Adams School of Dentistry: Policy for Management of Medical Emergencies

I. Introduction

Medical emergencies in the dental office setting are an unavoidable occurrence. The UNC Adams School of Dentistry (ASOD) experiences over 115,000 outpatient visits per year, so it is foreseeable that there will be medical emergencies among those patients as well as persons who accompany them. Medical emergencies also occur among our faculty, staff, students, and visitors. The purpose of this policy is to establish the responsibility for patient triage, treatment, disposition and documentation of the emergency incident in both treatment and non-treatment locations within the ASOD Complex. It is the responsibility of all faculty, staff, and student health care providers to be familiar with the medical emergency protocol.

II. Basic Responsibilities

A. Prevention of Emergencies: Medical History and Vital Signs

All patients who request admission to the ASOD are required to complete a medical history questionnaire for inclusion in their dental patient records. It is the responsibility of the faculty/health care provider to review and update the medical history prior to initiation of treatment. In addition, vital signs (blood pressure and pulse) must be taken and recorded as follows:

1. Adult patients 18 years old and older: blood pressure and pulse must be taken on each treatment visit
2. Children & adolescent patients, 10-17 years: blood pressure and pulse must be taken on the initial visit and each subsequent 6-month appointment
3. For treatment visits involving sedation, vital signs must be monitored in compliance with the North Carolina State Board of Dental Examiners, "Dental Rules of North Carolina State Board of Dental Examiners," Sub chapters 16O & 16Q.
4. For further blood pressure monitoring guidelines, review the "Hypertension Adams School of Dentistry Clinical Guidelines" of the Clinical Manual.

B. Medical Emergencies in the ASOD Complex During Regular Hours (Monday-Friday, 8 a.m.-5 p.m.)

The ASOD Complex is defined as Brauer Hall, Tarrson Hall, First Dental Building, and Koury Oral Health Sciences Building.

1. Clinical Areas: Medical emergencies

• Faculty/health care provider assumes responsibility for initial evaluation and appropriate action.
• When additional medical assistance is needed, a call to the ASOD Medical Emergency Team at 7-3911 is to be made immediately with the caller stating the location and type (if known) of emergency.
• Caller is to remain on the line so that information can be relayed from the emergency site to the ASOD Medical Emergency Team.
• If the patient is conscious, vital signs (blood pressure, pulse, and respiratory rate) are to be taken immediately and the dental chair positioned according to patient symptoms.
• An oxygen tank is to be brought to the scene and when appropriate, oxygen is to be administered.
• If warranted, CPR is to be initiated immediately.
• Chronological recording of the emergency event is to be initiated as soon as sufficient personnel are available.
• Responsibility for emergency management is transferred to the ASOD Medical Emergency Team upon its arrival to the scene, and the Emergency Team shall follow the procedures outlined in Section III herein.
• As soon as sufficient personnel are available, faculty/health care provider is to submit an incident report with the chronological recording via the online Incident Report Form.

2. Non-Clinical Areas [EXCEPT Koury Oral Health Sciences Building]: Medical emergencies

• First person on the scene, employee or student, will contact the ASOD Medical Emergency Team at 7-3911. It is expected that the first faculty member arriving on the scene assumes responsibility for initial evaluation and appropriate action until the arrival of the ASOD Medical Emergency Team.
• As soon as sufficient personnel are available, faculty/health care provider is to submit an incident report with the chronological recording via the online Incident Report Form.

3. Koury Oral Health Sciences Building: Medical emergencies occurring

• First person on the scene, employee or student, will contact the ASOD Medical Emergency Team at 7-3911. It is expected that the first faculty member arriving on the scene assumes responsibility for initial evaluation and appropriate action until the arrival of the ASOD Medical Emergency Team.
• Operator that receives the 7-3911 call will direct the emergency call to 911.
• Caller must stay on the line to speak with the 911 operator. The employee or student must remain present until EMS arrives.
• If other persons are at the scene, the employee or student should instruct others to meet EMS at the appropriate entrance and guide them to the individual requiring medical assistance.
• As soon as sufficient personnel are available, faculty/health care provider is to submit an incident report with the chronological recording via the online Incident Report Form.

C. Medical Emergencies Outside the ASOD Complex Before/After Regular Hours (before 8:00 a.m., after 5:00 p.m. during weekdays, on weekends, or holidays)

Outside the ASOD complex is defined as outside Brauer Hall, Tarrson Hall, First Dental Building, and Koury Oral Health Sciences Building, which includes sidewalks and immediately surrounding area.

• When additional medical assistance is needed, the first person on the scene, ASOD employee or student, will request assistance from Orange County EMS by calling 911.
• An ASOD employee or student must meet Orange County EMS personnel at the appropriate entrance and direct them to the individual requiring assistance.
• As soon as sufficient personnel are available, faculty/health care provider is to submit an incident report with the chronological recording via the online Incident Report Form.

III. ASOD Medical Emergency Team Responsibilities

A. Responsibility transferred to the ASOD Medical Emergency Team upon arrival

1. The ASOD Medical Emergency Team, consisting mainly of Oral and Maxillofacial Surgery (OMFS) personnel (faculty, residents, & nurses), will be notified of emergency calls and respond. In the absence of designated OMFS faculty members, the senior OMFS resident is the emergency team leader.
2. Upon arrival of the ASOD Medical Emergency Team, to a medical emergency in a treatment area during clinic hours, the faculty/health care provider reports the significant medical history of the patient, nature of the emergency situation, patients' vital signs, and all treatments rendered.
3. Upon the ASOD Medical Emergency Team's arrival to a medical emergency in a non-treatment setting, the caller or other health care provider at the scene reports the nature of the emergency situation and any other relevant information known about the individual requiring medical assistance.
4. Event documentation is the responsibility of the nurse or junior OMFS resident. Documentation must be scanned and emailed to the Director of Clinical Compliance at ASOD_ClinicalCompliance@unc.edu.

B. ASOD Medical Emergency Team Leader

1. Team Leader determines the disposition of the individual requiring medical emergency treatment
2. When emergency management is adequate:
   • Dental treatment may continue
   • Patient may leave ASOD unattended
   • Patient is released to the care of a responsible adult
3. When additional evaluation and treatment is required
   • 911 is activated and the patient is assessed and transported by Orange County EMS to the UNC Hospitals Emergency Department
   • An employee or student must meet Orange County EMS personnel at the appropriate entrance and direct them to the emergency patient. The ASOD Medical Emergency Team gives report to Orange County EMS upon their arrival.
   • Once responsibility for the patient is transferred, Orange County EMS personnel determine disposition of the patient and further treatment.

C. Transportation and the ASOD Medical Emergency Team

1. The ASOD Medical Emergency Team does not provide emergency transportation services to other health care facilities, including the UNC Hospitals.
2. In case of a medical emergency requiring transportation to other health care facilities, 911 must be activated.
3. For non-emergency situations where additional medical care is recommended, the patient should be released into the care of a responsible adult and advised to follow up with their Primary Care Provider.

D. Liability Insurance Coverage

Members of the ASOD Medical Emergency team must carry liability insurance separate from their dental malpractice insurance coverage.

IV. Documentation

A. Medical Emergency Record

1. An ASOD Medical Emergency Record is generated each time the ASOD Medical Emergency Team responds to a call, which is completed by an OMFS nurse or junior resident.
2. Record is signed by the ASOD Medical Emergency Team faculty member present at the patient emergency.
3. Form must be scanned and emailed to the Director of Clinical Compliance at ASOD_ClinicalCompliance@unc.edu, within 48 hours of the incident.
4. Original medical emergency record is to be included in the ASOD patient record (chart) or, for non-patients, in the medical emergency file maintained by the Director of Clinical Compliance.

B. Incident Report

1. For all injuries occurring in the ASOD complex, an Incident Report must be generated by going to the online Incident Report Form.
2. Patient Injuries:
   • Health care provider (student, resident, and/or faculty) completes this report
3. Non-ASOD Patient Injuries:
   • First employee/health care provider on the scene of the emergency completes the report by going to the online Incident Report Form.
   • When no provider/employee/witness to an injury is apparent, the Director of Clinical Compliance completes the Incident Report.
   • All Incident Reports are must be completed within 48 hours of the incident.

C. Patients of Record

When the emergency involves an ASOD patient of record, the faculty/health care provider documents the emergency event in the patients' record.

V. Training Requirements

A. Basic Life Support (BLS/CPR) Training

All ASOD personnel providing direct patient care must maintain Basic Life Support (CPR) for Provider certification in accordance with the ASOD BLS Policy.

B. Advanced Training including Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS)

1. Designated ASOD Medical Emergency Team members will maintain current ACLS certification.
2. All ASOD Medical Emergency Team members will annually attend an update on the use of the defibrillator.
3. If required by the North Carolina Board of Dental Examiners, ASOD employees and residents will maintain current ACLS and/or PALS certification.

C. Medical Emergency Training

All full-time employees and residents who provide direct/human subject care must complete Medical Emergency training on an annual basis. Failure to comply with training requirements may result in suspension of clinical privileges in all areas to which the individual is assigned until evidence of course completion is presented to the Director of Clinical Compliance. Disciplinary action may be initiated in consultation with Human Resources.

VI. Emergency Equipment Monitoring

A. Automated External Defibrillators (AED's)

Automated External Defibrillators (AED's) located in Brauer Hall, Tarrson Hall, First Dental Building, and Koury Oral Health Sciences Building will be inspected once a quarter and after use by a designated ASOD employee. Equipment is serviced by the vendor every two years, or as needed.

B. Oxygen Equipment

• Emergency oxygen tanks and related equipment located in Brauer Hall, Tarrson Hall, First Dental Building, and Koury Oral Health Sciences Building.
• Each respective area will be checked periodically by a designated ASOD employee.
• Inspection and maintenance records will be maintained electronically, by the Director of Clinical Compliance.
• Records will be maintained by the Director of Clinical Compliance.
• Replacement equipment will be ordered by the Director of Clinical Compliance.

C. ASOD Medical Emergency Team Drugs and Equipment

The OMFS nurse (or junior OMFS resident and OMFS staff in the nurse's absence) will monitor and update emergency drugs and equipment on a weekly basis, and restock emergency supplies immediately after each emergency call. Maintenance records will be forwarded to the Director of Clinical Compliance.

D. Departmental Emergency Drugs and Equipment

All departmentally maintained emergency drugs and equipment must be checked weekly by a member of that department designated by the Faculty Chair. Electronic inspection records will be kept with the equipment/materials detailing date and inspector.

VII. Related Requirements

A. External Regulations and Consequences

• North Carolina Administrative Code, Title 21, Chapter 16 - Dental Examiners, SubChapters 16O and 16Q.

B. Unit Policies, Standards, and Procedures

• Adams School of Dentistry: Emergency Response Manual
• Adams School of Dentistry: Blood Pressure Monitoring Guidelines
• Adams School of Dentistry: BLS Policy
• Adams School of Dentistry: Procedure Following Bloodborne Pathogens Exposure
• Adams School of Dentistry: Procedure for Swallowed Foreign Objects

IX. Contact Information