UM, Shock Trauma partner to train dental students, residents

The University of Maryland's (UM) School of Dentistry has teamed up with the UM School of Medicine's R Adams Cowley Shock Trauma Center for training future dentists to respond efficiently and effectively to life threatening medical emergencies in a dental setting.

Medical training is a growing trend in dental education in the United States since the early 1990's.

To enhance the UM School of Dentistry's current course work in prevention and management of medical emergencies, the School has added a partnership with the center known worldwide as simply 'Shock Trauma.' "It is a pioneer of trauma care and is dedicated to treating the critically sick and severely injured with "groundbreaking research and innovative medical procedures with one goal in mind, to save lives," says Thomas Grissom, MD, FCCM, associate professor of anesthesiology, UM School of Medicine.

'Sim Man,' a computerized, life-size human simulation mannequin utilized by Shock Trauma will be part of the dental training, according to Gary Hack, DDS, director of clinical simulation at the School of Dentistry.

Sim Man, made by the Laerdal Medical Corporation electronically responds to treatments. The mannequin actually talks back to attending health care professionals, offers pulse and blood pressure rates, responds to cardiopulmonary resuscitation (CPR), simulates lung function, and has other features like those of a live patient in a dental chair, including becoming cyanotic, wheezing, or exhibiting pupillary responses.

"This new program will dramatically improve our students' ability to respond to medical emergencies, and my hope is that we will be able to expand this program to include training on how to screen for diabetes," said Hack.

While a student or resident attends to a simulated emergency such as a heart attack on Sim Man, faculty instructors can monitor and change the mannequin's vital signs, which are displayed on standard monitors that are found in dental offices, via the computer. This control unit can access the depth and effectiveness of chest compressions being applied during CPR to the mannequin by the student, as well as pulse rate, blood pressure levels, and more.

Recently Grissom and colleague John Blenko, MD, associate professor, department of anesthesiology, UM School of Medicine, ran a pilot demonstration of Sim Man at the School of Dentistry just across Lombard St. Faculty, of the Advanced Education in General Dentistry Program (AEGD), chose two dental residents, with no advance notice, to attend to Sim Man in a simulated medical emergency that occurred during a routine dental exam.

When Sim Man suddenly went into cardiac arrest, AEGD resident Sara Franz, DDS determined that he had no pulse and was not breathing. She started CPR. As Franz called for help, she attached an automated external defibrillator (AED) to Sim Man's chest.

"The exercise teaches residents to stay calm and act decisively during an emergency," says Gary Kaplowitz, DDS, who is the AEGD, associate director. Shock Trauma's Sim Man is much more than a plastic manikin. He weighs 160 pounds and simulates realistic and dynamic patient conditions.

Detailed computer data allows real time evaluation of many elements of resuscitation, for example. "This simulator is so high-tech it can tell us if the CPR compressions are deep enough," remarks Kaplowitz.

Hack added that it was good to scientifically determine that effective chest compressions can be achieved with the patient remaining in the dental chair. Attempting to move the patient to the floor to perform CPR is no longer necessary as it wastes time and can result in trauma to the patient.

The Sim Man exercise includes an immediate debriefing. Franz said she was surprised by how much effort she had to put into the CPR compressions. During the frantic rescue, Franz used an AED for the first time and learned how to break open the doors of a crash cart. "The simulator is a good learning tool. It felt more real than a classroom lesson. It definitely got my blood pumping," said Franz.

Blenko told Franz, "What I really saw was someone who jumped in, who picked up and saw that this is the real thing and at the same time, it is very hard to suspend your disbelief, but you got into it starting compressions, ventilations.

Kaplowitz, says, "I think many dentists are not fully prepared for medical emergencies, though they are aware of the possibilities. These things do happen and you never know when. If a dental patient goes unconscious in the chair, you are it," he told dental students, residents and faculty at the debriefing. Blenko said, "The take away from this is that there should be no panic and to assess the patient quickly. And the student will not know what do unless he or she practices." Ira Bloom, DDS, the AEGD assistant director, added, "The whole idea (of the training) is that you don't have to think about what to do. You just do it."

Grissom offered, "It is like muscle memory. Once you have it set, it is instinctive. When you find yourself in private practice, who are you going to turn to? You are the one who will be in charge. This is not about testing and scoring grades. It's about learning to do it right and save lives," said Grissom.

The training includes a team effort consisting of the dentist, an assistant, and additional medical help, which arrives after the dental resident has initiated emergency treatment themselves. The hand off of the patient from one team member, such as the dentist to an arriving medic, is vitally important, Grissom says. The dentist must "hand over" the patient by relaying his situation, what has been performed so far, and some history of the patient's state of health. "Is he or she a diabetic? Has she taken her medications today? What other medications is he on?, etc.," he said.

"I want to sincerely thank Drs. Grissom and Blenko for their true spirit of collaboration. This is a great example of promoting inter-professional initiatives. It is the tremendous synergy at Maryland that makes this type of activity possible", said Hack.