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California Respiratory Therapy — Requirements & Free Practice

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Respiratory Care Practitioner Applicant Work Permit

Employer-specific temporary applicant authorization; the Board states this permit is not a license.

Licensing authority: Respiratory Care Board of California · Application information

Applicant work permit — statutory extension
Therapist Multiple-Choice Examination
Extension
BPC § 3739(b): inability to finish the application for causes completely outside applicant control, or successful CRT passing evidence with an otherwise complete application and no previous authorization under subsection (b)(2). The latter authorization is capped at six months from graduation or application, whichever is later.
Implementation
The current Board Work Permit page asks for CRT credential, complete application and California employer. Current TMC supplies CRT; historical CRT examination scores remain conditions.
Supervision
Direct supervision; title is respiratory care practitioner applicant; Board may deny or rescind permission for failure to pass the RRT examination or licensure denial grounds.
Applicant work permit — initial employer specific request
Therapist Multiple-Choice Examination
Application
Complete application for licensure and education; Board page requests an NBRC CRT credential and California employment or job offer, plus employer-specific work-permit request.
Duration
Valid only for Board-specified dates and employer; typically up to 180 days. Stop practice on expiration absent full licensure. Request a new permit for a different or additional employer.
Licensure pending
Permit is temporary while completing remaining full-license examination requirements; CSE is required for full ordinary licensure, not as a passed prerequisite to this permit.
Supervision
Direct supervision by a California licensed RCP on duty and immediately available in the assigned patient-care area.

Respiratory Care Practitioner (RCP) License

Ordinary California respiratory care license; education pathways, prior examination evidence and waivers are applicant conditions.

Licensing authority: Respiratory Care Board of California · Application information

Active license renewal

All of the following:

Continuing education
30 approved hours every two years, including at least 10 RCP leadership hours, 15 clinical hours and 15 live interactive hours; report compliance and retain documentation four years.
Course cycle
Law and Professional Ethics course with its post-course exam is due every other renewal cycle. In other cycles it is optional approved CE; completion and CE waivers are applicant conditions.
Other certification credit
16 CCR § 1399.351(c)-(f) permits ACLS, NRP, PALS and ATLS certification examination credit; these multidisciplinary training assessments are applicant conditions. AE-C formerly provided by NAECB continues under NBRC after its September 1, 2022 acquisition, rather than a second distinct NAECB examination. Pulmonary rehabilitation, tobacco/smoking cessation and COPD educator certifications in subsection (d) are CE conditions, not separately identified examination leaves. Initial certifications, renewal credit and excluded credit must satisfy the specific subsection limits.
Renewal
Renew every two years by license expiration; pay the renewal fee. Practice with an expired license is prohibited.
Rrt exam credit
Optional CE path under 16 CCR § 1399.351(b)(7): first RRT award earns 15 hours only when RRT was not required at initial licensure. Coursework can satisfy CE instead. TMC and CSE leaves identify currently offered examinations this optional path involves, not a mandate to retest every renewing licensee.
Unregistered nbrc specialty examinations
16 CCR § 1399.351(b)(1)-(6) accepts examinations awarding initial Adult Critical Care Specialist (ACCS), Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Neonatal/Pediatric Specialist (NPS), Sleep Disorders Specialist (SDS), and Asthma Educator Specialist (AE-C) credentials for 15 hours of CE. These nationwide respiratory-care examinations have no frozen registered versions in the supplied context. They remain conditions pending nationwide registration; they are optional CE alternatives to coursework.
New application after three year license expiration and cancellation

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Previous license
16 CCR § 1399.355(c): after expiration for three years the license is cancelled; file an initial application and meet all current licensure criteria.
Other disciplinary reinstatement, restoration or probation petition

At least one of the following alternatives:

  • California Law & Professional Ethics Course — post-course test (practice unavailable)
  • Law and Professional Ethics Course — post-course examination (practice unavailable)
Course recency
A petitioner for reinstatement completes law and professional ethics within six months before filing; other probation petition applicants may be excused from this course condition if not petitioning for reinstatement.
Other examination
BPC § 3751(g) permits a Board-required examination without identifying a particular examination. BPC § 3756 professional competency assessment and fitness evaluations likewise are unnamed individualized conditions; no separate examination identity is invented.
Petition
Observe BPC § 3751 waiting periods applicable to probation, illness or revocation/surrender; pay outstanding amounts and provide verified recommendations and rehabilitative evidence. No petition while under criminal sentence/probation/parole or pending accusation/petition to revoke probation.
Disciplinary reinstatement after revocation or surrender for three or more years

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Course recency
16 CCR § 1399.372.5: successfully complete course within six months before filing the petition.
Discretion
Board may reject or impose terms; additional examinations not identified by official text are applicant conditions, not invented exam leaves.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Petition
BPC § 3751: pay all outstanding fees, fines and cost recovery, remain current on monthly monitoring; obey minimum waiting periods; submit at least two verified practitioner recommendations. Revoked or surrendered for three or more years requires current initial education and examinations.
Restoration of license expired more than two but within three years

All of the following:

Course cycle
Law and ethics course if due; § 3774 no-examination protection applies when expiration is solely for unpaid fees. Examination leaves identify applicable or optional CE, not a new compulsory licensure examination.
Expiration
Document 30 CE hours within the preceding four years, and pay accrued renewal and penalty fees.
Other certification credit
16 CCR § 1399.351(c)-(f) permits ACLS, NRP, PALS and ATLS certification examination credit; these multidisciplinary training assessments are applicant conditions. AE-C formerly provided by NAECB continues under NBRC after its September 1, 2022 acquisition, rather than a second distinct NAECB examination. Pulmonary rehabilitation, tobacco/smoking cessation and COPD educator certifications in subsection (d) are CE conditions, not separately identified examination leaves. Initial certifications, renewal credit and excluded credit must satisfy the specific subsection limits.
Rrt exam credit
Optional CE path under 16 CCR § 1399.351(b)(7): first RRT award earns 15 hours only when RRT was not required at initial licensure. Coursework can satisfy CE instead. TMC and CSE leaves identify currently offered examinations this optional path involves, not a mandate to retest every renewing licensee.
Unregistered nbrc specialty examinations
16 CCR § 1399.351(b)(1)-(6) accepts examinations awarding initial Adult Critical Care Specialist (ACCS), Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Neonatal/Pediatric Specialist (NPS), Sleep Disorders Specialist (SDS), and Asthma Educator Specialist (AE-C) credentials for 15 hours of CE. These nationwide respiratory-care examinations have no frozen registered versions in the supplied context. They remain conditions pending nationwide registration; they are optional CE alternatives to coursework.
Restoration of license expired two years or less

All of the following:

Course cycle
Complete law and ethics if due under every-other-cycle rule. BPC § 3774 prohibits making an examination a reinstatement condition during three years if the license lapsed solely for nonpayment; any continuing-education examination leaves describe accepted or otherwise applicable CE, with this statutory limitation controlling.
Expiration
Expired for two years or less; document 15 CE hours within the preceding two years and pay required accrued renewal and penalty fees.
Other certification credit
16 CCR § 1399.351(c)-(f) permits ACLS, NRP, PALS and ATLS certification examination credit; these multidisciplinary training assessments are applicant conditions. AE-C formerly provided by NAECB continues under NBRC after its September 1, 2022 acquisition, rather than a second distinct NAECB examination. Pulmonary rehabilitation, tobacco/smoking cessation and COPD educator certifications in subsection (d) are CE conditions, not separately identified examination leaves. Initial certifications, renewal credit and excluded credit must satisfy the specific subsection limits.
Rrt exam credit
Optional CE path under 16 CCR § 1399.351(b)(7): first RRT award earns 15 hours only when RRT was not required at initial licensure. Coursework can satisfy CE instead. TMC and CSE leaves identify currently offered examinations this optional path involves, not a mandate to retest every renewing licensee.
Unregistered nbrc specialty examinations
16 CCR § 1399.351(b)(1)-(6) accepts examinations awarding initial Adult Critical Care Specialist (ACCS), Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Neonatal/Pediatric Specialist (NPS), Sleep Disorders Specialist (SDS), and Asthma Educator Specialist (AE-C) credentials for 15 hours of CE. These nationwide respiratory-care examinations have no frozen registered versions in the supplied context. They remain conditions pending nationwide registration; they are optional CE alternatives to coursework.
Initial licensure by examination — approved program and associate degree

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education
BPC § 3740(a): graduate from a CoARC-accredited respiratory care program and hold at least an associate degree from a regionally accredited institution.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Initial licensure — baccalaureate enrollment equivalence

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education
BPC § 3740(b): enrollment in an accredited baccalaureate program and completion of science, general academic and respiratory therapy coursework commensurate with an associate degree.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Initial licensure — Canadian educational equivalence

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education
BPC § 3740(d): Canadian institution applicants whose education does not meet subsection (a) or (b) must document an equivalent degree and a respiratory therapy program recognized by the Canadian Board of Respiratory Care. Any Canadian examination or credential is an applicant condition, not a California or nationwide US examination leaf.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Initial licensure — foreign or non equivalent other jurisdiction education

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education
BPC § 3740(c): approved advanced-standing respiratory educational program evaluates education and training; document equivalent associate or higher degree, equivalent respiratory education and knowledge and skills for competent national-standard practice.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Active duty military renewal waiver
No examination is required for this applicant pathway.
Eligibility
Current valid license when called to remote active duty; document orders; waiver lasts only the remote temporary assignment. Board may waive renewal fees, CE and other renewal requirements.
Practice
Military Active Renewal Waiver prohibits private practice; Military Inactive Renewal Waiver prohibits all practice. Notify Board within 60 days of receiving a discharge date and meet applicable renewal requirements before return to private practice.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure — qualifying pre 2015 examination evidence

At least one of the following alternatives:

  • California Law & Professional Ethics Course — post-course test (practice unavailable)
  • Law and Professional Ethics Course — post-course examination (practice unavailable)
Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education
Meet one applicable BPC § 3740 education pathway or obtain a 16 CCR § 1399.330 education waiver.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
Must provide pre-January 1, 2015 CRT Examination or Written Registry Examination passing evidence and satisfy the Board’s no-discipline determination under BPC § 3735(b). Current national examinations are excused on this route; the independently required course examination remains.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Initial California licensure — applicants already licensed elsewhere

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Other license
California has no reciprocity. Provide verification of all applicable licenses and education. The Board FAQ states: "If you already hold the RRT credential, you will not need to retake the initial licensing examinations." A pre-2015 CRT credential may also satisfy the statutory historical exception.
Reactivation from inactive to active status

All of the following:

Application
Written request; pay current, delinquent and accrued fees; document 15 CE hours within preceding two years under 16 CCR § 1399.356(b).
Course cycle
Law and ethics only as required by the applicable cycle; otherwise optional CE. Examination-based CE alternatives may be replaced by coursework.
Other certification credit
16 CCR § 1399.351(c)-(f) permits ACLS, NRP, PALS and ATLS certification examination credit; these multidisciplinary training assessments are applicant conditions. AE-C formerly provided by NAECB continues under NBRC after its September 1, 2022 acquisition, rather than a second distinct NAECB examination. Pulmonary rehabilitation, tobacco/smoking cessation and COPD educator certifications in subsection (d) are CE conditions, not separately identified examination leaves. Initial certifications, renewal credit and excluded credit must satisfy the specific subsection limits.
Rrt exam credit
Optional CE path under 16 CCR § 1399.351(b)(7): first RRT award earns 15 hours only when RRT was not required at initial licensure. Coursework can satisfy CE instead. TMC and CSE leaves identify currently offered examinations this optional path involves, not a mandate to retest every renewing licensee.
Unregistered nbrc specialty examinations
16 CCR § 1399.351(b)(1)-(6) accepts examinations awarding initial Adult Critical Care Specialist (ACCS), Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Neonatal/Pediatric Specialist (NPS), Sleep Disorders Specialist (SDS), and Asthma Educator Specialist (AE-C) credentials for 15 hours of CE. These nationwide respiratory-care examinations have no frozen registered versions in the supplied context. They remain conditions pending nationwide registration; they are optional CE alternatives to coursework.
New application after permanent retired status

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Retirement
Board states retired status is permanent; a person seeking practice again must apply for a new license and meet current requirements.
Initial licensure — Education waiver — military respiratory care experience

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education waiver
1399.330(a)(3): minimum one-year approved respiratory program, two full-time military practice years within the preceding four years, military verification of good standing; applicant does not meet subsection (1) or (2).
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Waiver discretion
Board discretion; sufficient documentary evidence and personnel-record release. Good standing means no current investigation, substantially related public-agency charge, consent agreement/administrative discipline or adverse negligence judgment/arbitration award. No guaranteed waiver and no fee refund if denied.
Initial licensure — Education waiver — pre 2004 training or prior California license, licensed jurisdiction

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education waiver
1399.330(a)(1)(A): qualifying minimum one-year program before July 1, 2004 or previous California license in good standing; current license in good standing elsewhere and two full-time years of practice there within the preceding three years.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Waiver discretion
Board discretion; sufficient documentary evidence and personnel-record release. Good standing means no current investigation, substantially related public-agency charge, consent agreement/administrative discipline or adverse negligence judgment/arbitration award. No guaranteed waiver and no fee refund if denied.
Initial licensure — Education waiver — pre 2004 training or prior California license, unregulated jurisdiction

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education waiver
1399.330(a)(1)(B): qualifying pre-2004 training or previous California license in good standing; three full-time years of respiratory practice within the preceding four years where respiratory care is not regulated.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Waiver discretion
Board discretion; sufficient documentary evidence and personnel-record release. Good standing means no current investigation, substantially related public-agency charge, consent agreement/administrative discipline or adverse negligence judgment/arbitration award. No guaranteed waiver and no fee refund if denied.
Initial licensure — Education waiver — experience without qualifying program, licensed jurisdiction

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education waiver
1399.330(a)(2)(A): no qualifying subsection (1) program; current license in good standing elsewhere and four full-time years of competent practice there within the preceding five years.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Waiver discretion
Board discretion; sufficient documentary evidence and personnel-record release. Good standing means no current investigation, substantially related public-agency charge, consent agreement/administrative discipline or adverse negligence judgment/arbitration award. No guaranteed waiver and no fee refund if denied.
Initial licensure — Education waiver — experience without qualifying program, unregulated jurisdiction

All of the following:

Application
Completed application, required application fee, recent passport photograph, official transcripts and required health-related license verifications; fingerprint criminal history clearance. Applications may be filed up to 90 days before completing the education program and must be completed within one year.
Education waiver
1399.330(a)(2)(B): five full-time years of respiratory practice within the preceding six years where respiratory care is not licensed.
Expedited processing
Eligible active-duty members, honorably discharged veterans, military spouses/domestic partners, SkillBridge participants, refugees, asylees and SIV holders may receive expedited processing with supporting documentation; ordinary licensure qualifications still apply.
Historical exception
BPC § 3735(b): proof of passing the historical CRT Examination or Written Registry Examination before January 1, 2015 satisfies the examination requirement if the Board finds no prior license or job-related discipline. The historical examinations were replaced in January 2015; passing evidence is a condition, not a discontinued examination leaf. The Board application page describes the exception as a CRT credential earned before January 1, 2015.
Law and ethics
Complete one approved three-hour AARC or CSRC course and its scored post-course examination; provide the completion certificate before issuance. Only one provider is required.
National examinations
BPC § 3735(a): TMC at the high cut score and CSE; previously earned current RRT credentials need verification, not automatic retesting. TMC and CSE remain examination leaves whenever involved, regardless of when passed.
Waiver discretion
Board discretion; sufficient documentary evidence and personnel-record release. Good standing means no current investigation, substantially related public-agency charge, consent agreement/administrative discipline or adverse negligence judgment/arbitration award. No guaranteed waiver and no fee refund if denied.

Therapist Multiple-Choice Examination

Provider
The National Board for Respiratory Care (NBRC); administered Monday through Saturday at more than 300 assessment centers through the NBRC testing agency PSI
Format
Computer-based multiple-choice examination; each scored item is linked to a content area and cognitive level (recall, application, analysis); the TMC ends December 31, 2026 and the Respiratory Therapy Examination is used from January 1, 2027
Exam questions
160 multiple-choice items: 140 scored and 20 pretest
Time limit
3 hours
Passing score
Raw score (each item worth one point) compared with two cut scores: the low cut score earns the CRT credential; the high cut score earns the CRT credential and eligibility for the Clinical Simulation Examination for candidates eligible to earn the RRT
Exam fee
$190 new applicants; $150 repeat applicants
Examination outline
  • I. PATIENT DATA (50 of 140 scored items; Recall 15, Application 27, Analysis 8) (35.71%)
    • I.A. Evaluate Data in the Patient Record (10 of 50 section items; Recall 4, Application 6, Analysis 0) — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, APGAR scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment (10 of 50 section items; Recall 3, Application 6, Analysis 1) — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, APGAR score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information (12 of 50 section items; Recall 4, Application 7, Analysis 1) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary stress testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results (10 of 50 section items; Recall 2, Application 4, Analysis 4) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary stress testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures (8 of 50 section items; Recall 2, Application 4, Analysis 2) — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF DEVICES, AND INFECTION CONTROL (20 of 140 scored items; Recall 8, Application 9, Analysis 3) (14.29%)
    • II.A. Assemble / Troubleshoot Devices (15 of 20 section items; Recall 4, Application 8, Analysis 3) — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention (2 of 20 section items; Recall 2, Application 0, Analysis 0) — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures (3 of 20 section items; Recall 2, Application 1, Analysis 0) — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS (70 of 140 scored items; Recall 10, Application 30, Analysis 30) (50%)
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways (10 of 70 section items; Recall 3, Application 4, Analysis 3) — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques (5 of 70 section items; Recall 2, Application 2, Analysis 1) — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation (15 of 70 section items; Recall 1, Application 5, Analysis 9) — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan (18 of 70 section items; Recall 1, Application 7, Analysis 10) — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice (6 of 70 section items; Recall 0, Application 2, Analysis 4) — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care in High-Risk Situations (5 of 70 section items; Recall 0, Application 2, Analysis 3) — 1. Emergency a. cardiopulmonary emergencies, excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, endobronchial ultrasound (EBUS), navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education (3 of 70 section items; Recall 1, Application 2, Analysis 0) — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent
Examination sources

California Law & Professional Ethics Course — post-course test

Examination outline
  • Module 1:
    • Differentiate between morals and ethics; distinguish between ethical problem, distress, and dilemma; identify the three components of an ethical problem; and identify the six steps in the analysis of an ethical problem.
  • Module 2:
    • Identify and define deontological theories, teleological theories, and virtue ethics; and describe the benefits of evaluation in future decision-making situations.
  • Module 3:
    • Define decisional capacity; differentiate between informed consent and implied consent; identify how informed consent is applied to minors and those who lack decisional capacity; and define and explain advance directives, to include living wills, power of attorney and do not attempt resuscitation/limitation of treatment orders.
  • Module 4:
    • Define and explain confidentiality and the release of information; define HIPAA and understand its impact on the health care environment; identify what information is confidential and how it relates to the patient's right to privacy; explain truthful disclosure and its impact on the health care environment.
  • Module 5:
    • Define and relate professional ethics to the health care professions; define "self-deception" and how it affects personal integrity; explain the purpose of a scope of practice; and recognize consequences of practicing outside scope of practice.
  • Module 6:
    • Relate the need for continuing education to the maintenance of clinical competency and identify the role continuing education plays in patient safety.
  • Module 7:
    • Define conflict of interest; define real and perceived conflicts of interest; and recognize situations in which a conflict of interest exists.
  • Module 8:
    • Distinguish between intentional and unintentional torts; identify common unethical or illegal acts that result in disciplinary action; identify the three basic elements of fraud; identify the consequences of tort law violations; and distinguish the differences between negligence and malpractice; and understand the licensure issues affecting respiratory care practitioners.
  • Module 9:
    • Relate relevant history regarding biomedical research to current research practice; identify directives for biomedical research, to include the Nuremburg Code, the Declaration of Helsinki, the Belmont report, and 45 CFR 46; identify the role of the Institutional Review Board in biomedical research.
  • Module 10: Part 1:
    • Cite the requirements of the laws and regulations governing the practice of respiratory care in the state of California including patient related violations.
  • Module 10: Part 2:
    • Cite the requirements of the laws and regulations governing the practice of respiratory care in the state of California including license administration violations.
  • Module 1: Part 3:
    • Cite the requirements of the laws and regulations governing the practice of respiratory care in the state of California including conviction violations.
Examination sources

Law and Professional Ethics Course — post-course examination

Examination outline
  • Law and Professional Ethics Course: Leadership 3.00 CEs
    • Current legal and ethical issues in Respiratory Care; critical thinking with relevant laws and regulations; California legal and regulatory framework
Examination sources

Clinical Simulation Examination

Provider
The National Board for Respiratory Care (NBRC); administered Monday through Saturday at more than 300 assessment centers through the NBRC testing agency PSI
Format
Computer-based clinical simulation examination of patient-management problems with information-gathering and decision-making sections; each section of each problem is classified to a minor content heading of the Detailed Content Outline. Admission requires the CRT and a TMC pass at the high cut score; with the implementation of the Respiratory Therapy Examination the CSE is available only to those who passed the TMC at the high cut score by December 31, 2026, and it ends December 31, 2027
Exam questions
22 problems: 20 scored and 2 pretest
Time limit
4 hours
Passing score
Points associated with the candidate’s set of responses are summed across the whole examination into one score compared with a cut score linked to examination committee decisions on whether each positively-scored option is required as a demonstration of minimal competence
Exam fee
$200 for both new and repeat applicants
Examination outline
  • I. PATIENT DATA
    • I.A. Evaluate Data in the Patient Record — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, Apgar scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, Apgar score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary exercise testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary exercise testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF EQUIPMENT, AND INFECTION CONTROL
    • II.A. Assemble /Troubleshoot Devices — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation device; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care Techniques in High-Risk Situations — 1. Emergency a. cardiopulmonary emergencies excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, EBUS, navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent
Examination sources