Duty of care

Dental practices have a duty of care to ensure that an effective and safe service is provided to their patients. The satisfactory performance in a medical emergency in the dental practice has wide-ranging implications in terms of equipment, training, standards of care, clinical governance, risk management and clinical audit.

Maintaining the knowledge and competence to deal with medical emergencies is an important aspect of all dental care professionals’ (DCPs’) continuing professional development (CPD).1 The updated posters described in this article are designed to be aide-memoires to assist DCPs to safely and effectively manage medical emergencies occurring in their workplace.

The aim of this article is to provide an overview to the updated posters which are designed to help manage medical emergencies in the dental practice.

Incidence of medical emergencies

Medical emergencies in the dental practice that have been reported include vasovagal syncope (63%), angina (12%), hypoglycaemia (10%), epileptic seizures (10%), choking (5%), asthma (5%) and anaphylaxis.2 Vasovagal syncope is the most common emergency, accounting for approximately two thirds of all emergencies reported.3

The GDC and medical emergencies

A medical emergency could occur at any time in the dental practice. The General Dental Council (GDC)1 states it is important to ensure that:

  • There are arrangements for at least two people to be available within the working environment to deal with medical emergencies when treatment is planned to take place. In exceptional circumstances the second person could be a receptionist or a person accompanying the patient

  • All members of staff, including those not registered with the GDC, know their role if there is a medical emergency

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

National guidance on the management of medical emergencies

The ‘Medical emergencies in the dental practice’ section of the British National Formulary (BNF)4 provides guidelines on the management of the more common medical emergencies which may arise in the dental practice. Further information is also available from the BDA (if your principal is a member) at www.bda.org/medicalemergencies.

Specific guidance is also provided by other authoritative bodies including the British Thoracic Society (asthma), the British Heart Foundation (cardiac emergencies), the National Institute for Health and Care Excellence (NICE) (epileptic seizures), the Stroke Association (acute stroke), Diabetes UK (hypoglycaemia) and the Resuscitation Council (UK) (anaphylaxis).

The Resuscitation Council (UK) no longer provides specific guidance on medical emergencies in the dental practice (formerly provided in their publication Medical emergencies and resuscitation standards for clinical practice and training for dental practitioners and dental care professionals in general dental practice). This was superseded in November 2013 by its publication Quality standards for cardiopulmonary resuscitation practice and training in primary dental care, in which the Resuscitation Council (UK) continues to provide helpful guidance on all aspects relating to cardiopulmonary resuscitation in the dental practice.5

Poster 1

The ‘Medical emergencies in the dental practice’ A3 poster (Fig. 1) was first produced in 2009 as an aide-memoire to assist dental staff to safely manage medical emergencies occurring in the dental practice.6 It was updated7 in 2012 and now revised again in 2015. The 2015 revisions include:

Figure 1
figure 1

Poster 1: Medical emergencies in the dental practice

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  • Increased emphasis on the Airway Breathing Circulation Disability Exposure approach to the management and treatment of medical emergencies

  • Inclusion of adrenal crisis in line with guidance in the BNF4

  • New NICE guidance concerning midazolam administration for epileptic seizures (midazolam injection is no longer considered an option for buccal administration)8

  • Emphasis on the importance of having immediate access to an automated external defibrillator (AED).5

The poster is intended to be placed on the wall in the surgery where it can be easily and quickly accessed should an emergency occur. The emergencies covered are listed in alphabetical order:

  • Adrenal crisis

  • Anaphylaxis

  • Asthma

  • Cardiac emergencies

  • Epileptic seizures

  • Hypoglycaemia

  • Stroke

  • Syncope.

The important signs and symptoms to look out for to help correctly diagnose each emergency are listed, together with the principles of safe and effective treatment. Where appropriate, the recommended doses of drugs (including paediatric doses) and routes of administration are also stated.

This poster can be downloaded from Walsall Healthcare NHS Trust's website: https://www.walsallhealthcare.nhs.uk/medical-education.aspx.

Poster 2

The ‘Emergency drugs in the dental practice’ A4 poster (Fig. 2) was first produced in 2012 as an aide-memoire to assist dental staff to safely administer medications in the emergency situation.7 This poster has also been revised in 2015 to incorporate the new NICE guidance concerning midazolam administration for epileptic seizures (midazolam injection is no longer considered an option for buccal administration).8 The poster is designed to be kept in the emergency drugs box for quick reference. Further copies can be downloaded from Walsall Healthcare NHS Trust's website: https://www.walsallhealthcare.nhs.uk/medical-education.aspx.

Figure 2
figure 2

Poster 2: Emergency drugs in the dental practice

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Training

All dental staff should be trained and receive regular updates in the management of medical emergencies and possess up-to-date evidence of capability.9 Running regular mock scenarios/drills involving the team approach is advised.1 In the author's experience, some surgeries find it helpful to use the poster in the training session to increase familiarity in its use.

Conclusion

Every dental practice has a duty of care to ensure that an effective and safe service is provided for its patients.

This article has provided an overview to the updated posters designed to help manage medical emergencies in the dental practice.

The author is grateful to Najam Rashid and Ruchi Joshi, ED Consultants and Sarah Church, Consultant Orthodontist, Manor Hospital, Walsall UK for proof reading the poster and to Daniel McAlonan, Head of Health & Safety, British Dental Association for his suggestions and helpful advice.