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RESPONSE


Systems should be in place for a rapid assessment and referral to hospital where appropriate. The assessment should include baseline medical observations: pulse, temperature and possibly blood pressure. Similarly, when faced with acute dental trauma cases, a plan for rapid assessment and management should be in place. Each team member has a role in both types of case, even if that is simply documenting the notes and comforting the relatives.


Well rehearsed The nearest to the Dr Bawa-Gaba situation is an acute medical emergency in the dental surgery. The dental team often has the advantage of an up-to-date medical history and list of medications, but that may not always be the case, especially if the unknown companion of the patient collapses in the waiting room. A well-rehearsed drill should follow, with a scribe capturing the times


and key steps taken, liaising with the ambulance service to ensure a safe transfer to secondary care. Imagine that a new team member was the only other person present when the patient collapsed and they didn’t know where the oxygen and emergency drugs were kept, nor the exact address of the practice to tell the 999 operator. Whilst it might not amount to manslaughter by gross negligence, HM Coroner and the relatives would be asking some searching questions in the subsequent investigation.


Speaking up What steps can an inexperienced member of any team do to protect themselves, and their patients from a disaster as outlined in the examples above? First and foremost, speak up. No one should be


treated badly for saying “I don’t know” or “help, what should I do?” Team leaders and senior members of the team should ensure that in any given situation no one is expected to operate outside their level of competence. In the examples given above, medical emergency care should be


practised with the whole team, including non-clinical members, so that everyone has a basic competence in life support techniques. Lifelong learning is crucial, but it has to start somewhere and no one has special skills without starting at the beginning.


Key lessons • Have a clear plan in place to rapidly assess and refer patients who require urgent care.


• Ensure the entire practice team – including non-clinical staff – are familiar with this plan and act only within their competence.


• Encourage staff to speak out.


• Induction and training logs are crucial to an investigation, as are the contemporaneous notes of any interaction with a patient in distress.


• A confident leader is a leader who is present and welcomes challenge and debate from their teams.


Stephen Henderson is a dental adviser at MDDUS (This article is adapted from one originally published in the BDJ)


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