Most dentists have the drugs and equipment required for managing medical emergencies

Key Points

• The vast majority of dentists have the necessary drugs and equipment for managing medical emergencies in their practice.

• The findings of this survey should stimulate debate in the profession about the emergency drugs and equipment which should be available in the dental practice.

• Any guidelines for emergency drugs should include routes of administration which it is reasonable to expect a dentist to be able to carry out.

Abstract

Objective

To ascertain the emergency drugs and equipment possessed by general dental practitioners (GDPs), the treatment provided and drugs used in management of the medical emergency events they reported.

Design

Postal questionnaire survey of a random sample of GDPs in Great Britain.

Subjects

1500 GDPs, 1000 in England & Wales and 500 in Scotland.

Results

There was a 74% response. An aspirator, an airway, oxygen, adrenaline and an injectable steroid were possessed by about 90% of respondents; glucose, glyceryl trinitrate and a salbutamol inhaler by about 80%. Glucose was used in the management of nearly one in ten of the events reported, an inhaler, glyceryl trinitrate and oxygen were the next most commonly used. Cardiopulmonary resuscitation (CPR) was carried out in management of 1.1–1.4% of events not associated with general anaesthesia (GA) and in 4.7–16% of events associated with GA, an average of once in 250 years of practice.

Conclusions

Most respondents possessed drugs and equipment necessary to manage a medical emergency. Half the drugs recommended by the 'Poswillo report' to be available in every dental practice were not used in more than 8000 years of practice

Main

Medical emergencies in general dental practice in Great Britain Part 2: drugs and equipment possessed by GDPs and used in the management of emergencies G J Atherton, J A McCaul and S A Williams Br Dent J 1999; 186: 125–130

Comment

This paper shows the percentage of respondents who possess each of the 20 items of equipment and emergency drugs specifically asked about in a questionnaire. It would have been helpful to know precisely how the randomisation was carried out, nevertheless the authors have made a good attempt at obtaining information on the possession and use of drugs for medical emergencies in the practice. These drugs were recommended by the Poswillo report published in March 1990, which contained the advice of two members of the working party who were anaesthetists and were on the Resuscitation Council (RC).

The report of the RC was published in 1977 and there have been dramatic changes in the practice of dentistry generally, and particularly in the management of emergencies in medical and dental practice, since that time. The RC has also re-published its guidelines on resuscitation and the Poswillo report recommended that every practice should have the RC's manual ABC of Resuscitation in their practice.

After almost 10 years, the recommendations of the Poswillo report are considerably out of date with current management procedures and it would have been appropriate if in its recent document 'Maintaining Standards' the GDC had reminded practitioners that they should have an up to date version of this particular manual for immediate reference and regular review during CPR training. The authors' reference 10 – to a more recent paper by McCarthy, 'Emergency drugs and devices: less is more', – should be mandatory reading for all practitioners. It gives an updated version of what the working party on 'General anaesthesia, sedation and resuscitation in dental practice' would undoubtedly have provided had it been written at approximately the same time. McCarthy's article suggests that the majority of respondents possessed the equipment and drugs which are currently recommended for the management of medical emergencies and that they checked on the expiry date of these drugs either individually or by a reminder from the supplier. They reported on drugs which were recommended by McCarthy yet the three most commonly used were possessed by approximately only 4 out of 5 respondents.

Some members of the original Poswillo working party have for a number of years run courses at which both dentists and their assistants were entitled to attend and practice CPR on a mannequin with a recorder to assess efficiency and were also trained in venepuncture using a cannula inserted into the back of the hand. It was evident to the teachers on these courses that the dental nurses were better at managing the insertion of indwelling cannula than the dental practitioners! Considerably more training is required in this area during the period of dental teaching at the undergraduate level.

The drugs most commonly used in the management of medical emergencies are listed in the conclusions but no specific advice is given about the rapid rate of deterioration of glyceryl trinitrate tablets. Those that are carried by patients and brought into the dental surgery may well have lost anything up to 70% of their potency in 6 months. It may be preferable to substitute the tablets with a canister which dispenses an aerosol dose of nitroglycerine which can be sprayed under the tongue, where it is much more readily absorbed. The spray also has a shelf life of three years, a considerable cost advantage.

In summary, this is an excellent paper, all the references are relevant and I believe that many, if not all, should be read by those who advise the GDC on any further changes which are to be made in the sections on general anaesthesia, sedation and resuscitation.