Good afternoon from fabulous Las Vegas!
Tomorrow begins the AARC National Sputum Bowl competition, and I couldn't be more excited! I know we are all anxious to see those wonderful sputum bowl participants represent their states in this fun competition.
Whether here in Las Vegas or at home, you can follow your team's progress with online brackets available at If you are in Las Vegas, make sure to stop by the competition to cheer on the teams, and stop by the Covidien booth in the exhibit hall.
Look forward to seeing you tomorrow!
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Hey Montana RT's!
happy thanksgiving week!

please note that the nominations emails you received a few weeks back from the MSRC via the AARC are due by no later than November 30th!

we encourage all to participate. 

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November is COPD Awareness Month! A few of the initiatives of the COPD Foundation is to wear the color orange (the official color of COPD) and to #Tell10 people about COPD every day of the month.
Wearing orange should not be a problem for me since I am from Tennessee (#GBO), but I would like to do better about spreading the word concerning health promotion and education in COPD. I have found one of the best resources to be the COPD screener. My students use this tool during community service efforts on and off campus. Let's find a way to eliminate one of the leading causes of death in the U.S.
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You probably know that November is National COPD Awareness Month and that today is World COPD Day. There are so many ways that respiratory therapists can spread awareness but many of us don't wait for a special month or day. We're out there advocating for our COPD patients day in and day out. I salute all of you who are working so hard to make a difference in our patients' lives.

At the beginning of the month, the AARC gave a laundry list of things that respiratory therapists can do to raise awareness and educate others about COPD ( Today, the COPD Foundation launched its new patient community, COPD360SOCIAL.

COPD360SOCIAL is an interactive community that provides an opportunity for persons diagnosed with COPD, their loved ones, healthcare providers, researchers, and anyone interested in learning more about COPD research to connect and collaborate. While it was only launched this morning, it already has an active discussion forum. RTs (and other healthcare providers) are welcome to join and engage in the discussions.

And don't forget to screen today! My goal is to screen 10 people with the DRIVE4COPD digital screener today. I challenge you to do the same.
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I wanted to reach out to other facilities that are using Nitric Oxide. The use of this gas continues to be a growing concern due to the aggressive price increases of the company. I know there was some discussion about 12th man, but I have not heard anything within the past 2 years. We are looking for alternatives to delivering this expensive therapy. Has anyone had success with decreasing the use of nitric oxide? If so would you mind sharing your success? I have experience with the use of Flolan and Illiprost (inhaled,) but that is a tough sell for the physicians.
    Greg Merritt
    Clinical Educator
    Medical City Children's Hospital
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As Respiratory Care Week (October 19-25, 2014) draws to a close, it is an excellent time to reflect on the many activities to celebrate the role of respiratory therapists (RTs) in caring for patients with diseases and injuries of the lungs.  RTs are essential team members in acute care settings, but they also contribute significantly in post-acute care.  They serve as experts to help educate patients and health care workers (HCWs) on respiratory equipment and supplies used by patients with Chronic Obstructive Pulmonary Disease (COPD).  They assist medical device manufacturers and represent product segments focused on obstructive sleep apnea (OSA); invasive and non-invasive ventilation, humidification, drug delivery devices (nebulizers), and long-term oxygen therapy (LTOT).  This year’s respiratory care week was especially fun for me, because of the opportunity to partner with a medical device manufacturer, which hosted an event to share perspectives with a large group of home care respiratory professionals from Japan. 

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It's no secret that I love Respiratory Care Week. I've worked at several facilities over my career and I have enjoyed a robust Respiratory Care Week at all of them. Over the years, I've taken this for granted. We're respiratory therapists. Why wouldn't we celebrate OUR week? The AARC worked hard to get this week to be official and President Reagan proclaimed this OUR week in 1982. My world view just didn't provide me with the experience to understand that not every department or every RT in the US celebrated Respiratory Care Week. It breaks my heart to see emails, blogs, Facebook posts, Tweets, and other communications about how no one in a certain facility celebrates our week. There are a number of potential reasons why a department manager would not celebrate this week; I won't speculate on the motivation of or challenges presented to any RT manager.

I want to take this moment to tell all respiratory therapists around the world that you are appreciated. Whether your department manager has the budget to purchase gifts and food or not; whether your industry representatives have the budget, company approval, or hospital approval to bring food or not; whether anyone hangs a Respiratory Care Week banner or not;
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The Fall Diagnostics Section Bulletin is now available:

The fall issue features more great contributions from section members.  Elizabeth Koch BHS RRT RPFT discusses pediatric metabolic testing and Holly Wilson RPFT sheds light on the rationale for exercise testing.  The Quarterly Case Report covers several issues regarding test quality including technologist oversight, responding to non-physiologic values, and avoiding software quality feedback fatigue.  

I'm currently looking for articles for the spring issue, please contact me if you have any ideas for articles or a quarterly case report to submit.

Coming this winter: Creating Levey-Jennings Plots for Biologic Controls in Excel by Jennifer Weltz Horpendahl, RRT-NPS, RPFT, AE-C 

If you conduct pulmonary function testing and are not a member of the Diagnostics Specialty Section you're really missing out on a lot of great educational opportunities.  Yearly memberships are $15 or about 4 cents/day, that's less than a.............everything!
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Hand offs-I used to think of this in clinical terms only. Hand Offs are essential to patient safety, and transfer of clinical information. In my I was blessed to get 3 sessions with the retiring HV Director, we developed 12 pages of notes. Consider this reality the successful handoff to the next Director of the HV Center started with this handoff.

HV Center Services-Non-invasive (PVL, Echo), GXT, Cardiac and Pulmonary Rehab, Cath lab, EP Lab

Daily Rounding with staff-daily from 0730-0800 I make rounds with staff. This is before they start patient testing often with closed doors in the their labs. This week we had a great time sharing staff recognition for folks we have been at SRMH 5-10-15 and 20 years, this is a very big deal.

Ebola-the hotest topic this week! Instant opportunity as Interim Director to be very visable with Managers to share our plans, listen to concerns, and simply assure our team I am nervous also, BUT we will do eveything possible to keep everyone safe.

Outcomes-There are at least 4 data bases that outcomes are tracked. Payment is connected to these outcomes, and public reporting of outcomes. This requires dedicated staff to accurately input data. "NO OUTCOME NO INCOME" This the the future of health care NOW
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I see Nurses have unions, where's Respiratory Therapist's Union??? With everything going on out there, Enterovirus68 , Respiratory virus's, Ebola. Who's looking out for us? The AARC? not so much. any thoughts? any ideas?
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Here we go  Round #3. In 2012 Co Interim Director of the ER, 2013 Interim Director of Peri-Operative Services, now 2014 Interim Director of Heart and Vascular Center. This is special because twenty four years ago Dave Grembi  RRT hired me as Asst Director of CardioPulmonary Services. He has now retired as of Oct 3. I worked for Dave for 15 years before becoming Director of Pulmonary and Sleep Services. So this really is like a HOMECOMING. 

Many lessons I bring with me. My  3 page orientation from past Interim roles grew into 12 pages. I have learned this is like a patient handoff as I start preparing now to handoff to the next HV Director. This helps because I will oriente the Next Director as I have the last three Acute Care Directors. More to come...

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First, I have to beg forgiveness for blatantly stealing the "Rock the Vote" theme. I saw a really awesome video for the national "Rock the Vote" campaign this morning, which was not only my catalyst for today's blog but also where I got the very non-creative idea to steal the theme.

Second, I'd like to take a moment to give a shout-out to the AARC volunteers. I've blogged about volunteers and volunteerism before but I'm not sure that the majority of AARC members truly understand the lengths to which these volunteers will go to promote the profession, access to respiratory care for patients, and patient safety. Look around at the AARC activities. Yes, there is a core group of paid individuals at the AARC making things happen, but a lot of the creativity, planning, and elbow grease comes from our volunteers. Do you read the AARConnect section threads? Those section chairs are volunteers elected to lead the sections. Have you been to AARC Congress or Summer Forum? The program committee is all volunteer. Have you read an AARC Clinical Practice Guideline? The research committee is all volunteer. I could keep going but you get the idea.

The real reason for my blog today is to encourage all AARC members to vote in the election that is happening
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We are excited to announce our Ghana Medical Mission dates for Spring 2015  

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We are currently working hard in Maryland to change the minimum entry into the field from CRT to RRT.  We are looking to host a stakeholder's meeting in November to allow everyone to come forward and voice their opinions.  We really want to hear from the students as this will affect them the most.  Although it won't affect current students because we are setting a later date as to not change the rules on the students who have already entered school.  We feel with the changes the NBRC has brought to the testing that we should require a higher score and have the highest standards.  Looking to make this change in 2016... If you are reading this and have feedback for us let me know.
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My wife taught math for 26 years before retiring.  She always says that "educational choices have consequences."  Nowhere is that more true than in the intersection between the medical and legal worlds.

One of the things we see frequently with professionals that get sued, or get hauled up on charges before their professional board, is minimal compliance with continuing education requirements.

Continuing education is not a punishment, it's a reward.  Continuing education is what keeps you out of the plaintiff's lawyer's crosshairs.  It arms you with the knowledge of what's current (the state of the art), and protects you from a suggestion that you don't know what you're doing.  Science marches on.  What was good in the 1980s may not be good medicine today.

Many years ago when I practiced I had read about Epiglottitis but I had never seen it.  At a seminar we watched a video and saw the management of a 2 year old infant with the condition.  Less than four months later I saw the same type of child in the ER, and the ER doctor wanted IPPB.  I patiently explained that we could not and should not do that, but should call Anesthesia.  The ER doctor took umbrage, called my supervisor, and when I refused to give a crowing child a mask IPPB treatment, he did.  I still wonder how he didn't kill that boy.  A few minutes after the treatment as the child continued to get worse, I grabbed an anesthesiologist who recognized the problem right away and got the child sedated and intubated.  Catastrophe was avoided by only the narrowest of margins.  But if I had not gone to the seminar, if I had not seen the video, I likely would have been part of the child's death.  
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Have you ever participated in a DRIVE4COPD event? If you have, you know that this is a collaboration of the AARC and COPD Foundation and the purpose is to drive awareness about COPD and promote respiratory care as a profession. Many events have occurred over the past several years, including an amazing display of pinwheels made of license plates in Tampa, Florida, during AARC Congress 2011, representing those suffering from COPD in the US.

The screener is made up of 5 questions that can be asked and answered in under 60 seconds:
  1. During the past 4 weeks, how much time did you feel short of breath?
  2. Do you ever cough up any "stuff," such as mucus or phlegm?
  3. During the last 12 months, I do less than I used to because of my breathing problems.
  4. Have you smoked at least 100 cigarettes in your entire life?
  5. How old are you?

The survey scores the responses for a total between 0 and 10. The higher the score, the higher the risk of developing COPD.

In the past, we've used paper screeners to distribute the survey. But now, the DRIVE4COPD has taken a new turn with a new format. While the survey is electronic, the purpose is to engage in conversation with folks in the community about COPD and show the value of the respiratory therapist as a vital member of the healthcare team.

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AARC Times is looking for creative members to enter our AARC Photo Contest. Finalists will receive a FREE one-year membership renewal and will have their photo entered into our Photo-of-the-Year Contest.

The deadline for submitting photos is November 14, 2014. AARC members will then vote online for their choice following the release of the January 2015 issue. We plan to have the winning photo on the cover of April AARC TImes.

Go here to find out more about the contest and to enter:

Don't miss this great chance – enter your photo today!

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Yesterday, I received an email from one of the most amazing volunteers I know. She was passing along a picture of a group of eight respiratory therapists who volunteered their time to promote the profession and raise awareness of pulmonary disease in the community. She wasn't even at the event; she was just so proud of the group there that she had to share their smiling faces.

If you've read my blogs before, you know I'm a big proponent of volunteerism. This summer, I was fortunate to be asked to discuss volunteerism at the AARC Summer Forum and the feedback I received was amazing. So many people offered stories of their own volunteer efforts, descriptions of their unique volunteer events, and how their hospital or college encourages volunteerism in multiple ways to meet the mission and vision of the organization.

As our summer season draws to a close (how is it August already?!?) and the school year beckons, I thought it would be a good time to reflect on volunteerism, why it is so important to our profession, and how we can positively impact our communities through these efforts. You see, volunteerism benefits us all. It benefits the person who receives your volunteer efforts, obviously, but it also benefits your employer/school as your performance at these events reflect positively upon the organization. It also helps us improve our ability to work as a team, communicate with members of the community, improve our disease management knowledge, and understand the health barriers our community faces. All of these skills translate to improved performance in the workplace, making our managers and/or teachers very happy.
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