Link 4: Written Medical Emergency Plan, Link 5: Emergency Drug Kit and Link 6: Proper Equipment are known as the Physical Links.  The dental team will be accountable for authoring a medical emergency plan specific to their office as well as purchasing the appropriate equipment and necessary emergency medications for their reserves.  Action is needed to achieve each of these three links individually.  These actions must be taken seriously and in conjunction with the Educational Links.  This creates one complete chain cycle known as the Six Links of Survival™.

The C.O.R.E. acronym, meaning Critical Office Resuscitation Emergencies, delineates the primary 16 medical emergencies.  Another “CORE” exists to aid in the retention of the Physical Links; this CORE is referred to as Critical Operatory Response Equipment.  It consists of the three facets of the Physical Links which a dentist and team will need to access; these are: 1) a written, visible medical emergency plan, 2) all emergency medications, and 3) all proper medical equipment.

The Medical Emergency Plan is the action blueprint; once designed, it must be built into the facility through continual development, maintenance, and practice. This document must be visible at all times and easily accessible for quick retrieval.

Seven foundational medications plus oxygen are required in all dental offices. For ease in remembering, the algorithm A – G, O is used. Please note: Oxygen, although technically a medication, is covered under equipment because of its heavy dependency on the related armamentarium.

A = Aspirin (MI)
B = Bronchodilator (inhaler for use in asthma)
C = Coronary Artery Dilator (e.g. nitroglycerine)
D = Diphenhydramine (histamine blocking agent)
E = Epinephrine (cardiac arrest, analyphyaxis, some asthma)
F = Fainting (ammonia inhalants to stimulate CNS during syncope)
G = Glucose (hypoglycemia)
O = Oxygen

Compliance with the Physical Links is a task to be nurtured by the entire dental team in that medications and equipment need maintenance and monitoring to ensure proper functionality. Proper equipment working condition can only be assured by constant review, testing, and use in mock drills. Emergency medications can be maintained by monthly monitoring and a system of First-In, First-Out use and replacement. Expired medications are unacceptable and potentially dangerous if an emergency arises.

Advance anesthesia techniques demand the availability of more advanced emergency medications in addition to those previously listed.