Medical Emergencies
The CQC: Drugs and equipment required for a medical emergency

From www.cqc.org.uk, provided under OGL

Our priority is to carry out an assessment of the quality of primary care dental services. From this we make a judgement about whether they provide people with care that is safe, effective, caring, responsive and well-led, based on whether the regulations (including the fundamental standards) are being met.

Our inspectors will consider this topic of drugs and equipment for a medical emergency when they review if the practice is safe which relates to regulation 12 (safety of care and treatment).

The medicines and equipment should be in an accessible and central location known to everyone.

Mandatory requirements

The GDC standards for the dental team state that, as a dental professional, you must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council (UK).

We expect a practice to follow the national guidance issued by the Resuscitation Council. Immediate access to an automated external defibrillator (AED) in an emergency increases the chances of survival of the patient. Where an AED is not available, we would expect to see a robust and realistic risk assessment detailing how an AED could be accessed in a timely manner, as the emergency services may not always be able to respond in the critical first few minutes of an acute cardiac arrest.

Recommended practice

A practice could be in a difficult position from a medico-legal point of view if a patient came to harm during dental treatment due to the lack of emergency medicines and equipment listed below.

Professional guidelines: British National Formulary

1. To manage the more common medical emergencies encountered in general dental practice the following drugs should be available:
   • adrenaline injection (1:1000, 1mg/ml)
   • aspirin dispersible (300mg)
   • Glucagon injection 1mg
   • Glyceryl trinitrate (GTN) spray (400micrograms / dose)
   • Midazolam Oromucosal Solution, midazolam 5mg/ml
   • oral glucose solution / tablets / gel / powder
   • oxygen
   • Salbutamol aerosol inhaler (100micrograms / actuation)

Professional guidelines: Resuscitation UK Guidelines November 2013: Minimum equipment list for cardiopulmonary resuscitation in Primary Dental Care

2. The following is the minimum equipment recommended:
   • adhesive defibrillator pads
   • automated external defibrillator (AED)
   • clear face masks for self-inflating bag (sizes 0,1,2,3,4)
   • oropharyngeal airways sizes 0,1,2,3,4
   • oxygen cylinder (CD size)
   • oxygen masks with reservoir
   • oxygen tubing
   • pocket mask with oxygen port
   • portable suction e.g. Yankauer
   • protective equipment – gloves, aprons, eye protection
   • razor
   • scissors
   • self-inflating bag with reservoir (adult)
   • self-inflating bag with reservoir (child)

3. Oxygen cylinders should be of sufficient size to be easily portable but also allow for adequate flow rates, eg, 15 litres per minute, until the arrival of an ambulance or the patient fully recovers. A full ‘CD’ size cylinder contains 460 litres of oxygen and should allow a flow rate of 15 litres per minute for approximately 30 minutes.

4. Quality Assurance Process: Expiry dates for emergency medicines and equipment and availability of oxygen should be checked at least weekly.

The CQC: Storing Glucagon injection

Our inspectors will consider this topic of drugs and equipment for a medical emergency when they review if the practice is safe, which relates to regulation 12 (safety of care and treatment).

Glucagon is a hormone which helps to raise blood glucose levels. A glucagon injection kit is used to treat episodes of severe hypoglycaemia, where a patient is either unable to treat themselves or treatment by mouth has not been successful.

Severe hypoglycaemia is defined as having low blood glucose levels that requires assistance from another person to treat. Classed as a diabetic emergency, it is a complication that can occur in people with diabetes that take insulin and certain anti-diabetic tablets.

The most commonly available form of Glucagon injection is the GlucaGen HypoKit 1 mg: (Glucagon Injection).

Mandatory requirements

1. GlucaGen HypoKit should be stored at a temperature of 2–8°C (in a refrigerator), but it must not be frozen. If stored in the refrigerator the shelf life from the manufacturer is 36 months.
2. GlucaGen HypoKit can be stored outside the refrigerator at a temperature not exceeding 25°C for 18 months provided that the expiry date is not exceeded. It should be stored in the original package in order to protect from light. This is common practice as it needs to be easily accessible for emergency use. The provider must able to demonstrate either:

• when the product was out of refrigerated storage, for example label the product with the date it was taken out of the fridge or a revised expiry date, or
• how the product is safe for use, for example by referring to the purchase invoice showing that 18 months has not elapsed from delivery.