By Duane Tinker – The Toothcop
Dental Compliance Consultant | Former Investigator | NREMT
The Emergency That Exposed Everything
I walked into the office four days after the patient coded.
The patient died.
Group practice. Busy schedule. Great online reviews. Beautiful operatories.
And now a patient was dead.
The regional leader met me with that look I’ve seen too many times.
Part of it said, We have good people.
The other part said, How bad is this going to be?
I’ve been involved in other cases where the outcome was different.
In one, the patient went unresponsive in the dental chair. The team activated its emergency response. EMS arrived.
That patient survived.
Barely.
And when we started reconstructing what happened, the records told a very different story from the one the team believed about itself.
Vital signs were missing.
Nobody could clearly establish when 911 had actually been called.
Notes conflicted about who started CPR and when.
The AED had been “checked,” but the documentation didn’t show consistent checks.
And three different people gave me three different versions of who had been in charge.
These were not uncaring people.
They had equipment.
They had CE.
They had policies.
They believed they were prepared.
But when the pressure hit, they didn’t perform like a coordinated emergency team.
They performed like a collection of well-meaning people trying to figure things out on the fly.
That’s an important distinction.
Because when a patient is deteriorating in your chair, good intentions are not an emergency response system.
And that’s what this article is really about.
Not drug dosages.
Not algorithms.
Not another checklist for your compliance binder.
It’s about the assumptions that quietly weaken a dental emergency response long before the patient ever crashes.
Assumptions Worry Me More Than Ignorance
Ignorance at least has a chance of announcing itself:
“I don’t know.”
An assumption sounds much safer:
“We’re good.”
Maybe you’re not.
The American Dental Association says dentists should provide appropriate training so staff know what to do and can act promptly during a medical emergency. Because emergency skills are not used every day, the ADA recommends regular review—at least annually and preferably more often—and specifically notes that mock emergencies can help office staff become more confident in their roles.
For practices providing sedation or anesthesia, the expectations can be even more specific. The ADA’s 2025 Guidelines for the Use of Sedation and General Anesthesia by Dentists call for written emergency protocols and documented training sessions, including rehearsed emergency drills at least every six months. State laws and dental-board rules may impose additional or different requirements.
There is a reason for all this preparation.
Healthcare safety science has taught us that catastrophes often aren’t caused by one giant mistake.
James Reason’s Swiss Cheese Model is one way of looking at it. Systems have multiple layers of defense, but each layer can have weaknesses. When enough of those weaknesses line up, the defenses can fail. AHRQ uses the model to explain why serious errors can occur even when the people involved are competent and well intentioned.
In a dental office, the holes can look ridiculously ordinary.
Nobody specifically owns the oxygen check.
The new assistant doesn’t know where the AED is.
Everybody assumes somebody else called 911.
The emergency kit got moved.
Nobody practiced what happens when the normal lead assistant is out.
The dentist assumes somebody is documenting.
Everybody assumes somebody is in charge.
Most days, nothing happens.
Until something happens.
Here are seven assumptions I would challenge in just about every dental practice.
Assumption #1: “Someone Else Will Call 911”
I’ve heard versions of this conversation more times than I care to remember.
“Who called 911?”
“I thought she did.”
“I assumed the front desk called.”
“I think somebody called.”
Think about that for a minute.
A patient is unresponsive.
People are moving.
Someone is trying to assess the patient.
Someone is bringing oxygen.
Someone is looking for the AED.
People are talking over one another.
And everybody assumes somebody else made the single phone call that brings more help through the door.
This is exactly why emergency roles should not depend on telepathy.
Someone needs to know:
My job is to call 911.
Not “somebody.”
Not “the front desk usually does it.”
A person.
A role.
A responsibility that has actually been practiced.
Try this at your next staff meeting.
Don’t warn anyone.
Just ask:
“A patient just went into cardiac arrest in Op 3. Who calls 911?”
Then stop talking.
If you get four different answers, don’t be embarrassed.
Be grateful.
You just found a weakness during a staff meeting instead of during a cardiac arrest.
That’s a win.
Assumption #2: “Everybody Knows Where the AED Is”
Try another one.
Don’t ask:
“Do we have an AED?”
Ask:
“Point to it.”
Watch what happens.
If people start looking at one another, you’ve learned something important.
Having an AED and being able to immediately retrieve and use the AED are not the same thing.
The ADA includes emergency drugs and equipment as a component of a sound medical emergency plan and emphasizes that the dental team should be prepared to recognize, respond to and manage medical emergencies. (Ada Association)
That means the equipment can’t simply exist somewhere in the building.
People have to know where it is.
They have to be able to get to it.
It has to be maintained.
And the people expected to use it should have seen it before the day somebody is lying on the floor.
The middle of an emergency is a terrible time to hear:
“I think it’s in the closet.”
Your AED needs a home.
Same place.
Every time.
And everyone who may need it should know exactly where that is.
Assumption #3: “Somebody Checked the Oxygen”
This one drives me nuts.
I’ve walked into practices and found emergency oxygen setups that were not ready for immediate use.
Then I’ll ask:
“Who checks the emergency oxygen?”
“The assistants.”
Which assistant?
“Well…the assistants.”
That’s not ownership.
That’s hope wearing a name badge.
The same thing happens with AED checks, emergency drugs, suction, airway equipment and emergency kits.
Who owns it?
What exactly gets checked?
How often?
Where is the check documented?
What happens when something is missing, expired, discharged, empty or not working?
Emergency readiness needs an actual system.
A named person.
A backup.
A schedule.
Documentation.
And somebody in leadership who notices when the checks don’t happen.
If the answer to:
“Who owns oxygen readiness?”
is:
“The team.”
there’s a pretty good chance nobody owns it.
Assumption #4: “We’ve Never Had a Problem Before”
This one is seductive.
Especially in a busy, successful dental practice.
“We’ve been here 15 years.”
“We see thousands of patients.”
“We’ve never had a serious emergency.”
Good.
I hope you go another 15 years.
But please don’t confuse a quiet history with evidence of readiness.
High-reliability organizations deliberately resist that kind of complacency.
AHRQ identifies preoccupation with failure as one of the central characteristics of high reliability. The idea is that an organization doesn’t interpret the absence of catastrophe as proof that everything is fine. It pays attention to near misses, small problems and weak signals before they become something bigger. (PSNet)
That principle fits dentistry beautifully.
The oxygen check that got missed.
The assistant who didn’t know where the emergency kit was.
The drill where everybody forgot to call 911.
The dead battery.
The expired medication.
The new employee who has no idea what her emergency role is.
Those aren’t little annoyances.
They’re information.
The question is whether leadership listens while the information is still cheap.
Your past luck is not proof of your future readiness.
Assumption #5: “Everyone Will Just Jump In and Help”
I hear this one from leaders all the time.
“We have a great team. Everybody would jump in.”
I believe you.
But jump in and do what?
Who’s leading?
Who’s doing compressions?
Who’s managing the airway?
Who’s retrieving the AED?
Who’s getting the emergency kit?
Who’s calling 911?
Who’s meeting EMS at the door?
Who’s documenting?
Who’s keeping unnecessary people out of the operatory?
Who’s looking at the whole situation instead of performing one task?
That’s where a room full of motivated people can still become a mess.
Two people do the same job.
Nobody does another.
Three people start giving directions.
Nobody knows which direction to follow.
Somebody assumes a task was completed because somebody yelled about it.
That’s not a motivation problem.
That’s a coordination problem.
AHRQ’s high-reliability work emphasizes sensitivity to operations, resilience and deference to expertise—recognizing what’s happening in the real operating environment and allowing the people with relevant expertise to respond effectively.
So yes.
I want everybody willing to help.
But I want something more important:
I want everybody to know how to help.
That’s why roles matter.
That’s why leadership matters.
And that’s why practice matters.
Assumption #6: “Everybody Knows What to Do. We Took CE.”
My years as a dental board investigator changed the way I look at certificates.
A certificate tells me somebody completed something.
That’s useful.
What it doesn’t necessarily tell me is what that person will do when a real patient is deteriorating three feet away.
There’s a huge difference between:
“What is the correct answer?”
and:
“Show me what you do.”
You can know CPR and still have a team that has never worked a code together.
You can know where the emergency drugs are supposed to be and still discover during a drill that they’re not there.
You can know that EMS needs to be activated and still have a front desk employee who has never practiced making that call.
You can complete an online course while sitting alone at your kitchen table.
None of that tells me how six people will communicate when the room suddenly gets very loud.
That’s why the ADA encourages mock emergencies for dental teams, and why the 2025 ADA sedation guidelines require documented rehearsed emergency drills at least every six months for offices and providers subject to those guidelines.
CE matters.
Of course it matters.
But CE and team readiness are not the same thing.
Education teaches people what to know.
Drills show you what your system can actually do.
You need both.
Assumption #7: “Our Policies and Manuals Will Guide Us”
Now we’re getting personal.
I write compliance manuals for a living.
I believe in policies.
You need them.
You need written emergency protocols.
In fact, the ADA’s current sedation guidelines expressly call for written emergency protocols for providers and offices covered by those guidelines.
But I’ve never seen a three-ring binder perform CPR.
A policy is a layer of protection.
It establishes expectations.
It gives people a framework.
It helps create consistency.
But a policy sitting in a binder is not the same thing as a team capable of executing that policy.
So when I’m reviewing emergency preparedness, I don’t stop with:
“Show me your policy.”
I want to know:
Does anybody understand it?
Have they practiced it?
Does the equipment support it?
Does the physical layout support it?
Can the team execute it with the people who are actually working today?
What happens when the normal lead assistant is out sick?
What happens when somebody new is working the front desk?
What happens when a drill reveals that the policy doesn’t work the way somebody in corporate thought it worked?
That’s the point of testing.
If your emergency plan lives only in a handbook, an onboarding slideshow or a folder on the shared drive nobody opens, you may have a documentation strategy.
You don’t necessarily have an emergency response system.
What Separates Better-Prepared Teams From Everyone Else?
It’s not necessarily intelligence.
It’s not compassion.
It’s not the size of the emergency kit.
It’s not how many CE certificates are hanging on the wall.
It’s how seriously the organization takes human performance and systems under stress.
AHRQ describes five characteristics associated with high-reliability organizations:
- Preoccupation with failure
- Reluctance to simplify
- Sensitivity to operations
- Deference to expertise
- Commitment to resilience
I like those principles for dentistry.
A lot.
Because they force us to stop asking:
“Do we have everything?”
and start asking:
“Does everything actually work together?”
Better-prepared teams pay attention to the little failures.
They learn from near misses.
They know who owns critical responsibilities.
They make it safe for an assistant to say:
“Hey, this isn’t working.”
They practice.
They debrief.
They make changes.
Then they practice again.
They don’t wait for a patient to expose the holes in the system.
They go looking for the holes themselves.
Every Dental Team Thinks They’re Ready
Few have actually tested that belief.
So here’s what I want you to do.
Stop asking:
“Do we have an emergency plan?”
Ask:
“What would actually happen if a patient crashed in our office tomorrow at 10:17 in the morning?”
Who leads?
Who calls 911?
Where is the AED?
Where is the oxygen?
Who starts compressions?
Who manages the airway?
Who meets EMS?
Who documents?
What does the front desk do?
What happens to the patients in the reception room?
What if your normal lead assistant is at lunch?
What if the dentist is the one who becomes incapacitated?
What if your newest employee has been there three days?
What if the emergency happens at your location that almost never does drills?
Those questions cost almost nothing to ask.
Finding out the answers during a real emergency can cost considerably more.
Where CodeReady™ Fits
This is exactly why we built CodeReady™.
Not because dental practices need another certificate.
They need a way to turn emergency preparedness into something the team actually does.
CodeReady combines recurring education with realistic emergency drills, team discussion and documentation designed to keep emergency readiness from becoming another once-a-year checkbox.
The principle behind it is simple:
Preparation Beats Panic™
We want teams discovering the problems during a drill.
Not while somebody’s patient is turning blue.
For group practices and DSOs, this gets even more important.
You can write one corporate policy.
You can standardize an emergency kit.
You can assign one LMS course across 40 locations.
But that doesn’t mean Location 17 responds the same way as Location 3.
People change.
Managers change.
Equipment moves.
New employees arrive.
Responsibilities drift.
Local habits develop.
That’s why I’ve come to believe this:
A policy can be standardized centrally.
Readiness has to exist locally.
That’s where CodeReady fits.
We help practices challenge the assumptions.
Clarify the roles.
Practice the response.
Find what doesn’t work.
Talk about it.
Fix it.
Document it.
And do it again.
Because the question isn’t whether your emergency plan looks good on paper.
The question is:
What will your people actually do when it counts?
Don’t wait for a patient to test your assumptions.
Test them yourself.
Before the patient does.
Need a written emergency plan, policies/procedures and protocols? Check out our Medical Emergency and Sedation Safety manual.
Duane Tinker – The Toothcop
Clinical & Legal Disclaimer
This content is provided for general educational and informational purposes only and does not constitute legal, medical, or clinical advice or establish a standard of care. Laws, regulations, professional standards, and clinical guidance vary by jurisdiction and change over time. Readers should verify current requirements and exercise independent professional judgment based on their specific circumstances.
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.
Dental Compliance Specialists, LLC and The Toothcop provide compliance education and consulting services, not legal or medical advice. Consult qualified legal counsel or an appropriate healthcare professional regarding specific circumstances.