Bulletin of Dental Education

Moving From Panicked to Prepared

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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 experience.

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.

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