Sir, we would like to congratulate James Andrews for his recent article CQC outcome for medicines management: an outsider's inside view. In this paper, he highlighted a number of essential aspects of the CQC document Essential standards of quality and safety1 that have received little attention in the dental press to date:

  • Outcome 9H states that it is a practitioner's responsibility to ensure that medicines required for resuscitation or medical emergencies are easily accessible in tamper evident packaging1

  • Outcome 11 is more concerned with equipment and training and states that 'all staff involved in using the equipment have the competency and skills needed and have appropriate training'.1

This equipment should be properly maintained, tested, serviced and renewed under a recorded programme. It should be stored safely and securely and where the service requires it this should be tamper proof.1

Although the CQC does not state what emergency drugs and items of emergency equipment practices should have access to, the information is already available in national guidelines produced by the Resuscitation Council (UK)2 and accepted by the GDC. These were listed as the MINIMUM that was required.

We organise and deliver medical emergency training courses at a regional and local level. Although the national guidance was originally published in 2006, and revised in 2008,2 it appears that there are still a number of practitioners who are either not aware of it or choose not to comply with it. This proportion of the profession seems not to recognise that failure to comply with CQC guidelines could have severe implications both in terms of a civil case for negligence as well as leading to a withdrawal of CQC registration and/or disciplinary action by the GDC.

Emergency events are rare but they do occur and it is every professional's responsibility to ensure that they are adequately prepared with the correct drugs, but equally as important, the correct training so that emergencies can be recognised and managed at an early stage. Mr Andrews used an example where midazolam was inappropriately delivered in an emergency and led to aspiration: staff were inappropriately trained. This emphasises the importance of medical emergency training rather than training in basic life support alone. In our experience, the majority of professionals subscribe to basic life support training, which 'ticks the CPD box' but is of little use for the management of more common emergency events.

We propose that standardisation of medical emergency training in addition to standardisation of emergency drugs and equipment is required in primary dental care to optimise patient care should an emergency event occur and that CQC recommendations should be incorporated into medical emergency care in general dental practice.