ACKNOWLEDGEMENTS

The RTSO would like to thank the 2018- 2020 Co-chairs and members of the Leadership and Community Care Committees for their contributions to this document. The document has been reviewed and approved by the RTSO 2019-2020 Board of Directors.

We would also like to acknowledge special review and feedback from RRT colleagues Rob Bryan, RRT-AA, A-EMCA, Jason Macartney, RRT, Michael Finelli, RRT, NRCP Akhilesh Patel, RRT, BSc, Janet Hyatt, RRT and Tara Fowler RRT, CHT, MHSc and recognize Nancy Garvey RRT, MAppSc, for her work coordinating and consolidating the final document.

Registered Respiratory Therapist (RRT)
Integrated Role Profile in Ontario

Hospital, Primary, Home, Long-Term, Palliative, and Complex Care, Private Clinic and Industry Practice Settings

Objective:

This document is intended to provide a broad, inclusive role description for registered respiratory therapists (RRTs) working in a variety of practice settings across the continuum of care, demonstrating that with our specialized expertise, RRTs can have a positive impact on patient, caregiver, and provider outcomes. The goal is to maximize quality, safety, health, and health care utilization outcomes across those settings, and through transitions in care within a patient centric model of care.

Introduction:

As integral members of the interprofessional health care team, RRTs support the Ontario Ministry of Health vision for health care through the provision of cardiorespiratory expertise to:

  • Improve the patient experience
  • Focus on patients’ and specific local needs
  • Assist patients, families, and caregivers to navigate the system, and experience transitions from one health provider to another and/or one health care setting to another more easily, and
  • Reduce “hallway medicine” in acute care facilities.

RRTs make unique contributions to integrated patient care across the health care system by providing specialized cardiorespiratory expertise in the context of evidence-based care plans from emergency visits to admission and discharge including all transitions in care to the community and primary care settings. RRTs advocate for patients and their caregivers especially the vulnerable.  Patients who have or are at risk of developing chronic (e.g., chronic obstructive pulmonary disease [COPD], asthma, etc.) and/or infectious (e.g.,  pneumonias, severe acute respiratory syndrome [SARS]) respiratory diseases or experience an acute respiratory event related to an accident or harmful exposure to chemicals/other account for significant utilization of health care services in Ontario.

The COVID-19 pandemic highlights the importance of the RRT role in caring for the respiratory care needs of patients across the continuum with both preventive counselling to high risk patients, and care for those affected by the disease. It has also highlighted the impact of post traumatic distress disorder (PTSD) on first responders, including RRTs, who play an integral role in the critical care of acutely ill COVID-19 patients.

RRTs provide services to patients, caregivers, interprofessional teams, students, and administrators through direct patient care, diagnostic testing, education, and administrative supports, including program development. Contributions as subject matter experts are made to the development and modification of electronic records, quality improvement processes, policies and procedures, medical gas supply and system pipeline design and maintenance, and other relevant interprofessional team functions and processes.

The following identify key responsibilities related to care for adult, pediatric, and neonatal patients across all practice settings, followed by those additional responsibilities related to the particular settings:

  • Hospitals:
    • Inpatient Settings:
      • Critical care (neonatal, pediatric, and adult), emergency response teams, emergency department, surgical suite, labour and delivery, and all inpatient wards
    • Surgical Suite: Anesthesia Assistants
    • Ambulatory Care Settings:
      • Clinics, education and rehabilitation programs, bronchoscopy suite, sleep laboratories, hyperbaric
      • Cardiopulmonary and related diagnostic testing
  • Primary Care (Family Health Teams, Community Health Centers, etc.)
  • Home, Long-Term, Palliative and Complex Care
  • Private clinics
  • Private industry

Note: A bibliography with related evidence is included in the Appendix.

KEY RESPONSIBILITIES ACROSS ALL PRACTICE SETTINGS

The RRT

  • Is accountable for the interpretation and implementation of respiratory therapy protocols, medical directives, and medical orders for the provision of:
    • Emergency and routine respiratory therapy assessments, treatments, and interventions, including respiratory ventilation strategies, and defibrillation during medical emergencies
    • Standard and specialized inhaled medications
    • Respiratory diagnostic testing, such as spirometry, oxygen saturation, blood gas analysis, vital capacity, negative inspiratory and positive expiratory force measurements to aid in the assessment and diagnosis of respiratory impairment
    • Assessment and management of patients with tracheotomy tubes including interventions such as suture removal, tube changes, including determination of patient appropriate size and type of tube required, determination of patient suitability for weaning, corking and decannulation parameters
    • Use of point of care ultrasound to guide arterial line insertion, perform diaphragm thickness measurements/movement and lung assessments and to guide line insertion
    • Care related to the management of patients supported via extra corporeal life support systems
    • Cerebral function monitoring in neonates at risk for seizures
  • Leads the development of evidence-based coordinated care plans for specified groups of patients relative to needs of the patient and their caregiver, such as quality-based procedures (QBPs) for chronic obstructive pulmonary disease (COPD), including those with complex needs and multi-morbid conditions, to maximize health outcomes.
  • Uses critical thinking skills to assess information on patient’s medical, biomedical, laboratory parameters, psychosocial, and ethno-cultural background through the patient’s medical charts, online data. Patient-centered interviews help assess and address potential barriers, and guide decisions, care, and recommendations for therapy and treatment.
  • Provides relevant diagnostic testing, including point-of-care (POC) testing along with quality assurance, quality control, and maintenance of device/s in accordance with established medical and manufacturer’s standards. Maintenance includes but is not limited to pulmonary function testing, oximetry, and arterial blood gas collection and analysis.
  • Leads and/or participates in relevant quality improvement, evaluation and/or research initiatives within hospital and other practice settings. This may include collaboration with internal as well as external partners, assessing process and outcome measures that impact the providers’ and patients’ experiences and health outcomes, and improving respiratory therapy practice.
  • Provides clinical and technical expertise for respiratory and critical care equipment, including verification of functions, quality control, and application of treatment modalities of all respiratory therapy life support ventilators and adjunctive monitoring equipment, to ensure quality and safety in the administration of respiratory care by other health care providers.
  • Identifies, manages, monitors, and reports adverse reactions to medications, flu shots, blood products, vaccines, subcutaneous allergy, and other injections to facilitate the prevention, diagnosis, and treatment of respiratory-related conditions.
  • Actively engages in safety and incident reporting, including adverse reactions and medical device incidents, debriefing of critical events, and simulation experiences to enhance patient care and safety.
  • Leads the development, implementation, and evaluation of Lung Health-related programs, including policies and procedures within a quality improvement framework, in collaboration with management and other relevant team members ensuring patient-centred care, guideline compliance, and best practices.
  • Provides respiratory and related education services, both on an individual and group basis in response to the specific needs of patients, their caregivers, interprofessional team members, students, and/or community groups.
  • Provides guidance and mentorship to respiratory therapy students and their counterparts in other healthcare disciplines. Their role includes supervision, ensuring fulfillment of clinical competencies, direct assessment of performance, and feedback through direct conversation and the use of standardized performance tools.
  • Actively engages in education and ongoing professional development by participating in webinars, courses, conferences, focus groups, journal reviews, and other related activities.
  • Contributes to the planning and strategic direction for the organization and relevant partners, such as Ontario Health Teams initiatives and Local Health Integration Networks, including policies, procedures, the implementation of relevant regulations, compliance with accreditation standards, industry standards and guidelines, patient safety processes, as well as identifying health equity and other relevant issues that impact patient outcomes and organizational processes and efficiency.
  • Collaborates, recommends, and develops best practice guidelines with Infection Prevention and Control to ensure safe practice during respiratory therapy procedures.
  • Actively participates in the implementation, training, and evaluation of electronic health record systems, equipment evaluations, and transition planning.

HOSPITAL INPATIENT SETTINGS: CRITICAL CARE (NEONATAL, PEDIATRIC AND ADULT), EMERGENCY RESPONSE TEAMS, EMERGENCY DEPARTMENT, SURGICAL SUITE, INPATIENT WARDS– ADDITIONAL RESPONSIBILITIES

In addition to key responsibilities across all practice settings, RRT in acute care facilities:

  • Assumes a first responder role as a member of emergency response teams. Examples include: emergency resuscitations, medical gas failures, fires, patient evacuations, CBRN (chemical, biological, radiological and nuclear), SARS (severe acute respiratory syndrome), Ebola, SARS-2/ COVID-19 and other disaster plans, assessing, monitoring and managing neonatal, pediatric, and adult critically ill patients, as well as those inpatients with complex respiratory and/or related conditions.
  • Identifies patients requiring ventilatory support, supplemental oxygen and/or other respiratory care procedures by assessing patients, participating in interprofessional rounds, performing respiratory screening and through consultation with the interprofessional health care team.
  • Provides monitoring of critical care, surgical and ambulatory patients, as applicable, including heart rate, respiratory rate, blood pressure, pulse oximetry, end-tidal carbon dioxide, and other relative parameters.
  • Enhances patient safety and enables best practice related to the provision of treatment and therapy by delegation, as per Regulated Health Professions Act (RHPA) controlled acts. Delegation to physiotherapists, occupational therapists, or other healthcare providers, including a process of education, testing, and sign off to ensure competency.
  • Uses RRT driven evidence-based protocols to initiate, administer, monitor, titrate and discontinue:
    • Mechanical ventilation to ensure optimal patient ventilatory care, including use of conventional and specialized modes of ventilation, such as high frequency oscillation and high frequency jet ventilation,
    • Lung volume recruitment therapy,
    • Bronchodilator therapy, oxygen therapy, and other specialty medical gases, such as heliox, inhaled nitric oxide, and epoprostenol sodium for the treatment and prevention of oxygen insufficiencies, airway obstruction, bronchospasm, pulmonary hypertension, and rescue therapy in difficult to oxygenate and ventilate patients.
  • Responsible for patient preparation, including administration of topical anesthetic to upper airway, application of hemodynamic monitoring, inserting intravenous lines, providing clinical expertise in the performance of bronchoscopy in the operating room, critical care, and ambulatory clinics, to facilitate diagnostic sampling, therapeutic lung intervention, percutaneous tracheostomy insertion, and radiation therapy administration (brachytherapy).
  • Responsible for patient monitoring and clinical expertise in circumstances of difficult or emergency airway management, including awake/asleep fiberoptic intubations, failed airway management (cannot secure an airway or ventilate a patient), medical conditions which indicate known or suspected airway emergencies (unstable c-spine, airway edema, cervical spine collar in place etc.), and procedural sedation in areas inside and outside of the operating room, such as cardioversions or fracture reductions in the emergency department.
  • Performs radial arterial line insertion, monitoring and troubleshooting which facilitates invasive monitoring of patients with hemodynamic instability and allows for the procurement of arterial blood samples to evaluate effectiveness of treatment and intervention.
  • Performs arterial, venous, and capillary puncture, through medical directive or direct physician order, to allow procurement of blood samples for laboratory analysis to guide evaluation of patient condition, response to treatment and therapy.
  • Performs arterial blood sample analysis and daily quality assurance, troubleshooting, and maintenance of blood gas analyzers  in accordance with College of American Pathologists (CAP), Quality Management Program – Laboratory Services (QMP-LS) and Ontario Association of Medical Laboratories (OAML) to support patient assessment in the critical care, operating room, emergency department, and other areas of the hospital.
  • Performs respiratory management and patient monitoring of critically ill patients during transfers outside the critical care unit for diagnostic testing and therapeutic procedures, such as CT, MRI and angiography.
  • Provides critical monitoring and ventilatory management outside of critical care areas to ensure safety and management of critically ill patients requiring ventilation or airway support during emergency and urgent care until such time as they can be transferred to a critical care area.
  • Perform intubation and laryngeal mask insertion as per medical directive, and urgent care guidelines to facilitate resuscitative and ventilation interventions.
  • Determines readiness for and performs extubation, as per medical directive and hospital policy.
  • Provides support for patients requiring invasive hemodynamic monitoring and intravenous volume therapy through the insertion of arterial and venous lines, and the set up and assistance in the insertion of central venous and pulmonary artery lines in the operating room, critical care and emergency department.
  • Provides support for patients requiring extracorporeal life support systems as per medical directives and hospital policies, including management of veno-arterial, veno-venous extracorporeal membrane oxygenation, and other ventricular assist and extracorporeal devices.
  • Initialization and monitoring of non-invasive positive pressure ventilation (BiPAP, CPAP) to assist in the emergency and routine management of patients with ventilatory and oxygen insufficiency.
  • Performs all necessary testing to determine patient’s eligibility for home oxygen therapy, and interpretation of test results, to determine patient’s oxygen prescription at rest, sleep, and on exertion as per provincial guidelines in order to facilitate safe and timely discharge from the acute care hospital.
  • Liaises with home care partners including the Ventilator Equipment Pool (VEP), to facilitate seamless patient transition from hospital to home or alternate care facility.
  • Supports escalation of patient management on the inpatient units through consultation and assessment as part of the Critical Care Outreach/ Critical Care Response teams.
  • Supports patient centered and end of life patient care on inpatient units through consultation and assessment with interprofessional staff.

HOSPITAL SURGICAL SUITE: ANESTHESIA ASSISTANT – ADDITIONAL RESPONSIBILITIES

In addition to key responsibilities across all practice and hospital settings, an RRT working as an Anesthesia Assistant (AA) ensures patient safety, maximum operative outcomes, and efficiency e.g. as a member of the pre-operative block room program, being responsible to:

  • Obtain an appropriate and accurate preanesthetic health history, perform an appropriate physical examination, and record pertinent data  in an organized and legible manner, to assess operative risk relative to individual patient’s condition.
  • Obtain diagnostic laboratory and related studies as appropriate, such as drawing arterial and venous blood samples, and any other necessary patient fluids.
  • Insert and interpret data from standard and advanced, invasive, and non-invasive monitoring modalities, such as oximeters, arterial lines, pulmonary artery catheterization, and central venous lines, as delegated by the supervising physician anesthesiologist.
  • Administer anesthetic agents and controlled substances under the direction of a supervising physician anesthesiologist. This includes, but is not limited to, administration of induction agents, maintaining and altering anesthesia levels, administering adjunctive treatment, and providing continuity of anesthetic care into and during the post-operative recovery period.
  • Perform set up, troubleshooting and use of anesthesia machines, fluid warming devices, pressure-monitoring devices, cell-saving and autotransfusion units, nerve stimulating units and ultrasound units, for the purpose of inserting pressure lines and regional blocks.
  • Establish and maintain appropriate airway management, and provide appropriate ventilatory support before, during, and after the operative procedure.
  • Conduct post-anesthesia patient rounds to ensure patients’ safe post-operative recovery.
  • Provide anesthesia support in intensive care units, pain clinics, diagnostic imaging, and other settings, as required.
  • Respond to code omegas (life threatening massive hemorrhage response team), Obstetrics Alerts (obstetrical emergency response team for expectant mothers and/or unborn neonates in distress requiring immediate intervention and possible resuscitation), back up to the code blue adult and pediatric resuscitation teams for airway support, and other emergency anesthesia care.
  • Perform and monitor regional anesthesia to include, but not limited to, spinal, epidural, IV regional, and other special techniques, such as local infiltration and nerve blocks.
  • Use point of care ultrasound to insert arterial lines, assess regional anesthesia, and estimate gastric contents.
  • Perform administrative duties in an anesthesiology practice or anesthesiology department, including management of personnel, assisting with requests for proposals and evaluation of anesthesia capital equipment, anesthesia consumable contracts, and anesthesia inventory logistics, and quality assurance programming for anesthesia pharmaceuticals, medical gases, anesthesia technologies, anesthesia related diagnostic equipment, air quality and pollution control monitoring, as outlined in the Canadian Anesthesia Society national standards and hospital accreditation requirements.

HOSPITAL AMBULATORY CARE SETTINGS: CLINICS, EDUCATION AND REHABILITATION PROGRAMS, BRONCHOSCOPY SUITES, SLEEP LABORATORIES – ADDITIONAL RESPONSIBILITIES

An RRT working in ambulatory care clinics (e.g., neuromuscular disease clinics, spinal cord, cystic fibrosis, and tracheostomy clinics) patient education and rehabilitation programs, bronchoscopy suites, and sleep laboratories, contributes to the holistic care of the patient in collaboration with the interprofessional team, and is responsible for the following Respiratory Therapy Services:

  • Assess, monitor, and manage patients during the administration of medications and aerosols for diagnosis and establishment of treatment plans.
  • Responsible for calibration, quality control, maintenance compliance, and operation of stress testing systems, bronchoscopes, sleep study systems and electroencephalographic systems as required.
  • Provide patient preparation, including administration of topical anesthetic to upper airway, monitoring and clinical expertise in the performance of bronchoscopy to facilitate diagnostic sampling, therapeutic lung intervention, and radiation therapy administration (brachytherapy).
  • Responsible for clinical assessment, monitoring, and direct supervision of respiratory compromised patients during rehabilitation classes.
  • Provides comprehensive respiratory education and follow up, including ongoing assessment of home oxygen needs for patients and families in the Respirology Clinics related to disease process, medication use, and strategies for management of disease processes, such as asthma, COPD, pulmonary fibrosis, and other chronic and infectious diseases, neuromuscular diseases, and others.
  • Provides smoking cessation counselling and support for patients.
  • Provides support for the use of invasive and non-invasive (i.e., continuous positive airway pressure [CPAP], bi-level positive airway pressure [BiPAP]) mechanical ventilation, mouthpiece ventilation (MPV), and cough assist respiratory devices in the community which may include adjustment of settings, transition to a new ventilator, and education to the care providers.

HOSPITAL AMBULATORY CARE SETTINGS: CARDIOPULMONARY AND RELATED DIAGNOSTIC TESTING – ADDITIONAL RESPONSIBILITIES

The RRT is responsible for timely, accurate and reproducible measurements of various diagnostic indices of cardiorespiratory function and allergic reactions, on pediatric and adult patients, as well as processing specimens, aligned with the relative Canadian Thoracic Society (CTS), American Thoracic Society’s (ATS) and/or European Respiratory Society (ERS) standards for pulmonary function and related testing, being responsible to:

  • Conduct comprehensive patient assessments by taking patient history, conducting cardio-respiratory assessments, and relevant previous diagnostic testing, information, and records.
  • Perform quality diagnostic procedures, including flow volume curves, lung diffusion, body plethysmography, including lung volumes and airway resistance, MIPS/MEPS (maximal inspiratory and maximal expiratory pressures), walk tests on room air and supplemental oxygen for independent exercise assessments, bronchial provocation, sputum inductions for AFB (Acid-Fast Bacillus) tests, hypoxic ventilation response, hypercapnic challenge, research studies, Stage 1 and steady state exercise studies for exercise induced asthma and bronchial reactivity measures, skin testing for routine and special allergens (e.g., venoms, penicillin, anesthetics), and antigen challenge tests including foods and latex.
  • Administer bronchodilator medication and substances, such as methacholine, as per ATS/CTS/ERS and best practice protocols.
  • Provide clinical expertise to clients through individualized patient education, including disease management, the use and role of medication, and information related to disease processes, such as chronic and infectious diseases, neuromuscular diseases, etc., and smoking cessation counseling.
  • Plan and direct patient care in collaboration with the interprofessional team  by assuming responsibility as well as accountability for the development, review, and implementation of the respiratory care plan.
  • Evaluate patient respiratory progress  toward achievement of personal goals through benchmarking and comparison of expected outcomes and goals.
  • Manage data by maintaining accurate records of patient care, diagnostic reports, statistical data, preventative maintenance, and related information.
  • Troubleshoot and maintain equipment by providing operational verification through regular quality assurance, quality control using biologic and mechanical controls, calibration, routine troubleshooting, and maintenance of respiratory equipment as per established protocols, and in accordance with manufacturer’s and ATS/ERS guidelines.

PRIMARY CARE – ADDITIONAL RESPONSIBILITIES

The RRT works as part of an interdisciplinary team to provide direct client, team, and community support, respiratory care and education programs, and performs necessary clinical functions, to facilitate the delivery of comprehensive primary health care to achieve best health outcomes for clients with or at risk of developing respiratory disease. The RRT:

  • Leads and facilitates the development of relevant population health cardiorespiratory-related programs and services needed in the community through local partnerships with a range of community stakeholders.
  • Provides health education and disease prevention services both on an individual and group basis in response to the specific needs of patients, their caregivers, interdisciplinary team members, and/or community groups.
  • Assesses and addresses potential barriers to respiratory management, including the social determinants of health.
  • Performs home oxygen assessment, including walk test, and blood gas procurement, and completes the Application for Funding Home Oxygen and other relevant documentation in accordance with provincial policies and legislation.
  • Leads the development of an evidence-based coordinated care plan for a specified group of clients relative to needs of the client and their caregivers, including those with complex needs and multi-morbid conditions, to maximize health outcomes, and facilitate navigation of the healthcare system.
  • Collaborates with clients/families, primary care providers, and other team members in the circle of care to develop, implement and revise customized self-management plans (Action Plans)
  • Leads and/or participates in relevant quality improvement and/or research initiatives within the primary care setting, as well as external partnerships and collaborations, assessing process and outcome measures that impact the providers’ and patients’ experiences and outcomes.
  • Collaborates with community support organizations to meet the unique health and social needs of patients, e.g. home health needs, such as ventilatory support, oxygen therapy, pharmacotherapy, home safety audit, social needs, such as transportation, food security, and social prescribing.

HOME, LONG-TERM, PALLIATIVE, AND COMPLEX CARE FACILITIES – ADDITIONAL RESPONSIBILITIES

The RRT works independently, and as part of an interdisciplinary team, to provide direct patient care, develop, and implement care and treatment plans, and provide respiratory education and support to facilitate quality respiratory care, and achieve best health outcomes for clients in their home and community setting.

The RRT:

  • Works collaboratively with primary, acute, long-term, and specialized care providers, and community partners, to provide support for the client in their home and community setting.
  • Leads the development, implementation and evaluation of home respiratory care programs, including policy and procedures within a quality improvement framework, in collaboration with management and other relevant team members ensuring patient-centered care, guideline compliance, and best practices.
  • Leads the development and implementation of coordinated care plans for clients with respiratory conditions, relative to the local individualized needs of the client and their caregivers, to maximize health outcomes.
  • Participates in case management conferences with providers directly involved in their patient’s circle of care.
  • Provides initiation, ongoing monitoring, and management of invasive and non-invasive ventilatory devices, lung recruitment maneuvers, and high flow nasal cannula therapy  according to protocols.
  • Provides education and self-management education, for patient and families, including resources to facilitate self-mastery for clients in their home setting.
  • Provides home-based pulmonary rehabilitation services.
  • Provides point-of-care (POC) and home oxygen assessments relative to the client’s home setting.
  • Facilitates procurement of necessary equipment through Ministry funded programs, such as the Assistive Devices Program (ADP) and the Ventilator Equipment Pool (VEP). An RRT may also work for or with home respiratory care companies to obtain required equipment for delivery of respiratory care at home, including for those clients with short- or long-term tracheostomies, or those who require long term ventilation.
  • Provides education, training, and demonstrates respiratory care procedures to clients and their circle of care, e.g., family members, health care professionals, and student trainees. This may include but is not limited to the use of non-invasive and invasive mechanical home ventilators, suctioning, home oxygen, sleep therapy, and point of care testing devices.

PRIVATE CLINICS

The RRT works independently, and as part of an interdisciplinary team, to provide direct patient care, develop and implement care and treatment plans, diagnostic testing, anesthesia support, and provide patient and staff education, to facilitate quality care and achieve best health outcomes for clients in private clinics.

In addition to the Key Responsibilities for All Practice Settings, please refer to additional responsibilities relative to particular respiratory services provided by the Private Clinic, as described in other practice settings, above.

PRIVATE INDUSTRY

Registered Respiratory Therapists may also work in the private sector for companies that specialize in the manufacture and/or distribution of respiratory-related medications or medical devices. RRTs’ specialized expertise may contribute to product and/or service development, production, sales, and/or education of company staff or current or potential customers. RRTs may also provide consultation services.

In addition to Key Responsibilities Across All Practice Settings, please refer to additional responsibilities in various practice settings for other expertise that may be relevant to an RRT’s role as a consultant or as an employee of a particular company, as described above.

QUALIFICATIONS TO PRACTICE RESPIRATORY THERAPY IN ONTARIO

RRTs are licensed by the College of Respiratory Therapists of Ontario (CRTO) and are expected to adhere to the policies and practice standards established by the CRTO. The Respiratory Therapy Society of Ontario (RTSO) represents RRTs in the province of Ontario. The Canadian Society of Respiratory Therapists (CSRT) represents RRTs at the national level.

The RRT

  • Is a graduate of an accredited Respiratory Therapy program (or equivalent), is registered to practice, maintains practice standards, and participates in continuing education, as required by the CRTO.
  • May have an undergraduate degree in a relevant discipline from a recognized university as an asset.
  • May hold additional certifications, such as Anesthesia Assistant, Smoking Cessation Counsellor or Certified Tobacco Educator, Certified Respiratory Educator and/or has other relevant specialization.
  • Participates in ongoing international resuscitation programs, such as Basic Life Support, Advanced Cardiac Life Support, Neonatal Resuscitation, and/or Pediatric Advanced Life Support as either a program instructor or provider.
  • May have previous clinical experience working with clients, conducting spirometry, lung health assessment, management, treatment and education, the development and delivery of health education and promotion programs, in an interprofessional care setting.
  • Provides effective and accessible education and care to patients, families, community groups, and health professionals based on current best practice recommendations.
  • Understands the intersection between a range of health challenges to improve the prevention and management of chronic diseases across the continuum.
  • Is experienced in working with diverse clients and communities.
  • Understands concepts of health promotion, patient education, research, and secondary prevention as a part of primary care.
  • Demonstrates computer literacy with the use of electronic medical records, and is familiar with various relevant computer programs.
  • Has excellent organization, written, and oral communication skills.
  • Can prioritize, manage time effectively, and be flexible with tasks at hand.
  • Demonstrates the abilities to
    • Engage conflict management skills, as necessary
    • Be autonomous and function effectively with minimal supervision
    • Function as part of a high performing team
  • Demonstrates critical thinking, using logic, reasoning, and evidence-based knowledge, to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems at the patient, team, and community service levels

WORKING CONDITIONS

The RRT

  • Works in an environment with moderate to high demands, relative to ambulatory care, critical care, clinic, community or industry-related environments respectively, administering medical tests, patient assessment, management, education, and/or consultation, within an interactive team-based approach. The ‘clinical environment’ may include the patient’s home or elsewhere within the community.
  • Is at risk for human fatigue and other adverse health effects due to the stress of critical decision-making affecting life and death situations, heavy workload, physical stress, shift work and 24/7 operation.
  • Is at high risk for the transmission of infectious diseases due to occupational exposures via contact, droplet, or airborne routes.
  • Is at high risk for occupational stress injury (OSI) resulting in post-traumatic stress disorder (PTSD) related to traumatic incidents and/or experiences during their practice.
  • Has a considerable demand on sensory attention, as work activities require a need for sustained concentration, particularly when interacting with clients for lengthy periods of time, calibrating equipment, or when maintaining accurate client records.
  • Prioritizes work to accommodate urgent cases and complex needs of individual patients and their caregivers, collaborating with colleagues as appropriate.
  • Collaborates with others to manage scheduling, personal, and interpersonal conflicts as they may arise, to minimize or eliminate impact on responsibilities and priorities, patient care and outcomes.

Approved by the Respiratory Therapy Society of Ontario Community Care Committee, October 31, 2019
Approved by the Respiratory Therapy Society of Ontario Leadership Committee: November 12, 2019
Approved by the Respiratory Therapy Society of Ontario Board of Directors January 19, 2020


Appendix

Registered Respiratory Therapist Integrated Role Profile: Bibliography

  1. Where Are Ontario’s Respiratory Therapists Working? Brenda Gamble, PhD, Frieda Daniels, PhD, Raisa Deber, PhD, Audrey Laporte, PhD, and Winston Isaac, PhD, Healthc Policy. 2011 Nov; 7(2): 40–46. PMCID: PMC3287947 PMID: 23115568
  2. Respiratory therapists in a primary role as disease manager: Wendy Fascia, MA, RRT corresponding author1 and Jennifer Pedley, BS, RRT, Can J Respir Ther. 2018 Winter; 54(4): 10.29390/cjrt-2018-023. Published online 2018 Feb 1. doi: 10.29390/cjrt-2018-023 PMCID: PMC6516141 PMID: 31164791.
  3. Putting the “RT” in redevelopment: Jackman AA. Can J Respir Ther 2017;53(2):33–36 PMID: 30996628 PMCID: PMC6422210.
  4. COPD: Does Inpatient Education Impact Hospital Costs and Length of Stay?: Hosseini HM, Pai DR, Ofak DR. Hosp Top. 2019 Oct-Dec;97(4):165-175. doi: 10.1080/00185868.2019.1677540. Epub 2019 Oct 17. PMID: 31621519 DOI: 10.1080/00185868.2019.1677540.
  5. A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit: Miller AG, Haynes KE, Gates RM, Zimmerman KO, Heath TS, Bartlett KW, McLean HS, Rehder KJ. Respiratory Care November 2019, 64 (11) 1325-1332; DOI: PMID: 31088987 DOI: 10.4187/respcare.06626.
  6. Effect of Health Coaching Delivered by a Respiratory Therapist or Nurse on Self-Management Abilities in Severe COPD: Analysis of a Large Randomized Study. Benzo R, McEvoy C. Respir Care. 2019 Sep;64(9):1065-1072. doi: 10.4187/respcare.05927. Epub 2019 Mar 26. PMID: 30914491 DOI: 10.4187/respcare.05927
  7. Utilizing Respiratory Therapists to Reduce Costs of Care. Becker EA, Hoerr CA, Wiles KS, Skees DL, Miller CH, Laher DS. Respir Care. 2018 Jan;63(1):102-117. doi: 10.4187/respcare.05808. Epub 2017 Nov 28. PMID: 29184048 DOI: 10.4187/respcare.05808.
  8. New Home Care in Respiratory Therapy, Clarke BT. Home care in respiratory therapy. Can J Respir Ther. 2016 Spring;52(2):51-2. PMID: 27471424; PMCID: PMC4948574.
  9. Staffing patterns of respiratory therapists in critical care units of Canadian teaching hospitals. West AJ, Nickerson J, Breau G3, Mai P, Dolgowicz C. Can J Respir Ther. 2016 Fall;52(3):75-80. Epub 2016 Sep 1. PMID: 30123021 PMCID: PMC6073513.
  10. Lung Ultrasound: The Emerging Role of Respiratory Therapists: Karthika M; Wong D; Nair SG; Pillai LV; Mathew CS, Respiratory Care [Respir Care], ISSN: 1943-3654, 2019 Feb; Vol. 64 (2), pp. 217-229; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 30647101
  11. Role of a respiratory therapist in improving adherence to positive airway pressure treatment in a pediatric sleep apnea clinic: Jambhekar SK; Com G; Tang X; Pruss KK; Jackson R; Bower C; Carroll JL; Ward W, Respiratory Care [Respir Care], ISSN: 1943-3654, 2013 Dec; Vol. 58 (12), pp. 2038-44; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 23764862
  12. The importance of a multidisciplinary approach to VAP prevention: the role of the respiratory therapist: Sandrock C; Daly J, Respiratory Care [Respir Care], ISSN: 0020-1324, 2012 May; Vol. 57 (5), pp. 811-2; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 22546300
  13. Asthma disease management and the respiratory therapist: Kallstrom TJ; Myers TR, Respiratory Care [Respir Care], ISSN: 0020-1324, 2008 Jun; Vol. 53 (6), pp. 770-6; discussion 777; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 18501030
  14. Pragmatic Challenge of Sustainability: Long-Term Adherence to COPD Care Bundle Maintains Lower Readmission Rate: Zafar MA; Nguyen B; Gentene A; Ko J; Otten L; Panos RJ; Alessandrini EA, Joint Commission Journal On Quality And Patient Safety [Jt Comm J Qual Patient Saf], ISSN: 1938-131X, 2019 Sep; Vol. 45 (9), pp. 639-645; Publisher: Elsevier; PMID: 31331860
  15. Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol: Wood G; MacLeod B; Moffatt S, Respiratory Care [Respir Care], ISSN: 0020-1324, 1995 Mar; Vol. 40 (3), pp. 219-24; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 10141679
  16. Pulmonary rehabilitation and chronic lung disease: opportunities for the respiratory therapist: Carlin BW, Respiratory Care [Respir Care], ISSN: 0020-1324, 2009 Aug; Vol. 54 (8), pp. 1091-9; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 19650949
  17. Cystic fibrosis and the respiratory therapist: a 50-year perspective: Volsko TA, Respiratory Care [Respir Care], ISSN: 0020-1324, 2009 May; Vol. 54 (5), pp. 587-94; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 19393103
  18. ICU team composition and its association with ABCDE implementation in a quality collaborative: Costa DK; Valley TS; Miller MA; Manojlovich M; Watson SR; McLellan P; Pope C; Hyzy RC; Iwashyna TJ, Journal Of Critical Care [J Crit Care], ISSN: 1557-8615, 2018 Apr; Vol. 44, pp. 1-6; Publisher: W.B. Saunders; PMID: 28978488
  19. A role for the respiratory therapist in flexible fiberoptic bronchoscopy: Coppolo DP; Brienza LT; Pratt DS; May JJ, Respiratory Care [Respir Care], ISSN: 0020-1324, 1985 May; Vol. 30 (5), pp. 323-7; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 10315659
  20. Successful Use of Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease. How Do High-Performing Hospitals Do It?: Fisher KA; Mazor KM; Goff S; Stefan MS; Pekow PS; Williams LA; Rastegar V; Rothberg MB; Hill NS; Lindenauer PK, Annals Of The American Thoracic Society [Ann Am Thorac Soc], ISSN: 2325-6621, 2017 Nov; Vol. 14 (11), pp. 1674-1681; Publisher: American Thoracic Society; PMID: 28719228
  21. Tobacco treatment and prevention: what works and why: Goodfellow LT; Waugh JB, Respiratory Care [Respir Care], ISSN: 0020-1324, 2009 Aug; Vol. 54 (8), pp. 1082-90; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 19650948
  22. Demographics and financial impact of home respiratory care: Dunne PJ, Respiratory Care [Respir Care], ISSN: 0020-1324, 1994 Apr; Vol. 39 (4), pp. 309-17; discussion 317-20; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 10184075
  23. Pulmonary rehabilitation for chronic obstructive pulmonary disease: a scientific and political agenda: Fahy BF, Respiratory Care [Respir Care], ISSN: 0020-1324, 2004 Jan; Vol. 49 (1), pp. 28-36; discussion 36-8; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 14733620
  24. Monitoring ventilator weaning–predictors of success: Weavind L; Shaw AD; Feeley TW, Journal Of Clinical Monitoring And Computing [J Clin Monit Comput], ISSN: 1387-1307, 2000; Vol. 16 (5-6), pp. 409-16; Publisher: Springer; PMID: 12580224 https://www.semanticscholar.org/paper/Monitoring-Ventilator-Weaning-%E2%80%93-Predictors-of-Weavind-Shaw/16431ba9478de3aa31920a71773143ccef9a3bae https://page-one.springer.com/pdf/preview/10.1023/A:1011480409161
  1. Asthma education–home-based intervention: Kallstrom TJ, Journal Of The Chinese Medical Association: JCMA [J Chin Med Assoc], ISSN: 1726-4901, 2004 May; Vol. 67 (5), pp. 207-16; Publisher: Chinese Medical Association; PMID: 15357106
  2. Tracheostomy decannulation: Christopher KL, Respiratory Care [Respir Care], ISSN: 0020-1324, 2005 Apr; Vol. 50 (4), pp. 538-41; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 15807918
  3. The development and implementation of a multidisciplinary neonatal resuscitation team in a Canadian perinatal centre: Aziz K; Chadwick M; Downton G; Baker M; Andrews W, Resuscitation [Resuscitation], ISSN: 0300-9572, 2005 Jul; Vol. 66 (1), pp. 45-51; Publisher: Elsevier/north-Holland Biomedical Press; PMID: 15993729
  4. Increasing Awareness of the Roles, Knowledge, and Skills of Respiratory Therapists Through an Interprofessional Education Experience: Zamjahn JB; Beyer EO; Alig KL; Mercante DE; Carter KL; Gunaldo TP, Respiratory Care [Respir Care], ISSN: 1943-3654, 2018 May; Vol. 63 (5), pp. 510-518; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 29362218
  5. The roles, they are a changing: Respiratory Therapists as part of the multidisciplinary, community, primary health care team: Rickards T; Kitts E, Canadian Journal Of Respiratory Therapy: CJRT = Revue Canadienne De La Therapie Respiratoire: RCTR [Can J Respir Ther], ISSN: 1205-9838, 2018 Winter; Vol. 54 (4); Publisher: Pulsus Group Inc; PMID: 31164789
  6. Palliative care as an emerging role for respiratory health professionals: Findings from a cross-sectional, exploratory Canadian survey: Goodridge D; Peters J, Canadian Journal Of Respiratory Therapy: CJRT = Revue Canadienne De La Therapie Respiratoire: RCTR [Can J Respir Ther], ISSN: 1205-9838, 2019 Sep 16; Vol. 55, pp. 73-80; Publisher: Pulsus Group Inc; PMID: 31595226
  7. Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia: Werre ND; Boucher EL; Beachey WD, Respiratory Care [Respir Care], ISSN: 1943-3654, 2015 Feb; Vol. 60 (2), pp. 151-4; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 25118305
  8. The Calgary COPD & Asthma Program: The role of the respiratory therapy profession in primary care: Slack CL; Hayward K; Markham AW, Canadian Journal Of Respiratory Therapy: CJRT = Revue Canadienne De La Therapie Respiratoire: RCTR [Can J Respir Ther], ISSN: 1205-9838, 2018 Winter; Vol. 54 (4); Publisher: Pulsus Group Inc; PMID: 3116478755
  9. A role for respiratory therapists in shaping Canada’s changing health policy landscape: Nickerson JW, Canadian Journal Of Respiratory Therapy: CJRT = Revue Canadienne De La Therapie Respiratoire: RCTR [Can J Respir Ther], ISSN: 1205-9838, 2016 Spring; Vol. 52 (2), pp. 41-2; Publisher: Pulsus Group Inc; PMID: 27471421
  10. Respiratory therapists’ smoking cessation counseling practices: a comparison between 2005 and 2010: Tremblay M; O’Loughlin J; Comtois D, Respiratory Care [Respir Care], ISSN: 1943-3654, 2013 Aug; Vol. 58 (8), pp. 1299-306; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 23232737
  11. Therapist-directed protocols designed with health-care reform in mind: Hoerr CA, Respiratory Care [Respir Care], ISSN: 1943-3654, 2015 Feb; Vol. 60 (2), pp. 304-5; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 25634881
  12. A randomized, controlled study to evaluate the role of an in-home asthma disease management program provided by respiratory therapists in improving outcomes and reducing the cost of care: Shelledy DC; Legrand TS; Gardner DD; Peters JI, The Journal Of Asthma: Official Journal Of The Association For The Care Of Asthma [J Asthma], ISSN: 1532-4303, 2009 Mar; Vol. 46 (2), pp. 194-201; Publisher: Informa Healthcare; PMID: 19253130
  13. Empowering respiratory therapists to take a more active role in delivering quality care for infants with bronchiolitis: Conway E; Schoettker PJ; Moore A; Britto MT; Kotagal UR; Rich K, Respiratory Care [Respir Care], ISSN: 0020-1324, 2004 Jun; Vol. 49 (6), pp. 589-99; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 15165292
  14. Disease management as an evolving role for respiratory therapists: Stoller JK; Niewoehner DE; Fan VS, Respiratory Care [Respir Care], ISSN: 0020-1324, 2006 Dec; Vol. 51 (12), pp. 1400-2; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 17134519
  15. Alpha-1 antitrypsin deficiency: an under-recognized but important issue for respiratory therapists: Stoller JK, Respiratory Care [Respir Care], ISSN: 0020-1324, 2003 Nov; Vol. 48 (11), pp. 1022-4; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 14585113
  16. 2000 Donald F. Egan Scientific Lecture. Are respiratory therapists effective? Assessing the evidence: Stoller JK, Respiratory Care [Respir Care], ISSN: 0020-1324, 2001 Jan; Vol. 46 (1), pp. 56-66; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 11175240
  17. Imperative Instruction for Pressurized Metered-Dose Inhalers: Provider Perspectives: Schmitz DC; Ivancie RA; Rhee KE; Pierce HC; Cantu AO; Fisher ES, Respiratory Care [Respir Care], ISSN: 1943-3654, 2019 Mar; Vol. 64 (3), pp. 292-298; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 30254041
  18. Critical Care Therapy and Respiratory Care Section (CCTRCS) National Institutes of Health, Critical Care Medicine Department Critical Care Therapy and Respiratory Care Section (CCTRCS), Retrieved from https://clinicalcenter.nih.gov/ccmd/services/cctrcs.html January 18, 2020.
  19. Using a Standardized Patient to Improve Collaboration and Problem Solving Skills With CPAP Usage in the Home: Williams MG; Ruhs J, Home Healthcare Now [Home Healthc Now], ISSN: 2374-4537, 2017 Jun; Vol. 35 (6), pp. 314-320; Publisher: Lippincott Williams and Wilkins; PMID: 28562401
  20. Multidisciplinary Difficult Airway Course: An Essential Educational Component of a Hospital-Wide Difficult Airway Response Program: Leeper WR; Haut ER; Pandian V; Nakka S; Dodd-O J; Bhatti N; Hunt EA; Saheed M; Dalesio N; Schiavi A; Miller C; Kirsch TD; Berkow L, Journal Of Surgical Education [J Surg Educ], ISSN: 1878-7452, 2018 Sep – Oct; Vol. 75 (5), pp. 1264-1275; Publisher: Elsevier; PMID:
  21. Prevention of Ventilator-Associated Pneumonia in the Intensive Care Unit: Beyond the Basics: Larrow V; Klich-Heartt EI, The Journal Of Neuroscience Nursing: Journal Of The American Association Of Neuroscience Nurses [J Neurosci Nurs], ISSN: 1945-2810, 2016 Jun; Vol. 48 (3), pp. 160-5; Publisher: American Association of Neuroscience Nurses; PMID: 27049715
  22. Public health in Canada: Evolution, meaning and a new paradigm for respiratory therapy: West AJ, Canadian Journal Of Respiratory Therapy: CJRT = Revue Canadienne De La Therapie Respiratoire: RCTR [Can J Respir Ther], ISSN: 1205-9838, 2013 Winter; Vol. 49 (4), pp. 7-10; Publisher: Pulsus Group Inc; PMID: 26078595
  23. Role of the management pathway in the care of advanced COPD patients in their own homes: Ramani AA; Pickston AA; Clark JL; Clark CA; Brown M, Care Management Journals: Journal Of Case Management ; The Journal Of Long Term Home Health Care [Care Manag J], ISSN: 1521-0987, 2010; Vol. 11 (4), pp. 249-53; Publisher: Springer Pub. Co.; PMID: 21197932
  24. Improving outcomes in chronic obstructive pulmonary disease: the role of the interprofessional approach: Amalakuhan B; Adams SG, International Journal Of Chronic Obstructive Pulmonary Disease [Int J Chron Obstruct Pulmon Dis], ISSN: 1178-2005, 2015 Jun 26; Vol. 10, pp. 1225-32; Publisher: DOVE Medical Press; PMID: 26170651
  25. Dysphagia and respiratory care in individuals with tetraplegia: incidence, associated factors, and preventable complications: Shem K; Castillo K; Wong SL; Chang J; Kolakowsky-Hayner S, Topics In Spinal Cord Injury Rehabilitation [Top Spinal Cord Inj Rehabil], ISSN: 1082-0744, 2012 Winter; Vol. 18 (1), pp. 15-22; Publisher: Thomas Land Publishers; PMID: 23459783
  26. Tobacco: the role of health professionals in smoking cessation. Joint statement: Canadian Association of Occupational Therapists; Canadian Association of Social Workers; Canadian Dental Association; Canadian Medical Association; Canadian Nurses Association; Canadian Pharmacists Association; Canadian Physiotherapy Association; Canadian Psychological Association; Canadian Society of Respiratory Therapists, Journal (Canadian Dental Association) [J Can Dent Assoc], ISSN: 0709-8936, 2001 Mar; Vol. 67 (3), pp. 134-5; Publisher: Canadian Dental Association; PMID: 11315390
  27. Interprofessional Perspectives on ABCDE Bundle Implementation: A Focus Group Study: Boehm LM; Vasilevskis EE; Mion LC, Dimensions Of Critical Care Nursing: DCCN [Dimens Crit Care Nurs], ISSN: 1538-8646, 2016 Nov/Dec; Vol. 35 (6), pp. 339-347; Publisher: Lippincott Williams & Wilkins; PMID: 27749438 https://www.ncbi.nlm.nih.gov/pubmed/27749438 entered
  28. Designing and evaluating an effective theory-based continuing interprofessional education program to improve sepsis care by enhancing healthcare team collaboration: Owen JA; Brashers VL; Littlewood KE; Wright E; Childress RM; Thomas S, Journal Of Interprofessional Care [J Interprof Care], ISSN: 1469-9567, 2014 May; Vol. 28 (3), pp. 212-7; Publisher: Informa Healthcare; PMID: 24593326
  29. Respiratory care practitioners as secondary providers of endotracheal intubation: one hospital’s experience: Zyla EL; Carlson J, Respiratory Care [Respir Care], ISSN: 0020-1324, 1994 Jan; Vol. 39 (1), pp. 30-3; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 10145994
  30. Interdisciplinary onsite team-based simulation training in the neonatal intensive care unit: a pilot report: Reed DJW; Hermelin RL; Kennedy CS; Sharma J, Journal Of Perinatology: Official Journal Of The California Perinatal Association [J Perinatol], ISSN: 1476-5543, 2017 Apr; Vol. 37 (4), pp. 461-464; Publisher: Nature Publishing Group; PMID: 28055027
  31. Respiratory care of the hospitalized patient with cystic fibrosis: Newton TJ, Respiratory Care [Respir Care], ISSN: 0020-1324, 2009 Jun; Vol. 54 (6), pp. 769-75; discussion 775-6; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 19467163
  32. The patient who has undergone lung transplantation: Implications for respiratory care: Levine SM; Angel LF, Respiratory Care [Respir Care], ISSN: 0020-1324, 2006 Apr; Vol. 51 (4), pp. 392-402; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 16563192
  33. Insights from exemplar practices on achieving organizational structures in primary care: Tubbesing G; Chen FM, Journal Of The American Board Of Family Medicine: JABFM [J Am Board Fam Med], ISSN: 1558-7118, 2015 Mar-Apr; Vol. 28 (2), pp. 190-4; Publisher: American Board of Family Medicine; PMID: 25748759
  34. Caring for critically ill children in the community: a needs assessment: Gilleland J; McGugan J; Brooks S; Dobbins M; Ploeg J, BMJ Quality & Safety [BMJ Qual Saf], ISSN: 2044-5423, 2014 Jun; Vol. 23 (6), pp. 490-8; Publisher: BMJ Pub. Group; PMID: 24347650
  35. The 2007 GOLD Guidelines: a comprehensive care framework: Gold PM, Respiratory Care [Respir Care], ISSN: 0020-1324, 2009 Aug; Vol. 54 (8), pp. 1040-9; Publisher: Daedalus Enterprises for the American Association for Respiratory Therapy; PMID: 19650945
  36. North American neonatal extracorporeal membrane oxygenation (ECMO) devices and team roles: 2008 survey results of Extracorporeal Life Support Organization (ELSO) centers: Lawson DS; Lawson AF; Walczak R; McRobb C; McDermott P; Shearer IR; Lodge A; Jaggers J, The Journal Of Extra-Corporeal Technology [J Extra Corpor Technol], ISSN: 0022-1058, 2008 Sep; Vol. 40 (3), pp. 166-74; Publisher: American Society of Extra-Corporeal Technology; PMID: 18853828
  37. Physical, occupational, respiratory, speech, equine and pet therapies for mitochondrial disease: Millhouse-Flourie TJ, Mitochondrion [Mitochondrion], ISSN: 1567-7249, 2004 Sep; Vol. 4 (5-6), pp. 549-58; Publisher: Elsevier Science; PMID: 16120413
  38. Do the correlates of smoking cessation counseling differ across health professional groups?: Tremblay M; Cournoyer D; O’Loughlin J, Nicotine & Tobacco Research: Official Journal Of The Society For Research On Nicotine And Tobacco [Nicotine Tob Res], ISSN: 1469-994X, 2009 Nov; Vol. 11 (11), pp. 1330-8; Publisher: Oxford University Press; PMID: 19770488
  39. Role of the pulmonary provider in a terrorist attack: resources and command and control issues: Geiling JA, Respiratory Care Clinics Of North America [Respir Care Clin N Am], ISSN: 1078-5337, 2004 Mar; Vol. 10 (1), pp. 23-41; Publisher: Wb Saunders; PMID: 15062225
  40. Transition programs in cystic fibrosis centers: perceptions of team members: Flume PA; Taylor LA; Anderson DL; Gray S; Turner D, Pediatric Pulmonology [Pediatr Pulmonol], ISSN: 8755-6863, 2004 Jan; Vol. 37 (1), pp. 4-7; Publisher: Wiley-Liss; PMID: 14679482