Why Specializing In Critical Care Transport Was Right For Me

My life as a respiratory therapist began to take shape in 1989, when a best friend of mine introduced me to his father, an RT who lived and practiced in New Orleans, LA. I did some research on the profession and it seemed like I would enjoy it! It was a given that I was going to be in respiratory care, but to what extent remained to be determined. My interest in transport can probably be traced back to my childhood. When I was a kid, I would have my grandfather take me to the airport to watch planes land and take-off and I was enthralled by it. So when I finished college, I wanted to combine the two things I loved most — my respiratory career and flying. However, I ended up carving out my niche in the adult critical care world, so finding the opportunity to be involved with critical care transport was going to be a challenge. Neo-peds RTs were a fixture on transport teams, but adult based teams that included a full-time RT were a rarity.

Critical Care Transport – Just You And Your Partner Fast forward 22 years and I found that opportunity here with the Florida Flight 1 program at Florida Hospital Orlando. Our crew configuration is an RN/RRT on every flight and has been that way since this program’s inception in 1985. We do not perform scene or trauma calls but strictly inter-facility critical care transports, completing over 750 missions annually. The differences between the ICU and air transport lie in the confined space and rapid thought and decision-making processes necessary during transport. You don’t have other folks to call when you’re 1500 feet in the air, whether it’s for eight minutes or 60 minutes. It’s just you and your partner. The approach you take for each individual patient and the plan you devise for that transport can make or break what that patient outcome will be. A typical day starts at 6:15 in the morning with a shift change checkout of the aircraft with the off going team. We then have a daily safety briefing with our pilot, mechanic, dispatcher, and neo and peds teams. Our downtime consists of patient follow-up, education, flight QAs (where we critique the performance of other team members on their flights), and sometimes helping out in the ER. My training consisted of 22 years of experience, medical director interviews, panel interviews, a three-month orientation process with multiple “mock calls,” timed scenarios, protocol memorization, and a preceptor’s observation. It all ultimately led to my spot on this incredible team!

No Matter What It Takes It’s hard to pinpoint one particular call as the one that sticks out the most in my mind. I have been a part of a few in-flight emergencies that presented the ultimate challenge for two people. Compressions, airway control, medication delivery, and if called for, defibrillation — all of this is going on in sync. It’s pretty incredible. Probably the most rewarding part of the job is the successful patient outcomes. I enjoy the challenge of getting the sickest of the sick and knowing that we will get them to a place where they can get the definitive care they need, no matter what it takes. If you find yourself wanting to pursue a position in critical care transport, know that it is a different world than the ICU. Yes, we are a mobile ICU, but there are limited resources. Attributes to have are critical care experience, critical care skills (ACLS/PALS/NRP/ ACCS/NPS, depending on whether you’re doing adult or neo-peds), critical thinking and decision-making skills, professional involvement (societies, committees, councils, etc.), nonstop education, no fear of heights, and an unrelenting passion for your job. I love going home but can’t wait to come back the next day. That’s what it’s all about.

Jon Inkrott is a flight respiratory therapist with Florida Flight 1 at Florida Hospital- Orlando in Orlando, FL.

A Day in the Life of a Respiratory Therapist by Minority Nurse Staff | Mar 30, 2013 | Magazine, Nursing Careers | Name: Tonie Perez education: Kettering College of Medical Arts title: Respiratory therapist workplace: Cincinnati Children’s Hospital’s Regional Center Neonatal Intensive Care Unit (RCNIC) location: Cincinnati, Oh.

Every eight seconds in the United States a new baby is born. Each newborn begins their lives as independent humans with their very first breath. Throughout our lives, how often we breathe and how much we breathe is often taken for granted. For some children, however, this simple function is not so effortless.

The science of respiration or breathing leads us to the profession of respiratory therapy. Respiratory therapy is utilized in all hospital settings, nursing homes and even home health care. Some respiratory therapists choose to become instructors in the world of education, while others work within the hospital environment where there are various levels of care.

Meet Tonie Perez, a respiratory therapist at Cincinnati Children’s Hospital Medical Center. Perez has been a respiratory therapist for 17 years. She graduated from Kettering College of Medical Arts in Kettering Ohio in 1987. “I chose Kettering because they are state-of-the-art, and I knew I would get a good education,” she says. At the Cincinnati Children’s Hospital Perez works in the newborn intensive care unitÑthe Regional Center Neonatal Intensive Care Unit (RCNIC)Ñwhere she is involved with the intensive care aspects of respiratory therapy.

The population of the RCNIC varies from pre-term (24-weeks gestation) to post term (greater than 40 weeks). The role of the respiratory therapist in this critical care environment is to work with pre-term infants prior to 40-weeks gestation or a term pregnancy, which requires constant monitoring of respiratory status. The infant’s lungs are not fully mature until 34-weeks gestation, so birth prior to 40 weeks brings potential problems. For example, during the lung development a substance called Surfactant, which is critical for normal lung function, isn’t readily available.

Being born early not only requires more ventilator support, it also necessitates the need to give Surfactant artificially. Oxygen given to the infants must be monitored continuously because of potential detrimental side effects to their eyes and lungs. It’s like that old adage, too much of a good thing is bad.

Some of the patients require medication like bronchodilators to increase the diameter of their airways in order to decrease the work it takes to breathe. Airway management is also needed when patients stop breathing. Immediate intervention is required until the problem is resolved. Respiratory therapists will place a mask over an infant’s face and squeeze a bag that inflates the lungs and breathes for the infant. Depending on the severity of the situation, infants may also be placed on a ventilator. Doctors, nurses and respiratory therapists all work collaboratively for the best care of the child.

Obviously this is challenging and demanding work, but Perez thrives in the environment. She recently received the Zenith Award as an acknowledgement that she has gone above and beyond the call of duty in her position.

Perez originally chose this field of expertise because she felt she could make a profound difference in her parent’s lives. She also enjoys being part of a team that is working together to improve patients’ outcomes.

Perez encourages all students interested in respiratory therapy to learn more about this exciting field. “I can’t stress enough the fact that respiratory therapy is an ever changing and growing field,” she says, “and if you are one who loves new and exciting things and loves people, respiratory [therapy] is for you.”

Read on to discover what a typical day is like for respiratory therapist, Tonie Perez . 7:00 a.m. Perez’s day starts early; she will work a 12-hour shift, three days a week. Upon arrival to the unit, the night shift gives her a progress report on the patients she is assigned to for the next 12 hours. Once Perez has gotten the report, she checks her orders for the patients.

8:00 a.m. Perez is in her area making ventilator rounds. She assesses the patients and their ventilators and makes sure they are working correctly.

9:30 a.m. The physicians, residents, nurses, dieticians, pharmacists and respiratory therapists go to each bedside and discuss the course of care for that particular patient. Patients on ventilators are assessed and ventilator settings are documented every two hours.

10:00 a.m. Ventilator rounds are again made, settings are documented, and patients’ lungs are listened to and assessed for secretions or other negative sounds. If needed, corrective intervention is made. Perez says that this is the predictable element of her job, which makes up about 40%. The other 60%, she says, is not scheduled or predictable because this is a very unstable environment. “Our doors are open 24-hours a day, seven days a week to accommodate the various needs of the infant population,” she says.

11:00 a.m. A 30-week-old infant is coming in with the transport team from an outside birthing center that was not able to accommodate his breathing needs and possible surgical issues. He is placed in a radiant warmer and connected to a ventilator. The monitors are functional so they are continuously monitoring him. An x-ray is ordered to determine if the ventilator is adequate, and blood is drawn, which will be sent to the lab so that they can access his ventilation.

11:30 a.m. A half hour has passed while they admit the infant boy. Surgery is called in to assess the need for surgery on a questionable lung mass that was seen on his x-ray. Meanwhile, the staff is doing total supportive care. With all the activity, the infant in the next bed is becomes sensitive to the increased noise. She starts to show signs of distress; her heart rate drops and she begins to have an apnea episode where she holds her breath and begins to turns blue. Perez attempts to stimulate the infant’s breath by repositioning her and making sure her airway is open. The girl begins to breathe again and her color returns to normal.

1:30 p.m. Perez begins assessing various ventilator patients. With the new baby boy, she now has four patients to attend to. On any given day Perez can have from two to 12 patients, but she says that she usually has six. “You’re responsible for those patients’ ventilator assessment every two hours, respiratory medication administration, laboratory blood draws, and constant monitoring of their vitals,” she says.

3:00 p.m. Surgery returns to the new admit to inform Perez and the nursing staff that surgery is not needed at this time. They continue supportive methods.

4:00 p.m. Perez is informed that another new admit will be coming in. The mother of the baby girl had no prenatal care and has no idea what the gestation is of the infant.

5:15 p.m. The infant girl arrives. It was determined by the outside birthing hospital that the infant was approximately 29 weeks old. The birthing hospital was not equipped to take care of her, so she came to RCNIC for supportive care. She’s placed on a nasal cannula so that oxygen can be delivered to her. She’s also placed on monitors and observed. Perez obtains lab values to assess her ventilatory status. Everything appears normal, but the staff will continue to watch her.

6:30 p.m. Perez makes her last ventilator rounds and takes notes. When 7:00 p.m. arrives she’s prepared to give her progress report on all the patients for that day. “The average day is very lively but that is what I love the most about my job,” Perez says. She also values her great co-workers and the continuous learning environment. “There is nowhere else you can get paid to learn,” Perez asserts. “Medicine is always changing and you have to be the kind of individual that accepts change and takes it with open arms.”

Resources for those interested in the Respiratory Field: http://www.aarc.org/careers/how-to-become-an-rt/ https://www.coarc.com/ https://www.nbrc.org/ http://www.aarc.org/education/educator-resources/transitioning-associate-to-baccalaureate- degree-program/ https://www.youtube.com/watch?v=XPu04FOnCso