Frequently Asked Questions

  • Do I need any specific hardware or software requirements for the online membership?
  • What is IMEP's Emergency Response System (ERS)?
  • How do I change my email login?
  • What is IMEP's Medical Emergency Membership?
  • What is included in the Emergency Response System (ERS)?
  • Are there Continuing Education Units available?
  • How can I get my old test results for CE requirements?
  • What are the 12 Monthly Mock Emergency Drills?
  • What is the function of the Emergency Response Team (ERT)?
  • Where should I locate IMEP's Emergency Response System (ERS) in my office?
  • What is IMEP's Medical Emergency Specialty Tests?
  • What is the Emergency Response Zone?
  • Does IMEP's Emergency Response System (ERS) and Membership have a reporting mechanism?
  • What TVS?
  • What are the Six Links of Survival?
  • What are the Sixteen Deadly Misconceptions?
  • What is America's Volunteer Registry?
  • What is the return policy?
  • How do I cancel my membership?
  • Can I cancel my membership?
  • How does monthly automatic billing work?
  • What is the Speakers Resource Bureau?
  • When building a training team, how do I add a team member?
  • What is IMEPs privacy policy?
  • What is The Six Links of Survival Reference Guide?
  •  
    Do I need any specific hardware or software requirements for the online membership?

    None, all you need is internet access.

    File Attachments:
      << back to top
      What is IMEP's Emergency Response System (ERS)?

      The Emergency Response System is a comprehensive approach to Medical Emergency Preparedness, created by doctors for rapid response, victim-side assistance during medical emergencies. It is a Medical Emergency Plan ready for deployment in medical and dental offices, public and private facilities, homes, schools and workplace.

      It fills the national void of Medical Emergency Preparedness in America today.

      << back to top
      How do I change my email login?

      Simply login using your current username (email login), go to MY PROFILE, ind your current email address, make the changes and click submit.

      Click here for a quick tutorial. 

      File Attachments:
        << back to top
        What is IMEP's Medical Emergency Membership?

        The Institute of Medical Emergency Preparedness Medical Emergency Membership has two components:

        1. 12 monthly mock emergency drills

        2. >30 medical emergency specialty tests   A total of 53 hours of online medical emergency continuing education is available all focused around:

        • medical emergencies
        • airway emergencies & equipment
        • anesthesia emergencies
        • emergency medications
        • basic life support(BLS)
        • advanced cardiovascular life support(ACLS)
        • pediatric advanced life support(PALS)
        • emergency response team development
        • emergency action planning and documentation
        Year round online medical emergency preparedness through the IMEP Medical Emergency Membership. File Attachments:
          << back to top
          What is included in the Emergency Response System (ERS)?

          The Emergency Response System offers a comprehensive Medical Action guide containing each of the following:

          • 22 step-by-step Standard of Care medical algorithms:
            1. Adrenal Disease
            2. Chest Pain / Angina
            3. Diabetic Coma / Acute Hyperglycemia
            4. Allergic Reaction
            5. Local Anesthetic Toxicity
            6. Asthma Attack / Breathing Difficulty
            7. Choking / Foreign Body Obstruction
            8. Heimlich Manuever
            9. Stroke/ Cerebrovascular Accident (CVA)
            10. Seizure Disorder
            11. Hyperventilation/ Rapid Breathing
            12. Vomiting (Emesis)
            13. Fainting/ Syncope
            14. Heart Attack/ Myocardial Infarction
            15. Hypoglycemia
            16. Apnea
            17. Laryngospasm
            18. Hypertensive emergency
            19. Hypotensive emergency
            20. Benzodiazepine overdose
            21. Narcotic overdose
            22. Malignant hypertherma
          • Four (4) Medical Emergency Educational Workbooks
          • Emergency Treatment Record & Grease Pencil
          • Emergency Response Team Guide
          • Emergency Directory Card
          • Medical Emergency Sign and Storage Rack
          << back to top
          Are there Continuing Education Units available?
          53 hours of Medical Emergency Continuing Education (MECE) credit per person are available annually. Monthly Mock Drills, E-Mail Alerts, Clinical Scenarios and convenient 24/7 Online Testing keeps Medical Emergency Preparedness an ongoing, continual process rather than an occasional event.
          << back to top
          How can I get my old test results for CE requirements?

          Simply login to the website, click on training reports, click on your score for the test results you want and then you may print it out.

          << back to top
          What are the 12 Monthly Mock Emergency Drills?

          These monthly mock emergency drills are delivered online to all team members on the first of each month.

           MONTHLY MOCK EMERGENCY DRILLS  

          January :  Foreign Body Obstruction/Chocking Mock Drill  -1 hour CE Credit

          February : Stroke (CVA)/Transient Ischemic Attack(TIA) Mock Drill  -1 hour CE Credit

          March: Syncope/Loss of Consciousness Mock Drill  -1 hour CE Credit

          April: Hyperglycemia Mock Drill  -1 hour CE Credit

          May: Vomiting (Emesis)/Aspiration Mock Drill  -1 hour CE Credit

          June: Hyperventilation Mock Drill  -1 hour CE Credit

          July: Angina (Chest Pain)/Myocardial Infarction Mock Drill  -1 hour CE Credit

          August: Acute Hypoglycemia Mock Drill  -1 hour CE Credit

          September: Sudden Cardiac Arrest Mock Drill  -1 hour CE Credit

          October: Asthmatic Attack/Bronchospasm Mock Drill  -1 hour CE Credit

          November: Allergic Reaction/Anaphylaxis Mock Drill  -1 hour CE Credit

          December: Seizure (Epilepsy) Mock Drill  -1 hour CE Credit

           

           

          << back to top
          What is the function of the Emergency Response Team (ERT)?

          The Emergency Response Team (ERT) is an important part of your Medical Emergency Plan and has the primary responsibility during an emergency situation. ERT members should be of the highest skilled qualification.

          In an emergency situation, an ERT must function together and communicate clearly and rapidly. Regularly scheduled group study will facilitate familiarity, not only with the subject matter, but also with each team member and their individual role in the event of a medical emergency. Medical Emergency Education is a process, not an occasional event.  We recommend creating a 5-member (ERT) per facility of up to 20 people. A 1:6 ratio is a good standard.  The ERT should participate in monthly mock drills as provided by IMEP and take role-playing very serious.  The ERT should know their role as described from the Medical Emergency Plan.

          << back to top
          Where should I locate IMEP's Emergency Response System (ERS) in my office?

          The Emergency Response System should be in a designated central location within the office.  It should be visible and accessible by all members.  IMEP's Emegency Book (Action Guide) in the accompanying wire rack should be placed in the medical center with the following components (not provided with the Emergency Response System):

          • Emergency Drug Kit
          • AED
          • Portable Oxygen with attachable breathing apparatus
          • Blood pressure monitor with pulse oximeter on mobile stand
          • Medical Emergency Plan
          • Fire Extinguisher

          (The Medical Emergency Book (Action Guide) should never be removed from the wire rack except during emergencies.)

          << back to top
          What is IMEP's Medical Emergency Specialty Tests?

          2009 MEDICAL EMERGENCY SPECIALTY TESTS (members can choose any or all of these that apply to their practice)

          These may be taken anytime online at your office, your home or even on vacation

          -Heimlich manuever -1 hour CE Credit

          -Local Anesthetic Toxicity -1 hour CE Credit

          -Hypertensive emergency -1 hour CE Credit

          -Hypotensive emergency -1 hour CE Credit

          -Benzodiazepine overdose -1 hour CE Credit

          -Narcotic overdose -1 hour CE Credit

          -Apnea -1 hour CE Credit

          -Laryngospasm -1 hour CE Credit

          -Malignant Hyperthermia -1 hour CE Credit

          -Epinephrine Overdose -1 hour CE Credit

          -Hypertrophic Cardiomyopathy -1 hour CE Credit

          -Thyroid Storm -1 hour CE Credit

          -Adrenal Crisis -1 hour CE Credit

          -Acute Coronary Syndrome (ACS) -1 hour CE Credit

          -Ventricular Fibrillation  -1 hour CE Credit

          -Pulseless Ventricular Tachycardia  -1 hour CE Credit

          -Tachycardia-1 hour CE Credit

          -Bradycardia -1 hour CE Credit

          -Asystole -1 hour CE Credit

          -Pulseless Electrical Activity -1 hour CE Credit

          -Premature Ventricular Contractions -1 hour CE Credit

          -EKG Rhythm Review -1 hour CE Credit

          -Airway Emergencies: Management & Equipment -1 hour CE Credit

          -Emergency Drug Kit: Equipment & Explanation -1 hour CE Credit

          -Cardiopulmonary resuscitation (CPR/BLS) Review -1 hour CE Credit

          -Advanced Cardiovascular Life Support (ACLS) Review -1 hour CE Credit

          -Pediatric Advanced Life Support (PALS)  Review -1 hour CE Credit

          -Local Anesthetic Reversal: ORAVERSE -1 hour CE Credit

          -Epinephrine Auto-injector: TWINJECT -1 hour CE Credit

          -Medical Emergency Plan -1 hour CE Credit

          -Patient Safety Coordinator -1 hour CE Credit

          -Automated External Defibrillator -1 hour CE Credit

          -Latex Allergy -1 hour CE Credit

          -Emergency Medications -1 hour CE Credit

          -Medical Emergency Event Documentation -1 hour CE Credit

          -Comprehensive Medical Emergency Examination(a comprehensive review worth 6 hours)

          << back to top
          What is the Emergency Response Zone?
          The Emergency Response Zone is the critical period during a medical emergency when a victim is Ten Minutes to Life or Death.
          << back to top
          Does IMEP's Emergency Response System (ERS) and Membership have a reporting mechanism?

          Yes, Carbonless Emergency Treatment Records provide documentation of the medical emergency to proper distribution channels and Emergency Medical Services personnel and the membership includes Training Verification Systems (TVS).  TVS  is a service provided by the Institute of Medical Emergency Preparedness.  IMEP acts as an independent third party for CME substantiation and for you to demonstrate your due diligence and regular emergency preparedness in the event of litigation.

          << back to top
          What TVS?
          Training Verification Systems (TVS)  is a service provided by the Institute of Medical Emergency Preparedness.  IMEP acts as an independent third party for CME substantiation or demonstrate due diligence and regular emergency preparedness in the event of litigation.
          << back to top
          What are the Six Links of Survival?

          The Six Links of Survival are imperative for every office when confronted with the issue of being prepared for medical emergencies. Any missing link will cause a decrease in the survivability of the patient. The six links of survival are:

          • Doctor Training
          • Staff Training
          • Medical Emergency Plan
          • Emergency Drug Kit
          • Proper Equipment
          • Mock Drills
          File Attachments:
            << back to top
            What are the Sixteen Deadly Misconceptions?

            16 Deadly Misconceptions:

            1. A medical emergency will not happen to me.
            2. A medical emergency will not happen in the office.
            3. Calling 911 is the answer.
            4. My staff and I will not panic during a medical emergency.
            5. CPR is all we need to know.
            6. All Ineed is Epinephrine
            7. The fire station/EMS station is just around the corner so that is my plan
            8. The physician's clinic is across the street so that is my plan
            9. I don't need an AED!
            10. The only thing that is going to happen is syncope!
            11. I don't want to deal with it right now!
            12. That is why I have malpractice insurance
            13. I would much rather spend my money on something else
            14. I teach at a health professional school
            15. Who needs a drug kit, nothing is going to happen!
            16. My cousin is an attorney, he will take care of me

            Emergencies happen everyday. It's not a question of "if"you have a medical emergency. It's a question of will you be prepared to respond when you have a medical emergency.

            The best way to handle the medical emergencies is to realize the risk and be prepared.

            << back to top
            What is America's Volunteer Registry?
            If you are willing to provide volunteer assistance in the event of national, regional or local emergencies, you can sign up via the America's Volunteer Registry.

            In the event of an emergency, you will be notified by email and your assistance will be requested according to identified skill sets. Specific information will be provided accordingly. There is no obligation, in the event of emergency, you simply will receive notification if your specific skills are in demand.

            << back to top
            What is the return policy?

            Returns

            You may return most new, unopened items sold and fulfilled by EmergencyActionGuide.com within 30 days of shipment for a refund. We'll also pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.), method of shipment is at the sole discretion of IMEP. We do not accept returns on workbooks. All returns are subject up to a 20% restocking fee..

            Please send any returns to:

            Project, Inc.
            c/o Institute of Medical Emergency Preparedness, LLC
            6301 Manchester Road
            St. Louis, MO 63139
            Include the name, address, daytime phone number and email address of the person that made the purchase.

            You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days). We'll notify you via e-mail of your refund once we've received and processed the returned item.

            IMEP memberships and/or subscriptions may be cancelled, effective immediately, and you will receive no additional charges however, no prorated or partial refunds will be given.

            << back to top
            How do I cancel my membership?

            Per the Terms of Agreement, you may cancel your membership at any time.  Simply login to the website, go to MY PROFILE, click on CANCEL MY MEMBERSHIP, and confirm.  Your membership will be cancelled, effective immediately, and you will receive no additional charges and no prorated or partial refunds will be given.

            IMEP representatives will not terminate your membership by email, fax, verbal  or other forms of communication.   The subscriber must perform termination procedures in accord with the Terms of this Agreement. Cancellation of the Medical Emergency Membership Subscription, must be performed by the subscriber after subscriber login to the website.   Failure to do so will result in you being charged again.

            << back to top
            Can I cancel my membership?

            Yes, you may cancel your membership at any time.  Simply login to the website, go to MY PROFILE, click on CANCEL MY MEMBERSHIP, and confirm.  Your membership will be cancelled, effective immediately, and you will receive no additional charges and no prorated or partial refunds will be given.

            IMEP representatives will not terminate your membership by email, fax, verbal  or other forms of communication.   The subscriber must perform termination procedures in accord with the Terms of this Agreement. Cancellation of the Medical Emergency Membership Subscription, must be performed by the subscriber after subscriber login to the website.   Failure to do so will result in you being charged again.

            << back to top
            How does monthly automatic billing work?
            If you signed up for the convenience of monthly IMEP membership your card will be automatically be charged on the first day of your billing cycle until you cancel your membership or your card is no longer valid. You may cancel at anytime, and you will not be charged again. In the event your card expires we will contact you to get the current card information so you may continue your IMEP membership and the peace of mind that comes with being prepared to handle a medical emergency.
            << back to top
            What is the Speakers Resource Bureau?

            IMEP's Speaker Resource Bureau is a group of leading industry professionals who provide information on Medical Emergencies through regularly scheduled seminars. Speaker connections and seminar dates are provided.

            If you would to become a member or would like more information please contact us.

            << back to top
            When building a training team, how do I add a team member?
            Click here for tutorial.
            << back to top
            What is IMEPs privacy policy?

            Links
            The  emergencyaction guide.com and getrede.com web site may contain links to other Web sites. IMEP is not liable for the privacy practices or the content of other Web sites.

            Privacy
            IMEP is committed to providing customers with the best online training system for emergency response in the workplace. We've asked for your personal identity information, so we want you to know how it will be used. By registering with or contacting us through IMEP's web sites, you agree that any information or comments you provide may be shared between IMEP, its affiliated companies and dealers, and used without restriction to process customer orders and improve or market our products and services. We will not sell or rent your information to any third party, and will exercise reasonable efforts to keep the information secure. IMEP, LLC recognizes and respects your online privacy.

            Cookies
            When you visit our websites we may send you a cookie. A cookie stores a small data file on your computer. This file enables us to recognize you each time you visit us. Cookies help us in many ways, for example, by saving your region and language preference and for purposes of collecting non-personal data.
            IMEP web security cookies (if the user has an emergencyactionguide.com or getrede.com web security ID) are not used to collect personal information on this web site.

            << back to top
            What is The Six Links of Survival Reference Guide?

            The Six Links Of Survival Reference Guide

            A Risk Management Resource for Medical Emergency Preparedness

            Nicole Cunha, Executive Director
            Sarah Selbe, Operations Manager
            Larry J. Sangrik, DDS, National Director of Medical Emergency Preparedness

            2748 Sonic Drive, Virginia Beach, VA 23453
            www.gotsixlinks.com 

            866.729.7333


            Background:  The average response time for emergency medical services (EMS) to respond to a 911 call can be 11 minutes in an urban setting and 15 minutes in a rural setting.  These times were based on the primary EMS unit being available and not already responding to another call, necessitating an alternate squad being dispatched.  Consequently, dental offices should be prepared to manage a medical crisis for up to 30 minutes without outside assistance.  The Six Links of Survival™ is a checklist of the educational needs and physical items necessary to fulfill the needs of a dental patient in that time period between the identification of a medical problem and the arrival of outside assistance.

            Educational Links 
            Link 1: Doctor Training
            Link 2: Staff Training
            Link 3: Mock Drills

            Link 1: Doctor Training, Link 2: Staff Training and Link 3: Mock Drills are known as the Educational Links.  Educational link compliance demands a consistent pursuit of updated knowledge, data, and information on emergency medicine within the dental office.  The training received in dental school or even last year, cannot be assumed sufficient for modern medical emergency response.  As with all science and technology, the disparity gap widens quickly as our knowledge base and equipment access is ever-widening.  Education vigilance incorporates a system of medical emergency updates akin to consistently monitoring the temperature of a patient.  It is vital to track progress to create an MEP sustainable environment.  This is a process of continual quality and education improvement.  The C.O.R.E. 16 (Critical Office Resuscitation Emergencies) are unpredictable in nature and the industry continues to learn better, safer means of responding to these issues; therefore, the Educational Links are paramount in preparing the dental team. 

            The decisions regarding formal and in-office training for medical emergencies are unique to each office setting; but dentists and their staff can use the acronym “PREPS” to make sure they are adequately addressing these training needs.

            P = Participatory courses and drills are preferable.

            R = Renew BLS and other life support courses every 2 years.

            E = Everyone in the office should participate in BLS and CE related to medical emergency preparedness.

            P = Practice on a regular basis with in-office emergency drills.

            S = Stay current by regularly taking medical emergency CE courses.

            Once the Educational Links are fully instituted in your practice, they should continue for the lifetime duration of your practice without interruption or discontinuance as this greatly compromises the integrity of the office’s safety and readiness.

            Link 1: Doctor Training
            The dentist is the core of the Six Links of Survival™.  Each of the other links depends upon the strength of the dentist’s professional leadership.  As such, the dentist should participate in an Emergency Medicine lecture either in person or online to stay current with the latest available information on Medical Emergency Preparedness (MEP). 

            MEP is of the utmost importance to you, your staff, your patients and the facility; and it is vital that each member becomes familiar with both the acronym and the message.  MEP is the heartbeat of the rescue operation.  The Six Links of Survival™ covers every topic necessary for readying a dental unit to competently handle a crisis; it is the culmination of decades of research and literature on the topic.  Six Links of Survival™ training promises your patients and staff the most comprehensive, up-to-date MEP knowledge and skills in the industry.

            Basic Life Support (BLS) is imperative.  Every dentist should complete the BLS for the Healthcare Provider course that is equivalent to those offered by both the American Heart Association (AHA) and the American Red Cross (ARC).  BLS should be taken at least once every two years under the advisory of the AHA which holds this as the maximum interim duration.  Depending on the patient mix and patient acuity of the facility, more frequent reviews may be appropriate.

            The dentist is the team leader, and when a medical emergency occurs, should be expected to guide with efficiency and effectiveness.  MEP training should include this sense of importance and urgency in order for the entire team to grasp the gravity of this preparatory instruction. 

            Highlights

            Over the period of two years, a dentist shall take one or more courses on medical emergencies.  The sum of the course(s) over the two-year period should cover all of the topics in the following three areas:

            1. A review of normal physiology with an emphasis on the systems that play important roles during a medical emergency

            ·         Peripheral Nervous System

            ·         Cardiovascular System 

            ·         Respiratory System

            2. The Six “P’s” of Preparation for a medical emergency

            1.  Prevention: proper use of a medical history
            2.  Personnel:  staffing requirements and task pre-assignments
            3.  Products: monitors, AEDs and airway adjuncts
            4.  Protocols:  office manuals to develop a planned response
            5.  Practice:  ongoing training and review
            6.  Pharmaceuticals: having the proper medication on hand

            3. Recognition and response to the C.O.R.E. 16 (Critical Office Resuscitation Emergencies) common to dental offices

            1.     Syncope

            2.     Angina

            3.     Myocardial Infarction

            4.     Cardiac Arrest

            5.     Hypertension

            6.     Hypotension

            7.     Asthma

            8.     Anaphylaxis

            9.     Hyperventilation

            10. Allergic Reactions

            11. Diabetes (Hypoglycemia)

            12. Seizures

            13. Sudden Cardiac Arrest (SCA)

            14. Cerebrovascular Accident (Stroke)

            15. Foreign Body Obstruction (FBO) with Airway Management

            16. Local Anesthetic Toxicity

            Although not universally available, dentists should favor training that is participatory in nature with hands-on involvement.

            Link 2: Staff Training
            The importance of staff training cannot be overstated.  Both the Dentist and the Staff members should jointly attend an Emergency Medicine lecture, either in person or online, to stay current with the latest information, techniques, and technologies in Medical Emergency Preparedness (MEP).  The Staff is composed of the Dental Hygienists, the Dental Assistants, and the Front Office Personnel - each of which is vital to crisis outcome and patient safety.  Therefore, each of these members should be incorporated into the MEP training initiative to guarantee complete facility readiness. 

            Because a medical emergency can occur when the dentist is not physically on the premise (e.g. Registered Dental Hygienist (RDH) general supervision) or the medical crisis may happen to the dentist, all staff should be trained on how to handle an emergency without the participation of the dentist. Currently, RDHs are allowed to administer local anesthesia in 44 states; undoubtedly, they will need comprehensive training in handling an adverse reaction that may occur before, during, or after the injection is received.  Similarly, assistants work side-by-side with the dentist and are essential to the team.  Likely, they will be one of the first people who witness the medical crisis.  Without proper knowledge, valuable moments can be lost in confusion or in a slow reaction to crisis signs and symptoms.  Also, the front office personnel facilitate front end action, including overseeing the reception area where events may occur, as well as guiding EMS into the office during a medical emergency.  The question is not if staff should be trained, but when and how; our answer is urgently and excellently.  Crises are not to be denied, but confronted; and total-staff training arms the office with the competence and confidence to achieve this task.   

            The MEP acronym and meaning should become part of your team’s language fluency and awareness activity.  MEP is the critical lifeline for the successful rescue of a distressed patient in your office.  The Six Links of Survival™ covers every area that your Staff will need to know to be fully prepared for an emergency situation.  The Six Links™ is the merging of decades of research and expertise - the core response that is addressed in every book, article, and blurb on crisis management.  The Six Links™ is the nucleus of authentic life-affirming action.  It is encouraged that every member of the dental team, particularly the staff, be MEP ready and able to fill-in for other members if necessary. 

            Part of this commitment includes taking the Basic Life Support (BLS) for Healthcare Provider course that is equivalent to those offered by American Heart Association (AHA) or American Red Cross (ARC) at least every two years.  AHA states that two years is the absolute maximum time allowable between BLS course completion and that healthcare providers would benefit from more frequent study and practice.  Patient mix and patient acuity determines the degree of complication prediction which translates into increased BLS frequency; however, it is crucial to remind the dental team that medical emergencies happen at any time, at any place, to anyone; the issue is whether your staff is ready to respond.

            The staff team will assist the team leader if and when a medical emergency occurs in your office.  These events are unannounced and unforeseeable.  Your role as the TEAM leader should be that you are fluent in MEP response and that your staff is similarly skilled in this area as every second counts in patient suffering and even death.  Now is the time to get ready and stay ready. 

            Highlights

            Over the period of two years, each member of the dental team should considering taking one or more courses on medical emergencies.  The sum of the course(s) over the two-year period should cover all of the topics in the following three areas:

            1. A review of normal physiology with an emphasis on the systems that play important roles during a medical emergency

            ·         Peripheral Nervous System

            ·         Cardiovascular System 

            ·         Respiratory System

             2. The 6 “P’s” of Preparation for a medical emergency

            1.  Prevention: proper use of a medical history
            2.  Personnel:  staffing requirements and task pre-assignments
            3.  Products: monitors, AEDs, and airway adjuncts
            4.  Protocols:  office manuals to develop a planned response
            5.  Practice:  ongoing training and review
            6.  Pharmaceuticals: having the proper medication on hand

            3. Recognition and response to the C.O.R.E. 16 (Critical Office Resuscitation Emergencies) common to dental offices

            1.     Syncope

            2.     Angina

            3.     Myocardial Infarction

            4.     Cardiac Arrest

            5.     Hypertension

            6.     Hypotension

            7.     Asthma

            8.     Anaphylaxis

            9.     Hyperventilation

            10. Allergic Reactions

            11. Diabetes (Hypoglycemia)

            12. Seizures

            13. Sudden Cardiac Arrest (SCA)

            14. Cerebrovascular Accident (Stroke)

            15. Foreign Body Obstruction (FBO) with Airway Management

            16. Local Anesthetic Toxicity

            Please Note: Although not universally available, dentists should favor training for their staff that is participatory in nature with hands-on involvement.

            Dentists should consider developing a mechanism to train newly hired staff to be competent and productive members of the entire team during a medical emergency.

            Link 3: Mock Drills 
            Mock medical emergency drills are paramount for preparation.  These should be performed on a monthly basis, with a set date and time to maintain consistency.  Most importantly, the tone of the drill should be serious; otherwise, the likelihood is that the instruction will be undermined. Annual drills are not sufficient due to employee turnover and insufficient exposure to the material.  The “once a year” mentality sets the staff up for failure instead of success. 

            Consider this: if you had to perform CPR/BLS/PALS/ACLS right now, would you be able to?  What are the correct steps, life-saving tips - what first and when?  If you are honest with yourself, there is a great chance that you will confront more questions than answers.  Recertification should be taken every two years; however, this minimum is far below optimal.  AED use is a perfect example of this natural disparity: could you seamlessly operate this life-saving technology without pause? 

            The point is that training is a continual and repetitive process.  This fact should be stressed in your offices.  Mandatory attendance by all members should be expected and documented.  Each member has a unique role in a medical emergency and should be expertly prepared to fill that need according to the office’s individual medical emergency response plan.  This includes total participant knowledge of the plan itself, the contents and uses of the emergency drug kit, as well as the location and operation of the AED.  It is also plausible that a member, including the dentist, may be unavailable; therefore, each member should be able to substitute in other positions and the emergency plan should flow without hindrance.

            Highlights

            ·         Mock drills of medical emergencies should occur monthly but no less than every other month.

            ·         All of the following C.O.R.E. 16 (Critical Office Resuscitation Emergencies) common to dental offices should be covered within your mock drills:

            1.     Syncope

            2.     Angina

            3.     Myocardial Infarction 

            4.     Cardiac Arrest

            5.     Hypertension 

            6.     Hypotension

            7.     Asthma

            8.     Anaphylaxis

            9.     Hyperventilation

            10. Allergic Reactions

            11. Diabetes (Hypoglycemia)

            12. Seizures

            13. Sudden Cardiac Arrest (SCA)

            14. Cerebrovascular Accident (Stroke)

            15. Foreign Body Obstruction (FBO) with Airway Management

            16. Local Anesthetic Toxicity

            ·         Mock drills should not be a mere lecture, but an opportunity for interaction of the staff with the dentist.  Equipment used in a particular scenario should be demonstrated.

            ·         The date, topic covered and list of attendees should be documented.

            Please Note:
            Mock drills may be developed within the office or purchased from an outside vendor.

            Physical Links
            Link 4: Medical Emergency Plan
            Link 5: Emergency Drug Kit
            Link 6: Proper Equipment

            Link 1: Medical Emergency Plan, Link 2: Emergency Drug Kit and Link 3: Proper Equipment are known as the Physical Links.  The dental team will be accountable for authoring a medical emergency plan specific to their office as well as purchasing the appropriate equipment and necessary emergency medications for their reserves.  Action is needed to achieve each of these three links individually.  These actions should be taken seriously and in conjunction with the Educational Links.  This creates one complete chain cycle known as the Six Links of Survival™.

            The C.O.R.E. acronym, meaning Critical Office Resuscitation Emergencies, delineates the primary 16 medical emergencies.  Another “CORE” exists to aid in the retention of the Physical Links; this CORE is referred to as Critical Operatory Response Equipment.  It consists of the three facets of the Physical Links which a dentist and team will need to access; these are: 1) a written, visible medical emergency plan, 2) all emergency medications, and 3) all proper medical equipment.

            The Medical Emergency Plan is the action blueprint; once designed, it should be built into the facility through continual development, maintenance, and practice.  This document must be visible at all times and easily accessible for quick retrieval.

            Seven foundational medications plus oxygen should be in all dental offices. For ease in remembering, the algorithm A – G, O is used. Please note: Oxygen, although technically a medication, is covered under equipment because of its heavy dependency on the related armamentarium.


            A = Aspirin (MI)

            B = Bronchodilator (inhaler for use in asthma)

            C = Coronary Artery Dilator (e.g. nitroglycerine)

            D = Diphenhydramine (histamine blocking agent)

            E = Epinephrine (cardiac arrest, analyphyaxis, some asthma)

            F = Fainting (ammonia inhalants to stimulate CNS during syncope)

            G = Glucose (hypoglycemia)

            O = Oxygen

            Compliance with the Physical Links is a task to be nurtured by the entire dental team in that medications and equipment need maintenance and monitoring to ensure proper functionality.  Proper equipment working condition can only be assured by constant review, testing, and use in mock drills.  Emergency medications can be maintained by monthly monitoring and a system of First-In, First-Out use and replacement. Expired medications are unacceptable and potentially dangerous if an emergency arises. 

            Advance anesthesia techniques demand the availability of more advanced emergency medications in addition to those previously listed.

            Link 4: Written Medical Emergency Plan
            A medical emergency plan or emergency response plan should be considered for every dental office.  This is simple logic.  This plan needs to be easily located and visible at all times where it can serve as reminder and guide to the team.  The plan should have a Team Leader, the Dentist, as well as a backup who is capable of filling in if needed.  Each member of the team will be assigned specific duties and this role should be second nature to the member, meaning that these duties, as indicated on the plan, should be understood thoroughly and without a doubt.  Most importantly, each position should have a substitute should a team member be absent from the office.  When a medical emergency occurs, the response should be well-organized, tightly controlled, and expertly executed with all members quickly and calmly alerted.  This streamlined process includes an alarm system, paging system, lighting system, or some other means of immediately communicating the emergency to all team members to activate the planned response.

            The team leader is responsible for recognizing and initiating the decision to notify EMS.  When the EMS order is given, one team member is in charge of making that call.  There can be no confusion whether EMS has been contacted.  Additionally, it is advisable to become familiar with EMS services in your area.  Estimated time of arrival to your office in the event of an emergency should be identified prior to any actual occurrence.  The average EMS response time for urban areas is 11 minutes and 15 minutes for rural areas.  However, this wait can be longer if EMS is occupied or circumstances prevent expediency.  Time is critical and therefore cannot be discounted.  There is no embarrassment in calling EMS; a false alarm is better than a funeral.  If in doubt, call EMS out!

            Highlights

            1.     Every dental office should consider having a written medical emergency response plan.

            2.     The plan should be kept in an easily accessed area in the clinical portion of the dental facility although multiple placement of the plan may be appropriate in some offices.

            3.     The plan should contain all of the following

            ·         Specific task assignments for each member of the dental team, both full and part time.  Attention needs to be paid to making sure all tasks are covered even with a reduced staff.

            ·         General instruction on calling emergency medical services (EMS), including the address and best point of entry into the office for EMS.

            ·         A general review of CPR guidelines, airway management, and patient positioning.

            ·         A list of the signs and symptoms and an algorithm outlining the appropriate response for each of the following C.O.R.E. 16 (Critical Office Resuscitation Emergencies) common to dental offices.

            1.      Syncope

            2.      Angina

            3.      Myocardial Infarction

            4.      Cardiac Arrest

            5.      Hypertension

            6.      Hypotension

            7.      Asthma

            8.      Anaphylaxis

            9.      Hyperventilation

            10. Allergic Reactions

            11. Diabetes (Hypoglycemia)

            12. Seizures

            13. Sudden Cardiac Arrest (SCA)

            14. Cerebrovascular Accident (Stroke)

            15. Foreign Body Obstruction (FBO) with Airway Management

            16. Local Anesthetic Toxicity

            Please Note: Offices offering dental hygiene services under general supervision should consider having a set of supplemental algorithms for circumstances when the dentist is not on the premises.

            The medical emergency response plan may be either made by the individual office or purchased from a vendor and supplemented with office-specific information.

            Link 5: Emergency Drug Kit
            The list of emergency medications varies in dental offices based on the nature of the dental practice, the medical health of the anticipated clientele and complexity of services offered. All members either administering or assisting with the administration of the drugs during an adverse event should have an in-depth understanding of the associated practical uses and complications of each specific drug. A designated person should be assigned the task of checking the inventory of medications to assure that none will expire before the next anticipated inspection.  Inspections should occur at regular intervals (e.g. beginning and ending of daylight savings time).  Finally, a system of First-In, First-Out use and replacement should be implemented.    

            Highlights

            The following seven emergency medications should be known by name and function. They are the foundational medications that are required in all dental offices. Multiple doses of each of these medications should be kept on hand at all times. Please Note:  Oxygen, although technically a medication, is covered under equipment because of its heavy dependency on the related armamentarium.

            1.     Aspirin

            2.     Albuterol Inhaler

            3.     Nitroglycerin

            4.     Diphenhydramine

            5.     Epinephrine

            6.     Ammonia Inhalants

            7.     Glucose Tablets

            An adequate number of the following syringes need to be available for the delivery of the medications via subcutaneous, intramuscular or sublingual techniques.

            ·         1cc / 25 GA X ⅝ in.

            ·         5cc / 22 GA X 1 in.

            *Offices not routinely loading syringes are encouraged to purchase epinephrine and a pre-loaded device such as a Twin-jet or EpiPen     

            Please Note: Some states do not permit EMS units to carry epinephrine.  Epinephrine has a short half-life and may need to be re-administered.  Consequently, the inventory of epinephrine may need to be increased based on the length of time it takes for EMS to respond and transport to a hospital emergency department. 

            Link 6: Proper Equipment
            The following is a comprehensive list of the fundamental equipment necessary for MEP readiness in your office.  Even if the entire team is expertly trained, these items are irreplaceable and highly important to your facility and patient’s safety.  Your staff should understand the purpose of each item as well as how to use or operate these efficiently and effectively.  In many cases, this may take further training (i.e. AED) and frequency of use to gain a familiarity with the practical application of these life-saving machines and products.  Mock drills and open forum discussions are ways to gain this mastery.  Additionally, it is vital to perform routine maintenance and equipment checks often, tracking these dates, times, and surveyors to ensure that the equipment is kept in optimal operational capacity.  Equipment updates, information, and education are also essential to maintaining a Six Links of Survival™ office.  The proper training, the proper plan, and the proper equipment allow the proper people to provide patient safety - always. 

             

             

            Highlights

            Automated External Defibrillator (AED)

            ·         The only treatment for Sudden Cardiac Arrest (SCA), use of AED is taught in all CPR/BLS courses

            Monitors

            ·         Glucose monitor (Inspection should take place regularly to assure the battery is working and the test strips have not expired.)

            ·         A stethoscope

            ·         A method of taking blood pressures

            ·         Aneroid sphygmomanometers typically are made with the cuff permanently attached.  Therefore, multiple sizes are necessary.  A typical dental office should have at least three sizes available: adolescent (or small adult), standard adult and large adult.  The anticipated clientele of a practice (e.g., pediatric dentistry) may require different or a wide range of sizes.

            ·         Automatic blood pressure machines designed for home monitoring are inaccurate at low blood pressures and should not be relied upon during an emergency.

            ·         Hospital-grade automatic blood pressure machines may be reliably used during an emergency.  However, a manual backup should be available in the event of device failure.

            Oxygen Source

            ·         A portable oxygen source (E-tank, holding apparatus, regulator and universal oxygen port.)

            ·         A supplemental oxygen source (This may be a second E tank of oxygen or a nitrous oxide unit.)

            ·         A portable nitrous oxide unit with multiple oxygen tanks meets the requirement for both an oxygen source and a reserve, if it is fitted with a universal oxygen port.

            Supplies to Supplement a Breathing Patient

            ·         Nasal cannula (3)

            ·         Non-rebreathing masks (3)

             

            Supplies to Assist a Non-breathing Patient

            ·         A set oral-pharyngeal airways in seven sizes

            ·         A pocket mask

            ·         A disposable bag-valve-mask (commonly called a BVM or Ambu® bag)

            Supplies to Assist a Patient with an Obstructed Airway That Cannot Be Cleared By Non-Invasive Means

            ·         A commercially available Cricothyrotomy Kit

                                        or

            ·         10 GA. Angiocatheter

            ·         5 cc Syringe with the Needle Removed

            ·         No. 7 Endotracheal Tube

             Other Supplies

            ·         Paper Bag

            ·         Backup Suction

            ·         Magill Forceps

            ·         Thermometer

            ·         Medical Tape

            ·         Flashlight

            ·         Penlight

            ·         Pen and Paper to record history of the event (commercial forms are also available)

            An office that has the Six Link of Survival™ in place on a continual, active basis is a patient-rescue-ready office.  If not, the safety and wellbeing of staff and patients could be threatened. If your office is Six Link™ ready, take advantage of listing your practice on the RMBF, Inc. website free-of-charge by taking the Six Links™ Pledge.  A great initiative deserves to be celebrated.  Join the list and let your patients know that your word is your promise and your promise is protection.

            File Attachments:
            << back to top
            Please fill out the information below to create your IMEP account.






             
            Renew your membership