To our Texas Society for Respiratory Care Members,
On behalf of the Texas Society for Respiratory Care (TSRC) Board of Directors please find the message below related to the newly released Mechanical Ventilation for COVID-19 Course developed in collaboration with the American Association for Respiratory Care (AARC), edX, Harvard Medical School and Massachusetts General Hospital. It is important Respiratory Therapists are aware of the facts surrounding this collaborative effort in response to staffing models during pandemic times (like COVID-19).
The Mechanical Ventilation for COVID-19 Course was developed with the intent to provide an overview of mechanical ventilation and patient interaction for the non-critical care practitioners or Respiratory Therapy extenders when, in pandemic times, the surge of ventilated patients may overwhelm the number of trained critical care clinicians. During a pandemic time, the critical care team is augmented by non-critical care clinicians. This staffing model is NOT the model used during non-Pandemic times.
The Society of Critical Care Medicine’s (SCCM) Tiered Staffing Strategy during a pandemic (like COVID-19) allows a single critical care physician to oversee large numbers of ventilated patients as seen in the diagram below. This model was developed by SCCM years ago in response to the prior H1N1 pandemic and the crisis of caring for many mechanically ventilated patients at one time. In this model, the critical care physician would be responsible for over 100 mechanically ventilated patients. In this model, the Respiratory Therapist would assume leadership and be responsible for 24 mechanically ventilated patients. This is clearly an unsafe Respiratory Therapist-to-patient ratio. The augmented non-critical care clinicians or Respiratory Therapy extenders would be available to support the Respiratory Therapist by assessing the mechanically ventilated patient’s needs and may result in the need for suctioning or notify the respiratory therapist when the patient’s status changes.
It is important to recognize the AARC Executive Office and all AARC Board members, including the Board of Medical Advisors (BOMA), support the following statement, “The AARC does NOT endorse this crisis staffing model in non-pandemic times or in facilities that are not experiencing the patient surge that makes this staffing model necessary. This is not a safe model to follow if alternative means are available. The AARC believes the best person to care for the patient’s cardiopulmonary care is the respiratory therapist. The intent of this collaborative project was not to demean, demote, or discard the vital role the Respiratory Therapist holds in healthcare.“
Neither the AARC nor the TSRC wants anyone other than Respiratory Therapists managing ventilators; however, this pandemic may leave many institutions facing unprecedented staffing issues. We cannot allow a patient to suffer simply because a Respiratory Therapist is not available. Texas has not reported situations like other states that are inundated with COVID-19 patient cases. This Mechanical Ventilation for COVID-19 course in no way prepares a person to operate as a Respiratory Therapist or an independent critical care clinician, and it does not provide competency for mechanical ventilation or respiratory therapy in general. The Mechanical Ventilation for CoVID-19 Course provides a foundation of knowledge. The Mechanical Ventilation for COVID-19 Course was designed to provide support to our Respiratory Therapists in those critical care areas experiencing a high number of ventilated patients.
The value of Respiratory Therapists to the healthcare team is evident in the fact that outside organizations recognize the AARC and Respiratory Therapists are the mechanical ventilation experts. Let me also remind you of the “Battle of Texas RCP Licensure” that we fought and won in 2014-2015. The AARC stood strong next to the TSRC, and together we completely changed the idea that licensure is not needed for our profession. We had one chance to prove our value as a critical and essential licensed provider for the health care team. We now fall under the same licensure board as physicians. The Texas Medical Board holds us to a higher standard and provides us more opportunity to broaden our scope of practice and provide the best care for our patients. Both the AARC and TSRC continue to advocate on your behalf with our government officials and increasing our value in the future as telehealth providers.
During this time of crisis, we must work together, communicate, and provide and utilize the best resources available. We are seeing enormous increases in news coverage on the role of the Respiratory Therapist in the healthcare team. The AARC is spreading the message. The TSRC is spreading the message. Now, more than ever, we need solidarity. We will not always agree on the best course of action, but we cannot break from our shared ambition of supporting the Respiratory Care profession. We are stronger together. Let us all share the common goals of Professionalism, Advocacy, Commitment and Excellence. The TSRC values each of you and your ongoing support and dedication to Respiratory Care. Please reach out to your professional organizations, the AARC and the TSRC, with questions or concerns. We have been and will always be, here for Respiratory Therapists.