By Nicole Fauteux
A healthy 30-year-old male sits down in your
operatory. He needs a crown, and he is visibly nervous, probably experiencing
white-coat syndrome. You administer a Novocain injection, and within seconds he
complains of nausea and dizziness. He looks pale. You take his blood pressure
and see that it is quite low. What should you do?
“Call 911,” suggested a participant in one of
several Office Emergency Simulation Labs offered at the 2015 ADEA Annual
Session & Exhibition last month in Boston. The sessions were scheduled in
response to the expressed desire of faculty to gain hands-on training in
dealing with medical emergencies on the clinic floor. Advancements in
simulation technology now make it possible—and affordable—for faculty and
students to practice responding to emergency scenarios such as the one above.
David Shafer, D.M.D., Associate Professor and
Chair of the Division of Oral and Maxillofacial Surgery at the University of
Connecticut School of Dental Medicine, vividly remembers the first time he was
called upon to perform CPR. “I remember going like this,” he says, indicating a
compression motion, “and I felt—BRRRUMPH—as the sternum came off the ribs. And
[the physician in charge] said, ‘Don’t stop! Keep going!’” Dr. Shafer pointed
out that practicing on high-fidelity simulators, as were available in the
simulations, can be an effective way to prepare health care providers for their
first stressful patient care emergencies.
Dr. Shafer was one of several ADEA members who
organized and led the simulation sessions to help others prepare for the
stresses of patient-care emergencies. Participants were able to restore the
flow of oxygen in an airway manikin using a variety of devices. These included
a laryngoscope equipped with a video camera, which allowed them to see the
action of the vocal cords and look for obstructions in the airway.
Participants also took turns performing chest
compressions on Resusci Anne®, a high-fidelity manikin that helps trainees
improve the quality of their rescue techniques. The accompanying monitor
provides feedback on hand position, speed, depth and recoil during chest
compressions. The monitor also indicates if the rescuer has a good seal around
the manikin’s mouth and is providing adequate ventilation.
Practicing resuscitation skills can make a
major difference in the effectiveness of rescue efforts and in the confidence
individuals bring to their handling of an emergency. Another session
facilitator, Anders Nattestad, D.D.S., Professor of Oral and Maxillofacial
Surgery at the University of the Pacific, Arthur A. Dugoni School of Dentistry,
reinforced the idea that knowing what to do and being able to do it “in the
moment,” are two very different things. He has witnessed numerous emergencies
and says faculty often panic, even when they have been instructed on how to
handle an unexpected event.
Presenter Pamela Hughes, D.D.S., Associate
Professor and Chair of the Department of Oral and Maxillofacial Surgery at the
Oregon Health & Science University School of Dentistry, had similar
observations. Dr. Hughes was instrumental in getting faculty to practice
emergency response in the simulation center at the University of Minnesota (UM)
while on the faculty at the UM School of Dentistry. She says that the training
produced a significant reduction in the number of calls to the code team made
for non-emergencies. Since her departure, the school has introduced the use of
standardized patients to reinforce that training. According to one Lab
participant, each month an individual fakes an emergency in the campus clinic,
keeping everyone on their toes.
For their final exercise, Lab attendees were
introduced to a full-body high-fidelity manikin that appeared to breathe and
have a pulse. The adjacent monitor displayed oxygen levels, blood pressure,
capnography and an EKG. According to Rick Ritt, EMT-P, M.A., President of
Dental Simulation Specialists, which provided the equipment for the training,
the system was also capable of displaying x-rays and scans and could be used to
create case scenarios.
Mr. Ritt’s company recently provided training
to California’s oral and maxillofacial surgery society. A team acted out
scenarios drawn from insurance records of actual cases where patients died
under anesthesia. According to Dr. Nattestad, these reenactments “felt real,”
and watching patients “flat line” made a big impression on attendees. They were
subsequently shown the proper way of handling each of the emergency situations.
In Boston, meeting attendees were presented
with a less dire scenario. The simulated 30-year-old male just needed some
handholding and calm words to recover from his anxiety, something his care
givers might be better able to discern with more simulated emergency
Session presenters made clear that a full
simulation suite is not essential for running similar scenarios or practicing
these techniques. Resusci Anne, for example, comes in various configurations,
some of which cost just a few thousand dollars, far less than the price tag for
many all-purpose high-fidelity manikins. Dr. Shafer suggested that medical
schools can also be a resource. He indicated that curricular mandates are
leading them to put simulators in place specifically to train their students on
handling emergencies. At his institution, the dental students now spend two
sessions in their third year of dental school using the medical school
simulators to run through emergency scenarios.