CAMLS’ Airway Management for Dentists is a simulation-based course that meets the state of Florida’s requirement for dental professionals with sedation permits to complete 4 hours of continuing education in airway management. This course includes 2 hours of didactic instruction and 2 hours of hands-on practice for dental professionals to enhance their skills in preparing for and responding to a difficult airway.

AIRWAY MANAGEMENT FOR DENTISTS

Provided by

September 23, 2016Tampa, Florida

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 2

STATEMENT OF THE PROBLEM

Despite modern advances in dentistry, there are still 10% to 20% of adults in the United States who may not seek dental care because of anxiety or fear of dental procedures.1 The proportion of children who become anxious or uncooperative at the dental office is even higher.2 Anxiety can elicit a delay of treatment and a decline in dental health for both adults and children. A common intervention to minimize patients’ anxiety and discomfort is sedation.3 Sedation can be beneficial to those who need extensive treatment or have special needs, disabilities, or medical conditions. It can also be used to manage the behavior and movement of younger patients to ensure the safety and success of care.4

Pharmacological sedation, although a proven method of relaxing a patient and controlling pain, poses much higher risks than non-pharmacological management techniques.3 One major challenge that may arise with anesthesia use is a difficult airway.5 The difficult airway is defined as a situation in which a practitioner trained in administering anesthesia “experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both.”6 If improperly managed, a difficult airway can result in airway trauma, myocardial injury, brain injury, and death.7

CURRENT PRACTICE

Results of a 2011 survey of 716 dentists revealed that 76% of the dentists used sedation in their outpatient offices.8 Although many dentists have experience in sedation techniques, their knowledge is often founded on the dental program in which they were trained.9 Some may not have the skills to manage patients under higher levels of sedation or handle adverse reactions.9 This is evident in a 2006 study where over half of the 718 dentists surveyed revealed that they had insufficient sedation training and were unprepared, or they didn’t receive opportunities for practice in their pre-doctoral studies.10 Because of inadequate training, varying anesthesia practices, and less availability of resources, problems in the sedation process are more likely to occur in non-hospital settings such as dental offices. If dentists’ only recourse is to initiate emergency medical services, they may experience failure in attempts to resuscitate a patient.4

CLOSING THE GAP Difficult airway is the leading issue in dental patient safety when anesthesia is used; it is a critical part of sedation training.3 In Florida, where there are over 1,150 dentists who hold sedation permits, an increased interest in safety prompted Section 466.0135 of the Florida Statutes, which mandates dentists who hold a permit for sedation must complete 4 hours of continuing education training on airway management.11 The training must include 2 hours of didactic training and 2 hours of hands-on skills training, and dentists are required to repeat this training every 4 years.

Dentists must know the facts and principles of airway management. They must be able to conduct a focused airway examination and manage emergency or adverse events. Although there are modern techniques and devices for airway management that have the potential to save lives, dentists who care for sedated patients may not have had sufficient training to perform procedures or react appropriately to an emergency. The Center for Advanced Medical Learning and Simulation, a Florida Board of Dentistry approved continuing education provider, offers Airway Management for Dentists as an educational intervention to bridge this gap. This course adheres to the American Society of Anesthesiologists’ “Practice Guidelines for Management of the Difficult Airway”6 and provides learners with comprehensive instruction and practice in a risk-free, simulated environment. In this course, learners will demonstrate the skills required to evaluate and mange a difficult airway in clinical practice. They will gain confidence in their ability to perform procedures and walk away with a strategy of patient care.

GAP ANALYSIS

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 3

GOAL

The purpose of Airway Management for Dentists is to educate Florida dental health providers who hold sedation permits to identify and manage difficult airway situations in adult and pediatric dental patients. OBJECTIVES

Upon completion of this course, learners will be able to:

• Describe airway anatomy and respiratory physiology

• Demonstrate basic airway assessment using patient medical history and physical evaluation

• Identify the risk factors for potential difficult airway in dental patients

• Demonstrate, through simulation, airway management techniques for adult and pediatric patients

TARGET AUDIENCE

This course is designed for oral surgeons, pediatric dentists, periodontists, and general dentists in Florida who are required to complete 4 hours of continuing education in airway management.

PREREQUISITES

The learner must hold a permit for sedation.

COMPLETION CRITERIA

To achieve course completion, learners are required to:

• Attend all sessions

• Complete the confidence pre- and post-surveys

• Demonstrate the critical steps for airway management on adult and pediatric mankins as outlined in the observation checklists

COURSE OVERVIEW

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 4

COMPETENCIES ACGME/ABMS

• Practice-Based Learning and Improvement (PBL)

• Patient Care and Procedural Skills (PCP)

• Systems-Based Practice (SBP)

• Medical Knowledge (MK)

• Interpersonal and Communication Skills (ICS)

Institute of Medicine (IOM)

• Provide Patient-Centered Care (PPC)

• Employ Evidence-Based Practice (EEB)

• Apply Quality Improvement (AQI)

Dental professionals are required to abide by their practice privileges allowed by certification and licensure. They should thereby perform in accordance with their education and training while remaining within their scope of practice.

ACCREDITATION Dental Professionals USF Health is accredited by the Florida Board of Dentistry to provide continuing education for dentists.

USF Health designates this live activity for a maximum of 4.0 credits. Dentists should claim only the credit commensurate with the extent of their participation in the activity.

LOCATION

Center for Advanced Medical Learning and Simulation (CAMLS) CAMLS is a state-of-the-art healthcare simulation and training center that provides world-class health education and professional development to practitioners, specialists and teams. CAMLS offers a comprehensive menu of healthcare training services and curriculum development in simulation technology, healthcare team performance training, and professional development.

124 South Franklin Street | Tampa, Florida 33602(813) 224-7840 | www.CAMLS-us.org

COURSE OVERVIEW

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 5

REGISTRATION

ONE EASY WAY TO REGISTER; TWO EASY WAYS TO PAY

One Easy Way to Register Registration is easy. Go to www.cme.hsc.usf.edu and click on “Course Calendar” or, for direct access, visit https://cmetracker.net/USF/Catalog?eventid=340863.

Two Easy Ways to Pay

1. Pay by Credit Card Online: A payment confirmation will be emailed to the participant.

2. Pay by Check: After registering online, a payment voucher with instructions will be emailed to the participant. Registration will not be confirmed until payment is received.

Please Note: Payment will not be accepted onsite.

Registration Fee: $850 The registration fee for this course includes course content, simulation-based training, program materials, snacks, parking and CE credit.

Cancellation Cancellations must be requested in writing via fax to 813‐224‐7864 or e‐mail to cpdsupport@health.usf.edu, and received by September 13, 2016 in order to receive a refund. A $75 cancellation fee will be assessed to cover administrative costs. There are no refunds for no‐shows or for cancellations received after September 13, 2016. Substitutions are welcome without penalty.

USF Health Office of Continuing Professional Development reserves the right to cancel this activity due to unforeseen circumstances, in which case the full registration fee will be refunded. USF Health is not responsible for travel expenses incurred by the participants in the unlikely event that this activity is cancelled.

DISCLOSURE

USF Health adheres to ACCME Standards regarding commercial support of continuing medical education. It is the policy of USF Health that the faculty and planning committee disclose real or apparent conflicts of interest relating to the topics of this educational activity, that relevant conflict(s) of interest are resolved and also that speakers will disclose any unlabeled/unapproved use of drug(s) or device(s) during their presentation. Detailed disclosure will be made in the course syllabus.

DISCLAIMER

The information provided at this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

EQUAL OPPORTUNITY AND ADA

For disability accommodations, contact (800) 852-5362 within five days of the event.

FURTHER INFORMATION

If you have activity related questions please contact cpdsupport@health.usf.edu, or call 813‐224‐7860.

COURSE OVERVIEW

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 6

AGENDA

Start Time Event Topic CompetenciesTeaching Method

12:30 PMRegistration and WelcomeConfidence Pre-Survey

Survey

1:00 PM Airway Anatomy and AssessmentPBL, PCP, MK, PPC

Lecture

1:30 PM Managing a Difficult AirwayPBL, PCP, MK, PPC

Lecture

2:30 PM Break

2:45 PM Pediatric ConsiderationsPBL, PCP, MK, PPC

Lecture

3:15 PM

Skill Stations:

• Adult Airway Management

• Pediatric Airway Management

• Airway Scenarios

• Automated External Defibrillator

PCP, SBP, MK, ICS,

PPC, EEB, AQISimulation

5:15 PM Confidence Post-Survey Survey

FACULTY

Luis E. Llerena, MD, FACS - Activity Co-DirectorAssistant Professor of SurgeryUSF Health, Morsani College of MedicineMedical Director, Surgical and Interventional TrainingCenter for Advanced Medical Learning and SimulationTampa, Florida

Jonathan B. Cohen, MD, FCCPAssistant Member, AnesthesiologyMoffitt Cancer CenterTampa, Florida

Alfred Tennant, DDS - Activity Co-DirectorPrivate Practice, Orofacial PainTampa, Florida

L. Alan Todd, DNP, CRNA, ARNPAssistant ProfessorNurse Anesthesia Simulation CoordinatorUSF Health, University of South Florida

Frederick L. Slone, MD, FAADMAssistant Professor of MedicineUSF Health, Morsani College of MedicineTampa, Florida

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 7

1. Gordon D, Heimberg RG, Tellez M, Ismail AI. A critical review of approaches to the treatment of dental anxiety in adults. J Anxiety Disord. 2013;27(4):365-78. doi:10.1016/j.janxdis.2013.04.002

2. Tan GM. A medical crisis management simulation activity for pediatric dental residents and assistants. J Dent Educ. 2011;75(6):782-90. http://www.jdentaled.org/content/75/6/782.full. Accessed February 25, 2016.

3. Vanderbilt AA, Husson MM. Current Sedation and Anesthesia Practices among Dentists: A Statewide Survey. Oral Health Dent Manag. 2013;12(4):230-6. http://www.omicsonline.com/open-access/current-sedation-and-anesthesia-practices-among-dentists-a-statewide-survey-2247-2452.1000518.pdf. Accessed February 25, 2016.

4. Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118(6):2587-602. http://pediatrics.aappublications.org/content/118/6/2587.full-text.pdf. Accessed February 25, 2016.

5. Yang D, Wei YK, Xue FS, Deng XM, Zhi J. Simulation-based airway management training: application and looking forward. J Anesth. 2015:1-6. http://link.springer.com/article/10.1007/s00540-015-2116-7. Accessed February 25, 2016.

6. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American society of anesthesiologists task force on management of the difficult airway. Anesthesiology. 2013;118(2):251-70. doi:10.1097/ALN.0b013e31827773b2.

7. Morse Z, Sano K, Kageyama I, Kanri T. The relationship of placement accuracy and insertion times for the laryngeal mask airway to the training of inexperienced dental students. Anesth Prog. 2002;49(1):9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2007408/pdf/anesthprog00009-0019.pdf. Accessed February 25, 2016.

8. Goodchild JH, Donaldson M. The use of sedation in the dental outpatient setting: a web-based survey of dentists. Dent Implantol Update. 2011;22(11):73-80. https://www.researchgate.net/profile/Mark_Donaldson/publication/51834531_The_use_of_sedation_in_the_dental_outpatient_setting_a_web-based_survey_of_dentists/links/0912f50252c813dc0d000000.pdf. Accessed February 25, 2016.

9. Wilson S. Pharmacologic behavior management for pediatric dental treatment. Pediatr Clin North Am. 2000;47(5):1159-75. doi:10.1016/S0031-3955(05)70262-5.

10. Boynes SG, Lemak AL, Close JM. General dentists’ evaluation of anesthesia sedation education in US dental schools. J Dent Educ. 2006;70(12):1289-93. http://www.jdentaled.org/content/70/12/1289.full. Accessed February 25, 2016.

11. Fla Stat §466.0135.

REFERENCES

© 2016 University of South Florida, Center for Advanced Medical Learning and Simulation. All Rights Reserved. v.8.5.2016 Activity#MR20171901128 8

Center for Advanced Medical Learning and Simulation124 South Franklin Street | Tampa, Florida 33602(813) 224-7840 | www.CAMLS-us.org