When a life-threatening emergency happens at a dental practice, staff must be prepared with the necessary medications and appropriate training to quickly respond. Learn what standards and guidelines determine the emergency medical kit and supplies most appropriate for your dental office and which medications are necessary for basic emergency response.
What Should an Emergency Medical Kit Include?
Dr. Malamed is a dentist anesthesiologist and Emeritus Professor of Dentistry at the Herman Ostrow School of Dentistry of USC in Los Angeles, where he taught from 1973 to 2013 and has authored more than 160 scientific papers and 17 chapters in various medical and dental textbooks in the areas of physical evaluation, emergency medicine, local anesthesia, sedation and general anesthesia.
When determining what belongs in a dental emergency medical kit, Dr. Malamed recommends asking three questions:
- Based on my emergency response training certification level, what do I need in order to offer the highest level of medical emergency care possible?
- How do I pass an inspection (for example, by a state dental board or an insurance provider)?
- How do I protect myself in a lawsuit?
Answers will vary based on your practice type and location, but it is always important to follow best practices to choose the drugs and equipment necessary to satisfy all three questions.
Standard of Care for Dental Emergency Medical Kits
Medical emergency preparedness guidelines are based on the concept of “standard of care” which is the general consensus of professional groups including the American Dental Association, Journal of the American Dental Association (JADA), American Association of Oral and Maxillofacial Surgeons (AAOMS), and dentistry thought leaders such as Dr. Malamed. Standard of care represents the professional expectation of dental office medical emergency preparedness based on practice type, patient profile, location, and emergency response training.
State Dentistry Board Regulations
Dental practices are licensed and governed by individual state dentistry boards and not the federal government. State standards often, but not always, specify required equipment, medications, and training primarily based on the level of sedation the dentist uses. Some states treat guidelines such as the ADA Guidelines for Use of Sedation and General Anesthesia or the AAOMS Office Anesthesia Evaluation Manual as absolute requirements that must be met in order for the dentist to be issued a sedation permit.
State requirements vary widely regarding the medical emergency drugs, equipment, and training necessary for general anesthesia. The general trend is that the more sedation used, the more likely the practitioner will need to have the medications, training, and equipment necessary to perform Advanced Cardiac Life Support (ACLS) and intubation.
To meet your state’s requirements for standard of care, it’s important to include each medication and piece of equipment that your training qualifies you to treat in your emergency medical kit. Consider if your state defers authority to another body for requirements, what level of sedation you practice, if you are a member of AAOMS, and if your accreditation requires you to have any specific equipment at hand. If in doubt, always contact your state dental board.
7 Essential Medications for Basic Emergency Medical Kits
Both the ADA and JADA have published guidelines for emergency medical kits for general dentistry. Dr. Malamed has published clear directives and authored a well-known textbook, “Medical Emergencies in the Dental Office.”
Dr. Malamed calls for seven drugs in a basic dental emergency medical kit including:
- Epinephrine– More commonly known as adrenaline, epinephrine is a hormone that causes an increase in heart rate, muscle strength, blood pressure, and sugar metabolism. Epinephrine injections are used to treat anaphylaxis resulting from a severe allergic reaction or acute asthmatic attack. An epinephrine auto-injector, commonly referred to by the branded name EpiPen® but widely available as generic, is essential to providing a rapid initial response. A back-up injection should also be on hand in case the patient has a biphasic reaction.
- Albuterol– An albuterol inhaler is an asthma inhaler used to treat acute bronchospasms in asthma attacks.
- Diphenhydramine– Diphenhydramine is a histamine blocker used to treat patients with mild or delayed-onset allergic reactions.
- Aspirin– Aspirin is administered as part of the MONA protocol when myocardial infarction is suspected.
- Nitroglycerin– Nitroglycerin is a coronary vasodilator used to relieve severe angina symptoms such as chest pain or pressure. Nitroglycerin may be administered through a sublingual tablet or translingual spray.
- Ammonia Inhalants– Commonly known as smelling salts, ammonia capsules act as a stimulant to improve the consciousness of patients who have fainted.
- Glucose– Glucose is a simple sugar used to treat diabetic or hypoglycemic patients during a blood sugar-related emergency.
In addition to the seven kitted drugs, members should also be prepared with a portable oxygen setup capable of delivering positive pressure ventilation. The HealthFirst Medical Advisory Board, including Dr. Malamed, recommends the addition of a seventh drug, naloxone (often sold under the brand name NARCAN®) as a result of the opioid crisis.
HealthFirst Emergency Medical Kits for All Dental Offices
Founded in 1971, HealthFirst provides services to more than 50,000 dental and medical facilities each year. HealthFirst emergency medical kits, sharps management, and amalgam recovery solutions have been widely adopted by healthcare providers for over 50 years.
Some of HealthFirst’s emergency medical kits include:
- SM basic emergency medical kits are designed so the general dental practice can be prepared for medical emergencies and compliant with state regulations and the standard of care.
- SM-Z emergency medical kits offer advanced organization and mobility, featuring essential medications to meet the standard care. The kit is on wheels, with a telescoping handle, and places to store an AED and/or portable oxygen cylinder.
- Mobile ACLS® emergency medical kits help provide dental office medical preparedness where ACLS response may be required.
All kits align with recommendations from the American Dental Association (ADA), Journal of the American Dental Association (JADA), and the HealthFirst Medical Advisory Board.