Sometime a few years ago, my principal dentist showed me an article about a dentist who had unfortunately experienced a patient fatality at his practice. The patient had suffered an allergic reaction to a mouth rinse that contained chlorhexidine.
The fortunate thing for this dentist was that he and his dental team dealt with the emergency in the correct manner, even though it had a tragic ending. Even the paramedics (who arrived within five minutes) could not help the patient, and had nothing but praise for the dentist and his team.
We, like everyone else, receive annual CPR training - but when you think about it, how often do you actually deal with a real, life-threatening situation in a dental surgery? I have been in dentistry for twenty years, and fortunately the only medical situations I have experienced have been patients who have fainted.
The above story really drove home the message for me that you can never be over- prepared when it comes to dealing with medical emergencies. I have a medical nursing background, and the story motivated me to make sure that all our teams across the group are fully prepared to deal with emergencies. I therefore set about creating a medical training program that stretches out across the year.
The plan that I created is simple and educational. Using the Resuscitation Council (UK) Standard for Clinical Practice and Training, I made sure that I had all the listed medical emergency scenarios covered. The common medical emergencies that could happen in a dental practice are:
1. Asthma
2. Anaphylaxis
3. Cardiac emergencies
4. Myocardial infarction
5. Epileptic seizures
6. Hypoglycaemia
7. Syncope (fainting)
8. Chocking and aspiration
9. Adrenal insufficiency
I broke the theory sheets for these down into one training session each per month. With each theory sheet, a flow chart of how to deal with the emergency was provided.
We have a monthly staff meeting that is booked for a minimum of two hours. Each month a different person is nominated to lead the training so that each person gets a turn to prepare and to teach. My desire is for our teams to learn to be interactive and to enjoy the learning, but most importantly to become informed. The more they learn, the less stressed I feel! The educational or tool box talks can also form part of the personal development plans of your members of staff.
During the staff meeting, half an hour is dedicated to learning about common medical emergencies. The theory sheets are used for teaching the signs and symptoms of the emergency. We discuss the chosen subject in depth and we share relevant incidents that any of us have experienced over the years.
We then go through the emergency drug kit, discussing each drug and what it is used for. To make the drugs easier to recognise during a stressful situation, I have instructed my practice managers to have each drug labelled in terms of what it is used for. The label on the box is marked in red ink on a white label – so, for example, if it is Glyceryl Trinitrate spray (GTN) it would be marked CHEST PAIN – ANGINA ATTACK. In this way, staff would not have to think too much while under pressure.
We then go through the procedure of the O2 cylinder. We make sure that we all know how to open the O2 cylinder and close it, ensuring that it is closed completely to avoid a disaster. We make sure that we have the correct masks and tubing in place and that they are left in situ. The less time you need to spend trying to connect your tubing and mask, the quicker you can assist the patient.
It is also very important to make sure that staff members replace any used drugs or masks and tubing. Don’t wait until your weekly audit of your stock or drugs to replace used goods. My advice is to review your medical health questionnaire to ensure that it covers all medical questions. Make sure to update the health status of your patients at each visit. Notes of any changes are to be made on the back of the questionnaire, and this must be dated and then signed by the patient and dentist.
The nominated health and safety officer must be sure to do their weekly audits to ensure that the nominated individual is effectively carrying out their weekly checks. These can be done on different days. I conduct them randomly so that my staff members do not know when to expect them. I do this to ensure that they are always prepared and cannot work around my pending site visits.
Before ending the training session, we go through who the nominated persons are for each step of dealing with an emergency. One person needs to call the ambulance - in our case, this is our practice manager. A second person needs to stand outside the practice to wave the ambulance down. The dentist and nurse deal with the patient. When there has been an incident of fainting in any of our practices, I always find that one of the other dentists will come to the assistance of the dentist in need. This is great team work as we are all working for the needs of the patient.
As Winston Churchill once said ‘I never worry about action - only inaction’.
