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First aid/disaster management & dentistry

The document discusses the significance of first aid in dentistry, highlighting its role during medical emergencies and in disaster management. It elaborates on the ethical and legal responsibilities of dental practitioners in responding to emergencies, as well as the various first aid protocols and triage procedures. Additionally, it emphasizes the critical role dentists can play in public health emergencies, including their involvement in forensic assistance and bioterrorism surveillance.

Health & Medicine◦
Related topics:
Emergency First Aid•Disaster Management•
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GOOD MORNING
FIRSTAID IN DENTISTRY Dr.AASHNA DHINGRA Postgraduate Student Department of Public Health Dentistry DISASTER MANAGEMENT
Theme… World FirstAid Day is a global observance held on the second Saturday in September. It was instituted by the International Federation of Red Cross and Red Crescent Societies (IFRC) in 2000 and has been celebrated each year ever since.
Incidence : 67% medical emergencies - routine dental practice around 7.5 - 8% emergencies occur in a dentist’s life in a decade. 
 (Morrison AD, Goodday RH. Preparing for medical emergencies in dental office. J Can Dent Assoc 1999;65:284-6.)
Marks, Luc & Van Parys, Celine & Coppens, Marc & Herregods, Luc. (2013). Awareness of dental practitioners to cope with a medical emergency: A survey in Belgium. International Dental Journal. 63. 10.1111/idj.12046.
Definitions …. First aid is defined as the initial assistance or treatment provided to someone who is injured or suddenly taken ill, covers a wide range of scenarios from simple reassurance following a minor mishap to dealing with life-threatening situations.
Responsibilities . . . golden rule: “first - do no harm” Purpose of First aid is 
 - To Save Life
 - To prevent further injury
 - To preserve vitality and resistance to infection
Practitioner’s Legal and Ethical Responsibilities . . . 1. It is an oral health practitioner’s ethical and legal obligation to attend to a medical emergency. 2. They are expected to attend to a medical emergency within their competence and skill levels 3. Failure to respond to a medical emergency is a significant departure from the standard of care expected of oral health practitioners.
First Aid Rules: 1. Do not get excited. First, check for danger and then check for responsiveness. 2. Do not move injured victim unless it is necessary. 3. Keep the victim lying down with his head level with his feet while being examined. 4. Keep the victim warm and comfortable. Remove enough clothing to get a clear idea to the extent of the injury. 5. Examine the victim gently. Treat the most urgent injuries first and then treat the other injuries to the best of your ability.
6. Avoid allowing the victim to see his own injury. 7. Do not try to give any solid or liquid substance by mouth to an unconscious victim. 8. Do not touch open wounds or burns with fingers or other objects except when sterile. 9. Do not try to arouse an unconscious person. 10. Seek medical attention immediately. First Aid Rules:
Assessment of the Casuality Safe approach Primary Survey Secondary Survey Definitive Care
Safe approach… Assessment of the Casuality : Initial priority - check for any dangers. Approach the casualty carefully, ensuring no harm to either the rescuer or to patient. Measures to minimize the risk of cross infection.
Primary Survey . . . Assessment of the Casuality : Providing life saving treatment.
Secondary Survey . . . Assessment of the Casuality : Once the casualty is out of danger… Taking history Looking for external clues Assessing signs and symptoms Head to toe survey
Definitive care . . . Assessment of the Casuality : Providing advice only Advising to visit a GP Arranging transport to take the casualty to hospital Calling for ambulance 108/102/1298
 - To alert emergency services
 - Name, Tel no., Exact location of dental practice, time of incident, and exact details of the incident.
DISASTER MANAGEMENT AND DENTISTRY
Disasters … India : highly vulnerable and susceptible and has seen and continues to face considerable loss of lives.
WHAT is YOUR ROLE? Response of Dental Professionals
Response of Dental Professionals 1. Supporting other Health Professionals Dentists and other dental auxiliaries can augment the existing medical professionals in responding to a declared medical emergency. Dentists can enhance the surge capacity until additional physicians arrive.
Response of Dental Professionals 2. Dental Offices acting as Medical Sites Dental offices are equipped with potentially useful supplies and should be prepared to serve as decentralized auxiliary hospitals if need arises. Air and suction lines, x-ray equipment, and sterilizing capability can be used.
Response of Dental Professionals 3. Forensic Assistance Forensic odontology - crucial element in all mass disasters (natural, accidental or intentional). At the onset of disaster, teams of dentists can be established to start collecting ante mortem data based on the list of missing persons.
Why teeth?? 
 Teeth are a source of DNA : dental pulp. 
 DNA profiling is the gold standard for identification of unknown remains • Dental records • Rugaescopy • Chieloscopy • Dental treatment and restoration • Radiology • DNA • Carbon dating • Microchip • Denture labeling • Dental cast • Saliva Sampling • Skyce Methods
1. Visually Identifiable Body • Photographs • Radiographs • Dental Charting • Dental Impressions, as applicable • Resection by Infra-mandibular Dissection 2. Decomposed/Incinerated Body • Photographs • Radiographs • Dental Charting • Resection and Preservation of Jaw Specimens 3. Skeletonized Remains • Photographs • Radiographs • Dental Charting • Preservation of Jaw Specimens, if indicated
Rugaescopy ChieloscopyLip patterns - as unique as fingerprints.
Dental Restorations Outlines, slopes, presence of corrosion or wear of restoration helps in identification. IntraOral Radiographs Comparison between ante mortem and postmortem radiograph. To reveal hidden details.
DNA analysis 1) Restrictionfragment length polymorphisms(RFLPs). 2) Amplified fragment length polymorphisms(Amp-RFLPs). 3) Short tandem repeats(STRs). 4) Polymerase chain reaction(PCR). Carbon Dating Determines individuals age by estimating radio carbon 14 contents of enamel
Response of Dental Professionals 4. TRIAGE In mass casualty cases - triage is done to prioritize treatment, as immediate care is not possible with the limited facilities and medical supplies. This allows physicians to provide definitive care for patients most urgently in need. Dental offices can be served as triage centers.
Triage.. French word ‘tier’
 high priority t/t or transfer medium priority ambulatory patients dead or moribund
Response of Dental Professionals 5. Definitve Treatment OMFS practitioners - can provide first aid in endotracheal intubation, cardiopulmonary resuscitation, treating dentoalveolar injuries and facial fractures, administering anesthetic and surgical services.
Response of Dental Professionals 6. Distribution of Medication Dentists can be called on to prescribe and dispense medications required for managing a disease outbreak. Can also monitor patients for adverse reactions and side effects.
Response of Dental Professionals 7. Immunization To limit the spread of infectious agents - natural pandemic, bioterrorism attack etc. Rapid immunization may be required in short period of time. Dentists can participate in mass immunization Dental offices - can be immunization sites.
Bioterrorism Surveillance Dentists can contribute by being alert to clues that might indicate a bioterrorist attack. (intentional release of biologic agents or toxins, like Anthrax, Ebola virus, etc.) Note if there is an influx of flu-like or possibly neurological or paralytic symptoms. Since dentists are scattered throughout a community, they can be a part of effective surveillance network with their eyes and ears open to information on unusual syndromes. Bethesda MD. National Institute of Dental and Craniofacial Research. Dentistry’s Role in Responding to Bioterrorism and Other Catastrophic Events. 2011.
DENTAL TEAM SET-UP As of January 1, 2009, the Dentist Practice Act was modified. In case of emergency, the dentists who were a part of the local emergency response team or Dental Emergency Responder (DER) - provide services for which they had been trained. Dental Identification (ID) team consists of: ‘GO TEAM’ ‘SUPPORT TEAM’ ‘COMPARISON UNIT’ A. Providing Cardiopulmonary Resuscitation(CPR) B. Obtaining medical histories C. Providing or administering anesthesia D. Starting IV lines E. Suturing and doing appropriate surgeries F. Assisting patient stabilization G. Assisting shock management
Essential Crisis Preparedness Action Steps: Association of State andTerritorial Dental Directors (ASTDD) 2010
Why dentists ?? Dentists are well versed in the daily practice of infection control, taking and using information from medical histories to guide their actions, taking and interpreting radiographs, administering injections, suturing wounds, managing infections, prescribing medications, making diagnosis. All these skills apply directly to catastrophe response. To SUMMARIZE…
CONCLUSION In the future years, mankind will face challenges that can be unparalleled Dentists, forming an important part of the health care community, will be looked upon to perform potential service to the society in event of any mishap. 
 Introduction to disaster training in undergraduate and postgraduate curriculum will better prepare the dentist for any torrent event.
REFERENCES: • Gambhir RS, Kapoor D, Singh G, Sawhney G, Setia S. Disaster management: Role of dental professionals. Int J Med Sci Public Health. 2013 Apr 1;2(2):169-73. • Loomis PW. DisasterVictim Identification. InForensic Odontology 2018 (pp. 81-102) • Sharma M, Brandler ES. Emergency medical services in India: the present and future. Prehospital and disaster medicine. 2014 Jun;29(3):307-10 • Park K Park'sTextbook of Preventive and Social Medicine. 22nd ed. Banarsidas Bhanot Publisher. p.16. • Guay AH. Dentistry’s response to bioterrorism: a report of a consensus workshop. J Am Dent Assoc 2002;133(9):1181-7. 1. • Nuzzolese E,Vella GD. Future project concerning Mass Disaster Management: a forensic odontology prospectus. Int Dent J 2007;57:26, 1-6. 1. • Guay AH. Role of dentists can play in mass casualty and disaster events. Dent Clin N Am 2007;51(4):767-8. • Community based education of health personnel. Report ofWHO study group. (WHO 1987).Tech. Rep. ser., No. 74.
First aid/disaster management & dentistry