Imagine having to move, load, and transport a critically ill patient in cardiovascular failure who will not survive without intubation, or someone who is bleeding out after a serious accident.
First, the patient must be stabilized, when time is of the essence, and they must be kept breathing long enough to be transferred under precarious conditions to an acute care facility for life-saving surgery or other treatments.
Now imagine trying to deliver this level of care onboard a moving ambulance or stretcher service, on a helicopter, or airplane.
This is the role of Manitoba’s Advanced Practice Respiratory Therapists (APRT), a high-pressure role with high risk, and which is vital to patient survival. APRTs are respiratory therapists who are trained to provide advanced diagnostic and therapeutic interventions while en route to trauma centres. They have expertise in managing patients on mechanical ventilation and performing procedures like line placement, bronchoscopy, and tracheal intubation for adults, pediatrics, and neonates.
On a truck, APRTs often work alongside one Primary Care Paramedic, and this team of two is accountable for a patient surviving the journey to access appropriate care. The moral and psychological weight of having someone’s life in your hands is a huge responsibility.
Transport is emergency care with no physicians present.
Respiratory Therapists work in virtually all healthcare settings as essential members of multi-disciplinary teams, in lockstep with physicians and nurses, helping patients to breathe. You’ll find them in emergency departments, ICUs, neonatal ICUs, in polysomnography departments, in clinics and community testing and supporting those living with chronic respiratory conditions, in long-term care environments, and more.
In Manitoba, to become an APRT, a respiratory therapist must have five years of experience in the RT role, plus one year of on-the-job training. They can then work in one of three Shared Health Emergency Response Services departments, which operate 24/7, 365 days a year:
- Adult Transport: The Adult Transport team, created in 2000, takes instructions on a call-by-call basis. These APRTs may also be responsible for transporting paediatric and neonatal patients. They can be responsible for moving pregnant moms, patients who are one-hour old, toddlers, adults, and the elderly. MAHCP is calling on Shared Health to develop clear protocols and Standard Operating Procedures to help guide when the critical care paediatric team should step in.
- Child Health Transport: This team transports critically ill paediatric patients under the age of 17 from throughout Manitoba, Northwestern Ontario, and Nunavut, triaging an average of 2,500 calls a year, and travelling to approximately 700 calls where a child’s condition is considered critical.
- VECTRS, or Virtual Emergency Care and Transfer Resource Service: This centralized, coordinated source for clinical guidance and patient transport support, formed in 2023, is staffed by emergency physicians, Advanced Care Paramedics (ACP), and Advanced Practice Respiratory Therapists (APRT). The team provides 24/7 emergency care and transport advice with the support of Inter-Facility Transport Coordinators (IFTCs) who answer the phone.
RT staffing levels is a critical issue across all healthcare settings, and vacant shifts, overtime, and burnout are plaguing MAHCP members. Until recently, Respiratory Therapy programs had an intake of 16 students – not nearly enough to staff up the system appropriately.
“MAHCP has been calling on this government for a provincial allied health workforce plan urgently to deal with critical staffing issues like those affecting RTs and the Transport teams,” says MAHCP President Jason Linklater. “Due to the sheer physical size of our province, and the fact that we have only one major trauma centre to serve critically-ill residents, APRTs are vital to Manitoba patient care. There are just seven RTs on the Adult Transport today today, where there used to be 20. That is not sustainable.”