RTSO Airwaves Summer 2014

Summer 2014
Congratulations
Nancy Garvey
RRT, MAppSc
Winner of the
Amethyst Award
see page 18
RTSO Airwaves
www.rtso.ca
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RTSO
Airwaves
Summer 2014
President's Message from

Rob Bryan A-EMCA, RRT, AA
Dear Colleagues,
Greetings and on behalf of the RTSO Board of Directors,
I would like to welcome you to another edition of the
RTSO Airwaves. Once again, I would like to take this opportunity to thank Dave McKay and
Elisabeth Biers for all of their hard work to put together another fantastic issue.
With great relief, summer has finally arrived and I hope that everyone is having a great
time enjoying some of the beautiful weather and time off with their loved ones. I would
also like to welcome our new RRTs into the profession and extend our best wishes to each
new graduate on a career filled with passion, excitement and continued growth. As well,
a special recognition should be extended to the first graduating class of the Respiratory
Therapy Program at St. Clair College in Windsor. May all of you use your new skills and
abilities to serve your patients and their families with expertise and compassionate care!
Congratulations also to the entire faculty at St. Clair College, for all of their hard work and
their dedication that has resulted in the graduation of their first class. This is a very exciting
time for them.
As you may already be aware, this will be Dave McKays last issue as editor of the RTSO
Airwaves. Dave is stepping down and passing the torch on to Shawna MacDonald from
Hamilton. I would like to personally thank Dave for all his years of volunteer service to the
RRTs of Ontario through his work with the RTSO. Dave has served in many positions on the
Board of Directors but is best known for his work as editor of the RTSO Airwaves. Thanks
RTSO Airwaves Summer 2014
President's Message from Rob Bryan A-EMCA, RRT, AA

again Dave, we have all enjoyed what you have done to transform Airwaves and for giving
us a fresh and unique perspective on our practice here in Ontario. Your dedication and
passion for our profession will not be forgotten. We all wish you the best of luck with your
future endeavors.
At this time, I would also like to welcome Shawna as the new editor of the RTSO Airwaves
journal. We look forward to many future issues that will cause us to pause and reflect on
our practice, share stories about our workplaces and colleagues and celebrate the successes
of our profession.
On behalf of the RTSO, I would like to extend a very special congratulation to Nancy
Garvey on her retirement from the Ministry of Health and Long Term Care (MOHLTC).
Nancys dedication in promoting and advocating for the lung health of Ontarians and
championing best practices in respiratory care through her work with the MOHLTC, the
Ontario Lung Association (OLA), the Ontario Respiratory Care Society (ORCS), and as
Chair of the RTSO research committee has touched and inspired many of us. Nancys
tireless work in asthma and COPD programming at all levels has made a huge difference
influencing many lives including patients and their families, caregivers and clinicians
alike. Her continuous promotion of lung health and disease prevention, education and
disease management has helped keep lung health strategies in the forefront of many key
stakeholders at the MOHLTC. In addition, Nancys successful career as a RRT is one that
we can all look upon with pride and admiration. Without doubt, she is someone who has
represented our profession with true grace and dignity and has certainly made a difference.
Congratulations to Nancy on her well deserved retirement and please read the special
article in this issue of Airwaves celebrating her decorated career.
This year marked the fiftieth anniversary of Respiratory Therapy as a profession in Canada.
To mark this occasion, the Canadian Society of Respiratory Therapists (CSRT) education
conference held in Montreal in May was an event that celebrated this milestone. The
conference and trade fair was filled with fantastic speakers and entertaining events that left
everyone who attended with several fond memories and hopefully, some new friendships.
Congratulations to Christiane Menard, Angela Coxe, the CSRT Board of Directors and all
the CSRT staff for putting together another world class meeting and education forum. In
addition, I would like to acknowledge Angela and thank her for all of her work with the
CSRT, particularly as she ends her term as the CSRT president. We also welcome Jessie Cox
from Newfoundland, as the incoming president.
With regards to business matters, the RTSO has been very busy for the past three months
working on several initiatives to promote the profession and assert our position with key
healthcare stakeholders in Ontario relating to professional advocacy and continuing
education. Please take time to read about our current events in this issue of Airwaves.
2

As a reminder, the RTSO has put together a very robust membership portfolio for the
current and upcoming membership year which includes enhanced membership programs
and liability insurance to all RRTs in Ontario. The new RTSO membership platform also
offers an array of values including an adjunct membership with the ORCS. In addition,
the RTSO continues to perform its role regarding professional and political advocacy. Most
recently, we have been campaigning around lung health strategies and expanding the
role of the RRT in out-of-hospital settings through our strategic partnership with the OLA.
The RTSO is also working collaboratively with the OLA and the College of Respiratory
Therapists of Ontario (CRTO) in an effort to provide a broad range of continuous medical
education (CME) sessions and workshop-based programs for our provincial, evening
education series and fall education programs.
As previously stated, our main professional advocacy for the current membership year is
pertaining to the role enhancement of the RRT in the community. The RTSO is working
closely with the CRTO and the OLA with a goal towards the establishment and recognition
of a formal role and list-of-services that could be provided by RRTs in Community Care
Access Centers and Family Health Teams throughout the province. This work is being done
by our primary care and community respiratory care advocacy committee which is headed
by Dr. Mika Nonoyama and Ginny Myles.
At the request of our membership, the RTSO is also forming two new special interest groups
(SIGs). The first SIG is for RRT-Anaesthesia Assistants and the second is for RRTs who work
in Cardio-Respiratory Diagnostics. The RRT-AA SIG will focus on current issues and topics
relevant to AAs for program development and strategic business planning for Anaesthesia
Care teams (ACTs), growing and expanding roles of RRT-AAs, Quality-Based Performance
funding and its implications on the ACT. The Cardio-Respiratory Diagnostics and Pulmonary
Function SIG will focus on awareness and advocacy regarding respiratory diagnostics and
changing funding formulas with OHIP and out-of-hospital practice. If you are interested in
participating in either of these new SIGs, please contact the RTSO office at office@rtso.ca
or call 647-729-2717.
This fall, the RTSO has several value added events for RRTs to take part in. On October
4, 2014, the RTSO will take great pleasure in hosting a Zombie Run. This event will take
place at Downsview Park in Toronto. This is a 5 km fun run that utilizes a course filled with
obstacles and Zombies that will be in the shadows, ready to devour participants (try to
grab one of the orange flags around your waist that represent your organs!!!). Proceeds will
benefit Respiratory Therapists without Borders, the Kiwanis Club and the RTSO research
and bursary programs. For more information about participating as a runner, a Zombie or
entering a team or sponsorship program, please go the RTSO website at www.rtso.ca and
click on the undead/unleashed thumbnail.

In celebration of twenty years of self-regulation under the RHPA, the RTSO and the CRTO
are collaborating on a fall education conference called "Inspirevolution 2014". This event
will be held at the La Ka Shing Knowledge Institute in downtown Toronto on November 2122, 2014. This two-day event will include both clinical and regulatory topics of interest as
well as a celebration of the evolution of our practice as RRTs in Ontario. You can register
online at the CRTO website or via the RTSO homepage at www.rtso.ca by clicking on the
"Inspirevolution 2014" thumbnail. We have also secured a block of rooms at the Phantages
Hotel Toronto across the street from the conference. Space is limited, so be sure to register
early to secure your spot!
The RTSO is also co-hosting a full-day education conference in Ottawa in collaboration
with a committee of practice leaders, educators and managers from the Ottawa area. This is
in an effort to establish an annual education program for the RRTs in the eastern part of the
province. The program will be held on October 22, 2014 at the Hellenic Centre in Ottawa.
Please note that the education program outline and the registration form will be released in
the near future.
As you can see, the RTSO continues to perform a vital role for respiratory therapists across
the province. These are exciting times for the RTSO and the practice of Respiratory Therapy
in Ontario. If you are interested in volunteering with the RTSO please contact our head
office at office@rtso.ca
On that note, please enjoy a safe and happy summer and another great edition of the RTSO
Airwaves!
Sincerely.....
Rob Bryan A-EMCA, RRT, AA
CANADIAN ANTI-SPAM LEGISLATION

THE RTSO CARES ABOUT YOUR PRIVACY
On July 1, 2014, the Canadian Anti-Spam Legislation (CASL) came into effect. The legislation
was created to ensure that Canadian residents are no longer inundated with unwanted
commercial emails from unauthorized sources. It stipulates that you must give your
consent to the company or organization that is sending you these eblast messages.
The RTSO takes this matter very seriously. We have already taken several steps to ensure
that only members who have indicated that they wish to receive correspondence from the
RTSO via email do so.
Not sure if you provided consent? If you indicated on your membership application that
you wish to receive correspondence via email, then you have given consent. In addition, in
June we sent our RTSO Information Update message that included a distinct paragraph
regarding this matter. We asked at that time that you confirm your receipt for RTSO
email. It is from these sources, that we have based our limitations to create our present
distribution list.
If you had previously indicated that you wish to receive emails, but have decided NOT to
continue to receive them, please email office@rtso.ca and ask to have your name removed
from the list.
Email has been the prime source for the RTSO to connect to our members, so if you are a
member who is not a part of the distribution list and would like to be, you may also contact
office@rtso.ca and ask to be included.
Please note that adding or deleting your name must be done via the email address as
indicated above.
Please continue to visit the RTSO web site at www.RTSO.ca and watch for the addition
of future social media sources that will be coming soon, such as LinkedIn. These sources
ensure that our members remain in touch with the activities of their professional
association.
Submitted by
Dave McKay, RRT
An RRT Perspective
RTSO Airwaves Editor
As my fingers are moving across the

keyboard, I am acutely conscious that
this will likely be the final perspective
that I write, so Im going to try to keep
it short. This issue of the RTSO Airwaves
is also my last as editor and I welcome
Shawna MacDonald as my replacement
to this position. I am confident that
Shawna will find new pathways to
inform, educate and most importantly,
inspire you.
Over the years, the topics I have chosen
to write about have included a variety
of things that I felt were important to
Dave McKay, RRT
our profession. These have included
with Luger and Lily
workplace bullying, the need for good
communication skills and most recently, the major concern regarding
the apathy that exists within the respiratory therapy community across
Ontario. Ive also shared stories of personal experiences and observations
that I believed would offer some value or entertainment. However, what
Ive hoped for all along is that Ive been able to write some things that
have made you think.
For the most part, what I have strived to do over the years is to focus
on the people, the places and the practice of respiratory therapy
in Ontario. As most of you already know, when I took on the role
to redevelop Airwaves, I found no reason to compete with the
scientific journals that already existed. Those needs were already
being met. What we lacked as a community was a sense of
identity, a sense of engagement and a sense of pride regarding
our profession. Im confident that the stories that I have enticed
others to write and maybe even some of the ones that I have
written myself have offered some semblance of each to those
of you who have read them.
6
An RRT Perspective
Over the time that I have spent in this position, I have occasionally
received e-mails that have offered feedback or inquiry. In the past few
months, Ive received two that continue to stand out in my mind. They
were from students at both Algonquin College and Fanshawe College
and were regarding a desire to contribute an article to Airwaves. What
struck me most about the time I spent collaborating with these students
was their enthusiasm for their future career and the keen desire to be part
of a great profession. And it is a great profession! In fact, part of me envies
the students who are entering respiratory therapy at a time when boundaries
seem to be crumbling and allowances for full scope of practice have finally
arrived.
For the most part, Id like to believe that I still maintain an enthusiasm for our
profession. After all, it is incredibly dynamic in that it is always changing and
progressing. It is autonomous in that we are often our own decision makers. It
is collaborative in that we work with a variety of disciplines that can provide
us with a continuous source of learning. It is also a difference maker in the lives
of others, whether it is the essential roles that we possess in a number of critical,
life-altering scenarios or the simplicity of offering attention to and reassuring
an elderly patient. The variety is astounding. What more could you ask for in a
career?
Unfortunately, throughout my career, I have come across many who have
completely lost their enthusiasm. I can also say that mine has waxed and
waned over the years but this has been the result of outside influences, having
a family and in general, the challenges of life. Fortunately, for the most part,
I can still say that I have always and continue to enjoy the way I make my
living. However, like many of you, the road has never been flat nor has it
ever been straight but understanding that makes us recognize that our career
is itself, a journey.
So the question begs, how do we regain our enthusiasm? Is the answer
in a reflection of what used to make us happy or is it via an attempt to
rediscover our career values or goals? In other words, what originally
made you want to enter into the profession and where did you want it
to take you? Is change necessary? Change can be a lateral movement
or it can be via another path as new challenges, new faces or a new
environment may be necessary? Quite possibly, the key may simply be
a manner to become re-engaged with your profession.
An RRT Perspective
Overall, I like to say that my enthusiasm is what allowed me to
fulfil my role as the editor of Airwaves. I am quite proud of the
accomplishments that we have achieved with the journal. I do
believe that it has served its purpose and brought our community
closer together but unfortunately, the only hurdle that it didnt succeed
in leaping over during my term was to grow and solidify the RTSO
membership numbers and strengthen our collective voice. I guess, in
some ways, I may have been nave to believe that strengthening our
community would create an enthusiasm that would also potentiate an
exponential growth in membership but to me, it made sense.
In reality, the strength and existence of professional associations, like the
RTSO, the CSRT and others that represent various health disciplines are
tenuous. They rely on membership numbers to sustain their life but where
have the membership numbers gone and why have they lost their enthusiasm?
Without an adequate representation, life expectancy of any organization is
short. Can we as a profession risk that?
In closing, Id like to ask those of you who are reading this and who are not
members, three final questions. As healthcare delivery changes and boundaries
for providers cross and overlap, will we as a small profession be safe without a
voice? Is the tax-deductible cost of membership worth that risk? Since you do
not have a membership, you obviously believe so. As such, I ask you to have
the courage to tell me, how will we be heard?
Thank you
to Dave McKay for his many dedicated hours as

Editor of RTSO Airwaves. During his tenure he managed to change the tone
of the original "newsletter" by securing in-depth articles that have been
interesting and informative to all Respiratory Therapists. Certainly anyone
who reads RTSO Airwaves will agree.
With the fall issue, we begin a new era with Shawna MacDonald
assuming the position of Editor for RTSO Airwaves. We meet her in the
following introduction.
Elisabeth Biers promises to give the journal a fresh new look to keep
in step with the changes.
Watch for the fall issue of RTSO Airwaves.
Meet Shawna MacDonald

Incoming Editor for RTSO Airwaves
Our collective voice is strengthened
by the RTSO, which finds its strength
from membership. As Rob Bryan
pointed out in the spring edition of
RTSO Airwaves, there is tremendous
value in becoming an RTSO member.
It is through the RTSO that the
personal and professional interests of
all Respiratory Therapists in Ontario
gains representation, as the RTSO is
the collective voice of our profession
in the province. I have been a member
of the RTSO since being a second year
RT student at Fanshawe College in 1991 and I strongly believe
in the value of membership. I believe it is important to have a
voice, and so should all of you.
Submitted by
Shawna MacDonald, RRT
RTSO Airwaves Editor
I have been thinking about becoming more active in the RTSO for many years,
always encouraged by a dear friend, fellow RRT and past Board member Doris
Franklin. I didnt think I could manage it with my hectic multi-site role as
Education Clinician in addition to being a part-time student, wife and mother
of two to Ariana (9) and Bryce (5), with a husband (Tim) who is away an
awful lot for his work. Practicing mindfulness, doing yoga, gardening, and
watching the koi in my fishpond which overlooks the beauty of the Niagara
Escarpment, are things which keep me grounded and somewhat sane with
this hectic life! After reading Dave McKays article on apathy, I became
inspired. I CAN do more. I WILL find the time. I am already a professional
advocate to the point where I have been told "sometimes to my own
demise", but that never deters me. I am a lifelong learner who loves being
creative, sharing ideas, storying experiences and encouraging others to
become more engaged and empowered in their practice.
I believe that an idea shared with emotion tells a compelling story; it
is what brings meaning to who we are and what we stand for. Lean
Six Sigma training has sparked renewed interest in healthcare storyRTSO Airwaves Summer 2014
Meet Shawna MacDonald - Incoming Editor for RTSO Airwaves

telling; in Change and the Power of Story: How to Spark Motivation
through Emotion, retrieved from http://www.leanhealthcareexchange.
com/?p=2653, the author shares the following:
"In a story, you not only weave a lot of information into the telling but you
also arouse your listener's emotions and energy. Persuading with a story is
hard. Any intelligent person can sit down and make lists. It takes rationality
but little creativity to design an argument using conventional rhetoric. But
it demands vivid insight and storytelling skill to present an idea that packs
enough emotional power to be memorable. If you can harness imagination and
the principles of a well-told story, then you get people rising to their feet amid
thunderous applause (and action results!) instead of yawning and ignoring you.".
In this, I see the apathy Dave McKay recently wrote about, but I also find motivation
that inspires actionmotivation to get involved! Let all of us "rise to our feet amid
thunderous applause" and have our collective voice heard! The RTSO advocates and
represents this profession, and it is with this in mind that I have decided to carry the
editorial torch for the RTSO Airwaves.
I certainly plan to tap many of you on the shoulder and badger you to author an
article or share a story. I encourage you to become involved and to volunteer
your stories, experiences, your vision and your time. I also want to extend
heartfelt thanks to Dave McKay for his commitment and passion to the role of
Editor, and I think WE (I dont plan on doing this alone!) should continue on
the same path that Dave started us on, being a publication about the people,
places, products and practice of respiratory therapy in Ontario.
I look forward to this new challenge, and I hope to hear your voices in future
editions of the RTSO Airwaves.
Shawna
RTSO Airwaves is a publication of
and may not be copied or duplicated in full or in part

without prior permission.
Editor - Dave McKay, RRT

Shawna MacDonald RRT
Layout/Design - Elisabeth Biers
Opinions expressed in RTSO Airwaves do not necessarily represent
the views of The RTSO. Any publication of advertisements does
not constitute official endorsement of products and/or services.
10
RTSO Committee Updates

Community RT
We take great pleasure in announcing that at the most recent Board of

Directors meeting, the Community RT Group was granted approval as
a standing committee of the RTSO.
As reported in the spring issue of Airwaves, the Co-Chairs, Mika
Nonoyama and Ginny Miles, had sent out a survey to interested
RTs asking that they select the objectives that the committee should
Ginny Myles, RRT, address first.
CRE, BHA (Hons).
Community RT
The top 3 priorities from the wider group were
Committee Co-Chair Improved liaisons between acute and community RT services.
1. Address transitioning gaps for patients, such as hospital to
home and paediatric to adult.
2. Improve respiratory services in the home and respite
population consistently across the province.
The other priorities from the survey, in order of importance from
the survey were:
3. Funding and resources (include equipment).
4. Provide appropriate, consistent respiratory care and
education to patients and other health care providers based
on best-evidence.
5. Encourage more research in the field of respiratory care by
Mika Nonoyama,
RTs in the community.
RRT, PhD,
6. Include primary care such as Family Health Teams,
RTSO Director /Community
community health centers, private practices along with
RT Committee Co-Chair
hospitals, long term care and Community Care Access
Centers within the Community RT practice realm.
7. Investigate and promote a formal program and/or certificate for
Community RT services.
8. Promote an increased and consistent clinical exposure for RT students
in the Primary Care/Community RT role with formal evaluation in order to
graduate.
12
Committee Reports - Leadership / Community RT

9. Importance of linking and supporting other like-minded organizations (OLA)
and their programs.
Fifteen volunteers from across Ontario have come forward to sit on the
Community RT Committee. Our first teleconference was held on May 30,
2014. The experience offered an opportunity to share some of the great
community initiatives involving Respiratory Therapists presently taking
place around the province. Business items such as developing a terms of
reference document and establishing a strategic work plan for the priorities
identified above were also discussed. Work will continue by email
and telephone over the summer and the monthly telephone meetings
will re-convene in September 2014 with an in-person meeting also
planned for the RTSO/CRTO Educational Forum in November 2014.
Upcoming RTSO Events

1: Eastern Ontario RT Week Education Forum - October 22, 214 to be held at
Hellenic Meeting and Reception Centre, 1315 Prince of Wales Drive, Ottawa. This new event is highly
informative day that includes speakers like Tom Pirano on the topic of Esophageal Pressure Monitoring and
Dr. Bernard Thibault on the topic of NeoNatal Stem cell Research, Rob Bryan A-EMCA, RRT, AA, RTSO
President - just to name a few. Further information and registration details will follow.
2: InspireEvolution 2014 - This is RTSO Education Forum with an added twist. The event will run
from Friday November 21 to Saturday November 22 at the Li La Shing Knowledge Institute (at St. Michael's
Hospital) 209 Victoria St., Toronto. Day 1 is dedicated to the CRTO 20th Anniversary and Day 2 is the RTSO
Education and Awards day. Details and registration are available on the RTSO web site at www.rtso.ca as
well as the CRTO web site at www.crto.on.ca. Hotel accommodation information available at www.rtso.ca.
Abstracts and Poster Presentations will be accepted at InspireEvolution 2014 by the Research
Committee of the RTSO. This is always a great time to learn and share the knowledge of new developments
in the Respiratory profession. Details and applications are available at www.rtso.ca (under the Research tab)
or directly to the Research micro-site at rtsoresearch.ca
Knowledge Translation Award - Here is your opportunity to apply for an RTSO Funding Award to be
presented at the awards ceremony of InspireEvolution 2014 (Day 2). Full details, guidelines and applications
are available at rtsoresearch.ca
3: Undead Unleashed Zombie Run - October 4th at Downsview Park, Toronto. Another
new and fun event that will benefit Kiwanis International with their "Eliminate Project" and Respiratory
Therapists without Borders. Get ready to join in and have some fun. Full details and registration are available
at www.undeadunleashed.com and the RTSO web site at www.rtso.ca.
13
Research & Education

Lots to celebrate for all RRTs with the
RTSO Research Committee!!
The Research Committee (RC) supports all RRTs who want to
translate knowledge into practice, building on the great work
that their colleagues continue to do, as well as those
interested in and/or pursuing research, evaluation or
Nancy Garvey
quality improvement initiatives. We hope that all of you
RRT, CAE, MAppSc.
will enjoy accessing some of the initiatives weve been
Research Co-Chair
working on over the past few months! They have been
and
busy ones for RTSO Research Committee members:
Akhilesh Patel
Louise Chartrand RRT, MA, PhD(c)
RRT, BSc.
Marianne Ng RRT, CRE, BSc
Research Co-Chair
Shelley Prevost RRT, MAppSc
Brooke Read RRT, BSc, MHS
Ashley Waugh GRT, B.Sc. Hons
Mika Nonoyama RRT, PhD, RC Clinical Scientist, RTSO
Akhilesh Patel RRT, BSc, Co-chair
Nancy Garvey RRT, MAppSc, Co-chair
Along with the Research section of the web-site, forms and processes
for the Call for Abstracts, as well as the Advanced Practice Education
and the Knowledge Translation Awards have been updated and are
ready to go! Another initiative is a new RC LinkedIn Group that has
been established to support an Ontario RRT Research Network!
Research Website Update http://rtsoresearch.ca/
Take a look! There have been major additions and some reorganization
of the research section of the website to make information and resources
more readily accessible to all RRTs. Theres a lot to choose from with
related school-based and online education programs for novice and
experienced researchers, funding opportunities... And a list of Ontario
14
Lots to celebrate for all RRTs with the RTSO Research Committee!!
RRT publications to both celebrate colleagues work and provide examples
of what has been done for those interested in pursuing publications of
their own. We look forward to the list continuing to grow! Were open for
feedback on the site and any additions you might have for the publication
list! Please forward information to office@rtso.ca .
Call for Abstracts http://rtsoresearch.ca/call-for-abstracts-posterpresentations/
Now more than ever, opportunities are arising for RRTs to become
leaders and/or significant members of teams helping to transform
the healthcare system. Introducing new programs or procedures in
both traditional and non-traditional settings, abstracts can describe
the program or initiative, or reflect the research or evaluation of
a program or initiative. Theres a lot going on with Health Links,
Quality-Based Procedures, new roles for RRTs in homecare and
primary care settingsand Public Health?...as well as innovative
solutions for issues in critical care, long-term care and other settings.
The Forum is a great place to network and share experiences with
your colleagues!
Advanced Practice Education Awards http://rtsoresearch.ca/
funding/#fundingawards
Continuous practice improvement leads some RRTs to pursue
advanced practice programs such as the ones for anaesthesia assistants
or certified respiratory educators. The RTSO is being supported this
year by AbbVie Canada to be able to offer two awards of $5,000 each
for RRTs enrolled in an anaesthesia assistant program as well as up to
$1,500 for other courses of study. We encourage colleagues who are
pursuing knowledge related to advancing their practice through formal
programs to apply for an Advanced Practice Award.
Knowledge Translation (KT) Awards http://rtsoresearch.ca/
funding/#fundingawards
15
Lots to celebrate for all RRTs with the RTSO Research Committee!!
Research results and changes in practice have widespread impact when
they are shared with colleagues! Knowledge can be translated into practice
through presentations at conferences (especially the RTSO Forum!),
publications and a variety of workshops, electronic tools or other types
of resources that help make changes for the better. The KT award process
offers up to $1,000 to successful applicants, helping promote translation
of knowledge into practice!
Research LinkedIn Group
Since the inception of the RTSO Research Committee three years ago,
there has been interest in creating some type of research network,
making it easier for interested colleagues to share information
related to research, evaluation and quality improvement activities.
Creating a LinkedIn Group and anticipating RTSOs use of other
social media tools, RTSO policies have been put in place providing
the foundation for the respectful use of social media amongst our
members. The Research Committee LinkedIn Group will enable
automatic emails regarding resources and opportunities that arise
to be shared across the groups membership as well as discussions
about relevant topics. We are excited about the introduction of this
new feature and hope that it will be a relevant service for those who
participate!
On behalf of the Research Committee members, we hope that youll all
enjoy and benefit from our contributions!
Nancy and Akhilesh
16
Health Links QBPs Homecare Initiatives

Primary Care Initiatives Hospital Procedures
Have you been part of a team involved with the implementation
and/or evaluation of an initiative or a research study that is
helping change RRT practice? Or is integrating RRT practice
into a non-traditional setting? Or resulted in changes in the
way things are done in traditional settings?
Your colleagues would love to hear about it!!
We invite you to submit an abstract describing that work for

poster presentation at the RTSO Inspire 2014 Forum
http://www.rtso.ca/education-forum/ this November.
Check out the Call for Abstracts
http://rtsoresearch.ca/call-for-abstracts-poster-presentations/
information on the RTSO Research Committee website!
We look forward to seeing and hearing about
your great work in November!!
Congratulations Nancy Garvey
RRT, CAE, MAppSc
Amethyst Awardee
Amethyst Awards recognize excellence within the Ontario Public Service,
an organization of over 60,000 people working in Ontarios twenty-seven
ministries. Established in 1993, the Awards recognize individuals and groups
who have made outstanding contributions in client service, innovation,
valuing people and professional achievement. The award is a trophy
featuring Ontario amethyst, the provincial mineral.
The recipients of the Amethyst Awards have gone the extra mile for client
service, inspiring colleagues with their leadership skills and
their abilities to encourage others. They have extended the
boundaries of knowledge using technical and professional
expertise. They have worked across ministries. The recipients
have extended themselves beyond the call of duty by
creating a whole new way of delivering a service, developing
time and money-saving technology, or showing extraordinary
professionalism and care in performing their daily tasks. They
prove that public service is not just a job, but a vocation that
inspires excellence every day.
The annual Amethyst Awards are presented by the Secretary
of the Cabinet and head of the Ontario Public Service to employees from
across the OPS nominated in three categories: individuals, groups and the
Sandra D. Lang Lifetime Achievement Award.*
This past June 27th, Nancy Garvey RRT, MAppSc was one of four individual
recipients who received the award along with other recipients of the one
life-time achievement and nineteen team awards. The RTSO extends their
congratulations to Nancy for this honour and achievement!
The following is the nomination:
In 2000, following recommendations from an inquest into the death of a young
asthmatic, Ontario's Ministry of Health and Long-Term Care (MOHLTC) called
together an expert panel and three working groups. Their recommendations
resulted in an evidence-based plan that supports best practices for addressing
asthma across a variety of practice settings and community environments. In
January 2002, the Ministry announced $4 million in annual funding for the
18
Congratulations Nancy Garvey - Amethust Awardee

Asthma Plan of Action (APA), an integrated strategy of 13 initiatives based on
Canadian asthma guidelines. The APAs goal is to reduce mortality, morbidity and
health care utilization for children and adults with asthma through initiatives
focused on health promotion, prevention, management, treatment, research
and surveillance.
Nancy Garvey joined the Ministry in 2004 as a Senior Program Consultant
and is responsible for the Asthma Program. Her exceptional leadership and
horizontal networking skills have leveraged limited
funding into major gains for patients and providers.
Facilitating collaborative partnerships across six
ministries, and with traditional and non-traditional
stakeholders, Nancy has enabled the development,
implementation and evaluation of innovative tools
and approaches that have resulted in significant
improvements in health outcomes for people with
asthma. The many examples of her leadership and
horizontal networking provide lessons learned
that can be shared across the OPS (Ontario
Public Service).
A key example within the APA is the Primary Care
Asthma Program (PCAP), an evidence-based
tool box including a care map, action plan,
treatment algorithm and program standards used
Deputy Minister Chisanga Puta-Chekwe,
by interdisciplinary teams of primary care providers Ministry of Citizenship and Immigration
to support asthma assessment, diagnosis and
Nancy Garvey RRT, MAppSc, and Peter
management. The PCAP pilot project included the
Wallace, Secretary of the Cabinet
integration of certified respiratory educators into
primary care teams, and was trialed in eight primary
care sites. Nancy demonstrated an ability to build collaborative partnerships
among medical, administrative and allied health staff, the research team
and non-governmental organizations optimizing resources for effective
implementation and evaluation in the primary care sites. Over 1,400 children
and adults with asthma were involved in the pilot project from 2003-2006.
The results demonstrated a 45% decrease in emergency department visits,
significant improvements in asthma control, school and work attendance,
quality of life, and high ratings for patient and provider satisfaction.
Building on this success, Nancy facilitated a partnership between the Ontario
Lung Association (OLA) and PCAP sites resulting in a governance structure that
19

ensures coordinated annual planning to integrate guideline updates, and enhance
programs and resources. The structure keeps PCAP aligned with Ministry
priorities and maximizes efficiencies that take advantage of collaborative
partnerships. Through annual work plans, Nancy fostered the development
of an implementation process and project management approach to support
adoption of PCAP in other primary care sites. Nancy also established a link
with Primary Health Care Branch, increasing the PCAP reach to over 150
sites across the province.
The next step in the PCAP journey was the translation of the tools
into electronic formats. Nancy initiated links
with the eHealth Liaison Branch, the eHealth
Ontario agency including Ontario MD, the
OLA and PCAP sites. The connections resulted
in a subset of the asthma care map elements
being included in Ontario MD specifications
used for vendors clinical management system
certification. The issue of electronic data
standards not being unique to Ontario, Nancy
initiated correspondence with the Canadian
Thoracic Society, which made addressing
respiratory data standards for use in electronic
Dr. Itamar Tamari, Stonegate Community records a priority. Nancys facilitation of
Health Centre, Nancy Garvey, Sr. Program provincial eHealth links is making a significant
Consultant, Provincial Programs Branch, contribution to the availability of valid, reliable
MOHLTC, Dr. Bob Bell, Deputy Minister, consistent data that enables performance,
Ministry of Health and Long-Term Care outcome measures and benchmarks not only in
(MOHLTC), Teresa To, PhD, The Hospital for Ontario but across Canada.
Sick Children Research Institute, Kathryn
Pagonis, Director, Provincial Programs
Poor air quality which is a major contributor to
Branch, MOHLTC, Carole Madeley, RRT, poor asthma control provided Nancy another
MAppSc, Director, Ontario Lung Association opportunity to connect some dots. At an Air
Quality Health Index (AQHI) symposium hosted
by Health Canada and Environment Canada, presenters reflected on the
paucity of evidence related to the practical utility of air quality notification
and messaging. Talking with Health Canada, Environment Canada and Ontario
Ministry of Environment colleagues, Nancy facilitated strategic partnering
with staff at the Windsor PCAP site leading to funding from Health Canada for
an innovative pilot project. The Windsor team engaged University of Windsor
information technology expertise to design a system that uses Smartphones as
a vehicle for bi-directional asthma management documentation and air quality
20

notifications. Based on the pilot project results that demonstrated feasibility and
a trend toward significant health outcomes, Nancy facilitated a proposal for a
larger project including partnerships with the Kingston PCAP site and the OLA
resulting in a $1M grant from Canada Health Infoway. This demonstration
project includes the University Health Networks Centre for Global eHealth
Innovation leading the technical development of the web-based asthma
Smartphone app. Including 600 patients in a rigorous evaluation of the
project makes it one of the largest of its kind in the world and positions
Ontario as a leader both in innovative eHealth tools and as an exemplar of
translating evidence-based knowledge into practice.
Translating knowledge into practice is an ongoing challenge noted
by researchers and organizations responsible for developing
medical practice guidelines. Sharing Ontarios experience and
establishing the province as a knowledge translation leader,
Nancy was invited to publish articles describing Asthma Program
initiatives in the Canadian Institute for Health Research (CIHR)
casebook and the Canadian Respiratory Journal. In 2007, Nancy
responded to a request from the Guideline Dissemination
Committee for the Global Initiative for Asthma for lessons learned
and tools that had been developed for use in primary care and
the emergency department, sharing experience on the worldwide stage. In 2009, Nancy facilitated PCAP sites contributions
to Health Quality Ontarios Quality Monitor as an example of
a program Success Study, reducing complications of chronic
disease. In 2010, Nancy was invited to present the benefits of
partnering activities as a keynote speaker to CIHRs Institute for
Circulatory and Respiratory Health Partners Forum.
Nancy Garvey RRT, MAppSc

with the Amethyst Award
In summary, children and adults with asthma and their caregivers across
Ontario are living better lives and experience better health outcomes with
the help of Nancys unfailing dedication to patient-centred care, leadership
and skill in connecting the dots. Nancys ability to establish and maintain
strategic partnerships has contributed to reduced emergency department
visits and hospitalizations for asthma consistent with the Action Plan for
Health by providing the Right Care, Right Time, Right Place.
*Written by Maria DAddona Volume: 19 Issue: 6: Canadian Government
Executive, http://www.canadiangovernmentexecutive.ca/leadership/item/1283and-the-amethyst-goes-to.html .
21
Focus on Insurance
The Question of Liability Insurance
The Regulated Health Professionals Act (RHPA), 1991 (Health Professions
Procedural Code) dictates that all regulated healthcare professionals
engaged in practice must carry liability insurance. Further, the College of
Respiratory Therapists of Ontario (CRTO) also mandates that all members
engaged in the practice of respiratory therapy must possess liability
coverage. In fact, the CRTO has put together an excellent policy that
details the facts about liability insurance and it is a recommended read.
(http://www.crto.on.ca/pdf/Policies/Insurance-eng.pdf )
For those who are employed by a hospital, most will have professional
liability coverage through your employers plan. However, one should
ensure that their employers coverage does not just pertain to the
organization but also to the individual employees. It does not need to list
every HCP individually; it just needs to state that the policy covers the
employees. This type of insurance does meet the demands of the RHPA
and the CRTO, but is it enough?
Employer policies offer blanket coverage to incidents that occur within
the organization and most of these hospital policies offer the indemnity
coverage that is mandated by the MoHLTC. Unfortunately, what a lot of
RRTs fail to realize is that these insurance companies can also opt out
of covering you, if your actions are considered negligent or criminal. As
well, there are several other issues that exist in which that policy may not
offer the coverage and protection that you may require. These include legal
costs for CRTO disciplinary hearings, human rights tribunals, criminal acts
and coroners inquests. Any one of these events could lead to emotional
devastation as well as financial ruin. Even a false accusation can lead to
horrendous legal costs with no ability to recoup those costs even when
proved innocent.
The Respiratory Therapy Society of Ontario (RTSO) now offers Personal
Liability Insurance (PLI) as part of its membership. This coverage expands
beyond what employers offer because it protects you against allegations that
may include:
22
Focus on Insurance - The Question of Liability Insurance

Malpractice
Error, omission or negligence in providing a service
Failure to provide a service
Misrepresentation of Facts
Improper Documentation
The RHPA states that PLI is required by all HCPs engaged in practice as a
means to protect the public. Would it not then be feasible as a clinician to
ensure that you are personally protected as well? Yes, hospital employers
offer a coverage that satisfies the requirements of the RHPA but is that
coverage enough to protect you and everything important to you?
Liability Insurance
So what is my coverage offered with the
RTSO membership?
Professional Liability & Indemnity Insurance coverage:
$2M/incident / $4M aggregate; Nil Deductible

Disciplinary Defense: $175,000/claim / $175,000 Annual Aggregate

Criminal Defense Reimbursement: $200,000/incident / $200,000 Annual Aggregate;

Sexual Abuse Counselling & Rehabilitation: $10,000/insured / $250,000 Annual Aggregate

Legal Representation Expenses: Subpoenaed as witness $1,500 each claim

Complaint $5,000 / Max annual aggregate for both $50,000
23
Professional Liability Insurance

DO I REALLY NEED IT?
Oh yes, you certainly do. Heres why:

Liability insurance protects both Respiratory Therapists
and the public they serve. It enables a patient/client
to have adequate financial compensation should harm
Kevin Taylor
occur as a result of an error, omission or negligent
Registrar and CEO
act, and also protects the RT by providing legal and
financial support if a patient/client makes a claim against them.
Members may obtain liability insurance from any source, including
an employer, the professional association, or directly from an
insurance company.
In addition to patient/client and personal protection, liability
insurance is a professional responsibility for every health care
professional in Ontario. In other words, having this insurance is as
much a responsibility as ensuring that you remain competent in your
area of practice. In fact, last year every regulatory health college in
the province was asked to confirm that they have a requirement for
liability insurance for their members.
Confused? Here are some details:

Members engaged in the practice of respiratory therapy must carry
minimum liability insurance as follows:
24
Professional Liability Insurance - Do I really need it?
a) The minimum coverage shall be no less than $2,000,000 per

occurrence;
b) The aggregate coverage shall be no less than $4,000,000;
c) The insurer must be licensed with the Financial Services
Commission of Ontario; and
d) The Member must be personally insured under the insurance
policy.
At a minimum, coverage should also include conduct or omissions
within the scope of practice of respiratory therapy as defined in
section 3 of the Respiratory Therapy Act, the Regulated Health
Professions Act and standards of practice of the profession. The
insurance coverage should only have standard exclusion clauses
that do not materially detract from comprehensive professional
liability coverage, for example, criminal or deliberate acts.
For a full description of the CRTOs requirements, read the
Professional Liability Insurance Policy at: http://www.crto.on.ca/
pdf/Policies/Insurance-eng.pdf
Examples of the coverage types available for Respiratory

Therapists:
Employer (hospital, home care company, educational program)
If you are covered by your employers professional liability
insurance plan in the amounts and coverage set out in the bylaw (see above), then you are not obligated to obtain additional
liability insurance coverage, although you may wish to. Members
should note that it is not sufficient if the employers policy
just covers the employer or the facility. The Health Professions
Procedural Code requires Members practicing a health profession
to be personally insured. This means you must ensure that your
employers insurance policy covers not just the organization, but
you as an individual as well. The policy does not have to list you
individually by name, but must specify that it covers the employees
of the organization as added insureds. A Member who performs
25
any respiratory therapy services, even on a part time or temporary

basis, outside of the employing organization must obtain additional
professional liability insurance coverage.
Professional Associations
Professional associations often negotiate a reduced rate for their
members and are able to arrange coverage meeting the requirements
of regulatory bodies. Details are available on both the RTSO and CSRT
websites, and be sure to read the coverage specifics to confirm they
adequately meet your needs.
Private insurance providers
Consult with your insurance broker.
Individual considerations when youre choosing your

coverage:
The majority of Members will likely have insurance coverage of at
least two million dollars with their employer. However, Members
should determine if these amounts are sufficient according to their
specific circumstances (see Examples of available coverage for
Respiratory Therapists Employer above). The CRTO recommends
that all Respiratory Therapists review their liability insurance coverage
from time-to-time; whether it be an individual plan, or one provided by
an employing agency for paid or volunteer work. To determine if you
have sufficient coverage, you may wish to ask yourself the following
questions:
Does your plan cover reimbursement of legal or criminal defence
expenses?
Will your plan provide for the cost of legal representation in the event
you are subpoenaed to appear as a witness?
What type of coverage does your policy provide e.g., Malpractice,
Errors & Omissions, and Legal Expenses?
What is the liability aggregate limit (4 million, 10 million)?
26
Do you have an "occurrence" type of policy (covers claims that occur

after the policy has lapsed) or "claims made" policy (only covers you for
claims made during the term of the policy)? If you have a claims made
policy, (the most common form of liability insurance today) you should
ensure that you have enduring coverage (often called tail insurance)
to protect against any claims made after you leave or the particular
insurance policy ends.
Is there a deductible, and if so how much? It should not be more than
$1,000.00.
What are the exclusions under the policy? Such exclusions
should be standard provisions that do not materially detract from
comprehensive professional liability coverage (for example, criminal
or deliberate acts).
If you are covered by an employee insurance plan, check your
coverage and make sure you are an additional insured under
the policy. You may wish to request a letter from the employer
confirming coverage as well. In addition if you practise outside of
your employment, you will need to obtain supplemental insurance to
cover those services.
Finally, you may want to consider if you should purchase additional
individual coverage through one of the professional associations.
For more information, questions or concerns, please refer to the CRTO
website (www.crto.on.ca) or contact us directly at 416-591-7800.
27
Focus on Insurance
The Need for Personal Liability Insurance
A Respiratory Therapists Story
Contribtuted by
Louise Chartrand
RRT, PhD sociology.
University of Ottawa
It has only been within the last five years, that on our
licensing and registration body, the College of Respiratory
Therapists of Ontario (CRTO) has required their members to
have personal liability insurance (PLI). Like many of you,
I always thought that this was a big waste of my money. I
believed that I was a good respiratory therapist, that my
documentation was well done and that I am not the type
of person that could get into any legal trouble. In fact, I
have taught research, ethics and legal issues in healthcare
since 2007 and was self-assured that there was no way that I
would ever receive a complaint against me.
Despite my own nave and cocky way of thinking, in the

spring of last year, I received a big white envelope from
the College with the words private and confidential boldly written on it.
When I opened the envelope, to my astonishment and surprise, I learned
that someone from the public had actually launched a complaint against
me. I was shocked, petrified, worried and angered. Most of all, I was
deeply saddened and confused because I never thought in a million years
that my actions would have hurt someone to the point of having this type of
complaint launched against me.
When I eventually accepted the reality of this event, I suddenly realized

that even though I have taught courses pertaining to ethical and legal issues
in healthcare for numerous years, I really had no idea of what was going to
happened to me. In addition, I did not know where I could turn for help.
This is my reason for writing this article. I am not doing this to critique the
CRTO in any shape or form but rather as a means to offer advisement to
other respiratory therapists, like you, in the event that they find themselves in
a similar situation. As well, I hope by sharing my story, others will wake up
28

and realize that any one of us has the potential to have a complaint filed against
us, justly or unjustly. As such, the importance of having personal liability and
insurance will also be detailed in my story.
To begin, I will discuss the different steps that are involved with the complaint
process itself. Secondly, I will describe my personal experience and the day
that I realized that I needed help and where I found it. Finally, I will provide
you with an overview of the cost both emotional and financial. Hopefully,
after reading this brief article, more respiratory therapists will understand
the process and more importantly, recognize the value of personal liability
insurance. In my mind, this is one of our professions greatest tragedies. Too
many respiratory therapists view PLI as being a waste of money instead of
buying a piece of mind and security.
The Complaint Process

As mentioned above, the initial contact that you receive from the College
is a big white envelope with private and confidential written above your
name. In this package, you receive the original letter of complaint AKA,
the reason why the public member felt the need for an investigation and
the accusations that have been laid against you. Once this is received, you
have thirty days to make a response. In the response, you need to write a
recollection of the event and provide the name of a witness of it. In a case
where you have no witness because it happened in a setting where only
you and the plaintiff were present, you are allowed to provide the name
of a witness who can offer a general sense of your personality and your
professional behavior. After you have sent this letter of explanation and your
witness list, the College will do a thorough investigation of the event which
includes a phone discussion with the plaintiff and the witness that you have
provided. Further, the College will request any and all documents from your
employer that are relevant to the case. Not only does this pertain to things
such as physical paper charts but also, in this day and age in which technology
is always evolving, computer charts and emails also. This is to assist the College
with their investigation. After a delay of approximately three months, you will
then receive the entire report that was done by the College. This report also
includes your initial letter of response to the plaintiffs accusations. You then
have another thirty days to respond to this report. Following this response, the
College will deliver a verdict that can be contested and brought to the Health
Professions Appeal and Review Board. Thankfully, in my case this was not
29
necessary. The CRTO had decided that the accusations were without grounds
and no actions were taken towards me. None the less, the experience and
stress of this event really shook me to the core.
My Experience and Realization
When I received the first letter, I was still with the same employer as when the
incident had occurred. I was very fortunate to have great colleagues who
were able to give me advice on how to handle this situation. Furthermore,
they were able to read my first response and offer feedback regarding the
wording and the information that I was providing. They were a big help
and I honestly dont know what I would have done if I did not have this
kind of support because at that point, no one had even suggested the
need for legal counseling.
However, it was during the request for the second response when things
became difficult. I was no longer working for the same employer. I
had decided, after my initial response to the College that I was going to
concentrate solely on my schooling. I am doing my PhD in sociology but
this decision had nothing to do with this incident, it just happened at the
same time. As a very important aside, if you think that you dont need to
pay for liability insurance because your employer is providing it, I have to
say that you might want to reconsider this train of thought. Sometimes life
just happens. Decisions of changing jobs can happen at any time and quite
unexpectedly. It is also possible that the past may come back to haunt you at
any time and if you are no longer an employee, the institution or company
may not be required to protect you. This is possible even if the event
happened while you were working for them.
When I received the second letter from the CRTO, I was not aware that I
had to respond to it until I was faced with their report and asked to answer
again. The first letter only contained the initial complaint letter but the
second envelope contained a report that was approximately 15 pages long.
For me, this report took a life of its own. More precisely, in my case, the initial
complaint of not acting in a professional manner turned into a malpractice
complaint. The first week following receipt of the report, I was spending
full days in front of the computer trying to write my second response. But,
every day after looking it over, I was not satisfied and would start all over
again. Every night, I was crying myself to sleep and I had horrible nightmares
about the whole process and the accusations. After seeing my emotional
state degrading for an entire week, my boyfriend became very concerned and
30
encouraged me to seek help from a lawyer. However, as we all know, lawyers

are not cheap. Since I was a fulltime student with little income, there was
no way that I could afford this. It was then that I realized that I had liability
insurance. In that moment, a few of my concerns went away but it also opened
up different avenue of procedures that I was unaware of.
My first step was to contact the company that provided me with the insurance
to know how to proceed. They informed me that I had to provide them with
the full report that was sent to me by the CRTO. A couple of days later, I
received confirmation that I could seek help from a lawyer and that the
insurance policy that I had would pay for those services. However, it was
up to me to select a lawyer to represent me. Keep in mind that lawyers are
like doctors, there is vast number of specializations and it was more difficult
for me to find one that specialized in healthcare law, was located close to
where I live and who could also provide services in both languages as I am
a lot more comfortable speaking in French than English. In my search, I was
fortunate enough to stumble upon a firm named Gowlings.
Gowlings is a company that has represented the legal interests of physicians
and physiotherapists. As a result, they were quite comfortable to take my
case on. (Note: I have been granted permission by the firm to provide their
name in case any other respiratory therapist who reads this article is seeking
representation.) From that day on, the stress I was under slowly came down.
The Gowlings representative was absolutely amazing! We met once, so I
could explain what had happened and what the CRTO expectations were.
She wrote the second response for me and it turned out to be exactly what I
wanted to say but I was unable to write since my emotional involvement was
too deep. She also facilitated the communication between the College and
me which, in some ways, allowed me to step back from the turmoil that I felt
without fearing how it would look in the Colleges eyes.
Today, I honestly believe that Gowlings not only saved my career but also
my state of mind. I was fortunate that my story did end well, but I realize that
without the help that I received by having personal liability insurance, it could
have taken a different turn. Furthermore, in my experience, the emotional costs
associated with dealing with such a complaint surpassed the monetary aspect
of what personal liability insurance coverage costs. Having legal representation
was a gift because it gave me my life back.
31
Cost Overview Money is only one small aspect of it.

After everything that has happened, I have to admit that the amount of money
I had to spend towards the insurance and the total insurance claim is only one
small aspect of it. Indeed, the total insurance claim came up to $3,879.77, but
looking back, my biggest regret was to not seek legal advice right away. Right
when I had received the first letter from the CRTO. I am sure that if I had, I
would have avoided a lot of sleepless nights. Not to mention the time taken
from my life, the effort to write and respond to the accusations put forth and
the emotional toll it had on me. Receiving a complaint from the College is a
significant concern, no matter what the complaint is about. The repercussion
of it is endless and it does not just limit itself to the job; it will creep into
your personal life too. Getting legal advice is the only way you can protect
yourself in these matters and you should not attempt to go through this
type of event alone. You may have good support from your colleagues and
supervisors but remember that they are respiratory therapists or healthcare
professionals. They are not lawyers. If the complaint is not dealt with in an
appropriate manner, you will be the one that can lose big, professionally
and personally, not them.
Conclusion
I am sure that most of you now wonder what I did to have such a complaint
launched against me. The initial assumption might be that I must have done
something horribly wrong. Well the event that led to the complaint was that
I was simply less than thirty minutes late for an appointment. Even until this
day, I still believe that I did everything in my power to resolve the situation
that arose. However, I can only take solace in the belief that there are still a
lot of things that are not for us to decide or to judge. As such, I strongly believe
that there is a reason for everything and this event has certainly made me
more aware that anything is possible. I hope by sharing my experience, other
respiratory therapists will better understand the complaint process and the
absolute value of personal liability insurance. I am also hopeful that this piece
can prevent others from experiencing the grief that I have been through.
32
Toronto, Ontario
Downsview Park
DEAD LAST
IS NOT AN
OPTION!
5k
FUN
Run
Its not a timed run..its a survival run!
Runners will have to navigate a series of challenging
obstacles and escape the horde of the undead waiting to
claim them as one of their own!
SPACE
Registration is now open! Register and download your
pledge sheet online at www.unleashedundead.com.
Group packages
Special group packages for teams of 12 or more are
available through the website.
SPACE
Corporate sponsorship information can be found
through the Respiratory Therapy Society of Ontario
(RTSO) office at office@rtso.ca.
All pledges received will go

directly to Kiwanis Club,
Respiratory Therapist Without
Borders and the RTSO.
You can also participate in the
Zombie Run 2014 by
volunteering at
www.unleashedundead.com
A Look at the RTs of Trillium

Health Partners
Credit Valley Hospital
At the Trillium Health Partners Credit Valley Hospital (CVH)

site, the Respiratory Therapists (RRT) embody a great sense of
respect, teamwork, communication and progressive thinking. As
healthcare becomes more collaborative, there is a strong sense of
interdisciplinary respect for and from doctors, nurses, and allied
Submitted by
health such as Physiotherapy (PT), Speech Language Pathologists
Melissa Morrison,
(SLP) and Registered Dieticians (RD) towards our collective
Hons. BSc., RRT
Interim Professional Practice
contributions. As such, the inherent goal of our working
Lead for Respiratory Therapy
community is geared towards improving the lives of our patients.
Trillium Health Partners,
Credit Valley Hospital
Our role as RTs at Credit Valley is not one to be taken lightly and it
is one that deserves merit and respect. The pioneering role created
by the senior RTs has laid a great foundation for the future of our
profession at CVH. With the strong, supportive involvement of our
manager Gail Lang, we continue to be a dynamic community hospital.
We have strong intelligent staff members who are keen on learning
and implementing best practices
to stay current with technological
advancements within our field. We
are often in an enviable position
with what we do in the hospital, and
our skillset and proficiencies are
respected by the physicians. They
also value our knowledge and clinical
expertise to safely and effectively
perform our role. We are fortunate to
possess an autonomous role within
the hospital and it is a privilege that
we do not take for granted.
Brenda Whatmough Respiratory
Therapist working in the COPD/
Asthma Education
34
We are employed throughout the

hospital in various departments such as
A Look at the RTs of Trillium Health Partners - Credit Valley Hospital

the Operating Room (O.R.) as Anesthesia Assistants, in the asthma clinic and
in pulmonary rehabilitation as educators and as clinicians, in the Neonatal
Intensive Care Unit (NICU), throughout the Emergency Department (ED),
the Intensive Care Unit (ICU), and the Pulmonary Function Lab (PF). In
addition, we sit on several administrative councils as our clinical expertise
is recognized and our opinions are valued; also our contributions are
warranted as frontline staff.
We are proud of our pulmonary rehabilitation program that is run jointly
by RTs and PTs, who together provide a comprehensive program for
individuals with chronic lung diseases, such as Chronic Obstructive
Pulmonary Disease (COPD). The program promotes self-management
and improves quality of life by physically strengthening patients and
teaching them how to manage their chronic diseases on a daily basis.
Research has shown that by increasing the patients knowledge and
strength you in turn decrease the re-admittance rates to the hospital.
In the ICU, we are one of a few community hospitals in Canada
to have repeatedly used the NOVA lung. The NOVA lung is
an innovative lung protective strategy to eliminate CO2, while
performing protective ventilation. We are also forerunners in the use
APRV and PAV, in order
to effectively improve
oxygenation and strengthen
the diaphragm in order
to successfully wean
patients from the ventilator,
respectively.
Our RACE Team is unique
to other Critical Care
Response Teams (CCRT), in
that we have a dedicated
RT and RN for each shift
who work together in
order to assess patients
whose condition has
worsened and warrant a
focused assessment. This
collaborative framework
permits immediate
RACE Team
35

attention to complicated patients who, for example, could be in respiratory
distress due to cardiac or renal failure. The RT can effectively manage
any respiratory distress immediately as the RN manages the patients
hemodynamic status. A dedicated physician for the team is always close
at hand, and through constant communication directs the team regarding
therapeutic interventions and treatment. By having this framework and
this collaborative approach, the RT, RN and the physician are able to
expedite the direction of the patient quickly and effectively, based
on the quick and tireless work of the team. Following the initial
assessment, these patients are then followed by the team for the next
twenty-four hours. By having this collaboration, there is always
constant education, support and respect between RTs and RNs.
The Trach Team, initiated
a few years ago, is a
team whereby the RTs
collaborate with SLPs to
help tracheostomy patients
follow a timely path
towards decannulation.
Once the patient has
successfully passed cuff
deflation for twenty-four
hours, SLP will perform
a swallowing test. With
regular meetings between
the RT, SLP and the
physician, the patients
are followed closely and
any improvements or
Tracheostomy Team
changes in their status are
communicated to the RNs.
This approach that has been implemented has been very successful for
not only achieving a faster decannulation for the patient, but also in
creating a mutual respect between RTs and SLPs.
The future for RTs is quickly changing, especially at Trillium Health
Partners. The merger of Credit Valley Hospital and the Mississauga Hospital
has allowed us to definitely have the best of both worlds especially since
the focus of each site is vastly different. At the Mississauga Hospital,
36

cardiac care and neurology are the primary specialties while the CVH site
focuses on the Mother Baby unit, nephrology and the cancer center. As a
result, our learning and communication will grow, as will our knowledge
of each sites expertise. With equal acuity levels and equal roles for RTs,
we look forward in continuing to strengthen our role and partnership with
our colleagues at the Mississauga Hospital.
In the future, as the area surrounding the hospital continues to grow,
the number of deliveries will increase as will the acuity of babies.
Our future role as the regional Mother Baby unit will strengthen as
we attend more premature deliveries, multiple births and high risk
deliveries. Presently, RTs are involved with high risk deliveries and
work closely with the pediatricians to administer surfactant, manage
babies on the ventilators and on non-invasive modalities. As the
changes and advancements in ventilation for neonates continues,
so too will the education and role of the RT. Working in close
collaboration with pediatric specialty hospitals, allows us to manage
more premature babies safely, effectively and longer; thereby
allowing families living in the community to stay close to home.
In the future on our pediatric floor, we hope to utilize a portion of
it to enable us to be more involved with the outpatient trachs and
ventilated children living in our
community. Many of these children
are presently seen at CVH for their
follow-ups from SickKids. By being
more involved with this community
of patients, we believe that we can
then alleviate the burden on SickKids
and the families that presently
commute to the citys core.
As well, we also look forward to
increasing our opportunities for
education and we also hope to
participate in more research within
our hospital. In addition, we hope
to develop and strengthen our
Diane Tourgis, RRT taken at Skills Day
clinical role as Anesthesia Assistants
in the OR.
37

Currently, we are embracing our first year of affiliation with the Medical
Academy of Medicine (MAM) based out of the University of Toronto. This
partnership provides our staff with an opportunity to educate medical
students on the importance of the role of Respiratory Therapists. It also
provides us with an opportunity to display our vast knowledge, skill and
clinical expertise within our hospital and how our interdisciplinary team
approach is vital for respect and communication throughout any hospital.
As an RT who has worked at Credit Valley for seven years, I have
thoroughly enjoyed the role that we have been so fortunate to develop.
The respect garnered from physicians, nurses and allied health makes
every day at work a great day. The camaraderie between colleagues
and staff and the belief that anything is possible, which is fostered by
our manager Gail Lang, has definitely made Credit Valley Hospital a
place to stay and grow.
38
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Congratulations St. Clair College
Many MilestonesAre We There Yet?

Submitted by:
Connie Sivyer, Program Coordinator, Respiratory Therapy

St. Clair College is proud to have its first graduates from its accredited
Respiratory Therapy Program (School of Health Sciences) at the end
of May 2014. The program faculty, college administrators, clinical
partners and students have worked diligently over the last three years to get
to this point and they are to be commended and congratulated for all of their
efforts! The experience has verified that healthcare is a team sport even at
its very beginnings in education and training.
When the RTSO asked me if I/we would submit material to them for publication
in the summer of the RTSO Airwaves it seemed like a fairly benign request. "Tell
us what its been like to start from the ground up. Tell us some of the experiences.
Tell us whats great about your program" is the gist of the letter and email that
was sent to me. Graduates and faculty were asked to participate; comments,
thoughts and photos were requested and received. Now it is time to put all that
was sent into some kind of order and send it off to the RTSObut my mind
wanders. Where did the last three years go? Did we do everything we were
supposed to do?
When I think about those questions, I recall family and non-medical or nonteaching friends saying that now that weve lived through the initial three
years of the program, the work is done and we can just carry on we have
"arrived"! We are "there"! I would like to agree, but I cannot. We are not
"there" yet. I am not convinced that in a world of evolving and advancing
healthcare that any educational program for healthcare providers can be
"there". "There" keeps changing and therein lays the challenge. It is
one of my hopes that our graduates come to realize this as well that
they never perceive that they have learned enough, that they never
feel like they are there and can stop growing.
What its been like to start a new program "from the ground up" is a
lot like riding a roller coaster for the first time you have an idea
that there are going to be ups and downs and that it will have
moments of scariness, but really you have NO idea. In addition,
this particular roller coaster must have the ability to "go back"
and do parts over but you hope that when you are finished the
40
St. Clair College - Many Milestones....Are We There Yet?

ride, the experience will have been something that you can be
incredibly proud of surviving. Our "ride" at St. Clair College was
designed before students and even faculty were selected. Changes
on route were made along the way while moving at top speed. An
unbelievable amount of support was provided and continues to be
provided by administrators, faculty and coordinators from other St.
Clair programs and clinical partners. Our program faculty and our
students provide continuous, helpful feedback which has also been a
valuable means of support.
One of the questions from the RTSO
was "Tell us what is great about your
program". We are very fortunate to
have some great things going on at
St. Clair. Our Respiratory Therapy lab
is located in the newly built Center
for Applied Health Sciences (CAHS).
It is bright, cheery and spacious with
each bedside having piped O2, air and
suction. Mannequins rest in each bed and
in the isolette. ICU ventilators and noninvasive ventilators wait at each bedside.
Cupboards and shelves are fully stocked
with soft-goods. Bedside monitors
are available and connect to the
VitaSim man that lives in our lab. PFT
equipment is also available and ready
for use. What is great is that everything
is still (relatively) shiny and new. One
of the great perks of starting from the
Professor Donna Pilutti teaching ground up.
neo/pead lab (photo Bilal Raza)
The CAHS also houses the high
fidelity simulation labs shared by all the health science programs at St.
Clair. Eight simulation suites are available for use and include adult,
paediatric, obstetrical and neonatal mannequins. This definitely falls
under the category of "great".
The remainder of what I can think of that is great falls under the
category of people. The roles that various people have taken
on, the time they came into contact with our program and what
they have given to ensure its success helps mark the significant
milestones of the last three years.
41

Milestone number one was when we started with our first students in
September 2011. Twenty-eight students were selected from a pool of
about 200 applicants who replied to a two-week media campaign. The
candidates who met the academic entry
criteria were interviewed for admission
and they arrived on campus being fully
aware of the unique position that they
were in being the first class in a brand
new program. I have to acknowledge
their courage in this situation. I am
not convinced that I would have been
brave enough to choose to pay tuition
and enter a program that was only just
starting. From the very beginning, those
28 students took a team approach to
their learning, growth, success and
The lobby area in the Center for Applied Health
failures in the program. In that very
Sciences at St. Clair College is the common place
first semester, a Student Respiratory
for students of all disciplines to meet in between lab Therapy Club was formed and continues
classes or on breaks. Here some of the graduates to remain active. Over the past three
are pictured during their second year. (L to R)
years, the club has held bake sales to
Back row: Farhana Chowdhury, Harjinder Johal, raise money for various causes (Cystic
Nathaniel Carter, Kate Oliver, Nicole Coffey,
Fibrosis was their first), hosted pub
Andreea Chircu
nights, created and sold RT hoodies
and held a "meet and greet" night for all
Front: Adriana Marcarian, Laura Caro,
three cohorts and their professors with
Nina Kovacevich (photo Nicole Coffey)
Kevin Taylor (Registrar, CRTO) acting as
guest speaker.
Three years later, we have twenty-one graduates.
Like all graduates from all RT programs, these
students worked hard for their success. What makes
this particular class great is that they are the first
graduates of our program a program in which they
entered that had no history, no track record and no
guarantees. As they grew in their knowledge, skills
and abilities, they continuously required the program
to stay one step ahead of them and they trusted us to
do that. Greatness!
Kate Oliver, SRT, puts Timmy back
to bed. Where did his other leg
go??? (photo Nicole Coffey)
The majority of the classes in the first year, when

there was only one cohort, were taught by the sole
full-time person. The milestone of adding parttime faculty was significant and occurred when the
42

coordinator duties were taken on by the full-time faculty
member. Each successive semester saw more and more
part-time faculty added. These part-time faculty members
became and remain one of the greatest assets of our
program.
The vast majority of professionals that teach in the RT
program at St. Clair continue to work clinically as RRTs
locally in hospitals, home care companies and in the
community in physician offices and Family Health Teams.
Because the faculty members still work clinically, the
students are gaining knowledge, skills and abilities that
are current, relevant and reality based. As well, the parttime faculty has always been energetic and dedicated
to the training of future respiratory therapists. They
participate in faculty meetings, training, curriculum
development and program reviews, including taking a
large role in the accreditation process.
Students in the Respiratory
Laboratory practice some of the
skills required for patient transport.
(photo Nicole Coffey)
As each semester approaches, the entire faculty works

hard to review and revise their course materials, texts
and other literature to ensure that the best and most
accurate information is being taught. Taking on a parttime teaching role at St. Clair, while still working clinically, has meant that these
professionals have used vacation days, switched shifts, worked unusual schedules
or committed themselves to very long days. Not all faculty members are RRTs
and we are pleased to have experts in other areas committed to our program
and our students who are willing to share their expertise in pharmacology and
anatomy and physiology. Our faculty is the base of our program, as it is for any
program, and I truly believe that I work
with a great team.
Another milestone for our program was

the initiation of clinical partnerships and
the students first clinical experiences.
Beginning in the second year of
the program, students have clinical
placements. For our initial cohort, this
began in September 2012. Clinical
CAira Davis and Bilal Raza working in the lab with
partnerships with Windsor Regional
Professor Connie Sivyer
Hospital Metropolitan Campus (WRH),
Hotel-Dieu Grace Hospital (HDGH),
Leamington District Memorial Hospital and 3 local Home Care
Companies (MediGas, ProResp and VitalAire) were formed. These
43

partners took second year students
for a total of 7 days per student spread
out over 2 semesters. The students
were able to get their first glimpses
into the day-to-day activities of frontline
RTs in both the hospital and community
environment. When we started our second
year for the first time, both WRH and
HDGH were still clinical site partners with
Fanshawe College, taking 3rd year students
for full clinical semesters. St. Clair College,
Fanshawe College, WRH and HDGH were
able to work collaboratively with regards
to clinical placement of students at these
hospitals. During this "transition" time period,
CAira Davis thinking hard
2nd year St. Clair students often had opportunity
in the lab.
to shadow, talk to and learn from and with 3rd
year Fanshawe students at WRH and HDGH.
This was a very unique opportunity and experience for all the students involved
and would not have been possible without the support of WRH and HDGH and
the generosity and consideration of the Respiratory leaders at Fanshawe College.
The "great" factor here is, again, the people. All of the leaders at the clinical sites
mentioned above were willing to work with and support St. Clair College and its
students in developing and providing an essential part of the RT training process
through provision of clinical experiences.
Experiencing what the patients experience is encouraged in the lab.

Left: Andreea Chircu tries out the NIV
Right: Javad Fardinnejad, Kevin Bayliss and Bilal Raza get to experience
NIV with various patient interfaces.
44

Summer of 2013 was
spent preparing for
accreditation for the
program which would
be another important
milestone. In support
of the program, and
two other new programs
undergoing accreditation,
St. Clair College hired an
Mr. Smith has some cyanosis..well, at least his accreditation consultant
teeth do!
to facilitate the process.
The Center for Applied Health Science at St. Preparing for accreditation
Clair College houses 8 hi-fidelity simulation afforded us the opportunity to
labs in addition to all of the profession specific ensure that we were providing
laboratory spaces. As instructors are trained on and meeting all components
the equipment and laboratory courses are further of the National Competency
developed, use of this space by the RT Program Profile in addition to the services
and opportunities for feedback
continues to increase.
that are necessary for a good
program. Though it is part of our
normal practice to evaluate what we are doing, how we are doing it and making
improvements, the structure of the accreditation process and working to meet
those standards provided a roadmap and framework for evaluation. Preparing
for accreditation may not sound like a great thing to do, but it was! The
accreditation consultant, L. Piccinin, and all faculty members worked together to
make our submission as complete and comprehensive as possible and to get it
done on time.
Another milestone during the summer of 2013
was completion of preparations for the first
clinical year where our students would be
on clinical placements from September 2013
through to the end of May 2014 (with brief trips
back to the college to write exams). All of the
clinical partners previously noted committed to
placements for third year students. Additional Respiratory Therapy Students promote their
placement sites were added at the Chathamprofession, sell baked goods and raise funds
Kent Health Alliance, Sarnia Bluewater Health,
for Cystic Fibrosis. (photo Bilal Raza)
the Hospital for Sick Children in Toronto,
Asthma Research Group Inc. and Dhar Medical Professional Group.
All clinical partners participated in review/information sessions
about our processes for scheduling, evaluation and assessment,
communication as well as roles and responsibilities. The clinical
45

leaders were forthcoming in their
feedback, concerns and questions as
we prepared for the upcoming year. It
was clear that they were committed
to working with us through this first
clinical year. As a result, each would
be a significant contributor to program
and process improvement at the end
of the year. Our clinical partners are
most definitely great!
In February 2014 we had the onsite visit by the review team from
CoARTE as part of the accreditation
process. Though preparing for the
Program Coordinator Connie Sivyer presents
visit was stressful and the scheduling
Javad Fardinnejad with the Program Student of the interviews was challenging,
Leadership award
the days flew by and it was an
June 2014
excellent experience. All part-time
faculty, clinical partners/leaders,
administrators and students from all three cohorts participated! The reward for
the hard work arrived in April 2014 with notification that an official accreditation
status was granted. There were many, many instances in the formal reporting
from CoARTE that noted the dedication and enthusiasm shown by everyone
involved in the program students, faculty, clinical partners and administrators.
Truly the success of the program lies with the people!
Our first potential graduates arrived back to St. Clair for the final time at the
end of May 2014. One case study presentation, one didactic exam and one
clinical exam to successfully complete and they would officially graduate.
The class that started with 28 students began their final year with 23 and
finished with 21. Twenty one students successfully completed that week
and graduated from the Respiratory Therapy Program at St. Clair College.
While there will be more graduating classes for (hopefully!) many more
years to come, there will never be another FIRST class. I think this also
classifies as a pretty great thing.
In review of these students' logbooks of competencies and evaluation/
assessment forms, flashes of 'greatness' were seen. Sometimes it was
the level of awareness and thought that was displayed in the students
writing in the section on self-evaluation. Other times it was the
comments written by a preceptor acknowledging the unusual or
particularly difficult situation that the student handled with expertise.
All in all, the logbooks and the assessment forms for each student
46

creates a record of progression over time that advances towards a goal
that the student had three years prior. They also note and record the
amazing number of professionals who interacted with and impacted
on that students journey. All those people working towards the goal of
creating a Respiratory Therapisthow can that not be great?
June 19, 2014 Convocation ceremonies for St. Clair College include the
inaugural class of the Respiratory Therapy Program. There are no words.
Adriana Marcarian, Tom Liu, Professor Connie Sivyer,

Praveen Nakesvaran, Sarah Balogh
What is great about our program? The people.
I would be remiss if I did not include the following:
Over the last three years, I have learned more about Respiratory Therapy
education than I ever thought possible. Generous coordinators and
faculty from other schools have let me/us take a peek into their programs.
There is a huge variety in how RT students are trained and every program
/ school has some aspect that makes it unique or is a highlight, yet
once completed, we have all taught to the same endpoint (NCP). It is
difficult not to compare our program to other more established and
obviously successful programs and think that we have a long way
47

to go to be successful there are lots of great things happening in
RT programs everywhere and there are so many things that wed like
to incorporate! I am continuously amazed at the energy, dedication
and ability to think outside the box that is evidenced by the leaders of
respiratory education. Most particularly I am grateful to those leaders for
sharing, guiding and mentoring over the last three years.
Student comments:
"Over the past 3 years, I have learned so much about my new field but I
have also learned a great deal about myself in the process. It has been a
difficult road for many reasons, but I have learned to overcome obstacles with
dedication and confidence that I know will be invaluable to me. I feel as though
all of this has made me a better person and future RT. I started this program as a
way to have a better life for me and my son and after three years, I finally feel like
I am capable. This program has forever changed me." Nicole Coffey GRT
"I had 3 wonderful years of great experiences at college and clinical placements.
The instructors and professors were really nice and supportive. I made some
great friends and we all helped each other get through the tough times. "
Harjinder Johal GRT
"The Respiratory Therapy program at St. Clair College is fantastic. I loved the small
class sizes and the heavy emphasis on practical experience. The faculty was very
approachable and the teachers really care about your development as an RT.
There was a lot of blood, sweat and Ventolin involved but in the end it is a highly
rewarding experience." Bilal Raza GRT
This program has been a huge symbol of accomplishment for me. For as long
as I can remember, I have always wanted to do something in healthcare, but
some of my teachers and guidance counselors told me I would never make
it into a field like this. They said my grades were not high enough and that
I should try looking for a more "realistic dream." Little did they know that
when people tell me I cannot do something, I make sure to do it, and
do it well. When I found out about Respiratory Therapy, I was instantly
interested, and I worked hard to become accepted into St. Clair's inaugural
class of the Respiratory Therapy Program. It has been a long road to get
to graduation; but there have been many great experiences, friends,
and people that have come out of it. I know that I am a better person
after having been in this program, and I wouldn't change a thing. It
is a learning process, and one that I am very proud to be a part of.
CAira Davis
48
Professor comments:
The experience of teaching at St. Clair College has elicited a range of
feelings and emotions. When I first began, I was scared. I remember
I was sweating like I did at my first code pink intubation....but as my
experience grew with that of the students, teaching became less scary and
more challenging. The students had so many questions and their quest
for knowledge was exciting. Upon the students entry into the hospital, my
challenge became rewarding; it was so much fun to see the light bulbs turn
on and the correlation between things we had been teaching them finally
make sense. The students were finally able to see the importance of what we
had been trying to convey. This feeling is priceless. I'd also like to say that
along the way, I've gained a great degree of understanding and patience and
have also learned a thing or two along with the students. So, I'd like to wish the
first graduating class of St. Clair College congratulations and great success as they
enter the profession of Respiratory Therapy. I hope they love it as much as I have
during my career! Professor Stephanie Shaw (Stephanie teaches part time in the
respiratory laboratory at St. Clair College and works full time at Windsor Regional
Hospital, Metropolitan Campus)
Professor Connie Sivyer,

Professor Wendy Foote, Nicole Coffey
and Professor Erica Bacon
More photos of Convocation follow.

Congratulations to all of the Graduates,
the Professors and a special congratulations to
Professor Connie Sivyer.
Dr. Ken Blanchette (Chair of Health

Sciences, St. Clair College) and
Professor Frank Foote
49
Andreea Chircu, Laura Caro and Sarah Balogh
The very first graduate to cross

the stage in our inaugural year!
(Kassandra Armstrong and
Professor Sivyer)
Kassandra Armstrong
Farhana Chowdhury
Nina Kovacevich and Harjinder Johal
CAira Davis and Nicole Coffey
50
Laura Groulx, Navjot Grewal and

Javad Fardinnejad
Praveen Nakesvaran
Adriana Marcarian, Erin MacNeil

and Tom Liu
Congratulations
Bilal Raza and Kate Oliver
51
Student Corner
Welcome to Algonquin College

Submitted by
Patricia Lopez
Since 1968, Algonquin College in Ottawa, Ontario has offered the

Respiratory Therapy (RT) program to individuals who meet the entry
requirements and possess a desire to enter this great profession. However,
it wasnt until 2013 that our class finally stepped through the door
to start the educational process to our career goal. So far, during the
first year of our three-year program, our journey has taken us on a
carrousel of adventures and experiences. We have come to love our
school and have also learned that the value that it offers lies within
its extraordinary people, staff and alumni. As such, we would like
to share our story, as a tribute to the amazing people who form this
team, of which we are proud to now be members.
Andrea Walkau preparing a simulation
From the very first day, this program

has been beyond expectation. As the
time wound down for our first class
to begin, students slowly entered
the classroom and the desks were
gradually occupied. Everyone was
anxiously waiting and many of our
faces were showing genuine distress;
after all, this was the departure point
for this exciting challenge; one that
would define our future. The tension
was palpable and most of us were in
silence waiting and wondering what
lay ahead.
Without preamble, the teacher finally appeared and introduced himself

as Ian Summers. Ian announced that he would be our teacher for two
courses in the first year, Applied Basic Sciences as well as Administration
and Legalities. We could describe him as an easygoing, straightforward
teacher who does not show off despite being easily identified as someone
who is quite knowledgeable. He is also extremely proud of his profession.
Ian took the time to describe the program for us and he was the first to let us
know that it was not going to be easy. Not surprisingly, we soon realized that
52
Student Corner - Welcome to Algonquin College

this was quite an understatement. He also
prompted us to introduce ourselves and share
the reason why we chose the RT program at
Algonquin College. That was how we started
to get to know each other.
At the end of our introductions, the first thing
that we noticed was the heterogeneity of our
class. The multiple backgrounds, the diverse
origins and the ages that differed by more
than twenty years seemed a difficult challenge
to overcome. However, our mixture has not
Laboratory
been a drawback, but an advantage in the
development of an incredible camaraderie.
The previous educations, which include a variety of university degrees,
have balanced perfectly with the fresh and younger minds of recent
high school graduates. Despite our differences, our goals were the
same, and we did not encounter any difficulties to become a strong
and cohesive team.
Our second class
was not very different
as we got to know
our second teacher,
Sharon Lightfoot, who
taught us Anatomy
and Physiology during
the first semester, and
Mechanical Ventilation
and Pathophysiology
during the second.
Sharon, a passionate
Gaby Speck and Martina Ouellette
teacher, spent her
Intubation Practice
inexhaustible energy to
keep us alert in class. We
will remember until eternity how she showed us the unorthodox uses that
some people have given to their inhalers such as hair spray or to jet power
their running shoes.
The mechanical ventilation laboratory was also Sharons responsibility. There,
we had the opportunity to actually use the initially intimidating ventilators.
53

In addition, during the theory class, she would bring the ventilators to the
classroom and encourage us to get to know them. For example, we were able
to connect the oscillator to swine lungs (The smell will haunt us forever) and
it allowed us to see how stiff lungs gradually opened. We also experimented
with some of the ventilator modes on ourselves which also gave us an idea
of how our patients will feel. We shared countless hours with Sharon in
the laboratory, the classroom and her office and we are certain that she is
happy to finally have a break from us.
The rest of our classes came with new teachers to
get to know. For the medical gas and basic protocols
laboratories, we were divided into two groups for the
laboratory sessions. We were excited about them.
Both Jackie Thompson and Andrea Walkau were in
charge of these laboratory sessions and they gradually
introduced us to the real world with their easy style
and warm smiles.
The laboratory experience also grew into an interesting
chiaroscuro which, in the terms of art, represents the
use of deep variations of light and shade. While we
enjoyed the casual hands-on learning sessions in the
laboratory, the simulations used for evaluating us were
some of the more demanding challenges that we have
faced yet. We quickly learned that the difficulties
of the simulations were not always the simulations
Gaby Speck and Martina Ouellette
per se, but rather a result of the anxiety building
within ourselves, particularly when we did not know
what scenario would be set. Every time that the mannequins oxygen
saturation dropped, the sweat would begin to appear on our foreheads
and the tension between our ears would begin to grow. To complicate
things further, the use of critical thinking was not easily systematic because
most of our brains were concerned with the seconds ticking away on the
chronometer while also being keenly aware of the judgments being made
of our performances.
The simulations soon became our worst nightmare because the gas tanks
would be empty, the non-rebreathing masks would lack valves, the gas outlet
would be set up with an unrecognized air flowmeter (instead of an oxygen
flowmeter), the laryngoscope would not have batteries, the blades would not
54

fit the handle or the suction would malfunction when the simulated patient
began to vomit. In a nutshell, everything that could go wrong went wrong.
While we have realized that these simulations are to prepare us for the
worst scenarios with real patients, we are hopeful that the sweating hands,
frustration, tears and feelings of helplessness will fade to the past tense as
our skills and expertise continue to grow. Throughout this learning process,
we quickly discovered that the essential bright light in this environment
was to work collaboratively as a team. Supporting each other and being
supported, made things easier but learning about teamwork has only been
the beginning.
During the evening, on the same day that the laboratory sessions were
held, a very special class took place throughout
our first semester. When we saw that the
Psychosociology class was going to be held
from 1700 to 2000, most of us thought that
those days were going to be cumbersome
and mind-numbing. However, we enjoyed
every minute of that class, thanks to Murray
Hillier, our professor. Murray, an exceptional
teacher, drove two hours every week to share
his knowledge and insight. If he could not,
most of us would likely have agreed to drive
the two hours in order to have the privilege
of attending his lectures. This class turned
Lindsay McNamara, Ben Leung
into a friendly reunion of sorts as we enjoyed
and Mathew Eberley
engaging in discussions of profound topics.
In fact, we always believed that we left the class having grown as better
persons, professionals-to-be and as friends. If understanding the relevance
of confidentiality, professionalism and self-respect was not enough, this
class was also the buffer to reverse the frustrations we felt when we stumbled
during simulations, papers or exams.
Andrea Walkau, a burst of youthful energy, conducted the Medical Gas
Theory class. She was the first one to make us write a quiz for this program.
Most of us left the room feeling pretty confident about it, but we soon realized
that the questions were trickier than we had originally thought and the marks
worse than we expected. The message was clear; we were expected to work
harder to understand the concepts taught rather than to simply memorize
theories and formulas. Fortunately, the teachers always had the disposition to
55

help us and we took full advantage of that offering and the multiple resources
that were available to gain a greater comprehension of the many complex
concepts being introduced to us each day.
As the teachers had promised, the journey through the first semester was
not easy. The exams were tough, the simulations morally devastating and
the time left outside of the classroom felt like there was not enough to
study, sleep or eat. Consequently, our classroom became less crowded as
some of our classmates realized that this was not the path they wanted to
follow or needed more time to finish it. Regardless of the time they spent
with us, every one of them left a mark that will accompany us for the
rest of our journey, because we shared more than just a classroom, we
shared our lives and had become a family.
When the Christmas break finally arrived, we parted ways and
reconnected with our own family and friends, most of who were
neglected during the endless days of study. Unfortunately, the break
was too short and the second semester came very fast. However,
it seemed as though the first day of class of the second term was
contrastingly different. Instead of the anxious and frightened faces
seen on the first day of the program in the fall, the beginning of the
second semester was marked by friendly and cheerful people, each
possessing a little more energy after the break and eager to get started.
The teachers made sure that we were aware that the first term had been
just a sneak peek of what awaited us and we were certainly not nave to
think that this semester was going to be easier. However, our confidence
lay within the teamwork that we had developed and we all knew that
this was going to be the landmark of our success for this semester. As
well, we now knew each other well and as a result, we each took full
advantage of the strengths of others to counteract our own weaknesses.
Gabriela Speck, who in addition to teaching us the basic respiratory
protocols theory, soon shared with us her inner peace as she conducted
our first class in the second term. This was likely a method of reassurance
to us but not even Dalai Lamas peace would suffice to keep us calm during
the second round of simulations. Anyone would say that knowing how the
simulations were conducted would decrease the anxiety, but that was not
what really happened. Despite lacking the reprieve of our Psychosociology
class, we instead utilized the support of our classmates as a resource to
overcome our worries and apprehensions.
56

We comforted each other when we inadvertently picked the wrong
bag of solution which was mischievously placed in the wrong drawer
during the heated humidity simulation, or when we forgot to use the
required PPE while performing tracheostomy care. We also did it when
we miscalculated the dosage of bronchodilators while preparing a
nebulization, or when we ran out of time because we could not find the
right cable to connect the humidifier. Although the simulations were still
a big challenge during the second half of the first year, we finally learned
to laugh about them and realized that our silliest mistakes were caused
by the anxiety of the stopwatch and the clipboard in the hands of the
judging teacher. As a method of learning, we informally gathered after
the simulations to discuss what we did wrong and what could be done
differently to succeed while encouraging each other to perform better.
The second semester proved to be harder in more than one aspect. The
Pharmacology course was a big challenge. However, this challenge
confirmed that the friendship between us made things easier. One of our
classmates with a remarkable background in Pharmacology selflessly
invested valuable hours of his time to make a comprehensive list of
the studied drugs, which resulted in an invaluable study tool. Still, this
was not a unique event during our last semester as a chain of generous
actions would characterize our team. Each of us would contribute
whatever we thought could be useful to others and profited from the
items shared by our partners.
Regardless of the heavy academic load, we still had time to have
fun in and out of the college. There was always someone arranging
fun activities. We fought each other during paintball and laser tag
confrontations and we also shared lunches, dinners and birthday
celebrations. We enjoyed and teased each other during Jeopardy!
type quiz competitions prepared by one of our classmates while Linda
ORegan, our teacher in the Pulmonary Diagnostics course, also
prepared another Jeopardy! quiz as a review for her class. We had
someone to make us smile with his pranks on April Fools day; the jokes
included some of the teachers who proved to have sense of humor.
We also had treats on Valentines Day provided by the most generous
classmate ever. The days would have been harder if we did not share
breakfasts, or the smooth music accompanied by the virtual fireplace
while studying. Undoubtedly, the long hours of study would not have
been bearable without the frequent funny comments, videos and
pictures shared in the social media. But most importantly, our success
57

would have been more difficult if we had not had each other and learned
to work together.
After almost a year of sharing our lives at
Algonquin College, we all have agreed
that what makes this program special is the
people; people who care about people. It is
about teachers with an amazing generosity to
share their insight, know-how and experience.
It is about students aware of their strengths
and weaknesses, smart enough to accept that
together we are stronger and that studying
side by side is more rewarding. It is also about
teachers and students together, heading in
the same direction with one common goal.
That being, the formation of a new generation
Gaby Speck, Andrea Walkau
of respiratory therapists able to apply the
and Martina Ouellette
knowledge, skill and expertise that they have
learned and proudly represent the profession while endeavoring to
provide a positive change for every patient they care for. We are proud
to be that new generation.
58
Your RTSO membership now gives you MORE!
One low annual RTSO membership fee now gives you..

Professional Errors & Liability Insurance

Access to the Research bursary fund through the Advanced Education Practice Award
Stethoscope Discount Program
Research and Education Committee Networking
Discounted Rates on RTSO Educational Programs
Employment listings on the RTSO web site
Membership in the Ontario Respiratory Care Society (ORCS) and all of the benefits they have to offer
Subscription to RTSO Airwaves Newsletter
Leadership networking
Regular updates of pertinent information affecting Respiratory Therapy in Ontario
Government Representation on Matters of Interest to the Profession
College of Respiratory Therapists of Ontario Representation
The Ontario Respiratory Care Society (ORCS) is an

interdisciplinary section of The Lung Association for health
care professionals involved in respiratory care.
The ORCS provides members with educational
opportunities, funding of research and post-graduate
education in the field of respiratory care, information
dissemination related to respiratory health and lung disease as well as access to Lung Association
resources. In addition, the ORCS provides health professional expertise to the Ontario Lung Association.
The ORCS provides full day and evening educational seminars throughout Ontario organized by their
seven regional groups and an annual Better Breathing Conference held in Toronto.
Full details available at www.on.lung.ca.
Together you have...
The opportunity to help improve the quality of respiratory care in Ontario

plus Networking opportunities with others involved in respiratory care
What are you waiting for?

Application form available now at
www.rtso.ca
Pioneers of Positive
Pressure Ventilation
In past issues of the RTSO Airwaves, we have focused on various pioneer

individuals who, indirectly through their work, have aided the development
of the respiratory therapy profession. In this issue, we will focus on four
individuals who strived to establish the use of positive pressure as the primary
means to provide ventilatory support.
The use of positive pressure to aid those unable to sustain their own ventilatory
efforts has been documented throughout history. In Christianity, biblical passages
exist that reflect on the administration of positive pressure breathing (mouth to
mouth) to create or restore life. However, the first written account was noted in 1550
BC within an Egyptian medical document called the Ebers Papyrus (Wilkins, Stoller, &
Kacmarek, 2009). During the middle ages, Paracelsus, a Swiss German Renaissance
physician, described the first use of mechanical ventilation in 1530 when he used a
fire-bellows with a fixed tube to pump air into a patients mouth (Somerson & Sicilia,
1992). In 1653, Andreas Vesalius, a Flemish anatomist, recognized that artificial
respiration could be administered via a tracheotomy on a dog when he used a reed
as an airway to facilitate ventilation. In his published text, De Humani Corporis
Fabricia, Vesalius made one of the more profound statements of his time when
he wrote, But that life may be restored to the animal, an opening must be
attempted in the trunk of the trachea, in which a tube of reed or cane should be
put; you will then blow into this so that the lung may rise again and the animal
take in air... (Granton & Slutsky, 2000)
Throughout the next three and a half centuries, other names took up the
stance to utilize a bellows-oriented method of positive pressure ventilation,
most based on results from animal experimentation. Those individuals
include Robert Hook, John Hunter and William Harvey but tragically, these
concepts eventually fell into disrepute (Somerson & Sicilia, 1992). In the
latter half of the 19th century and early years of the 20th century, the
concepts for ventilatory support were focused upon the development of
tank-type ventilators that utilized sub-atmospheric pressure to expand the
chest wall. At the same time, George Fell, a physician and engineer born
in 1849 in Chippawa, Ontario, a community now found within the City
60
Pioneers of Positive Pressure Ventilation

of Niagara Falls, resurrected the bellows technique and began human
use with a method he termed, forced respiration. (Trubuhovich, 2007a)
Fell was educated at the University of Buffalo and was elected Chair
of Physiology and Microscopy at Niagara University where much of his
time was spent in the laboratory. Through his experiments with dogs, Fell
became quite adept at resuscitating those animals that developed apnea as
a result of excessive anesthesia administration. He did this through the use of
intermittent positive pressure ventilation. (Trubuhovich, 2007a)
In June 1886, Fell attended a failed resuscitation of a man who had taken an
overdose of morphine. At this time, opiates were readily available to the public
and as a result, addiction and overdose had become an epidemic. The failed
resuscitation irked Fell, because he was acutely aware of the inadequacy of the
techniques used at that time and he, without doubt, believed that his method of
forced respiration would have provided a different outcome. (Trubuhovich, 2007a)
Fells landmark case occurred in July 1887, when the similar techniques used
previously were provided to another opiate overdose which, again, offered a poor
prognosis due to their lack of effectiveness. In fact, the patients respiratory rate
had fallen to an average of one breath per minute. It was then that Fell was granted
approval to provide support using his forced respiration methods. This approval
was unorthodox because current dogma stated that techniques of this type were
inappropriate since it was believed that the lungs could not tolerate forcible
mechanical measures (Trubuhovich, 2007a). Undeterred, Fell disqualified these
beliefs when his efforts yielded a successful outcome.
Unfortunately for Fell, despite the successful outcomes of several of the cases
that he attended and thus presented, his pioneering techniques were never
readily accepted during his lifetime. He instead suffered great skepticism,
criticisms and opposition from the majority of the medical community outside
of Western New York. He passed away in 1918 with little fanfare despite his
now recognized contributions to modern medicine.
For the next three decades, negative pressure iron lung tank ventilators
dominated the world as a means of ventilatory support particularly during
the polio epidemics of the 1920s. However, the use of positive pressure
ventilation made a slow evolution into anaesthesia when thoracic surgery
became more feasible. Previously, a high mortality rate existed due to
pneumothoraces and mediastinal shifts that occurred when the pleural
cavity was opened. These experiences were greatly reduced when
positive pressure ventilation was utilized during anaesthesia (Somerson
& Sicilia, 1992). Yet, it wasnt until the polio epidemics that occurred
61

in California in 1948-49 and later in Copenhagen that the true value
became more evident and accepted outside of the operating room.
Analyzing data prior to 1948, Dr. Albert G. Bower and biomedical
engineer, V. Ray Bennett came to the conclusion that intermittent negative
pressure ventilation (INPV) was inadequate to treat the growing number of
patients afflicted with polio despite the use of tracheostomy and optimized
respiratory care. High mortality rates and their dissatisfaction with the
performance of standard tank ventilators led them to seek other alternatives
(Trubuhovich, 2007b).
Bennett had already designed positive pressure devices, several of which were
used at the Los Angeles County Hospital for short term ventilation in respiratory
emergencies. Unfortunately, it was unfit for prolonged use but Bennett was able
to make alterations to the design and retrofit a device that could be attached to a
tank ventilator to augment tidal breath delivery and as such, minute ventilation. The
device could provide PPV via a mask or mouthpiece or via a tracheostomy adaptor
developed by Bower (Trubuhovich, 2007b).
By providing this form of therapy, Bower and Bennett noted a significant improvement
in tidal volume delivery and a decrease in mortality. One documented case reports
that a change of therapy from -18 cmH2O via INPV to a similar pressure differential
of combined therapies (-9 cmH2O INPV and +9 IPPV) and synchronized cycles
(positive pressure applied during the iron lungs negative inspiratory phase with
passive expiration) resulted in an increase of 300-400 mL for tidal ventilation. They
also realized that IPPV alone could produce tidal volumes greater than 450 ml
using the same 18 cmH2O pressure differential. As a result, their focus turned
to engineering a device that could provide positive pressure ventilatory support
in long-term cases and consequently enabled Bennett to develop the TV-2P
pressure-cycled ventilator (Trubuhovich, 2007b).
Similarly, in Copenhagen in 1952, Dr. Bjorn Ibsen recognized the advantage
that positive pressure ventilation could offer when he was called to consult on
a 12-year-old girl suffering from paralytic poliomyelitis. His recognition was
stemmed by his experience managing curarized patients during surgery. As
well, Ibsen had read articles written by Bower, Bennett et al documenting
their successes utilizing this new and unconventional form of therapy (Puri,
Puri, & Dellinger, 2009).
The large scale epidemic that occurred in Denmark also brought the
limitations of the iron lung to the forefront. These included its size,
62

expense, difficulty to provide nursing care, failure to rectify atelectasis
or respiratory acidosis and inability to protect the patients airway. Using
these limitations, Ibsen was able to convince the value that IPPV could
offer to senior officials of an overwhelmed medical system. As a result,
over one thousand medical students, retired anaesthetists and volunteers
were recruited to manually ventilate these patients for weeks and months on
end. Smaller centers with less manpower sought the assistance of mechanical
devices and as a result, technologies from across the world started to be
developed and marketed. (6) Ibsens mandate to localize patients requiring
such care to a specialized unit has provided him with the acknowledgement of
being the father of Intensive Care Medicine (Puri, Puri, & Dellinger, 2009).
Several names are recognized (Morch, Engstrom, Bird and Emerson) and can be
credited with the development of the technology that began the evolution of the
mechanical ventilators that we use today. However, Fell, Bower, Bennett and Ibsen
must be recognized for their contributions to solidify the use of positive pressure as
the primary means of providing ventilatory support.
References:
1. Wilkins, R.L., Stoller, J.K. & Kacmarek, R.M. (Eds.). (2009). Egans Fundamentals of
Respiratory Care, (9th ed.). Philadelphia: Mosby, Inc.
2. Somerson, S.J. & Sicilia, M.R. (1992). Historical perspectives on the development
and use of mechanical ventilation. Journal of the American Association of Nurse
Anesthetists, 60(1), 83-94.
3. Granton, J.T. & Slutsky, A.S. (2000) Mechanical ventilation: Whats new when your
patient is blue? Canadian Medical Association Journal, 162(2), 241-242.
4. Trubuhovich, R.V. (2007). 19th century pioneers of intensive therapy in North
America: Part 1: George Edward Fell. Critical Care and Resuscitation, 9(4), 377-393.
5. Trubuhovich, R.V. (2007). On the very first, long-term, large-scale use of IPPV.
Critical Care and Resuscitation, 9(1), 91-100.
6. Puri, N., Puri, V. & Dellinger, R.P. (2009). History of technology in the
intensive care unit. Critical Care Clinics 25, 185-200. Retrieved from: http://
criticalcaremedicine.pbworks.com/f/history+of+technology+in+the+ICU.pdf
63
Ask aRTee
Dear aRTee,
In my search to find
further information, I
was able to discover
one article found
in the Journal
of Emergency
Primary Health
Care (Williams, Fallows & Allan, 2007)
that investigated several medical databases
asking the same question and utilizing
several key words. Apparently, until that
time, only nine papers were found with
low levels of evidence to support its use. In
contrast, according to these authors, several
anecdotal opinions and case reports exist
that support its use. The authors of other
articles offered the same anecdotal evidence.
Ive provided care to a few patients

presenting to our ER with severe asthma
but fortunately nothing that has been
life-threatening. However, Ive often
wondered about assisting exhalation with
chest compressions. Are you aware of any
literature that establishes whether this is a
viable therapy option?
Thanks,
Helping to Exhale
Dear Helping,
The technique you refer to is often called
external chest compression (ECC) and I did
spend some time doing a literature search
as a result of your question but was unable
to come up with any conclusive evidence
to promote or deny its use. Most studies and
reports simply followed the proverbial path
of if all else failswhy not?
The procedure involves the application
of a steady and firm but gentle pressure
to the lower thoracic cage in an inward
and downward motion at the onset of
expiration. The aim is to reduce the dynamic
hyperinflation (gas trapping) that occurs
in severe asthma. The technique can be
done posteriorly if the patient is standing
or sitting or from an anterior position if the
patient is supine.
64
An internet search allowed me to come

across a webpage called BestBETs that
highlights best evidence topics. On this
particular page, an emergency medicine
resident by the name of Kris Chiles also
did a literature search and formatted the
findings of that search in a chart. Again,
the conclusion dictated another if all else
fails approach.
Interestingly, also in my search, I came
across one author who was quite a
proponent of ECC. In an article in the
Emergency Medical Journal (Harrison, 2010),
the author described three separate cases
in which the use of ECC enabled survival.
Similar to the previous articles, Harrison
also concluded that this may be a lifeRTSO Airwaves Summer 2014
Ask aRTee
saving technique in acute asthma. Of note,
he actively promotes on various internet
webpages that it should be taught to relatives
and care providers of persons with asthma.
Unfortunately, it would appear that no
conclusive studies exist that can confirm
the benefit of ECC. I am certain that several
RTs across the province can attest to having
utilized this technique at one time or another.
I am also certain that an equal party will exist
within both groups with one camp saying it
aided the recovery of their patients while the
others will say it did nothing.
References:
Chiles, K. (2011). External chest compressions in
severe asthma. Retrieved from http://www.bestbets.
org/bets/bet.php?id=2155
Harrison, R. (2010). Chest compression first aid for
respiratory arrest due to acute asphyxic asthma.
Emergency Medical Journal, 27, 59-61.
Williams, B. Fallows, B. & Allan, J. (2007)
Investigating the benefits of out-of-hospital external
chest compression. Journal of Emergency Primary
Health 5(3). Retrieved from http://ro.ecu.edu.au/
jephc/vol5/iss3/2/
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and Ontario Respiratory Care Society (ORCS) Membership & benefits***) = $192.10
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Includes Ontario Respiratory Care Society (ORCS) Membership & benefits*** = $226.00
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RTSO Airwaves Summer 2014

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