Milestones Of The Profession

An overview of  key events in the profession and key agencies (AARC, NBRC, CoARC, and ARCF) since the first on-the-job training program began over seven decades ago.

OriginsOrigins
Origins
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!
1940s1940s
1940s
Edwin R. Levine, MDEdwin R. Levine, MD
Edwin R. Levine, MD
Edwin R. Levine, MD is credited with establishing the first on-the-job training program for inhalation therapy in 1943.

In 1952, Dr. Levine served as President of the Inhalation Therapy Association (now AARC) and was the only physician ever elected to do so.
1943 OJT Inhalation Therapy Program established1943 OJT Inhalation Therapy Program established
1943 OJT Inhalation Therapy Program established
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.
1943 A.H. Andrews textbook1943 A.H. Andrews textbook
1943 A.H. Andrews’ textbook
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
ITA formed on July 13, 1946ITA formed on July 13, 1946
ITA formed on July 13, 1946
In Chicago, Dr. Levine’s students, oxygen orderlies, doctors and nurses met on July 13, 1946 to form the Inhalation Therapy Association.
AofIncorpAofIncorp
March 7, 1947
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.
1947 ITA Chartered1947 ITA Chartered
1947 ITA Chartered
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.
1947 First ITA Annual Meeting1947 First ITA Annual Meeting
1947 First ITA Annual Meeting
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.
1950s1950s
1950s
Illinois_ArtIllinois_Art
1955 First Chapter
Illinois is designated as the Alpha Chapter or first Charter Chapter of the AAIT in 1955. Chapters later evolved into Chartered Affiliates.
1956 AAIT Published First Journal1956 AAIT Published First Journal
1956 AAIT Published First Journal
AAIT published science journal, INHALATION THERAPY.
1953- Effective Inhalation Therapy published1953- Effective Inhalation Therapy published
1953 – Effective Inhalation Therapy published
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
Scan-of-AAIT-Logo067Scan-of-AAIT-Logo067
1954 ITA Renamed AAIT
ITA was renamed the American Association of Inhalation Therapists (AAIT). The initial sponsor was the American College of Chest Physicians (ACCP).
1954 Medical Advisory Board1954 Medical Advisory Board
1954 Medical Advisory Board
The Medical Advisory Board was formed - now called BOMA.
1954 Special Joint Committee in Inhalation Therapy1954 Special Joint Committee in Inhalation Therapy
1954 Special Joint Committee in Inhalation Therapy
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.”
1955 First AAIT Annual Meeting Held1955 First AAIT Annual Meeting Held
1955 First AAIT Annual Meeting Held
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.
1950s Department Sign1950s Department Sign
1950s Department Sign
1950s - Department Sign
Image from Gayle Carr
Resolution to Develop I.T. Schools ApprovedResolution to Develop I.T. Schools Approved
Resolution to Develop I.T. Schools Approved
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.
Certificate of CompetencyCertificate of Competency
Certificate of Competency
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
1960s1960s
1960s
1960 ARIT Incorporated1960 ARIT Incorporated
1960 ARIT Incorporated
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.
1960 ARIT Purpose1960 ARIT Purpose
1960 ARIT Purpose
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.
Registered Inhalation Therapist #1Registered Inhalation Therapist #1
Registered Inhalation Therapist #1
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...The First Ten...
The First Ten...
The first ten individuals in the United States to become registered inhalation therapists are listed.
Image from Trudy Watson
1962 Example of Registry Certificate1962 Example of Registry Certificate
1962 Example of Registry Certificate
American Registry of Inhalation Therapists Example of Registry Certificate Charles L. McKnight #113
Image from Charles McKnight
1963 Board of Schools Formed1963 Board of Schools Formed
1963 Board of Schools Formed
The AMA's Board of Schools of Inhalation Therapy Technicians was formed in Chicago, IL as “an inspecting, surveying, and reporting agency.”
1964 Initial AMA-Approved IT Programs Announced1964 Initial AMA-Approved IT Programs Announced
1964 Initial AMA-Approved IT Programs Announced
In the Summer 1964 AAIT Newsletter, it was announced that seven programs were approved by the AMA Board of Schools of Inhalation Therapy Technicians.
1966 AAIT Banner1966 AAIT Banner
1966 AAIT Banner
1966 – AAIT Banner

The AAIT changed its name to the American Association for Inhalation Therapy.
Image from Bob Weilacher
1966 AAIT established the HOD1966 AAIT established the HOD
1966 AAIT established the HOD
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."
Editorial Board formedEditorial Board formed
Editorial Board formed
1966 Education Forum Held1966 Education Forum Held
1966 Education Forum Held
AAIT held an Education Forum, which later evolved into the Summer Forum.
Expanded Content and Duration of IT ProgramsExpanded Content and Duration of IT Programs
Expanded Content and Duration of IT Programs
ASA, ACCP, AAIT, AMA recommended expanded content and duration for IT educational programs.
FundamentalsofITFundamentalsofIT
1969
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
technician Certification Board establishedtechnician Certification Board established
1969 – TCB
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.
1970s1970s
1970s
1970 AAITF Incorporated1970 AAITF Incorporated
1970 AAITF Incorporated
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.
1970 JRCITE Established1970 JRCITE Established
1970 JRCITE Established
Joint Review Committee for Inhalation Therapy Education (JRCITE) was established as a recommending body to the Committee on Allied Health Education and Accreditation (CAHEA).
970 ARIT Credentialed Over 1,500970 ARIT Credentialed Over 1,500
970 ARIT Credentialed Over 1,500
In the first decade of operation, the ARIT credentialed 1,594 Registered Inhalation Therapists.
1971 Journal Renamed1971 Journal Renamed
1971 Journal Renamed
In the December 1970 issue of INHALATION THERAPY, the name change of the journal was announced. The name change RESPIRATORY CARE went into effect with the January-February 1971 issue.
Image from Sam Giordano from INHALATION THERAPY Vol. 15 No 6
1972-Essentials0611972-Essentials061
1972 Essentials Established
“Essentials” for Respiratory Therapy Technicians and Respiratory Therapists 1972
TCB-CRTTTCB-CRTT
TCB CRTT Certificate
ASSN-AART-patchASSN-AART-patch
1973 Profession Renamed
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
NBRT74NBRT74
1974 – Credentialing Transferred to NBRT
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).
ASSN-sugarloafippb-1974ASSN-sugarloafippb-1974
1974 Sugarloaf Conference
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
AARTimes_before-AARCTimesAARTimes_before-AARCTimes
1977 AARTimes Began Publication
AARTimes (now AARC Times) began publication in July.
19771977
1977 Technician Essentials Adopted
New “Essentials” for educational programs for Respiratory Therapy Technicians were adopted.
DHEWDHEW
1977 DHEW Validated Profession
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.”
specsectspecsect
1978 Specialty Sections Created
Specialty Sections were created to focus on the needs of practitioners working in specific areas of the profession.
BLBABLBA
1979 AART's Efforts Overturn Secretary of Labor's Directive
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.
Written-Exam_1979Written-Exam_1979
1979 Oral Exams Replaced
NBRT replaced oral exams with clinical simulation examination.
1980s1980s
1980s
ModelpracticeactModelpracticeact
1980 Model Practice Act Developed
AART advocated for licensure of respiratory therapy practitioners. A Model Practice Act was developed.
AARTPACAARTPAC
1981 PAC Established
AARC established a Political Action Committee to advocate on behalf of respiratory therapists and patients who needed access to quality respiratory care.
CaliforniaCalifornia
1982 First Licensure Law Passed
California was first state to pass modern licensure law governing the profession of respiratory therapy.
President Reagan proclaimed the first “National Respiratory Therapy Week”in 1982.President Reagan proclaimed the first “National Respiratory Therapy Week”in 1982.
1982 First National Respiratory Therapy Week
President Reagan proclaimed the first “National Respiratory Therapy Week” in 1982.
1983_DRGs_Layout1983_DRGs_Layout
1983 DRGs Implemented
When Medicare implemented DRGs, RT faced cutbacks and decentralization.
cpftcpft
1984 Specialty Exams Introduced
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.
ASSN-AARC-patchASSN-AARC-patch
1986 Profession Changed Name
Profession changed name to Respiratory Care

AART became AARC
Kelly Crawford Jones
1986essentials1986essentials
1986 Updated Essentials Adopted
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."
LB86LB86
Lambda Beta Society formed
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”.
banban
1987 Airline Smoking Ban Survey
AARC members participated in nationwide surveys advocating for an airline smoking ban.

Congress banned smoking on flights of two hours duration or less.
zenith1989zenith1989
1989 Initial Zenith Awards Presented
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.
airplanenosmokingairplanenosmoking
1989 Smoking Banned on All Domestic Flights
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.
1990s1990s
1990s
GlobeGlobe
1990 AARC International Fellowship Program
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.
ICRCICRC
1991 ICRC Established
AARC promoted the formation of the International Council for Respiratory Care.
1st-CPG-Spirometry0711st-CPG-Spirometry071
1991 Clinical Practice Guidelines Released
Initial Clinical Practice Guidelines published
rcabrcab
1994 Respiratory Care Accreditation Board Formed
AARC withdrew sponsorship from JRCRTE for amending bylaws without seeking the approval of sponsors. The Respiratory Care Accreditation Board was formed.
TFRestructuringTFRestructuring
1996 Task Force on Restructuring Appointed
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.
1996_aarc_home_page1996_aarc_home_page
1996 Website Launched
AARC launched the www.aarc.org website.
transitiontransition
1997 JRCRTE Dissolved
JRCRTE was dissolved. A Transition Committee was established to transition to new accreditation agency.
98coarc98coarc
1998 CoARC Established
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
FAARCFAARC
1998 AARC Fellows (FAARC)
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.
2000s2000s
2000s
AARC_Times_April_2000AARC_Times_April_2000
2000 Respiratory Care Journal Accepted into Index Medicus
Respiratory Care journalaccepted into Index Medicus and MEDLINE
2000CoARC2000CoARC
2000 Standards Adopted
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.
lunghealthdaylunghealthday
2003 Lung Health Day Launched
Lung Health Day launched and continues to be held on the Wednesday of National Respiratory Care Week.
2-yr-presidency2-yr-presidency
2007 Presidential Term Expands
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.
coarc20091coarc20091
2009 Commission on Respiratory Care
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.
2010s2010s
2010s
2015TaskForce2015TaskForce
2015 and Beyond
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.
20112011
Transitioning the Workforce for 2015 & Beyond
This article that summarizes the 2015 and Beyond Task Force activities and recommendations appeared in the Respiratory Care journal in May 2011.
2010CoARC2010CoARC
2010 New Standards Adopted
The revised COARC standards required respiratory care programs to prepare students at a competency level consistent with the RRT credentialing exam.
AARC70AARC70
AARC's 70th Anniversary
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.
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Future Milestones?