Respiratory caregivers in the US military have both the challenge and the privilege of serving their country and their patients, both at home and abroad, in peace and in combat.
By Phyllis Hanlon
Respiratory therapists, whether working in a civilian medical facility or a combat support hospital, perform many of the same duties. But while the knowledge, training, and skills may be similar at a basic level, RTs in the armed forces—particularly those working in a combat zone—face unique challenges.
From the threat of attack to challenges with equipment, the latter cohort must be prepared to provide respiratory care while fulfilling their military responsibilities at the same time.
Operating in a War Zone
SSG Gilbert Marquez, formerly an infantryman in the US Army and now an Army instructor at the Medical Education and Training Campus, Interservice Respiratory Therapy Program (IRTP) in San Antonio, Texas, was seeking a career path that would translate to a job in civilian life once he retired from the military. “I couldn’t see myself jumping out of planes for the next 20 years. I needed a technical, marketable skill and [respiratory therapy] was an opportunity to come into the medical field,” he said.
During his military service, Marquez worked for a time at a combat support hospital in Iraq where he witnessed many cases of chest trauma, among other respiratory issues. But working in a war zone involved much more than just offering medical care. “The challenge in Iraq was that you had to be a respiratory therapist, but you also had to deal with taking care of soldiers. You had to make sure they had the right equipment, the right supplies, clean water, and you had to deal with heat and weather,” he said. “You had to be able to duplicate the medical care we provide here [in the United States] in austere conditions. In order to do that, we had to come together as a team—surgeons, medics, nurses, therapists.”
Additionally, Marquez pointed out that civilians do not usually have to worry about defending the hospital from attack. But in a war zone, mortar shells could bomb a facility at any moment. “Our biggest challenge was that we would receive indirect rocket attacks. You would brace yourself and wait to see where it landed. This [type of activity] keeps soldiers motivated and ready to do their jobs,” he said.
Staffing levels pose another issue for respiratory therapists in conflict situations. Unlike stateside facilities that have several respiratory therapists on staff, the combat support hospital in Iraq operated with limited personnel. “We had only two respiratory therapists who ran 24-hour operations for a few months. It gets very tiring,” said Marquez.
Serving Two Populations
HM1 Chad Galvin, Navy veteran and instructor at IRTP San Antonio, pointed out that during wars, respiratory therapists often have to serve two populations. “Not only do they care for soldiers and sailors, but they also have to be concerned with local nationals,” he said. In many cases, the US military personnel would be transferred to Germany or some other location, so the RT was charged with stabilizing the patient using a transport vent—such as an Impact Eagle ventilator by Zoll Corp—before he shipped out. The locals, however, required different equipment. In some cases, therapists had to care for three or four local patients on ventilators for several months.
Working conditions and medical devices can be problematic as well. Oscar Lopez-Martinez, SFC, retired US Army and director of clinical education at IRTP San Antonio, served in Desert Storm where soldiers had to erect hospitals using canvas material. “This differs from a big facility,” he said. “We also had old ventilators and had to be careful of chemical contamination. The equipment was using room air, which had to be treated with filters. In a civilian hospital you don’t worry about those things.”
Additionally, respiratory therapists in the armed forces have to have a strong working knowledge when it comes to recycling and fixing equipment. “We don’t have supply lines like civilians do,” said Lopez-Martinez. He pointed out that in some instances older equipment is standard, such as the tall green oxygen cylinders, so it’s imperative for RTs to understand all types of medical devices available.
In the US, RTs who are active duty or retired may find work at a Veteran’s Administration (VA) hospital or some other medical facility affiliated with a branch of the armed services that is both fulfilling and complementary. William P. Shattuck, RRT, clinical supervisor, respiratory care in the Boston VA Healthcare System, West Roxbury campus, who served as a medic in the US Air Force from 1988 to 1991, participated in Desert Storm. He landed a job at the West Roxbury VA in 1996 as an RT and has been there ever since. His workday resembles that of any other respiratory therapist for the most part. In addition to managing ventilators and performing typical respiratory-related duties, Shattuck is in charge of clinical education for residents and nursing students. “This is a teaching hospital so I talk with students about home oxygen and other issues,” he said. At times he has worked at the other Boston VA sites in Bedford, Brockton and Jamaica Plain campuses as well.
Shattuck had worked in a community hospital as well as at Massachusetts General Hospital, but believes that the VA facility, where he has had the opportunity to meet veterans from World War I, World War II, Korea and Vietnam, had “more soul and more character.” “As a veteran, I can identify with these guys. It’s easier to talk with patients in a VA facility. There is an overall sense of team. We’ve all been there. They know what you are talking about,” he said.
While most of the patients who come to the VA hospitals are older, Shattuck does see some younger veterans who often present with allergies and occupational asthma related to their deployment. “These people inhale a lot of sand and dust and are more sensitive to allergens when they come back home,” he said. “We try to de-intensify the system.”
Like any other respiratory therapist, those who work in a military facility must take continuing education classes, but the VA focuses on specific issues. “Our continuing education is sensitive toward all types of returning veterans” including servicewomen, and those with disorders like PTSD, said Shattuck. “We have online learning modules that we are required to complete monthly. Techniques change all the time as well. This is why we keep up with our education.”
VA system facilities are oftentimes affiliated with civilian hospitals. Such is the case for the Boston VA system, which partners with the Harvard and Boston University medical schools, giving it an advantage when it comes to training and equipment. “We are pretty much on top of things,” Shattuck said, although he cited a disparity in pay scales that favors civilian compensation over that in the military. “Although we do the same work as other hospitals in the city, we don’t get paid the same.”
Shattuck pointed out that veteran’s hospitals are obligated to interview and hire qualified veterans. In his department, five of the 14 full-time RTs are veterans. “We are ‘veterans serving veterans,’” he said and strongly urged other respiratory therapists who have served in the military to apply. “I’ve been here for 25 years now and will probably be here another 25. I would never go back to the private sector.”
Training and Education
In the mid-1980s, respiratory therapists in the armed forces completed an eight-month training course but were not required to become licensed. Harry Roman, 1SG, retired US Army and program director IRTP San Antonio, was serving in the military as a medic when he completed his RT training at Fort Sam Houston, Texas four years into his service. He explained that education and training requirements are vastly different now. “Now you have to have an Associate’s degree in respiratory therapy and be credentialed,” he said, noting that the military follows the same rules for accreditation and certification that civilian institutions do.
IRTP offers comprehensive training that includes a range of academics, clinical work, instruction for operating in adverse conditions, and hands-on internships to members of the Army and the Navy, according to Roman. During his training, Roman had to complete a four-month internship at Brooke Army Medical Center, also known as San Antonio Military Medical Center (SAMMC), the largest military hospital in the country. “For eight hours a day you would go to all the departments—pediatrics, the NICU, pulmonary function. We also rotated through some civilian hospitals as well,” he said. “At some of the civilian hospitals there was more opportunity for students. For instance, in long-term care facilities there are patients with trachs so we did procedures we would not normally do.”
Today the IRTP program graduates between 90 and 100 members of the combined Army and Navy forces each year, whereas civilian programs normally graduate between 12 and 15.
Roman’s staff consists of 12 instructors—a combination of civilian, Army and Navy personnel. “I have another 10 clinical instructors in the hospital,” he said. While RTs trained in the military perform many of the same duties as graduates of civilian programs, they also have an opportunity to conduct research along with their military experience and deployment.
Lopez-Martinez reported that today’s students demonstrate a deep commitment to the profession. “They are looking to improve lives. But they are also looking to the future and want skills transferable to civilian life. They are highly motivated,” he said and added that the mix of male and female therapists is beginning to balance out. “Twenty years ago, there were 98% males. As the military gets more integrated, we are seeing about half-and-half male and female.”
Rebecca J. Proffitt, Sgt. US Army MEDCOM TAMC (US) recently received her respiratory therapy training at IRTP Fort Sam Houston. “The program is set up in partnership with Thomas Edison State College so students complete the program with an Associate’s degree in Applied Sciences. This allows graduates to take the CRT and RRT in order to have the same credentials as a therapist working in the civilian sector,” she said.
Proffitt explained that the Army program takes approximately one year and is broken down into three phases. During the first phase, which runs approximately 10 weeks, students take psychology, college math and English II. “These courses, along with pre-requisite classes needed before acceptance to the course, combine to apply to the Associate’s degree,” she said. The second phase is approximately five months of didactic instruction, where students learn the fundamentals of respiratory care. During the final, clinical phase, which is fast-paced and thorough, Proffitt said, students work at Brooke Army Medical Center and other medical centers and long-term acute care facilities (LTACs) throughout San Antonio. There they get as much experience as possible in a limited amount of time.
Although she has completed her training and earned certification, Proffitt continues to participate in ongoing educational endeavors. “As an RT at my current duty location, we practice quarterly skills validations in order to assess that we are still following departmental standards of procedure,” she said. “As far as being in the military, there is annual mandatory training that everyone in the Army must do. The hospital holds frequent training sessions that accommodate shift work so that all personnel can stay current on training.”
Proffitt currently works 12-hour shifts in the respiratory department of a major medical center. “At the beginning of the shift, the hospital workload is divided up amongst the therapists who are scheduled. I could be working the NICU, ICU, PCU, PICU, or the wards of the hospital. From there, it is like any other facility,” she reported. “I check my orders and care for my patients. I contact the doctors when I believe a patient’s orders need to be modified.”
Respiratory therapists who are also members of the armed forces realize a number of benefits in the dual role. Proffitt said, “Working as an RT in the military gives me regular military benefits, the ability to train in different parts of the world and a support structure that comes with being in the military.” However, the position also brings with it some challenges. “Additional Army duties that come with every duty station can change your schedule and your plans from time to time. We don’t get paid extra for in-services that take us past our shift, but we still have to do it,” she added.
RTs in the armed forces play a vital role in protecting our country and have a dual responsibility: service to country and to the patient, whether at home or abroad, in times of peace and war. For those who choose this career path, like Proffitt, Roman, Lopez-Martinez, Shattuck, Galvin and Marquez, their work and service have provided them with the pride of serving their country while saving lives, as they have acquired the medical expertise to continue serving veterans upon retiring from the military.
Phyllis Hanlon is a contributing writer to RT. For further information, contact [email protected]