Preparedness of dental practices to treat cardiac arrest: Availability of defibrillators

Abstract

Cardiac arrest is a significant medical emergency that can occur in outpatient medical facilities. Guidelines 2010 of the European Resuscitation Council advocate that defibrillators should be available throughout outpatient medical facilities (www.resus.org). The occurrence of cardiac arrests in dental practices is low (0.002 per dentist per year), but several studies indicate dental surgeons may have to treat a cardiac arrest and the availability of a defibrillator may be useful.1Collange O. Bildstein A. Samin J. et al.Prevalence of medical emergencies in dental practice.Resuscitation. 2010; 81: 915-916Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 2Muller M.P. Hansel M. Stehr S.N. et al.A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience.Emerg Med J. 2008; 25: 296-300Crossref PubMed Scopus (106) Google Scholar The Resuscitation Council (UK) and several publications recommend that dental practices have an automated external defibrillator.3Rosenberg M. Preparing for medical emergencies: the essential drugs and equipment for the dental office.J Am Dent Assoc. 2010; 141: 14S-19SAbstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 4Wilson M.H. McArdle N.S. Fitzpatrick J.J. et al.Medical emergencies in dental practice.J Ir Dent Assoc. 2009; 55: 134-143PubMed Google Scholar, 5Resuscitation Council (UK). Medical emergencies and resuscitation. Standards for clinical practice and training for dental practitioners and dental care professionals in general dental practice, http://www.resus.org.uk/pages/MEdental.pdf; 2008 [accessed 04.03.11.].Google Scholar We studied the availability of defibrillators in general dental practices (GDP) in Paris, France. Specifically, we intended to evaluate why unequipped practices did not have defibrillators and determined how often those practices with a defibrillator actually used it. This study also assessed the apprehension GDPs had toward using or purchasing a defibrillator. We conducted a prospective study by contacting all dental offices in Paris, France. The questionnaire covered five defibrillator issues: presence, type, usage, apprehension, reasons for not having a defibrillator. Our results are presented in Fig. 1. None of the 33 equipped practices had used the defibrillator. Most (27 (82%)) GDPs indicated that they were ‘not apprehensive’ about using their defibrillator, 3 (9%) were ‘slightly apprehensive’, 0 were ‘fairly apprehensive’, 1 (3%) was ‘highly apprehensive’, and 2 (6%) did not answer. Among the practices that did not have a defibrillator, 1146 (94%) did not plan to purchase one in the next 12 months, and 73 (6%) did plan to purchase one. The main reasons for not having a defibrillator were: the futility of having a defibrillator in the dental office (25%), the expense (19%), there was no prior need (11%), a defibrillator was not mandatory (7%), the proximity of a physician or emergency facility (9%), the dentist is near to retired (6%), a lack of training (4%), the presence of a defibrillator in the building (3%), and that no actual surgery took place (2%). This study confirms the finding by Muller et al. in 2005 that found that only 2% of dental practices in Germany had a defibrillator.2Muller M.P. Hansel M. Stehr S.N. et al.A state-wide survey of medical emergency management in dental practices: incidence of emergencies and training experience.Emerg Med J. 2008; 25: 296-300Crossref PubMed Scopus (106) Google Scholar Two limitations of our study are that we surveyed an urban area which may not be representative of all French dental practices and the short nature of our questionnaire. This study determined that despite the recommendations of the European Resuscitation Council, most dental practices in Paris do not have a defibrillator and are reluctant to purchase one. The response from dental surgeons regarding their plans to purchase defibrillators indicates further recommendation efforts may be ineffective. The chances of dental surgeons witnessing a cardiac arrest may be more substantial in their personal lives than in their dental practices. As dental practices are typically located in residential areas, we suggest a common-use defibrillator be set-up in a location accessible to residents, dental practice staff, pharmacies and all health offices in the same building in order to share the expense. The authors have no conflict of interest in this study. All authors conceived, designed, and supervised the conduct of the study.