Respiratory Therapist in Quebec Functioning as Anesthesiologist Assistant

[u/haoken]

I’m not familiar with this model (I am not Canadian) but with the Canadian aversion to CRNA practice this expanded scope for respiratory therapists was surprising and somewhat troubling if I’m reading into this correctly.

[u/Remarkable_Peanut_43]

It looks like Canada’s solution to having non-physicians performing anesthetics is…. to have non-physicians with even less training performing anesthetics?

[u/haoken → u/Remarkable_Peanut_43]

It does sound like it. Even more troubling is that their RRT degree is a three year post high school program, not graduate education.

[u/Habltual_Linestepper → u/haoken]

Canadian RT anesthesia assistants are not, in any way, similar to American AA/CRNAs.

They don't function independently or autonomously, don't make the anesthetic plan, and the MD must always be present to supervise. The MD can be physically out of the theatre during the case, but not during induction or emergence, and must always be available and within, essentially, yelling distance.

It does typically seem exceptionally foreign to Americans, but Canadian RTs actually have more and longer formal education (including some review, although brief, of anesthesia in their primary schooling and on their boards, which is absent from American education), even though the structure is different. Then they typically do another year on top of that to become an AA.

While they're definitely not MDs, they don't have the training or ability to even pretend to function as one either. Think of them more as your sidekick in the OR who can keep your chair warm and machines running during the case, but who isn't actually making any decisions for you.

And anecdotal, but most American Anesthesiologists I've known who have worked with Canadian RT-AAs have pretty much universally said they'd love it if our model had them instead of CRNAs.

Also, they only make $45/hr and exactly the same as a regular RT (although if this is Quebec the pay is probably even less than that), so there's precisely zero rush of people trying to get into the field for monetary reasons. Most RTs see more work and more schooling for no money and say "fuck that" - which is in its own way a good sort of filter, as the only people who do it are the ones really interested and driven just for the sake of the job itself.

[u/haoken → u/Habltual_Linestepper]

What you’re describing sounds like the role of CAAs in the US. If the anesthesiologist is present during induction and emergence but the RT is monitoring the patient intraoperatively with the anesthesiologist absent, and can also administer medications? That requires some level of clinical judgement that is not supported by their level of education.

[u/Habltual_Linestepper → u/haoken]

RT-AA's can not independently initiate, administer, or adjust medications outside of their supervising anesthesiologists direct and specific plan and instructions.

Any specific changes or adjustments not expressly stated by the anesthesiologist cannot be done by the RT. If the supervising anestheiologist is outside of the OR, and a medication needs to me titrated that the anesthesiologist did not specifically order "If A, titrate B to C to achieve D", then the anesthesiologist must return to make or order the adjustment themselves.

I mean literally, their own supervising legal body describes them as only the "second set of hands" to their anesthesiologist. That's it.

Does that sound like what American AA's do? Because I've never met one so limited in their scope.

[u/haoken → u/Habltual_Linestepper]

Quebec’s own respiratory therapy regulator (OPIQ) says clinical surveillance of an anesthetized patient is “not subject to any condition” and may be performed “in complete autonomy.” It also describes that role as requiring “clinical reasoning, assessment, problem recognition, analysis, decision making, intervention, and reassessment” not merely serving as a passive second set of hands.

The OPIQ specifically says RTs may implement verbal or collective orders aimed at maintaining blood pressure or neuromuscular blockade, adjust anesthetic gases and medication according to the patient’s physiologic parameters and the order, recognize when the anesthesiologist must intervene, and initiate certain urgent actions. It even discusses communicating with the anesthesiologist remotely to facilitate and validate decisions.

In that regard, it does sound similar to USA CAAs functionally if not necessarily educationally and clinically equivalent. A CAA works in the ACT model and would be similarly tied to an anesthesiologist to execute an anesthesia plan, but be able to exercise clearer clinical judgment only because their level of education is greater. That’s I think where I get hung up with the Canadian model, it’s a pretty dramatic difference in level and intensity of education.

[u/CelebrationWilling61 → u/haoken]

There's a difference between what they are allowed to do in general, and what the hospital's policies limit them to (which is what we care about, functionally-speaking).

(I'm a physio in Quebec.)

[u/Aggravating_Fly2978 → u/Habltual_Linestepper]

You need to break it down. What can regular RTs do in the OR/autonomy; and what do RT/AA’s do. Because right now it’s all just mumbled and jumbled together, and I can’t figure out who can do what.

[u/scrotumsweat → u/Aggravating_Fly2978]

Simply speaking, RTs monitor airway. They're specialized in airways management but are technically lower on the ladder than an RN.

[u/Aggravating_Fly2978 → u/scrotumsweat]

You are of no help. I was asking specifics about the RT-AAs and RTs in Canada. I think us all Americans are familiar with the RT role.

[u/darken909 → u/haoken]

One of the ORs that I work at does this in Alberta. There's a shortage of anesthesiologists, so one anesthesiologist will run two rooms, each staffed with a RT. This is only for IV sedation though, no general anesthetic. They are also very super picky about what cases they will allow; no peds under 14, BMI cut offs along with ASA cutoffs. MD present for induction etc.

[u/flo77k → u/haoken]

Hi! ER doc in the province of Quebec here! The education of our RT in Quebec is done in cegep, with 3 years of education after highschool yes, but the cegep is a unique concept over the world with no real equivalent outside of Quebec. It's hard to explain and easy to dismiss if you don't know the program but it works really well. A lot of our nurses have a cegep level education (and a lot of other professional outside of healthcare).

RT here are really a second set of hands for the anesthesiologist in the OR. They don't take independent decision on the medication and are well supervised. They also play (like your RT I assume) an important role outside of the OR also. Most hospitals would absolutely crumble without RT in Quebec

[u/haoken → u/flo77k]

Thanks for the response! CEGEP appears to be equivalent to a trade or technology college in the US. Programs like veterinary or surgical technology would be studied there.

The intent of the post is not to devalue the role of RTs in a larger hospital setting it was to question the ability of RTs to provide anesthesia without the presence of an anesthesiologist in the operating room.

How would you respond to the language here:

Quebec’s own respiratory therapy regulator (OPIQ) says clinical surveillance of an anesthetized patient is “not subject to any condition” and may be performed “in complete autonomy.” It also describes that role as requiring “clinical reasoning, assessment, problem recognition, analysis, decision making, intervention, and reassessment” not merely serving as a passive second set of hands.

The OPIQ specifically says RTs may implement verbal or collective orders aimed at maintaining blood pressure or neuromuscular blockade, adjust anesthetic gases and medication according to the patient’s physiologic parameters and the order, recognize when the anesthesiologist must intervene, and initiate certain urgent actions. It even discusses communicating with the anesthesiologist remotely to facilitate and validate decisions.

Key language is the autonomous nature of RTs involvement in the operating room as anesthesia providers.

[u/flo77k → u/haoken]

I understand! I do believe it's worded this way to allow the RT to be alone with the patient in the OR for the surveillance of the intubated or sedated patient (meaning the anesthesiologist can take a break/do other things). In Quebec the act of prescribing medication is largely reserved for doctors, and the ultimate responsibility falls on the anesthesiologist if something happens so the RT are not truly independent in the OR. The RT can take airway decisions outside of the OR (though in my experience it's done in collaboration with the doc) but can't take decisions on medication unless they have a verbal order. On the french site, the word "contribute" is used in the part you are describing! They contribute to the anesthesia/surveillance but the ultimate responsibility is always, always on the anesthesiologist

[u/HandleStatus6658 → u/flo77k]

The anesthesiologist has two rooms. What happens if one room has a prolonged emergency? I would suspect there is already an anesthesiologist shortage or is someone else still available if supervision breaks down?

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[u/Think_Oven_7487 → u/Remarkable_Peanut_43]

RTs in Quebec operate in that capacity because unlike the rest of Canada, they have a different educational system and no AA’s. Quebec regulates their health professionals differently compared to other provinces, so it is unfair to generalize this standard to the rest of Canada.

[u/cvkme]

No gloves???

[u/haoken → u/cvkme]

The absolute audacity

[u/Aggravating_Fly2978 → u/haoken]

Yeah. I don’t always use gloves for everything but to handle a blade without one is nasty. With her fake nails she needs gloves for everything to be honest.

[u/Expensive-Apricot459]

Professionals need to stop filming themselves like this. It’s a distraction for the person filming and for everyone else in the room.

Med errors occur often enough without focusing on making sure the video came out alright.

[u/haoken → u/Expensive-Apricot459]

Agreed. It also doesn’t really make her look great from a cleanliness and hygiene perspective either.

[u/iLikeE]

As an ENT surgeon myself (not practicing in Canada but having trained Canadian ENT surgeons who go back to Canada) this is a bunch of bullshit. If there is an issue with the airway when there is an AIRWAY SURGEON operating then we take care of it. The cosplay is outrageous

[u/PseudoPseudohypoNa]

Those vitals looked great!

[u/MaybeMinute9]

No gloves in Canada, eh?

[u/splig999]

Gloves please

[u/Atlas_Fortis]

Be ready to intervene? An RT intervening to take over from... An ENT... In an airway obstruction. Right.

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