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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Allow me to share some thoughts, and then formulate a question at the end.

According to an email I received from the NBRC, the RRT was instituted in April of 1961 as the advanced credential. That was 53 years ago. 

Isn't it long overdue for the RRT advanced credential to finally replace and eliminate the CRT? And by long overdue, I mean long overdue. So long overdue, that it should not be the very thing that people within our profession debate. But it is, and that's too bad, because the real focus should be on the minimum degree, not minimum credential. If the RRT is the advanced credential, as a healthcare profession, that's what we only want moving forward, right?

Our conversations should not be CRT vs. RRT. It should be Bachelors or Masters. However, we can't seem to seriously engage in that conversation because we can't seem to raise the minimum credential to the RRT, introduced 53 years ago.

In fact, when the Ohio Society of Respiratory Care backed by their licensing board, tried to raise the licensing requirement to the RRT for their state, they were strongly opposed
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Hey folks!
December is fast approaching, and with it, the deadlines for registration for the AARC National Sputum Bowl. We're going to be in fabulous Las Vegas this year and I can't wait to see all the competitors. In case you didn't know, we've added a new team category - the Renegades!
Do you like to play Sputum Bowl?
Do you have at least 2 friends that like to play too?
Can you make it the Mandalay Bay Resort in Las Vegas this December?
All you have to do is sign up and show up! Pair up with your friends and create the Sputum Bowl team you've always dreamed of.
Check out for more information, rules, and requirements
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As I hear from more people, the most common question I get is "how can I get involved?" It's a question I love to hear because for me, volunteerism has been in my blood for many years. It began in my younger years as a child when I watched my father and uncle volunteer at a fire department in my town and my mother's volunteerism with our church as a CCD teacher, our schools PTO and with the JC Women. It must have rubbed off on me because I've been a volunteer at the same firehouse my father and uncle are at for 30 years and I've been involved in the volunteer side of our profession since the early to mid-90s. So you can see why I love the question "how can I get involved"?

Here is my inside track to getting involved. I'm a firm believer that volunteerism needs to start close to home and then fan out. So my first thought would be to tell the person to get involved with the state respiratory society. I do this not in trying to slight the AARC, but knowing full well that our strength as a national organization is tied directly to the strength of the state affiliates. The AARC will always have membership campaigns and of course not only does the new member become an AARC member, but they become a state affiliate member as well. In all seriousness, I've been at this for a long time and one of the things that need to get some press time is the needs of the state society. Think about it, this is no slight to those who are currently serving, but how much has the state society board changed over the last few years? Many of the state board’s membership get recycled because there is no one who wants to run for those positions. I'm not making this up, go ahead and ask one of your state board members. I'm sure they'll tell you the same thing. State societies thrive when those serving are fresh and have new ideas. Anyone who's served on that level will tell you that. So next time there is a board meeting, go to it! They're open to the membership. It's your state affiliate board. Ask them what you can do to get involved. Yes, you can run for a position on the board, but they have committees and conferences where they may need someone to help out. I will guarantee you that they will welcome you with open arms! The second suggestion is an easy one and helps out the state and national organization. Get involved by asking others who aren't members to become one. If every member would ask one person to join, we'd grow quite nicely.

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The summer Diagnostics Section Bulletin is now online.

Gregg Ruppel discusses the use of z-scores to analyze pulmonary function data. Those of you who are statistic-phobic will find this article refreshingly easy-to-understand.  Matt O’Brien discusses the important and often overlooked issue of infection control in the pulmonary function laboratory, and then I briefly discuss an increasingly recognized disease pattern: combined pulmonary fibrosis and emphysema (CPFE). The Quarterly Case Report highlights the importance of biologic control testing, and I close out the issue with an amusing anecdote from my own practice.

I am currently looking for submissions for the winter issue, so if you'd like to submit an article or quarterly case report please let me know.


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Do you have a respiratory care-related photo that takes your breath away? If so, we want to see it!

AARC Times
is looking for creative AARC members to enter our monthly 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 March 2015 AARC TImes.

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

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I must say that this trip to Austin to address the Sunset Commission has been an eye-opener for a number of reasons. I've not been a very politically active person so Cheryl West (bless her) has been getting me up to speed so that I understand not only the basic issue but the consequences of the potential actions that could be taken by the Sunset Commission.

The basic issue is that the RT licensure act comes under review every so many years. In Texas, this was scheduled to happen in 2014... and it did. The group produced a report that addressed a great number of issues within the government bodies. One of the recommendations of this report is to deregulate respiratory therapists; specifically, eliminate the regulatory process that Texas RTs currently undergo to legal work as a respiratory care practitioner.

The Sunset Commission isn't bad, in and of itself; however, this recommendation is harmful for a great number of reasons. If you're interested in reading the background and the implications, check out this AARC news article:

My motivation for this blog is not to educate about the process (I would defer to my colleague Cheryl West for that!) but rather to record my observations during the 2 days I've been in Austin. As I sit here waiting to deliver testimony, I look around the viewing room, the hallways, and the hearing room and see respiratory therapists from all over the state supporting the profession. Yesterday, Senator Nichols reported that he has received countless phone calls, emails, and visits over the last 3 weeks from respiratory therapists in his district. He expressed great concern that a profession such as ours would be considered for deregulation. Several other representatives and senators on the commission appeared to echo his concerns and Chairwoman Nelson called together a subcommittee to address the regulation issues. We're not done yet (and we haven't given public testimony) but this is a good sign.
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As I write this, I'm about 30 thousand feet above the earth flying towards my home in Danbury, CT.  I've just spent the last two days in Mississippi saying goodbye to a dear friend of many RTs around the country.  Heck, Jerry Bridgers was a dear friend to all he met.  You've all heard the saying that we really don't know the lives we've touched until we're gone.  Fortunately for Jerry, he knew how many lives he touched. I met so many people in Mississippi this week and the stories were plentiful.

You never know a person until you hear about them from others. I met one gentleman who told me his story that was much like Jerry's.  He was addicted to alcohol and was at rock bottom.  He went into a rehab facility and as per the rules went to an AA meeting and the guest speaker was a Jerry B.  Well, you guessed it; Jerry Bridgers was the guest speaker.  The funny thing though was this gentleman had met Jerry before in his role as bio-med at the hospital.  After the meeting, Jerry and this gentleman met and 27 years later I was told Jerry changed his life and has been the only sponsor he had during that time.

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At 7:12 AM (CDT) on June 14, 2014 in Mississippi, a long-time member and ardent supporter of our profession passed away.  Jerry Bridgers was a man who would give you the clothes off his back if you needed them.  He was a strong advocate for every piece of legislation this profession has brought before Congress and his passion for getting people involved was unmatched.  Jerry was a man of 70+ years who I consider one of my very best friends.  We met at an AARC PACT meeting in Dallas and became friends immediately.  He was more than 20 years my senior, but I felt like and was treated like a brother.  Jerry and I would speak weekly.  His infamous 7:30 AM calls to my house on Sundays were met with my wife answering the phone because Jerry could not remember I went to church early on Sundays.  

In your life, you meet many people and most will not even make you turn your head.  Jerry with his beaming smile and jolly laugh knew how to live life.  He had a hard life early on, mostly by his own design.  With the love and support of his family and many RTs from the Mississippi and Louisiana area, Jerry righted his life and found God.  His passion for this profession could be seen in how he talked about it.  He knew history of things that went on not only in his hometown and in state, but he could tell you stuff about national respiratory events without having to think about it.  Those of us who served in the AARC House of Delegates always knew when something was brewing by how red and animated Jerry would get.  Then we'd see the Mississippi placard go up and then he'd stride to the microphone.  Everyone knew Jerry would command the microphone for quite some time, but when he spoke he spoke from the heart and always had a message....even if he used 2, 3, 4, 5...stories to get the point across.  If you wanted to hear how Respiratory Therapy was practiced in the early days, all you had to do was have Jerry tell a story from his early days as an oxygen orderly.  His passion for patient care was still there even after he retired about 3 years ago.  He would always tell me, the RTs today need to know it is not just about giving breathing treatments; they need to help the patient and even the nurse.

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I am being asked to research how many RT departments across the country intubate? We intubate at our facility, but our Risk department is wondering how prevalent this is accross the nation. In my research I have not been able to locate any such reference. I appreciate your help and insight!

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Very pleased to see fellow RTs utilizing the use of social media (Facebook, YouTube) and various websites, such as to assist the hard work of our state societies and the AARC in promoting the profession. We need to make sure our profession has a strong presence in all these avenues.
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