MEDICAL EMERGENCIES IN THE DENTAL SURGERY GUIDELINE

FOR THE MANAGEMENT WITHIN THE WORCESTERSHIRE

PRIMARY CARE TRUST SALARIED DENTAL SERVICES

Version: Final

Ratified by (name of Committee): Quality and Safety Committee

Date ratified: October 2008

Date issued: November 2008

Expiry date: October 2011

(Document is not valid after this date)
Review date: January 2011

Lead Executive/Director: Sandra Rote

Name of originator/author:
Target audience:
Director of Clinical Development
and Executive Nurse
Lorna Hollingsworth
Assistant Clinical Director
Salaried Dental Service Staff

This guideline must be read in conjunction with:

Worcestershire Primary Care Trust Resuscitation Policy
Consent Policy
Record Keeping Guidelines
Contribution List

Key Individuals involved in developing the document

Name Designation
Lorna Hollingsworth Assistant Clinical Director
Tony Kinsey Senior Resuscitation Officer

Circulated to the following individuals for consultation

Name Designation
Finbarr Costigan Salaried Dental Services Clinical Director
Rod Smith Assistant Salaried Dental Services Clinical Director
Kate Cross Assistant Resuscitation Officer Worcestershire PCT
Rosemary Pickford Pharmacist – Acute Trust
Sue Lunec Senior Pharmaceutical Advisor, Worcestershire PCT
Lesley Way Patient Safety Manager
Carole Clive Nurse Consultant – Infection Control
Della Lewis Clinical Governance Co-ordinator

Medical Emergencies in the Dental Surgery Page 2 of 21

 Contents

1. INTRODUCTION…………………………………………… page 4

2. SCOPE ……………………………………………………… page 4

3. TRAINING …………………………………………………... page 4

4. ACCESSING EMERGENCY SERVICES………………… page 4

5. RISK ASSESSMENT………………………………………. page 4

6. EQUIPMENT AND DRUGS……………………………….. page 5

6.1 AUTOMATIC EXTERNAL DEFIBRILLATORS ( AED) page 6

6.2 MONITORING OF DRUGS AND EQUIPMENT page 7

6.3 RE-ORDERING…………………………………… page 7

7. TRANSFER RECORD AND AUDIT……………………… page 7

Appendix 1 UK Resuscitation Council Guidelines - Medical Emergencies and

Resuscitation for Dentists (Separate attachment)
Appendix 2 Emergency Call
Appendix 3 Management of Medical Emergencies in Dental Practice
Appendix 4 Adult basic life support algorithm
Appendix 5 Paediatric basic life support algorithm
Appendix 6 AED algorithm
Appendix 7 Adult and child choking algorithm
Appendix 8 Anaphylactic reaction – Initial treatment
Appendix 9 Drugs and equipment daily check
Appendix 10 Worcestershire County Area Prescribing Committee May 2008
Epistatus (buccal midazolam)

EQUALITY IMPACT ASSESSMENT …………………………………….page 20

Medical Emergencies in the Dental Surgery Page 3 of 21

1. Introduction
The Salaried Dental Services (SDS) have adopted the UK Resuscitation Council
Guidelines - Medical Emergencies and Resuscitation for Dentists (appendix 1)
alongside the Worcestershire PCT Resuscitation Policy.

The following additional guidance has been produced to accompany these

guidelines and policies which will be accessible on the Worcestershire PCT
internet policies page. Clinical staff will be made aware of these guidelines through
the SDS monthly newsletter.

WPCT recommends that staff do not print off or photocopy policies and guidelines
unless absolutely necessary. The internet version is the definitive version.

2. Scope
This guideline applies to clinical staff of the Worcestershire PCT Salaried Dental
Services (SDS) for the management of medical emergencies and resuscitation
within the dental surgery.

3. Training
All clinical dental staff (dentists, dental therapists and dental nurses) and
receptionists (where appropriate) based within clinics will undergo resuscitation
training. Training will follow the Worcestershire PCT Resuscitation Policy

This will be provided by Central Training Services (CTS) Resuscitation Training

Team. A record of this training will be placed on the Open Learning Management
part of Electronic Staff Records by CTS.

4. Accessing Emergency Services

All SDS staff will be responsible for knowing how to call for emergency help from
the clinic they are working in each day. Emergency Call information (Appendix 2)
will be completed by the Team leader of each site and placed by the reception
telephone to enable staff to give the correct details to the emergency services.

5. Risk Assessment
The SDS will undertake risk assessment by ensuring medical history is taken from:
• all new patients who attend the SDS.
• all patients commencing a new course of dental treatment .

This should be recorded on the department’s medical history form and signed by
both dentist and patient (or parent / legal guardian if under 16 years old).
Any underlying condition likely to place the patient at increased risk of a medical
emergency whilst visiting the dental surgery should be noted on the medical
history form.

Where there is a positive answer to any of the questions the history should clearly
detail:

• The name of the underlying condition

• The stability of the condition
• Any prescribed medication for the condition.

Medical Emergencies in the Dental Surgery Page 4 of 21

 6. Equipment and Drugs:
In line with Worcestershire PCT Resuscitation Policy the following equipment will
be available in each SDS clinical area where defibrillators have been allocated.
ITEM QUANTITY SUPPLY
UNIVERSAL PRECAUTIONS
Non-sterile gloves (medium & large) 2 each Any latex free( not plastic
gloves)
Plastic apron 2 Any
Eye protection visor mask 3 Kent
Sharps box( yellow topped for disposal of sharps 1 FSL 316
contaminated with blood, body fluids and/or
pharmaceutical products)
AIRWAY EQUIPMENT
Oxygen – light weight cylinder with regulator 1 BOC
CD cylinder
Non – rebreath oxygen mask with tubing (adult) 1 FDD 321
Non – rebreath oxygen mask with tubing (child) 1 FDD 619
Pocket mask device with oxygen port 1 Laerdal
83 00 11
Suction – portable hand held unit, including 1 Laerdal – V-Vac unit.
suction catheter for V Vac 98 50 00
Bag/valve/mask device with oxygen reservoir 1 FDE 370
With size 5 face mask
Single use face mask size 4 1 Marshall
200750
Bag/valve/mask device – Child (520ml) 1 Timesco
With size 1, 2 and 3 clear face masks TDM MP 10422P
Tongue Depressor 1 Any
Oro-pharangeal airway size 0 1 FDB 209
size 1 1 FDB 212
size 2 1 FDB 213
size 3 1 FDB 214
size 4 1 FDB 215
AeroChamber device standard blue with mask 1 Pharmacy
child yellow with mask 1
CIRCULATION EQUIPMENT
Defibrillator 1

ECG electrodes (if defibrillator with monitoring 3 packs FDK 090 (x 100)
facility allocated to clinical area) (1 on Southern Syringe M7R-
machine) 00-S/3 (x3)
Pre-Connected defibrillation pads (if defibrillator 2 (1 on AED) Medtronic 11996-000017
allocated to clinical area) Welch Allyn WA –
C001857
Paediatric attenuated pads 1 Medtronic
Surgical prep-razor (if defibrillator allocated to 2 (1with FSF 007
clinical area) AED)

Tuff cut scissors 1 Timesco

12.710.05
Surgical prep-razor 2 (1 with FSF 007
AED)
DOCUMENTATION
Transfer/record form for medical emergencies Book of 10 Central Training Services
and cardiac arrest
Resuscitation Guidelines (Resuscitation Council 1 Resus Officer
UK)
Equipment checking book 1

Medical Emergencies in the Dental Surgery Page 5 of 21

The dental clinics will additionally have in place Optium Xceed Glucometers
supplied by Abbott.

In line with National Guidelines and WPCT Resuscitation Policy the following
drugs will be kept in each SDS clinical area. All medications and glucose testing
strips must be obtained from the Alexandra Hospital pharmacy department.

• Glyceryl trinitrate (GTN) spray (400micrograms / dose)

• Salbutamol aerosol inhaler (100mircrograms / actuation)
• Adrenaline injection (1:1000, 1mg/ml) x 2
• Aspirin dispersable (300mg)
• Glucagon injection 1 mg
• Oral glucose solution / tablets / gel / powder
• Midazolam 10mg/ml (buccal)
• Oxygen

The drugs should be used in accordance with the instructions contained in the
“Medical Emergencies in Dental Practice” grid displayed in each surgery (appendix
3). All emergencies should now follow the ABCDE approach to management.

• A Airway
• B Breathing
• C Circulation
• D Disability
• E Exposure

The equipment and drugs should be used with the algorithms:

Adult Basic Life Support algorithm- appendix 4
Child Basic Life Support algorithm- appendix 5
AED algorithm -appendix 6
Adult and Child Choking algorithm- appendix 7
Anaphylactic algorithm -appendix 8.

Dental nurses will be expected to deliver oxygen in the event of a life threatening
situation occurring within the dental clinics. Instruction on the administration of
oxygen is given during annual resuscitation training. All other drugs will only be
given by General Dental Council Registered Dentists.

6.1 Automatic External Defibrillators (AED).

The following sites have an AED sited within the dental clinic:

• Dental Clinic, Smallwood House, Redditch

• Dental Clinic, Warndon Clinic, Warndon
• Dental Clinic, Moor Street Clinic, Worcester
• Dental Clinic, Winyates Health Centre, Winyates
• Dental Clinic, Kidderminster Health Centre, Kidderminster
• Dental Access Centre, Crown House, Kidderminster
• Dental Access Centre, Malvern Health Centre, Malvern

Medical Emergencies in the Dental Surgery Page 6 of 21

 • Dental Access Centre, Lowesmoor

The following sites will have AED’s and staff trained to use them within the clinical/
hospital area. Staff working in these sites must ensure they know how to raise the
call for emergency help and who will respond with their AED in the event of an
emergency:

• Dental Clinic, Evesham Community Hospital

• Dental Access Centre, Evesham Community Hospital
• Dental Clinic, Princess of Wales Community Hospital
• Dental Access Centre, Tenbury Community Hospital
• Prison Clinics: HMP Longlartin, HMP Hewell (Brockhill and Blakenhurst).

6.2 Monitoring of Equipment and Drugs

It is the responsibility of the Dental Nurse Team Leader in each location, and the
dentist in each surgery, to ensure the drugs are in date and equipment is fully
available for use. Resuscitation equipment (including AED) and emergency drugs
must be checked weekly. Details of this checking/monitoring should be routinely
recorded on the Drugs and Equipment Daily Check List (Appendix 9).

Compliance with stock control guidance - and clear labelling on drugs and
equipment storage - will be checked by the Dental Nurse Team Leader in charge
of the location on a monthly basis.

Please note Midazolam is a schedule 3 controlled drug; the guidelines from

Worcestershire County Areas Prescribing Committee May 2008 (appendix 10)
should be followed. Midazolam must be ordered as a controlled drug. It must be
kept in a locked cupboard or an area not accessible to the public but always
remaining with the rest of the emergency drugs and equipment.

6.3 Re-Ordering of Equipment and Drugs

If any drugs are used/expired they must be re-ordered immediately.

7. Transfer Record and Audit

All medical emergencies and resuscitation attempts must be fully recorded on the
PCT Transfer and Record form. The top copy of the form is sent with the patient to
A&E and the carbon copy is sent to the Trust Resuscitation Officers for audit
purposes. Details of the form can be found in the WPCT Resuscitation policy.
Copies of the form are obtained from CTS.

To comply with Worcestershire PCT policy there will be an equipment spot check
at least once a year audited by the Trust Resuscitation Officers.

Appendix 1: see separate attachment Medical Emergencies in the Dental Surgery

Appendix 1

Medical Emergencies in the Dental Surgery Page 7 of 21

Appendix 2: Emergency Call

TO CALL FOR THE EMERGANCY SERVICES FROM THIS TELEPHONE;

CALL…………………………………………

CLINIC LOCATION

…………………………………………………………………………….
……………………………………………………………………………..
……………………………………………………………………………..
………………………………………POSTCODE………………………

TELEPHONE NUMBER OF CLINIC IN FULL

……………………………………………………………………………

Medical Emergencies in the Dental Surgery Page 8 of 21

 Appendix 3: Management of Medical Emergencies in Dental Practice
All emergencies should follow the ABCDE approach to management.
All medications with the exception of oxygen will only given by Dentists
SIGNS
Adrenal Collapse in a patient who is at risk due to
insufficiency steroid therapy or other endocrine disorder
Anaphylaxis Use Airway, Breathing, Circulation,
Disability and Exposure approach.
Diagnosis – look for:
• Acute onset of illness
• Life threatening airway and/or
breathing and/or circulation
problems
• And usually skin changes
Cardiac Angina - retrosternal pain
Emergencies
Myocardial infarction
Progressive onset of severe, crushing pain
across front of chest
Pain may radiate towards the shoulder, arm
or neck
Skin pale and clammy and pulse weak
Cardiac arrest Collapse, no respiration or pulse
SIGNS
Asthma Mild - wheezing- normal speech
Acute severe - distress or tachycardia-
cannot complete sentences
Medical Emergencies in the Dental Surgery
MANAGEMENT
Lay patient flat
Give high flow oxygen
Call for a 999 ambulance / call 2222
Call for a 999 ambulance
Secure the airway
Lay patient flat and raise the legs (may need to modify to
ease breathing)
Give high flow oxygen
Give 0.5mg (0.5mL) of 1:1000 adrenaline IM : use
suitable syringe to measure small volumes
PAEDIATRIC DOSES OF ADRENALINE:
Child over 12* years 500mcg ( 0.5ml)
Child 6-12 years 300mcg ( 0.3ml)
Child less than 6 years 150mcg ( 0.15ml)
Repeat at 5 minutes if no improvement
* reduce dose to 300mcg ( 0.3ml) for small or pre-
pubertal over 12s.
Give GTN spray: spray 1 to 2 doses under the tongue
and close mouth
Call for a 999 ambulance / call 2222
Allow the patient to rest in the position that feels most
comfortable Give high flow oxygen
If available, give 50% nitrous oxide :50% oxygen for pain
relief
Give aspirin dispersible 300mg : chew or disperse in
water
(send a note to the hospital to say this has been done)
Commence CPR and dial 999 / call 2222
In the first instance begin Basic Life Support until
AED arrives then move to the AED algorithm)
Appendix 4 and 6.
MANAGEMENT
Give two puffs from a salbutamol inhaler
Repeat the above if necessary
If unable to use the inhaler effectively or no
response: give further 4-6 puffs each inhaled
separately or via spacer device
In young children: Give up to 10 puffs via spacer +/-
face mask
Call for an 999 ambulance / call 2222
Page 9 of 21
 Give high flow oxygen
Life-threatening – cyanosis
- bradycardia or exhaustion As above
Epileptic seizures Brief warning (variable) Ensure patient is safe

Sudden loss of consciousness Do not attempt to restrain

Patient becomes rigid, falls, may give a After convulsive movements have subsided, put patient
cry Cyanosis in recovery position

After 30 seconds, there are jerking No need for medical care unless: Injury, prolonged or
movements of the limbs; the tongue may repeated, atypical
be bitten (clonic phase)

Seizures lasting 5 minutes or longer (or Call for an ambulance

rapidly repeated):-
Frothing from the mouth After 5 minutes of convulsive movements give buccal
Urinary incontinence midazolam (Epistatus) NB//1 bottle contains 4 adult doses)

Seizure only lasts a few minutes - the

patient may then become flaccid but ADULTS AND CHILDREN OVER 10 YEARS
remain unconscious 1mL [one millilitre (10mg)]

Regains consciousness but may be CHILDREN

confused 6-12 months 0.25mL ( quarter a millilitre (2.5mg))
1 - 4 years 0.5mL [half a millilitre (5mg)]
5 - 10 years 0.75mL [three quarters of a
millilitre(7.5mg)]

One repeat dose only may be given 10minutes later

Hypoglycaemia Shaking and trembling, sweating Use glucometer to measure blood glucose levels.

Pins and needles in lips and tongue If blood glucose less than 4 mmol/L:

Palpitations, hunger, headache, double Give 10 to 20mg glucose (2 teaspoons of sugar, 3

vision sugar lumps, 200mL milk or non-diet soft drinks, etc.)

Difficulty in concentration, slurred OR Give "Hypo-stop" sublingually [ TIP: Be firm with

speech, confusion an argumentative hypo. pt Delay conflict e.g. "Take this
now and we can argue later"]
Irritability, aggression,

Unconsciousness ------------------------------- If patient is unconscious Give glucagon 1mg IM

(Glucagen HypoKit 1mg/1ml after reconstitution)

CHILDREN: under 8 (or under 25kg) 0.5mg IM

(Glucagen Hypokit)

Syncope Patient feels faint Lay patient flat and raise legs
Pallor and sweating Loosen any tight clothing around the neck
Yawning and slow, weak pulse Recovery is usually rapid - within seconds
Nausea and vomiting
Dilated pupils Once consciousness is regained, give sugared drink
Muscular twitching

Medical Emergencies in the Dental Surgery Page 10 of 21

Appendix 4

Adult basic life support algorithm*

UNRESPONSIVE?

Shout for help

Open airway

NOT BREATHING NORMALLY?

Call 999

30 chest
compressions

2 rescue breaths
30 compressions

Medical Emergencies in the Dental Surgery Page 11 of 21

Appendix 5
Paediatric basic life support algorithm

UNRESPONSIVE ?

Shout for help

Open airway

NOT BREATHING NORMALLY ?

5 rescue breaths

STILL UNRESPONSIVE ?
(no signs of a circulation)

15 chest compressions
2 rescue breaths

After 1 minute call resuscitation team then continue CPR

Medical Emergencies in the Dental Surgery Page 12 of 21

Appendix 6 AED algorithm

Unresponsive

Call for help

Open airway
Not breathing normally

Send or go for AED

Call 999

CPR 30:2
Until AED is attached *

AED
Assess
rhythm

Shock advised No shock advised

1 shock

150-360 J biphasic
Or 360 J monophasic

Immediately resume
Immediately resume CPR 30:2
CPR 30:2
for 2 min
for 2 min

Continue until the victim starts to

breathe normally

• Use paediatric pads / attenuated mode for children under 8 years if available

Medical Emergencies in the Dental Surgery Page 13 of 21

 Appendix 7
Adult and child choking algorithm (Not for use under one year of age)

Assess severity

Mild airway
obstruction
Severe airway (Effective cough)
obstruction
(Ineffective cough)

Unconscious Conscious
Encourage cough
Start CPR 5 back blows
Continue to check for
5 abdominal deterioration to ineffective
thrusts cough or relief of
obstruction

This algorithm is suitable for use in children over the age of 1 year.

Medical Emergencies in the Dental Surgery Page 14 of 21

Appendix 8
Anaphylactic reaction – Initial treatment

Anaphylactic reaction?

Airway, Breathing, Circulation, Disability, Exposure

Diagnosis – look for:

• Acute onset of illness
• Life-threatening Airway and/or
Breathing and/or Circulation
problems 1
• And usually skin changes

• Call for help

• Lie patient flat
• Raise patient’s legs
(if breathing not impaired)

Intramuscular Adrenaline 2

1 Life-threatening problems:

Airway: swelling, hoarseness, stridor

Breathing: rapid breathing, wheeze, fatigue, cyanosis, confusion
Circulation: pale, clammy, faintness, drowsy/coma

2 Intramuscular Adrenaline

IM doses of 1:1000 adrenaline (repeat after 5min if no better)

* Adult: 500 micrograms IM (0.5mL)
*Child more than 12 years: 500 micrograms IM (0.5mL)
* Child 6 – 12 years: 300 micrograms IM (0.3mL)
* Child less than 6 years: 150 micrograms IM (0.15mL)
Reduce dose to 300mcg (0.3ml) for small or pre-pubertal over 12s.

Medical Emergencies in the Dental Surgery Page 15 of 21

Appendix 9 Drugs and equipment daily check:

Name of
Clinic:

date Equipment Drugs Name of staff Signature

checked Checked checking
Tick Tick

Medical Emergencies in the Dental Surgery Page 16 of 21

Appendix 10
Worcestershire County Area Prescribing Committee
revised July 2008 to replace May 2008 version

Epistatus (buccal midazolam)

Use of Epistatus (buccal midazolam) as an intervention for

prolonged seizures and prevention of Status Epilepticus

Background
Traditionally first line pharmacological intervention for severe and enduring
seizures has been diazepam administered rectally from a proprietary solution
contained in a small enema tube. Buccal midazolam has been shown to be as
effective as diazepam and offers a more socially acceptable alternative to rectal
treatment.

Buccal midazolam (Epistatus) is unlicensed whereas rectal diazepam is licensed. The

National Institute for Health and Clinical Excellence (NICE) supports both options. Both
the BNF and the BNF for Children recognise buccal administration of midazolam as a
pharmacological strategy in the management of status epilepticus. The BNF for Children
acknowledges that the buccal route may be more acceptable in children and gives
suggested doses in a monograph. Special Products Ltd (01932 820 666) manufacture a
midazolam solution, 10mg/ml formulated in a sugar-free syrup and supplied in a bottle
with four 10mg doses and oral syringes and full instructions on its use and is available on
NHS prescription.

Aim of Guideline
The aim of the guideline is to provide a safe and consistent practice in the use of the
unlicensed preparation buccal midazolam in the pharmacological management of
enduring seizures that carries minimal risk to the client whilst maintaining the dignity of all
concerned.

Prescribing Responsibility
Specialist services will only introduce buccal midazolam as a rescue medication under a
clinical management plan. GPs are invited to prescribe ongoing medication supplies.

Administration
Registered nurses and support workers who have undertaken specific training in
administering buccal midazolam may administer client’s own ready dispensed midazolam
or may administer against a prescription. If these are not available then rectal diazepam
should be used following the individual Trust’s Patient Group Direction.
Midazolam may also be available in some areas as an emergency response to
status epilepticus by prescribers only (doctors, dentists and non-medical
prescribers within their area of competence).
Note that midazolam is a schedule 3 Controlled Drug with CD register and safe
custody exemptions but local policy may require that stricter controls are in place.

Medical Emergencies in the Dental Surgery Page 17 of 21

Medication Details
Indication
Contra-indications
Medicine Name
Form
Route of administration
Dose and frequency:
Legal Category
Duration of treatment;
Acute intervention only
Potential Adverse Reactions
Management of Adverse
Reactions
Medical Emergencies in the Dental Surgery
Status epilepticus and prolonged fits
Febrile convulsions
Hypersensitivity to midazolam
Pregnancy (only use if no alternative available)
Acute narrow angle glaucoma
Buccal Midazolam brand name EPISTATUS
Midazolam 10mg in 1ml sugar free liquid in a 5ml bottle
(4 x 1ml doses) with 4 x 1ml syringes.
Store between 150C and 250C NOT in a refrigerator as
crystallisation may occur.
Half of the prescribed dose is administered in to each side
of the buccal cavity using the oral syringe provided.
Replace cap immediately.
Dose is 300microgram / kg to a maximum of 10mg
Age Dose
6-12 months 2.5mg (0.25ml)
1 – 4 years 5mg (0.5ml)
5 – 10 years 7.5 mg (0.75ml)
10 years and over 10mg (1ml)
A second dose may be given 10 minutes later if needed
and the patient is breathing normally. If response is not
seen after a further 5 minutes call for assistance. Do not
give any further EPISTATUS doses within the next 6
hours for children (40kg or less) or 12 hours for adults.
Unlicensed Prescription Only Medicine (POM)
Onset of effect is usually within 5 minutes. Patient may be
drowsy for several hours after administration and may be
protected from recurring seizures for up to four hours
Commonly drowsiness lasting for several hours
Somnolence
Rare: paradoxical reactions e.g. agitation, restlessness,
and disorientation.
Rare: respiratory depression
Monitor for side effects allowing for the need to rest and
sleep off effects of medication. If breathing becomes
compromised call for emergency assistance/ apply
resuscitative measures.
Excess effects/overdose may be reversed by use of
flumazenil 200micrograms IV bolus over 15 seconds:
repeated at one minute intervals to resolution or a
maximum of 1mg is reached.
Page 18 of 21
Key individuals involved in developing the document Buccal Midazolam (Epistatus)
Alan Pollard Chief Pharmacist, Mental Health Partnership Trust
Sue Lunec Senior Pharmaceutical Adviser WPCT
Tony Kinsey Senior Resuscitation Officer WPCT
Circulated to the following for comment
Drug & Therapeutics Committee, The Mental Health Partnership Trust
Child Health Services , Worcestershire PCT
References
1 Epilepsy in Children and Young Adults. NICE 2004
2 BNF and BNF for children 2007 BMA/Royal Pharmaceutical Society of Great Britain
3 Midazolam (Epistatus) data sheet. Special Products Ltd, Orion House, 49 High Street,
Addlestone, Surrey, KT15 1TU, Tel 01932 820 666

References for document ‘The Management of Emergencies within the Dental

Surgery’
• BDF Number 55 March 2008 ,Medical Emergencies in Dental Practice
• Worcestershire Area Prescribing Committee Guidance on the use of Buccal
Midazolam

Medical Emergencies in the Dental Surgery Page 19 of 21

 EQUALITY IMPACT ASSESSMENT

Title of the GUIDELINE FOR THE MANAGEMENT OF MEDICAL

policy/guidelines: EMERGENCIES WITHIN THE DENTAL SURGERY
WITHIN THE WORCESTERSHIRE PRIMARY CARE
TRUST SALARIED DENTAL SERVICES. August 2008

Yes/No Comments
1 Does the policy/guidance affect one group
less or more favourably than another on
the basis of:
• Race no
• Ethnic origins (including gypsies and no
travellers)
• Nationality no
• Gender no
• Culture no
• Religion or belief no
• Sexual orientation including lesbian, no
gay and bisexual people
• Age no
• Disability – learning disabilities, no
physical disability, sensory
impairment and mental health
problems
2 Is there any evidence that some groups no
are affected differently?
3 If you have identified potential N/A
discrimination, are any exceptions valid,
legal and/or justifiable?
4 Is the impact of the policy/guidance likely no
to be negative? (If no, please go to
question 5.)
• If so can the impact be avoided?
• What alternatives are there to
achieving the policy/guidance without
the impact?
• Can we reduce the impact by taking
different action?
5 Health inequalities no
6 Please consider the following questions
relating to Human Rights Act:
• Will it affect a person’s right to life? no
• Will someone be deprived of their no
liberty or have their security
threatened?

Medical Emergencies in the Dental Surgery Page 20 of 21

 • Could this result in a person being no
treated in a degrading or inhuman
manner?
• Will anyone’s private and family life no
be interfered with?
If you have identified a potential discriminatory impact of this procedural
document, please complete Impact Assessment Action Plan identifying the action
required to avoid/reduce this impact.

For advice in respect of answering the above questions, please contact the PCT
Equality and Diversity Manager.

Is further detailed impact assessment required? Yes/No

no

Details (names and roles) of staff involved in this impact assessment

Name Role Date completed Outcome
Lorna Assistant Clinical 30 July 2008 No further action
Hollingsworth Director Salaried
Dental Services
Della Lewis Clinical Governance August 2008 No further action
Co-ordinator required.
Vicky Preece Associate Director of September 2008 No further action
Nursing
Lisa Levy Associate Director September 2008 No further action
Sue Lunec Pharmaceutical Lead September 2008 No further action

Medical Emergencies in the Dental Surgery Page 21 of 21