Dental Practices - Cardiopulmonary Resuscitation & Medical Emergencies

The following extracts have been taken from the Resuscitation Council UK Website, and do not constitue the full guidelines.

Standards for Clinical Practice and Training for Dental Practitioners and Dental Care Professionals in General Dental Practice

"The General Dental Council's core ethical guidance booklet ‘Standards for dental professionals' and associated, supplementary guidance, emphasise that all dental professionals are responsible for putting patients' interests first, and acting to protect them.

Central to this responsibility is the need for dental professionals to ensure that they are able to deal with medical emergencies that may arise in their practice. Such emergencies are, fortunately, a rare occurrence, but it is important to recognise that a medical emergency could happen at any time and that all members of the dental team need to know their role in the event of a medical emergency.

Our guidance ‘Principles of dental team working' states:

If you employ, manage or lead a team, you should make sure that:

• There are arrangements for at least two people available to deal with medical emergencies when treatment is planned to take place.

• All members of staff, not just the registered team members, know their role if a patient collapses or there is another kind of medical emergency.

• All members of staff who might be involved in dealing with a medical emergency are trained and prepared to deal with such an emergency at any time, and practise together regularly in a simulated emergency so they know exactly what to do.

Executive Summary

• Medical emergencies are rare in general dental practice.

• There is a public expectation that Dental Practitioners and Dental Care Professionals should be competent in managing common medical emergencies.

• All dental practices should have a process for medical risk assessment of their patients.

• All Dental Practitioners and Dental Care Professionals should adopt the ‘ABCDE' approach to assessing the acutely sick patient.

• Specific emergency drugs and items of emergency medical equipment should be immediately available in all dental surgery premises. These should be standardised throughout the UK.

• All clinical areas should have immediate access to an automated external defibrillator (AED).

• Dental Practitioners and Dental Care Professionals should all undergo training in cardiopulmonary resuscitation (CPR), basic airway management and the use of an AED.

• There should be regular practice and scenario based exercises using simulated emergencies.

• Dental practices should have a plan in place for summoning medical assistance in an emergency. For most practices this will mean calling 999.

• Staff should be updated annually.

• Audit of all medical emergencies should take place.

The 2002 GDC document ‘The First Five Years. A Framework for Undergraduate Dental Education' states that Dental Practitioners must be competent in resuscitation techniques, have the knowledge to diagnose common medical emergencies and be confident in managing such situations. Despite such recommendations, many Dental Practitioners do not feel capable of identifying many of the causes of collapse and even fewer feel comfortable dealing with emergencies like myocardial infarction, anaphylaxis and cardiopulmonary arrest.

Emergency Drugs in General Dental Practice

Specific emergency drugs should be immediately available in all dental surgery
premises. These should be standardised throughout the UK.

1.  To manage the more common medical emergencies encountered in   general dental practice the following drugs should be available:

• Glyceryl trinitrate (GTN) spray (400micrograms / dose)

• Salbutamol aerosol inhaler (100micrograms / actuation)

• Adrenaline injection (1:1000, 1mg/ml)

• Aspirin dispersable (300mg)

• Glucagon injection 1mg

• Oral glucose solution / tablets / gel / powder

• Midazolam 5mg/ml or 10mg/ml (buccal or intranasal)

• Oxygen

2.  Where possible drugs in solution should be in a pre-filled syringe.

3.  The use of intravenous drugs for medical emergencies in general dental practice is to be discouraged. Intramuscular, inhalational, sublingual, buccal and intranasal routes are all much quicker to administer drugs in an emergency.

4.  All drugs should be stored together in a purposely-designed ‘Emergency Drug' storage container.

5.  Oxygen cylinders should be of sufficient size to be easily portable but also allow for adequate flow rates, e.g., 10 litres per minute, until the arrival of an ambulance or the patient fully recovers. A full ‘D' size cylinder contains 340 litres of oxygen and should allow a flow rate of 10 litres per minute for up to 30 minutes. Two such cylinders may be necessary to ensure the supply of oxygen does not fail when it is used in a medical emergency.

Training of Staff

1.  Staff should undergo regular training in the management of medical
emergencies to a level appropriate to their expected clinical responsibilities.

2.  Dental Practitioners and Dental Care Professionals must be trained in cardiopulmonary resuscitation (CPR) so that in the event of cardiac arrest they should be able to:

• Recognise cardiac arrest.

• Summon help (dial 999).

• Start ‘CPR', i.e., ventilate the patient's lungs with a pocket mask or selfinflating bag and mask device and provide chest compressions (at a rate of 100 per minute) according to current resuscitation guidelines. Evidence suggests that chest compressions can be effectively performed in a dental chair.

• Give high flow rate oxygen (10 litres per minute) as soon as practicable.

• Attach an AED as soon as possible after collapse. Follow the prompts from the machine and attempt defibrillation when indicated.

• Provide other advanced life support skills if appropriate and trained to do so.

3.  Staff working in practices that treat children should learn the modifications to
adult CPR for use in children (see Appendix (iii)) and practise on paediatric
manikins.

4.  Staff should update their skills at least annually.

5.  A system must be in place for identifying which equipment requires special training, such as defibrillators (AEDs) and self-inflating bag and mask devices.

6.  All new members of staff should have resuscitation training as part of their induction programme.

7.  Training can be undertaken locally within the dental practice or within local and regional training centres. Designated ‘trainers' from within the dental practice staff should be encouraged to undertake ‘cascade' training, e.g., BLS. More complex training e.g., AED, may require a specific trainer (Resuscitation Officer) or attendance at a designated course.

8.  Training in resuscitation must be a fundamental requirement for Dental
Practitioner and other Dental Care Professional qualifications.  Undergraduate and postgraduate examinations for all Dental Practitioners and Dental Care Professionals should include an evaluation of competency in resuscitation techniques appropriate to their role.

9. All general dental practices should recognise the need for and make provision for staff to have sufficient time to train in resuscitation skills as part of their employment.

10.  All training should be recorded in a database.

11.  Training and retraining should be a mandatory requirement for Continuing Professional Development and maintenance on professional healthcare registers.

To view the full version of 'Standards for Clinical Practice and Training for Dental Practitioners and Dental Care Professionals in General Dental Practice' please visit the Resuscitation Council Uk website on www.resus.org.uk.

To speak to one of the Back to Life team directly concerning your training requirements, please do not hesitate to Contact Us.