Following is a report from Dr. Clive Rayner, Chair of the FSOMS Anesthesia Committee, who attended the November 16 Board of Dentistry anesthesia committee meeting, which followed the full Board of Dentistry meeting:
Re-inspections will now be done every 3 years; again at no charge. AAOMS requires office inspections every 5 years, so the state inspections will still suffice for AAOMS, as the Board uses the AAOMS office inspection guidelines already.
Most states already require that a sedation provider who sedates “children” have PALS training, and that a sedation provider who treats “adults” have ACLS. The difficulty lies in defining a “child” vs. “adult.” The board staff, members of the committee and the Board’s attorney researched the issue and determined that although various organizations have a variety of definitions of a “child,” the most logical thing to do was to use the American Heart Association’s own definition since they are the PALS/ACLS course provider, which is that PALS is the appropriate course “until puberty.” Obviously, this is very individual and difficult thing to determine, so the age of 12 was chosen by the committee as being an acceptable compromise. The dentist anesthesiologist, pediatric dentist, and periodontists (who is also a practicing Paramedic) on the committee argued strongly in favor of this definition as being in the best interest of patient safety. PALS and/or ACLS if applicable to the individual provider will therefore be required every CE biennium effective the biennium ending in 2020.
The issue of using EMTs as sedation providers was again discussed at length, as it is apparently the practice of some OMS offices to hire EMTs as sedation providers. The Board’s attorney reiterated that under Florida statute, an EMS’s ability to practice falls under the medical license, not a dental license. Therefore, an EMS provider (either EMT or Paramedic) can function as a surgical assistant, and can function as an anesthesia assistant to monitor and maintain the airway under sedation, and can monitor a patient following sedation in recovery. But an EMS provider CANNOT start IVs, NORadminister sedative drugs under the direction of a dental licensee. The dentist anesthesiologist and periodontist (who is also a practicing Paramedic) on the committee confirmed this.
The committee again discussed requiring dental assistants to get regular continuing education to function as anesthesia assistants and be part of the “dental anesthesia team model.” Many states now require such CE for staff assisting in sedation, and some specifically require DAANCE training. But the anesthesia committee did not move these recommendations forward.
Ryanodex is now acceptable as an alternative to Dantrolene, if the office provides volatile gas anesthesia. Dexmedetomidine was added to the list of drugs only to be used by GA permit holders.
- CE Rule #1- 4 hours of didactic lecture in anesthesia and/or medical emergencies
- CE Rule #2- 4 hours of live “hands-on” airway training and/or live “hands-on anesthesia emergency simulation training.”
The Board staff commented that they still have a shortage of office anesthesia inspectors in the Orlando and Sarasota areas, and requested any interested OMSs to contact the Board.