First aid, defined as the initial assistance or treatment provided to someone who is injured or suddenly taken ill, covers a wide range of scenarios from simple reassurance following a minor mishap to dealing with a life-threatening emergency. Dental professionals may need to provide first aid in their dental practice to a patient, relative or member of staff.
The aim of this article is to provide an overview to first aid in the dental practice.
Priorities of first aid
The priorities of first aid are to:
Call 999 for an ambulance in a timely manner (if required)
Ensure the safety of the casualty and work colleagues is maintained
Keep the casualty alive: attention to airway, breathing, circulation, disability and exposure is paramount
Prevent the casualty from deteriorating
Promote the recovery of the casualty
Provide reassurance and comfort to the casualty.
Responsibilities when providing first aid
Remember the golden rule: ‘first do no harm’ while applying the term ‘calculated risk’.1
Responsibilities when providing first aid include:
Assessing the situation quickly and safely
Ensuring appropriate help is summoned
Protecting the casualty and others from possible harm
Identifying, as far as possible, the cause of the illness or the nature of the injury
Providing first aid within your own sphere of expertise and competence
Ensuring that any first aid provided follows current and up-to-date guidelines where appropriate
Minimising the risk of cross-infection
Reporting observations/findings to those taking over the care of the casualty
Adhering to the GDC's Standards for the dental team2
Maintaining the casualty's confidentiality following GDC's guidelines
Obtaining the casualty's consent (if possible) before administering first aid.3
Assessment of the casualty
The initial priority is always to check for any dangers. Approach the casualty carefully, ensuring there is no danger to either the rescuer or to him/her: look out for hazards, for example, electricity, fire and traffic. Measures should be taken to minimise the risk of cross infection.
Once it is deemed safe to approach, the priority is then to assess the casualty for life-threatening conditions and provide life-saving treatment as required. This phase, often referred to as the primary survey, involves assessing:
Once it is established that the casualty is out of immediate danger, perform a secondary survey. Depending on the situation, this could involve:
Taking a history
Looking for external clues
Ascertaining the mechanics of injury
Assessing signs and symptoms
Head to toe survey.1
Depending on the scenario, definitive care could involve:
Providing advice only
Advising the casualty to visit their GP
Arranging transport to take the casualty to hospital
Calling 999 for an ambulance.
Calling for an ambulance
If it is necessary to call for an ambulance: dial 999 (or 112) to alert the emergency services and request the service required (usually ambulance). The following information is important:
Exact location of the dental practice
Time of the incident
Exact details of the incident; if it is relevant the number of casualties, their age and sex and any information known about their condition
If appropriate, details of any hazards for example, gas and toxic substances.
Measures to minimise the risk of cross infection
Take measures to minimise the risk of cross infection, for example, hand-washing and wearing disposable gloves. Blood is the single most important source of the transmission of HIV and hepatitis B virus and universal precautions should be taken to avoid bodily fluids. Care with sharps is paramount as both HIV and the hepatitis B virus have been contracted by healthcare workers following needlestick injuries.
There are a number of environmental hazards that may be encountered when providing first aid including, gas, electricity, fire and poisoning.
If there is a smell of gas, if a gas leak is suspected or if there are concerns that fumes containing carbon monoxide are escaping from a gas appliance:
Call the National Gas Emergency Service immediately on 0800 111 999
Open all doors and windows to ventilate the property and disperse the gas
Do not turn on/off any electrical switches (including the doorbell)
Extinguish all naked flames, do not smoke, strike matches or do anything which could cause ignition
If there are any electrical security entry phones/locks, open the doors manually.4
Low voltage electricity
Injuries caused by electricity can potentially occur in the dental practice resulting from contact with a low-voltage domestic current, usually due to a faulty switch or appliance. The presence of water presents additional risks. The electrical contact needs to be broken.
Switch off the current at the mains or meter point if it can be easily reached; otherwise remove the plug or wrench the cable free.1 If unable to reach the plug, cable or mains:
Stand on some dry insulating material, for example, telephone directory, wooden box
Using a wooden object, for example, broom, push the casualty's limbs away from the electrical source or push the latter away from the casualty. Do not use anything metallic
If the casualty still remains attached to the electrical current, carefully loop some rope around their ankles and pull them away from the source.3
Raise the alarm: activate the nearest fire alarm and warn people who are at risk; call 999 (or 112) for the fire and rescue services
Vacate the building following the fire escape route if appropriate; ensure all staff, patients etc meet at assembly point. Undertake roll call
Don't use a lift – if the electricity fails the lift may abruptly stop working; also the lift shaft can act like a chimney, sucking up flames and fumes
If in a room full of smoke, remain close to the floor and if possible cover the nose and mouth with a damp cloth or towel
Close doors on a fire
Never open a door that is hot or has hot handles – this suggests that a fire is raging behind it
If unable to find an escape route, locate a fire-free room that has a window; shut the door, open the window and call out for help, and remain close to the floor; if possible block any gaps under the door
Even if it is dark, don't turn on the light as this may cause an explosion
If clothing is on fire: stop, drop and roll: stop the casualty from running around as this can fan the flames – drop him to the floor and if possible quickly wrap him in a heavy fabric, for example, woollen blanket (do not use anything synthetic) – roll the casualty gently along the floor until the flames are extinguished.1
First Aid in the Dental Practice poster
The new First Aid in the Dental Practice poster (Fig. 1, thumbnail below, see previous page for readable size) has been designed as an aide mémoire for dental staff to provide basic first aid in the dental practice.
First aid can cover a wide range of scenarios ranging from simple reassurance following a minor mishap to dealing with a life-threatening emergency. When providing first aid, it is important to remain calm and focused on the priorities. An overview to the principles of providing first aid in the dental practice has been provided.
Did you see our earlier article from Phil Jevon about resuscitation? It was published in BDJ Team in July and is available to read at the following link: http://www.nature.com/articles/bdjteam2016120