|Year : 2015 | Volume
| Issue : 4 | Page : 422-428
Evaluation of preparedness for medical emergencies among dental practitioners in Khammam town: A cross-sectional study
L Surya Chandra Varma, K. V. N. R. Pratap, T Madhavi Padma, V Siva Kalyan, P Vineela
Department of Public Health Dentistry, Mamata Dental College, Khammam, Telangana, India
|Date of Web Publication||7-Dec-2015|
L Surya Chandra Varma
Department of Public Health Dentistry, Mamata Dental College, Khammam, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: Medical emergencies can occur frequently in the dental setting. Effective management of an emergency situation in the dental office is ultimately the dentist responsibility. The assessment of preparedness of dental practitioners would help to bring about required changes in the teaching aspects of dental institutions, which would ultimately help dental graduates to improve knowledge regarding management of medical emergencies. This would also make dental offices available with required emergency drugs. Aim: To evaluate the preparedness for medical emergencies among the dental practitioners in Khammam town. Materials and Methods: A cross-sectional questionnaire-based study with a sample of 301 was conducted among dental clinicians at Khammam to evaluate their knowledge regarding medical emergencies. The questionnaire consisted of nineteen questions. First nine questions are objective questions, requiring a simple yes or no reply. Next ten questions are multiple choice questions regarding Emergency Medical Services and basic life support. Chi-square test was used to analyze the data. A P < 0.05 is considered significant. Results: The results of this study showed that almost all the participants (94.02%) enquired about medical and drug history, but only 67.11% of them obtained a complete health history proforma of the patient. About 83.06% record vital signs, 74.09% of members report about attending workshops on emergency training and management, and 50.5% of members were either not sure or not in a position to handle the emergency condition. Conclusion: The results of this study reflect an alarming situation of the capability of dentists to deal with medical emergencies at dental offices and make available all the emergency drugs at their offices.
Keywords: Cardiopulmonary resuscitation, dental offices, dentists, emergencies
|How to cite this article:|
Varma L S, Pratap K, Padma T M, Kalyan V S, Vineela P. Evaluation of preparedness for medical emergencies among dental practitioners in Khammam town: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:422-8
|How to cite this URL:|
Varma L S, Pratap K, Padma T M, Kalyan V S, Vineela P. Evaluation of preparedness for medical emergencies among dental practitioners in Khammam town: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jul 5];13:422-8. Available from: http://www.jiaphd.org/text.asp?2015/13/4/422/171178
| Introduction|| |
An emergency is a medical condition that demands immediate attention and successful management. The practitioners should be aware of the life-threatening situations so that needless morbidity can be avoided. About half of the patients visiting a dental office have one or the other chronic disease or condition. Few diseases and their treatments lead to medical emergencies during dental care or dental treatments. Although a number of studies were conducted to improvize the availability of emergency drugs and equipment, the lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action.,, The golden rule in managing any emergency is by rendering basic life support (BLS), cardiopulmonary resuscitation (CPR) by following the basic principles which include position, airway, breathing, circulation, and definitive therapy.
The most frequently encountered medical emergencies in a dental office are vasovagal syncope, angina pectoris, hypertensive crisis, and epileptic fits. All the emergencies may not be life-threatening but the ability of a dentist to manage them play a key role in minimizing morbidity and mortality.
Hence, this study was conducted with an aim to assess the preparedness for medical emergencies among the dental practitioners in Khammam town. The objectives of this study were to compare, their ability to manage patients at the dental office, availability of emergency kits with emergency drugs, immediate response to a medical emergency, and knowledge on providing proper treatment to special cases between general dental practitioners (BDS) and specialized dental practitioners (MDS).
| Materials and Methods|| |
This study was a cross-sectional questionnaire-based study on a sample of 301 dental practitioners in Khammam town, South India. All the participants willing to participate were included in the study based on convenience sampling. Ethical clearance was obtained from the Institutional Ethics Research Committee. The list of the practitioners was obtained from the District Medical Health Officer Khammam district and the Indian Dental Association Khammam branch.
The instrument used in the study is a standard questionnaire designed in English language. The questionnaire consists of two parts (part A and Part B). Part A, consists of questions related to the demographic data and part B, consists of 19 questions related to the preparedness of dental practitioners toward medical emergencies. The questionnaire included the following topics: Emergency training and management, most common medical emergencies in the dental office, CPR, systemically compromised conditions and their management, and availability of emergency drugs. The questionnaire consisted mainly of objective questions, requiring a simple yes or no reply, and informed consent was taken from all the study participants. A pilot study was conducted on 25 dental practitioners who were selected randomly; based on their doubts related to the questions, the questionnaire was modified. The content validity of the questionnaire was assessed with the panel of experts. Reliability of the questionnaire was determined using Cronbach's alpha coefficient test, which gave a value of 0.82.
The self-administered questionnaire was distributed in the morning to all the dental practitioners after obtaining their consent and promising the confidentiality and then was collected at the end of the day by only one investigator.
Data collection was done in March and April 2015 over a period of 2 months. The data obtained were entered into Microsoft excel sheet and was subjected to analysis, which was done using Statistical Package for Social Sciences (SPSS) version 21 IBM Corp, Released 2012, IBM SPSS, Statistics for windows, Version 21., Armonk, NY:IBM Corp. Descriptive statistics were calculated. The value P < 0.05 was considered statistically significant.
| Results|| |
Demographics of the participants
All the 301 dental practitioners participated in the study, yielding a response rate of 100%. Among the study participants majority (45.51%) of them belonged to 30–39 years and most of them were males (56.81%). More than half of the participants were with a designation of MDS [Table 1].
Comparison among BDS and MDS practitioners regarding collection of case history and their ability to manage patients at dental office
A total of 96.27% of MDS practitioners enquired about medical and drug history and about 91.43% of BDS practitioners did so. Only about 67.70% of MDS practitioners and 66.43% of BDS practitioners obtained a filled health history proforma. 85.71% of MDS practitioners and 80% of BDS practitioners obtained vital signs such as blood pressure, pulse, and respiration, temperature of the patients before commencing any treatment. Comparatively more number of MDS practitioners (78.88%) attended workshops on emergency training or management programs than BDS practitioners (68.57%). About half of the MDS practitioners (50.31%) and BDS practitioners (48.57%) were sure about handling an emergency situation at dental offices. 78.88% of MDS practitioners and 66.43% of BDS practitioners were able to administer intramuscular injection, whereas only 75.16% of MDS practitioners and 67.86% of BDS practitioners were able to administer the intravenous injection [Table 2].
|Table 2: Comparison among BDS and MDS practitioners regarding to collection of case history and their ability to manage patients at dental office|
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Comparison of availability of emergency drug kits with emergency drugs among BDS and MDS practitioners
More than three-fourths of MDS practitioners (83.23%) and BDS practitioners (82.14%) maintained emergency drug kits in their dental office. The most commonly available emergency drugs in the dental offices of MDS practitioners were oral glucose (88.82%), adrenaline (82.61%), ammonia inhalant (72.67%), and epinephrine (72.67%) and less commonly available were hydrocortisone (66.46%) and atropine (70.81%). The most commonly available emergency drugs in the dental offices of BDS practitioners were oral glucose (85%), ammonia inhalant (80%), adrenaline (78.57%), and epinephrine (69.29%) and less commonly were atropine (68.57%) and hydrocortisone (62.86%) [Table 3].
|Table 3: Comparison of availability of emergency drug kits with emergency drugs among BDS and MDS practitioners|
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Comparison of immediate response to a medical emergency among MDS and BDS practitioners
About 83.85% of MDS practitioners were aware of placing the patient suffering from syncope during a dental treatment in Trendelenburg position and administer ammonia inhalant, whereas only 78.57% of BDS practitioners were aware of this. Very less ratio of MDS practitioners (65.22%) and BDS practitioners (57.86%) knew the correct way of managing a patient suffering from foreign body aspiration. Surprisingly, about 83.85% of MDS practitioners and 80% of BDS practitioners were not aware of activating Emergency Medical Services when a person is not responding [Table 4].
|Table 4: Comparison of immediate response to a medical emergency among MDS and BDS practitioners|
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Comparison between knowledge of BDS and MDS practitioners on providing proper treatment to special case
Only 68.32% of MDS practitioners and 60% of BDS practitioners were aware of planning extractions in patients with a prosthetic heart valve. 67.08% of MDS practitioners and 55.71% of BDS practitioner were aware of the dental procedures, which can be performed in patients with prosthetic heart valve without giving antibiotic prophylaxis. About 91.93% of MDS practitioners and 86.43% of BDS practitioners were aware that BLS stands for basic life support. About 80.75% of MDS practitioners and 76.43% of BDS practitioners do not know that the right location of chest compression is midchest. Moreover, very few MDS (37.89%) and BDS (32.86%) of practitioners were aware that correct ratio of CPR in single rescuer in adults is 30:2. Less than half of the MDS (42.24%) and BDS (45.71%) practitioners were not aware that CPR should be performed when they do not want to perform mouth to mouth respiration. About 75.78% of MDS and 72.14% of BDS practitioners were not aware of the procedure of giving rescue breathing in infants [Table 5].
|Table 5: Comparison of knowledge of BDS and MDS practitioners on providing proper treatment to special cases|
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| Discussion|| |
Fortunately, the incidence of emergency events seen in the general practice setting is less, but when an emergency does occur it can be life-threatening. The recognition of "at-risk" patients and subsequent appropriate management plays a key role in reducing the probability of an adverse event.
This study was done with an aim to assess the preparedness of dental practitioners toward medical emergencies by enquiring about the key start points such as medical history, drug history, vital signs of the patients, and availability of emergency drug kits at their dental office. 94.02% of the total practitioners enquired about medical and drug history, but only 67.11% of them obtained filled Performa and about 83.06% recorded vital signs. All the above findings were high when compared to a similar study conducted by Kumarswami et al. which was mainly due to increase in the awareness regarding medical emergencies among dentists.
An oral temperature in excess of 99.6°F (37.5°C) is a good indicator of the presence of a viral or bacterial infection. Thus, it is mandatory to provide Performa's to the patients and obtain these properly filled forms containing all previous health history including fever, cough, hepatitis, hypertension, diabetes, etc., before commencing of any treatment, so that required precautions can be taken to prevent the occurrence of such emergency situations. Monitoring of blood glucose should be performed in patients with a history of diabetes.
74.09% of the practitioners received training in the management of medical emergencies during their under graduation and postgraduation education course, which is relatively higher when compared to the study done by Gupta et al.
Only 50.5% of the dentists were confident in managing any emergency condition at their dental offices, which was similar to the findings in a study done by Muller and Broadbent, whereas the remaining had an attitude of calling an ambulance in case of emergency conditions.,
87.2% of the practitioners had emergency kits at the dental office to handle medical emergencies, but this was in contrast to the findings (8.9%) in a study done by Gbotolorun et al.
The most commonly available emergency drugs were adrenaline (80.73%), oral glucose (87.4%), and ammonia inhalant (76.08%) and less commonly available were hydrocortisone (64.78%) and atropine (69.77%), these findings were similar when compared to the study done by Kumaraswam  and Gupta et al.
It is of outmost importance to conduct BLS programs among dental practitioners and in almost all corners and sectors of our society, with the intention of creating numerous BLS responders as the knowledge was very poor among the dental practitioners on BLS.,
A better acquaintance of medical emergencies is crucial for the further expansion of dentistry in India. This will ensure better provision of safer dental health care services for the population.
In addition to being aware of state dental practice acts, the dentists should also be familiar with the accepted treatments and protocols for medical emergencies, which often become the basis for a legal standard of care. The standard of care can be defined as "what a reasonable, prudent person with the same level of training and experience would have done in the same or similar circumstance." Failure to use the degree of care considered reasonable under the circumstance, which result in unintentional injury is negligence. The extent of treatment by the dentist requires preparation, prevention and then management as necessary. Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required. The most important aspect of nearly all medical emergencies in the dental offices is to prevent, or correct, insufficient oxygenation of the brain and heart. Therefore, the management of all medical emergencies should ensure that oxygenated blood is being delivered to these critical organs. This is consistent with basic CPR, with which the dentist must be competent. This CPR provides the skills to manage most medical emergencies, which begins with the assessment and if necessary the treatment of airway, breathing, and circulation (the circulation-airway-breathings [CABs] of CPR). Usually, only after these CABs are addressed, the dentist should consider the use of emergency drugs.
This suggests that although training is received in the theoretical aspect of emergencies, participants are not particularly confident to treat emergencies and may require further practical training. Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. Thus, need of the hour is framing of legislations and update of the emergency medical kits.
Though comparison was made between general dental practitioners and dental specialists with regard to the preparedness, we could not find any significant difference between the both in spite of the dental specialists ranking higher in majority of the aspects in handling emergencies.
| Conclusion|| |
The best way to handle an emergency is to be prepared in advance. Dentists, being members of the healthcare profession, should be prepared to deal with medical emergencies, which may arise at their workplace. However, the results of our study reflect an alarming situation about the capability of dentists to deal with such conditions. Attending continuing dental education program consisting of workshops and hands-on courses in this field should be made mandatory. Awareness of BLS among dental practitioners is very minimal and needs improvization.
Since the study was conducted in a single geographical area, generalization should be done with caution.
- Dental institutions should improve teaching levels to create awareness among students regarding medical emergencies
- All the dental graduates should attend at least few training programs on BLS and managing medical emergencies
- Emergency drug kits with required emergency drugs should be available at each dental office
- All the dental graduates should improve their knowledge regarding managing emergency cases at dental offices before establishing dental offices.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]