Global Perspective of Respiratory Care

Vijay Deshpande, MS, RRT, FAARC

Emeritus Professor

Georgia State University

Atlanta, Georgia, USA

Adjunct Visiting Professor,

Manipal University

College of Allied Health Professions

Manipal, Karnataka, INDIA

Globalization of

Respiratory Care

International Fellowship Program

● Implemented in 1991, inviting select candidates

to USA to observe the practice of Respiratory

Therapy

● The program has brougt 135 RC professionsls

from 54 countries to the US: 68 physicians, 29

PTs, 21 RTs and 11 Nurses.

● This program has generated interest in other

countries to follow AARC’s footsteps and develop

a new profession in the health care system.

AARC Promotes RT in the World

● Clinical Practice Guidelines are translated in Chinese,

Japanese and Spanish

● “A guide to Aerosol Delivery System” is translated into

Arabic, Chinese and Spanish

● AARTimes and RC articles appear regularly in Italian and

Japanese Publications

● Student exchange between Taiwan and Torrence

Community College in Fort Worth, Texas is implemented.

● Students from Saudi Arabia and Gulf Countries are

routinely admitted to Georgia State University, University

of South Alabama and other institutions.

Global Awareness

■ Over 50 countries are aware of the RT profession.

■ Currently, there are 70 formal RT programs in 8 countries

outside the US.

■ A few countries such as India have started Master’s

degree in RT.

■ Canada, Taiwan, Panama and Philippines received legal

recognition by their Government and require mandatory

credentialing

■ Ten (10) countries have professional organizations

Hiser, John;We are on Mission, AARC Times, 34:12 (39-42), Dec 2010

EVOLUTION OF RESPIRATORY CARE IN USA (1947-1966)

5/10/2012 7

1947

Inhalation Therapy

Association (ITA)

was

established in

Chicago

1950

ITA issued Volume 1 of the professional

Bulletin which contained technical information

and how to organize RT departments

1953

Association

changes their

name to

AAIT

1957

Industrial Advisory

Committee was

formed

1963

“Board of Schools”

was formed

Respiratory Care- Evolution Of A Profession, by Gary Smith, AMP Publication, Lenexa, Kansas,1989

1966

Bennett

MA-1 was

introduced

EVOLUTION OF RESPIRATORY CARE IN USA (1967-1986)

5/10/2012 8

1967

"Essentials" for

training developed,

extending program

length to 18 months

1969

Arkansas becomes the first

state to enact a respiratory

therapy Licensure Law

1970

Joint Review

Committee for

Inhalation Therapy

Education (JRCITE)

was formed (4 AAIT

members and 2

members from ASA and

ACCP each)

1974

NBRT

was

formed

1978

Last RRT

oral exam

administered

Respiratory Care- Evolution Of A Profession, by Gary Smith, AMP Publication, Lenexa, Kansas,1989

1986

AART

becomes

AARC

1979

First Clinical

Simulation

Exam

administered

1980

Home O2 Therapy

guidelines introduced

Women will never be equal to men,

until they can walk down the street with

a bald head and a beer gut, and

still think they are sexy.

RT Global Community

● United States of America

● Canada

● Taiwan

● Saudi Arabia

● Philippines

● United Arab Republic

● Mexico

● Colombia

● India

● China

● Argentina

● Brazil

● Chile

● Costa Rica

● Guatemala

CANADA

● The Canadian Society of Respiratory Therapists (CSRT)

was founded in 1964

● Since Canada has a large population that speaks French

language, the national credentialing examinations are given

in English and French.

● The practice of respiratory therapy in Canada is equivalent

to that in USA and a reciprocity agreement exists between

CSRT and NBRC for recognition of credentials.

● Canada has 21 accredited programs and approximately

3,000 members.(www.csrt.com)

Canadian idea of Good Time

MEXICO

Associon de Terapia Respiratoria

■ The Mexican Association for Inhalation Therapy and

Respiratory Physiology was established in 1967.

■ Currently, approximately 7,000 Respiratory Therapists

practice RT in Mexico

■ Dr. Hector Leon Garza, Executive Director worked with

other Latin American Countries and the National Board for

Respiratory Care to establish Latinamerican Board for

Professional Certification in Respiratory Therapy in 2003.

■ The Mexican Society for Respiratory care has conducted

10 International Congresses.

South America

COLOMBIA

COLOMBIA

COLOMBIA

■ Established an Associasion Colombia

Professional Terapia Respiratoria in 1996.

■ In 2001, Colombian Association for Faculties for

Respiratory Therapy was established and is still

functioning.

■ There are six (6) RT programs operating in the

country.

■ Approximately 5,000 therapists working in the RT

profession.

How do you explain these remarks?

Central America

Costa Rica

Guatemala

Costa Rica

■ Medical Center in San Jose, Costa Rica obtained a

grant from Hope Foundation Inc. USA.

■ In 1985 Hope Grant contracted Susan Pilbeam,

MS, RRT, FAARC, a renowned RT teacher in

USA, to initiate and implement a Respiratory

Therapy Program in Costa Rica.

■ This program graduated RTs in Costa Rica and

the profession is an integral part of the health care

system in the country.

Guatemala

■ In 1992, Helen Montereso started a program

in Respiratory Therapy in Guatemala City.

■ This small country has a well established

Respiratory Therapy profession.

South America

Argentina, Brazil, Chile, Venezuela, Panama

Venezuela

Chile

Brazil

Argentina

SOUTH AMERICA

■Argentina, Brazil, Chile, Venezuela, and Panama

rely upon the competent Physical therapists to

deliver Respiratory Care

■A group of Physio-Respiratory Therapists formed

an informal association of Respiratory Care in

these countries. Training courses in RT with

emphasis on mechanical ventilation are offered,

on a regular basis, to Registered Physiotherapists

at various institutions in the countries.

Major accomplishments of Latin

American Countries

■ In 2003, Dr. Hector Leon Garza, Executive Director of

Mexican Society for Respiratory Care worked with other

Latin American Countries and the National Board for

Respiratory Care to establish Latin American Board for

Professional Certification in Respiratory Therapy.

■ In 2011, the first meeting of representatives from all Latin

American countries to establish Latin American

Association for Respiratory Care

Europe

● Although Respiratory Therapy profession does not exist in

European countries as a distinct profession, specialty

courses and seminars are consistently offered to trained

Physiotherapists and Critical Care Nurses.

● These individuals are members of the European

Respiratory Care Association (ERCA), a society formed by

physicians involved in treating respiratory diseases

● Each year ERS organizes a Conference in different

countries of Europe (www.ers.com). The 2012 ERS

conference is scheduled in Vienna on September 1-4, 2012

Europe

● Italy: RT is primarily done by PTs. Italian

Physicians routinely give presentations at the

AARC Congress. Many RT/PT attend AARC

Congress

● Slovenia: Ljubiana has an excellent RT department

formed by past International fellows (4). Assist

neighboring countries (Croatia, Hungary) by

delivering workshops on Mechanical Ventilation.

Saudi Arabia

Saudi Arabia

Kingdom of Saudi Arabia

■ Saudi Society for Respiratory Care (SSRC) was

established in 2004.

■ Loma Linda University in California assisted

Saudi education system by coordinating RT

program at King Faisal Medical center.

■ SSRC and NBRC , agreed to implement

credentialing examination for SSRC to provide

external evaluation and standardization of

curriculum

THOUGHTS TO PONDERTHOUGHTS TO PONDER

The reason grandparents and The reason grandparents and

grandchildren get along so well is thatgrandchildren get along so well is that

they have a common enemy.they have a common enemy.

I N D I A

INDIA AND USA

Medical community has recognized the need for RESPIRATORY THERAPISTS, especially in the ICUs

5/10/2012 41

�Until recently (15 years) India was a poor country at all levels

�Economic development has taken strides and the middle class has grown exponentially

�Economic development has Increased the demand for advanced medical procedures and treatments.

�In 1947 Inhalation Therapy evolved in US and India became an independent country

�India is 1/3 the size of USA but population is 3x the US

HOSPITALS IN INDIA

� Private and Corporate hospitals

� Identical to most hospitals in US

� Well equipped and well funded

� Well-trained staff

� Expensive

� Excellent patient care

5/10/2012 42

� Community Hospitals

� Relatively cheaper

� Mediocre care

� Funding is a problem

� More training for staff is desirable

HOSPITALS IN INDIA

� University Hospitals

� Primary training centers

� Private Universities are well

equipped and well funded

� Well-trained and in-training physicians

� Good patient care

� Higher rate of infections than Corporate Hospitals

5/10/2012 43

� Government Funded Hospitals

� Free of Charge

� Good Physicians but inadequately funded

� Minimally trained staff

� High rate of infection in many sites

EVOLUTION OF RESPIRATORY CARE IN

INDIA

● Influence of British medical practice for the first 25-30 years

● Increased interactions with American trained physicians

● Significant and sustained economic growth

● Influx of advanced medical equipment including Mechanical Ventilators

● A need for training physicians on many aspects of mechanical ventilation

was recognized

● Pulmonologists from US were invited as conference speakers

● Respiratory Therapists were mentioned by all US speakers

● Initial reluctance to add one more allied health profession slowly

diminished

5/10/2012 44

RT TRAINING IN

INDIA

■ Recognized need for Respiratory Therapists

■ 1995: A well planned BSRT program was initiated by

Manipal University

■ Other programs in the southern part of India –

Hyderabad, Chennai , Vellore, Pune, Kochi

■ Hospital based training programs in Mumbai, Delhi,

Bangalore and Kolkata

■ Mechanical Ventilation Workshops for physicians at

ISA and ISCCM Conferences

■ A well designed Mechanical Ventilation Workshop at

Pune conducted by local chapter of ISCCM

5/10/2012 45

5/10/2012 46

SITES OF RT PROGRAMS

Pune

ManipalVellore

Cochi

Chennai

Hyderabad

Mumbai

RT EDUCATION

■ Manipal College of Allied Health Sciences – Manipal

University in Karnataka, India.� BScRT, MScRT,Master of RT, PhD of RT.

� longest running program for 16 yrs (1995)

■ Symbiosis Instituteof Health Sciences in Pune,

■ Nizam’s Institute of Medical Science in Hyderabad,

■ Christian Medical College – Vellore, Tamil Nadu

■ Shri Ramchandra Medical College Chennai,

Tamilnadu.

■ Amritha Institute of Medical Sciences – Kochi

$$$$

FEDERAL GRANTS

MEDICARE REIMBURAEMENT

PHYSICIANS NURSING OCCUPATIONAL

& PHYSICALTHARAPY

HOSPITALSRESPIRATORY

THERAPY

INTERNATIONAL FELLOWS AND RT IN INDIA

• In 1990 AARC implemented an International

Fellowship Program

• 135 International Fellows from 54 countries

have visited US since 1990

• 12 physicians from India were amongst this

select group

5/10/2012 49

5/10/2012 50

● 16 Major languages and

Multiple Dialects

● Court Languages: English,

Hindi and Local Language

● College Education is in English

UNDERSTANDING INDIA

5/10/2012 51

DIFFERENCES IN RC PROFESSIONS

USA INDIA

Well Established over the past 60

years

Just entered the infancy stage – 5

yearsOver 150,000 working RTs ~ 200 RTs

Excellent Communication within the

profession

Severe Lack of Communication

One Language Multiple Languages

Industrial Support No Industrial Support

Involvement of Medical Associations

(ASA, ATS, ACCP)

Limited Physician involvement

Plethora of Leadership seeking

Therapists

Lack of Leadership Enthusiasm

Financially Stable Financially unstable

GOING TO WORK

5/10/2012 52

ALTERNATE WAYS TO

WORK

5/10/2012 53

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5/10/2012 55

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THE PHILIPPINES

R.A. # 10024

Republic Act No. 10024 known as

the Philippine Respiratory

Therapy Act of 2009.

1. Officially regulating the

practice of respiratory care

through licensure exam.

2. Creating the 1st Professional

Regulatory Board for

Respiratory Therapy.

Signed into a law on March 9, 2009

by then Philippine President

Gloria M. Arroyo.

“Light at the end of the tunnel!”

Philippine Respiratory Therapy Act of 2009

RT EDUCATION

DATE MILESTONES

1980 1st formal RT Program – a 2-year Associate in Respiratory

Therapy Program was offered by Mary Chiles Hospital

College in Manila.

1987 The first 4-year Bachelor of Science in Respiratory Therapy

was offered by the University of Perpetual Help in Binan,

Laguna.

Until 2008 A total of 24 RT schools in the entire Philippines offer either

a 2-year Certificate in Pulmonary Therapy or 4-year B.S.

Respiratory Therapy.

Until 2009 A total of almost 3,000 RT students have graduated from the

RT educational program and almost half have gained

employment abroad.

RTs ‘IN and OUT’ of the country

Distribution of Filipino RCPs

RT DEMOGRAPHICS

Estimated number of Filipino RCPs working outside of the Philippines :

COUNTRY ESTIMATE NUMBER

Saudi Arabia 967

UAE 173

Qatar 61

Singapore 28

Kuwait 20

Bahrain 16

Oman 04

USA 02

TOTAL 1,271

MAINLAND CHINA

RT EDUCATION

RT Program:

� 2-year Associate Degree

� 4-year Bachelors Degree

•West China School of Medicine/West China

Hospital of Sichuan University is the 1st school

to set-up the BSRT in 1997.

Current Situation

■ Only 3 schools/universities offer a formal RT

Program in China.

■ There are only 4 hospitals that has an established

RT Department.

■ There are only 200 Respiratory Therapist in

China for a population of 1.3 billion

■ China has 9 AARC International Fellows as of

2010.

RT DEPARTMENT

■ Sir Sun Sun Show Hospital in Hangzhou is the

1st RT Depatrtment in China and it was fully

supported by Loma Linda University – USA.

■Hospitals with RT Department in China:

● West China Hospital – Sichuan

● Chao Yang Hospital – Beijing

● Beijing Hospital – Beijing

● Sir Sun Sun Show Hospital - Hangzhou

Since light travels faster than sound,

some people appear bright until you

hear them speak.

T A I W A N

TAIWAN

HISTORICAL BACKGROUND

DATE HISTORICAL BACKGROUND

1980 The RC profession began in the hospital as an

IPPB Room.

April 1990 The Respiratory Care Association of Republic of China

(RCAROC) was established.

Dec. 1990 The 1st AARC International Fellow from Taiwan was

recognized – Chiang, Ling-ling.

December

21, 2001

The Respiratory Therapist Act was passed and approved

by the Parliament.

2004 The RCAROC was renamed Taiwan Society for

Respiratory Therapy (TSRT).

RESPIRATORY

THERAPIST ACT

• The Respiratory Therapist Act was passed into

law last December 21, 2001

• The law professionalized the respiratory

therapy profession.

• The law specified the Scope of Practice of

respiratory therapist.

• The law specified the creation of new

professional group “Respiratory Therapist

Society of the Republic of China”.

TSRT

• There are about 1,877 members.

• Three Level of Training for Members :

1. RRT – Registered Respiratory Therapists

2. ARRT – Advanced Registered Respiratory Therapists

3. SRRT – Specialist Registered Respiratory Therapists

THE FUTURE OF RC

• Taiwan has the most established and well-

organized RC profession in Asia.

• Taiwan has 5 AARC International Fellows

since 1990.

• The RC profession in Taiwan is growing

rapidly and has progressed dramatically

since its inception in 1980.

Behind every successful man is his woman.

Behind the fall of a successful man is usually

another woman.

Japan

■ Japan has a different system to treat

pulmonary patients

■ Physicians and Physical Therapists manage

the clinical aspects of the patient

■ Clinical Engineers manage the equipmet

such as Ventilators.

Japan

■Many clinical engineers and PTs from

Japan attend the AARC Congress.

■ Japanese physicians are involved in

delivering clinical lectures related to their

research at the AARC Congress.

■ Japan was awarded 12 International Fellows

since 1991.

Thank You !!