Preparation and Practice Are Essential
Few of us will be charged by an irate grizzly, but the chances of having an office emergency are very real.
What can you do in three seconds? This subject came up during a hike in Wyoming’s magnificent Teton Range. Shortly before we set off on a beautiful late summer day, my friend Steve Ratcliff, DDS, MS, hands me a long black canister and a booklet. “Read this,” he says. “You may need it.” The booklet, Bear Safety Tips, offers instructions for avoiding these creatures and, if necessary, using the canister, which is loaded with pepper spray. Basically, it notes that a grizzly bear can cover 50 yards in three seconds. If the bear charges, within seconds you must grab the canister, release the safety, and spray before being attacked.
What does this have to do with dental practice? More than you might think. It is common for dental professionals to administer medications, including local anesthetics, that can elicit a rapid allergic response. These problems always seem to pop up at the worst possible time — on a late Thursday afternoon, for instance, when your primary assistant is absent and the temp is new. In light of scenarios like this, it behooves dental teams to know how to respond quickly and appropriately. In case of an allergic reaction, for example, does the office have epinephrine available? Is the entire team trained in its use?
A rapid, coordinated response takes preparation and practice. The broader question, of course, is whether the office is prepared to handle a full range of emergencies. For example, does the practice have a defibrillator (part of basic cardiopulmonary resuscitation)? Do all team members know how to use it? Is a portable, positive-pressure oxygen delivery system available? Is it connected to an ambu bag?
Few of us will be charged by an irate grizzly, but the chances of having an office emergency are very real
Dental teams should be particularly well versed in handling sedation emergencies. The majority of problems occur during Class 2 cases (oral sedation) and Class 4 cases (deep/general anesthesia). Some problems are self-inflicted, so to speak, through inadequate medical evaluation, improper administration of sedative/anesthetic drugs, or inappropriate monitoring (via machine and visually). Improper dismissal criteria and postoperative instructions can also lead to complications. With preparation and practice, however, teams can avoid the vast majority of these problems.
In addition to ongoing training, every dental practice should conduct regular drills to simulate office emergencies. Teams should be trained in cardiopulmonary resuscitation, and designate specific staff members to call 911 and meet emergency medical responders. Offices should also have a written plan in case of fire or natural disaster. For example, has an outdoor meeting place been designated? And does the team have a safe refuge in case of a high-wind event, earthquake or flood?
Luckily, few of us will be charged by an irate grizzly, but the chances of having an office emergency are very real, so the three-second rule should serve as a wake-up call to oral health professionals. Dental teams must prepare and train for emergencies so they are ready to provide an appropriate and rapid response.
And then hope they never have to.
Thomas G. Wilson Jr., DDS
Editor in Chief
From Decisions in Dentistry. November 2016;2(11):8.