General requirements to prepare for medical emergencies

Ensure all staff are appropriately trained (see Training in the Management of Medical Emergencies) and are competent in the use of the equipment and drugs that they would be expected to use.

Ensure an up-to-date medical history is taken for all patients to facilitate identifying patients at particular risk of having a medical emergency.

Appoint a member of the dental team and a deputy to be responsible for resuscitation equipment and drugs.

Ensure that all staff know where to find emergency equipment and drugs, and that drugs are stored safely in an ’emergency drug’ box/container.

Check supplies of equipment and drugs for use in medical emergencies weekly to ensure that you have adequate quantities, drugs are in date and equipment is in working order (see Emergency Drugs and Equipment Weekly Log template).

• Note that the automated external defibrillator (AED) battery and pads should be replaced periodically; the timescale of this will depend on the AED model.

Check oxygen cylinders weekly, and after use, to ensure that they are at least 75% full, to enable adequate flow rates (15 litres/minute) to be maintained until the arrival of the ambulance or the patient recovers fully (see Medical Emergency Drugs).

Keep a log of these checks (see Emergency Drugs and Equipment Weekly Log template).

Store a fully assembled bag-valve-mask and tubing with the oxygen cylinder, but not connected to it.

Ensure a pocket mask with oxygen port is available in each surgery.

Ensure oxygen cylinders and regulators are serviced or replaced in accordance with manufacturers’ current guidelines. (This is currently 5 years for standard steel/aluminium cylinders and standard regulators; new carbon-fibre cylinders might have to be serviced or exchanged every 3 years).

Keep test certificates for oxygen cylinders and regulators (if not integral to the cylinders).

As recommended by the GDC [1], ensure that arrangements are in place for at least two people to be available to deal with a medical emergency when treatment is planned to take place.

Keep a written protocol (see Managing Medical Emergencies Policy and Procedure template) for the management of medical emergencies [2,3] that includes:

• signs and symptoms for each medical emergency;
• details of how to manage each type of medical emergency, and who in the dental team should do what;
• directions to the practice to give to emergency services;
• a note to give emergency services to include written details of any dental procedure that the patient has undergone and details of the medical emergency and any treatment given.

Undertake a Significant Event Analysis (SEA) after every medical emergency. Share any learning points with all staff and, where necessary, produce an action plan for improvement.

• If the response to the medical emergency involved a problem with medical equipment, this should be reported via the national incident reporting system.