When an emergency occurs in your office—and it will—you will sink to the level of your training. If you don’t have the knowledge to respond to the emergency properly, and you haven’t drilled for such situations to perfection, your patient’s life may be at risk.
Failing to have the proper knowledge, failing to drill, and failing to conduct sedation anesthesia medical emergency readiness inspections (SAMERI) mean failing to meet the standard of care. And that will be indefensible in the eyes of your state dental board, your malpractice carrier, state and federal regulators, and attorneys, judges, and juries.
If the office has been properly prepared and inspected, the dentist and staff will be ready for these emergencies. Compromises will lead to disastrous results. Inadequate medical emergency planning, lack of protocols, and ill prepared personnel will lead to chaos. Offices that choose to be unprepared won’t be ready for emergencies and will have breaches in patient safety.
If a patient dies in your office, a wrongful death suit will be brought against you. You will then go through the proper channels with your malpractice company. You will answer interrogatory questions, followed by a deposition. There, the trial attorney you face will be prepared to ask you many questions, including but not limited to:
- What is your training in medical or sedation emergency preparedness?
- What is your staff’s training in medical or sedation emergency preparedness?
- Do you have Basic Life Support training? Advanced Cardiovascular Life Support training? Pediatric Advanced Life Support training? What about your staff?
- Have you attended a medical or sedation emergency course? If so, when?
- Do you have all of the necessary emergency medications? Are they in date? May we see where you keep them?
- May we see your automated external defibrillator (AED)? What kind of training have you and your staff had with the AED? (Note: If you don’t own an AED but did take a Basic Life Support class, you will not be able to say you didn’t think an AED was important. A thousand people die of sudden cardiac arrest every day. The only treatment is the use of an AED.)
- May we see copies of the documentation that you use during a medical or sedation emergency?
- What is your Medical Emergency Plan?
- Do you know to call 911 during an emergency? Did you call 911 during this emergency? If so, when did you decide to do so? How long did it take emergency medical services to arrive? What were you and your staff doing during that time?
- May we see your training log outlining your medical and sedation emergency drills? How often do you perform them?
- Which medical and sedation emergencies are you ready for in this office? Please list them.
- Which medications did you use to treat the medical or sedation emergency? Please explain each one.
- Who inspected your office to ensure that your medical and sedation emergency preparedness was in place? May we see the inspector’s credentials? May we see the inspection report? How often is your office inspected? When did these inspections take place?
How do you think you would fare facing these and so many other questions? Prevent failures at many levels by preparing yourself and your team and reducing the potential for catastrophic events that can affect your livelihood. Your patients already expect you and your facility to be fully prepared when they arrive for their visit.
Mind the six P’s of preparation for medical and sedation emergencies:
- Prevention: Complete a proper medical history on every patient who comes into the office and update it regularly.
- Personnel: Your staff should be trained and prepared for medical and sedation emergencies. They are vital individuals when a crisis is unfolding in your office.
- Products: Proper gear such as a glucometer, an AED, an emergency drug kit, and proper airway equipment are imperative if you administer any form of sedation or anesthesia.
- Protocols: Develop a medical emergency plan that is consistently reviewed by everyone in the office on a monthly basis. Review all of the potential emergencies previously described in this article.
- Practice: Stay current when it comes to the proper care for the emergencies outlined here. Training just once a year won’t ensure successful results. You and the members of your team need to drill for emergencies monthly and take your roles very seriously. The time to practice is not when the actual emergency is occurring.
- Pharmaceuticals: Have current, in-date emergency medications in your office. There are specific medications unique to different emergencies that all dental offices should have. Know the right medications for all of the emergencies presented in this article. Everyone in your office should know where these medications are kept. If you struggle with maintaining these medications, activate an automatic renewal program.
Take the six P’s of preparation seriously so you can prevent the seventh P—panic, which doesn’t do any good during an emergency. Panic only introduces chaos. When you panic, you forget simple lifesaving skills and won’t know what to do. And that puts your patient’s life at risk. Or to put it another way:
Know planning = no chaos
No planning = know chaos
No one can ever guarantee positive outcomes from a medical or sedation emergency. But you and your staff can be prepared.
Dr. Roberson obtained his DMD at the University of Mississippi School of Dentistry. He performed his residency in oral and maxillofacial surgery at the University of Cincinnati Medical Center. He is a dual-board certified oral and maxillofacial surgeon with board certifications from the American Board of Oral & Maxillofacial Surgery and the National Dental Board of Anesthesiology. He is a member of the American College of Oral & Maxillofacial Surgeons, American Dental Association, American Academy of Oral Medicine, American Academy for Oral Systemic Health, Mississippi Dental Association, and South Mississippi Dental Association. He can be reached at drjohnroberson@megagate.com.
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