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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 440-444

Experience, awareness, and perceptions about medical emergencies among dental interns of Chennai city, India


1 Department of Public Health Dentistry, Tagore Dental College, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Narayana Dental College, Nellore, Andhra Pradesh, India
3 Department of Public Health Dentistry, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
4 Department of Public Health Dentistry, Priyadarshni Dental College, Chennai, Tamil Nadu, India

Date of Web Publication15-Dec-2016

Correspondence Address:
L Leelavathi
G3/7, Eden Castle, Nerkundram Road, Virugambakkam, Chennai - 600 092, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.195831

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  Abstract 

Introduction: Every dental health professional should have the essential knowledge to identify, assess and manage a potentially life-threatening situation. Aim: To assess the experience, awareness, and perceptions about medical emergencies among dental interns in Chennai city, India. Materials and Methods: A cross-sectional study carried out in four randomly selected dental colleges of Chennai city. Data were collected using a self-administered, structured, closed-ended 20-item questionnaire. It consists of questions on experience of medical emergencies encountered by interns during their graduation, awareness of the essential drugs and equipment, the amount of medical emergencies training undertaken by participants, preparedness of interns in handling medical emergencies. Descriptive statistics, independent sample t-test, were used. Results: Out of 335 interns, 157 (47%) said that syncope was the most common medical emergency event encountered by the interns. Regarding awareness about essential drugs, about 161 (48%) study participants answered oxygen, epinephrine, nitroglycerin, antihistamine, salbutamol, and aspirin as emergency drugs. About half of the study participants, 187 (56%) were aware that pressure should be given to the affected site, with or without suturing if the greater palatine artery is inadvertently cut. The majority of the interns (93%) preferred to have a specified training on the handling of medical emergencies in dental practice. Conclusions: Syncope was the most common medical emergency event. Awareness about the essential drugs, equipment, and preparedness of dental interns in handling medical emergencies was low.

Keywords: Awareness, emergencies, internship, residency


How to cite this article:
Leelavathi L, Reddy V C, Elizabeth CP, Priyadarshni I. Experience, awareness, and perceptions about medical emergencies among dental interns of Chennai city, India. J Indian Assoc Public Health Dent 2016;14:440-4

How to cite this URL:
Leelavathi L, Reddy V C, Elizabeth CP, Priyadarshni I. Experience, awareness, and perceptions about medical emergencies among dental interns of Chennai city, India. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Nov 15];14:440-4. Available from: http://www.jiaphd.org/text.asp?2016/14/4/440/195831


  Introduction Top


Professional bodies usually have its own code of conduct for their members.[1] The code of ethics for dentist, toward patients and public was standardized by the Dental Council of India, “Treat the welfare of the patients as paramount to all other considerations and shall conserve it to the utmost of his ability.”[2]

In 1971–1972, health professions education worldwide was assessed by the World Health Organization commission and the commission concluded that education and health service system are inextricably interwoven with each other and questions about the training of health-care providers follow soon after when questions arise about the delivery of service.[3]

Dental professionals are expected to provide safe and painless dental procedures when they complete their education from dental colleges. Undergraduate dental education's aim has been described as “to produce a caring, knowledgeable, competent, and skillful dentist who is able, on graduation to accept professional responsibility for the effective and safe care of patients who appreciates the need for continuing professional development, who is able to utilize advances in relevant knowledge and techniques and who understands the role of the patient in decision-making.”[4]

A medical condition demanding immediate treatment is an emergency. Medical emergencies have many forms including syncope, asthmatic attacks, epileptic attacks, cardiac arrest, etc.[5] In dental offices, medical emergencies do occur. A survey was conducted among 4000 dentists by Fast and others, and the results of the survey revealed that for 10 years 7.5 emergencies per dentist was reported.[6] A total of 13,836 emergencies were reported within a 10-year period in a survey conducted among 2704 dentists throughout North America.[7]

It is mandatory that every dental health professional should have basic knowledge to manage a potentially life-threatening situation. A study was conducted in Japan between 1980 and 1984 by the Japanese Dental Society and it was reported in the study that anywhere from 19% to 44% of dentists had a patient with a medical emergency in any 1 year [8] and about 70.2% of general dental practitioners in the United Kingdom have managed medical emergency events.[9] One study conducted in Australia reported that approximately 15% of dental surgeons had done cardiopulmonary resuscitation (CPR) for the patients in their dental offices in 1 year.[10]

In a study conducted by Gupta et al. it was reported that less than half (42.1%) of the dentists received training during their undergraduate and postgraduate education.[11] The lack of training and inability to cope with medical emergencies can cause tragic consequences and sometimes legation action.[9] Hence, as all the health care professionals, dental care professionals must be well prepared to manage medical emergencies.

Few studies have done among dentists assessing their knowledge and preparedness in managing medical emergencies, and very few studies to our knowledge have reported studies involving dental interns. Thus, the present study was done as an attempt to assess the experience, awareness, and perceptions about medical emergencies among the dental interns in Chennai city, India.

Aim and objectives

Aim

The aim is to assess experience, awareness, and perceptions about medical emergencies among the dental interns in Chennai city, India.

Objectives

  • To know the experience of medical emergencies encountered during their graduation
  • To know the awareness of the essential drugs and equipment in handling medical emergencies
  • To assess the preparedness of interns in handling medical emergencies in dental practice
  • To find out whether any additional training is required for interns in handling medical emergencies in dental practice.



  Materials and Methods Top


A cross-sectional study was carried out among the dental interns in Chennai city, India. The study was carried out for the duration of 4 months from October 2013 to January 2014. Those who were present on the day of the survey and willing to participate in the study were included. The study participants were explained about the purpose of the study, and informed consent was obtained from them. Ethical clearance was obtained from the institutional review board.

A pilot study was carried out to pretest the questionnaire and check the feasibility of the study among 50 interns attending a dental college in Chennai. Following the pilot study, using the G power version 3.1.7, with the power of study being set at 90%, alpha error at 5% a sample size of 296 was assigned for the study. Cluster sampling methodology was followed in which the dental colleges in Chennai formed the clusters. Among the dental colleges in Chennai city, four were selected randomly to reach the required sample size. As cluster sampling methodology was followed all the interns in the randomly selected dental colleges were included and hence a sample size of 335 has been arrived.

Dental interns were given a self-administered questionnaire which included twenty close-ended questions on the experience of medical emergencies encountered during their graduation, about the awareness of the essential drugs and equipment, on the amount of medical emergencies training undertaken by participants, about the preparedness of interns in handling medical emergencies.[12],[13],[14]

The data were processed using Statistical Package for the Social Sciences (SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0 Chicago: SPSS Inc.). Independent sample t-test was used to assess the responses for the questionnaire between male and female study participants. A P < 0.05 was considered to be statistically significant.


  Results Top


Among 335 interns, 202 (60%), said that during their graduation they have experienced some medical emergency situation of patients. Syncope was the most common medical emergency event encountered by the interns, and epileptic attacks were the least common medical emergency event encountered [Figure 1]. About 206 (61%) interns said that the management of medical emergencies was a part of their curriculum during their undergraduate training. Regarding medical emergency and basic life support (BLS) training, about 38 (11%) said that they did not receive any training. About 186 (56%) interns received theoretical training only and about 111 (33%) received practical training.
Figure 1: Medical emergencies encountered by dental interns during their graduation

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Regarding the awareness of the essential drugs and equipment in handling medical emergencies, it was found that the awareness was found to be inadequate among dental interns. Among 335 dental interns, about 161 (48%) answered oxygen, epinephrine, nitroglycerin, antihistamine, salbutamol, aspirin as emergency drugs. Only 69 (21%) study participants were aware that diphenhydramine was used to treat allergic reactions.

Only 98 (29%) study participants were aware that nitroglycerin was contraindicated to those with chest pain, those who are exhibiting signs of a drop in blood pressure and those with chest pain who have taken Sildenafil (Viagra) within the previous 24 h. About 98 (29%) study participants were aware that adrenaline should be given intramuscularly and about 135 (40%) said that adrenaline should be administered at the dosage of 0.3 ml injection of 1:1000. Only 49% of the interns were aware that emergency drug kit should contain preloaded syringe of epinephrine. About 276 (82%) study participants were aware that administering sugar was the most common treatment for someone with low blood sugar (hypoglycemia) and about 87 (26%) said that automated external defibrillators (AEDs) can reduce mortality from cardiac arrest caused by ventricular fibrillation and pulseless ventricular tachycardia and adult AEDs can safely be used on children over 8 years old.

Preparedness of dental interns in handling medical emergencies was found to be low. For the question of the acronym for managing medical emergencies about 74 (22%) of interns gave the correct answer as PABCD (position [P] the patient; airway [A]; breathing [B]; circulation [C]; definitive treatment, consisting of differential diagnosis, drugs, and defibrillation [D]) and for the question related to positioning of unconscious patient, about 170 (51%) said that the unconscious patient should be positioned in the supine position with their feet slightly elevated. About half of the study participants, 187 (56%) were aware that dentist must control the bleeding quickly and pressure should be given to the affected site, with or without suturing if the greater palatine artery is inadvertently cut.

About 206 (61%) study participants were aware that if an angina attack does not go away, or if the pain gets worse or comes back one should suspect that the patient is having a myocardial infarction. Out of 335 interns, 311 (93%) said that they preferred to have a specialized training on the management of medical emergencies in dental practice [Figure 2].
Figure 2: Responses of interns regarding the requirement of any additional training in medical emergencies management

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The mean awareness score between genders was not statistically significant (P = 0.379). The mean preparedness score between genders was statistically significant (P < 0.001) [Table 1].
Table 1: Comparison of the mean awareness score and preparedness score among the study subjects-gender wise

Click here to view



  Discussion Top


Dental professionals' most important contribution is to provide BLS to the patients until absolute treatment for medical emergency situations. If the students have minimal knowledge about these emergency situations, it may cause dissatisfaction, in secured feelings, and a minimal appreciation of the dentists' responsibility. Interns reach out to the community as dental care providers after the internship period.

In the present study, 60% of the interns said that they have experienced some medical emergency situation during their graduation which is similar to the study conducted by Jodalli and Ankola.[15] In a study conducted by Dalila et al., among the dentists in the municipality of Porto, 67% reported an emergency situation since the beginning of their practice.[16] The emergency situations reported was more as the same emergency situation in the dental colleges could be reported more than once.

In this study, syncope (47%) was the most common medical emergency event encountered by the interns This is similar to a study conducted by Jodalli and Ankola which shows 40.9% of the respondents said that syncope/faints was the most commonly encountered emergencies.[15] This could be because dental treatment is often associated with increased stress caused by pain and/or fear.

In the current study, the most common medical emergency event syncope was followed by allergic reactions (4%), hypoglycemic attacks (2%), asthmatic attacks (2%), and epileptic attacks (1%). This would indicate that the students to be trained for dealing with these emergencies. In a study conducted by Chapman among general dental practitioners in Australia, the most prevalent medical emergencies were allergic reactions to local anesthetics, epileptic attacks, hypoglycemia, and angina.[10] In a study conducted by Arsati et al. among Brazilian dentists, it was found that the most common emergency reported was syncope and the least reported was infarction, and heart arrest.[17] This finding was not similar to the present study findings as they were conducted among the general dental practitioners, they might have encountered more emergency situations in their practice.

Regarding medical emergency and BLS training, about 67% said that they did not receive any training. This was similar to the study conducted by Shenoy et al., which shows that 50.70% of the respondents had not undergone training in CPR.[18] In a study conducted by Jodalli and Ankola, 43% of respondents had received no medical emergency training.[15] Whereas in a study conducted among 136 dental students by Stoeva, 86% had never trained in this procedure.[19] Furthermore, in a study conducted by Singh et al., 88% of the study participants had not received practical training in basic CPR.[20] In a study conducted by Gonzaga et al. among the dentists it was reported that most of them had not received practical training for resuscitation.[21]

In the present study, 48% of interns gave the correct answer for the question of essential emergency. In addition, only 48% of the interns said the correct answer for the question regarding diphenhydramine. Only 49% of the interns were aware that emergency drug kit should contain preloaded syringe of epinephrine. Only 29% of interns gave the right answer for the question of contraindication to nitro-glycerine as those with chest pain who have a fall in blood pressure and those with chest pain who have taken Viagra within 24 h. Thus, the knowledge regarding the essential drugs was not at an acceptable level and this is an alarming situation. This could be due to their lack of adequate training about medical emergencies management during their graduation.

Only 33% of interns answered correctly that for opening a patient's airway. For the question of acronym for managing medical emergencies only about 22% of interns answered correctly as PABCD. In addition, only 51% answered that the unconscious patient should be positioned in the supine position with their feet slightly elevated. Only 21% were able to give right answer for the question of carotid artery location. Only 56% said that if the greater palatine artery is inadvertently cut the dentist must control the bleeding quickly and pressure should be given to the affected site, with or without suturing. This shows that dental students have poor preparedness and less understanding about medical emergencies. This could be considered as an indication to denote that the training of medical emergencies management was not sufficient. Although the medical emergency management have been included in the undergraduate curriculum, there has been no specification about the duration and method of training.[11] Effective management of such situations is of paramount importance. Lack of training and inability to manage such emergencies can lead to loss of life.

In the present study, 93% said that they preferred to have a specialized training on the management of medical emergencies in dental practice. This was similar to the study conducted by Shenoy et al., which shows that 95.3% of the young graduates were willing to undergo training.[18] In a study conducted by Sharma and Attar, all the interns preferred to have BLS training in their academic curriculum.[22] In a study conducted by Dalila et al. among the dentists in the municipality of Porto, 77% of respondents indicated that they need more training in this area.[16] This reflected their strong desire to obtain this knowledge, indicating a need for a revision in the dental graduate curriculum.

Chirag Babu et al. found that BLS can be effectively obtained skills in a previously untrained group through a combination of teaching methods such as lectures, video demonstration, and hands on experience on the mannequin.[23]

The present study was done to assess the awareness of interns about medical emergency management but the practical skills of the interns in managing medical emergencies was not assessed. This could be a limitation of the study.

Management of medical emergencies should be an integral part of dental curriculum. Realistic simulation training should be provided in the management of medical emergencies at the undergraduate, postgraduate, and continuing education levels. In addition, medical emergencies management training in teaching institutions should be standardized. There should be regular updating and at least on an annual basis through continuing dental education programs.


  Conclusions Top


It can be concluded from the study that syncope was the most common medical emergency event. Awareness about the essential drugs and equipment was found to be low. Also, preparedness of dental interns in handling medical emergencies was found to be low. It was found that they preferred to have a specialized training on the management of medical emergencies. Dentists are responsible for the patients in their clinic and they should be well knowledged and trained to deal with the emergency situations in the dental office.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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2.
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9.
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22.
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