Emergency cardiac care. Moral, legal, and ethical considerations.

According to the American Heart Association, "Successful completion of an ACLS course means in accordance with the cognitive and performance standards of the American Heart Association. It does not warrant performance, nor does it, per se, qualify or authorize a person to perform any procedure. It in no way related to licensure, which is a function of the appropriate legislative, health or educational authority." The same can be said for BLS; however, with the recent revisions in ECC programs, even this disclaimer has been eliminated from the most recent textbooks in BLS and ACLS. This is in keeping with "...the American Heart Association's reaffirmation of its role as an educational resource rather than as a certifying agency." Lay public course participants in BLS (which technically includes dentists) will now receive course participation cards. Health care provider course participants will continue to receive "course completion cards" if all criteria have been satisfied by the student. The trend is to categorize what was previously termed testing as evaluation. Certification has become a thing of the past. It is unclear at this time what the impact this policy change will have on agencies who rely upon documentation from the American Heart Association to satisfy requirements that have been imposed upon dentists and other health professionals for initial licensure and relicensure. Semantics aside, one thing that remains clear is the expectation of the dentist with regards to emergency management. Expertise (for lack of a better term) in specific aspects of ECC remains a standard. For all dentists, expertise in BLS is that standard. For dentists administering deep sedation and general anesthesia, expertise in ACLS is the community standard. Although there is some ambiguity for those dentists administering conscious sedation, at the very least, they should have expertise in BLS. In addition, they are strongly encouraged to have expertise in ACLS, particularly because the limited hours of training in conscious sedation provide less medical background than is acquired during training in deep sedation and general anesthesia. In addition, the dentist is ultimately responsible for the demeanor of his or her office and staff. In the prehospital dental office setting, the matter of converting a dental office team geared to efficient delivery of dental procedures, into a team primed to perform emergency cardiac care seems daunting. This is especially so if the dentist has little undergraduate or clinical preparation for managing life-threatening emergencies. Therefore, an emergency management plan (with oversight for its implementation by the dentist) is of paramount importance.