Each dental practice must stock a selection of drugs for use in medical emergencies. The Prescription Only Medicines (Human Use) Order 1997 [1] lists injectable drugs that can be administered by anyone for the purpose of saving a life in an emergency; this includes adrenaline and glucagon. Therefore, all dental team members may administer adrenaline and glucagon, and the non-injectable drugs listed below. However, dental team members must be competent in the use of these drugs, and employers must accept responsibility for the actions of staff.
NB: The list of drugs for use in medical emergencies includes midazolam which is a Schedule 3 controlled drug and therefore its use must comply with relevant legislation (see Controlled Drugs for further information).
To enable you to deal with medical emergencies, ensure that you have immediate access to the following drugs [2,3]:
- Adrenaline, 1 ml ampoules or pre-filled syringes of 1:1000 solution for intramuscular injection.
- Aspirin, 300 mg dispersible tablets.
- Glucagon, for intramuscular injection of 1 mg.
- Glyceryl trinitrate spray, 400 micrograms per metered dose.
- Midazolam oromucosal solution (or when permitted [4], midazolam injection solution, 5 mg per ml, 2 ml ampoules, for topical buccal administration)
NB: Midazolam oromucosal solution is available as pre-filled oral syringes; several sizes are available to allow for exact dosing for different age groups.- Oral glucose/sugar (there are several alternative forms, including non-diet fizzy drinks, glucose gel, powdered glucose and sugar lumps).
- Oxygen cylinder(s)
NB: some cylinders have a built-in (integral) regulator, whereas others have a bolt-on regulator. These are not interchangeable so ensure you are aware of the type of cylinder in use and that spare cylinders are fit for use.- Salbutamol inhaler, 100 micrograms per actuation.
NB: Emergency drug boxes that contain recommended drugs can be purchased from suppliers.
In addition, dental practices might wish to stock the following to aid the management of patients with mild allergic reactions [3]:
- Cetirizine, 10 mg tablets or oral solution (5 mg/5 ml);
- Chlorphenamine, 4 mg tablets or oral solution (2 mg/5 ml);
(NB: chlorphenamine can cause drowsiness) - Loratidine, 10 mg tablets or syrup (5 mg/5 ml).
Risk assess the number of oxygen cylinders you will need to stock and ensure you have sufficient oxygen for at least 30 minutes supply at 15 litres per minute e.g. two Size D or two Size CD or one Size E cylinder [5].*
- If the ambulance response times are likely to be prolonged (e.g. for remote practices), additional cylinder capacity may be required to ensure that a collapsed patient can be adequately maintained on oxygen.
* In dental practices, oxygen cylinders that are typically used include:
- Size D - contain 340 litres of oxygen when full and should provide oxygen for approximately 22 minutes;
- Size CD - contain 460 litres of oxygen when full and should provide oxygen for approximately 30 minutes;
- Size E - contain 680 litres of oxygen when full and should provide oxygen for up to 45 minutes.
The oxygen cylinders should be able to provide a flow rate of at least 15 litres per minute, should be at least 75% full, within the expiry date, checked regularly and serviced at least every 5 years (or according to manufacturer’s instructions). See Storage of Medical Oxygen Cylinders for advice on safe storage.
Sources of information
- The Prescription Only Medicines (Human Use) Order 1997
- Medical Emergencies in Dental Practice. British National Formulary
- Drug Prescribing For Dentistry. (3rd ed) (updated 2021) Scottish Dental Clinical Effectiveness Programme
- Use of midazolam 10mg/2ml ampoules for buccal administration in emergency dental boxes. CDO letter of 18 March 2022. Scottish Government
- Emergency drugs and equipment in primary dental care. (2024) Scottish Government