Being prepared for unexpected medical emergencies

DESPITE increased availability of publicly accessible defibrillators, it is not uncommon for dental practices to be asked for help, or even asked to provide access to their defibrillator if a medical emergency occurs close to the practice.

MDDUS often hears from members who are unsure how to respond to such incidents that happen outside normal clinical practice.

It is important to remember that both medical and dental healthcare teams have a professional responsibility to help.

The key is to be prepared. Make sure there is a practice policy in place for responding to emergencies (including those in the community) and that all staff are aware of it.

Things can go horribly wrong if the clinical team are uninformed about their professional obligations, or if the practice has failed to meet the good practice standards required of them. In extreme cases, staff may be unable to respond appropriately or equipment may be unavailable or fail to be of use due to inadequate systems of training or maintenance.

Professional obligations

There is no legal obligation in the UK for registered healthcare staff to provide assistance outside a clinical setting – but there may be a moral or contractual obligation.

Doctors have a professional obligation to assist with a medical emergency in line with the General Medical Council’s Good medical practice guidance, which states (paragraph 26): “You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care.”

The Nursing and Midwifery Council (NMC) code states (paragraph 15) that nurses should “always offer help if an emergency arises in your practice setting or anywhere else”.

GDC Standards (paragraph 6.6.6) require you to ensure that:

• there are arrangements for at least two people to be available within the working environment to deal with medical emergencies;
• all members of staff know their role if there is a medical emergency; and
• all members of staff who might be involved in dealing with a medical emergency are trained and prepared to do so at any time, and practise together regularly in a simulated emergency so they know exactly what to do.

GDC Standards (paragraph 1.5.3) also require dental professionals to follow national guidance from Resuscitation Council UK. In its Dental mythbuster 4: Drugs and equipment for a medical emergency, the Care Quality Commission (CQC) highlights the General Dental Council’s guidance on medical emergencies, which includes references to Resuscitation Council guidance.

The article states: “We expect a practice to follow the national guidance issued by Resuscitation Council UK. 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.”

If the practice has a defibrillator there would be an expectation that any team members attending a medical emergency would be competent in using the equipment. However, use for community-based incidents is not always included in policies and operational arrangements.

Practice polices and processes

To ensure an appropriate response to community-based incidents (often a member of the public arriving at the door seeking immediate help) there are important factors for practice leads to consider. These include:

• Setting out the professional responsibilities of clinicians in relation to community-based scenarios.
• Carrying out a risk assessment and establishing practice policy in areas including:
  • The safe and accessible location of emergency equipment and drugs. The Resuscitation Council UK has a list of minimum equipment which should be available. A walk-round at induction of new staff should include the location and use of emergency equipment.
  • Mandatory staff training, suitable to roles. This can include online training and, for regulated professionals within the team, should be cross-referenced against any minimum CPD requirements for medical emergencies and CPR.
  • The role of front-line staff. Administrative team members are usually the public’s first port of call. Are they aware of what action is expected of them when clinicians are busy seeing patients or dealing with other matters? How should they call for help? Clear processes can be particularly important in circumstances where clinical team members are not immediately available, and a member of the community is seeking immediate attention.
• Ensuring a system of device maintenance (including to check and replace equipment, e.g. spare pads, out of date pads, battery life of the device) that follows the manufacturer’s instructions. Registering the device with the manufacturer can help ensure alerts are received in relation to safety/maintenance.
• Establishing relevant record-keeping requirements (including in relation to maintenance of staff training records, incident reporting and significant event analysis).
• Establishing at the time of the request whether there are sufficient staff to release a colleague to assist, mindful of patient safety within the practice. This will depend on the care ongoing at that precise time.
• Establishing that it is safe to release the AED. Once again this will require an assessment of the risk to patients undergoing treatment in the practice at the time and whether they are at particular risk of requiring the AED, e.g. patients with significant cardiac disease or those receiving sedation. A record must be kept of the reasons for the decision.

If it is decided that practice policy is not to release defibrillators for use by the public outside the practice premises, it will be especially important that the team know the location of other defibrillators available locally and how to access them.

Of course this would be unlikely to be relevant if the practice defibrillator is on the list of public-access defibrillators and linked to the 999 service. Some dental practices may be obliged to be on the list but even if there is no obligation to register a device with the 999 service, a practice could find themselves criticised by an inquiry if this is found to have prevented a member of the public accessing emergency assistance.

Indemnity for Good Samaritan acts

In general terms, MDDUS provides indemnity to our members on the basis that they act in accordance with the guidance of their regulators, and they hold the appropriate subscriptions for their role. In the event that an incident occurs prompting a practice response, it will be important afterwards to understand what happened through the use of existing incident reporting systems and thorough analysis. This will be of particular importance if the outcome for the individual concerned has not been a positive one.

Actions

• Ensure everyone in the team understands the practice’s professional obligations to members of the public seeking assistance in these circumstances.
• Review your policies and processes to ensure they reflect good practice set out by the Resuscitation Council UK and that they include reference to, and risk assessment of, incidents arising outside normal clinical practice.
• Contact MDDUS for advice in the event of an incident on advice@mddus.com

Liz Price is head of training at MDDUS