Applying a Form of Energy
Applying a Form of Energy
The “application of a form of energy”, which is listed as a controlled act in the RHPA, is not authorized to Respiratory Therapists under the Respiratory Therapy Act, 1991. Two of these procedures outlined under this controlled act, can apply to the practice of Respiratory Therapy, and may be performed under specific circumstances, with the requisite knowledge, skill and competency. These include:
use of an Automatic External Defibrillator (AED)
Diagnostic ultrasound is classified as an ultrasound that produces an image or other data and is used to visualize structures (e.g., for procedural guidance) and requires frequencies between 2 and 20MHz .
As of January 1, 2019, RTs who wish to use diagnostic ultrasound in their practice (e.g., radial arterial line catheterization, lung ultrasound) require both delegation and a valid order (direct order or medical directive). Information regarding the delegation process can be found in the CRTO’s Delegation of Controlled Acts PPG. Information regarding orders can be found in the CRTO’s Orders for Medical Care PPG.
In addition, the Respiratory Therapy Society of Ontario (RTSO) has assembled resource documents, including templates that can be adapted to local practice settings to assist RTs in establishing the necessary delegation and order processes. This material can be found on the RTSO webpage entitled Ultrasound for RRTs & RRT/AAs – Respiratory Therapy Society of Ontario (rtso.ca).
The use of an AED can only be performed if authorized by:
An order and delegation, or;
Exercise of the emergency exception in the RHPA.
How to Authorize the Use of an AED
Order and Delegation
The preferred authorization mechanism is the combination of an order and delegation. Under this approach, the order serves to authorize the use of the AED (the application of energy) and the delegation transfers that authority to the RT. Ideally, this is done “in the moment” on a case-by-case basis, although this may not be practical in the urgency associated with the management of a cardiac arrest. As such, it is permissible to use a standing medical directive and delegation that would apply in these scenarios (i.e., an organization-wide medical directive and delegation that allows any RT who has been trained in the use of AEDs to apply them in specified situations, such as a cardiac arrest).
There is an emergency provision in the RHPA that allows for an exception to the restriction on controlled acts. This exception assumes that performance of the controlled act in question is not carried out frequently and that it is truly an emergency. Further, it is important to distinguish between an unforeseen emergency and a “regular” emergency. This distinction is recognized in the Good Samaritan Act, 2001, which provides immunity from negligence lawsuits for health professionals who provide “emergency health care services or first aid assistance” at a place other than a hospital or health care facility, thereby implying that those are unforeseen emergencies, whereas the work they do IN hospital and health care facilities are “regular” emergencies. The combination of an order and delegation would be the most appropriate approach for managing “regular” emergencies, although clearly not all cardiac arrests are foreseeable. Therefore, it is acceptable for an RT to apply an AED under the emergency exception, yet only in circumstances where an order and delegation are not available.