By accepting government money for AEDs, did dentists sign up to more than they had bargained for, Phil McCafferty questions.
Nearly five years ago it was announced that all dental practices would have to have an automatic external defibrillator (AED) on their premises, as a requirement of the criteria demanded by the NHS Combined Practice Inspection. And as a token of the government’s appreciation of our participation in this project, they would, as an act of executive munificence, provide the AEDs, or reimburse us for the cost of the equipment if we had already procured one at our own expense.
Dentists have long recognised the value in having an AED to augment our emergency kit. Medical emergencies do occur in a dental setting, and, God forbid, if any of us should ever encounter such a scenario, we would all wish a successful outcome.
AEDs undoubtedly increase the chances of a patient surviving a life-threatening cardiac event. Of that there is no doubt. Dental teams are well versed and should be familiar with how to react in a dental surgery when an emergency is encountered. Basic life support training is undertaken annually, as is required by the CPI inspection. We usually know our patients fairly well, we take a full medical history, and we work in a setting where the emergency can be tackled to the best of our ability, and if something should go wrong, we should be able to assess the patient and react accordingly.
The same cannot be said for an emergency that takes place in the street or in someone’s home.
And that is where I, as a practising dentist, am extremely uncomfortable with our designation as first responders.
Call and response
The average Scottish Ambulance Service response time in 2018 for an emergency call was about 13 minutes. However, that is significantly slower than it was three years ago, when it was around nine minutes. This is a statistic I feel the government should be addressing by looking at the resource being made available to fund the Scottish Ambulance Service.
Recently there have been reports of dental teams being called as first responders to aid in situations in which the teams feel more than just a little uncomfortable. There have been instances where dentists and their staff have been whisked from the chairside to attend incidents several flights up in a high rise flat, to a situation they are unfamiliar with, in one example to what was rather graphically described as ‘a needle-strewn crack house’, understandably fearing for their own safety.
One cannot help feeling this was not quite what we signed up to in 2014, if indeed we actually signed up to anything when we took the Scottish government shilling.
I suspect, before we were recruited to this first responder scheme, the government perhaps considered chancing their arm with our colleagues in general medical practice with this little scheme, but they are much more militant in response to government tinkering, they attract much more in terms of public sympathy and are thus inclined to tell them where to stick their ideas if they feel they are being taken advantage of.
A pig in a poke
We were told in 2014 that the AEDs would be ours, and we would be responsible for their maintenance, replacement of pads and batteries, and for the cost of training in the use of the equipment. We would also be placed on a Scottish Ambulance mapping system to be contacted as first responders in the event of an emergency in our area.
A further Scottish government circular was issued last month clarifying our responsibilities. It is now quite clear we should not attend incidents where drug or alcohol use is suspected, or if the situation is more than 150 metres away. Whilst this is of some reassurance in addressing some of the concerns expressed by colleagues, it is quite clear if we are called out, we basically have to down tools immediately and go out.
I am quite happy to have an AED in my emergency kit to cope with cardiac emergencies on my premises, where I am in control of my own surroundings and hopefully familiar with the medical circumstances of the person I am dealing with. I am less comfortable fulfilling this role in the street, with the threat of voyeurism by the seemingly omnipresent mobile filmmakers and their propensity for sharing material on social media, no matter how distasteful.
I believe that as a profession we were sold a pig in a poke with this initiative and our natural willingness to do the right thing has been abused to take up the slack of underfunding in the ambulance service. It is for individuals to make their own judgement on this one, but I opted long ago to purchase my own AED and have not taken any public money by way of compensation. I know colleagues who have handed theirs back and replaced it out of their own pocket, just to get off the mapping system. It is not a decision I took lightly, but it is one I think we should all have a think about.
For more information, Phil McCafferty can be contacted through Dentistry Scotland. Responses to the article should be emailed to the editor, firstname.lastname@example.org.