Basic Life Support

Of even greater importance than the overall emergency review program is the requirement for the clinical ability to perform BLS, more commonly known as cardiopulmonary resuscitation (CPR). It is my opinion that no other preparatory step is as important as this one because training in BLS enables a rescuer to recognize an acute life-threatening situation and to know what to do. The steps of BLS require no additional equipment*: the mouth, hands, and knowledge of the rescuer are quite adequate in most cases to maintain a life. In the presence of a drug-related emergency, BLS usually proves to be the first and most important step in management. The acronym PABCD, where P is position; A is airway; B is breathing; C is circulation; and D is definitive care (D also means: Diagnosis, Drugs, Defibrillation), forms the basis of life support and management of all medical emergency situations. The Australian Resuscitation Council (ARC)’s acronym for health care providers is DRABCD, where D is danger; R is response; and D is defibrillation.²

The dentist should mandate that all office personnel remain proficient in BLS techniques after receiving their initial course. There is a rapid decline in CPR skills following an initial BLS training program. Within 6 months of completing a provider-level training program, the average person loses approximately 60% of his or her ability to perform adequate BLS.³ In a clinical experiment, only 4 of 30 postdoctoral dentists (graduate students), who had been retrained in BLS within the previous 4 months, were able to perform adequate one-person CPR on a mannequin for 1 minute.⁴ Maintaining proficiency is important because even when BLS is performed perfectly (a rarely achieved goal), the delivery of oxygenated blood to the victim’s brain is only 25% to 33% of normal.⁵ Faulty CPR technique leads to diminished cerebral blood flow and to a decreased likelihood of survival with or without permanent neurologic damage.

If a dentist, assistant, or hygienist was in a dental office with only one other person present and was the victim of cardiac arrest, this second person would be the only one available to provide BLS. Making certain that all personnel are proficient in BLS thus becomes the single most important step in ensuring that medical emergencies are managed efficiently and effectively.

Advanced Cardiovascular Life Support

Advanced cardiovascular life support (ACLS) involves the use of adjunctive equipment and drugs to further stabilize and manage a victim of cardiac arrest or other serious cardiac rhythm disturbance. The ACLS course includes training and evaluation in techniques of venipuncture and endotracheal intubation, interpretation of electrocardiograph (ECG) rhythms, and management of cardiac dysrhythmias through drug therapy and defibrillation.