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Information for Students>Clinical Policies and Procedures>Chapter 2 
 
Clinical Policies and Procedures
Chapter:
1 School of Dentistry
2 Emergency Procedures
3 Acquisitions & Assignment of Patients
4 Patient Chart
5 Student Fee Tickets/Data Forms
6 Practice Management (PM) Courses
7 Pre-doctoral Clinical Competencies
8  Instrument Sterilization & Distribution System
9 Conduct, Professional Appearance and Clinic Attire
Standard Abbreviations
 

Chapter 2   Emergency Procedures

2-1. Fire or Disaster Situation (Code 17).

A.      Remove persons in immediate danger of the fire.  Close doors to areas affected.

B.      Activate the nearest fire alarm box and call PUBLIC SAFETY DIVISION at 12911.  Give the location of the fire.

C.      Calmly notify other personnel in the area.

D.      Attempt to extinguish the fire with the proper fire extinguisher provided in your area.

E.      Follow established fire safety and evacuation procedures.  Escort patients from building.

F.      Remain calm.  Never yell "FIRE."

 2-2. Medical Emergencies. 

A.      Preparedness:  Students, faculty, residents and staff involved in patient services must be CPR certified.  The student is advised to periodically review and mentally rehearse the steps, materials and drugs to be followed and used for a circulatory arrest emergency as presented in the course material of the Cardiopulmonary Resuscitation Course. 

B.      Location of Emergency Equipment:  Emergency carts containing oxygen, resuscitation equipment and medications are located on each floor.  

1.       Third floor:  Dispensary (AD-3420).

2.       Second floor:  Clinic 12 (AD-2311).

3.       First floor:  (Clinic 1, Room 1334)

4.       A wheelchair is located in the Oral Surgery Clinic for emergency use.

5.       An emergency action protocol is posted by each telephone in the clinics.

Oral Surgery is responsible for monthly inspection of carts to determine if they are intact and have no unexpired drugs.

Eyewash Units

Eyewash units are available in sinks throughout the school to be used in cases of contamination of the eye(s) by chemical splash, foreign objects from grinding, etc.

Clinic

Room #

Area

Department

1

1334

Instrument Room

Oral Surgery

3

2703

Instrument Room

Pediatric Dentistry

4*

 

None Available

 

 

2510

Wet Lab between 3,4,5,6

 

5

2536

Clinical Research Instrument Room

General Practice Residency/Clinical Research

6

2631

Instrument Room

Endodontics

8

2922

Open Clinic

Orthodontics

10

2103

Supply Station

Periodontics

11*

 

None Available

 

 

2111

Wet Lab between 10, 11, 12, 13

 

12

2302

Supply Station

Emergency Dental Service

13*

 

None Available

 

14

 

Supply Station - Middle Bay

Oral Rehabilitation

 

2009

Removable Prosthodontics Lab

Oral Rehabilitation

 

3009

Fixed Restorative lab

Oral Rehabilitation

 

3324

3rd Floor Preclinical Technique Lab - sink on either side (2 units)

Oral Rehabilitation

16*

 

None Available

 

 

3201

Dental Materials Lab

Dental Materials

 

3202A

 

 

17

3117

Laboratory

Oral Rehabilitation

 

3136

Laboratory

 

 

1411B

Laboratories

Oral Biology

 

1412

 

 

 

1415, 1420

 

 

 

1422, 1428

 

 

 

1431, 1432

 

 

 

1437A

 

 

 

1441A

 

 

 

1444, 1450

 

 

 

1459

 

 

 *None Available

C.      Student Responsibilities 

1.       In case of emergency, the student should STAY WITH THE PATIENT and obtain assistance from a nearby dental assistant or from another student who can obtain the emergency cart and a supervising faculty doctor

2.       Students as freshmen and again as juniors (spring semester) are required to pass a course in basic life support procedures that involves CPR certification.   

Medical Emergency Protocol for the School of Dentistry

OBJECTIVE:

The Dental Practitioner is constantly faced with the possibility of a medical emergency during the course of patient care.  He or she should, therefore, be prepared to handle such emergencies with the greatest expediency.  Our plan is to instill awareness in the faculty, students and staff of the Medical Emergency Protocol and a mechanism for its activation within the School of Dentistry.

PLANNING AND TRAINING:

Each department is obligated to have its faculty maintain certification in CPR and to formulate its specific medical emergency plan and, if necessary, to activate the Medical Emergency Protocol formulated by the Oral and Maxillofacial  Surgery Department, Medical College of Georgia, School of Dentistry.  Compliance with the development of Departmental Medical Emergency plans will be monitored by the Oral and Maxillofacial Surgery Department.

It is the responsibility of the faculty/practitioner to provide initial management of the patient until the medical emergency response team arrives.  Therefore, it is recommended that each department have frequent scheduled and unscheduled medical emergencies practice sessions, as part of the medical emergency plan.

Scheduled and unscheduled medical emergencies practice sessions will be part of the School of Dentistry's Medical Emergency Protocol throughout the school.

MEDICAL EMERGENCY RESPONSE TEAM

The designated medical emergency response team in the School of Dentistry will carry pagers that are keyed to the MCG medical emergency operator.

The designated response team includes: Oral Surgery faculty, residents and nurses.

1.       MEDICAL EMERGENCY PROCEDURES

During any MEDICAL EMERGENCY when assistance is needed call the MCG emergency operator (1-2222) and request activation of CODE #66.

The activation of Code #66 will alert all members of the dental school emergency response team as to the location of the medical emergency in the dental school.  Every individual on the response team who is on campus will respond to the emergency.  Exceptions to the policy will be those critical individuals that are actively involved with patient treatment in the operating room or sedated patients in the clinic.

The medical emergency response team at the School of Dentistry will respond as noted above with the activation of Code #66.

Upon activation of Code #66 the members of response team that are physically on campus will respond to the emergency situation except for those critical personnel involved with patient care as noted above.

A designated code #66 flow-sheet will be filled out for each emergency situation. At a minimum the information listed below should be included on all flow-sheet.

  • Time emergency recognized
  •  Time resuscitation begun
  • Time telephone calls made
  • Time any drugs administered and which ones
  •  Time help arrived
  • Time patient recovered or was moved to hospital
  • Time of any other pertinent actions
  •  Drs. attending

After initial assessment, a decision will be made by the emergency response team as to the disposition of the patient.

E M E R G E N C Y

1.       Call 1-2222

2.       Tell the operator to "Activate CODE #66 for a patient located in the School of Dentistry, Floor, Clinic #                      .”

3.       Send individuals to the elevator and stairway to meet the response team to direct them to the emergency.

4.       Send someone else to retrieve the emergency cart located in            .

NOTE: If no response within five minutes, reactivate the initial Code and call 911.

2-3. Dental Emergency Care Policies and Procedures.

A.      Emergency Care for Assigned Patients:

  1. The provider is responsible for the complete oral health care of his/her assigned patients including emergency treatment.  Providers should give each assigned patient his/her phone number and instruct the patient to contact him/her first if an emergency situation arises.
  2. When contacted by a patient in need of emergency care, the student/provider should arrange to see the patient in a timely manner in the appropriate departmental clinic if possible.  If the student/provider's schedule does not permit this, the student may arrange for his/her patient to be seen in the Emergency Dental Service (EDS).
  3. To arrange for care in the EDS, the student/provider should contact Admissions (721-2371).  Scheduling of patients, obtaining charts, and all administrative processing prior to being seen is accomplished by Admissions personnel.  Patients should not be told to report to Admissions for emergency treatment without prior arrangement by the student dentist.

B.      Normal Operations of the Emergency Dental Service

1.       The Emergency Dental Service is available to all adults (age 14 or older) who request urgent dental care including those with no previous care at MCG School of Dentistry. 

2.       The goal of the Emergency Dental Service is to treat urgent dental problems and to provide palliative relief for symptomatic conditions in an expeditious manner. 

3.       Normal hours of operation for the EDS are Monday - Friday from 12:30 - 5:00 PM.  The clinic is closed during student breaks, exam week and other periods when students are unavailable for clinic assignment.

Procedure for the Emergency Dental Service

Admissions (721-2371) is the initial entry point for the EDS and provide information and administrative support. 

a. For assigned patients, if their student cannot, for valid reasons, provide urgent care, the student should contact Admissions to arrange for treatment in the EDS. 

b. New patients can directly obtain information on clinic hours, fees and request treatment from Admissions. Patients are seen on a first-come, first-served basis.  "Fee Tickets" are sequenced numerically to identify those who present earliest. 

      c.  For Assigned Patients, existing dental records are used to record all treatment.  For new patients, an emergency record consisting of a record jacket, health history, treatment record, radiographic exposure log, and registration form is constructed

Emergency Care When School is not in Session 

Dental emergencies may be treated in the school only during normal clinic hours when the school is open.  Evening and weekends and days when the school is closed, emergency patients may be seen in the hospital ER only. 

Evenings/Weekends: The patient should first call his assigned student who will call 721-3893 (Paging and Locator Service) and ask the operator to page the General Practice Resident on call. If necessary, the student will meet the patient at the MCG Hospital Emergency Room and the resident will supervise the emergency treatment or suggest appropriate consultation. Should it be impossible for the patient to contact the student after normal school hours, the patient should have been advised earlier by the student to call 721-3893 (MCG Emergency Services) and ask the operator to page the resident on call. Emergency treatment will be accomplished in the Medical College of Georgia Hospital. Patients will be billed by the Medical College of Georgia Hospital for these services.

Holidays, Breaks and Periods When Students Are Not Available in EDS.

Patients of record experiencing emergency dental problems should contact the Patient Admissions Office at (706) 721-2371 and schedule an appointment for emergency treatment.  The patient will be triaged by faculty and taken to the appropriate department for treatment.

2-4. Emergency Supervision for Patients with Acute Periodontal Problems. 

The dentist or dental student providing treatment for any patient will be responsible for the treatment of any emergency problem that may arise.  For those emergencies which occur after school hours, the general policies and procedures for providing this treatment are listed below.

  1. Dental Students.  Dental Students will contact the Periodontics Resident concerning the emergency problem.  Contact can be obtained by calling the page number (723-1150) and leaving a message for the resident.  If the emergency is the result of periodontal surgery, during normal business hours, the dental student will contact the faculty member who was present during the treatment to evaluate the patient's problem.  If the faculty member cannot be contacted, the student will page the Periodontic Resident by calling 723-1150 and leaving a message for the resident.  The patients will be examined and treated in Clinic 11 of the School of Dentistry by the Periodontic resident or faculty.  If the emergency occurs after hours or on weekends, the patient must be treated in the hospital emergency room.
  2. Faculty members or Periodontic residents.  If the faculty members or Periodontic residents who are responsible for the treatment of a patient with an acute periodontal emergency cannot be contacted by the patient, then the patient should contact the Periodontic resident on call, again by calling (723-1150) and leaving a message.

 2-5. Reporting Accidental Injuries. (Contact Mr. Michael Budd, Admissions) 

  1. Should a patient accident/injury occur (related to dental therapy) the student should first report to the attending faculty member.

IF THE ACCIDENT IS LIFE THREATENING, follow the Medical Emergency Protocol for the School of Dentistry (pages 11 -13).

If the accident/injury is NOT life threatening, the student and patient should report to Admissions to fill out an "Employee's Report of Accident/Injury" form.  Detailed instructions for completing this form and follow-up activity (Emergency Room, blood testing, etc.) are available in Admissions.

If the accident/injury is NOT related to dental therapy, (patient falls, slips on wet floor, trips on stairs, etc.), the Admissions personnel will fill out the proper forms.  If medical treatment is required, Public Safety will be called. 

  1. Incident Reports

An incident is defined as adverse, unexpected occurrence of sufficient magnitude that it has the potential to be a risk management situation.  Examples of instances for which incident reports are necessary include (1) required emergency medical attention by persons other than the attending dental staff for medical situations arising during the course of treatment, (2) injuries to the patient of significant magnitude that they require medical or surgical intervention, (3) dental treatment which is so substandard as to be judged grossly negligent, (4) any threat of legal action by any patient for treatment/diagnosis or the lack thereof, (5) death.

Reports should be filed by the attending dental staff and forwarded to the Chairperson, Quality Assurance Committee, MCG School of Dentistry within 24 hours.  Information required is listed below:

  • Name of patient
  • Patient number or identifier
  • Date of occurrence
  • Location of patient at time of occurrence
  • Individual reporting
  • Date of report
  • Brief summary, i.e. anaphylactic reaction, angina, threat of legal action
  • Detailed description of event (copies of treatment report, if completed in detail, may suffice)

2-6. Reporting needle sticks, cuts, and treatment related injuries. 

  1. All needle sticks and sharp instrument cuts inflicted on students must be reported immediately to their supervising faculty member. Exposures considered significant* include:
  2. Needle sticks with contaminated needles
  3. Puncture wounds from contaminated, sharp dental instruments
  4. Contamination of any obviously open wound or the mucous membranes with saliva, blood, or a mixture of both saliva and blood

·         Exposure to a patient's blood or saliva on the unbroken skin is not considered significant.

 Protocol for Injury Management 

1.       Immediately cleanse the wound thoroughly with soap and water

2.       The patient and the dental health care provider (student or assistant or faculty member involved) report to Mr. Michael Budd - Dental Admissions - for further instructions (as discussed in section 2.5).

3.       Obtain the patient's and exposure recipient's permission for blood testing and arrange for pretest counseling.

4.       Hepatitis Blood Test Results and Treatment Recommendations

A.      HBsAg Negative (PATIENT)

1.       Hepatitis vaccine if not already received   (STUDENT)

B.      HBsAg Positive (PATIENT)

1.       If recipient is already anti-HBsAg positive:  No treatment (STUDENT).

2.       If recipient has had Hepatitis B vaccine with laboratory proven seroconversion:  No treatment (STUDENT)

3.       If recipient has had Hepatitis B vaccine without laboratory proven seroconversion:  One additional dose of vaccine and one dose of HBIG if anti-HBs negative on testing.  (STUDENT)

4.       If recipient is negative for anti-HBs:

·         Start HBIG within 48 hours of exposure (0.06 ml/kg IM) and hepatitis B vaccination series within 7 days.  (STUDENT)

·         HIV Blood Test Results and Treatment Recommendations

C.      Diagnosed AIDS, anti-HIV (+), refuses testing or unknown source (PATIENT)

1.       If recipient is anti-HIV (+): should receive post-test counseling and medical evaluation (STUDENT)

2.       If recipient is anti-HIV (-): should receive post-test counseling and repeat testing at 6, 12, and 24 weeks. (STUDENT)

D.      Anti-HIV (-) (PATIENT)

1.       If recipient is anti-HIV (+): should receive post-test counseling and medical evaluation   (STUDENT).

2.       If recipient is anti-HIV (-):  should receive post-test counseling and optional follow-up at 12 weeks.  (STUDENT).

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Patient Services
 School of Dentistry | Medical College of Georgia
 Please email comments, suggestions or questions to:
Linda Kimberly,

October 13, 2006