The dental emergency responder - Emergency Dentistry Articles

The dental emergency responder

Expanding the scope of dental practice
By:Michael D. Colvard, DDS, MTS, MS, Lewis N. Lampiris, DDS, MPH, Geoffrey A. Cordell, PhD, James James, MD, DrPH, MHS, Albert Guay, DMD, Moses Lee, MD, Catherine M. Stokes, RN and Gregory Scott, RN, BS, EMT-P
J Am Dent Assoc, Vol 137, No 4, 468-473

ABSTRACT

Background. Natural disasters, the potential for terrorism and weapons-of-mass-destruction events occurring within the continental United States necessitate that all licensed health care providers understand the National Incident Management System and be able to contribute to inoculation, mass casualty assistance and triage care of the populace.

Conclusions. Health care and political leaders constantly revise "all hazard" response plans, using the available health care assets that local, state and federal agencies bring to emergency events. Illinois Public Act 49-409 modifies the scope of dental practice within Illinois to allow for a dental emergency responder (DER).

Practice Implications. The DER is a dentist or dental hygienist "acting within the bounds of his or her license when providing care during a declared local, state or national emergency."

Key Words: Disaster medicine; National Incidence Management System; inoculation; drug dispensing; triage

Natural disasters such as hurricanes, tornadoes, earthquakes and floods, along with ongoing domestic and global terrorism and the potential for pandemic flu epidemics, demonstrate that complex disasters will require an increase in the numbers of available health care providers trained in emergency response. Recent disasters such as the ones experienced in the United States,1Ò5 Indonesia6 and Turkey7 demonstrate that regardless of the advancement of science and technology, large-scale natural and manmade disasters continue to overwhelm local health services and emergency medical services (EMS) personnel and infrastructure. Damage and destruction to local infrastructure, clinics and hospitals can render these systems and the response personnel severely compromised for postevent triage and medical management.

Natural disasters are part of the fabric of life. The frequency, scope and magnitude of future disasters and mass-casualty events will increase as the global population continues to grow. Many countries strive to maintain emergency services6,7 and mobile field hospitals that can be used for both defense and humanitarian purposes.8 In 2003, the World Health Organization and the Pan American Health Organization sponsored a workshop in El Salvador to discuss the pros and cons of using foreign field hospitals in the aftermath of natural disasters.8 One of the key recommendations to emerge from the workshop was to have friendly nations provide advanced trauma care and life support to a disaster site within 48 hours of the impact of an event. Urban areas face the most pressure to plan for and respond to large numbers of casualties and fatalities, whether driven by the "inevitable influenza pandemic" as described by Cinti,9 by failed human design, by terrorism, by earthquake or by hurricane.

In the United States, the 1993 and 2001 terrorist attacks on the World Trade Center and the 2001 attack on the Pentagon stimulated the federal and legislative branches of government to approve the largest U.S. government transformation since the formation of the Department of Defense. More than 22 different agencies, in whole or in part, underwent reorganization, in the establishment of the cabinet-level Department of Homeland Security.10 The mission of that agency is to protect the American homeland.10 The Federal Emergency Management Agency (FEMA) and several Department of Health and Human Services assets moved to the Department of Homeland Security, including the Office of Emergency Management, the National Disaster Medical System, the Strategic National Stockpile and the Metropolitan Medical Response System.

With the formation of the Department of Homeland Security, policy leaders recognized that an integrated, coordinated and comprehensive health care preparedness and response system was needed. Policy leaders recognized a lack of a consistent intrastate/interstate plan for coordination, communication and cooperation and a response structure that would work synergistically to bridge numerous public health and health care jurisdictions, civilian communities, response disciplines and first responders.

In an effort to address this issue, the Department of Homeland Security developed the National Incident Management System (NIMS). The president signed a directive requiring the establishment of a process that would lead to a unified and coordinated approach to health care preparedness and response during a disaster. The NIMS provides the policy directives for a national response plan10 and the framework for a national and statewide coordinated and hierarchical response structure within the United States.

The complete article is available online.