RTs are authorized to “administer a substance by injection…” via various routes, including subcutaneous, intravascular, Intramuscular and Intradermal. What medications an RT can administer via these routes by injection depends on both professional scope of practice and personal competency.

For the administration of a medication to be within the scope of practice of Respiratory Therapy, it must be aimed to treat “cardio-respiratory and associated disorders to maintain or restore ventilation”. This includes influenza and pneumococcal pneumonia vaccines, as well as the new COVID-19 vaccine.

As with all other activities that an RT engages in, it is essential to obtain the requisite knowledge and skill to ensure the vaccine can be delivered in the safest possible manner. Having a mechanism to verify competency attainment is strongly recommended (e.g.,record of attendance for training sessions, learning packages, etc.).

More information on the administration of substances by injection is outlined in the CRTO’s Interpretation of Authorized Acts Professional Practice Guideline (p. 10).

There are currently no official IPAC recommendations for PFT and spirometry testing during a pandemic outbreak such as this one. However, the American Thoracic Society (ATS) has recently released the following statement entitled Pulmonary Function Laboratories: Advice Regarding COVID-19.

The ATS echoes the concerns of many RTs regarding the difficulty in adequately screening patients who have pre-existing respiratory symptoms, as well as the uncertainly surrounding the risk of transmission when performing PFTs and spirometry. In this document, the ATS recommends the use of:

• PPE that limits aerosolized droplet acquisition for staff; and
• enhanced cleaning of the testing space, such as wiping down surfaces with appropriate cleaners.

The CRTO encourages all RTs to work with their healthcare team to ensure an appropriate risk assessment tool is being applied before deciding to perform either PFTs or spirometry. When testing is deemed to be essential, the necessary administrative controls should be in place, such as:

• adequate time for testing;
• spacing of appointment to allow for proper cleaning of the testing area;
• a designated testing area that allows for proper social distancing; and
• a separate designated clerical and charting space.

The federal government defines an essential service as one that is “…necessary for the safety or security of the public or a segment of the public.” And although the provision of healthcare is a provincial entity, it is clearly an essential service. However, for the purpose of minimizing risk during a pandemic, the actual services a particular healthcare profession provides can usually be broken down into essential and non-essential.

The Ontario Ministry of Health and Long-Term Care’s Directive for Health Care Providers states that clinicians are in the best position to determine what is essential in their specific health practice. The directive goes on to provide healthcare providers with some considerations to guide their decisions regarding which services are essential and which are not (e.g., is it necessary to minimize patient risk?)

For example, a diagnostic test like spirometry is generally considered to be a non-essential service during a pandemic outbreak. However, if the test is necessary to determine if a patient can be safely discharged, then it could be considered to be essential.

For the purpose of the mandatory closure of non-essential services (which began March 24^th), the Government of Ontario has defined essential and non-essential services. The List of essential workplaces lists health care as an essential service.

Please note that any RT services offered remotely (i.e., telepractice) are subject to the same restrictions under the MOHLTC’s directive in that they must:

• involve time-sensitive issues that need to be dealt with urgently to avert or avoid negative patient outcomes; and/or
• be necessary to avert or avoid a situation that would have a direct impact on the safety of patients.

During the COVID-19 outbreak, RTs may be asked to perform tasks usually considered to be outside the professional scope of respiratory therapy. In our current healthcare situation, the essential consideration when deciding whether or not to perform a given task is whether or not you can do so safely and competently. Period. For those tasks outside of the RT scope of practice, the CRTO encourages its Members to obtain whatever additional training is necessary to ensure competency.

It is important to note, however, that most Professional Liability Insurance (PLI) polices – such as those purchased from professional associations – only covers the performance of tasks considered to be within the scope of practice of the profession. Therefore, if you are going to be engaging in activities outside of the scope of practice of Respiratory Therapy, the CRTO recommends you consult with your employer to determine if you are adequately covered under their organizational liability insurance policy.

The Occupational Health and Safety Act includes some provisions that permit an individual to refuse to work, such as unsafe equipment or work environment. However, the legislation goes on to explain that this “refusal to work” provision does not apply in the following circumstances:

• where the circumstances related to risk is inherent in the worker’s job; or
• where the worker’s refusal to work would directly endanger the life, health, or safety of another person.

Respiratory Therapists care for patients with respiratory illness every day, and this is inherent in the work that we do.

Your best option is to work proactively with your employer to find out ways that you can assist in the provision of care that best suit your competencies.

The Information and Privacy Commissioner of Ontario (IPCO) has provided some general guidance relevant to healthcare professionals during this current pandemic. The IPCO recognizes these are exceptional circumstances and recommends all organizations do their best to maintain reasonable security and privacy measures while at the same time addressing urgent needs in a timely manner. The guidelines from the IPCO speak to considerations regarding the following:

• Mobile devices
• Emails
• Paper copies and files

If you have specific concerns related to the privacy and security of information, the IPCO can be reached directly by email at info@ipc.on.ca.

The American College of OB/GYN’s has a statement on Vaccinating Pregnant and Lactating Patients Against COVID-19 | ACOG, in addition the CDC has released information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding | CDC.

Whether or not you need to be registered with the CRTO depends upon what type of assistance you would be providing. If the task(s) involved fall within the public domain (e.g., working at a screening centre, performing nasopharyngeal swabs), then registration with the CRTO is not required. However, if the task(s) involved fall with controlled acts authorized to RTs (e.g., oxygen administration, ventilation, intubation, etc.), or rely heavily on your RT-specific knowledge, then you would need to be a registered member of the CRTO. For information on the registration process, please contact Lisa Ng, CRTO Manager of Registration at ng@crto.on.ca.

If you are registered with the CRTO as a GRT, you may wish to sign up on HealthForceOntario’s COVID-19 Health Care Provider Recruitment website. This will allow the Ministry of Health to build a regional roster that makes it easier for employers and hospitals to get in touch with those in their area who can help.

Currently, the CRTO is only registering students once they fully complete their program and have had their completion confirmed by their educational facility. For students looking to assist in the COVID-19 workforce, please see Health Force Ontario’s website: COVID-19 Health Care Provider Recruitment.

The RTSO also has many COVID-related resources: Joining the Frontline During COVID-19 – Respiratory Therapy Society of Ontario (rtso.ca)

For anyone who has been out of practice for an extended period of time, some limitations may need to be placed on your certificate of registration (e.g., general supervision).  What those limitations might be are guided by the CRTO’s  Registration Currency Requirement Policy.

Holding current Professional Liability Insurance (PLI) of at least $2 million coverage is a requirement for any practicing RT. Some employers will include RTs under their organization’s insurance – you should inquire about this when you are hired. PLI is also commonly purchased through the RTSO or CSRT.