Dentists put their education, skills and training into action every day, but when faced with a life-threatening emergency, they are truly put to the test. While dentists may not like to think about the unfortunately possibilities of medical emergencies, they should be prepared to handle anything that occurs under their roof, whether it is a patient suffering an allergic reaction or a diabetic employee with low blood sugar.
Emergency preparedness can sometimes mean the difference between life and death. Well-trained staff and clear emergency protocols are essential, as are regularly-performed drills to ensure expediency should an emergency occur. But one of the simplest ways to prevent an emergency from becoming a tragedy is a well-stocked and up-to-date emergency kit.
While all dental practices are required to have emergency medical kits on hand, the type of kit and what it contains is determined by each practice’s type, patient base and level of training. The Dentists Insurance Company recommends dental practices have two emergency kits: one for patients and one for employees.
There are no regulations governing what should be contained within an emergency kit for patients; however, dental practices that contract with dental plans should be aware that many plans have specific requirements. In addition, individual states may have their own requirements, so TDIC recommends dentists check with their state dental boards. For example, the California Dental Practice Act requires dentists to have both adult and pediatric Magill forceps on hand and be trained in their use to clear the airway of foreign objects, according to attorney Arthur Curley of Bradley, Curley, Barrabee & Kowalski.
Dentists can refer to the American Dental Association’s general recommendations on office emergency kits at ada.org. TDIC’s kit content recommendations, which are aligned with ADA’s, include the following:
• Ammonia inhalants
• Blood pressure monitoring equipment
• Bronchodilator (asthma inhaler)
• CPR pocket mask
• Epinephrine 1:1,000 (injectable)
• Glucose (orange juice or non-diet soda)
• High-volume suction and aspiration tips or tonsillar suction
• Nitroglycerin (sublingual tablet or aerosol spray)
• Oxygen with positive-pressure administration capability
TDIC advises practice owners to designate a staff member to be in charge of regularly checking kits to ensure each is complete and medication contained within is not expired. One helpful practice is to check the kit on the same schedule as checking smoke detector batteries: on the dates daylight saving times begin and end. Alternatively, practice owners can purchase commercial emergency medical kits with refill service options that automatically send up-to-date medications when existing medications are due to expire.
But simply having a comprehensive medical emergency kit is not enough. Dentists and staff must know where it is located and know how to use the items within it, especially medications. Many off-the-shelf kits come with instruction manuals or DVDs and TDIC recommends dentists obtain training in the administration of the emergency medications their kits contain.
Offices that provide general anesthesia or conscious sedation are required to have specific medications in their emergency kits. The requirements vary from state to state, so check with your state dental board or dental association for details. In California, emergency kits for offices that provide general anesthesia or conscious sedation are required to include the following:
• 50 percent dextrose or other antihypoglycemic
• Antiarrhythmic (not required for conscious sedation)
• Antihypertensive (not required for conscious sedation)
• Appropriate drug antagonist
• Coronary artery vasodilator
• Intravenous medication for treatment of cardiopulmonary arrest (not required for conscious sedation)
• Muscle relaxant (not required for conscious sedation)
• Vasopressor (other than epinephrine)
The U.S. Department of Labor’s Occupational Safety and Health Administration requires employers to keep emergency medical kits on-site should an employee be injured on the job. In addition to the required items below, employers are advised to consider the type of injuries likely to occur on the job and add to their kits accordingly. Some states, including California, require a doctor’s sign-off on medical emergency kits, while other states do not.
Following are required emergency kit items as outlined by OSHA:
• Adhesive tape
• Box of adhesive bandages
• Directions for requesting emergency assistance
• Elastic wraps (two)
• Gauze pads (at least 4 x 4 inches)
• Gauze pads (two, at least 8 x 10 inches)
• Latex gloves
• One blanket (minimum)
• One package gauze roller bandage at least 2-inches wide
• Resuscitation equipment such as resuscitation bag, airway or pocket mask
• Triangular bandages (two)
• Wound cleaning agent such as sealed moistened towelettes
Keeping office medical emergency kits stocked and up-to-date is a simple way to keep your patients and employees safe and to protect yourself from liability. As a practice owner, it is your responsibility to ensure emergency kits are regularly maintained and staff members understand their roles during emergencies. In addition, it is crucial to make sure the entire team knows where the emergency kits are located. Preparing for the worst can go a long way in preventing tragedy and can help you mitigate risk should an emergency occur.