Amid the COVID-19 pandemic, the primary health care focus has been on physicians and nurses as front-line workers. Respiratory therapists, though, have an especially critical role in helping patients fight and recover from the coronavirus. While physicians and nurses have some knowledge and skills in every organ system, respiratory therapists specialize only in the heart and the lungs. And COVID-19 is a respiratory disease, after all.
“Respiratory therapists play a critical role in protecting the health and safety of our community throughout the COVID-19 pandemic,” said Dr. Greg Kendrick, medical director of the Conway Regional Medical Center hospitalist program. “They are the experts in mechanical ventilation, monitoring lung pressure, airway resistance, and oxygen levels. As COVID-19 affects the lungs and respiratory system, respiratory therapists aid patients in every step of their care — from the emergency department to the entirety of a hospitalization. They are truly on the front lines of COVID-19, and we are grateful for their sacrifice, compassion, and dedication.”
The pandemic has highlighted the shortage of ventilators and personal protective equipment, but there is also a need for more respiratory therapists who are trained to operate ventilators. Jobs for respiratory therapists are projected to grow 21 percent by 2028, faster than the average for all occupations. However, the number of practicing respiratory therapists has been gradually declining by a rate of 4 percent to 7 percent over the past few years.
According to the National Board for Respiratory Care, there are nearly 175,000 active, credentialed respiratory therapists in the United States. But in Arkansas, there are only 2,083.
Respiratory therapists are specially trained and licensed to treat diseases, infections or viruses of the cardiopulmonary system. They need to complete at least an associate’s degree program before taking the necessary exam to become a certified respiratory therapist (CCT) or registered respiratory therapist (RRT) through the National Board for Respiratory Care. The 2019 median salary for a respiratory therapist was $61,330, according to the U.S. Bureau for Labor Statistics.
The National Board for Respiratory Care launched an online campaign in April with videos from respiratory therapists around the country explaining their jobs and calling for “More RTs.” Lori Tinkler, CEO of the National Board for Respiratory Care, has been a major proponent behind the campaign.
“Respiratory therapy has been around for 60 or 70 years, but respiratory therapists are still not recognized as much as other health care professionals,” Tinkler told Arkansas Money & Politics. “The world needs more respiratory therapists. The shortage of these professionals is growing, and I think part of it is because there is not enough awareness. They are an integral part of the health care team that works at the bedsides of patients, hand in hand with nurses and are highly skilled in pulmonary care who deserve to be recognized.”
Karrie Thrower, a respiratory therapist for 25 years who works at Conway Regional, actually contracted COVID-19 herself earlier this year but recovered and now shares her story with patients to help them cope.
“Having had the coronavirus myself, I know what my patients are going through,” Thrower said. “They are scared and worried about their loved ones. Hopefully, when I tell them my story, it gives them hope that things are going to be OK.”
After recovering completely from the virus with no lasting effects, she returned to her job at Conway Regional.
“Depending on what area of the hospital I am working in, my role looks different,” she said. “I may be managing a ventilator, assisting a physician in intubating a patient, giving breathing treatments, drawing blood or educating patients and their family members on COPD or asthma.”
As a respiratory therapist, Thrower assists physicians, patients and family members at various capacities. With social distancing and lots of hand sanitizer, she tries to remain safe while treating patients.
“I want people to realize that this virus is very real. It affects everyone differently, but hopefully, by everyone doing their part, we can slow down the spread,” she said. “Keep your distance, wash your hands, and cover your coughs and sneezes.”
Shannon Hall has been a respiratory therapist at Arkansas Children’s for 11 years. For many of those years, she worked regularly in the neonatal intensive care unit.
“The job role in that unit is to help manage a patient’s ventilator, provide the nurses with help regarding the patient’s airway and offer chest physiotherapy that helps to remove secretions,” Hall said. “All of these functions help the small babies breathe a little easier to give them assistance if their lungs are underdeveloped.”
She is also the respiratory coordinator at the hospital. One of her responsibilities is to assess incoming patients and help come up with an appropriate treatment plan to resolve their breathing issues.
Although Arkansas Children’s currently does not have any COVID-19 patients, the virus has still created challenges and altered life for workers.
“The challenge at work is to treat each child to the very best of our ability, while not fearing COVID-19 symptoms, are very real,” said Hall. “And it’s not just COVID-19 per se, but a relentless drive to do everything we can to protect the patients and our fellow healthcare workers.”
However, Hall also believes that a silver lining of the pandemic is the bright light that has been cast on the value of respiratory therapists.
“Because this pandemic has been a respiratory disease, it requires the expertise of respiratory therapists,” she said. “ I hope this era shows people how respiratory therapists are a lifeline to help intubate patients who can’t breathe and help manage life support. The very specific knowledge we have is vital and unique to our profession. We are educated for two long years in nothing but cardiopulmonary disease and treatment. That plays a huge role in treating patients during this pandemic and every other day of the year for children who need help breathing.”
Another respiratory therapist at Arkansas Children’s, Alyssa Springsteen, volunteered to help patients in New York after seeing the significant peak in cases in early March. She worked with COVID-19 patients at Southside Hospital in Bay Shore, N.Y., and spoke with AMP before returning home to Arkansas.
“A few days before I left for New York, I remember looking at news articles and videos to mentally prepare myself for what I would be walking into,” Springsteen said. “The truth is, there is no way to prepare what is inside of these hospital doors. I have watched someone go from a stable condition to gasping for air within a matter of minutes. I have seen patients FaceTime their families on an iPad right before they’re about to be intubated, somehow finding the strength to mutter ‘I love you’ to their family back home.
“For the month that I have been at Southside Hospital, I have been in the same unit for the most part, and I think the hardest part about caring for these patients is that we are doing everything we possibly can to save these patients, but they’re still dying. The ICU team becomes so dedicated to the care of these patients, especially since they have been intubated for so long and we work with them every day – so when a patient dies, it is extremely hard to know that what you did wasn’t enough.”
A small percentage of the COVID-19 patients have recovered, though, which gives Springsteen and other workers hope. Still, she heard “code blue” over the intercom and ventilator alarms from bedsides countless times.
Working in the Southside ICU, Springsteen’s daily routine included putting on a gown, her one N95 mask for the day, surgical mask, hair cover, goggles and face shield. She collaborated with doctors to try to improve ventilation and oxygenation for patients.
“Typically, everyone will look worse than they did [the day] before,” she said. “Some will be on different ventilator settings, more oxygen, proned [moving patients into positions compatible with respiratory support therapies] or on nitric oxide. There is a lot of give and take right now when treating these patients, but no one really knows how to treat COVID. Every patient has been treated differently based on the symptoms they are having.
“What we do is not simple. It is important. And it is nice to finally be acknowledged.”
Springsteen returned to her family in Arkansas after four weeks in New York. She self-quarantined for 14 days and was tested for COVID-19. And she continues to stay in touch with her respiratory team at Southside Hospital who are still treating COVID-19 patients.