Dentists In Emergencies: Is It Fine If I Do Nothing?

I was on one of my morning runs when I came across a young lady who had been a victim of a motorbike accident. There was a crowd around her prone form. As I looked at her, it was obvious that she had no oral or facial injuries, no Le Fort fractures (partial or complete separation of facial skull bones from brain skull bones), and no head and neck injuries. She had had her helmet on, luckily or unluckily for her?

 As an Oral and Maxillofacial Surgeon, this technically wasn't my job to do as it's outside my specialization, but do I leave this helpless individual? What if she dies? Will her death be on me because I didn't do what isn’t my job? 

Ethics demands that both in and out of hospital emergencies, doctors are usually legally obligated to do something. When it comes to non-dental cases though, many dentists dream of keeping their hands out. In this situation right now, if I do not interfere, will I be liable to be punished for my inaction as a doctor, or am I excused based on the fact that I am a dentist? 

Is it legal to keep hands-off? Or are dental students dreaming?

This isn't about whether dentists are doctors but strictly on roles expected of medical practitioners. Centuries ago, physicians treated all structures in the body together as one. The basis of this is inculcated in some schools going by curriculum taken. 

In preclinical classes in some medical schools, such as the prestigious University of Ibadan, students of Dentistry and Medicine are taught together. They take the same classes, practical sessions and even dissections!

In Anatomy for example, Dentistry students take the same classes as Medicine students, while taking classes to bridge their knowledge in Dental practices, by taking Dental Anatomy.

In clinical classes, for the first one or two years, students in medicine and dentistry (MBBDS) take postings together. 

Dental students go for postings in medical and surgical specializations like pulmonology, orthopedic surgery, neurosurgery, pediatrics together with medical students. 

This shows that Dental students have some knowledge in almost all that medical students learn. However, what limits dentists in emergencies are specialization.

Laws guiding the interference of Dentist in medical emergencies;

1. Treating Non-Medical or Non-Dental Conditions;

There is no specific legal provision that allows a dentist to treat non-medical/non-dental conditions.

2. Yes — under Nigerian law, dentists are allowed to refuse to treat conditions clearly outside the scope of dental practice. They are not obliged to intervene in non-dental medical issues. Not only Nigerian law, but in many other countries as well. 

3. If dentists attempt to treat conditions outside their training/scope and cause harm, they risk professional discipline from the MDCN, legal liability, and sanctions under the Act for practicing outside their permitted scope.

Therefore, dentists can always excuse themselves when the situation isn't in their capacity!

To accurately discuss the topic, the legal systems in place for dealing with the many possible outcomes of responding in emergencies must be discussed. Good samaritan laws are the blanket names for these laws. They differ from country to country and specify how much protection is afforded to emergency responders for the negative fallout of their interventions. Some countries have stronger laws and as such, also enforce medical and dental practitioners to respond in such conditions. In other places, while good samaritan laws are weaker or stronger, there is less enforcement. The choice is often left up to freewill just like the biblical good samaritan. In Nigeria, laws granting civilian immunity are non-existent.

As such, the police could arrest a passerby for trying to help in an accident despite not being complicit in anyway. This is not legally sanctioned, but it sometimes happens. For this reason, an Emergency Medicine consultant could legally walk past a crime scene where a gunshot wounded patient is dying and do nothing; there would be no legal prosecution. It’s a way of saying “I didn’t send you. I didn’t force you. So if it goes bad, I can’t help you.” That being said, the MDCN and the Dental Council encourage assistance in emergencies. So professional disciplinary consequences remain a possibility.

But “a dentist on duty in Nigeria is not allowed to leave anyone to die in an emergency, medical or dental".  A doctor or dentist on duty in a healthcare facility is legally obligated to treat emergencies, or at least to do their reasonable best. As long as the center is open, they are obligated to provide emergency stabilization according to available resources and expertise. And according to Section 20 of the 2014 National Health Act, refusal is punishable by a fine and possibly some jail time. For this reason, basic first aid and as much learning on emergencies as possible is needed, even by a dentist.

Nigeria may not have Good Samaritan laws, but doing nothing when you can reasonably help may be ethically indefensible as courts and MDCN also assess reasonableness, not just university degrees and specializations.

I moved past the crowd. She seemed to be finding it quite difficult to breathe. I looked closer, her chest was heaving noticeably on the left, but barely moving on the right. Neck veins distended. Hidden six. Possible tension pneumothorax. If the air in pleural space can’t escape, lung collapses. In emergency, prognosis worsens rapidly. Do nothing, she will die fast. What could I do? A needle in the 5th intercostal space on the right. Inserted from the top to avoid neurovascular injury. Odds that I could be wrong and killing the patient? I had no idea. I had forgotten most of my ATLS and emergency training. All I remembered, “You’ll hear shhhhhhhh and the patient will start breathing better if you are correct”. I stepped up. “Call a doctor”. A man in the crowd had a bunch of unopened large bore syringes, probably the local vet. I collected one. Stuck it in. Screamed again, “Call an ambulance”. As the shhhhh went off, she started breathing better. I waited long enough to not be suspicious, then took off on my morning run at a significantly heightened pace. If I helped, I didn’t need the accolades, but if I made it worse, I didn’t want to be around to find out. 

Amole Mustapha