John B. Roberson, DMD
Co-Founder

 
Chris M. Rothman, DDS
Co-Founder
Institute of Medical Emergency Preparedness, LLC
Hattiesburg, Mississippi
Phone: 866.729.7333
Email: info@emergencyactionguide.com
Web site: www.EmergencyActionGuide.com

This past Sunday at church, I had the pleasure of hearing our preacher’s sermon titled Preparing for the Unexpected. The unknowns were when, how, and where. Her sermon was related to preparations and I can’t help but see the parallelism to medical emergencies. Think about the 3 “unknowns” that were just mentioned and how they each relate to a medical emergency. When will I have my medical emergency? How will I perform during my medical emergency? Where will my medical emergency take place? Consider the dental office medical emergencies we’ve read or heard about over the past year. Some of these events had tragic results. Recently published in the ADA News, David Wilson, DMD, talked about the day we all dread—calling 911 to our office.¹ Why do we dread that? Is it the unknown? Is it that we are embarrassed? Is it that we know we aren’t prepared? These are all questions we have asked ourselves, but what are we doing about it?

Your State of Preparedness

To further assist us in establishing a good foundation for medical emergencies, our profession has been blessed by individuals who lecture on this topic such as Stanley Malamed, Larry Sangrik, Ernie Luce, and Mike Edwards just to name a few. All these individuals report that their courses seem to always have a good turnout. Again, what is the mystique? Does the audience like to hear the case reports of something that happened so tragically in another office? Be careful to criticize because none of us know when that case report might be our office. Do the participants lack a good foundation or base in medical emergency preparedness? An article written in the Journal of Dental Education stated that the training in dental schools had a large disparity in the number of hours dedicated in training of medical emergencies and a standardization of medical emergency education needed to take place to ensure an appropriate level of training for all dental students.²

In an interview with Stanley Malamed, DDS, by Steven Diogo that was published in the October 2004 issue of Dental Practice Report, Diogo asked the following question to Dr. Malamed: “What would you say is the general level of awareness and preparedness in the average general practice?” Dr. Malamed’s response: “Poor. I’ve been teaching medical emergency preparedness for 30 years, and it’s always been poor.”

Calling 911

Because none of us will know the when, how, and where of a medical emergency, all we can do is to prepare ourselves, our staff, and our facility by taking the necessary measures. The necessary measures are the 6 Links of Survival (which were discussed in the June issue of Dental Interactive) and are imperative for every dental practice and are as follows:

1. Dentist training

2. Staff training

3. Proper equipment

4. Medical emergency plan

5. Emergency drug kit (automatic external defibrillator [AED], vital signs monitors, portable oxygen, etc)

6. Mock drills.

A recent post on a popular dental web site told about a young woman who had a heart attack at a dental office. Her cries to call 911 were ignored 3 times by the staff. Luckily, a patient in the waiting room did call 911 and she has recovered.

Calling 911 shouldn’t be something you dread. It is part of a plan to assist you in preserving the life of a patient, staff member, or yourself. Consider 911 your colleague when you need help; however, you must do your part by being able to keep patients alive until emergency medical services (EMS) arrives. It’s your duty to demonstrate to the EMS personnel who arrive at your office that you are handling a stressful situation by being able to do something rather than nothing. Don’t dread 911, be thankful we have such a system in place but don’t make calling 911 your “only” plan for medical emergencies. Do your part for 911/EMS as well as your patients by taking charge of any deficiencies that you have in this area. This is your moral, ethical, legal, and professional obligation to your patient to be fully prepared. Are you meeting the legal standard of care with medical emergencies in your office?

Legal Standard of Care

All dentists employ local anesthetics. Be sure to notice what the package insert says on each can of local anesthetics. The package insert has a warnings section that states: dental practitioners who employ local anesthetic agents should be well versed in diagnosis and management of emergencies which may arise from their use. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use. This is a legal binding document.

PREPARE

September was National Preparedness Month as declared by the National Preparedness Coalition (NPC), which is part of the US Department of Homeland Security. The Institute of Medical Emergency Preparedness submitted the PREPARE campaign to the NPC (www.ready.gov). PREPARE is:

· Prevention—perform a thorough medical history on each patient.

· Recognition—be able to recognize signs and symptoms of any medical emergency.

· Education—purchase the Emergency Response System by IMEP to be adequately trained and prepared for a medical emergency.

· Plan—have a thorough medical emergency plan which includes a specific role/duty for each member of the dental team. The Emergency Response System already has the plan for you.

· AED—is the only treatment for a sudden cardiac arrest; purchase one and make sure everyone in the office knows how to use it. The Emergency Response System has a specific algorithm dedicated to sudden cardiac arrest and AEDs.

· Respond—be able to react and respond confidently and quickly to a medical emergency. The training one receives from the Emergency Response System will prepare you to handle this stressful, chaotic event.

· Emergency drug kit—have one in your office; everyone needs to know the contents of that kit as well as how to use it; never let any drug become expire. The Emergency Response System covers the emergency drug kit as well as provides you with an expiration checklist.

Conclusion

If you fail to take the when, how, and where of a medical emergency seriously, the manner in which you handle a medical emergency will be very poor. As the old saying goes, “no one plans on failing, they just fail to plan.” Life comes at us fast and the same applies for a medical emergency, especially in an unprepared office. Are you prepared to live with the fact that had you and your office been prepared, a difference could have been made in a person’s life?

You are either prepared or not prepared—there is no middle ground. Which one are you? Prepare for the unexpected today like your life depended on it tomorrow.

Are you truly prepared? For more information, please visit www.EmergencyActionGuide.com.

References

1. Wilson D. When a medical emergency takes place in the dental office. ADA News. 2007;38(15):4-5.

2. Clark MS, Wall BE, Payne BC. A twenty-year follow-up survey of medical emergency education in US dental schools. J Dent Educ. 2006;70(12):1316-1319.