Thursday, February 21, 2013

1920-1940: The birth of the RT profession x

Compared to physicians, who can trace their roots to ancient times, and nurses, who can trace their roots to Clara Barton's Civil War heroics, the profession of respiratory therapy is a relatively young profession that can be traced only as far back as 1922.

We could trace it back to 5,000 B.C. when Egyptians inhale fumes to gain breathing relief, or 100 A.D. when herbs were smoked in pipes in Ancient India, or even the 18th or 19th century when the first nebulizers and pressurized breathing machines were patented.

Yet the profession as we know it can only be traced back to 1922 when John Scott Haldane wrote about his research on oxygen in "The Therapeutic Administration of Oxygen." It was this book that sparked interest in the therapeutic use in oxygen to treat diseases.

Prior to the 1920s oxygen therapy equipment was purchased and/or put together by the physician, who would also set up the equipment, maintain the equipment, and also monitor the patient.   

By the 1920s physicians were working hard to lug large oxygen tanks from one room to another, and this task quickly became overwhelming for them, especially as they also had a practice and a home life that needed their attention.  

Yet by the 1920s, when oxygen tanks were available, doctors had to work hard to lug the tanks from one patient room to another. Patients who were set up on oxygen masks and oxygen tents and iron lungs needed constant attention and monitoring.   

Masks back then were made of black rubber, making it impossible to see if it was filling up with pulmonary edema or vomit, or if the patient was otherwise getting worse.  These masks were also known to stick to people's faces, further complicating their care.  

Therefore, to see if a patient was getting worse, these masks had to be removed from the patients faces on a regular basis. When this was done powder was placed around the mask to prevent it from sticking to the patients face.  (Glover)

This task became overwhelming for physicians, and so they recruited the assistants of nurses, and mainly female nurses.  It soon became the job of nurses to set up, manage, and maintain all the oxygen equipment, along with monitoring these patients.  And, of course, it was now their job to lug those large oxygen tanks and iron lungs from room to room, and then to clean all this equipment between patients.

Such caregivers also had to make sure the oxygen tanks still had oxygen in them, and this task was complicated by the fact that oxygen regulators were not always accurate.  If they didn't trust the regulator, they might have to change a tank even though there was plenty of oxygen in it.  

The first nonrebreather-type masks were made so these patients could get 100 percent oxygen, and they were made with two flaps with one way valves that prevented these patients from entraining room air. The problem with this system was that when a tank ran out without warning, these patients were prevented from getting air, and many of them suffocated.

To prevent this one of the flaps was removed.  In this way, if the oxygen in the tank ran out, the patient would still be able to entrain room air to prevent suffocation.  It is for this reason that nonrebreather masks to this day still only have one flap, and really, technically speaking, not truly nonrebreather masks but partial rebreather masks delivering only about 75 percent oxygen.  

Another problem developing at this time was that oxygen therapy had become so complicated and burdensome that knowledge of it was generally beyond the scope of a physician's knowledge. It mus also have been beyond the scope of a nurses knowledge.  The main reason that this was not because physicians and nurses weren't intelligent, but because most were educated and trained prior to the use of oxygen therapy, or before the oxygen revolution of the 1920s.    

So special training was required to learn how to set up, manage, operate it, transport and clean this equipment.  In most cases certain physicians and nurses were especially trained, and these physicians and nurses were in essence your first respiratory therapists. 

But keeping up with new knowledge in this era was always a challenge, especially for senior physicians who were skeptical of this new therapy and were resistant to change. 

So the job of managing oxygen equipment, which now included tanks, oxygen tents, and iron lungs, was doled off to nurses, mainly female nurses. 

By the 1930s managing patients with oxygen became routine, and large tanks were placed outside the hospital and piping systems were set up inside the walls to patient rooms.  This made it so nurses no longer had to lug tanks from room to room.
Also by this time, as physicians did a decade earlier, nurses started complaining of being overwhelmed by taking care of so many patients who were now requiring oxygen therapy, while at the same time having to manage all of their other patients.  It was for this reason that they started recruiting other hospital staff, particularly male orderlies and nurses assistants, to help them with all the oxygen related duties.  These orderlies in essence became your first true inhalation therapists, and the profession of inhalation therapy grew into its infancy.  (2)

Now, instead of trained physicians and nurses handling the job of oxygen therapy, the job was now performed people who had no medical training other than what they learned on the job.  These individuals were often referred to On Job Trainees (OJT).  

Because these OJTs were now taking care of patients and complicated life saving equipment, the need, the need arose for special training on oxygen equipment and how to care for patients requiring its use.  

Commercial companies who supplied the oxygen equipment, or physicians at the hospital itself, created programs to train OJTs to become inhalation therapists, who quickly became the experts on oxygen therapy.  

These specially trained OJTs were now separate from the other orderlies, and they began to meet with people with similar duties at other institutions. These orderlies, and nurses aids were now officially referred to as inhalation therapists, and sometimes as "oxygen orderlies." A young profession of inhalation therapy was born. (1, page 9)

  1. Wyka, Kenneth A, Paul Joseph Matthews, John A. Rutkowski, editors,"Fundamentals of Respiratory Care," 2011, Delmar, New York, Cengage Learning,
  2. Glover, Dennis W., "History of Respiratory Therapy," 

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