Fall 2013

Dental 911

These emergencies aren’t real—but the lessons they impart are

By Helene Ragovin

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Faculty, residents and staff from the department of oral and maxillofacial surgery are using high-fidelity simulators at Tufts Medical Center to train for anesthesia emergencies. Photo: Alonso Nichols

They breathe; their hearts beat, and they have a pulse. they can flail their arms, scream, turn blue, vomit or suffer cardiac arrest. And they can do it over and over again—and recover every time.

The troubled and tenacious patients in this case aren’t human—they’re high-fidelity simulators, used to train dentists to respond to medical and anesthesia emergencies. As patients’ needs and medical conditions become more complex, preparing dentists to manage emergencies in the dental office is more important than ever, according to dental anesthesiologists.

“Sedation in dentistry is a growing area, but practitioners must receive advanced educational and clinical qualifiers” to deliver such care, says Morton Rosenberg, D74, professor of oral and maxillofacial surgery and head of the division of anesthesia and pain control at the dental school.

Some patients want or need sedation because they are too anxious to undergo treatment otherwise. “Patients are as dental phobic as they were 50 years ago; that’s not changed at all,” Rosenberg says. “And we’re seeing more medically compromised patients, those who are mentally challenged, have Alzheimer’s and other conditions that make dental care impossible without the use of moderate and deep sedation and general anesthesia.”

Life-saving training

Sedation for pediatric patients requires special expertise and training. “Children are not simply small adults,” Rosenberg says. Providers must have an understanding of children’s anatomical, physiological, pharmacological and psychological differences.

While state practice acts and regulatory boards may require certain emergency equipment in dental offices, especially for the use of sedation or anesthesia, the Anesthesia Research Foundation of the American Dental Society of Anesthesiology has developed a comprehensive program for the drugs, equipment and training necessary to prepare dentists to deliver emergency care. Dubbed “Ten Minutes Save a Life,” the program is designed to help dentists keep a patient stable until medical assistance gets there.

“We feel a dentist, no matter if he or she uses local anesthesia, sedation or general anesthesia, has to be able to keep a patient oxygenated and ventilated for the 10 minutes that it might take for help to arrive,” Rosenberg says.

“My mannequin can tell you to shut up.” —Morton Rosenberg

That training can be even more successful if a practitioner goes through a hands-on simulation course, which is where the dummies come in. Rosenberg and others have been offering simulation courses for oral and maxillofacial surgeons, pediatric dentists, dental anesthesiologists and general dentists. Some states are incorporating simulation courses as part of relicensing credentials, and insurance companies have begun to offer discounts to dentists who have taken such training, Rosenberg said.

This fall, faculty, residents and staff in Tufts’ department of oral and maxillofacial surgery are going through training at the W. Heinrich Wurm Clinical Simulation Center at Tufts Medical Center—the same facilities Rosenberg uses to teach anesthesiology residents in his role as an associate professor of anesthesiology at the School of Medicine.

“What we are trying to impart is a philosophy on how to manage a medical emergency,” says Rosenberg.

“We’re going to be going through all this training in teams,” Rosenberg says. “How do you work as a team to make things better? How do you communicate? How do you talk to people when things are going wrong, and how can you be assured that what you said was actually done? How can we create an atmosphere so everybody on the team will not hesitate to speak up and say something to prevent common errors?”

The mannequins at Tufts Medical Center come in a variety of shapes and sizes, with flexible, fleshy-feeling skin, and interchangeable heads and limbs to create a range of emergency scenarios. For their part, the simulation dummies can talk back, struggle, yell or moan in pain.

“My mannequin can tell you to shut up,” Rosenberg notes. The mannequins are controlled by an operator in an adjoining room who creates “emergencies” and watches them unfold through a one-way mirror. “You can reproduce very rare events, or very simple events that one sees all the time, and do it over and over,” Rosenberg says.

The outcome in a simulation is not always the desired one—not all the inanimate patients pull through. But there is a reason Rosenberg calls them all by the name Lazarus. “The good thing is,” he says, “even though we may do damage to these mannequins, the next morning they all come back to life again.”

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