Quality Resource Guide –
Medical Emergencies:
Preparation and Management 4th Edition
www.metdental.com
Page 3
2. Dental Office Emergency Team.
When an emergency arises all office personnel
should be able to respond rapidly and efficiently.
This mandates the existence of a predetermined
plan describing each person’s function. A simple
plan is described:
Member #1 is the first person at the scene of the
emergency. When the situation develops in the
dental chair this might be the doctor, hygienist or
assistant. Where the situation occurs in the reception
area it is the ‘front office’ people who will respond
first. Thus the earlier recommendation that all office
personnel be BLS-HCP trained.
Member #1 (1) remains with the victim; (2) administers
BLS, as needed; and (3) activates the dental office
emergency team (e.g. Yells for help!).
Member #2 is assigned to immediately ‘bring the
stuff’ to the site of the emergency. The oxygen
cylinder, emergency drug kit, and AED are kept
together in an easily accessible location (e.g. near
a telephone).
Member #3 is, in fact, the remaining members of
the office staff. Possible duties include: activation
of EMS; waiting outside for arrival of EMS and
escorting them to the office; ‘holding’ the elevator in
the lobby for EMS; monitoring vital signs; preparing
emergency drugs for administration; keeping a
written record of the event, including a time line and
treatment (e.g. 10:15 AM – EMS called; 10:21 EMS
arrives in dental office); and assisting in BLS.
The dentist remains the team leader, the one legally
responsible for the health and safety of the patient
(e.g. victim). Tasks may be delegated as long as the
person performing the task is capable of doing it well
under the dentist’s supervision.
3. Summoning Assistance.
Two questions:
When? and Whom?
When to call for help: Emergency medical assistance
should be sought as soon as the doctor (the person
legally responsible for the patient) feels it is needed.
This occurs (1) if the diagnosis of the problem
remains unknown; (2) when the diagnosis IS known
but is disturbing to the doctor; and (3) at any time the
doctor feels uncomfortable and wishes help.
Never hesitate to seek assistance in managing a
medical emergency if you feel it is warranted.
Whom to call: Emergency Medical Services (EMS)
are the first responders to life-threatening medical
emergencies in your community.
In all areas of
North America 9.1.1. is the EMS number. EMS
response times vary significantly from community
to community. In almost all situations EMS arrival
will occur within ten minutes. Where response
time is prolonged (e.g. traffic or rural environment)
and
the
dental
office
is
located in
a
‘medical-
dental’
complex
there
might
be available
another healthcare professional well trained in
emergency management.
It is this author’s opinion
that the Oral & Maxillofacial Surgeon or Dentist
Anesthesiologist commonly meets that standard as
they are usually trained in Advanced Cardiac Life
Support and general anesthesia.
Once EMS arrive at the site of the emergency
they will take over its management. Primary duties
of EMS are to (1) stabilize the victims condition
at the scene and (2) transport to the emergency
department of a hospital for definitive care, if
needed.
Table 3
Preparation of the Dental Office and Staff for Medical Emergencies
BASIC LIFE SUPPORT
Annually
BLS for Healthcare Providers
ALL dental office employees in the office
Ventilate mouth-to-mask, NOT mouth-to-mouth
DENTAL OFFICE EMERGENCY TEAM
Member #1
First on scene of emergency
Stay with victim; yell for “HELP”; administer BLS, as needed.
Member #2
On hearing call for “HELP”... obtains and brings to site of emergency:
(1) emergency drug kit;
(2) portable 0
2
cylinder; and
(3) AED
Member #3, #4 and on...
Assigned ancillary tasks such as:
Monitoring vital signs (BP, hear rate and rhythm)
Assist with BLS
Activate EMS (9.1.1)
Keep elevator available in lobby while awaiting arrival of EMS
Prepare emergency drugs for administration
Keep written timeline record during emergency
ACTIVATION OF EMS
(
E
mergency
M
edical
S
ervices)
When:
As soon as YOU, the doctor, think it is necessary.
For example: (1) unable to
make a diagnosis; (2) know the diagnosis but are uncomfortable with it (e.g.
cardiac arrest); and (3) whenever you think EMS is warranted.
DO NOT HESITATE TO ACTIVATE EMS
, if you feel it is needed.
Whom to call:
9.1.1.
, or a near-by physician or dentist IF you know beforehand that
they
are well trained in the management of emergency situations.
EMERGENCY DRUGS AND EQUIPMENT
See Tables 4 and 5