Dentists are well versed in dealing with emergency dental problems, like severe toothaches, abscesses and traumatic facial injuries. However, these are not the only kind of emergency situations that people working in the dental healthcare industry need to be prepared for.
Serious medical emergencies, such as heart attacks, strokes, angina, epileptic seizures and asthma attacks, can occur anywhere, at any time. Unfortunately, dental surgeries are not immune to these occurrences and, for this reason, dentists need to have the skills, knowledge and equipment required to deal with life-threatening situations.
According to the General Dental Council (GDC), all registered dental professionals should be trained in dealing with medical emergencies and should have up to date evidence of capability. Furthermore, the GDC states that practices in which patients are seen clinically should have access to defibrillators and emergency drugs kits. While there is no legislation in place in the UK that states dentists must have a defibrillator on site, it is advisable to take such precautions not only to safeguard health, but because a business could be deemed negligent for not taking appropriate safety measures if a problem should arise.
A practice that takes the health of its patients seriously and is willing to invest in equipment to protect them is a responsible practice. Every dental practice has a duty of care to provide a safe and effective service. If you’re a dental professional and you want to make your surgery as safe as possible, it’s important to understand the ins and outs of the tools you need. If you neglect to obtain the right apparatus and drugs and do not know how to use them, lives could be lost.
An automated external defibrillator (AED) is a portable electrical device that is designed to detect the rhythm of the heart and provide a shock if an arrhythmia is present. Defibrillation is critical in the resuscitation of a person suffering from a sudden cardiac arrest (SCA) and should be performed within two to three minutes of collapse. If this technique cannot be performed straight away, cardiopulmonary resuscitation (CPR) should be carried out until an AED is on the scene. It is recommended that dental practitioners and other dental care professionals receive training in CPR so that in the event of a cardiac arrest they can recognise the symptoms and start performing chest compressions on the patient.
AEDs are designed to be used by anyone, including people that haven’t been trained. However, it’s a good idea to familiarise all staff members with the device so that they understand the importance of using it correctly and in a timely manner should someone experience a SCA while they are on duty. The machines require very little preparation before use and will give verbal instructions to guide the operator through the process. They will only deliver a shock if one is needed.
Adult AEDs can be used on children over eight years old. However, some devices have paediatric pads and settings that make them more suitable for younger children. This allows for effective and measured treatment regardless of patients’ age or size. These adjustable AEDs should be considered for practices that regularly treat children.
Fortunately, cardiac arrest emergencies are rare. However, it’s important to acknowledge that they can happen at any time. Indeed, Dr Chris Tavares was faced with a patient suffering a cardiac arrest in the dental chair on 16th April 2015. Luckily, he had been trained in how to deal with medical emergencies and had access to the right equipment in his practice, enabling him to effectively resuscitate the patient. Commenting on the incident, Dr Tavares said: ‘I have no doubts the AED contributed to the positive outcome.
‘It made the whole incident so much more easy to handle and I will forever be grateful we had one.’
The Resuscitation Council UK recommends that dental practitioners have immediate access to resuscitation drugs to enable initial treatment and help them manage common medical emergencies. Dental practitioners can obtain emergency drugs through a prescribing dentist or a doctor under patient-group directions. The following drugs are recommended by the Resuscitation Council UK for dental practices:
● Glyceryl trinitrate (GTN) spray (400 micrograms/dose)
● Salbutamol aerosol inhaler (100 micrograms/actuation)
● Adrenaline injection (1:1000, 1mg/ml)
● Aspirin dispersable (300mg)
● Glucagon injection (1mg)
● Oral glucose gel
● Midazolam 10mg (buccal)
The emergency drug kit should also provide information on how to identify and manage medical emergencies to help staff respond effectively while awaiting professional medical help. All drugs should be stored together in a purpose-made emergency drug kit.
Some dental practices also have emergency oxygen cylinder kits to help treat patients who suffer from medical emergencies, such as SCA. Oxygen cylinders are safe and simple to use and deliver immediate high flow oxygen (between one and 15 litres per minute) to prevent the patient from deteriorating before the emergency services arrive on the scene. They should be used in the first few minutes after the emergency has occurred by an appropriately trained first aider. Oxygen cylinders should be highly portable and enable the delivery of an adequate flow rate of oxygen. If available, a pulse oximeter should be used to monitor the level of oxygen given to the patient.
First aid kit
As well as life-threatening conditions, there are other situations that can occur in a dental practice that will require prompt first aid treatment, such as broken bones, sprains, cuts and burns. In every dental practice, it is recommended that there are at least two named first aiders who can deal with accidents and emergencies and who have an in depth knowledge of emergency treatment. Any member of staff in the dental team can become a named first aider.
As a minimum, first aid kits should include triangular bandages, wound dressings, eye pads, safety pins, disposable gloves and a guidance leaflet on how to effectively use the contents of the kit. Dental practitioners are not permitted to have creams, medicines or tablets in their first aid kits.