Is Your Dental Practice Rescue Ready?
A Practical Guide to Medical Emergency Preparedness in Dental Practice
By Garry Perkins, Director of Sussex First Aid Courses Ltd | Former Paramedic & Dental Medical Emergencies Trainer
Medical emergencies in dental practice may be uncommon, but when they happen, the whole dental team needs to know what to do.
Over many years of delivering medical emergency training to dental teams, I have seen how much expectations have changed. Patients rightly expect dental professionals to be prepared for a medical emergency and to have the appropriate training, equipment and systems in place.
The important question for any dental practice is therefore:
If a patient became seriously unwell today, would your team be rescue ready?
Being rescue ready is about much more than attending an annual CPR course. It means understanding individual roles, knowing where emergency equipment and medicines are kept, recognising the limits of individual scopes of practice, and regularly practising how the team will respond together.
Medical emergencies can happen anywhere
A patient could become unwell before, during or after dental treatment. They may even collapse in the waiting room without having received any treatment.
Resuscitation Council UK guidance makes clear that dental professionals should be trained to deal with cardiorespiratory arrest and that staff should update their resuscitation knowledge and skills at least annually.
Dental practices should also have a process for assessing patients' medical risks before treatment and should regularly practise simulated emergency scenarios as a team.
Medical emergencies encountered in primary dental care can include:
syncope and collapse
hypoglycaemia
seizures
anaphylaxis
asthma
chest pain and suspected cardiac emergencies
cardiorespiratory arrest
other acute deterioration.
An important clinical review published in the Journal of Paramedic Practice also highlights that syncope, hypoglycaemia and seizures are among the emergencies encountered by dental professionals and stresses the importance of maintaining knowledge, practical skills and teamwork.
Does everybody know their role?
One of the most useful exercises a practice can carry out is simply asking:
“If someone collapsed now, who would do what?”
Consider:
Who would take clinical leadership?
Who would call 999?
Who would start CPR if required?
Who would bring the AED?
Who would bring the oxygen and emergency equipment?
Who would retrieve the emergency medicines?
Who would record observations, medicines and timings?
Who would meet the ambulance crew and direct them to the patient?
Roles may change depending on which members of the team are present.
A dentist will not necessarily always be the first person to recognise an emergency, and a hygienist or therapist may sometimes be appropriately placed to take the initial clinical lead.
Regular scenario-based training helps a team discover these issues before a genuine emergency occurs.
Immediate access to an AED, oxygen and resuscitation equipment
Resuscitation Council UK states that all clinical dental areas should have immediate access to:
an automated external defibrillator (AED)
oxygen
appropriate airway and resuscitation equipment
a reliable means of calling for emergency assistance.
Staff should know where this equipment is kept and be trained to use equipment appropriate to their expected role. Resuscitation equipment should also be checked regularly, with RCUK recommending checks at least weekly.
Having an AED somewhere in the building is not enough if nobody knows where it is or valuable minutes are lost looking for it.
Emergency medicines – knowing what you can administer
This is understandably one of the areas that causes the most questions during our dental training.
Having emergency medicines available does not automatically mean that every member of the dental team is authorised to administer every medicine.
Individual team members need to understand:
What am I trained to administer?
What am I legally authorised to administer?
What is within my professional scope of practice?
What does our practice medicines policy say?
This becomes particularly important when considering the different roles of dentists, dental nurses, hygienists and therapists.
Changes introduced to the Human Medicines Regulations in June 2024 allow appropriately trained dental hygienists and dental therapists to supply and administer specified medicines under exemptions without requiring a PSD or PGD for those listed medicines.
Appropriate training, competence and clinical governance remain essential.
Practices should therefore ensure that their medicines policies reflect current guidance, rather than relying on arrangements that may have been written several years ago.
Dental hygienists and therapists – an important role
Dental hygienists and dental therapists are registered dental professionals and can have a significant role in responding to medical emergencies.
They are trained in basic life support and can undertake CPR, use an AED and administer oxygen when appropriately trained.
They may also potentially act as the team leader during a medical emergency.
The professional role of hygienists and therapists has developed considerably, and practices need to make sure their emergency procedures reflect the way their teams actually work today.
This is particularly relevant where hygienists or therapists practise without a dentist physically present.
The supporting clinical literature describes the differing emergency responsibilities and medicines considerations for dental nurses, hygienists, therapists and dentists.
What about midazolam?
Midazolam is an area where practices and dental professionals understandably seek clarification.
Midazolam is a controlled drug and should not simply be treated in the same way as other medicines contained within an emergency drugs kit.
For dental hygienists and therapists, appropriate patient-specific prescribing or direction arrangements are important where midazolam may need to be administered.
This is different from simply having a general practice protocol.
The clinical review also specifically identifies midazolam as requiring separate consideration from the newer medicines arrangements applying to dental hygienists and therapists.
This is an area where dental practices should ensure that their arrangements are based on current professional and medicines guidance and that individual clinicians understand their own legal authority and competence.
If there is uncertainty, the practice should obtain appropriate professional or medicines-governance advice rather than making assumptions.
Consider individual emergency care plans
Another area I strongly encourage dental teams to think about is anticipating risk before the patient sits in the chair.
Good medical history taking is fundamental, but for some patients it may also be helpful to have an individual emergency care plan clearly recorded within their clinical record, where clinically appropriate and with the patient's involvement.
Examples might include a patient with:
epilepsy or a recognised seizure disorder
a history of severe allergy or anaphylaxis
diabetes
adrenal insufficiency
another significant medical condition that could influence emergency management.
The objective is simple: if that patient's known condition causes an emergency, the team should not have to start working everything out from scratch.
Where relevant, the team should know:
What could happen?
What should we look for?
What is the patient's individual emergency plan?
Are patient-specific medicines involved?
Where are they kept?
Who can administer them?
When should 999 be called?
Resuscitation Council UK specifically recommends accurate medical histories so that patients at increased risk of certain medical emergencies can be identified before treatment.
Don't just practise CPR – practise the whole emergency
CPR remains an essential skill, but annual dental medical emergency training should be about much more than performing chest compressions on a manikin.
A realistic practice scenario might include:
Recognising that the patient is deteriorating.
Calling for help.
Allocating team roles.
Positioning and assessing the patient.
Retrieving oxygen, the AED and appropriate equipment.
Considering the relevant emergency medicine.
Calling 999 at the appropriate point.
Giving the ambulance service accurate information.
Recording observations, treatment and times.
Preparing for the ambulance team's arrival and transfer of care.
RCUK recommends simulation-based cardiorespiratory arrest scenarios, and its guidance also stresses the importance of having a clear process for summoning emergency assistance.
The more familiar the process becomes, the less the team has to work out under pressure.
Five questions for your next team meeting
You could start improving your emergency preparedness today by asking your team five simple questions:
1. Does everybody know where our AED, oxygen, emergency equipment and medicines are kept?
2. Does everybody understand their individual role and scope of practice during an emergency?
3. Do we know who can administer each emergency medicine available within our practice?
4. Have we identified higher-risk patients for whom an individual emergency plan may be appropriate?
5. When did we last practise a realistic medical emergency together as a team?
If any of those questions generate uncertainty, that gives you something useful to work on.
Becoming rescue ready
With the limited time available during formal medical emergency training, we cannot realistically explore every possible clinical circumstance that a dental professional may encounter.
That makes it particularly important for individual clinicians to understand their own professional responsibilities, medicines authority, scope of practice and level of competence.
There are still areas of medicines legislation and professional guidance that can feel complicated, particularly where professional roles have changed over recent years.
For that reason, dental practices should develop a culture in which people are comfortable asking questions and checking current guidance rather than simply saying:
“That's how we've always done it.”
For me, being rescue ready means creating a dental practice where:
risks are identified wherever possible
appropriate emergency equipment is immediately available
medicines are managed correctly
individual team members understand their roles
higher-risk patients are considered in advance
staff practise emergencies together
everybody knows how to summon additional help
training is refreshed regularly
and the team continues to learn.
Medical emergencies may be rare.
Being prepared for one shouldn't be.
About the author
Garry Perkins is the founder and Managing Director of Sussex First Aid Courses Ltd, a former paramedic and an experienced first aid and medical emergencies trainer. Garry has worked within emergency care and training for more than four decades and has spent many years supporting dental professionals with practical, scenario-based medical emergency training. www.sussexfirstaidcourses.co.uk
Further Reading and help:
Sussex First Aid Courses provides dental medical emergency, BLS, ILS and related continuing professional development training to dental teams across Sussex, Surrey, Kent and surrounding areas.
This article is intended as general educational information for dental teams. Individual professionals and practices should follow current GDC, Resuscitation Council UK, BNF/NICE and medicines-governance guidance relevant to their role and clinical setting.
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