Keep Your Emergency Skills Sharp and Your Tools Current

A 1986 study1 surveyed 4,000 dentists about the occurrence of medical emergencies in the dental setting.  Over a ten year period, the researchers found that every dentist surveyed experienced an average of 7.5 medical emergencies, almost one every year.  While that study may be dated, the take-home message certainly is very much relevant. 

As a healthcare professional, the public expects you to have the knowledge and means necessary to temporarily stabilize a patient experiencing a medical emergency.  Many lawsuits involving AEDs occur because a party did not have the equipment that they should have2.  McQuade3 named the difficulty for doctors to attain and maintain competency and the ability of doctors to meet their patients’ expectations, among other reasons, for malpractice lawsuits.  Recognizing several common emergencies, the American Dental Association (ADA) and the Academy of General Dentistry (AGD) both recommend that your office be equipped with emergency equipment including medications, oxygen and defibrillators.  But how good is a medication if it is expired?  Will expired AED pads work just the same as new ones?  Can you just use your nitrous machine to oxygenate a patient?

All medications have an expiration date.  One might look at these dates as sort of a warranty period.  Up until the date of expiration, the manufacturers will guarantee the strength and effectiveness of their products.  In some cases, such as injectables, the expiration date also applies to sterility.  Using expired medications is dangerous and may expose you to insurmountable liability.  Update your expired medications before you need to use them.

Similarly, AED pads and batteries have expiration dates as well.  This warranty covers the ability of the pads to stick to a person’s dry, hairless skin and for electrical impulses to be conducted through the pads properly.  Since the electro-conductive gel is water-based and the pads contain tin, the gel slowly oxidizes the metal.  This can prevent the pads from conducting a proper heart rhythm to the AED, reduce the energy in the shock that the AED is delivering, or trick the AED into shocking a person who didn’t need to be shocked.  AED units are constantly drawing power from the battery.  Therefore, most manufacturers will only guarantee their batteries for a limited time.  In short, using expired pads or a weak battery is dangerous and may expose you to insurmountable liability.  Replace your expired AED pads and weak batteries before you need to use them.

Proper oxygenation is important for patients experiencing a variety of medical emergencies including syncope, seizures, chest pain, respiratory difficulty and anaphylaxis.  In these cases, a patient requires 100% oxygen.  The only way to provide this is through a nonrebreather (NRB) mask, the industry standard in emergency medicine.  A nasal cannula is a second choice for patients who cannot tolerate a mask on their faces.  Neither device is compatible with most nitrous blending machines.  In addition, emergency oxygen should be portable enough to treat a patient in your waiting room.  The inability to properly oxygenate a patient is dangerous and may expose you to insurmountable liability.

Although you may rarely use your emergency equipment, it is important to update and maintain it.  Check the expirations of drugs, needles / syringes, AED pads and batteries before you need them.

 

1. Fast TB, Martin MD, Ellis TM. Emergency preparedness: a survey of dental practitioners. JADA1986; 112:499-501.

2. Lazar RA.   Saving Lives, Managing Risk: Understanding AED Program Legal Issues.  Early Defibrillation Law and Policy Center (2004).

3. McQuade, JS.  The medical malpractice crisis — reflections on the alleged causes and proposed cures: discussion paper.  J R Soc Med. 1991 July; 84(7): 408–411.

Erik Zalewski, M.S., EMT-CC 

CEO of Have Dummy Will Travel, Inc.

 

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