EMS Changed the Way It Thinks About Emergency Care. Maybe Dentistry Should Too.
By Duane Tinker – The Toothcop
Dental Compliance Consultant | Former Investigator | NREMT
I spent more than 30 years around emergency medicine before I started looking at medical emergency preparedness primarily through the eyes of dentistry.
One thing about EMS has always interested me.
There are protocols for practically everything.
Chest pain.
Cardiac arrest.
Anaphylaxis.
Seizures.
Hypoglycemia.
Overdose.
Airway problems.
Trauma.
But over time, EMS started asking a better question than simply:
“What does the protocol say?”
The better question became:
“Why does the protocol say it?”
What does the evidence show?
How good is that evidence?
Does what we’re doing actually improve patient care?
And how do we turn the evidence into something an EMT or paramedic can actually use when a patient is crashing in front of them?
Those questions eventually helped lead to the National Prehospital Evidence-Based Guideline Model Process. The federal EMS system describes evidence-based guidelines as a way to use scientific evidence to guide protocols and clinical decision-making rather than relying primarily on tradition. Developing those guidelines involves research review, expert input, and consensus-building.
That got me thinking about dentistry.
Where is our equivalent?
Dentistry Has Plenty of Emergency Guidance
Before somebody thinks I’m suggesting dentistry has ignored medical emergencies, I’m not.
We have the American Heart Association.
We have BLS, ACLS and PALS.
We have ADA sedation and anesthesia guidelines.
We have state dental board requirements.
We have textbooks.
CE courses.
Emergency drug recommendations.
Dental anesthesia organizations.
And plenty of very smart people teaching dentists how to manage medical emergencies.
The ADA also recently took an important step forward.
Its updated Guidelines for the Use of Sedation and General Anesthesia by Dentists, adopted in October 2025, require written emergency protocols and documented training sessions that include rehearsed emergency drills at least every six months.
I think that’s significant.
But I’m asking a slightly different question.
Do we have a systematic, dentistry-specific process for determining what the best available evidence says a dental team should actually do during a medical emergency?
And then:
How should we train them to do it?
I’m not convinced we’ve fully answered either question.
We Don’t Need “Dental CPR”
Let’s get this out of the way.
I’m not suggesting dentistry create its own version of emergency medicine.
A cardiac arrest doesn’t care whether it happens in a dental office, an ambulance, an airport, or Walmart.
CPR is CPR.
Defibrillation is defibrillation.
Anaphylaxis is anaphylaxis.
Where good evidence and established national guidelines already exist, dentistry should use them.
We don’t need to reinvent medicine simply because our patient happens to be sitting in a dental chair.
But there’s another side to this.
A dental office isn’t an ambulance.
It isn’t an emergency department either.
And that matters.
The Dental Environment Is Different
Think about how a medical emergency might actually begin in your office.
The patient may be reclined.
There may be instruments in the mouth.
Blood.
Water.
Gauze.
A rubber dam.
A prosthetic component.
Maybe the patient received local anesthetic.
Maybe nitrous oxide.
Maybe an oral sedative.
Maybe IV medications.
And the emergency doesn’t necessarily begin with somebody dramatically clutching their chest and falling to the floor.
Maybe the oxygen saturation starts dropping.
Respirations slow.
The patient becomes difficult to arouse.
The airway becomes obstructed.
Suddenly the dental team has to recognize what is happening, stop treatment, clear the mouth, reposition the patient, manage the airway, ventilate if necessary, administer appropriate medications, activate EMS and coordinate the response.
Same medicine.
Different operational environment.
That’s where I think dentistry could learn something from EMS.
Evidence Should Eventually Become Action
One thing I like about the evidence-based EMS model is that the research isn’t supposed to end with a journal article.
Evidence-based guidelines are intended to inform protocols and clinical decision-making. The larger model also includes implementation and evaluation rather than simply publishing recommendations and hoping people read them.
For dentistry, I think the progression might look something like this:
Evidence → Guideline → Dental Protocol → Training → Drill → Measurement → Debrief → Improvement
And that brings us to something I think dentistry needs to talk about more.
Emergency Training and Emergency Drills Are Not the Same Thing
We tend to use these words interchangeably.
I don’t think we should.
Training teaches you what to do.
A training session might teach someone how to recognize anaphylaxis.
Or use an AED.
Or operate a bag-valve-mask.
Or administer an emergency medication.
Or recognize respiratory depression.
That’s important.
But a drill asks a different question:
Can your team actually do it?
Put an unresponsive patient in the dental chair.
Go.
Who recognizes the problem?
Who takes charge?
Who clears the patient’s mouth?
Who gets the oxygen?
Who gets the AED?
Who manages the airway?
Who calls 911?
Who gets the emergency drugs?
Who documents what happened?
Who meets EMS at the door?
And does everybody know what they’re supposed to do, or are six people standing around waiting for the dentist to start handing out assignments?
Training and drilling aren’t the same thing.
One builds knowledge and skills.
The other puts those skills together.
What Should a Good Dental Emergency Drill Look Like?
I don’t think sitting around the breakroom asking, “What would everybody do if somebody had an allergic reaction?” qualifies as much of a drill.
That’s a discussion.
Discussions are useful.
But a meaningful drill should go farther.
It Should Be Scenario-Based
Something should happen.
The patient becomes unresponsive.
The patient develops signs of anaphylaxis.
The sedated patient’s respirations slow.
The patient starts seizing.
The team has to recognize what is happening and respond.
It Should Involve the Team
Medical emergency readiness isn’t just about the dentist.
The assistants, hygienists, front office team, and anyone else who may have a role in the response should know what that role is.
And the plan shouldn’t collapse because the one employee who knows where everything is happens to be on vacation.
It Should Use the Actual Environment
This is important.
Where is your oxygen?
Where is the AED?
Where are the emergency drugs?
Can somebody get to them quickly?
Can you actually position a BVM where you need it?
Does the team know how to get EMS into a locked office?
Those aren’t questions a PowerPoint presentation can answer very well.
Sometimes you need to physically do it.
The AHA’s 2025 resuscitation education guidance recognizes in-situ training—training conducted in the actual clinical environment—as an educational strategy, with studies showing improvements in measures such as team performance and recognition of deteriorating patients, although the evidence does not allow every improvement to be attributed to in-situ training alone.
It Should Test Communication
Emergencies get noisy.
People start talking.
Sometimes everybody starts talking.
Closed-loop communication is different.
“Sarah, call 911.”
“Calling 911.”
“911 has been activated.”
Simple.
Clear.
Confirmed.
It Should Have Objectives
How long did it take to recognize the emergency?
How long before somebody called 911?
How long until oxygen reached the patient?
How long until the AED arrived?
If ventilation was necessary, how long before effective ventilation began?
Now we’re measuring something.
That’s considerably more useful than:
“Everybody think that went pretty well?”
It Should Include a Debrief
This may be one of the most important parts.
What worked?
What didn’t?
What surprised us?
What couldn’t we find?
Where did communication break down?
Did someone have a job they didn’t understand?
What needs to change?
The AHA’s 2025 education guidelines specifically address structured approaches to debriefing and say scripted debriefing may be reasonable during resuscitation education.
Then somebody needs to make sure the problems discovered during the drill actually get fixed.
Otherwise, we’ve just documented the same problem we’re going to discover again next time.
How Often Should Dental Teams Drill?
Now we get to the interesting part.
The ADA says at least every six months for the sedation/general anesthesia emergency-training framework.
That’s progress.
But here’s the question I think we should ask:
Is the minimum frequency necessarily the optimal frequency?
We don’t currently have good dental-specific evidence showing that monthly emergency drills produce better patient outcomes than drills every three months or every six months.
So I’m not going to tell you that science has proven dental teams should drill monthly.
It hasn’t.
But we do have some interesting evidence from resuscitation education.
What the AHA Says About Spaced Learning
Traditional resuscitation education has often looked something like this:
Take a course.
Get your card.
Come back in a year or two.
Repeat.
The AHA’s 2025 resuscitation education guidelines specifically address a different approach: spaced learning and booster training.
Instead of concentrating training into one large event and then waiting a long time to do it again, spaced learning divides education into shorter sessions separated by weeks or months.
Booster training provides brief reinforcement between larger training events.
The AHA recommends booster sessions when a massed-learning approach is used for resuscitation training and says a spaced-learning approach is a reasonable alternative.
And here’s where things get particularly interesting.
The evidence reviewed by the AHA included studies using booster intervals from one to six months. Some studies found improvements in CPR performance, ventilation and compression quality, skill retention, or time to critical interventions. In some research, monthly boosters produced particularly strong CPR performance at 12 months.
That does not prove monthly dental emergency drills are superior.
Different population.
Different environment.
Different question.
But it certainly gives us a reason to ask whether more frequent, shorter reinforcement might make sense in dentistry too.
Should Monthly Emergency Drills Become a Best Practice?
Maybe.
I think there’s a strong argument for it.
But I don’t think we should call monthly drilling the new standard of care.
Not yet.
We don’t have the dental-specific evidence to support that statement.
I would describe monthly emergency readiness training differently:
A proposed best-practice model.
One that deserves to be implemented, measured, studied, challenged, and improved.
That’s a much more interesting proposition.
That’s Where CodeReady Comes Into the Conversation
This article wasn’t intended to be an advertisement for CodeReady.
But I can’t have this discussion without explaining why we built it the way we did.
CodeReady uses a monthly emergency-readiness model.
Rather than waiting six months between rehearsed drills, the team repeatedly returns to emergency preparedness throughout the year.
One month might address airway obstruction.
Another respiratory depression.
Another anaphylaxis.
Another aspiration.
Another local anesthetic systemic toxicity.
Another cardiac arrest.
The point isn’t to turn a dental office into an emergency department.
And we’re certainly not trying to turn dental assistants into paramedics.
The goal is much simpler:
Help the dental team become better at the first few minutes of a medical emergency occurring in their own office.
That’s the period when they’re on their own.
EMS isn’t there yet.
CodeReady Goes Beyond the ADA Minimum. That Doesn’t Automatically Make It Better.
This distinction matters to me.
The ADA says rehearsed emergency drills at least every six months in its updated sedation/general anesthesia guidelines.
CodeReady provides a monthly cycle of education and rehearsal.
So CodeReady clearly exceeds the ADA’s minimum frequency.
But twelve is not automatically better than two simply because twelve is a bigger number.
That’s not how evidence-based practice works.
If we’re going to argue that more frequent training is better, we should be able to explain why.
And eventually, we should be willing to measure whether we’re right.
The AHA’s support for spaced learning and booster training gives the monthly concept a legitimate scientific foundation worth exploring. But even the AHA identifies the optimal training frequency for different healthcare-provider groups as an area requiring further research.
That’s important.
We don’t know the perfect interval yet.
So Let’s Measure It
Instead of asking whether the team “completed” its emergency drill, I’d rather know whether the team is getting better.
How quickly did they recognize the emergency?
How quickly was EMS activated?
How long did it take to retrieve oxygen?
The AED?
The emergency drugs?
Could they correctly identify the medication needed?
Could they establish effective ventilation?
Did everybody understand their role?
Did they communicate effectively?
Did they correct problems discovered during the previous drill?
And six months later:
Did the improvement stick?
Now we’re starting to talk about performance.
Not participation.
Training, Drilling, Measurement and Improvement
Maybe dentistry needs a more deliberate emergency-readiness cycle.
I would frame it this way:
Training asks:
Do you know what to do?
Drilling asks:
Can you actually do it?
Measurement asks:
How well did you do it?
Debriefing asks:
What should we do better?
Repetition asks:
Did the improvement stick?
That’s continuous emergency readiness.
And I think that’s where dentistry should be heading.
Maybe Dentistry Needs Its Own Evidence-Based Emergency Model
Here’s where this gets bigger than CodeReady.
Maybe dentistry needs something analogous to what EMS developed.
Not a replacement for AHA.
Not a replacement for ADA guidelines.
Not a replacement for state dental board requirements.
And certainly not a bunch of dentists sitting around inventing their own version of emergency medicine.
What I’m suggesting is a structured process for taking the best available emergency and resuscitation science and asking:
How should this be applied in the dental environment?
Then we study the things that haven’t been adequately answered.
What’s the optimal frequency for dental emergency drills?
Which scenarios should be practiced most often?
How quickly should a dental team be able to retrieve emergency equipment?
Which airway skills should different dental team members be expected to perform?
What’s the best way to train teams for sedation-related respiratory depression?
Which emergency competencies deteriorate fastest?
Does monthly rehearsal improve retention?
Does in-office simulation improve response time?
Do those improvements ultimately affect real patient outcomes?
Those are research questions.
And they’re worth answering.
The Toothcop’s Take
I think the ADA’s updated sedation guidelines are an important step forward.
The requirement for written emergency protocols and documented, rehearsed drills at least every six months sends a message dentistry needs to hear:
Reading about emergencies isn’t enough.
I’d take that idea farther.
Certification isn’t enough.
Training isn’t enough.
Equipment isn’t enough.
A written emergency plan isn’t enough.
Eventually, the team has to put all of it together.
That’s what drills do.
I believe shorter, more frequent emergency training and rehearsal deserves serious consideration as a best-practice model for dental offices. The current resuscitation education science supporting spaced learning, booster training, simulation, deliberate practice, teamwork, and structured debriefing gives us good reason to explore that model.
That’s why CodeReady uses a monthly approach.
But if we’re going to talk about evidence-based emergency preparedness, then I don’t get to declare monthly drills the new standard just because I believe in them—or because I built a program around them.
We should study it.
Measure it.
Challenge it.
Improve it.
And follow the evidence wherever it takes us.
EMS learned to ask a better question than:
“What does the protocol say?”
Dentistry should ask the same question.
And when it comes to emergency preparedness, I think we should add one more:
Can your team actually do it when it counts?
Duane Tinker – The Toothcop
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Examples and case discussions may be simplified, modified, or de-identified for educational purposes and should not be interpreted as legal conclusions regarding any person or organization.
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