A New Year’s Message from the President’s Desk Announcing ...

2021: A Year for Hope and Healing

This is the time of year when we often look back and remember the high points of achievements and the celebrations: the degrees and certifica-tions earned, the births and marriages. We remember the low points of loss and frustration, the deaths, the promotions that didn’t materialize, friendships fractured. We may smile at the memory of the times when the days were pleasantly routine, perhaps even boring. This is also the time of year when many will set goals or make New Year’s resolutions.

As we begin this new year, as an organization, the theme is one of hope. Hope that the availability of therapeutics to treat COVID infections and vaccines to help prevent it will bring this pandemic under control. We have hope, recognizing that it will take more than the warm and fuzzy

feeling of hope to achieve our goals. It will take a continued diligence. It will continue to challenge the clinical healthcare community. It is this gray area that we are balancing respect and careful behaviors to mitigate spread, and the need for continuation of programs and initiatives that are not directly related to patient care. The availability of vaccines is just the beginning of COVID control. It is still difficult to plan some things, but many are too important to “just wait and see.” As respiratory therapists, you know all too well that you can’t hit “pause” and pick up when the crisis is over. As we welcome 2021, let this be a year of hope and diligence.

Although we are still in the midst of a global pandemic as we welcome the new year, we haveopportunity. We continue to have opportunities to serve our patients and their families. We continueto have opportunities to learn more about the virus and which therapies are the most beneficial. Wecontinue to have opportunities to comfort and help others, and to accept a comforting work from a co-worker, when we may be struggling. Those who are working in a hospital clinical affiliate of a respiratory care education program have opportunities to help students develop and master clinical skills, and to role model professionalism under pressure. Encourage those students. The interruptions to in-person learning have been difficult for students. Remind them it has been a hundred years since the last pandemic of this magnitude. Although the damages and losses are staggering, this too shall pass. Teach them to properly protect themselves so that they can care for the patients safely. Recognize that this student may be the next new member of your department. Let us remain hopeful, and open to opportunities.

Wishing you a Healthy and Happy New Year!

Midge Seim, President

A New Year’s Message from the President’s Desk

Announcing the 2021 ISRC Virtual Conference!!!

TRIVIA CORNER

How many college programs exist inIllinois for Respiratory Therapy?

QUESTION?

The ISRC’s 52nd Annual Conference, Because Education is Too Important to Miss,

closed on Dec. 1, 2020. The Program Committee would like to thank everyone for

their participation and support. Despite the many challenges of this year, we were

very pleased to present great speakers and content at such reasonable pricing for

the societies first ever virtual conference!

This year we are excited to announce the ISRC 53rd Annual Conference: 2021 A

Year of Hope, Using Knowledge to Empower. This virtual formatted conference will

begin on April 28, 2021 and feature ala-cart lectures that can be individually

purchased to meet all license renewal needs.

Announcing the 2021 ISRC Virtual Conference!!!

Clinical Hero_Thank You_outlines.indd 1 6/4/20 11:59 AM

Clinical Hero_Thank You_outlines.indd 1 6/4/20 11:59 AM

One thing I vividly remember as I started the Respiratory Therapy pro-gram years ago was that as a RT, we would need the ability to adapt to change.  Therapists need to be able to quickly adapt topatient status changes, assignments shifting around depending onstaffing, and advancements in medicine or newfound research.  In the nine years, I’ve worked as a therapist, much has changed, however I’ve never seen things evolve and shift as rapidly as I have in the past ten months. 

In the months leading up to the pandemic, the community hospital where I work at had been preparing to transition to all nebulizedmedications. This project came to a screeching halt mid-March,when the fear of viral transmission via aerosol generating procedures came to light.  Therapists administered MDI’s for months, many times feeling the patients were not receiving appropriate medication depo-

sition due to inability to comprehend procedure, poor technique, and limited inspiratory effort. The consensus was clear, our respiratory therapists wanted the autonomy to determine the device that would deliver the best deposition of medication depending on the patient situation, patient advocacy at its finest!  After studying multiple peer reviewed articles and publications including several written by Dr. Arzu Ari, a 2020 AARC SPOTY Award recipient, we were able to state the case for a change of procedure to hospi-tal administration and interdisciplinary team members assuring them that with proper PPE, filtration of nebulizers, circuits, and properly ventilated rooms, the administration of nebulized medication was safe.  Now, our staff is not limited to one delivery method and can use patient assessment skills to determine the best route of medication administration for the patient.  

Since then, several local RT leaders have reached out to our department to ask for resources toshare with their organizations.  It has been exciting to collaborate and share the information we havelearned in an effort to provide the best patient care. Watching social media the in the past months hasalso shown a shift in the mindset of respiratory therapists; at first there did seem to be strong avoidanceof the nebulization of medications. As more understanding and research has become available theredefinitely been a noticed increase in respiratory therapists advocating for the ability to have the choiceof nebulized medications for patients that warrant it. This is what it’s all about: patient advocacy,growth, and advancing our profession.  

I am proud to be a respiratory therapist and part of a profession that always rises to theoccasion. This pandemic has been difficult, but using science, knowledge and best practices ourrespiratory therapy community continues answering the call and leading the way.

Lexie Caraway MBA, RRT-NPS, RRT-ACCS, AE-C

New leadership takes the American Association for Respiratory Care (AARC) helm for 2021. The AARC Board of Directors has named Paul Divis as Interim Executive Director.

A Texas native, Divis brings a lifetime of business, finance, and leadership experience to the AARC team. He received his bachelor’s degree from the United States Military Academy at West Point and his master’s from Southern Methodist University’s Cox School of Business.

Most recently, Divis worked as the business development director with Pratt & Whitney, an aircraft manufacturer. There he led a team to selling $900 million in new sales. In addition to his business career, Divis is a former U.S. Army Officer.

“We are confident with Paul’s leadership and drive that AARC will continue to obtain and exceed orga-nizational goals and objectives with a commitment to transparency and a forward-thinking,” said Sheri Tooley, BSRT, RRT, RRT-NPS, CPFT, AE-C, FAARC, AARC President.

This change comes after the departure of Tom Kallstrom and Tim Myers, the AARC’s former executive director and chief business officer, respectively.

“We are encouraged and enthusiastic about 2021 as we begin a national search for a permanent executive director for the AARC,” Tooley said. “As always, our focus remains on the advancement of respiratory care, our patients, members, and organizational allies. We will continue to advance our mission and in-crease awareness and understanding about our profession.”

AARC Board Names New Interim Executive Director

News that a mysterious illness was sending people to the hospital in Wuhan, China, first surfaced in late December of 2019. On Jan. 11 of 2020, the disease was tied to what scientists were calling a “new corona-virus.” The virus quickly spread to other nations in Asia, and by Jan. 24, it was in Europe as well. The U.S. saw its first confirmed cases in late January when five people who had traveled to Wuhan fell ill with the disease.

By February, a major outbreak had occurred aboard a cruise ship, Italy was being devastated, and the CDC warned Americans to begin preparing for the spread of the virus in the U.S. Those fears materialized in early March with a significant outbreak in Washington State. New York City would bear the brunt next. The rest of the nation was not far behind.

It was a worst case scenario for everyone in health care, and respiratory therapists were in the middle of the fray from day one. We asked AARC members to share their thoughts on 2020 and the lessons they learned during the pandemic.

Pivoting to a new reality

Kenny Miller, MEd, MSRT, RRT, RRT-ACCS, RRT-NPS, AE-C, FAARC, educational coordinator and wellness champion for respiratory care services for the Lehigh Valley Health Network in Allentown, PA, says his hospital began addressing the pandemic daily beginning in early March.

“At 0700 there was a daily multidisciplinary team phone call that discussed and assessed current clinical practice germane to the COVID patient population,” he said. “This team included respiratory care leader-ship, the departmental medical director, infection control, hospital administration, and the ICUdirectors.” Continue Reading

Reflecting on 2020: Stories from the Front lines

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The group tackled topics ranging from infection control to equipment levels to practice changes, and all the information was placed in a staff folder that could be reviewed and revised as needed. The hospital continued with the daily meetings until early July.

At Henry Ford Hospital in Detroit, MI, Department Director Alicia Wafer, MBA, RRT, and Manager Jonathan Vono, RRT, say the pandemic catapulted their department from a typical ventilator load of 75-85 per day to more than 100 within a week’s time.

“COVID-19 changed our behavior and physical plant so very radically overnight,” Vono said. “Non–emer-gent surgeries stopped, the ER was overflowing, and hospital beds were filling with patients coming in with suspected COVID, or presenting with COVID symptoms, while we still had patients coming in sick and injured.”

As clinicians provided bedside care, department leaders worked closely with physician medical directors and other providers across all disciplines to create and revise system policies to meet the demands being placed on operations due to COVID-19. Their primary focus was on making the changes that made the most sense from a patient and staff safety standpoint. “Changes were communicated to teams in huddles, via electronic huddle boards, and via email,” says Wafer.

Dealing with interruptions

For Caitlin Coppock, RRT, RRT-ACCS, and her colleagues at INTEGRIS Canadian Valley Hospital in Edmond, OK, the early days of the pandemic were felt in terms of interruptions in their supply chains. “We were not of priority to get some of the disposables we use, so we had to become very efficient in using them, knowing we needed to try other modalities if patients could tolerate them, to avoid depletingcertain equipment supplies we had,” she said.

They learned some early lessons from their initial encounter with a confirmed case, which came inmid-March, as well.

“Our first positive system-wide knocked out an entire ICU of nurses and RTs and a few physiciansbecause of exposure at the time,” she said. The patient was not on the radar for COVID, but ultimately tested positive. The experience led to an immediate increase in measures to protect staff and otherpatients from aerosol generating procedures.

Lisa Ball, MHA, RRT, RRT-NPS, RRT-ACCS, RPFT, COPD-ed, CTTS, NCTTP, works in the IBMCpulmonary lab at INTEGRIS Health in Oklahoma City and she says the pandemic shut down many of their services at first.

“We initially canceled all PFTs, bronchoscopies, and 6MWTs for about two weeks while we determined if or how we could safely perform these services,” she said. Of the five full time RTs in the lab, two decided to furlough, one volunteered to work on the COVID unit, and the other two remained in the lab.

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“For about four weeks, before COVID testing was available, we only performed emergent bronchoscopies and PFTs,” Ball said. “Our emergent PFTs were for patients suspected of amiodarone toxicity, pre–che-mo clearance, and post–lung transplant suspected of rejection, liver transplant workup, and LVAD/heart transplant work up.” Lung transplants were canceled because neither donors nor recipients could betested.

The lab was able to fully open after about six weeks. Thankfully, their PFT rooms are all negative airflow, and they removed everything in them that was not necessary for testing. RTs wear N-95s, a face shield, and gloves, and patients are prescreened with a temperature check and symptom survey when they enter the hospital. All bronchoscopy patients must have a negative COVID test within seven days of their pro-cedure.

Ensuring safe travels

The flight team at AdventHealth in Orlando, FL, transported their first patient under investigation (PUI) for COVID-19 on Mar. 23. Until then, they focused solely on safety.

“We had an unofficial stand-down to make sure we were all on the same page,” said Fight Therapist Jon Inkrott, RRT, RRT-ACCS. “We had to make sure we had buy–in from our dispatchers and our mechanics and our pilots and ultimately, the entire crew.”

That first patient turned out to be negative, but the experience gave the team confidence that they had put all the necessary safety precautions into place. Since then, they’ve transported 20 PUI/positive cases in the aircraft and nearly 1,800 by ground. Among the latter group, 39% have ultimately tested positive for the virus.

Inkrott says the challenges they faced in the transport environment transcended those faced in thetypical hospital setting. For one thing, it is not possible to communicate in the aircraft while wearing a North mask or an N-95 due to the helmet microphone.

“So, we purchased masks with an integrated microphone in the mask, which made communication much easier and normal,” he said. They also had to create a proning protocol to safely transport patients in the ambulance.

Changes in practice

While mechanical ventilation was the mainstay of treatment for people with severe COVID-19 during the early days of the pandemic, the high mortality rate for patients receiving invasive ventilation soon drove RTs and their colleagues in medicine and nursing to consider alternatives.

“In the early phase, the threshold for intubation and ECMO was very low,” said Kenneth Miller. “After several months, those thresholds were elevated. Every intervention was utilized to prevent intubation and ECMO.”

At Henry Ford in Detroit, therapists began using HHFNC, NPPV, and proning relatively quickly, says Rena Laliberte, BS, RRT, clinical specialist in education and the emergency department.

“Our system kept up with daily CDC recommendations and shared and learned information as updates occurred, and our practice changed based on those updates,” she said.

Over the coming months, they would treat more than 3,000 patients with COVID, and among that group about 900 were ventilated. Laliberte worked in the ED during the entire surge, and says she feels proud of the work she did there.

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“I knew I was doing exactly what was recommended to help treat and save the patient,” Laliberte said. “When they improved, it was a very rewarding feeling.”

Caitlin Coppock says the initial policy to intubate early if the patient’s work of breathing and O2 demands required more than a flush oxymask soon gave way to a less invasive paradigm at her hospital in Oklaho-ma.

“Over the weeks and months to follow we were slowing down pushing mechanical ventilation and instead trying proning while on HFNC,” she said.

They saw some success, but she emphasizes that for some patients, those tactics just prolonged the inevita-ble need for invasive ventilation.

“Patients that are very critically ill still do not have great long–term outcomes,” she said.

Troy Whitacre, RRT, RRT-ACCS, clinical coordinator in the medical ICU at MU Health Care in Colum-bia, MO, says they were intubating their patients when Fio2 was greater than .60 on the HHFNC when the pandemic began.

“Now, if the patient is mostly asymptomatic with adequate mentation, we may not intubate patients on 1.0 fio2/60lpm HHFNC until there is a clear indication — such as increasing fatigue, confusion, or frequent drops in Spo2 to less than 88,” he said.

Beyond adult acute care

The pandemic has drawn great attention to the work RTs do in adult acute care, but its effects have been felt by therapists working in other settings too. Gary Wong, MBA, RRT, and Rick Morgan, BPA, RRT, RRT-NPS, represent two ends of the spectrum.

Wong is director of respiratory services at Islands Skilled Nursing and Rehabilitation, a 42-bed post-acute and respiratory care community specializing in short–term rehabilitation, ventilator, and tracheostomy care in Honolulu, HI. As hospitals on the island of Oahu began to fill up, they needed to discharge some of their patients to his facility to free up critical care beds, and that meant he and his colleagues had to make some immediate changes.

“Without all the physical plant advantages of piped in oxygen and suction, private rooms, and negative pressure rooms, we had to adapt and standardize our ventilator to the VOCSN, which provided us with the built-in oxygen and suction capabilities,” Wong said. “We followed the recommended CDC guidelines to control aerosol generation with HEPA filters, inline suction catheters, and inline Aerogen nebulizers.”

They stockpiled inhalation water for their heaters, ventilator circuits, and HEPA filters as well, in antici-pation of supply chain and inventory disruptions that were being predicted due to the surge in demand created by the pandemic.

Morgan and his colleagues at Johns Hopkins All Children’s Hospital in St. Petersburg, FL, may not have had many COVID patients — indeed, the only good thing about the pandemic is that it has largely spared children — but they have had their share of inventory disruptions as well.

“We have had to be innovative in our problem–solving solutions when our everyday supplies havebecome not available to us because they were consumed by the adult populations, including ventilators and components needed to carry out respiratory therapy across the board,” Morgan said. Continue Reading

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The pandemic has fostered a greater deployment of technology used to connect remotely in his facility as well, and that has increased productivity, since people can now connect to a meeting from any location.

Morgan believes the pandemic has highlighted the importance of resiliency and collaboration amongeveryone in health care. Only by working together and being willing to give and take can patient needs still be met.

A learning experience

At this point, therapists across the country have endured months and months of a pandemic that is still gripping the nation, despite the rollout of promising vaccines. What have they learned the process, not just about best practices in treatment, but about themselves and their colleagues in the hospital?

The RTs we talked to for this article have this to say — What I have learned is how versatile I am when I need to be, and that I can safely care for my patients while protecting myself from this virus. The only practice we have changed is that we wear a mask and face shield and we keep all of our supplies in the cupboards instead of on the counters. We will continue this practice. We thought we were practicing good disinfection techniques prior to the pandemic, but found that we could do better. — Lisa Ball

Lesson One — take your time, be deliberate in practice, and very methodical in protecting yourself with proper PPE and those around you. Lesson Two — be patient, take a breath and keep moving forward. It was a very stressful time and there was little time for breaks and breaths. It would have been easy to snap and break down. But you cannot. You have to keep your focus, remind yourself who you are, what you do, and what you mean to that patient. They are counting on us and we have to rest when we can and then remember who we are! — Rena Laliberte

A pandemic exposes health care professionals to a great deal of personal anguish—especially true when resources are limited and care is the best you can deliver, but not what you are usually able to give. More resources need to be focused on frontline staff to make sure their emotional needs are being met.Hospitals and departments need to reassess supply reserves, including PPE, ventilators, and ventilatoraccessories, filters, commercial endotracheal securing devices, and such. — Troy Whitacre

Read More @ https://www.aarc.org/an21-reflecting-on-2020-stories-from-the-front-lines/

?TRIVIA CORNER

There are 13 Respiratory Therapy colegeprograms in Illinois

ANSWER

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