NBRC Horizons, First Quarter 2015

First Quarter 2015 V. 41 / N. 1

C R E D E N T I A L I N G F O R T H E R E S P I R A T O R Y C A R E P R O F E S S I O N

H O R I Z O N S

Oct 1–Dec

31, 2012

Oct 1–Dec

31, 2013

Oct 1– Dec

31, 2014

CRT Examination

Entry-Level Graduates:

New Candidates79.2%

50.0%57.9%

Repeat Candidates 14.9%9.4%

6.3%

Advanced-Level Graduates:

New Candidates 73.0%75.5%

69.5%

R e p e a t 24.9%25.1%

22.2%

RRT Written Examination


55.5%

R e p e a t 31.8%33.0%

32.1%

RRT CSE Examination


53.4%

R e p e a t 47.7%44.4%

48.4%

CPFT Examination


61.8%

R e p e a t 45.2%48.3%

22.0%

RPFT Examination


47.1%

R e p e a t 0.0%25.0%

50.0%

Neonatal/Pediatric Specialty Examination


73.0%

R e p e a t 43.8%35.0%

48.5%

Sleep Disorders Specialty Examination

New Candidates 80.0% 100.0% 94.7%

R e p e a t 50.0%0.0%

0.0%

Adult Critical Care Specialty Examination


75.7%

Examination Statistics for the Fourth Quarter of 2014 10

2014 NBRC Awards Presented at AARC International Congress 8

Congratulations, AARC Honorary and Lifetime Members 7

2015 Annual Renewal 7

NBRC Participates in AARC International Congress 6

Congratulations, AARC Fellows 6

Setting the Tidal Volume in Adults Receiving Mechanical Ventilation: Lessons Learned from Recent Investigations 3 As I begin my second year as

President of the Board of Trustees of the National Board for Respiratory Care, I am honored and humbled by the opportunity that was provided to me to lead the NBRC in 2014 and again in 2015. The NBRC takes the responsibility of serving the credentialing needs of this wonderful profession very seriously and the dedicated volunteers and staff work very hard to assure the examinations and processes continue to meet extremely high standards.

2014 was an extremely busy year for the NBRC. The year was spent preparing for the changes that were implemented January 15. The new Therapist Multiple-Choice Examination replaced the CRT and Written RRT Examinations and combined them into one examination with two different cut scores. The new Clinical Simulation Examination was also released on January 15 and features more simulation problems that are half the length of the old simulation prob-lems. These changes also required modi-fications to the free practice examinations and Self-Assessment Examinations, as well as adjusting all of the operational processes and procedures. Results from the Validation Studies for these new

exams were also documented. The Board of Trustees and examination committees have been working very hard to implement these significant changes for the last several years in order to better serve the respiratory care community.

In addition to the work completed for the Therapist Multiple-Choice and Clinical Simulation Examinations, the dedicated examination committees reviewed and released seven examination forms into the computer testing network, completed a job analysis for the Sleep Disorders Specialty Examination, and started work on the practice examination and Self-Assessment Examination for the new Pulmonary Function Technology Examination that will be released in June 2015. This year will be equally busy for our examination committees. In addition to the ongoing committee work of review-ing and approving examination questions and examination forms, the commit-tees will also be working to implement the new combined Pulmonary Function Technology Examination that combines the CPFT and RPFT Examinations into one multiple-choice examination with two different cut scores. This new

From the NBRC President…

CONTINUED ON PAGE 2 »

2First Quarter 2015H O R I Z O N S

Published Quarterly by theNATIONAL BOARD FOR

RESPIRATORY CARE, INC.18000 W. 105th St.

Olathe, Kansas 66061-7543(913) 895-4900

Fax: (913) 895-4650Email: [email protected]

Website: www.nbrc.org

NBRC Horizons is published quarterly to com-municate information about the admission pol-icies and procedures, the day-to-day activities, and the short-term and long-range plans of the National Board for Respiratory Care, the national certifying board for the respiratory care profession. The NBRC is sponsored by the American Association for Respiratory Care, the American Society of Anesthesiol-ogists, the American Thoracic Society and the American College of Chest Physicians. Subscriptions to NBRC Horizons are free for active credentialed practitioners and $24 for inactive practitioners and others. Subscription forms can be obtained by contacting the NBRC Executive Office.

Copyright © 2015. The National Board for Respiratory Care, Inc. Permission must be secured in writing to reprint any portion of this issue. State societies for respiratory care, respiratory care education programs and state licensure agencies may reprint any portion of this publication in their newsletter provided they mention the source.

EXECUTIVE COMMITTEECarl F. Haas, MLS, RRT, RRT-ACCS, CPFT,

FAARC (AARC), PresidentAlan L. Plummer, MD, FCCP, FAARC (ATS),

Vice PresidentLinda A. Napoli, MBA, RRT, RRT-NPS, RPFT

(AARC), SecretaryRobert A. Balk, MD, FCCP (ACCP), TreasurerKerry E. George, MEd, RRT, RRT-ACCS, FAARC

(AARC), Past PresidentPUBLIC ADVISORGlenna L. Tinney, MSWMEMBERS-AT-LARGESusan B. Blonshine, BS, RRT, RPFT, AE-C,

FAARC (AARC)Robert L. Joyner, Jr., PhD, RRT, RRT-ACCS,

FAARC (AARC)Stephen A. Stayer, MD (ASA)

MEMBERS OF THE BOARDDoreen J. Addrizzo-Harris, MD, FCCP (ATS)Sherry L. Barnhart, RRT, RRT-NPS, FAARC

(AARC)Todd G. Bocklage, MPA, RRT (AARC)Suzanne Bollig, RRT, RRT-SDS, RPSGT, R. EEG

T., FAARC (AARC)William W. Burgin, Jr., MD, FCCP (ATS)Brian W. Carlin, MD, FCCP, FAARC (ACCP)Robin J. Elwood, MD, FAAP (ASA)Katherine L. Fedor, RRT, RRT-NPS, CPFT

(AARC)Hyacinth M. Johnson, RN, BSN, MPA, RRT

(AARC)Carl A. Kaplan, MD, FCCP (ACCP)David C. Levin, MD, FCCP (ATS)Robert A. May, MD, FCCP (ACCP)Omid G. Moayed, MD, MBA (ASA)Carl D. Mottram, BA, RRT, RPFT, FAARC (AARC)Theodora K. Nicholau, MD, PhD (ASA)Donald S. Prough, MD, FCCP (ASA)Gregg L. Ruppel, MEd, RRT, RPFT, FAARC

(AARC)Robert A. Sinkin, MD, MPH, FAAP (ATS)Mark S. Siobal, BS, RRT, FAARC (AARC)David L. Vines, MHS, RRT, FAARC (AARC)Teresa A. Volsko, MHHS, RRT, FAARC (AARC)

TRUSTEE EMERITUSH. F. Helmholz Jr., MD, FAARCRobert M. Lawrence, MDTheodore Oslick, MD, FCCP, FAARC

CHAIRMAN OF NBRC PUBLIC RELATIONS AND PUBLICATIONS COMMITTEE

Carl Mottram, BA, RRT, RPFT, FAARC (AARC)

STAFFGary A. Smith, RRT (Hon), FAARC, Chief Execu-

tive Officer and Executive DirectorLori M. Tinkler, MBA, Chief Operating Officer and

Associate Executive DirectorChelsea Earhart, MBA, Assistant

Executive DirectorRobert C. Shaw Jr., PhD, RRT, FAARC,

Assistant Executive DirectorHomer Rodriguez, RRT, Director,

International AffairsAmi Bishop, Administrative Support SpecialistScott M. Hermansen, CPA, Chief Financial OfficerGlenda Hocker, Executive AssistantNancy Sachen, Administrative Assistant

examination will allow candidates the opportunity to earn two credentials while taking only one examination.

In September, the NBRC Licensure Liaison Committee will host the 24th annual State Licensure Liaison Group meeting. Representatives from state licensure agencies will be invited to attend. This meeting, co-hosted with the American Association for Respiratory Care (AARC), has proved to be a very useful forum for discussing current challenges and issues that practitioners and state agencies face in the profession. This networking and learning opportunity has enabled the state respira-tory therapy licensure agency representatives to under-stand the latest developments and to use that knowledge and contact with other leaders to implement leading edge innovations in credentialing.

If you have already renewed your active status with the NBRC for 2015 – THANK YOU! If you have not, please do so.

Some of you may wonder what you get for the $25 you spend to maintain your active status with the NBRC. Your fee for maintaining that status allows the NBRC to carry out its mission of promoting excellence in respira-tory care by awarding credentials based on competence. Your continued support assists those newest members of our wonderful profession by maintaining the cost of the credentialing examinations at the lowest possible level for those who are just beginning their careers. Examination fees have not increased since computer based testing was

initiated in 2000. What else can be purchased today for the same price that item or service cost in 2000?

I strongly encourage each of you to demonstrate your professional commitment by renewing your active sta-tus with the NBRC for 2015. You can renew your status online at www.nbrc.org. In addition, if you are subject to the Continuing Competency Program (CCP), renewing your active status each year allows you to participate in the CCP at no additional cost! As an added incentive for renewing, every practitioner who renews receives the annual gift of appreciation. This year, the gift is a 2015 accordion style desk calendar. We hope you enjoy the incentive for renewing!

To fund the research necessary to keep the credential-ing examinations viable, as well as fund the professional development projects I have noted, your annual renewal fees are needed. Ensure your national credentials con-tinue to have value and meaning by renewing your NBRC active or supporter status this year. Your support will be greatly appreciated and used by the NBRC to accomplish its mission in 2015 and beyond.Sincerely,

Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC 2015 NBRC President� m

FROM THE NBRC PRESIDENT …º CONTINUED FROM PAGE 1



SETTING THE TIDAL VOLUME IN ADULTS RECEIVING MECHANICAL VENTILATION: LESSONS LEARNED FROM RECENT INVESTIGATIONS

DISCLOSURE:Both authors are trustees of the National Board of

Respiratory Care. Neither author has other real or poten-tial conflicts of interest or other disclosures to declare.

INTRODUCTIONSelecting the optimum tidal volume for adult patients

on ventilatory support is critical to achieving the best clin-ical outcomes. Over the years, guidelines about tidal vol-umes have varied including times when sigh breaths were set to prevent the development of atelectasis. The purpose of this article is to describe the transition that examina-tion committees have made over the last several years in which lung protection has become the primary goal when making decisions about mechanical ventilation.

VENTILATOR INDUCED LUNG INJURYSince the introduction of mechanical ventilatory

support over 60 years ago, there has been an increasing body of evidence that this form of potentially life-saving support, may also be the source of further lung damage and have potential deleterious impact outside of the respi-ratory system.(1,2) Studies in a variety of experimental animals, using large tidal volumes and/or high infla-tion pressures demonstrated physiologic and pathologic changes similar to the diffuse alveolar damage seen in the acute respiratory distress syndrome, which was termed ventilator induced lung injury.(1) The comparable scenario in humans was termed ventilator associated lung injury by an international consensus conference.(3) The primary insult was overstretching the alveolus, either by large tidal volumes or excessive inspiratory plateau pressures (>30 cmH2O) and was termed volutrauma and barotrauma, respectively.(2) In addition, the realization that systemic injury could also result from the elaboration of various inflammatory molecules, including reactive oxygen rad-icals and/or the translocation of bacteria or air into the systemic circulation to invoke a systemic inflammatory

response was recognized as a potential cause of biotrauma.(2) The application of positive end-expiratory pressure (PEEP) was found to be protective in a number of exper-imental circumstances and could also prevent the shear stress injury associated with repetitive recruitment-dere-cruitment (termed atelectotrauma).(2)

The concept of ventilator associated lung injury, or specifically damage from alveolar over-distention by large tidal volumes and/or elevated end-inspiratory plateau pressures challenged the common conventional venti-latory support practice of setting tidal volumes at 10-15 mL/kg measured body weight with a goal of achieving “normal values for acid base status, PaO2, and PaCO2. Recognition of this relationship gave rise to clinical inves-tigations designed to evaluate whether outcome could be improved by limiting the potential for ventilator associ-ated lung injury and using a lung protective ventilatory support strategy employing a smaller tidal volume and paying close attention to keeping the end-inspiratory plateau pressure under 30 cmH2O.(4-8) Adopting the lung protective strategy would have to compromise the prior goals of ventilatory support. Primary emphasis is on maintaining adequate oxygenation, while accepting an increase in PaCO2 and resultant respiratory acidosis, as a consequence of the controlled hypoventilation or per-missive hypercapnia.(4) This ventilatory support strategy had been utilized with obstructive airway disease to avoid dynamic hyperinflation and high levels of occult PEEP and resulted in improved outcomes compared to conven-tional ventilatory support.(9) In experimental models of lung injury there is evidence of decreased inflammation and lung water as a consequence of “therapeutic” hyper-capnia.(10)

CLINICAL TRIALS IN ALI AND ARDSThe adoption of lung protective ventilation strate-

gies by clinicians was slowed by conflicting results from

Todd Bocklage, MPA, RRT Assistant Manager – Respiratory Care Services & Pulmonary Function Lab University of Missouri Health Care University Hospital & Women’s and

Children’s Hospital Columbia, Missouri

J. Bailey Carter, MD Professor of Medicine Director – Division of Pulmonary and

Critical Care Medicine Rush Medical College and Rush University

Medical Center Chicago, IL

Corresponding Author:Robert A. Balk, MD

Division of Pulmonary and Critical Care Medicine

Rush University Medical Center Chicago, IL


LESSONS LEARNED…º CONTINUED FROM PAGE 3


different studies that were published between 1994 and 1999. Hickling (4) and Amato (5) demonstrated improved survival while limiting tidal volume and inspiratory pres-sure. However, Brochard (7) and Brower (8) found no difference in outcome could be associated with similar ventilation strategies although Brower expressed concern that the study sample may have been too small, which could have underpowered statistical analyses. Finally, the seminal work of the ARDS network established by the National Heart Lung and Blood Institute of the National Institute of Health published the results of a large, pro-spective, multicentered trial of lung protective ventilatory support using tidal volumes of 6 mL/kg ideal body weight and end-inspiratory plateau pressures < 30 cmH2O vs. 12 mL/kg ideal body weight and plateau pressure < 50 cmH2O in 861 patients with acute lung injury or ARDS.(11) The trial was stopped early because of the impact on mortality. The large tidal volume group had significantly higher mortality (39.8% vs. 31.0%) and significantly fewer days of being alive and off of ventilatory support.(11) The beneficial response was noted in ARDS from various risk factors.(12)

Subsequent network studies evaluated the benefits of higher and lower PEEP support, conservative vs. liberal fluid management, guidance of therapy based on central venous catheters vs. PA catheters, and continued to sup-port the concept of providing lung protective ventilatory support to improve patient outcome.(13-15) Implementing lung protective ventilatory support for ARDS patients was also reported by other centers as a way to improve survival compared to historical controls.(16) These results changed the standard of care for ventilatory support for patients with ARDS and extended the concept of lung protective ventilatory support as the guiding principle for all forms of ventilatory support. The paradigm governing ventilatory support also switched from one of normalizing arterial blood gas results to one of maintaining “adequate oxygenation” and providing lung protection.

LUNG PROTECTION FOR EVERYONEThe concept of protecting the lung from harm and

from additional systemic insult by employing a lung protective ventilatory support strategy spread into other clinical scenarios. A meta-analysis published in 2009 concluded that low tidal volume ventilation was benefi-cial for patients with acute lung injury and ARDS.(17) In addition to the mortality benefits of lung protective ven-tilatory support, a meta-analysis of 20 publications (over 2,800 patients) found that the low tidal volume strategy was associated with decreased pulmonary infections and

shorter hospital length of stay, despite the associated increase in PaCO2 and decrease in pH.(18) Using lung protective ventilation in 400 patients undergoing abdom-inal surgery who were judged to be at intermediate and high risk for developing post operative pulmonary com-plications resulted in significantly less major pulmonary and extra-pulmonary complications in the first seven days post surgery with the use of lung protective ventilation.(19) In addition, the lung protective ventilation group had less need for noninvasive ventilatory support , less need for invasive or noninvasive ventilatory support in the 30 day follow up period, and a shorter hospital stay. These find-ings have led some editorialists to suggest “low tidal vol-umes for all?”(20) Dr. Ferguson goes on to conclude that “in the ICU the ventilator should be set to a target tidal volume of 6-8 mL/kg in most patients receiving mechan-ical ventilation.”(20) If a patient’s spontaneous efforts result in a larger tidal volume than the volume provided by mandatory breaths, “should sedation or even paralytic agents be administered?” (20) This question sets the stage for future controversies.

DETERMINING IDEAL OR PREDICTED BODY WEIGHTAs mentioned previously, the new paradigm is to use

ideal body weight as opposed to actual patient weight. The ideal body weight is based on height as lung volume does not change based on gaining or losing weight. Ideal body weight is determined by a calculation by gender and height. The candidate is expected to know these formulas for calculating the ideal or predicted body weight in kg.

Male: 50 + (0.91) [height (cm) – 152.4] or 50 + 2.3[height (inches) – 60]

Female: 45.5 + (0.91) [height (cm) – 152.4] or 45.5 + 2.3[height (inches) – 60]

CONTROVERSY FOR THE FUTURERecognizing the concepts of lung protective ventila-

tory support has given rise to debate over the potential of tidal volumes over 6-8 mL/kg to produce lung injury, even in the setting of low inflation pressures and/or spon-taneous breathing efforts. Debates have been conducted to find agreement as to whether the stress response of a large tidal volume is equivalent in a normal versus an unhealthy lung. There is speculation whether a large vol-umes supported by low levels of pressure support will produce the negative outcomes that were described above. (21,22) Discussants have argued over the importance of volume vs. pressure for alveolar overdistention and the stress forces in the lung.(21,22) Dr. Gattinoni argues that the ideal tidal volume for a patient should be determined


LESSONS LEARNED…º CONTINUED FROM PAGE 4

by measuring the lung volume and transpulmonary pres-sure (which is impractical in the critically ill patient).(22)

SUMMARYThe convention of providing tidal volumes of 10 to

15 mL/kg of actual body weight regardless of airway pressure and aiming for normalization of arterial blood gases has been replaced by a new paradigm of lung pro-tective ventilatory support. The maximum tidal volume has been dropped to 8 mL per kilogram ideal or predicted body weight based on the patient’s height and sex. Lung protection also places an equal importance on maintain-ing an end-inspiratory plateau pressure ≤ 30 cmH2O to avoid alveolar overdistention and lowering the targeted tidal volume below 8 mL/kg if that pressure is exceeded. In the setting of ARDS, PEEP plays a therapeutic role in decreasing the potential for recruitment-derecruit-ment injury (atelectotrauma). Controversy continues as to whether increased tidal volumes or increased inflation

pressures pose the greatest risk for lung injury and whether pressure controlled or volume controlled modes of venti-lation offer distinct benefits. The jury is still out on this question, but the verdict is clearly one in favor of using lung protective ventilatory support. For now the goal of lung protection with set tidal volumes of 6-8 mL/kg ideal body weight seems to fit the right answer for just about everyone, but there will likely be refinements in the future.

A candidate taking an NBRC examination should look for opportunities to use a lung protective strategy by delivering tidal volumes of no more than 8 mL/kg, holding plateau airway pressures below 30 cmH2O, and including an appropriate PEEP level. If blood gases can be normalized at the same time, then do so. However, doing so is secondary to the volume and pressure limits. NBRC examination committees have migrated test con-tent to follow these guidelines over the last several years. Our purpose in writing this article was to document this fact so that educators can be confident about guiding stu-dents’ learning in this area. m

REFERENCES1. Dreyfuss D, Saumon G. Ventilator-induced lung injury: Lessons from experimental studies. Am J Respir Crit Care Med 1998;157:294-323.2. Slutsky A and Ranieri M. Ventilator Induced Lung Injury. N Engl J Med. 2013; 369: 2126-2136.3. International Consensus Conference Committee: International consensus confer-ences in intensive care medicine: Ventilator-associated lung injury in ARDS. Am J Respir Crit Care Med. 1999;160:2118-2124.4. Hickling KG, Walsh J, Henderson S. Jackson R. Low mortality rate in adult respi-ratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: A prospective study. Crit Care Med 1994;22:1568-1578.5. Amato MBP, Barbas CSV, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-354.6. Stewart TE, Meade MO, Cook DJ, et al. Evaluation of a ventilation strategy to prevent barotraumas in patients at high risk for acute respiratory distress syndrome. N Engl J Med 1998;338:355-361.7. Brochard L, Roudot-Thoraval F, Roupie E, et al. tidal volume reduction for prevention of ventilator-induced lung injury in acute respira-tory distress syndrome. Am J Respir Crit Care Med 1998;158:1831-1838.8. Brower RG, Shanholtz CB, Fessler HE, et al. Prospective, randomized, controlled clini-cal trial comparing traditional versus reduced tidal volume ventilation in acute respiratory

distress syndrome patients. Crit Care Med 1999;27:1492-1498.9. Darioli R, Perret C. Mechanical controlled ventilation in status asthmaticus. Am Rev Respir Dis. 1984;129:385-387.10. Laffey JG, Tanaka M, Engelberts D, et al. therapeutic hypercapnia reduces pulmo-nary and systemic injury following in vivo lung reperfusion. Am J Respir Crit Care Med 2000;162:2287-2294.11. The Acute Respiratory Distress Syndrome Network (ARDSnet). Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. N Engl J Med. 2000; 342:1301-1308.12. Eisner MD, Thompson T, Hudson LD, et al. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory dis-tress syndrome. Am J Respir Crit Care Med. 2001;164:231-236.13. Brower RG, Lanken PN, MacIntyre N, et al. for the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Higher ver-sus lower positive end-expiratory pressure in patients with acute respiratory distress syn-drome. N Engl J Med 2004;351:327-336.14. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid management strategies in acute lung injury. N Engl J Med 2006;354:2564-2575.

15. the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006;354:2213-2224.16. Kallet RH, Jasmer RM, Pittet JF, et al. Clinical implementation of the ARDS net-work protocol is associated with reduced hospi-tal mortality compared with historical controls. Crit Care Med 2005;33:925-929.17. Putensen C, Theuerkauf N, Zinserling J, et al. Meta-analysis: Ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Int Med 2009;151:566-576.18. Neto AS, Cardoso SO, Manetta JA, et al. Association between use of lung protective ven-tilation with lower tidal volumes and clinical outcomes among patients without acute respi-ratory distress syndrome: A Meta Analysis. JAMA 2012; 308:1651-1659.19. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal –vol-ume ventilation in abdominal surgery. N Engl J Med 2013;369:428-437.20. Ferguson ND. Low tidal volumes for all? JAMA 2012;308:1689-1690.21. Hubmayr RD. Point: Is low tidal volume mechanical ventilation preferred for all patients on ventilation? Yes. Chest 2011;140:9-11.22. Gattinoni L. Counterpoint: Is low tidal volume mechanical ventilation preferred for all patients on ventilation? No. Chest 2011;140:11-13.



The NBRC sponsored and participated in several important events during the 60th AARC International Respiratory Congress held December 9-12, 2014 in Las Vegas, Nevada. The Board of Trustees is excited about the future of respiratory care and continues to provide support for the profession by being well-represented at this significant meeting. A highlight of the 2014 AARC Congress was the annual NBRC Reception. This invita-tion-only event attracted several hundred leaders of the profession with the theme, “Celebrating Excellence in Credentialing.”

During the reception, 2014 NBRC President Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC pre-sented the 2014 Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award posthumously to Louis M. Sinopoli, EdD, RRT, AE-C, FAARC, recognizing his long record of outstanding service to the respiratory care profession. Louis’ wife, Joan Taylor, was present to accept this important honor.

In addition, James A. Harvey, RPFT was presented the 2014 Robert H. Miller, RRT Award, given annually to a respiratory therapist or pulmonary function technol-ogist who who has contributed significantly to the respi-ratory care credentialing system.

During the awards ceremony at the AARC’s International Respiratory Congress, the NBRC presented the 2014 Albert H. Andrews Jr., MD Award to Thomas

Fuhrman, MD, MMSc, FCCP. This award is given annually to a physician who has provided outstanding service to the respiratory care profession and the creden-tialing system.

The AARC, CoARC, Lambda Beta Society, and the NBRC sponsored the annual “Student Survivor Hour,” a program designed especially for students enrolled in respiratory care education programs. NBRC Associate Executive Director, Lori M. Tinkler, MBA, greeted students and outlined information regarding

NBRC PARTICIPATES IN A ARC INTERNATIONAL CONGRESS

LAMBDA BETA SOCIETY SCHOLARSHIP RECIPIENTS (LEFT TO RIGHT) ZORANO SIPOS AND LILA FERNANDEZ

CONGRATULATIONS, AARC FELLOWSSixteen dedicated professionals were named Fellows of the American Association for Respiratory Care

(FAARC) during the 2014 AARC International Respiratory Congress in Las Vegas, Nevada. The people in this group demonstrated excellence in key areas of the profession, ranging from management to education to research, and more. The NBRC congratulates the following new Fellows:

Jenni L. Raake, RRT, RRT-NPS, FAARCRaymond Pisani, BS, RRT, RRT-NPS, FAARCGene Andrews, BS, RRT, FAARCDenise M. Johnson, MA, RRT, FAARCMichael Scott Gibbons, BS, RRT, NRP, FAARCFloyd E. Boyer, BS, RRT, RCP, FAARCDouglas M. Pursley, MEd, RRT, RRT-ACCS, FAARCJoe Dwan, MSEd, RRT, RRT-ACCS, RRT-NPS, RRT-SDS, CPFT, RPSGT, FAARC

Lon W. Keim, MD, FACP, FACCP, FAARCSue Ciarlariello, MBA, RRT, RRT-NPS, CMTE, RCP, FAARCJohn A. Rutkowski, MBA, MPA, RRT, FAARCEileen M. Censullo, MBA, RRT, FAARCGeorgianna G. Sergakis, PhD, RRT, FAARCShane Keene, DHSc, RRT, RRT-NPS, CPFT, RPSGT, FAARCJonathan Brady Scott, MS, RRT, RRT-ACCS, FAARCCarl W. Willoughby, RRT, RCP, FAACVPR, FAARC m

A N N U A L R E N E W A L


NBRC PARTICIPATES…º CONTINUED FROM PAGE 6

the credentialing process. She gave a brief history of the organization and structure of the NBRC, and noted the many benefits derived from pursuit of the national respi-ratory care credentials. The AARC’s Associate Executive Director of Education, Shawna Strickland, PhD, RRT, RRT-NPS, FAARC, spoke about the role of the AARC in the respiratory care profession and the benefits and services that are available to AARC members. Sherry L. Barnhart, RRT, RRT-NPS, FAARC, spoke about the opportunities that Lambda Beta provides students.

The NBRC continues to promote Student Survivor Hour as an excellent tool for helping those attending respiratory care education programs to learn about the professional organizations supporting the field and to gather information helpful to a successful educational experience and career.

Attendees were then invited to attend the Lambda Beta Society reception immediately following the Student Survivor Hour presentation. During the reception, the $2,000 CoARC Steven P. Mikles, EdS, RRT, FAARC Media Award was presented to Lila Fernandez from Georgia State University in Conyers, Georgia. The $1,500 Applied Measurement Professionals, Inc. Scholarship was presented to Saido Abdirahman Abdulle from St. Catherine University in Woodbury, Minnesota. The $2,500 Lambda Beta Society Scholarship was awarded to Asma Alamoudi from Rush University in Chicago, Illinois,

and the $1,000 Hill/Lambda Beta Society Scholarship was presented to Zorano Sipos from Concorde Career College in Huntington Beach, California. At the recep-tion, Jana L. Anderson, Associate Executive Director and Director of Finance and Operation of CoARC, was awarded the distinction of a National Honorary Member for 2014. The reception was a great opportunity for the NBRC to interact with students and educators in the field of respiratory care.

The NBRC also staffed a booth in the exhibit hall for the 60th AARC International Respiratory Congress and representatives enjoyed meeting and talking with many who had questions about the credentialing pro-cess. Considerable information about the upcoming CRT and RRT Examination changes and the Continuing Competency Program was provided. NBRC staff and Board members also received significant feedback about current issues.

Through future participation in the AARC International Respiratory Congress, the NBRC plans to continue its efforts to communicate with and be accessible to the respiratory care community. We hope to see you in November at the 61st AARC International Congress in Tampa, Florida! m

2015 Annual Renewal

The 2015 annual renewal process is under-way! Annual renewal of active status is

based on the calendar year, and the bene-fits of renewing your active status remains an excellent way to support your nationally rec-ognized credential(s) and the achievement it represents. If you are not currently working in the profession, you may also renew your status as a supporter. To renew your active or supporter status for 2015, please visit the NBRC website at www.nbrc.org or contact the Candidate Support Center at (888) 341-4811. m

CONGRATULATIONS, AARC HONORARY AND

LIFETIME MEMBERS

D ebra J. Fox, MBA, RRT, RRT-NPS, FAARC was awarded AARC Lifetime

Membership, and Edna Fiore was awarded AARC Honorary Membership during the 2014 AARC International Respiratory Congress. The Jimmy A. Young Medal was awarded to Charles G. Durbin Jr., MD. The NBRC congratulates these individuals on these pres-tigious recognitions. m

http://www.nbrc.org



2014 NBRC AWARDS PRESENTED AT AARC INTERNATIONAL CONGRESS

Robert H. Miller, RRT, Award Presented to James A. Harvey, RPFT

The NBRC Board of Trustees presents the Robert H. Miller, RRT Award annually to a respiratory therapist and/or pulmonary function technologist who has con-tributed significantly to the respiratory care credentialing system. The NBRC honored James A. Harvey, RPFT, with this award for 2014, and recognizes Mr. Harvey as a respected leader whose contributions to the NBRC and the credentialing system are extensive.

Mr. Harvey spent the majority of his professional career at Stanford University Medical Center in the pulmonary physiology laboratory and served as a part-time instructor for nearly 40 years at various colleges and universities in the San Francisco Bay area. Because of research in which Jim was involved, the standard procedure for handling samples for blood gas analy-sis was fundamentally altered. Jim was appointed to the NBRC Board of Trustees in 1998 as a representative of the NSCPT and helped facilitate the transition of the NSCPT representatives to the AARC when the NSCPT went out of business. He continued to serve on the NBRC Board until 2009. During his time on the Board, Jim served as co-chair of the pulmonary function technology examination committee and as a member of the Executive Committee and Treasurer of the Board.

Jim has authored and presented many papers and abstracts during his career and is now entering into his next phase of life – retirement! Please join the NBRC Board of Trustees and staff in congratulating him on receiving the Robert H. Miller, RRT Award, and his many other outstanding accomplishments. The profession is fortunate to be able to benefit from his dedicated service and support.

Albert H. Andrews Jr., MD Award Presented to Thomas Fuhrman, MD, MMSc, FCCP

The Albert H. Andrews Jr., MD Award is presented annually by the NBRC to a physician who has distin-guished himself or herself through outstanding service to the respiratory care community. The Board of Trustees

was pleased to honor Thomas Fuhrman, MD, MMSc, FCCP, with this award for 2014. Dr. Fuhrman received the award during the AARC International Respiratory Congress Awards Ceremony in December 2014. Carl F. Haas, MLS, RRT, RRT-ACCS, CPFT, FAARC (AARC), and Chief Operating Officer and Associate Executive Director Lori M. Tinkler, MBA, presented the award on behalf of the NBRC Board of Trustees.

Dr. Fuhrman has been very involved with the American Society of Anesthesiologists and the American College of Chest Physicians having served as the Chairman of the respiratory care steering committee for both of these organizations as well as numerous other roles.

One of his biggest accomplishments is his 12 years of service to the NBRC. Dr. Fuhrman was a member of the Board of Trustees of the NBRC from 1999-2011, serv-ing on the Executive Committee and as Vice President of the Board. He also chaired the Judicial and Ethics Committee and was the co-chair of the Therapist Written Examination Committee for seven years. Dr. Fuhrman brought a unique perspective to the NBRC having first

ALBERT H. ANDREWS JR., MD AWARD PRESENTED TO THOMAS FUHRMAN, MD, MMSC, FCCP (CENTER)

BY NBRC ASSOCIATE EXECUTIVE DIRECTOR LORI M. TINKLER (LEFT) AND NBRC PRESIDENT CARL F. HAAS (RIGHT)


2014 AWARDS PRESENTED …º CONTINUED FROM PAGE 8

FROM LEFT TO RIGHT: CARL F. HAAS, JOAN TAYLOR (ON BEHALF OF HER HUSBAND, LOUIS M. SINOPOLI), LORI M. TINKLER, AND JAMES A. HARVEY

been a respiratory therapist before earning his medical degree.

The NBRC is delighted to add Thomas Fuhrman, MD, MMSc, FCCP, to the list of recipients of the Albert H. Andrews, Jr., MD Award. Without his unselfish ded-ication to respiratory therapy and those of other dedicated physicians, the respiratory care profession and its creden-tialing system would not enjoy the level of recognition and success that have been achieved today. Please join the NBRC in congratulating Dr. Fuhrman as the 2014 recip-ient of this significant award and on the numerous accom-plishments he has achieved during his illustrious career.

Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award Presented to Louis M. Sinopoli,

EdD, RRT, AE-C, FAARC

The Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award is the NBRC’s highest honor, signi-fying tremendous contributions to the growth of respira-tory care over a sustained period of time. It is presented by the NBRC to an individual whose career accomplish-ments have typically changed the direction of the profes-sion or the NBRC’s credentialing system. The 2014 award was presented posthumously in memory of our dear friend and colleague, Louis M. Sinopoli, EdD, RRT, AE-C, FAARC.

Dr. Sinopoli was the consummate respiratory care professional and dedicated his career to educating

students and advancing the profession across the globe. Louis earned his RRT in 1969 and held Registry #796. Renowned throughout respiratory care for his ability to innovate, Dr. Sinopoli will be remembered particularly for the work he did to advance respiratory care into the world of defensible, statistically validated competency examinations. Working with the NBRC, where he served as a member of the Board of Trustees for two terms (1974-77 and 1993-1996) and as a consultant over many years, he was instrumental in upgrading the quality of the respiratory therapist written examination, making it pos-sible for the profession to move to the forefront of com-petency-based testing years ahead of similar professions. His efforts to pioneer criterion-referenced examinations resulted in him being the first respiratory therapist to chair the NBRC’s Therapist Written Examination Committee.

Louis Sinopoli grew up in Bayonne, NJ, and first learned about the profession of respiratory care when his karate instructor, who was also a medical technologist, gave him a job in the inhalation therapy department at a local hospital. He fell in love with the profession and went on to earn his Bachelor of Science degree in respiratory care and instruction technology from the State University of New York, Empire State College in 1975.

He taught in the RT program at Upstate Medical Center in Syracuse, NY, for seven years before moving to California, where he earned his doctorate from UCLA in 1981, specializing in research methods and evaluation. Louis was honored as the recipient of the NBRC’s Robert H. Miller , RRT Award in 1999 for his outstanding con-tribution to respiratory care and credentialing.

Dr. Sinopoli’s final post in the profession was as program director and professor of the respiratory care program at El Camino College in Torrance, CA. Louis suffered a tragic accident at the 2013 AARC International Congress and later passed on January 8, 2014. Louis will always be remembered by his friends and colleagues on the NBRC as well as the many whose lives he touched throughout the respiratory care profession.

Dr. Sinopoli’s extensive contributions to education and changing the face of the respiratory therapy profes-sion made him uniquely qualified to receive the Sister Mary Yvonne Jenn, CRNA, RRT Lifetime Achievement Award. m

1 0First Quarter 2015H O R I Z O N S

CRT ExaminationOne thousand nine hundred seventy-nine (1,979) candidates

attempted the CRT Examination in the last three months of 2014, with 890 passing the examination to achieve the CRT credential. The total number of practitioners holding the CRT credential is 230,506.

RRT ExaminationsThe RRT Examination is a two-part credentialing process con-

sisting of the Therapist Written Examination (WRRT) and the Clinical Simulation Examination (CSE). Three thousand seven hun-dred seventy-nine (3,779) individuals attempted the WRRT in the fourth quarter of 2014, while 3,262 took the CSE. A total of 1,620 candidates earned the RRT credential by passing both portions. The total number of RRTs (who are also CRTs) now stands at 141,875.

Pulmonary Function Technologist ExaminationsThe CPFT Examination was administered to 109 candidates

during the fourth quarter of 2014. Of these individuals, 51 achieved a passing score and were awarded the Certified Pulmonary Function Technologist credential. From October 1, 2014 through December 31, 2014, 31 CPFTs attempted the RPFT Examination and 15 were awarded the advanced pulmonary function technologist designation. There are 13,043 individuals who hold the CPFT credential, and the total number of RPFTs (who are also CPFTs) is 4,365.

Neonatal/Pediatric Specialty ExaminationDuring the fourth quarter, 242 CRTs and/or RRTs attempted

the Neonatal/Pediatric Specialty Examination. One hundred sixty (160) individuals earned the credential, bringing the total number of CRT-NPS and/or RRT-NPS credentials awarded to 12,488.

Sleep Disorders Specialty ExaminationNineteen (19) CRTs and/or RRTs attempted the Sleep Disorders

Specialty Examination in the fourth quarter of 2014. Eighteen (18) individuals earned the credential, bringing the total number of CRT-SDS and/or RRT-SDS credentials awarded by the NBRC to 315.

Adult Critical Care Specialty ExaminationTwo hundred seven (207) individuals attempted the Adult

Critical Care Specialty Examination in the fourth quarter of 2014, with 151 individuals passing the examination to achieve the RRT-ACCS credential. The total number of RRT-ACCS credentials awarded is 984.

Please join the NBRC Board of Trustees and Executive Office staff in congratulating the individuals who achieved the 2,905 new credentials awarded by the NBRC in the fourth quarter of 2014! m

For the period of October 1, 2014 through December 31, 2014, the NBRC administered 9,628 credentialing examinations. A total of 2,905 new CRT, RRT, CPFT, RPFT, Neonatal/Pediatric Specialty, Sleep Disorders Specialty, and Adult Critical Care

Specialty credentials were issued during the fourth quarter. Statistics for each NBRC examination are presented below:

EXAMINATION STATISTICS FOR THE FOURTH QUARTER OF 2014

PASS RATES COMPAREDBelow are the passing percentages for NBRC creden-

tialing examinations given in the fourth quarter of 2012, 2013, and 2014.

Oct 1–Dec 31, 2012

Oct 1–Dec 31, 2013

Oct 1– Dec 31, 2014

CRT ExaminationEntry-Level Graduates:

New Candidates 79.2% 50.0% 57.9%

Repeat Candidates 14.9% 9.4% 6.3%

Advanced-Level Graduates:

New Candidates 73.0% 75.5% 69.5%


RRT Written ExaminationNew Candidates 60.2% 60.7% 55.5%


RRT Clinical Simulation ExaminationNew Candidates 53.3% 56.3% 53.4%


CPFT ExaminationNew Candidates 71.0% 64.6% 61.8%


RPFT ExaminationNew Candidates 69.3% 61.1% 47.1%


Neonatal/Pediatric Specialty ExaminationNew Candidates 71.1% 65.1% 73.0%


Sleep Disorders Specialty ExaminationNew Candidates 80.0% 100.0% 94.7%


Adult Critical Care Specialty ExaminationNew Candidates 82.4% 86.6% 75.7%


NBRC Horizons, First Quarter 2015

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