In her three-part article, "The Road to Excellence" [January, March, May 1995] Barbara Alexander had a list of approved CE providers. As an American Heart Association Basic Life Support Instructor, I am interested in the fact that she listed the American Heart Association (AHA), but not the American Red Cross (ARC), as an approved provider. Was this omission an error?
I am also interested in whether or not she found any state(s) that requires health care provider CPR for licensure. In recent research concerning CPR, I was unable to find any licensing board that distinguished between layperson community CPR and health care provider CPR. Many states have adopted the CDC recommendation to OSHA that a bag-valve-mask device be used in the dental office in place of mouth-to-mouth resuscitation. It is only in the health care provider course by the AHA or the professional rescuer course by the ARC that such instruction is given.
The standard of care demands that dental hygienists, as well as other members of the dental team, be prepared for an office emergency. Although the dental practice acts do not specify what level of CPR is required for licensure, is basic life support for the health care provider the only viable option?
Nancy Brisack, RDH
Fountain Valley, California
EDITOR`S NOTE: The reference to only the American Heart Association was an oversight. Certainly, the ARC and the National Safety Council are also recognized in every state, as well as by the U.S. Department of Labor.
In regards to your other questions, we deferred to the expertise of Larry Starr of the Oxygen Therapy Institute in Ardmore, Pa. He directs education for SOS Technologies, a national emergency care first aid, CPR, and bloodborne pathogens training agency. The company, for example, provides all CPR training for Temple University School of Dentistry.
Mr. Starr wrote: "CPR training requirements do not often distinguish between levels. Thus, I am also not aware of a specific requirement for `health care` as opposed to other curricula of CPR. Part of of the reason may be that the different names of the courses have changed over the years, or that the type of CPR training required depends on the clients being served. For example, if a CPR provider does not work with infants or children, there seems no reason to require child or infant CPR training.
"With respect to barriers used during CPR performance, the letter`s author should be aware of four types of these devices: CPR face shield overlays; CPR resuscitation masks; bag-valve masks manual devices; and mechanical resuscitators. According to the national CPR guidelines (published in Journal of the American Medical Association, 1992), the recommended device is the CPR resuscitation mask. Face shields are acceptable, but only until a better barrier arrives. Bag-valve masks devices are acceptable, but require regular practice, and a patient should have an oral airway inserted. Mechanical oxygen-powered devices have important reasons for acceptability, also require regular rehearsal, and should not be used on pediatric patients.
"Training for use of CPR face shield and CPR resuscitation mask barrier devices is available as a part of any of the AHA classes via `Module 4 - Barrier Devices.` According to the AHA BLS Instructor Guidelines (1994, Chapter 7, Course Outlines), `Additional information may be added to the Heartsaver Course, such as the AHA module on barrier devices.` There is no formal course on use of BVM devices in the Barrier Devices module. If CPR providers need to learn how to use these devices, qualified CPR instructors can teach it as a part of the Health Care or Heartsaver course, but it is not included in either, nor is it in any BLS materials published by AHA.
"The `standard of care` (I have not seen the one written for dental hygienists) usually focuses on performance requirements. Thus, an appropriate level of training is one which prepares a health care or allied health care provider to be able to render care for the patients under his or her charge. If a dental office treats only adults, CPR for adults (Heartsaver) is appropriate. If children are involved, the module for children (Module 2) may be added. If a practitioner is exposed to all variations of patients and needs to be trained in all the components of CPR (Health Care course), this should be provided. Much depends on the meaning of the term `office emergency.`"
By calling (800) 521-4836, Mr. Starr can answer additional questions about CPR training.