How often do first aiders need to re-qualify?

First aiders should re-qualify every three years, otherwise: the Health and Safety Executive (HSE) no longer considers them competent to act as a first aider they will not be counted towards the required number of first aiders in your workplace. First aiders can re-qualify by completing a two-day first aid at work requalification course, but if some time has passed since the certificate expired, the HSE recommends completing the three-day first aid at work course. We support the HSE recommendation that first aiders have annual refresher training to keep their skills up-to-date.

Whats our Legal obligation for first aid provision at work

Employers have an obligation under the Health and Safety (First Aid) Regulations 1981 and guidance documents L74 and GEIS to make adequate and appropriate first aid provision for their workforce. It is recommended that someone is able to undertake first aid duties at all times when people are at work.

What first aid equipment do I need?

Employers should provide at least one first aid kit per work site. Your needs assessment will help you identify what equipment you should provide but guidance is also available from the HSE. A first aid container should be green with a white cross (not a red cross, which is a protected symbol).

Should we have an automated external defibrillator?

Employers are not required to have an automated external defibrillator (AED) machine but you may wish to consider providing one for your staff. All Primary Health Care organisations Dental Practices, GP surgerys and Hospitals must have an AED in place. Many public venues have an AED on site and this should be avalable for all staff and the public to use if needed.

Can first aiders give medicine to casualties?

First aid at work training does not include giving tablets or medication except using aspirin to treat a casualty with a suspected heart attack, which is covered in our three-day first aid at work course. If a colleague has prescription medicine, you may help them to take this but should not administer it for them. There is no legal problem in any person administering adrenaline that is either prescribed for a specific person or administering adrenaline to an unknown person in such a life saving situation (through specific exemptions in the medicines act). However the first aider involved must be competent in being able to recognise the anaphylactic reaction and administer adrenaline using an auto-injector. First aiders must ensure that they work within the guidelines of the first aid training organisation that issued their qualification and their employer. The Health & Safety Executive also provides guidance. As at 25 January 2008 this stated: "Medicines legislation restricts the administration of injectable medicines. Unless self administered, they may only be administered by or in accordance with the instructions of a doctor (e.g., by a nurse). However, in the case of adrenaline there is an exemption to this restriction which means in an emergency, a suitably trained lay person is permitted to administer it by injection for the purpose of saving life. The use of an Epipen to treat anaphylactic shock falls into this category. Therefore, first aiders may administer an Epipen if they are dealing with a life threatening emergency in a casualty who has been prescribed and is in possession of an Epipen and where the first aider is trained to use it."

Can a First Aider use an Epipen to treat anaphylactic shock

There is no legal problem in any person administering adrenaline that is either prescribed for a specific person or administering adrenaline to an unknown person in such a life saving situation (through specific exemptions in the medicines act). However the first aider involved must be competent in being able to recognise the anaphylactic reaction and administer adrenaline using an auto-injector First aiders must ensure that they work within the guidelines of the first aid training organisation that issued their qualification and their employer. The Health & Safety Executive also provides guidance. As at 25 January 2008 this stated: "Medicines legislation restricts the administration of injectable medicines. Unless self administered, they may only be administered by or in accordance with the instructions of a doctor (e.g., by a nurse). However, in the case of adrenaline there is an exemption to this restriction which means in an emergency, a suitably trained lay person is permitted to administer it by injection for the purpose of saving life. The use of an Epipen to treat anaphylactic shock falls into this category. Therefore, first aiders may administer an Epipen if they are dealing with a life threatening emergency in a casualty who has been prescribed and is in possession of an Epipen and where the first aider is trained to use it."

If a patient suffering an anaphylactic reaction has a cardiac arrest, is it better to give adrenaline IM rather than wait until someone arrives who can obtain intravenous access and give adrenaline intravenously according to the advanced life support guidelines?

Once cardiac arres t occurs it is important to ensure expert help is coming and start cardiopulmonary resuscitation (CPR) immediately. Good quality CPR with minimal interruption for other interventions improves the chances of survival from cardiac arrest. Once cardiac arrest has occurred intramuscular adrenaline is not beneficial and attempts to give it may interrupt CPR. Absorption of adrenaline given by intramuscular injection will not be reliable once cardiac arrest has occurred. Advanced life support according to current guidelines should start as soon as possible.

Should I use an orange or blue needle to inject intramuscular (IM) adrenaline?

A standard blue needle (25 mm and 23 G) should be used to inject intramuscular adrenaline. The best site for an intramuscular injection of adrenaline for the treatment of an anaphylactic reaction is the anterolateral aspect of the middle third of the thigh. The needle needs to be long enough to ensure that the adrenaline is injected into muscle. The current Resuscitation Council UK guidance states that a 25 mm length needle is best and suitable for all ages (see Appendix 2). In the UK, a standard blue needle (25 mm and 23 G) is therefore best. In obese patients a longer needle may be needed (38 mm length). The standard orange needle that is most commonly available in the UK is only 16 mm in length. This shorter length needle can result in injecting the adrenaline subcutaneously. A 25 mm length orange needle is less commonly available.

The Resuscitation Council (UK) guidance on anaphylaxis is aimed at healthcare professionals and does not recommend the use of auto-injectors by this group for several reasons such as shelf life, needle length, cost, and dose. There is a new product (Emerade) which appears to address some of these issues. What is the Council’s position on the use of Emerade by any healthcare professional?

The decision whether to use Emerade adrenaline auto-injector, another brand of auto-injector, or an ampoule, needle and syringe is a local decision. The decision should factor in the ease of implementation and the likelihood of anaphylaxis.

Why does the guideline recommend giving repeat doses of intramuscular adrenaline every 5 minutes, when the manufacturers of adrenaline auto-injectors recommend a longer interval (10-15 minutes) between doses?

Auto-injectors are recommended primarily for use by laypeople for self administration. Guidance for their use must allow a greater degree of safety in terms of dose and recommended dosing interval. There is little science on which to base a recommendation for the dosing interval. The recommendation of 5 minutes is pragmatic and based on the personal experience of those who use adrenaline in their regular practice. Waiting for 10-15 minutes for a response before giving a further dose may be excessive in a patient with life-threatening airway, breathing or circulation problems caused by an anaphylactic reaction.

I work in general practice and feel that it would be easier to train our staff to use adrenaline auto-injectors rather than have to draw up adrenaline from ampoules to treat an anaphylactic reaction. This is not covered in the guidelines. Is it alright to do this?

Auto-injectors are primarily for self use by patients who are at risk of an anaphylactic reaction. They should be prescribed on an individual basis by a specialist in allergy. These guidelines are aimed at healthcare professionals in a variety of settings. We have not specifically recommended auto-injectors for use by this group for several reasons: Auto-injectors are relatively expensive with a limited shelf life compared with the cost of an ampoule of adrenaline and syringe and needle. Anaphylactic reactions are uncommon. Most auto-injectors purchased for the healthcare setting will not be used.
Auto-injectors come with standard length needle which may not be long enough to give intramuscular adrenaline for some patients.
Most healthcare staff likely to deal with an anaphylactic reaction in the healthcare setting should have the skills to draw up adrenaline and give an intramuscular injection of adrenaline. Ultimately it is a local decision whether a healthcare setting opts to use auto-injectors instead of adrenaline ampoules. If there is no other form of adrenaline available it would be appropriate for a healthcare professional to use an adrenaline auto-injector for the treatment of an anaphylactic reaction.

GDC Regulations for Dental Practice Medical Emergencies Equipment

All registrants must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK). The Resuscitation Council's document Quality standards for cardiopulmonary resuscitation practice and training is its main medical guidance document for dental professionals. We endorse this document and expects registrants to apply this guidance in practice. Equipment requirements – defibrillators and emergency drugs ​ Defibrillators: We endorse the Resuscitation Council's guidance that all clinical areas should have immediate access to an automated external defibrillator (AED). What does this mean in practice? Premises in which patients are seen clinically should have a defibrillator. This includes practices in which patients are seen by:

• A dentist only
• A clinical dental technician only
• A dental hygienist or dental therapist only
• A combination of members of the dental team

Dental Practice Drugs and equipment required for a medical emergency

Mandatory requirements: The GDC standards for the dental team state that, as a dental professional, you must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK). We expect a practice to follow the national guidance issued by the Resuscitation Council. Immediate access to an automated external defibrillator (AED) in an emergency increases the chances of survival of the patient. Where an AED is not available, we would expect to see a robust and realistic risk assessment detailing how an AED could be accessed in a timely manner, as the emergency services may not always be able to respond in the critical first few minutes of an acute cardiac arrest. Recommended practice: A practice could be in a difficult position from a medico-legal point of view if a patient came to harm during dental treatment due to the lack of emergency medicines and equipment listed below. Professional guidelines: British National Formulary To manage the more common medical emergencies encountered in general dental practice the following drugs should be available:

• adrenaline injection (1:1000, 1mg/ml)
• aspirin dispersible (300mg)
• Glucagon injection 1mg
• Glyceryl trinitrate (GTN) spray (400micrograms / dose)
• Midazolam Oromucosal Solution, midazolam 5mg/ml
• oral glucose solution / tablets / gel / powder
• oxygen
• Salbutamol aerosol inhaler (100micrograms / actuation)

First Aid at Work Requalification requirements

This qualification is valid for a period of 3 years. The Learner needs to retake the qualification before the certificate expiry date to remain qualified. It is possible to reduce GLH when requalifying and attend a 12 hour FAW requalifying course. In order to attend a 12 hour requalifying course, Learners must produce their current or previous recently expired FAW certificate. The certificate should be in a format as accepted by HSE. Requalification training should be delivered in no less than 12 hours (2 days) excluding breaks. Expired FAW certificates: If the Learner’s previous FAW certificate will have expired by more than one month at the start of FAW requalification course, the Centre must, in advance, provide the Learner/their Employer with the following information. FAW requalification courses are only 12 hours in duration, compared to 18 hours for the initial course. This means that the syllabus is covered at a significantly faster pace in the understanding that learners are familiar with the topics. Health and Safety Executive (HSE) guidance is clear that if an employee’s FAW certificate expires, they are “no longer considered competent to act as a first-aider in the workplace”. For this reason, you should make every effort to requalify a first aider before the certificate expires. Employers and Learners should be aware that there is an increased risk of failing to achieve the required standard if previous certification has expired by a considerable period (HSE defines this as in excess of 1 month). If this is the case, HSE recommends “it may be prudent to complete a 3 day course”.

Qualitative Face Fit Testing - guide.

Sussex First Aid Courses have been busy helping dental practices meet the needs of the staff and patients. New times and new challenges are ahead. Our team have been in training and now qualified to carry out qualitative testing for your dental team staff.

We are now able to offer you Qualitative Fit Face Testing. This will enable dental practices to meet the standards of the HSE, COSHH and UK resuscitation medical emergencies guidelines when dealing with a medical emergencies with-in the dental practice.
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Testing of your staff can be carried out at your practice at a time that fits in with your schedule by our qualified front line medical staff. We can even arrange for your yearly CPD medical emergency training and Face Fit Testing to happen on the same day as one package. This will ensure you are meeting all your COSHH, HSE requirements for AFFP treatments and medical emergencies with in the dental practice.
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Our Fit Testing Training team have a wealth of practical experience of face fit testing which really makes a difference to the quality of testing and provide practical guidance, advice and helpful hints and tips all gained from a working practical knowledge in frontline emergency work and providing Qualitative face fit testing with every make and model of mask from FFP1, FFP2 & FFP3 disposable masks through to semi-disposable and reusable half masks.
We provide Qualitative Fit testing (QLFT)
We conduct of face fit testing, qualitative testing that results in matching an individual’s face shape with a compatible mask to ensure a tight seal is achieved. All our staff are fully trained, qualified and compliant to the HSE Guidelines.


Qualitative Testing
Used only for disposable and half face masks.
The individual wears a hood over the head and shoulders and the tester sprays a bitter solution into the hood.
The wearer carries out a series of exercises, such as turning the head from side to side.
If the individual can taste the solution, there is a break in the mask’s seal.
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Qualitative fit testing (QLFT) is a pass/fail test based on the wearer’s subjective assessment of any leakage through the face seal region by detecting the introduction of bitter- or sweet-tasting aerosol as a test agent. QLFT methods are suitable for disposable and reusable half masks; they are not suitable for full-face masks. Although this type of test is based on subjective detection and response by the wearer of the RPE, it is important that it is administered by a fit tester competent in using this method.
A face fit test is a simple 20 minute test. Ideally face fit testing should be carried out at mask selection stage, so employers can ensure the correct mask models and sizes can be purchased. Repeat face fit testing should also be carried out on a regular basis (typically every one, two or three years depending on risk) or if the wearer loses or gains weight, has significant dental work, or gains scars, moles or other facial features where the mask seal meets the face.
Fit face testing for the dental practice teams with Sussex First Aid Courses
What does the test involve:
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Face fit is a series of tests and exercises emulating a full range of facial movement to ensure an adequate seal is maintained. The test is laid out as such:
Normal breathing
Deep breathing
Head side to side
Head up and down
Bending over
Talk out loud (reading a passage of text)
Normal breathing
All exercises (except bending over) are carried out while stepping on and off a low step.
All exercises must be passed.

How to prepare for your face fit test:
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Several things could affect the results of your face fit test, due to the accuracy of the equipment. These include, but are not limited to:
Facial hair (see below)
Long hair (will need to be tied back)
Eyewear It is also recommended that you do not smoke, eat or drink for at least 1 hour prior to the test.
Facial hair, stubble and beards make it extremely difficult to get a good seal. If there are good reasons for having a beard (ie, for religious reasons) alternative forms of RPE, that do not rely on a tight fit to the face are available: ie full hooded masks.

Dental Teams CPD Medical Emergencies training moving forward 2020 ( Covid-19 )

Dental Teams staff Medical Emergencies Core CPD training and moving forward in 2020. We are now conducting face to face Dental Medical Emergencies core CPD training. It’s a fine balance in the delivery of CPD training within the dental practice at during these current times and we are working within the UK Government and (Covid-19 Qualsafe) guidelines. All dental practices have different dynamics regarding location, space and team numbers to accommodate. We are looking at many different ways to meet your needs and flexibility is a key factor in theses challenging times. Due to the very nature of training we have adapted the presentation and delivery to make it all as safe as practicable. However, it's a little more challenging for larger groups and teams. A number of practices are hiring larger local venues for us to attend and deliver training or we can make arrangements for your team to attend and use our large training venue in Burgess Hill, West Sussex. We are able to make all the arrangements for you to hold your training session at our venue for up to 20 staff if required. The hire fee is around £60 and this would be added to your total training fee. For many practices this would be more cost effective than holding two training sessions with smaller groups at their venue. You may wish to consider a Saturday morning or midweek evening as this allows you to keep the practice open during the week. Conducting the training at our venue can be conducted in a morning, afternoon or evening in 3-4 hours sessions and is a great way of keeping it all very simple. This also helps to keep the costings lower and teams together. It also means your practice does not incur extra cleaning after training. A number of dental practices are arranging two training CPD sessions on the same day at their venues for larger teams. This allows a practice to train in two half day sessions and keeps the training more manageable and within the current Covid-19 guidelines. A discount would be applied with this type booking for an all day training booking at your venue. Some teams are having two separate training dates for larger teams and this would incur two sets of training costings and two separate training dates would be required to fit in with your plans. We are also running evening open CPD training events throughout the year for individuals or team members at our training venue in Burgess Hill, West Sussex. All bookings, dates and more information can be found on our Open Courses Page. Due to the very nature of Covid-19 we are continually adjusting to the new guidelines as and when needed. Please do contact us for a more personal plan to conduct your teams First Aid and Dental Teams CPD training needs. ​ Please see a link for the latest GDC COVID-19: GDC guidance for dental professionals. Please also note that the HSE has extended the First Aider at Work qualification for three months. ​ Garry Perkins HCPC Paramedic

Whats the Dental Teams Program content for Medical Emergencies and CPR training for the dental practice.

This course empowers the individual or team with the skills to recognise and the competence to deal with medical emergencies common to dental practices including basic/advanced life support (CPR) and the administration of first-line drugs such as oxygen, adrenaline, glucose, glucagon, midazolam, GTN, aspirin, and salbutamol.
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​All members of staff, not just registered team members should know their role if a patient collapses or there is another kind of medical emergency. All members of staff who might be involved in dealing with a medical emergency are [should be] trained and prepared to deal with such an emergency at any time.
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Our paramedic trainers will carry out a full review and check all emergency medications at your practice in-line with the clinical practice guidelines.

This training is CPD verifiable, 4 points and certificates of attendance will be supplied in-line with GDC guidelines.
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Course programme:

The session takes approximately four hours and will include practical CPR training, together with recognition and management of medical emergencies most common to the dental practice. You will be able to practice CPR with the manikins in your own dental chair. Hygienic CPR manikins will be provided by Sussex First Aid Courses for use during your training session.
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Basic life support – adult and child
Airway management – airway adjuncts, BVM and suction
Oxygen therapy
Asthma
Anaphylaxis
Cardiac emergencies
Epileptic seizures
Hypoglycaemia
Syncope
Choking and aspiration
Team-based training incidents
Administration of drugs in an emergency
​ AED training

Training will also include:
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Administering IM injections and the use of medical ampoules and administering common first line dental practice emergency drugs.

Whats The Combined ILS and PILS course for Dental teams and Sedationist

The session takes approximately 5 hours and will include practical ILS and PILS CPR training, together with the recognition and management of medical emergencies and medications common to the dental practice. Contact us for more information.
Contact us for a booking enquiry and quote.
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Course programme:
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The session takes approximately 5 hours and will include practical ILS and PILS CPR training, together with recognition and management of medical emergencies and medications common to the dental practice.

You will be able to practice CPR with the manikins in your own dental chair. Hygienic CPR manikins will be provided by Sussex First Aid Courses for use during your training session.
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ABCDE Approach
ILS and PILS – adult and child resuscitation
Airway management – airway adjuncts, Igels, BVM and suction
Oxygen therapy
Pulse oximeter training
Taking blood pressure
Taking blood glucose levels training
Asthma
Anaphylaxis
Cardiac emergencies
Epileptic seizures
Hypoglycaemia
Syncope
Choking and aspiration
Team-based training incidents
Administration of drugs in an emergency
Use of the AED in adults and paediatrics
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Our paramedic trainers will carry out a full review and check all emergency medications at your practice in-line with the clinical practice guidelines.

This training is CPD verifiable, 5 points and certificates of attendance will be supplied in-line with GDC guidelines. The Royal College of Surgeons (Conscious Sedation)
Practitioners must be able to provide age-appropriate immediate life support as defined by the main elements of the Resuscitation Council (UK) ILS and PILS training programmes. It is not essential to undertake a Resuscitation Council (UK) accredited ILS/PILS course. Alternative courses with equivalent content which are adapted to the needs of dental practice are acceptable: these might also include the management of common sedation, medical and dental emergencies.

Dental Practice CQC requirements for Drugs and equipment for a medical emergency

CQC consider drugs and equipment for a medical emergency when we review if a practice is safe. This relates to: regulation 12 (safety of care and treatment)
regulation 17 (good governance).
The medicines and equipment should be in an accessible and central location known to everyone. Mandatory requirements The GDC standards for the dental team state that, as a dental professional, you must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK). We expect a practice to follow the national guidance issued by the Resuscitation Council. Immediate access to an automated external defibrillator (AED) in an emergency increases the chances of survival of the patient. Where an AED is not available, we expect to see a robust and realistic risk assessment detailing how an AED could be accessed in a timely manner. Emergency services may not always be able to respond in the critical first few minutes of an acute cardiac arrest. Recommended practice Practices should ensure they have emergency medicines and equipment to keep patients safe. Professional guidelines: NICE: Prescribing in dental practice (Medical emergencies in dental practice) These should be available to manage common medical emergencies:

• adrenaline/epinephrine injection, adrenaline 1 in 1000, (adrenaline 1 mg/mL as acid tartrate), 1 mL amps
• aspirin dispersible tablets 300 mg
• glucagon injection, glucagon (as hydrochloride), 1 - unit vial (with solvent)
• glucose (for administration by mouth)
• glyceryl trinitrate spray
• midazolam oromucosal solution
• oxygen
• salbutamol aerosol inhalation, salbutamol 100 micrograms/metered inhalation.

Dental mythbuster : Storing Glucagon injection, How?

CQC inspectors will consider this topic of drugs and equipment for a medical emergency when they review if the practice is safe, which relates to regulation 12 (safety of care and treatment). Glucagon is a hormone which helps to raise blood glucose levels. A glucagon injection kit is used to treat episodes of severe hypoglycemia, where a patient is either unable to treat themselves or treatment by mouth has not been successful. Severe hypoglycemia is defined as having low blood glucose levels that requires assistance from another person to treat. Classed as a diabetic emergency, it is a complication that can occur in people with diabetes that take insulin and certain anti-diabetic tablets. The most commonly available form of Glucagon injection is the GlucaGen HypoKit 1 mg: (Glucagon Injection). Mandatory requirements GlucaGen HypoKit should be stored at a temperature of 2–8°C (in a refrigerator), but it must not be frozen. If stored in the refrigerator the shelf life from the manufacturer is 36 months.
GlucaGen HypoKit can be stored outside the refrigerator at a temperature not exceeding 25°C for 18 months provided that the expiry date is not exceeded. It should be stored in the original package in order to protect from light. This is common practice as it needs to be easily accessible for emergency use. The provider must able to demonstrate either:
when the product was out of refrigerated storage, for example label the product with the date it was taken out of the fridge or a revised expiry date, or
how the product is safe for use, for example by referring to the purchase invoice showing that 18 months has not elapsed from delivery. LINK