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All of our front-liners deserve our praise, aloha and respect for all that they do. These include our blue collar workers (our cashiers, janitors, security guards, delivery drivers, etc.) and gold collar workers (our medics, hospital staff, nurses, and doctors). They are the wai that feeds the loi.

One of the least talked about front liners in the medical field has been our respiratory therapists.

COVID-19 is a respiratory virus and these people are the last line of defense. They, along with doctors and nurses, play a pivotal role in this crisis and yet are normally lumped in with nurses despite their specialization.

In Hawaii, most RTs are locally born, bred and trained. Many of them got into that profession because of an experience with a loved one who had a respiratory illness. They know firsthand both as medical professionals and from the patient’s side.

Since they are from our community, they also have a special aloha with our community and most opt to stay in Hawaii despite better pay in the U.S. mainland.

Normally, RTs study at an Associate of Arts program at Kapiolani Community College and then take a board exam upon completing an AA. Class sizes (less than 22 are admitted into the program) are kept small in order to give more individualized attention.

Depending on your scoring, you become a Certified RT (CRT) or a Registered RT (RRT). But RTs begin their hospital or clinical training from the very first semester.

Upon being certified or registered, one can go into a hospital case, out-patient case, or to home care, such as setting up CPAPs (continuous positive airway pressure) and oxygen tasks including nursing homes. RTs handle everything from helping premature babies with their breathing to testing for asthma, to putting car accident victims on a ventilator to assisting those on life support.

When someone is pulled off of life support, they are pulled off by an RT. Literally, RTs are there from babies to kupuna. As Kalena Frank, a RRT, explains, “RTs are there for the first breath and the last breath.”

With the COVID-19 outbreak, the role of RTs has been more critical. RTs are the ones who set people up on ventilators. Even if there was an abundant supply of ventilators, you still need RTs to manage them. According to Kalena Frank, Hawaii hospitals had been preparing for worst case scenarios of COVID-19 similar to New York for the last month.

While only 13% of COVID-19 cases require ventilators, any sharp increase like in New York would not only put a strain on ventilators but on the RT staff capacity. While there are about 500 ventilators in storage, there are only around 230 RTs statewide.

While 230 may sound sufficient, anyone who is put on a ventilator due to COVID-19 requires 24-hour management — on top of the 24-hour management of non-COVID-19 cases they were handling prior to the outbreak.

This means that any sharp increase in COVID-19 cases would also reduce the amount of attention someone else on life support or a premature baby receives and will be scaled back due to staffing issues — thus straining other critical medical services. Some RTs who have come into contact with COVID-19 patients have already been sleeping in their cars or in tents in order to avoid infecting loved ones and patients.

In light of all of this, we should be thankful for our medical teams, including RTs such as Kalena Frank and support them wherever we can, including not putting their lives in danger. After this crisis, hopefully more of our community will be inspired to take notice of the role our RTs play, and perhaps some may consider joining this honorable profession.