In the early 1920s, the first departments of oxygen therapy were established after Dr. Alvan Barach and others recognized the benefits of oxygen administration for a variety of conditions. Compressed gas cylinders were large and heavy so many of the earliest practitioners spent the bulk of their time hauling cylinders and bulky oxygen tents to and from patient rooms. Other staff nicknamed them "oxygen orderlies" and "tank jockies". As time passed, more therapeutic gases were available for administration, medications targeted for pulmonary diseases became available, and departmental services expanded. Textbooks and training programs would not appear for several decades so the earliest practitioners were reliant upon physicians and other medical professionals to teach them basic procedures and patient assessment skills.
From oxygen aides to inhalation technicians to respiratory therapists---what a long way the profession has evolved since those early days!
Edwin R. Levine, MD is credited with establishing the first on-the-job training program for inhalation therapy.
In 1952, Dr. Levine served as President of the Inhalation Therapy Association (now AARC) and was the only physician ever elected to do so.
Dr. Edwin R. Levine established the first inhalation training program at Michael Reese Hospital, Chicago, Illinois in 1943. Dr. Levine and his colleagues provided didactic and clinical instruction for the on-the-job trainees at Michael Reese Hospital.
In his book entitled "Manual of Oxygen Therapy Techniques", Dr. Albert Andrews, Jr, MD outlined the purpose and structure for a hospital-based inhalation therapy department. The 191 page book was published by The Year Book Publishers, Chicago, 1943
In Chicago, Dr. Levine’s students, oxygen orderlies, doctors and nurses met on July 13, 1946 to form the Inhalation Therapy Association.
In 1947, Articles of Incorporation were filed on March 7 with the Secretary of State of Illinois to establish our professional association: The Inhalation Therapy Association. Incorporators were: George A. Kneeland, Richard E. Goss, Vincent T. McCue, Brother Roland Maher, Brother Silverius Case.
The Inhalation Therapy Association (ITA) was chartered as a not-for-profit association in Chicago, IL on April 15, 1947. The certificate issued by the state is shown.
The new Association had 59 members, 17 of whom were from various religious orders.
The first ITA Annual Meeting was held on May 5-7, 1947 at Palmer House, Chicago, IL. Officers were elected and included: George Kneeland, Chairman; Brother Roland Maher, Assistant Chairman; H. Edwin Smith, Secretary-Treasurer; Richard Lambert, State Agent.
In 1953, the National Cylinder Gas Company published "Effective Inhalation Therapy" which was written by Edwin R. Levine, MD, Alvan L. Barach. MD, J. Winthrop Peabody, MD, and Maurice S. Segal, MD. All aspects of inhalation therapy were covered in the 157 pages and the glossary of terms.
Images from Jim Hendelang and Gary Jeromin
ITA was renamed the American Association of Inhalation Therapists (AAIT). The initial sponsor was the American College of Chest Physicians (ACCP).
The New York State Society of Anesthesiologists and the Medical Society of the State of New York formed a Special Joint Committee in Inhalation Therapy to establish “the essentials of acceptable schools of inhalation therapy.”
In 1955, AAIT held its first Annual Meeting at the St. Clair Hotel in Chicago, IL.
Written examinations were required to maintain membership in the Association..
83 people attended this first meeting.
Illinois is designated as the Alpha Chapter (Chapters evolved into the Chartered Affiliates).
Resolution introduced to AMA’s House of Delegates to develop schools of inhalation therapy. “Essentials for an Approved School of Inhalation Therapy Technicians” were adopted for a 3-year trial period.
AAIT, ACCP, AMA, ASA were sponsor participants.
Before the registry exams or licensure existed, inhalation therapy technicians in some states were required to apply to a Board of Inhalation Therapy that functioned under a city or state board of health. An application from 1959 for a "Certificate of Competency" for inhalation therapy technicians in New York City is shown.
Image from Felix Khusid
The American Registry of Inhalation Therapists (ARIT) was incorporated in Chicago, IL in 1960.
Sponsors included the AAIT, ASA, and ACCP.
The ARIT's purpose was to test the competency of inhalation therapists. Upon successful completion of written and oral examinations, an individual was designated as a Registered Inhalation Therapist.
1. To advance the art and science of medicine by promotion of the understanding and utilization of inhalation therapy in the prevention and treatment of human ailments.
2. To assist in developing and maintaining educational and ethical standards in inhalation therapy for the public good, for the advancement of medical care, and for the professional guidance of registrants of the Registry.
3. To establish standards by which the competency of inhalation therapists to administer inhalation therapy under the prescription, direction, and supervision of licensed physicians may be determined.
The American Registry of Inhalation Therapists administered first Registry exams in November 1960 in Minneapolis, MN. Written and oral exams were required.
Sister M. Yvonne, CRNA became the first Registered Inhalation Therapist and received registry #1.
The first ten individuals in the United States to become registered inhalation therapists are listed.
Image from Trudy Watson
American Registry of Inhalation Therapists Example of Registry Certificate Charles L. McKnight #113
Image from Charles McKnight
The Board of Schools of Inhalation Therapy Technicians was formed in Chicago, IL as “an inspecting, surveying, and reporting agency.”
1966 – AAIT Banner
The AAIT changed its name to the American Association for Inhalation Therapy.
Image from Bob Weilacher
The American Association of Inhalation Therapists established the AAIT House of Delegates (HOD).
According to the Association's Bylaws, the House of Delegates shall "serve as a representative body of the general membership and the representative body of the Chartered Affiliates of the Association. It shall participate in the establishment of the goals and objectives for the Association and participate in the governance of the Association."
ASA, ACCP, AAIT, AMA recommended expanded content and duration for IT educational programs.
Egan's Fundamentals of Inhalation Therapy, the first comprehensive textbook on inhalation therapy was published in December 1969 by C.V. Mosby. (474 pages)
"Egan's" 11th edition was published in April 2016 (1,392 pages)
Image of textbook from Jeff Anderson
The Technician Certification Board (TCB) was established in 1969 by the AAIT to provide credential for inhalation therapy technicians. Over the next five years, over 10,000 practitioners were recognized as certified technicians.
The American Association for Inhalation Therapy Foundation (AAITF) was incorporated as a California not-for-profit corporation to fund research, education, and charitable activities in the profession.
Joint Review Committee for Inhalation Therapy Education (JRCITE) was established as a recommending body to the Committee on Allied Health Education and Accreditation (CAHEA).
In the first decade of operation, the ARIT credentialed 1,594 Registered Inhalation Therapists.
“Essentials”for Respiratory Therapy Technicians and Respiratory Therapists1972
Late in 1972 and early 1973, the profession was renamed respiratory therapy and the ARIT was renamed as the American Association for Respiratory Therapy.
Image from Gayle Carr
ARIT, which offered the credential for registered inhalation therapists and AART’s TCB, which offered the certification exam for inhalation therapy technicians transferred responsibility for credentialing to a single agency: the National Board for Respiratory Therapy (NBRT). The NBRT offered two credentials: RRT (registered respiratory therapist) and CRTT (certified respiratory therapy technician).
The National Heart and Lung Institute and the American Thoracic Society convened scientists to review the efficacy of oxygen therapy, aerosol therapy, IPPB, and chest physical therapy. The Sugarloaf Conference findings on IPPB, were published in the December 1974 issue of the American Review of Respiratory Disease. John F. Murray's conference summary identified the misuse of IPPB, one of the primary clinical modalities of respiratory therapy practitioners at that time.
Image from Gayle Carr
New “Essentials” for educational programs for Respiratory Therapy Technicians were adopted.
During congressional hearings scrutinizing health care costs, the Secretary of the Department of Health, Education, and Welfare challenged the need for respiratory therapy services.
After response from AART members and physicians, the DHEW issued a statement indicating that “respiratory therapy is an essential life-saving method of treatment” and “respiratory therapists are dedicated responsible professionals.”
Specialty Sections were created to focus on the needs of practitioners working in specific areas of the profession.
AART challenged the directive from the Secretary of Labor that prevented IPPB from being reimbursed under the Black Lung Program. AART’s efforts resulted in the directive being overturned.
AART advocated for licensure of respiratory therapy practitioners. A Model Practice Act was developed.
AARC established a Political Action Committee to advocate on behalf of respiratory therapists and patients who needed access to quality respiratory care.
President Reagan declared first “National Respiratory Therapy Week”
California was first state to pass modern licensure law governing the profession of respiratory therapy.
NBRT introduced specialty credentialing exams for certified pulmonary function technologists (CPFT).
The second specialty credentialing exam offered was for the registered pulmonary function technologists (RPFT) credential. In addition to the exams for pulmonary function technologists, the NBRC later added specialty credentialing exams for neonatal-pediatrics, adult critical care, and sleep disorders specialists.
Profession changed name to Respiratory Care
AART became AARC
Kelly Crawford Jones
The new job description included the following: "The respiratory therapy technician administers general respiratory care. The knowledge and skills of the technician are acquired through formal programs of didactic, laboratory, and clinical preparation. Technicians may assume clinical responsibility for specified respiratory care modalities involving the application of well-defined therapeutic techniques under the supervision of a respiratory therapist and/or physician."
The National Honor Society for the Respiratory Care profession was formed in 1986 to promote, recognize and honor scholarship, scholarly achievement, service, and character of students, graduates, and faculty members of the profession.
The name of the society is based on the profession's goals of sustaining “life and breath” for all mankind: Lambda (Λ) is the Greek letter “L”, and beta (Β) is the Greek letter “B”.
AARC members participated in nationwide surveys advocating for an airline smoking ban.
Congress banned smoking on flights of two hours duration or less.
Zenith Awards are presented to the top manufacturers, service organizations, and supply companies in the respiratory care industry.
AARC members vote for their top companies based on the quality of equipment and/or supplies, accessibility and helpfulness of sales personnel, responsiveness, service record, truth in advertising, and support of the respiratory care profession.
At the request of Rep. Dick Durbin (IL), the AARC participated in a second survey regarding the airline smoking ban. As a result, smoking was banned on all domestic flights in USA.
A new program that brings international health care providers to the U.S. for study of the profession of respiratory care is launched. Over 25 years later, more than 100 individuals have benefited from the rotation and hundreds more AARC members have supported the program.
AARC promoted the formation of the International Council for Respiratory Care.
AARC withdrew sponsorship from JRCRTE for amending bylaws without seeking the approval of sponsors. The Respiratory Care Accreditation Board was formed.
AARC established a Task Force on Restructuring of the profession association.
The Task Force, chaired by Trudy Watson, included Mike Runge, Shelly Mishoe, George Gaebler, Patrick Dunne, Charlie Brooks, Bob Weilacher, John Walton, Richard Sheldon, MD, and John Walton with Sam Giordano as the Executive Office Liaison.
After numerous focus groups and input from the BOD, HOD, and general membership, the nominations process for Directors and Officers was modified, the roles of BOD Officers were changed, the number of seats on the BOD were expanded to include Directors from the larger Specialty Sections, the number of standing committees were reduced, and consultants to the BOD were identified.
JRCRTE was dissolved. A Transition Committee was established to transition to new accreditation agency.
The Committee on Accreditation for Respiratory Care (CoARC) was established.
The Committee on Accreditation for Respiratory Care became the successor organization to JRCRTE and functioned as a recommending body to the Commission on Accreditation for Allied Health Education Programs (CAAHEP).
Logo supplied by CoARC
AARC Fellows exhibit the qualities and attributes of true professionals by contributing to the art and science of respiratory care. In 1998, AARC began this program to recognize the achievements and contributions of these members by conferring the AARC Fellow designation and the right to use the FAARC identifier after their names upon those AARC members who meet the criteria.
An AARC Fellowship is conferred upon those who have met a standard of excellence in the practice of respiratory care. A Fellows' contributions extend beyond his or her individual job to a wider sphere of influence. Through educational achievement, validation of competency through advanced credentials, research initiatives, publication, and clinical initiatives, an AARC Fellow has made a mark as a respiratory care professional of distinction.
Respiratory Care journalaccepted into Index Medicus and MEDLINE
Standards mandated minimum of Associate degree be awarded; Required new Program Directors and Directors of Clinical Education to have minimum of baccalaureate degree; Standards only referenced respiratory therapists.
Lung Health Day launched and continues to be held on the Wednesday of National Respiratory Care Week.
The length of the term of office for the President of the AARC was expanded to a two year term. Toni Rodriguez was the first AARC President to serve the two year term.
CoARC became the Commission on Accreditation for Respiratory Care, a freestanding accreditor of respiratory care programs. The "C" in CoARC changed from Committee to Commission.)
CoARC now accredits degree-granting programs in respiratory care that have undergone the process of voluntary peer review and meet or exceed the minimum accreditation Standards as established by the professional association in cooperation with CoARC.
AARC launched the “2015 and Beyond” project to identify the roles and educational requirements and competencies required of respiratory therapists in the future. The Task Force recommendations were shared with the leadership and membership and published in the Respiratory Care journal.
This article that summarizes the 2015 and Beyond Task Force activities and recommendations appeared in the Respiratory Care journal in May 2011.
The revised COARC standards required respiratory care programs to prepare students at a competency level consistent with the RRT credentialing exam.
The 70th anniversary of the incorporation of the AARC occurred on April 15, 2017. The April issue of the AARCTimes highlighted milestones of the past 70 years of the AARC.