General Requirements to Prepare for Medical Emergencies
Although medical emergencies in dental practice are rare, it is important that each dental team is prepared to deal effectively with any medical emergency at any time.
Ensure all staff are appropriately trained (see Emergency Life Support Training)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 that are 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 Mar 2021 template (Word)
- 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; this will 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 Mar 2021 template (Word)
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 , 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 Templates below) of how to manage 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 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.
Sources of Information
- Principle 6: Work with colleagues in a way that serves the interests of patients. Standards for the Dental Team. General Dental Council (2013) https://standards.gdc-uk.org/pages/principle6/principle6.aspx
- Drug Prescribing For Dentistry: Dental Clinical Guidance (3rd Edn)(2021). Scottish Dental Clinical Effectiveness Programme
- Joint Formulary Committee. British National Formulary, Edn 82, London. British Medical Journal Group and Pharmaceutical Press (2021) bnf.nice.org.uk/