First aid and disaster management

An overview of first aid and disaster management concepts as applied from a dental perspective.

1. GOOD MORNING

2. FIRST AID IN
DENTISTRY
Dr. AASHNA DHINGRA
Postgraduate Student
Department of Public Health Dentistry
DISASTER MANAGEMENT

3. Theme…
World First Aid 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.

4. Incidence :
67% medical emergencies - rou!ne dental prac!ce
around 7.5 - 8% emergencies occur in a den!st’s life
in a decade. 

(Morrison AD, Goodday RH. Preparing for medical emergencies
in dental office. J Can Dent Assoc 1999;65:284-6.)

5. 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.

6. 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.

7. 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

8. 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.

9. 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.

10. 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:

11. Assessment of the Casuality
Safe approach
Primary Survey
Secondary Survey
Definitive Care

12. 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.

13. Primary Survey . . .
Assessment of the Casuality :
Providing life saving treatment.

14. 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

15. 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.

18. DISASTER
MANAGEMENT
AND DENTISTRY

19. Disasters …
India : highly vulnerable and susceptible and has
seen and continues to face considerable loss of lives.

20. WHAT is YOUR ROLE?
Response of Dental Professionals

21. 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.

22. 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.

23. 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.

24. 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
M e t h o d s

25. 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

26. Rugaescopy
ChieloscopyLip patterns - as unique as fingerprints.

27. 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.

28. DNA analysis
1) Restriction fragment 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

29. 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.

30. Triage..
French word ‘tier’

high priority t/t or transfer
medium priority
ambulatory patients
dead or moribund

31. 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.

32. 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.

33. 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.

34. Bioterrorism Surveillance
Dentists can contribute by being alert to clues that might
indicate a bioterrorist attack. (in$n!onal release of biologic
agents or %xins, like An&rax, 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.

35. 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

36. Essential Crisis Preparedness Action Steps:
Association of State and Territorial Dental
Directors (ASTDD) 2010

37. 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…

38. 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.

39. 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. Disaster Victim 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's Textbook of Preventive and Social Medicine. 22
nd
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 of WHO study group. (WHO
1987). Tech. Rep. ser., No. 74.