Chest Physio ???!!!!! in the USA

[HoJoOregonPT]

Hello all, I am a seasoned PT living in the USA and working in a hospital in the acute setting. I am always intrigued as to why Respiratory Therapists do not employ any chest physio as we know it but rather are drawn to the technical side viz nebulizers and high flow masks and oximizers. They have a responsibility in the ICU and Cardiac ICU for setting up and manipulating ventillators. I have never seen them do percs and vibes and postural drainage, especially when our high tech beds would lend themselves to the latter. Have P and V become old fashioned techniques. I'd love to hear what the rest of the world of Physios think. Thanks and looking forward to your input and coments.

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[Fyzzio]

Hi,
I don't quite understand your comments. This is possibly due to the fact that our health system is different.
Could you pls explain what a Respiratory Therapist is? And where the difference to Physiotherapy lies?
Thanks,
Fyzzio

[physiobob]

I believe it is still the case that in the USA they have a dedicated professional called a Respiratory Therapist. The Physio's don't learn the cardiopulmonary treatment in their undergraduate training. Just like they don't learn to apply plasters and the US therefore has Plaster Technicians. These types of structures as the main reasons why USA PT's are unable to work in many other western countries. i.e. The training isn't as broad as they have several professionals doing what in say Australia is taught and later performed by the one professional category.

[HoJoOregonPT]

Hi,
I don't quite understand your comments. This is possibly due to the fact that our health system is different.
Could you pls explain what a Respiratory Therapist is? And where the difference to Physiotherapy lies?
Thanks,
Fyzzio

Thanks Fyzzio, PTs in the USA don't have any involvement in respiratory medicine. Instead there is another "professional" group with a 2 year degree that seems to only do nebulizers and pulse oximetry throughout the general hospital and ventillator manipulation and nebs and suctioning in the ICU and CICU. I never see them doing percs and vibes nor postural drainage nor teach patients the FET, Huff and cough technique for mucous clearance. I often feel that patients with bi-basal crackles and audible upper airway congestion could do with those techniques. I never see patient education on on positioning strategies for dyspnoea. I feel the American patient is missing out big time and perhaps they take way longer to get better. So, my question to you, are all the techniques that I learned still in vogue ?
Thanks

[HoJoOregonPT]

hello, Many thanks for your reply to my inquiry. FYI, I am an Australian trained and experienced Physio who has been working in the USA for 20 years. I am aware of the differences between the two countries modes of practise for Physio/PT. You are right, we who are lucky to be trained outside the USA are way more broadly trained. However, I do believe that the Americans are better trained in neuro rehab. Perhaps, being from Sydney I was not, as our focus was more on The Australian Approach (Maitland) orthopedic manual therapy and less on say spinal cord injury rehab, amputee rehab and non Carr and Shepherd Stroke Rehab. From what I think you are suggesting is that nothing has really changed in chest physio from when I was trained 20 years ago, except for perhaps the fully enclosed suction catheter in the ICU negating the need for that special sterile field procedure of preparation before suctioning. I have to say that was a pain in the neck. So that fully enclosed suction catheter is an improvement In these patient cases where I see the Physio could really be more beneficial to the patient than RTs are in terms of patient education on positioning strategies, I feel frustrated that I can't add my opinions. I would be crossing professional boundaries and it would not be appreciated by them. So herein lies the problem for the American respiratory or heart surgery patient. Cheers....

[Fyzzio]

Hi,
thanks all for the explanations!!!
I do understand your frustrations, HoJo - must be so difficult to want to get in there, but unable to do so.
Could you raise your concerns with the Unit Manager or somewhere else in the system?

Down here, I believe that all the "old fashioned" techniques are still part of the teaching programme. However, the difference these days will be that the connection to EB treatments and clinical analysis is much more prominent. I.e., just because someone has got bi-basal crackles, you wouldn't neccessarily treat them - could be due to pulmonary oedema after all...
Also, the importance of education and general mobilisation is much more highlighted.

As to Neurology - it takes up a lot of time these days and is certainly well covered.

Regards,
Fyzzio

[PhysioArgos]

So, my question to you, are all the techniques that I learned still in vogue ?
Thanks

Here, you may have some Greek feedback. In this country Schools are still teaching the "old" set of techniques and these are what students are using during their standard practice. However most of the veterans, base their approach in early mobilisation and in active breathing techniques. We prefer to have well trained patients who are trying to help themselves as much as they can.

Because we luck research so far, we do not have a general direction nor any official guidelines. Thus there are people how are only using the traditional respiratory battery of techniques.