Much has been said about the shortage of respiratory medical ventilators in the U.S. and the world to the point now that there are even Wikipedia pages about it. And more needs to be said and done too, however, there’s one group of healthcare workers that we also need to talk about – respiratory therapists.
“It’s not just this machine they talk about on TV that we don’t have enough of. It’s very complex,” said the respiratory therapy department director Julie Eason at University Hospital in SUNY Downstate Health Sciences University, Brooklyn.
“If you don’t set it up right, that patient outcome is different. You need skilled people who have lots of experience doing this to have good outcomes with these patients,” Dr. Eason added.
This is where respiratory therapists come in. Trained to care for people with respiratory problems, these therapists are the ones who track Covid-19 patients’ oxygen levels, manage their breathing and, if need be, intubate them and set up a mechanical ventilator.
One good example of the incredible work these professionals have to do is explained in this Inside the ER episode on CNN. In it, doctor Lorenzo Paladino explains how they’ve had to come up with entirely new ways to operate with the limited number of respiratory ventilators just so that they can use them for as many patients as possible.
“We try all sorts of maneuvers in order to keep them [Covid-19 patients] breathing and keeping them from suffocating or having a cardiac arrest.” Dr. Paladin has said.
As the report’s narrator added “Dr. Lorenzi Paladino has done groundbreaking work on putting more than one person on a single ventilator. It’s research he [Paladino] hopes that will never have to be used here.”
Despite their hard work, up until this crisis, respiratory therapists were a little-known part of the healthcare industry. Their job includes a lot of things, all of which are in incredibly high demand these days.
Lisa Shultis is a respiratory therapist and director for Long Island University’s respiratory care program. She shared that “When I tell people I’m a respiratory therapist, they look at me with a blank stare. Until this time. Now they look at me with fear.”
As of today, there are ~155,000 licensed respiratory therapists in the U.S. according to the American Association for Respiratory Care (AARC). Their median salary, according to the Bureau of Labor Statistics is just $60,000 per year.
A big part of why respiratory therapists are not well known to the general public until recently might be due to how they’re never represented in the media.
“On doctor (TV) shows, they never really show respiratory therapists,” said Tom Kallstrom, the CEO and executive director of the AARC. “They show others doing what we do. I’m grateful to know that at least people know who we are (now).”
Respiratory therapists were not suffering from boredom before the pandemic either – they have always been overly busy keeping patients alive and healthy. The normal job of a respiratory therapist is to treat acute conditions such as heart attacks, prematurely born babies with underdeveloped lungs, and other issues such as asthma and chronic obstructive pulmonary disease.
With Covid-19 being the biggest health concern right now, respiratory therapists are in even higher demand. Covid-19 affects the lungs of patients and tends to cause pneumonia, shortness of breath, and acute respiratory distress syndrome (ARDS) similarly to other respiratory viruses. Where viruses like Influenza usually cause localized pneumonia in one section of one lung, Covid-19 has the tendency of engulfing the entirety of both lungs.
And, the incredible number of people diseased at once also complicates the work of respiratory specialists.
“These patients are so different from any patients we have ever seen before,” Dr. Julie Eason said. “We normally have a couple patients that are this level sick. (Now) our ICUs are filled with them. And filled with them. None of them can breathe.”
Intubation and a ventilator aren’t the go-to for all patients either. One treatment that’s usually tried first is to provide supplementary oxygen through a nasal cannula. This is a device that goes into the patient’s nose. It’s only after the nasal cannula fails that respiratory therapists are forced to intubate and that’s why a big part of their job is to track the patient’s condition and oxygen levels at all times so that they know when they should use which procedure.
“It requires a lot of knowledge, experience, and skill to be able to advise a physician on the best way to ventilate,” said Tom Barnes, the lead faculty member and consultant for Northeastern University’s Master of Science in Respiratory Care Leadership program.
Tom Kallstrom also pointed out that no other healthcare specialist has the required knowledge and skillset to do this job.
“Neither party really has the background and training on mechanical ventilators that a respiratory therapist has. It’s really a three-legged stool. You really need your doctor, nurse, and respiratory therapist continually working together.”
“It’s like if you were to sit in the cockpit of an airplane, you wouldn’t know what to do,” said Kallstrom. “I don’t think a ventilator is that confusing necessarily, but there are a lot of buttons and modes that a modern-day ventilator has.”
Another thing to keep in mind is that respiratory therapists are also putting their lives on the line as they are directly at risk of getting infected themselves while performing intubations and caring for their patients.
“You have to see where you’re going with that tube down the trachea, not the esophagus. It’s very difficult when you’ve got a mask, goggles, everything on,” Shultis said. “The patient is having exhaled breaths in your face. So that’s why it’s very dangerous. That’s why it’s imperative that we have the right (personal protective equipment) for whomever is in the room, but especially for respiratory therapists.”
Barnes, Kallstrom, and Shultis all mentioned that they were frustrated by the lack of acknowledgment by the media and government officials of respiratory therapists’ role in the crisis. While everyone is talking about the need for more medical ventilators and while that is an important thing to talk about, respiratory therapists feel not only overworked but also overlooked.
“They’re out there working their hearts out and it’s especially hard when people don’t acknowledge them,” Barnes said.
Shultis also remarked that this lack of acknowledgment doesn’t just happen on the news, it happens in the hospitals as well.
“Call us by our name. We are not just the people who run the ventilators. We’re respiratory therapists. We’re an important profession on the health care team,” Shultis said.
And while the media today may feel overly focused on the Covid-19 pandemic and everything around it, it’s important to keep in mind that there’s still a great deal of professionals and situations that the general public doesn’t know or think about, including entire fields of medical professionals such as respiratory therapists.
As the narrator of CNN’s Inside the ER episode said: “What is most jarring about seeing the inside of an ER and hospital making the transition to being one of three in New York state that will only treat patients suffering from coronavirus is that outside [of the hospital] it is quiet and it feels like an early spring day.”