1. Global Perspective of Respiratory Care
Vijay Deshpande, MS, RRT, FAARC
Emeritus Professor Adjunct Visiting Professor,
Georgia State University Manipal University
Atlanta, Georgia, USA College of Allied Health Professions
Manipal, Karnataka, INDIA
Globalization of
Respiratory Care

2. International Fellowship Program
● Implemented in 1991, inviting select candidates
to USA to observe the practice of Respiratory
Therapy
● The program has brougt 135 RC professionsls
from 54 countries to the US: 68 physicians, 29
PTs, 21 RTs and 11 Nurses.
● This program has generated interest in other
countries to follow AARC’s footsteps and develop
a new profession in the health care system.
AARC Promotes RT in the World
● Clinical Practice Guidelines are translated in Chinese,
Japanese and Spanish
● “A guide to Aerosol Delivery System” is translated into
Arabic, Chinese and Spanish
● AARTimes and RC articles appear regularly in Italian and
Japanese Publications
● Student exchange between Taiwan and Torrence
Community College in Fort Worth, Texas is implemented.
● Students from Saudi Arabia and Gulf Countries are
routinely admitted to Georgia State University, University
of South Alabama and other institutions.

3. Global Awareness
■ Over 50 countries are aware of the RT profession.
■ Currently, there are 70 formal RT programs in 8 countries
outside the US.
■ A few countries such as India have started Master’s
degree in RT.
■ Canada, Taiwan, Panama and Philippines received legal
recognition by their Government and require mandatory
credentialing
■ Ten (10) countries have professional organizations
Hiser, John;We are on Mission, AARC Times, 34:12 (39-42), Dec 2010

4. EVOLUTION OF RESPIRATORY CARE IN USA (1947-1966)
1950 1963
ITA issued Volume 1 of the professional “Board of Schools”
Bulletin which contained technical information was formed
and how to organize RT departments
1947 1953 1957 1966
Inhalation Therapy Association Industrial Advisory Bennett
Association (ITA) changes their Committee was MA-1 was
was name to formed introduced
established in AAIT
Chicago
Respiratory Care- Evolution Of A Profession, by
Gary Smith, AMP Publication, Lenexa,
Kansas,1989
5/10/2012 7
EVOLUTION OF RESPIRATORY CARE IN USA (1967-1986)
1969 1974 1978 1980
Arkansas becomes the first NBRT Last RRT Home O2 Therapy
state to enact a respiratory was oral exam guidelines introduced
therapy Licensure Law formed administered
1967 1970 1979 1986
"Essentials" for Joint Review First Clinical AART
training developed, Committee for Simulation becomes
extending program Inhalation Therapy Exam AARC
length to 18 months Education (JRCITE) administered
was formed (4 AAIT
members and 2
members from ASA and
ACCP each)
Respiratory Care- Evolution Of A Profession, by Gary Smith, AMP
Publication, Lenexa, Kansas,1989
5/10/2012 8

5. Women will never be equal to men,
until they can walk down the street with
a bald head and a beer gut, and
still think they are sexy.

6. RT Global Community
● United States of America
● Canada
● Taiwan
● Saudi Arabia
● Philippines
● United Arab Republic
● Mexico
● Colombia
● India
● China
● Argentina
● Brazil
● Chile
● Costa Rica
● Guatemala
CANADA
● The Canadian Society of Respiratory Therapists (CSRT)
was founded in 1964
● Since Canada has a large population that speaks French
language, the national credentialing examinations are given
in English and French.
● The practice of respiratory therapy in Canada is equivalent
to that in USA and a reciprocity agreement exists between
CSRT and NBRC for recognition of credentials.
● Canada has 21 accredited programs and approximately
3,000 members.(www.csrt.com)

7. Canadian idea of Good Time
MEXICO

8. Associon de Terapia Respiratoria
■ The Mexican Association for Inhalation Therapy and
Respiratory Physiology was established in 1967.
■ Currently, approximately 7,000 Respiratory Therapists
practice RT in Mexico
■ Dr. Hector Leon Garza, Executive Director worked with
other Latin American Countries and the National Board for
Respiratory Care to establish Latinamerican Board for
Professional Certification in Respiratory Therapy in 2003.
■ The Mexican Society for Respiratory care has conducted
10 International Congresses.
South America
COLOMBIA

9. COLOMBIA
COLOMBIA
■ Established an Associasion Colombia
Professional Terapia Respiratoria in 1996.
■ In 2001, Colombian Association for Faculties for
Respiratory Therapy was established and is still
functioning.
■ There are six (6) RT programs operating in the
country.
■ Approximately 5,000 therapists working in the RT
profession.

10. How do you explain these remarks?

11. Central America
Guatemala
Costa Rica
Costa Rica
■ Medical Center in San Jose, Costa Rica obtained a
grant from Hope Foundation Inc. USA.
■ In 1985 Hope Grant contracted Susan Pilbeam,
MS, RRT, FAARC, a renowned RT teacher in
USA, to initiate and implement a Respiratory
Therapy Program in Costa Rica.
■ This program graduated RTs in Costa Rica and
the profession is an integral part of the health care
system in the country.

12. Guatemala
■ In 1992, Helen Montereso started a program
in Respiratory Therapy in Guatemala City.
■ This small country has a well established
Respiratory Therapy profession.

13. South America
Argentina, Brazil, Chile, Venezuela, Panama
Venezuela Brazil
Chile
Argentina

14. SOUTH AMERICA
■ Argentina, Brazil, Chile, Venezuela, and Panama
rely upon the competent Physical therapists to
deliver Respiratory Care
■ A group of Physio-Respiratory Therapists formed
an informal association of Respiratory Care in
these countries. Training courses in RT with
emphasis on mechanical ventilation are offered,
on a regular basis, to Registered Physiotherapists
at various institutions in the countries.

15. Major accomplishments of Latin
American Countries
■ In 2003, Dr. Hector Leon Garza, Executive Director of
Mexican Society for Respiratory Care worked with other
Latin American Countries and the National Board for
Respiratory Care to establish Latin American Board for
Professional Certification in Respiratory Therapy.
■ In 2011, the first meeting of representatives from all Latin
American countries to establish Latin American
Association for Respiratory Care

16. Europe
● Although Respiratory Therapy profession does not exist in
European countries as a distinct profession, specialty
courses and seminars are consistently offered to trained
Physiotherapists and Critical Care Nurses.
● These individuals are members of the European
Respiratory Care Association (ERCA), a society formed by
physicians involved in treating respiratory diseases
● Each year ERS organizes a Conference in different
countries of Europe (www.ers.com). The 2012 ERS
conference is scheduled in Vienna on September 1-4, 2012
Europe
● Italy: RT is primarily done by PTs. Italian
Physicians routinely give presentations at the
AARC Congress. Many RT/PT attend AARC
Congress
● Slovenia: Ljubiana has an excellent RT department
formed by past International fellows (4). Assist
neighboring countries (Croatia, Hungary) by
delivering workshops on Mechanical Ventilation.

17. Saudi Arabia

18. Saudi Arabia
Kingdom of Saudi Arabia
■ Saudi Society for Respiratory Care (SSRC) was
established in 2004.
■ Loma Linda University in California assisted
Saudi education system by coordinating RT
program at King Faisal Medical center.
■ SSRC and NBRC , agreed to implement
credentialing examination for SSRC to provide
external evaluation and standardization of
curriculum

20. THOUGHTS TO PONDER
The reason grandparents and
grandchildren get along so well is that
they have a common enemy.
INDIA

21. INDIA AND USA
In 1947 Inhalation Therapy evolved in US and India
became an independent country
India is 1/3 the size of USA but population is 3x the
US
Until recently (15 years) India was a poor country at
all levels
Economic development has taken strides and the
middle class has grown exponentially
Economic development has Increased the demand for
advanced medical procedures and treatments.
Medical community has recognized the need for RESPIRATORY
THERAPISTS, especially in the ICUs
5/10/2012 41
HOSPITALS IN INDIA
Private and Corporate hospitals Community Hospitals
Identical to most hospitals in US Relatively cheaper
Well equipped and well funded Mediocre care
Well-trained staff
Funding is a problem
Expensive
More training for staff is desirable
Excellent patient care
5/10/2012 42

22. HOSPITALS IN INDIA
University Hospitals Government Funded Hospitals
Primary training centers Free of Charge
Private Universities are well Good Physicians but inadequately
equipped and well funded funded
Well-trained and in-training Minimally trained staff
physicians High rate of infection in many
Good patient care sites
Higher rate of infections than
Corporate Hospitals
5/10/2012 43
EVOLUTION OF RESPIRATORY CARE IN
INDIA
● Influence of British medical practice for the first 25-30 years
● Increased interactions with American trained physicians
● Significant and sustained economic growth
● Influx of advanced medical equipment including Mechanical Ventilators
● A need for training physicians on many aspects of mechanical ventilation
was recognized
● Pulmonologists from US were invited as conference speakers
● Respiratory Therapists were mentioned by all US speakers
● Initial reluctance to add one more allied health profession slowly
diminished
5/10/2012 44

23. RT TRAINING IN
INDIA
■ Recognized need for Respiratory Therapists
■ 1995: A well planned BSRT program was initiated by
Manipal University
■ Other programs in the southern part of India –
Hyderabad, Chennai , Vellore, Pune, Kochi
■ Hospital based training programs in Mumbai, Delhi,
Bangalore and Kolkata
■ Mechanical Ventilation Workshops for physicians at
ISA and ISCCM Conferences
■ A well designed Mechanical Ventilation Workshop at
Pune conducted by local chapter of ISCCM
5/10/2012 45
SITES OF RT PROGRAMS
Pune
Mumbai
Hyderabad
Manipal
Vellore
Chennai
Cochi
5/10/2012 46

24. RT EDUCATION
■ Manipal College of Allied Health Sciences – Manipal
University in Karnataka, India.
BScRT, MScRT,Master of RT, PhD of RT.
longest running program for 16 yrs (1995)
■ Symbiosis Instituteof Health Sciences in Pune,
■ Nizam’s Institute of Medical Science in Hyderabad,
■ Christian Medical College – Vellore, Tamil Nadu
■ Shri Ramchandra Medical College Chennai,
Tamilnadu.
■ Amritha Institute of Medical Sciences – Kochi
$$$$
FEDERAL GRANTS
MEDICARE REIMBURAEMENT
PHYSICIANS HOSPITALS NURSING OCCUPATIONAL RESPIRATORY
& PHYSICAL THERAPY
THARAPY

25. INTERNATIONAL FELLOWS AND RT IN INDIA
• In 1990 AARC implemented an International
Fellowship Program
• 135 International Fellows from 54 countries
have visited US since 1990
• 12 physicians from India were amongst this
select group
5/10/2012 49
UNDERSTANDING INDIA
● 16 Major languages and
Multiple Dialects
● Court Languages: English,
Hindi and Local Language
● College Education is in
English
5/10/2012 50

26. DIFFERENCES IN RC PROFESSIONS
USA INDIA
Well Established over the past 60 Just entered the infancy stage – 5
years150,000 working RTs
Over years RTs
~ 200
Excellent Communication within the Severe Lack of Communication
profession
One Language Multiple Languages
Industrial Support No Industrial Support
Involvement of Medical Associations Limited Physician involvement
(ASA, ATS, ACCP)
Plethora of Leadership seeking Lack of Leadership Enthusiasm
Therapists
Financially Stable Financially unstable
5/10/2012 51
GOING TO WORK
5/10/2012 52

27. ALTERNATE WAYS TO
WORK
5/10/2012 53
5/10/2012 54

28. 5/10/2012 55
5/10/2012 56

29. THE PHILIPPINES
R.A. # 10024
Philippine Respiratory Therapy Act of 2009
Republic Act No. 10024 known as
the Philippine Respiratory
Therapy Act of 2009.
1. Officially regulating the
practice of respiratory care
through licensure exam.
2. Creating the 1st Professional
Regulatory Board for
Respiratory Therapy.
Signed into a law on March 9, 2009
by then Philippine President
Gloria M. Arroyo.
“Light at the end of the tunnel!”

30. RT EDUCATION
DATE MILESTONES
1980 1st formal RT Program – a 2-year Associate in Respiratory
Therapy Program was offered by Mary Chiles Hospital
College in Manila.
1987 The first 4-year Bachelor of Science in Respiratory Therapy
was offered by the University of Perpetual Help in Binan,
Laguna.
Until 2008 A total of 24 RT schools in the entire Philippines offer either
a 2-year Certificate in Pulmonary Therapy or 4-year B.S.
Respiratory Therapy.
Until 2009 A total of almost 3,000 RT students have graduated from the
RT educational program and almost half have gained
employment abroad.
RTs ‘IN and OUT’ of the country
Distribution of Filipino RCPs

31. RT DEMOGRAPHICS
Estimated number of Filipino RCPs working outside of the Philippines :
COUNTRY ESTIMATE NUMBER
Saudi Arabia 967
UAE 173
Qatar 61
Singapore 28
Kuwait 20
Bahrain 16
Oman 04
USA 02
TOTAL 1,271

32. MAINLAND CHINA
RT EDUCATION
RT Program:
2-year Associate Degree
4-year Bachelors Degree
•West China School of Medicine/West China
Hospital of Sichuan University is the 1st school
to set-up the BSRT in 1997.

33. Current Situation
■ Only 3 schools/universities offer a formal RT
Program in China.
■ There are only 4 hospitals that has an established
RT Department.
■ There are only 200 Respiratory Therapist in
China for a population of 1.3 billion
■ China has 9 AARC International Fellows as of
2010.
RT DEPARTMENT
■ Sir Sun Sun Show Hospital in Hangzhou is the
1st RT Depatrtment in China and it was fully
supported by Loma Linda University – USA.
■ Hospitals with RT Department in China:
● West China Hospital – Sichuan
● Chao Yang Hospital – Beijing
● Beijing Hospital – Beijing
● Sir Sun Sun Show Hospital - Hangzhou

34. Since light travels faster than sound,
some people appear bright until you
hear them speak.

35. TAIWAN
TAIWAN

36. HISTORICAL BACKGROUND
DATE HISTORICAL BACKGROUND
1980 The RC profession began in the hospital as an
IPPB Room.
April 1990 The Respiratory Care Association of Republic of China
(RCAROC) was established.
Dec. 1990 The 1st AARC International Fellow from Taiwan was
recognized – Chiang, Ling-ling.
December The Respiratory Therapist Act was passed and approved
21, 2001 by the Parliament.
2004 The RCAROC was renamed Taiwan Society for
Respiratory Therapy (TSRT).
RESPIRATORY
THERAPIST ACT
• The Respiratory Therapist Act was passed into
law last December 21, 2001
• The law professionalized the respiratory
therapy profession.
• The law specified the Scope of Practice of
respiratory therapist.
• The law specified the creation of new
professional group “Respiratory Therapist
Society of the Republic of China”.

37. TSRT
• There are about 1,877 members.
• Three Level of Training for Members :
1. RRT – Registered Respiratory Therapists
2. ARRT – Advanced Registered Respiratory Therapists
3. SRRT – Specialist Registered Respiratory Therapists
THE FUTURE OF RC
• Taiwan has the most established and well-
organized RC profession in Asia.
• Taiwan has 5 AARC International Fellows
since 1990.
• The RC profession in Taiwan is growing
rapidly and has progressed dramatically
since its inception in 1980.

38. Behind every successful man is his woman.
Behind the fall of a successful man is usually
another woman.
Japan
■ Japan has a different system to treat
pulmonary patients
■ Physicians and Physical Therapists manage
the clinical aspects of the patient
■ Clinical Engineers manage the equipmet
such as Ventilators.

39. Japan
■ Many clinical engineers and PTs from
Japan attend the AARC Congress.
■ Japanese physicians are involved in
delivering clinical lectures related to their
research at the AARC Congress.
■ Japan was awarded 12 International Fellows
since 1991.
Thank You !!