A medical emergency is a condition or circumstance that requires immediate attention for a person who has been injured or has suddenly become ill. When a medical emergency occurs, it is not possible to refer to a medical textbook for answers. You must be prepared to respond immediately. Your knowledge and skills could mean the difference between life and death.

At the time of a medical emergency, you may be the only person in the area. If this happens, you must initiate first response until the dentist or medical assistance arrives. If this is the case, it will be your responsibility to use well-chosen words of support, to show a willingness to help, and to demonstrate capable lifesaving skills.

Preventing a Medical Emergency

One of the most important ways to prevent a medical emergency is to know your patient. This means establishing open communication about the patient’s health and having a completed or updated medical history before dental treatment is begun.

The front desk assistant (business assistant) is responsible for ensuring that patients update this information as they enter the office. Once they have received the forms, patients should indicate any changes in their health, even if they were seen as recently as the previous week. They should also verify that the information is accurate by dating and signing the form (see Chapter 26 for a review of a medical history update).

Most emergencies that occur in the dental office are caused by the combined stress of a person’s daily life and the apprehension of going to the dentist. If a patient has had a negative experience or is nervous about a specific procedure, the patient’s stress level could be altered, which may lead to a medical crisis. It is important to recognize the areas of dental treatment that are most stressful for the patient.

1 What is the best way to prevent an emergency?

2 What is the cause of most medical emergencies in the dental office?

Emergency Preparedness

While the patient is in the dental office, the dentist is responsible for the individual’s safety. If a medical emergency involving the patient arises, the dentist and staff members are responsible for providing emergency care until more qualified personnel arrive. Emergency first aid protocols must be established and routinely practiced in the dental office.

Successful management of medical emergencies in the dental office requires preparedness, prompt recognition, and effective treatment. Every member of the dental team must be prepared for an emergency when one occurs in the dental office.

Ongoing observation of the patient is an important part of emergency preparedness. A calm, well-functioning staff is capable of handling an emergency in the dental office without complicating the seriousness of the situation by frightening the patient. To prevent added stress and complications, every staff member should know and practice his or her role in emergency protocols before any emergency arises. A standardized procedure for the management of emergencies must be established and followed.

Assigned Roles

In the management of an emergency, the combined efforts of trained persons are more efficient when each person takes on a specific, assigned role. It is the responsibility of the dentist to define these roles. Most often, dental team members are in charge of specific roles:

• Front desk staff (business assistant) will call emergency services and remain on the telephone at all times until appropriate medical assistance arrives (Fig. 31-1).

• A clinical assistant or dental hygienist will retrieve the oxygen unit and emergency drug kit and prepare for use (Fig. 31-2).

• The dentist, clinical assistant, or dental hygienist will remain with the patient to assist in assessment or with basic life support (Fig. 31-3).

• Additional dental team members will respond to the needs of other patients in the office.

FIG. 31-1 It is important to have open communication with emergency personnel.

FIG. 31-2 Preparing oxygen for an emergency.

FIG. 31-3 The dental assistant has repositioned the patient and is assessing vital signs.

Routine Drills

Training must be kept current at all times. A “mock emergency” should be created in the dental office monthly, so that dental team members can practice their roles, take on additional roles, and refine the office’s emergency plan.

Emergency Telephone Numbers

A list of emergency numbers should be posted next to each telephone throughout the office. Maintaining a current list of these telephone numbers is an important part of emergency preparedness.

The list should include telephone numbers for emergency medical services (EMS) personnel, local police, and firefighters. In most areas, all three services can be reached by dialing 911 (Fig. 31-4). The response time and availability in which these services respond to emergencies vary widely according to the geographic area and the population served. Two important factors in emergency preparedness are to know (1) the time it takes for local EMS personnel to reach the dental office, and (2) the life support capabilities that are available on arrival of the EMS staff (Fig. 31-5). Not all EMS personnel carry the same equipment or provide the same level of lifesaving care.

FIG. 31-4 Poster shows the most common number to be dialed for emergency services—911.

FIG. 31-5 Emergency medical services personnel on the scene. (From Henry MC, Stapleton ER: EMT: prehospital care, ed 4, St Louis, 2009, Mosby.)

A list of the telephone numbers of the nearest hospital, physicians, and oral surgeons should also be available. These professionals would be able to offer the life support needed while you are waiting for EMS personnel or another type of emergency response.

3 Who is responsible for a patient’s safety in the dental office?

4 Who in the dental office would most likely be in charge of calling the emergency medical services?

5 Where should emergency phone numbers be kept?

Recognizing a Medical Emergency

The dental staff must be aware that a medical emergency can occur at any time. For this reason, ongoing observation of the patient in the reception area, in the dental chair, or leaving the office cannot be overemphasized. The “attentive” dental team observes the patient’s general appearance and gait as he or she enters the clinical area. Note the patient’s response to routine questions. Slow responses and changes in speech patterns from a previous appointment should be noted for the dentist to evaluate. Recognition of a problem is critical.

Signs and Symptoms

When a medical emergency occurs, it is important for you to be attentive and take note in the patient’s response of a symptom and your observation of the signs. A symptom is what the patient is telling you about how they feel or what they are experiencing, such as, “I feel dizzy,” “I’m having trouble breathing,” or “My arm hurts.”

A sign is what you observe in a patient, such as a change in skin color or an increase in respiratory rate. Because signs are actually observed by you and/or another member of the dental team, they are considered to be more reliable than symptoms.

Emergency Care Standards

It is imperative that each member of the dental team have the following credentials and skills:

• Ability to assess and record vital signs accurately (see Chapter 27)

• Basic life support for the Health Care Provider (cardiopulmonary resuscitation, or CPR)

• Heimlich maneuver (also known as abdominal thrusts)

• Operation of the Defibrillator

Basic Life Support

The fundamental aspects of Basic Life Support include (1) immediate recognition of an emergency, (2) activating the emergency response system, (3) early performance of high-quality CPR, and (4) rapid defibrillation when appropriate.

Cardiopulmonary Resuscitation

In an emergency in which the patient is not breathing and the heart is not beating, cardiopulmonary resuscitation (CPR) must be initiated immediately. The 2010 American Heart Association guidelines for CPR has determined that immediate activation of the emergency response system and starting chest compressions for any unresponsive adult victim with no breathing or abnormal breathing increases CPR effectiveness, and will provide better odds in saving a life. Any rescuer, regardless of their training and background should provide chest compressions to all cardiac arrest victims.

The major change in the way CPR was taught to the new method is the sequence of steps from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, Breathing) for adults and pediatric patients (children and infants). By changing the sequence to C-A-B, chest compressions are initiated sooner and ventilation only minimally delayed until completion of the first cycle of chest compressions.

CPR combines external cardiac compressions to stimulate the heart, with rescue breathing to ensure that adequate air is entering the lungs. This emergency support system must be initiated immediately so that the flow of oxygen-carrying blood quickly reaches the brain. The cells of the brain, the most sensitive tissue in the body, are irreversibly damaged after 4 to 6 minutes without oxygen.

CPR for children and infants is similar to that for adults, but a few changes must be made to adapt to the anatomy and smaller bodies of children.

Emergency Procedure 31-1 reviews CPR for the adult, the child, and the infant.

EMERGENCY PROCEDURE 31-1

Performing Cardiopulmonary Resuscitation (One Person)

Equipment and Supplies

✓ Mannequin approved by the American Heart Association (AHA) and equipped with a printout for demonstration of proper technique (for instruction purposes and mock emergency drills)

Procedural Steps for Adult, Child, Infant CPR*

Determine unresponsiveness

Approach the victim and check for signs of circulation, such as normal breathing, coughing, or movement in response to stimulation. Pinch or tap the victim and ask, “Are you OK?”

Initiate Assistance

1 If there is no response, call for assistance and ask someone to call 911; obtain an AED/defibrillator if available.

2 If you are alone, and your patient is an adult, phone 911 first and than begin compressions.

3 If the patient is a child, give 2 minutes of compression first, then call 911.