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.

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!
Key events from the 1940s are featured.
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, Illinois in 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.
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, and 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 the Palmer House, Chicago, IL. Officers were elected and included: George Kneeland, Chairman; Brother Roland Maher, Assistant Chairman; H. Edwin Smith, Secretary-Treasurer; and Richard Lambert, State Agent.
Key events from the 1950s are featured.
1950s Department Sign1950s Department Sign
IT Department Sign
This vintage inhalation therapy department sign was from the 1950s.
Image from Gayle Carr
1953- Effective Inhalation Therapy published1953- Effective Inhalation Therapy published
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
ITA Renamed AAIT
The ITA was renamed the American Association of Inhalation Therapists (AAIT) in March 1954. The initial sponsor was the American College of Chest Physicians (ACCP).
1954 Medical Advisory Board1954 Medical Advisory Board
Medical Advisory Board Formed
The Medical Advisory Board was established in 1954. The group is now known as the Board of Medical Advisors (BOMA).
1954 Special Joint Committee in Inhalation Therapy1954 Special Joint Committee in Inhalation Therapy
Special Joint Committee in Inhalation Therapy
In 1954, 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
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.
AAIT's Alpha Chapter
Illinois was 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
AAIT Published First Journal
AAIT published its first scientific journal: INHALATION THERAPY (now RESPIRATORY CARE) in 1956.
Resolution to Develop I.T. Schools ApprovedResolution to Develop I.T. Schools Approved
Resolution to Develop I.T. Schools Approved
A resolution was 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
Key events from the 1960s are featured.
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 credentialed as a Registered Inhalation Therapist (ARIT).
1960 ARIT Purpose1960 ARIT Purpose
ARIT's 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 (Jenn), 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
ARIT Certificate
A 1962 certificate issued by the American Registry of Inhalation Therapists is shown for Charles L. McKnight ARIT #113 from Lutheran Hospital, Moline Illinois.
Image from Charles McKnight
1963 Board of Schools Formed1963 Board of Schools Formed
Board of Schools Formed
The AMA's Board of Schools of Inhalation Therapy Technicians was formed in Chicago, IL in 1963 as “an inspecting, surveying, and reporting agency.”
1964 Initial AMA-Approved IT Programs Announced1964 Initial AMA-Approved IT Programs Announced
Initial AMA-Approved IT Programs Announced
In the Summer 1964 issue of the 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
AAIT Name Change
The AAIT changed its name to the American Association for Inhalation Therapy in 1966 keeping the same initials but changing the "T" from therapists to therapy . The name was displayed on the Association's new banner.
Image from Robert 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
In 1966, the Editorial Board for the INHALATION THERAPY journal was established.
1966 Education Forum Held1966 Education Forum Held
Education Forum Held
In 1966, the 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
In 1967, the ASA, ACCP, AAIT, AMA recommended expanded content and duration for IT educational programs.
1969 "Fundamentals" Textbook
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" 12th edition was published in March 2020 with 1,400 pages)
Image of textbook from Jeff Anderson
technician Certification Board establishedtechnician Certification Board established
TCB of AAIT Established
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.
Key events from the 1970s are highlighted.
1970 AAITF Incorporated1970 AAITF Incorporated
AAITF Incorporated
In 1970, 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
JRCITE Established
In 1970, the 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
ARIT Credentialed Over 1,500
In the first decade of operation, the ARIT credentialed 1,594 Registered Inhalation Therapists.
1971 Journal Renamed1971 Journal Renamed
AAIT's 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
Essentials Established
“Essentials” for Respiratory Therapy Technicians and Respiratory Therapists were approved in 1972.
TCB CRTT Certificate
A 1972 certificate issued by the Technician Certification Board is shown.
Image from Trudy Watson
AART's Silver Anniversary
The AART celebrated its silver anniversary in 1972. The annual Congress was held in Las Vegas with an attendance of 3,000.
Presidents Council Formed
A group of 14 former Presidents of the ITA/AAIT/AART gathered in 1972 to celebrate the AART's silver anniversary. The Presidents Council, an advisory body and historical resource for the Board of Directors, was officially recognized by the AART in the following year.
1973 Profession Renamed
Late in 1972 , the ARIT was renamed the American Association for Respiratory Therapy (AART). The inhalation therapy profession was renamed respiratory therapy in 1973.
Image from Gayle Carr
Credentialing Transferred to NBRT
The 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) effective in 1975. The NBRT offered two credentials: RRT (registered respiratory therapist) and CRTT (certified respiratory therapy technician).
The Sugarloaf Conference
In 1974, 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 Published
The first issue of AARTimes was published in July 1977.
Technician Essentials Adopted
New “Essentials” for educational programs for Respiratory Therapy Technicians were adopted in 1977.
DHEW Validated Profession
During 1977 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 Created
Specialty Sections were created by the AART in 1978 to focus on the needs of practitioners working in specific areas of the respiratory care profession.
AART's Efforts Overturn Secretary of Labor's Directive
The AART challenged the directive from the Secretary of Labor that prevented IPPB from being reimbursed under the Black Lung Program. The AART’s efforts resulted in the directive being overturned in 1979..
Oral Exams Replaced
In 1979, the NBRT replaced the oral exams with the clinical simulation examination as part of the requirement for the registry credential.
Key events from the 1980s are highlighted.
Model Practice Act Developed
The AART advocated for licensure of respiratory therapy practitioners. A Model Practice Act was developed in 1980 and distributed to the Chartered Affiliates, hospital associations, and medical associations.
PAC Established
In 1981, the AART established a Political Action Committee to advocate on behalf of respiratory care practitioners and patients who needed access to quality respiratory therapy.
First Licensure Law Passed
In 1982, California became the first state to pass a 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.
First National Respiratory Therapy Week
President Reagan proclaimed the first “National Respiratory Therapy Week” in 1982.
DRGs Implemented
When Medicare implemented diagnosis related groups (DRGs) in 1983, RT departments faced dramatic cutbacks and decentralization.
Specialty Exams Introduced
In 1984, the 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.
Name Changes
In 1986, the profession was renamed Respiratory Care. The AART became the AARC (American Association for Respiratory Care).
Kelly Crawford Jones
Updated Essentials Adopted
In 1986, new Essentials for respiratory care technician and respiratory therapist educational programs were 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."
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”.
Airline Smoking Ban Survey
In 1987, AARC members participated in nationwide surveys advocating for an airline smoking ban.

Congress banned smoking on flights of two hours duration or less.
AARC's 40th Anniversary
In 1987, the AARC celebrated its 40th anniversary.
Initial Zenith Awards Presented
In 1989, the Zenith Awards were established to be 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.
Smoking Banned on All Domestic Flights
At the request of Rep. Dick Durbin (IL), the AARC participated in a second survey in 1989 regarding the airline smoking ban. As a result, smoking was banned on all domestic flights in USA.
Highlights from key events in the 1990s are featured.
1990 AARC International Fellowship Program
An International Fellowship program to bring international health care providers to the U.S. for study of the profession of respiratory care was launched in 1990. Over 25 years later, more than 100 individuals have benefited from the rotation and hundreds more AARC members have supported the program.
ICRC Established
In 1991, the AARC promoted the formation of the International Council for Respiratory Care (ICRC). Representatives from member countries and areas from across the globe work to advance the safe, effective and ethical practice of respiratory care.
Clinical Practice Guidelines Released
In 1991, the AARC's initial Clinical Practice Guidelines were published.
Respiratory Care Accreditation Board Formed
In 1994, the AARC withdrew sponsorship from JRCRTE for amending bylaws without seeking the approval of sponsors. The Respiratory Care Accreditation Board was formed. It was later dissolved in 1996.
Task Force on Restructuring Appointed
In 1996, the AARC established a Task Force on Restructuring of the professional 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 designated.
AARC Website Launched
The AARC officially launched their website in 1996:
AARC's Golden Anniversary
The AARC celebrated its 50 year anniversary in 1997.
JRCRTE Dissolved
The JRCRTE was dissolved in 1997. A Transition Committee was appointed to form a new accreditation agency.
CoARC Established
In 1998, 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 (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.
Key events from the 2000s are featured.
Respiratory Care Journal Accepted into Index Medicus
In 2000, the RESPIRATORY CARE journal was accepted into Index Medicus and MEDLINE.
Capitol Hill Lobby Day
In 2000, the first annual Capitol Hill Lobby Day was held to inform and educate members of Congress on key respiratory care issues.
New Standards Adopted
In 2000, new Standards for respiratory care education programs mandated a minimum of an Associate degree be awarded; required new Program Directors and Directors of Clinical Education to have minimum of baccalaureate degree; and Standards only referenced respiratory therapists.
Lung Health Day Launched
Lung Health Day was launched in 2003 and continues to be held during National Respiratory Care Week.
AARC 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 in 2007-2008. The terms for the Vice Presidents, Secretary-Treasurer, and Immediate Past President also expanded to two year terms
The United States Public Health Service's Commissioned Corps is a branch of the nation’s uniformed services “committed to protect, promote, and advance the health and safety of the nation.” In 2007, the AARC succeeded in efforts to allow RRTs with a minimum of a bachelor's degree to become commissioned officers in the USPHS.
Commission on Respiratory Care
In 2009, 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.
2015 and Beyond
In 2008, the 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.
Ventilator Survey
In 2009, the AARC, under contract from the US Department of Health and Human Services, conducted the first ventilator population survey of acute care facilities. The information collected would be used for mass casualty events. The survey response was 90%!
Key events from the 2010s are featured.
New Standards Adopted
The revised CoARC standards were adopted in 2010 and required respiratory care programs to prepare students at a competency level consistent with the RRT credentialing exam.
Networking Opportunities
In 2010, the AARC launched its social media presence on Twitter and facebook. The AARC created AARConnect, a members only networking platform, that same year.
AARC Leadership Institute
In 2010, the AARC launched a Leadership Institute consisting of a series of web-based courses designed to assist respiratory therapists expand their knowledge in education, management, and research.
Digital Flipbooks
In 2010, AARCTimes was offered in a digital flipbook style followed by the RESPIRATORY CARE journal in 2011. Both continued to offer the printed publications in addition to the digital formats.
Transitioning the Workforce for 2015 & Beyond
This article that summarized the 2015 and Beyond Task Force activities and recommendations appeared in the Respiratory Care journal in May 2011.
In 2012, the NBRC offered a new specialty examination for RRTs specializing in adult acute care. Successful candidates earned the RRT-ACCS credential.
AARC Executive Director Retires
After over three decades as AARC's Executive Director, Sam Giordano retired in 2012. Tom Kallstom was hired as the new AARC Executive Director.
AARC University
In 2014, the AARC University debuted as the portal for AARC's online educational offerings.
AARC's Virtual Museum Launched
In 2014, the AARC's Virtual Museum was launched and continues to expand the content and galleries.
Patient Advocacy Summit
The AARC hosts its first-ever Patient Advocacy Summit prior to AARC Congress 2015 in Tampa, FL, drawing participation from a range of patient advocacy groups as well as industry representatives.
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.
Cover of AARC Times' final print issueCover of AARC Times' final print issue
Final Print AARCTimes Issue
The December 2019 issue of AARCTimes was the final issue offered in print. The magazine was only offered in digital format in 2020.
COVID-19 Pandemic
Once the pandemic began in 2020, our lives were forever changed. One of the few positives that occurred during the on-going pandemic is that the critical role of respiratory therapists received national attention.
Final Digital Issue of AARCTimes
The December 2020 digital issue of AARCTimes was the final issue for the magazine.
AARC's 75th Anniversary
2022 marks the AARC's 75th anniversary. Throughout the year, the Association will celebrate our past and look towards building our future.
April 2022
In April 2022, Daniel D. Garrett was hired as the AARC's Executive Director.
Future Milestones?