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Link 4: Medical Emergency Plan

A medical emergency plan or emergency response plan is required in every dental office. This is simple logic. This plan needs to be easily located and visible at all times where it can serve as reminder and guide to the team. The plan should have a Team Leader, the Dentist, as well as a backup who is capable of filling in if needed. Each member of the team will be assigned specific duties and this role should be second nature to the member, meaning that these duties, as indicated on the plan, should be understood thoroughly and without a doubt. Most importantly, each position should have a substitute should a team member be absent from the office. When a medical emergency occurs, the response should be well-organized, tightly controlled, and expertly executed with all members quickly and calmly alerted. This streamlined process includes an alarm system, paging system, lighting system, or some other means of immediately communicating the emergency to all team members to activate the planned response.

The team leader is responsible for recognizing and initiating the decision to notify EMS. When the EMS order is given, one team member is in charge of making that call. There can be no confusion whether EMS has been contacted. Additionally, it is advisable to become familiar with EMS services in your area. Estimated time of arrival to your office in the event of an emergency should be identified prior to any actual occurrence. The average EMS response time for urban areas is 11 minutes and 15 minutes for rural areas. However, this wait can be longer if EMS is occupied or circumstances prevent expediency. Time is critical and therefore cannot be discounted. There is no embarrassment in calling EMS; a false alarm is better than a funeral. If in doubt, call EMS out!

Highlights

  1. Every dental office shall have a written medical emergency response plan.

  2. The plan shall be kept in an easily accessed area in the clinical portion of the dental facility although multiple placement of the plan may be appropriate in some offices.

  3. The plan must contain all of the following
    • Specific task assignments for each member of the dental team, both full and part time. Attention needs to be paid to making sure all tasks are covered even with a reduced staff.
    • General instruction on calling emergency medical services (EMS), including the address and best point of entry into the office for EMS.
    • A general review of CPR guidelines, airway management, and patient positioning.
    • A list of the signs and symptoms and an algorithm outlining the appropriate response for each of the following
    • C.O.R.E. 16 (Critical Office Resuscitation Emergencies) common to dental offices.

      1. Syncope
      2. Angina
      3. Myocardial Infarction
      4. Cardiac Arrest
      5. Hypertension
      6. Hypotension
      7. Asthma
      8. Anaphylaxis
      9. Hyperventilation
      10. Allergic Reactions
      11. Diabetes (Hypoglycemia)
      12. Seizures
      13. Sudden Cardiac Arrest (SCA)
      14. Cerebrovascular Accident (Stroke)
      15. Foreign Body Obstruction (FBO) with Airway Management
      16. Local Anesthetic Toxicity
Please Note:

Offices offering dental hygiene services under general supervision should also have a set of supplemental algorithms for circumstances when the dentist is not on the premises.

The medical emergency response plan may be either made by the individual office or purchased from a vendor and supplemented with office-specific information.