindingly obvious truth that the more work we did

ourselves, the less the overall cost would be. Instead of getting one

shipping company to do all the work, we’d break it down and separatthe things we couldn’t do ourselves from the things that we could do.

Maquet-Dynamed put me into contact with their transporter, Agility

Logistics, who then put me into contact with a customs broker, Cole

International. Friends and co-workers volunteered to help dismantle and

package the ventilators. I simply acted as a sort of ‘middle-man’ to mainta

the organization between these two different process components. The end

result was that the estimated total cost dropped to $1200 but I still believedwe could do more so our goal of raising additional funds went into action.

The fundraising was accomplished through rafe baskets within the Hamilton

hospitals, as well as a website with online donations through PayPal. We spread

the word about the fundraiser through various mediums; from work emails to

social media networks, like Twitter and Reddit. Astonishingly, because of the

amazing generosity of everyone who got behind the project, our fundraising

goals were surpassed. After the ventilators shipped and all the bills were

paid, we actually had an extra $410 left over – every cent of which was

then sent to ICHF as an additional monetary donation.

I am extremely proud of and grateful for the opportunity to have

been a part of these projects but I can’t help but believe it’s only the

beginning. I’ve had multiple staff members from across HHS contact

me about more phased out equipment in their own respective areas

and wondering if it could also be donated. Even while reading this,

you might know about some, as well. Maybe it’s time we somehoworganize a way for hospitals and non-prots to have a line of

communication about availabilities and needs. In the interim, let’s

keep these ideas and discussions going and maybe, together, one

day we can nd the path that will lead us to that destination!

Spotlight on Jenn Lewis, RRT




Pioneers ofEndotr acheal Intubation

First and foremost, I must make my apologies to Professor StephenHawking and his work, A Brief History of Time, for the title. I’veoften thought that medical history, specically the history related torespiratory therapy, had some really unique stories as well as a fewcurious personalities and characters. As such, we at the RTSO Airwaveshave developed this new regular feature (when we have time and space)to look at some of the more relevant gures and events in our history inhopes that they might offer an interesting read. - D.M .

Submitted by

Dave McKay RRT,

RTSO Airwaves Editor

A irway management has been a major role of respiratory therapy fordecades but the clinical management of the airway has been a medical practicefor thousands of years. In fact, evidence of tracheostomy procedures have beentraced to Egyptian tablets that date as far back as 3600BC and Hindu scripturesfrom 2000BC. Alexander the Great (356-323BC) was said to have saved a soldierby making a tracheal incision with his sword to alleviate his suffocation whileAntyllus, one of the most important physicians in Greek antiquity and Galen,a Roman physician, each made descriptions of tracheostomy in the secondcentury AD (Doyle, 2009). However, it wasn’t until the latter parts of the

19th century and early decades of the 20th century that the acceptance andprocedure of endotracheal intubation, nally took root.

Endotracheal intubation was rst described in 1543 when AndreasVesalius demonstrated the procedure as a means to allow articialventilation during resuscitation (Thomas & Moss, 2014). Unfortunately,it would take centuries before others took notice of the possibilities thatintubation could provide and fulll. Many names can be describedwhen we reect upon the equipment and devices developed to enable

endotracheal intubation but other individuals stand out when wereect upon the actual process of intubation and the promotionof its practice as a standard of care for airway management andanaesthesia. Some of those worthy of that acknowledgementinclude Dr. Joseph O’Dwyer (1841-1898), Sir William Macewen(1848-1924) and Sir Ivan Magill (1888-1986).

Born on the Isle of Brute on the Firth of Clyde, Scotland in 1848,William Macewen graduated from the University of Glasgow

in 1872. A brilliant surgeon, Macewen rst worked at the



Pioneers of Endotracheal Intubation


Western Inrmary and then the Royal Inrmaryin Glasgow. While there, he frequently lectureat the Royal Inrmary School of Medicine. Asa former student of Joseph Lister, his theoriesand practice of aseptic techniques werereadily accepted by Macewen. He not onlyutilized them throughout his career, he also

revolutionized these techniques within theoperating theatre (NHS Greater Glasgow andClyde). In fact, Macewen was one of the mostinnovative surgeons of his era and greatlyadvanced many practices of neurosurgery (braand spinal cord), orthopaedic surgery (bonegrafts), thoracic surgery (pneumonectomy)and the newly emerging eld of anaesthesia.As such, he is credited as the rst practitioner

to employ endotracheal intubation in clinicalpractice (Young, 2009).

Since the eighteen century, the use oforotracheal intubation was limited primarily

to resuscitation techniques while tracheostomy remained the preferred methodfor controlling and protecting the airway. Macewen was aware of this but hewas also aware of previous oral endotracheal airway placements for infectiousor edematous airway obstructions. As a result, he set out to establish a greater

understanding toward a less invasive approach to airway management thatcould be used with regularity. He rst conducted post-mortem experimentsvia both the oral and nasal route. Nasotracheal intubation proved difcult.This was likely the result of materials utilized to construct tubes at that timewhich was often coiled wire wrapped in leather. However, Macewen alsostated that using a stylette or directing with a nger placed in the oropharynxoffered some aid but disappointedly reported that the technique could not bcompletely relied upon (Haridas, 2011).

Once Macewen felt competent in his blind, digital oral intubationtechniques, he used this methodology for airway management for the rsttime during a surgical procedure on July 5th, 1878. The patient, a 55-yeaold male, suffered from an epithelioma on the right side of his mouth atthe base of his tongue leading into the pharynx and understanding theneed to remove the growth, consented to allow Macewen to performthe procedure using his newly devised method of airway management(Haridas, 2011).

Dr. William MacewenRetrieved from: http://www.hharp.

org/images/glasgow_william_macewen/400.jpg





The patient tolerated an awake-intubation prior to an induction withchloroform. Once anaesthetized, a closed sponge was xed within thelaryngeal orice to prevent aspiration of blood to the lower respiratorytract. Post-operatively, once the patient had regained consciousnessand the bleeding subsided, the tube was removed. Macewen was elatedbecause the process of oral intubation answered all of the purposes itwas intended to. The patient ventilated effectively; the administration of

anaesthetic was easily administered; the surgery was uninterrupted; theairway was protected and no complications arose following the procedure(Haridas, 2011). Macewen documented the successes of his approach in thepages of the British Medical Journal. It was not long after that, that others wereattempting similar approaches for a variety of clinical needs.

Joseph O’Dwyer was born in Cleveland, Ohio in 1841 but much of hischildhood was spent near London, Ontario where he was educated. While there,he also spent his rst two years of medical apprenticeship under the tutelage of

a local physician. O’Dwyer then entered the Collegeof Physicians and Surgeons (New York), graduatingin 1866 at the age of 25. After 2 years as a “sanitarysuperintendent” at the New York Charity Hospital,O’Dwyer entered into a general practice and latergained appointment as a staff member of the Sisters ofCharity New York Foundling Asylum (NYFA) where hedevoted most of his life to obstetrics and the medicalcare of children in need (Trubuhovich, 2008).

At the end of the 19th century, the prevalence ofdiphtheria was on the rise. During this period, manychildren were developing this gram-positive bacilli(Corynebacterium diptheriae) infection and as suchwere also developing the hallmark pseudomembranethat so often complicated the illness and heightenedmortality. Consequently, O’Dwyer was in angst afterseeing so many children at the NYFA succumb to

diphtheria due to asphyxia caused by closure of thelarynx so he used an intralaryngeal spring wire andexperimented with a bivalve speculum to no avail(Walsh, 1919). O’Dwyer invested countless hours studying cadaver airways foranatomical learning and performed intubation trials on them withseveral supraglottic devices that he had devised. Once his focus shiftedto utilizing tubes that offered intralaryngeal placement whereby the

tubes had a collar that to rest on the vocal cords, he nally found

Joseph O'Dwyer Retrieved from: http://fr.wikipediaorg/wiki/Joseph_O'Dwyer





some of the success he strived for so long to achieve. A colleague andco-researcher by the name of William Northup would later state that

O’Dwyer’s achievement was not a ash-in-the-pan but rather a tormentand prolonged, systematic study for over half a dozen years. Clinical use

and post-mortem discovery would lead O’Dwyer to eventually lengthen tubes to within half an inch of the tracheal bifurcation to bypass obstructio

and change construction from nickel-steel to hard, vulcanized rubber tube

O’Dwyer later hailed the survival of a four-year-old girl in 1884 as the rstrecovery in the history of intubation (Trubuhovich, 2008).

By the end of the century, intubation began to become less of a necessity asEmil von Behring’s antitoxin for diphtheria gained wider acceptance and use.

However, O’Dwyer maintained a steadfast belief that airway intubation serveda necessary purpose. He developed a successful technique of using his tubes

in the Fell method of forced respiration. This method of articial ventilation isnamed after Dr. George Fell, born in Chippewa, Ontario, who was an engineer a

physician who practiced medicine in Buffalo, New York. Fell has been credited asthe grandfather of mechanical ventilation by developia bellows device that could be used with a tracheostotube and provide positive pressure to enable assistedbreathing (Trubuhovich, 2007).

The contributions of Sir Ivan Whiteside Magill to the of anaesthesia and the practice of airway managemencannot be overstated. His genius and inventiveness

resolved a number of issues that plagued the equipmeand techniques of anaesthesia in the early years of thetwentieth century and of the medical discipline, itself.

Born in Northern Ireland in 1888, Magill attendedQueen’s University in Belfast and as a medical studenreceived a certicate verifying that he personallyadministered an anaesthetic and as such was nowqualied to do so for any type of operative procedure.

During the era of Magill’s training, this singleadministration was the only statutory requirement.He later commented that this process of training wasutterly inadequate and referred to the administrationof anaesthesia as an “onerous task” which inevitablyfrightened him (McLachlan, 2008).

Upon graduating medical school in 1913, Magill initiaworked as a general practitioner but soon began serving as a House

Surgeon and subsequently as the Resident Medical Ofcer in Liverpo

Sir Ivan Whiteside Magill Retrieved from: http://calder.med.miami.edu/Ralph_Millard/photos/ Sir_Ivan_Magill.JPG





The advent of the Great War quickly led Magill to join the Royal ArmyMedical Corps (RMAC) where he served as the medical ofcer for therish Guards until the end of the conict in 1918. The majority of hisservice involved deployment along the frontlines of the battleeld triagingthe wounded and tending to the sick. As a result, he had little exposureto the operating theatre to practice as a surgeon. In fact, at the war’s endand without much surgical experience, Magill described himself as an

anaesthetist while being discharged from the RMAC. Little could he foreseethe future surgical and anaesthetic advancements that he would subsequentlydevelop after making this impromptu claim (McLachlan, 2008).

Because of this proclaimed specialty as an anaesthetist, Magill was assignedto the Barnet War Hospital to administer occasional anaesthetics and laterto the Queen’s Hospital at Sidcup, Kent which specialized in traumatic facialand jaw injuries. While there, Magill was challenged to administer some of themost hazardous anaesthetics to a variety of complex, reconstructive surgical

cases. However, the administration of anaesthetics no longer disturbed Magill;nstead it reportedly intrigued and invigorated him. It also initiated his regular

use of endotracheal intubation. Until this time, general anaesthesia was still beingprovided by drip mask techniques covering the mouth and nose or by endotrachealnsufation which involved the use of a gum-elastic catheter positioned into the

pharynx through which a mixture of air and vaporized ether was provided viaa motorized pump. Both techniques were obtrusive to the surgeon and neitheroffered the benet of complete anaesthesia and still, the latter could not alwaysprevent airway obstruction (Dundee, 1987).

Part of the difculties with the insufation technique also included the fact thatthe surgeon was inevitably exposed to the anaesthetic-laden expirations ofthe patient and any blood that may have been coughed out. In 1922, Magillnadvertently devised a solution to this when, during an extensive surgicalprocedure, the deformity of a patient’s jaw prevented adequate expiration andwas the causation of laboured breathing. To resolve this issue, Magill passeda second tube through the patient’s nose into the trachea which offered anmmediate relief. Magill then advocated this technique for many years to

come (McLachlan, 2008).

As Magill’s experiences continued, he further explored the use ofendotracheal intubation primarily via the nasal route. This not onlyprovided a secure and unobstructed airway, it also removed theanaesthetist himself from the surgical eld permitting better accessto the face and jaw. The airway and ventilation could both now becontrolled which offered a distinct advantage as techniques of thoracicsurgery advanced. Prior to this, thoracic surgery had been plagued by

difculties arising from paradoxical respiration whereby, with an open




chest, a spontaneously breathing’s exhaled volume would simply shunfrom one lung to the other rather than being exhaled. Hypoxia and

hypercapnea could then result. By fashioning a balloon at the end of hisendotracheal tube, Magill was able to isolate the lungs and control the

patient’s ventilation (Dundee, 1987).

Blind nasotracheal intubation techniques were rst developed and detailed

by Magill in 1928. He later published his ndings in 1930 when interestin his methods had arisen. In 1932, Magill demonstrated his airway skills

for the Society of Anaesthetics in Liverpool referring also to the necessityof positioning the patient’s head as if he were to "sniff the air" to facilitate

insertion (McLachlan, 2008). However, it wasn’t until the end of the decadeand the beginning of the next that endotracheal anaesthesia nally became

widely accepted.

Throughout the remainder of his career, Magill continued to rene anaesthetic

apparatus and develop new ones as well as pioneering other anaesthetictechniques and providing several notable contributions to the eld. For this reason

he is often referred to as the father of modern anaesthesia.

While the names of these gentlemen should be respectfully remembered by allperformers of airway management, others like Sellick, Macintosh, Miller, andMurphy are also names of key contributors, whether it is as equipment inventors opractice innovators. Every life that has been saved directly or enhanced indirectly(post-operatively) because of endotracheal intubation also owes a bit of gratitude

to all of them.

References:Doyle, D.J. (2009). A brief history of clinical airway management. In Anesthesiology NewGuide to Airway Management. 9-14. Retrieved December 16, 2013 from: http://www.anesthesiologynews.com/download/ANSE08_HistoryWM.pdf

Dundee, J.W. (1987). Anaesthetics: With special reference to Ivan Magill. Ulster Medical Journal. 56. S87-S90. Retrieved January 14, 2014 from: http://www.ncbi.nlm.nih.gov/

pmc/articles/PMC2448193/pdf/ulstermedj00087-0090.pdf

Haridas, R.P. (2011). Sir William Macewen and the rst orotracheal intubation foranesthesia and surgery. The Airway Gazette. The Society for Airway Management.Retrieved December 16, 2013 from: http://samhq.com/wp-content/uploads/2011/09/FINAL-SEP-OCT-2011-Gazette.pdf

McLachlan, G. (2008). Sir Ivan Magill. Ulster Medical Journal. 77(3) 146-152.Retrieved January 18, 2014 from: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2604469/





Thomas, E.B.M. & Moss, S. (2014). Tracheal intubation. Clinical Anaesthesia 15(1) 5-7. Retrieved January 15, 2014 from: http://www.sciencedirect.com/science/ journal/14720299/15/1

Trubuhovich, R.V. (2007) 19th century pioneers of intensive therapy in NorthAmerica. Part 1: George Edward Fell. Critical Care and Resuscitation. 10(2) 154-168.Retrieved December 6, 2013 from: http://www.cicm.org.au/journal/2007/december/ ccr_09_4_1207_377_trubuhovich.pdf

Trubuhovich, R.V. (2008). 19th century pioneers of intensive therapy in North America.Part 2: Joseph O’Dwyer. Critical Care and Resuscitation. 9(4) 377-393. RetrievedDecember 6, 2013 from: http://cicm.org.au/journal/2008/june/ccr_10_2_0607_154_Trubuhovich.pdf

Walsh, J.J. (1911). Joseph O’Dwyer. In the Catholic Encyclopedia. New York: Robert AppletonCompany. Retrieved December 7, 2013 from New Advent: http://www.newadvent.org/ cathen/11213d.htm

Young, D.G (2009). Sir William Macewen CB, DSc, DCL, MD, FRS (1848-1924). HHARP:

the Historic Hospital Admission Records Project. (http://www.hharp.org), Kingston University.Retrieved December 11, 2013 from: http://www.hharp.org/library/glasgow/doctors/william-macewen.html



RRT Perspective Respiratory Therapy:

Beyond the Traditional Borders


F or those of you who have been a part of our profession for as long

as I have, you will remember the days when we often questioned its

longevity. We questioned it because outside of our profession, no one

really understood what we were capable of doing. We had a broad scopeof practice but, in most hospitals, we were constrained to practice within

a limited boundary of what we could actually do. Even within those

boundaries, there were even more limitations in the care that we wereactively able to provide.

Fortunately, across the province, several dedicated Registered Respiratory

Therapists (RRTs) advocated for our role and began to break down barriers

and open closed doors which enabled us to utilize our knowledge, skill and

expertise to make an impact on patient care. The outcome enabled us to havethe autonomy of decision making regarding many aspects of the care that we

provided. This garnered the notice and recognition that we long desired and

deserved, as physicians and other healthcare providers started to take noticof what we could bring to the table and the difference that we could make

Over the last few years, RRTs have been branching out. Moving into

positions in which, only a few years earlier, RRTs would never have bee

considered for. As a versatile profession, one that often works in severaareas of the hospital with a variety of patient populations, at times

all in the same day, Respiratory Therapists can bring a background

and experience that few other healthcare professions can. Certainlywithin the hospital environment, RRTs are now found working innon-traditional roles and are making a positive impact. However,

healthcare delivery is changing and one thing, we as a profession,

need to consider is whether we are as focused on what isoccurring outside of the hospital.

As you may have already noticed, this issue of the RTSO

Airwaves has focused on RRTs who are working in non-

Submitted by

Mika NonoyamaPhD , RRT




traditional roles but outside of the acute care hospital setting andwithin the “community-at-large”. We are all aware that the population

is changing, along with the health care system around us. The burden

of chronic disease and an aging population, as well as the limitedresources that are available, has required us to seek out creative options.

The good news is that RRTs are not only doing this but also flourishing

and making direct and real impacts to healthcare delivery. There arenumerous examples of this:

• RRTs working in home care companies have been leading the way for several

years by providing home oxygen therapy and other home-based respiratory

care. Now with the addition of the fth authorized act of “administering a

prescribed substance by inhalation”, they are now able to independentlyadminister oxygen, without the requirement of an order. This will greatly benet

patients requiring oxygen therapy because RRTs will be able to provide care

more effectively and efciently.• Recently, RRTs were added to the provincial government’s “Guide to

Interdisciplinary Team Roles and Responsibilities” and the “Guide toInterdisciplinary Provider Compensation”. Individuals with chronic respiratory

and cardiac disease will benet profoundly as increasing numbers of RRTs are

integrated into more and more Primary Care Health Teams such as Family HealthTeams and Community Health Centres.

• At the Southlake Regional Healthcare, an RRT (Ana MacPherson, who was

featured in the Summer 2013 Airwaves) has accepted the role of coordinator ofthe South Simcoe and Northern York Region Health Link Ontario Telemedicine

Network (OTN) Telehomecare program. The main objective of this program

is to reduce the impact of complex chronic diseases for patients within thehealth care system, starting with COPD and CHF. She is the rst RRT to be

hired for such a position.• Within several Community Care Access Centres (CCACs), including the

North Simcoe Muskoka and South East CCACs (in conjunction with

Professional Respiratory) and the Toronto Central CCAC (in conjunction

with West Park Healthcare Centre), RRTs are involved with the transitionand continuous follow-up of patients with complex respiratory needs such

as non-invasive and invasive ventilation and tracheostomy care.

And the list goes on…such as those featured in the most recent edition

of The College of Respiratory Therapists’ publication The Exchange (Fall2013)…and further in this edition of Airwaves. In this edition, we feature

the work of four RTs who work beyond the traditional borders. First is

Ivan Nicoletti, a care coordinator for the Erie St. Clair CCAC. Second are

Respiratory Therapy: Beyond the Traditional Borders



Respiratory Therapy: Beyond the Traditional Borders

Madonna Ferrone and Amy Reid of the Asthma Research Group Windso

Essex County Inc. (ARGI) and the nal article is by Carole Madeleywho is the Director of Respiratory Health Programs at The Ontario

Lung Association. Each article describes a broad range of experiences of

Respiratory Therapists in the community.

Madonna is the manager of the Asthma Research Group Windsor-Essex

County Inc. (ARGI, https://www.argi.on.ca/ ), which is a not-for-protcorporation leading the implementation and evaluation of the Essex County

Community Care Asthma Strategy. It recently received an honourable mention

for the 2013 Minister’s Medal Honouring Excellence in Health Quality andSafety. There were 140 applicants with one team winner and one individual

winner and 7 honourable mentions. Ivan, who was also mentioned in the Summ

2013 Airwaves was awarded the provincial leadership award at the annual OntarAssociation of Community Care Access Centres’ Awards for Excellence ceremony

The intent of this article is to rstly, acknowledge those RRTs who are currentlyworking in roles outside of the hospital and making change happen. Secondly,

is to inspire those who are thinking of making the leap. We, as a profession, have

predominantly worked within the connes of the hospital setting practicing in amedical curative approach. Despite the number of practicing Respiratory Therapists

having increased over the years; this approach is not fullling the needs of the

population because the burden of chronic cardio-respiratory diseases is alsoincreasing. Consequently, we as a profession need to pay attention to these issues

and start to focus on proactive movements and positions within the disciplines o

primary health, disease prevention and health promotion to lessen these burdenon acute care services and improve the cardio-respiratory health of all Ontarian

We need to do this before another profession assumes this responsibility.

Over the last two decades, Respiratory Therapists in hospitals across Ontario

and across the country have proven our value to the healthcare system. Today

we must break down any barriers that may exist and show that the strength o

our profession is not only found within the boundaries of the hospital wallsbut also beyond, reaching out to our healthcare clinics, our communities

and our homes. Let us hope that the accomplishments of Ana, Amy, CaroleIvan and Madonna are simply the preview of what is yet to come from

other Respiratory Therapists! Respiratory Therapists like you!



In this edition I decided to write on trust and getting rid of negativity.I have found that without trusting those you work with, one cannot

build a solid relationship. We have all seen that negativity can spreadlike a bad airborne virus, thus doing what you can to rid the teamof negativity should be paramount, for not only managers, but forall team members. Once trust and positivity is present within yourdepartment or team, only then can you truly come to work happy;able to enjoy your shift and feel proud of delivering excellence inpatient care.

Trust Your Team

Although skepticism has its merits, trust is crucial to team effectiveness. Tocultivate trust among your team members, place your trust in them rst andforemost. Show them that you believe that they are competent and capable.Value their contributions by trusting them with increasingly challenging tasks andgive them the autonomy they need to shine. Managers who ‘test’ employees cando serious harm to the overall well-being of the team. Trust is a two-way street,and the sooner you start walking down your side, the sooner the team members(frontline employees) will accelerate down theirs.

Get Rid of NegativityEvery department or team unit has both good and bad. As a manager, is it yourjob to accentuate the positive and eliminate the negative? You should try todo both but studies have shown that negative information, experiences andpeople have a far deeper power and impact than positive ones. A better use ofyour time and energy is to focus on clearing your team or unit of as many ofthe negatives as you can. This may mean tearing down frustrating obstaclesor shielding people from destructive behaviours. Grumpiness, laziness andnastiness are contagious, and by reducing these forms of negativity, you

then give your team a better chance for success.

Lucy Bonanno, RRT, MA, MBA, CAE, CHEExecutive DirectorSummerville Family Health TeamT: 905-272-9700 ext [email protected]

Management’s Corner




Ask aRTeeDear aRTee,I suppose while you spend the timeresearching your answers, you have likely

read a lot of journals, present day andhistorical. What are some of the things thatyou have come across that make you scratchyour head?

What’s Between the Lines?

Dear WBL,It’s not so much that things make mescratch my head because as we shouldexpect, therapies and technologieschange over time. This is in part dueto research and development but it isalso simply due to experience. To someextent, when I do read one of thosethings, it becomes more of a realization

of how far we’ve come. In any case, yourquestion actually does bring two cases tomind that I have come across over the years.

The first is in regards to a letter to theeditor of Chest in 1979. The letter waswritten by Dr. Gwendolyn Graybar, ananaesthesiologist who at the time wasworking in New Orleans. It seems that

Dr. Graybar took offence to a Puritan-Bennett (PB) advertisement regardingthe MA-1 in a previous issue of Chest.Twelve years earlier, PB had introducedthe MA-1 as the first volume-cycleddevice and by doing so ushered in a newage for ventilatory support. During the1970s, the MA-1 held the market shareof ventilators used in critical care units

throughout NorthAmerica. However,by end of the

1970s, PB wasstill advertisingthe MA-1 as “themost advancedlife support systemavailable” and “the most advancedvolume ventilator” causing Dr. Graybarto refute this claim.

Despite Dr. Graybar’s aversion to theadvertisement, the most interestingaspect of her letter today is her perceiveinadequacies of the MA-1’s capabilitiesHer greatest quarrels were that ofthe flow limitations and even moreconcerning was that it could not providthe necessary pressure to adequatelyventilate patients within her critical car

unit who had poor lung compliance,high airway resistance or both. To fortifthe justification of her argument withinthe letter, Dr. Graybar referred to arecent patient under her care, who shebelieved would have died if the MA-1was used, because the device was notable to generate the “required peakpressure of 110 cm H2O” to deliver the

appropriate tidal volume desired.

Surprisingly, only twenty-one years latethe ARDSnet study was published andoutlined the necessity of ventilatingwith small tidal volumes and controllingairway pressures. Today, these lungprotective strategies are still the normand even the idea of utilizing peak



pressures of 110 cmH2O to ventilate apatient will quickly send a shiver downthe spine of any Respiratory Therapist.

The second thing that comes to mindmay lessen the complaints from thoseof you who are still forced to provide

wet-nebulized bronchodilators. It seemsthat in years past, one common form ofadministering a bronchodilator was viathe use of rectal ether.

In a July 1966 issue of the BritishMedical Journal, a physician fromthe Queen Elizabeth Hospital inBirmingham, England by the name

of F.W. Wittmann described a recentcase of intractable status asthmaticusat his facility. Despite conventionalbronchodilator therapies (He does notdescribe what was used) for the time, aswell as aminophylline, oral prednisoloneand intravenous hydrocortisone, thispatient continued to deteriorate.

Running out of options, Dr. Wittmannturned to a “time-honoured”bronchodilator, that being ether.

Unfortunately, Dr. Wittmann felt that inthis particular case the patient’s dynamichyperinflation and subsequent small tidalventilation would make administrationof ether via inhalation futile. As a result,

he elected to administer rectally usinga solution of anaesthetic ether (65%)mixed with warmed olive oil (35%). Thismethodology was more commonly usedas delivery mechanism for analgesiaduring child birth but had beenpreviously cited in several anaesthesiatexts as a means for bronchodilation(e.g.: Cullen, 1948, pg. 93). He then

administered 100ml of the solutionand within 30 minutes the patient hadmarkedly improved.

As we can see nearly forty and fifty yearlater, advancements have occurred inboth therapeutic interventions that migh

today, permit us a desire to scratch ourheads when we read articles of thisnature. However, in their day, they weretreatment options that had justifiablemeasures that enabled acceptance intopractice. In addition, forty to fifty yearsfrom now, one has to wonder how manyof our common practices will have futurclinicians reaching for their heads.

References:Cullen, S.C. (1948). Anesthesia in generalpractice. Chicago, Ill: Yearbook Publisher Inc

Graybar, G.S. (1979, January). The mostadvanced respiratory life support systemavailable. [Letter to the editor]. Chest 75(1), 106 Retrieved from: http://journal.

publications.chestnet.org/data/Journals/ CHEST/21016/106.pdf?resultClick=1

Wittman, F.W. (1966, July). Rectal etherin intractable status asthmaticus. BritishMedical Journal 2(5506) 172 Retrieved fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1943712/pdf/brmedj02350-0072d.pdf



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RTSO Airwaves Winter 2014