Scope of Practice, Competencies & Authorized Acts
Scope of Practice
The CRTO has determined that the concept of Respiratory Therapists (RTs) as Anesthesia Assistants is consistent with the scope of practice outlined in the Respiratory Therapy Act (RTA), which is as follows:
The providing of oxygen therapy, cardio-respiratory equipment monitoring and the assessment and treatment of cardio-respiratory and associated disorders to maintain or restore ventilation.
For a comprehensive list of examples of technical, professional and administrative duties an AA may assist with, see the CAS 2019 Position Paper and the National Competency Framework 2016 document.
Competencies
Many of the procedures that Respiratory Therapists perform in the area of anesthesia are entry-to-practice competencies taught in respiratory therapy programs, however the degree of competency and skill can be expanded with the completion of the additional training. For those skills beyond entry-to-practice competency, many of the RRTs performing these activities have undergone on-site training.
Others have completed Anesthesia Assistant educational programs. Although the CRTO does not specifically require its Members to undergo additional certification or “proof” of formalized training from its Members to carry out or to enhance their practice, the CRTO supports and encourages a consistent and measurable process to enhance the skills of its members through the completion of the AA educational program.
Authorized Acts Performed by RRTs in an Operating Room Setting
Many of the tasks performed by RRTs under the supervision of an anesthetists are done under the controlled acts that are authorized to Respiratory Therapists via the RTA, which are as follows:
1. Performing a prescribed procedure below the dermis, such as:
- Arterial line insertion
- Intravenous and/or intra-arterial catheter insertion
- Pulmonary artery catheters and central venous catheter insertion
2. Intubation beyond the point in the nasal passages where they
normally narrow or beyond the larynx.
- Routine and difficult airway management
- Oro/nasogastric tube insertion
- Performing Bronchoscopy
- Assisting in emergence from anesthesia (e.g., tracheal extubation, removal of laryngeal mask airway)
3. Suctioning beyond the point in the nasal passages where they normally narrow or beyond the larynx.
4. Administering a substance by injection or inhalation.
- Assisting with induction and maintenance of anesthesia
- Providing procedural sedation (e.g., administration of narcotics)
- Administering blood products
- Ventilation management
5. Administering a prescribed substance by inhalation.
Procedural Sedation
The CAS position paper on Procedural sedation states that sedation may be provided by a team that includes a sedation supervisor (typically the anesthesiologist/ physician) and an approved and credentialed sedation assistant(s) (e.g., Respiratory Therapist, Anesthesia Assistant.) Sedation administration may be delegated to the AA/RRT by the sedation supervision. The sedation supervisor retains responsibility for the patient and must remain immediately available to support the sedation assistant as necessary.
Public Domain Activities Performed by RRTs in an Operating Room Setting
Other tasks performed by RRTs under the direction and supervision of an anesthetist are not controlled acts, and therefore rest within the public domain. This means that these activities can be performed by any healthcare professional who possesses the requisite competencies. The following are examples of public domain activities routinely performed by RRTs providing anesthesia services:
Set up, calibration and troubleshooting of anesthesia equipment and patient monitors