Garry Perkins at Sussex First Aid courses in Sussex with frequent questions on first aid and dental teams CPD medical training

We receive many enquires regarding First Aid and Dental Practices CPD medical training. Here we are building a list of the most frequent questions we are asked  with answers and outside links.

 

We are also building a community YouTube channel for sharing the most up to date advice in medical emergencies and training. Please join our community and lets grow together.

Garry Perkins

HCPC Paramedic

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Dental Practice and First Aiders Frequently asked questions

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
Emergency drugs: We endorse the Resuscitation Council's guidance that clinical dental settings staffed by dentists, hygienists, and therapists, are to have an emergency drugs kit. Further guidance on what drugs should be contained in emergency drugs kits can be obtained from the Department of Health and via the British National Formulary (you will need to subscribe to the British National Formulary in order to log into their website.) Clinical dental technicians: We recognise that the Human Medicines Regulations 2012 prohibit clinical dental technicians from purchasing or holding the prescription-only medicines contained within an emergency drugs kit. We do not therefore expect a clinical dental technician to have an emergency drugs kit or be trained in the use of an emergency drugs kit. We are aware that CDTs who work independently will not have an emergency drugs kit on their premises. Dental hygienists and therapists: the Human Medicines Regulations 2012 permit dental hygienists and therapists to hold emergency drugs on their premises, but not to purchase the medicines directly. A dental hygienist / therapist practice needs to ensure that they hold emergency drugs on site. Hygienist / therapist practices without an on-site dentist can obtain an emergency kit through a prescribing dentist or doctor under a patient-group directive.​ Staff skills requirements: A patient could collapse on any premises at any time, whether they have received treatment or not. It is therefore essential that all registrants must be trained in dealing with medical emergencies, including resuscitation, and possess up to date evidence of capability. Scope of practice Registrants must know their role in the event of a medical emergency, and ensure they are sufficiently trained and competent to carry out that role. If the setting in which you work changes, your role in the event of a medical emergency may change as well. You must ensure that you are suitably trained and competent to carry out your new medical emergency role. This might be the case for:
  • A dental hygienist moving to independent practice under direct access.
  • A clinical dental technician moving from a dentist's premises to independent premises.
  • A dental nurse working in a school.
  • A dental nurse assisting with domiciliary visits.

GDC LINK




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)
Professional guidelines: Resuscitation UK Guidelines November 2013: Minimum equipment list for cardiopulmonary resuscitation in Primary Dental Care The following is the minimum equipment recommended:
  • adhesive defibrillator pads
  • automated external defibrillator (AED)
  • clear face masks for self-inflating bag (sizes 0,1,2,3,4)
  • oropharyngeal airways sizes 0,1,2,3,4
  • oxygen cylinder (CD size)
  • oxygen masks with reservoir
  • oxygen tubing
  • pocket mask with oxygen port
  • portable suction e.g. Yankauer
  • protective equipment – gloves, aprons, eye protection
  • razor
  • scissors
  • self-inflating bag with reservoir (adult)
  • self-inflating bag with reservoir (child)
  • Oxygen cylinders should be of sufficient size to be easily portable but also allow for adequate flow rates, eg, 15 litres per minute, until the arrival of an ambulance or the patient fully recovers. A full ‘CD’ size cylinder contains 460 litres of oxygen and should allow a flow rate of 15 litres per minute for approximately 30 minutes.
Quality Assurance Process: Expiry dates for emergency medicines and equipment and availability of oxygen should be checked at least weekly.




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.

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.

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.


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:

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:

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