July 8, 2025 • 34 mins
Linked In: https://www.linkedin.com/in/richardmarn/
Readiness quiz: https://emergency.scoreapp.com/
A staggering statistic opens this eye-opening conversation with Dr. Richard Marn: one person per day dies in the United States due to medical emergencies that begin in dental offices. As a board-certified anesthesiologist with decades of experience, Dr. Marn reveals the critical safety gaps in dental practices and how his journey from academic medicine to founding Blue Pacific Medical Simulation led him to address this overlooked public health issue.
Dr. Marn introduces us to the fascinating "beehive versus lone wolf" concept – explaining how hospital teams function collaboratively like beehives during emergencies, while dental practices often rely on the dentist alone (the "lone wolf") to handle everything. This fundamental difference in approach creates dangerous vulnerabilities when seconds matter most.
The heart of the episode explores Dr. Marn's innovative Four Pillars of Sedation Emergency Readiness: Infrastructure, Competency, Culture, and Habit. Beyond just having the right equipment or knowing CPR, these pillars address psychological safety, team dynamics, and creating systems where everyone knows their role in a crisis. Through compelling examples and practical insights, Dr. Marn demonstrates how dental practices can move from simply checking regulatory boxes to building genuinely effective emergency response capabilities.
Perhaps most valuable are the actionable steps dental teams can implement immediately – from five-minute huddles that create psychological safety to using Dr. Marn's free online assessment tool (emergencyscorapp.com) to identify specific practice vulnerabilities. His approach acknowledges the realities of busy dental practices while providing a clear framework for meaningful safety improvements.
Whether you're a dental professional looking to enhance your practice's safety protocols or simply someone curious about what happens when things go wrong in healthcare settings, this episode offers profound insights into saving lives when every second counts. Connect with Dr. Marn on LinkedIn to learn more about his work transforming dental emergency preparedness.
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Episode Transcript
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Welcome to The Sim Cafe, apodcast produced by the team at
Innovative Sim Solutions, editedby Shelly Houser.
Join our host, deb Tauber, andco-host Jerrod Jeffries as they
(01:11):
sit down with subject matterexperts from across the globe to
reimagine clinical educationand the use of simulation.
So pour yourself a cup ofrelaxation, sit back, tune in
and learn something new fromThe Sim Cafe.
Deb Tauber (01:33):
Welcome to another episode of The Sim Cafe.
Today's guest is Dr RichardMarn, a board-certified
anesthesiologist and pediatricanesthesiologist with over two
decades of experience in patientcare, medical education and
simulation-based training.
He's the founder of BluePacific Medical Simulation.
(01:54):
Dr Marn has worked in topinstitutions like Mount Sinai
and now specializes in pediatricdental anesthesia across New
York.
He's here to share his insightsfrom his unique medical journey
and how he's helping shape thefuture of healthcare education.
Thank you, dr Marron, and yousaid that I could call you
(02:15):
Richard, so I will call youRichard.
Unfortunately, Jerrod is notgoing to attend this episode
today, so it's just going to bethe two of us, but we've got a
lot in common and I'm lookingforward to it.
So why don't you tell ourlisteners a little bit about
yourself?
Dr. Richard Marn (02:29):
Well, thanks for having me, Deb.
So yeah, I'm a board-surfer.
Anesthesiologist, pediatricanesthesiologist.
I live in the New York metroarea and I specialize in
pediatric dental sedations.
I basically have two main waysto deliver.
Safety for dental world is oneis the mobile sedation service
that I do, as well as a riskmanagement company called Blue
(02:50):
Pacific Medical Simulation,which essentially improves,
addresses team alignment forwhen it matters the most.
So we help improve the teamalignment that is stress tested
for medical and sedationemergencies, and so that's kind
of like where I am right now.
Deb Tauber (03:07):
Thank you and Richard.
How did you get involved withthis?
What started you down this path?
All of a sudden, you'rethinking dental emergencies.
How did you come up with that?
Dr. Richard Marn (03:17):
It was in a direct linear route here.
So I guess it kind of startedwhen I was.
I mean, I didn't even want tobe an anesthesiologist, Deb, I
wanted to be a surgeon way backwhen, but anyway.
So I was at Mount SinaiHospital, I had finished my
training at NYU and JohnsHopkins and my first job was at
(03:39):
Mount Sinai Hospital Thank you,David Rich who was the chairman
at the time and I spent 11 yearsthere and during that time I do
my traditional medicalpediatric sedation and
anesthesia cases tonsils,adenoids, circumcisions and such
, and some liver transplants andcraniotomy and premature kids.
(04:01):
But we'd also do in the hospitalgeneral anesthesia for
pediatric dental cases and thesekids who had needed full mouth
rehabilitation so they have like10, 8, 10, 12 cavities and
they'd be under anesthesia forone, two, three hours for their
care.
And my wife is actually apediatric dentist and so we do
(04:23):
cases together and the topicwould come up hey, why don't we
consider start doing cases inher office?
And so I really wasn'tcomfortable for that until maybe
about 10 years or so after Icut my teeth in academic
medicine and then about 11 yearsat Mount Sinai, I left academic
medicine and went to privatepractice with the goal of
(04:44):
helping what I thought was anunderserved community, if you
will, for in-office dentalsedations in the New York area.
And so that was back in 2016 iswhen I left Mount Sinai, and
I've been trying to address thatsince then, and so that's kind
of how I got into dentalsedation.
So my wife was my first client,if you will.
So she's kind of like my bossat work and at home and then and
(05:09):
so, yeah, that's how I got intothe dental world.
Deb Tauber (05:14):
Well, thank you, and I was really interested in
hearing your story and hearingwhat you're doing.
I remember back in the 80s whenI worked in the emergency
department I will never forget Ihad taken care of a young woman
.
She was probably mid between 25and 30.
(05:34):
And the dentist had given herVersed and Talwin intravenously
and she went into full arrestairway.
And she went into full arrestairway, stopped breathing and,
uh, they brought her into theemergency department and I'll
never forget this.
I was just, you know, 25, maybe26, myself taking care of this
(05:56):
woman and we were unable toresuscitate her and it was just
it left.
It just left.
You know something inside of me, something Something like how
could this, how could thishappen?
Right, but you know, you knowthis does happen.
This still continues to happenwith airway compromise, and are
we taking all the precautions weshould?
Dr. Richard Marn (06:18):
Right, right and unfortunately this is.
You have to kind of livethrough that, that situation.
This is.
You have to kind of livethrough that situation.
I tell dentists and dentalteams that the one event in all
that they do whether it'sclinical care in their dental
office, whether it's dealingwith patient complaints, whether
it's trying to keep up with thelatest regulations or CE
(06:42):
knowledge in their dental worldor making sure they make payroll
the one singular event thatwill shatter their practice, put
them under regulatory light intheir dental world, affect staff
morale, possibly even decreaserevenues and provide for
terrible reviews, is a medicalor sedation emergency that goes
(07:03):
wrong.
One event, and that will takeplace within a course of
literally minutes, that willliterally bring your practice to
a halt, more than any othersituation that they can think of
.
The way I look at it is youwant to be prepared for that.
Not just you, the whole teamneeds to be prepared for it, and
(07:24):
so the reason I got into it isbecause you know I'm doing
sedation for my dental clients.
You know dentists, oral surgeons, pediatric dentists and my wife
one day brings up this articleabout a bad event and she says
you know, I think this needs tobe addressed in my dental right.
I don't think it's properlyaddressed.
So you know, I honestly this isaround 2021, 22.
(07:48):
And I didn't know much,honestly, I didn't know much
about it, but I started lookinginto it and it is really a
problem bigger than we realizeBecause the late press you get
some late press that comes outin these catastrophic events,
but it's a much bigger problem.
So the data points to the factthat about one person per day in
(08:10):
this country one person per daydies due to a medical event
that starts in a dental practiceDies.
Okay, so that's about 350people per year.
The near misses account forabout five to eight times that
number.
So that's when you account fornear misses and actual deaths,
(08:31):
that's about three 4,000 events,not events people in this
country per year that are goingthrough that and that has a
trickle effect on the patientbut also the dental team and
their practice.
And so I said I must be in aposition to help address this.
And that's where I startedlooking into therapy, medical
(08:55):
simulation and how that canaddress this problem.
And eventually that led me toCenter for Medical Simulation
and I took their training.
I eventually became one oftheir adjunct faculty and I
teach basically what I teach atthe Harvard Hospitals through
Center for Medical Simulation tothe dental practices not only
(09:15):
that I work with, but any otherpractice that wants to learn
about this, and we're still kindof a young, young organization
in the risk management realm,but the mission is to improve
safety systems that protectlives and practices so that, you
know, no one dies, especially achild, in a dental office, ever
again.
Deb Tauber (09:35):
Right.
Dr. Richard Marn (09:36):
And so that's, that is what kind of led me to
where I am right now from thisrisk management simulation
standpoint.
Deb Tauber (09:44):
Right, I think you're looking at high risk, low
frequency events but I know now, even to this day, when I go to
the dentist, I get so anxious Ithink, oh my gosh, what if my
airway occludes, what if theyknow?
What if they?
I don't know, I just can't,can't stand being there.
Dr. Richard Marn (10:05):
Well, I think, the way I look at it, it's like
it's a numbers game.
You're most people would dolike they do thousands upon
thousands of cases every everyday across the country without
event.
And so what you have to do isyou look at the high risk groups
country without event.
And so what you have to do isyou look at the high risk groups
.
So the high risk groups formedical emergencies that go
(10:25):
wrong, when you really look atthe data, is typically going to
fall into the extremes of age.
So the young or the very old,or even just children.
So 12 and under, choose somearbitrary number but basically a
child or young adult tosomebody in their elderly age
60s, 70s, 80s or up, especiallyif they have underlying health
(10:46):
issues.
So that's number two.
Right, if they have underlyinghealth issues.
Number three is sedation.
Sedation seems to be a verystrong risk factor for these
emergencies in their office.
So people who don't really fallin those categories.
Yes, could emergency happen?
Yeah, of course it can happenwith any patient, but those are
really the strong risk factorswhen you actually look at some
(11:08):
of these reports in the dentalworld.
So I don't want you to feellike you should be too anxious,
deb, because I don't think youshould be, but I think it's
smart to be cognizant and aware.
That is your wellbeing properlycared for.
Have the dental team thoughtabout contingency plans should
you get a little bit too muchepinephrine in the local
(11:30):
anesthesia you give or you startto get an allergic reaction or
God forbid an anaphylacticreaction to one of their
supplies that they're using totreat the teeth Right right.
And also you could get ananaphylactic reaction to some of
the local anesthesia they getas well.
So, yes, it's always a riskfactor and so, again, we're
trying to address my team and Iare trying to address what we
(11:53):
see as a gap in theirpreparedness.
Deb Tauber (11:55):
No, I appreciate that.
Let's talk a little bit aboutthe current state of the dental
industry.
The beehive versus the lungwhat does that mean?
Dr. Richard Marn (12:05):
So for a long time I was trying to envision
what I couldn't put my finger on.
It.
Like, the way the dentalindustry prepares for a medical
emergency is very different thanwhat I'm used to in the
hospital setting.
It's very different than whatI'm used to in the hospital
setting.
So if you look at the medical,typical medical response in a
(12:27):
medical for a medical emergencyin a hospital setting just an
average hospital it's a veryteam-based approach and
especially the top tierhospitals where they use
simulation a lot, there's athere's this team alignment that
they they have.
That's that's very clear.
Like, for example, someoneknows what their airway, who's
responsible for the airway chestcompressions.
Leadership.
There's communication.
There's useful use of resources, very good use of crisis
(12:50):
resource management, crm.
Not to say everybody's perfectno, medical emergency management
is perfect but there'sdefinitely this sense of
teamwork.
And, by the way, if someonecan't perform that chest
compressions or airwaymanagement or IV placement,
someone comes in and takes overthat role, much like a beehive
right.
If somebody is not performingin that role, most teens I have
(13:14):
seen in most hospitals are ableto adjust on the fly and perform
well to help keep that patientalive as best as possible.
There's a sense of teamwork.
In the dental industry it's muchmore of a top-down approach and
it comes from the mentalitythat I feel a lot of dentists
(13:36):
have and I think this isindustry-wide and this idea that
me, as a dentist in in mypractice, has to do everything
on my own If there's a medicalemergency.
I have to remember what to doin an anaphylactic reaction.
I have to remember all the drugnames, the drug dosages.
I have to tell people what todo.
I have to tell them to call 911.
I have to tell them to drop themedications.
(13:57):
I have to tell them to drop themedications.
God, I have to drop themedications, I'm going to have
to do everything.
And this idea that they have tocarry this burden on their own,
I hear it in their voices.
They say I don't know what todo in an emergency.
I have to feel like I have to.
They literally say I feel likeI have to do everything on my
own Because they don't know how,or they haven't been taught how
(14:22):
, to utilize their team,leverage their team in those
critical moments, because it'snot taught in the dental world.
It's not taught.
They think basic life support,bls, cpr is enough.
They literally say, well, Imean, I have BLS.
Well, not to say that's notimportant, that's very important
(14:42):
.
But quite frankly, if you haveto use BLS, something went wrong
.
There could have been somethingthat before that happened, so
you never got to BLS.
Bls, to me, is your last skillset you want to use.
There's all these little thingsalong the way to potentially
delay the use of BLS or preventit from even happening, because
(15:06):
we already know out of hospitalCPR life expectancy outcomes are
very poor it's like what?
10%.
So we don't want to count onthat as a skill set.
And so what can you do inadvance of that to either delay
that from happening until 911does come and help you out or
other resources come and helpyou out, or what can you do to
(15:26):
again negate that from evenhappening at all.
And so again, that's where wetry to help people kind of
recognize that.
But again, that's a differencein mindset and mentality, the
sense that I have to doeverything on my own and
therefore I have to learneverything on my own.
And therefore this idea that,oh wait, we'll figure it out as
a team, but they don't know howto bring their team together
(15:49):
because they have not actuallyaligned their team in prior to
that event.
Deb Tauber (15:54):
Well, I mean, I think, if you think about I love
baseball, I love watchingbaseball, and you think you know
other professional sports.
Football is a little rough forme to watch sometimes, but
counts where lives are on theline.
Have we practiced?
Have we prepared?
For game day.
Dr. Richard Marn (16:26):
Agreed, agreed , and I will tell you medical
emergency sedation, emergencypreparedness and readiness is
not top of mind.
These are dentists that youknow, honestly.
They come in, they do theirclinical work and they want to
clock out at five o'clock.
They're done.
They literally tell me that,hey, you know this is going to
go, this is going to happenafter what time, and that's OK.
(16:48):
But this is not top of mind.
They're worrying about makingsure their patients are happy,
making sure they're doingclinical care, making sure
they're keeping up to date withtheir clinical knowledge, making
sure their staff is happy.
If their practice ownerspayroll regulations, I mean,
that's on their mind, I get that.
So, therefore, how can youintroduce what this is an
(17:11):
important topic into theirpractice and that is a bit of a
challenge how can you honestlychange the culture?
They're thinking that teamworkneeds to be a priority for these
crisis, versus thinking thatdentists have to do it on their
own?
Deb Tauber (17:24):
Yep, yep.
What are the four pillars ofsedation?
Emergency readiness that's agreat segue.
What are the four pillars ofsedation?
Dr. Richard Marn (17:29):
e That's a great segue.
So when I was looking atpreparedness and readiness for
emergencies, I was trying tostruggle to put it into
categories and these fourpillars or categories I found is
what you need.
It is essential in bestpractices I believe in dental
sedation, emergency readiness.
(17:50):
In best practices, I believe indental sedation, emergency
readiness.
But I also found that this isprobably holds true with really
any medical emergency, no matterwhere you're at.
So the four pillars, I'll justname them and then kind of talk
about them separately, if that'sokay, deb.
Yeah, all right.
So first is infrastructure,number two is competency, number
three is culture, number fouris habit.
Deb Tauber (18:12):
Yeah.
Dr. Richard Marn (18:14):
I think that addresses all the issues.
So what is infrastructure?
Infrastructure is the physicaltools and items or the
facilities that you're at.
Does it support your ability tomanage that medical emergency?
All right, so I came up withthis acronym.
Right, it's called MESV,m-e-s-v Medications, equipment
(18:36):
supplies, visual aids orcognitive aids.
Okay, that's what we all need.
Then there's also the physicalrealm with which you live in.
Is there ingress, egress?
Does 911 get into?
Can they get into your facilityor not?
Do you have a proper lighting,you know?
Is there enough space to workin that space should a medical
or sedation emergency happen?
(18:56):
I'll give you an example of whythat's so critical.
A few years ago there was aoral surgery practice that had a
sedation emergency on anelderly woman on, like I don't
know, their eighth floor, 16thfloor of their practice.
There was a delay in 911showing up because they went to
the wrong floor.
And then, when they got to thewrong floor, they went to the
wrong door.
(19:16):
Thank God, someone eventuallyescorted the 911 to the right
door, but that delayed care.
That delayed care.
Because the infrastructurewasn't set up properly.
No one thought about that.
Okay, so that's number oneinfrastructure.
(19:38):
Number two is competency.
Now, competency is kind of whata lot of us tend to focus on
and, quite frankly, the dentalindustry tends to focus on the
first two a lot.
So competency in the dentalworld is like BLS, cpr, acls,
pals.
It's kind of going to yourtypical one hour seminar and
reviewing anaphylaxis or MIs orseizure management.
It's competency, but in thereit's also competency.
(20:02):
Does your team know how to usethe tools that you actually have
in your infrastructure?
Do they know how to use whatyou actually have?
And there's sometimes adisconnect between competency
and infrastructure.
People assume that just becauseI have it, I know how to use it
.
And unfortunately, a lot ofthese dental offices, when we go
to them for the first time andwe actually go through a
simulation, they have theseemergency kits, these pre-made
(20:25):
health kits that have some basicmesvie in it.
You know an ambu bag and a maskand epinephrine and Benadryl
and such.
I kid you not, it is sometimesthe first time they're open in
it and it's still in the wrapper.
I literally there are EpiPensthat are literally in a wrapper.
They've never even opened it,and thank God we do this
(20:47):
simulation practice because itallows them to actually have
their hands on with theinfrastructure, the equipment,
the supplies, the medicationsfor the first time, as opposed
to, as you know, during anemergency.
Deb Tauber (20:59):
Right, that's ideal.
Dr. Richard Marn (21:00):
Right.
So now, in that competency isnot only just the individual
skills but also the teamworkskills.
Do they have teamworkcompetency skills?
Do they know how to assignroles?
Do they know how to call forhelp?
Do they know how to assignroles?
Do they know how to call forhelp?
Do they know how to assignleadership or take on leadership
that takes practice?
So that's again competency.
It's more than just I know CPR,again, even anesthesiologists.
(21:23):
It's more than, oh, I know howto give drugs.
All right, well, do you knowhow to communicate with your OR
team and do you practice that?
Have you been taught that?
Okay, so that's competency.
Number three culture.
Do you have a culture that insome way, this addresses
teamwork?
Do you have a culture thatallows for your teamwork to
(21:45):
perform at a high level?
So, do you actually have a bigpsychological safety?
That's a big one, right?
I know a lot of us talk aboutthis in simulation.
World is an area, of course,that is extreme importance.
But putting it into practiceand actually practicing is
another item, right?
It's one thing, knowing about,it's another one on executing on
(22:06):
it.
So, culture, shared mentalmodel is another aspect.
Do you have that shared mentalmodel?
Another aspect.
Do you have that shared mentalmodel?
Do you know how to communicatethat shared mental model when a
crisis happens?
So that's the cultural aspectof teamwork Because, as we know,
if someone doesn't know how tospeak up and they think the
dentist will know everythingbecause they talk about how they
have to manage everything ontheir own if the pulse oximeter
(22:27):
is not reading correctly andmaybe it fell off, but the
dental assistant doesn't want tospeak up because they don't
feel psychologically safe to doso, or they think that, oh, the
dentist will figure it out, I'mnot going to say anything,
they're not going to speak up,and so that's something that
needs to be addressed, of course, and that's the cultural aspect
(22:49):
of it.
The number four is habit.
I mean, I think it seems that'sself-explanatory, but again,
it's one thing to talk about,one thing to execute, and the
idea is have you madepreparedness and readiness for
an emergency a habit?
The habit that a lot of dentalteams have is oh, we have our
(23:10):
habit of every two years doingBLS.
Yeah, that's their habit,because, honestly, that's how
the dental industry as a wholekind of looks at it.
Yes, there's some niches, suchas the oral surgery, where there
are state requirements, tellingthe people that do sedation in
dental office that you have todo a little bit more, the people
that do sedation in dentaloffice that you have to do a
little bit more.
(23:30):
It's more, how should I say?
It is still not a strong habitfor the majority of dental
practices, even the ones that dosedation.
And so the habit is do you makeit a habit in your practice,
whether it's on a daily, weeklyor monthly or even a quarterly
or yearly basis, and what arethose habits and does your team
(23:50):
participate in that habit aswell?
It's not just, oh, more burdenon your dentist.
How can we offload some of thatburden so your team can support
you during a crisis?
So those are the four pillarsand, as I mentioned, a lot of
the dental team just kind oftends to focus on the first two,
and really it's the fourpillars that really prepare you
(24:10):
for those emergencies.
I mean, if you look, deb, atthe best teams, right, the teams
that are in lay press, right,the Navy SEALs, the Formula One.
When you look at Delta teams,or you look at the top
responding teams in any medicalfacility, all right.
Or you look at I also look atother safety systems as well,
(24:31):
whether it's like engineering ornuclear power or even other
automotive industry, oh, airlineindustry, they essentially do
these four pillars.
They are addressing these fourpillars in their own way.
I'm just kind of looking atthat and trying to say, okay,
how can we take those fouressential pillars and address
them in the dental world andmake sure they're addressed?
(24:53):
But that's what all these bestteams do.
Deb Tauber (24:57):
I want to say there's even a handful of dental
programs that have beenaccredited by the Society for
Simulation in Healthcare.
Their programs have actuallygone the distance to recognize
how important and how valuablesimulation is and being prepared
.
Dr. Richard Marn (25:15):
Do you know the names of those organizations
?
Deb Tauber (25:18):
Not off the top of my head.
Okay, all right, thanks.
Dr. Richard Marn (25:21):
I'd like to learn more about that.
We can talk about that later on, but I think that's definitely
the step in the right direction,you know, and hopefully it's
more than just checking offboxes the right direction, you
know, and hopefully it's morethan just checking off boxes,
right, absolutely Checking offboxes.
Deb Tauber (25:39):
Now, how do you think dental and oral surgery
can get better prepared forsedation emergencies.
Oh well, there's two simpleways, right?
I already talked about how youknow when we do simulations, deb
right, and we can make it likea small little micro simulation,
or it's like a half day or fullday.
Yep, that's a big ask for adental team new to sedation
(26:01):
readiness or medical emergencyreadiness, right.
And so for me and also keep inmind my wife's a pediatric
dentist they have a lot of otherthings they have to worry about
, and so how can we introducethis Still important, but how
can we introduce it so itdoesn't become another burden to
them, and so what I usuallyrecommend is start small, and so
there's two things I usuallyrecommend.
(26:24):
One is assess your current risk,and so I actually developed an
online tool.
It has about 20 questions or so.
It takes eight minutes, maybe10 minutes to take, and what it
is.
These questions address each ofthe pillars I just talked about
, and it helps you to as adentist, when you go through it.
(26:44):
It helps the dental team.
It could be the dentist, couldbe the hygienist, could be the
office manager Literally.
Take it and see where you scorein each of the four pillars,
and then also get a cumulativescore.
Furthermore, if you complete it, we send you a PDF and it's
like 10 to 15 pages, and what itis?
It gives you recommendations onhow you could address some of
(27:06):
your weaknesses in those fourpillars.
And I'm sure there's a lot of low hanging fruit
because again, you mentionedhabit.
People just get into these youknow habits and they're
overlooking things that arereally simple, and so it sounds
like by taking your assess, yourrisk test, you can find out
what some of those things areand implement them easily.
Dr. Richard Marn (27:29):
Yeah, yeah.
And if you take the scorecardand, by the way, it's free, it's
online I'll give it to you alink as we can put the show
notes.
It's actually emergencyscoreapp.
com Very professional, Looksgreat.
You can actually trend, see howyou do.
You take it now, do it sixmonths later after you execute
on some of the actions and seeif you actually improve your
score.
Even you can see theirperspective of how they think
(27:57):
your team is prepared for aemergency not just you as a
dentist.
I do want to highlight it's aonline scorecard that initially
was designed for pediatricdentists who do sedation, but
it's really.
The principles are the same.
Anybody could take it.
As long as you're a dentist andyou're worried about medical
emergency preparedness, it stillapplies.
(28:19):
So that's, that's just ameasurement tool.
It's not perfect, but it getsyou in the right mindset and
framework and gives you theideas to start getting not just
you but also the dental teamprepared for a medical emergency
.
The second thing talk aboutlow-hanging fruit is I usually
recommend start with a simplehuddle.
It doesn't cost anything buttime.
(28:40):
Do it once every day, Do itonce a week as a topic.
I mean, if you have huddlesevery day, great, but you don't
have to necessarily do thisevery day.
You may want to do it initially, but have a huddle where you
literally bring up the topic, ifyou're a dentist and just ask
hey what are we doing?
(29:00):
great right now for a medicalemergency.
What do you think we're notprepared for?
Right, you can do a little plusdelta if you really want and
really just kind of get thepulse of your team.
And I would say, havingrecommended this, the team has a
lot of insights that thedentist does not have, and
(29:22):
simply having that starts aconversation.
You're starting to create somepsychological safety by even
asking your team their thoughts,and that's easy.
That takes literally fiveminutes for one huddle just to
get the conversation going andit will reveal a lot.
Deb Tauber (29:37):
But it gets back to habit.
So if you get in the habit ofdoing it, you're going to be
breaking the barrier, you'recreating a psychologically safe
environment, you're creating ashared mental model for
improvement and to think aboutwhat's the worst thing that
could happen and how would we beprepared for it.
Dr. Richard Marn (29:53):
Yeah, and simple things.
You don't need a fancy degreefor this type of huddle.
It's really like, hey, what iseverybody's thoughts?
Should we have a medicalemergency?
And once you get through thatemotional like, oh my goodness,
okay, well, what would you do?
What do you think your rolemight be?
And again, you don't need tobring someone like me into to do
(30:21):
that.
That's a simple thing to getthings started and then you know
, once you get momentum, thenyou can start thinking as a
dentist hey, what else can we do?
How can we get to that nextlevel?
Deb Tauber (30:29):
yep, absolutely now.
We're getting ready to wrap upright now.
Um so, when you look back atthis phase of your life and
career, what are the coreachievements you'd hope to be
remembered for?
Dr. Richard Marn (30:40):
Ah well, I would just simply put it.
If I could break it up in twoparts, deb, I would say
personally, I would just saythat I was a good dad, a good
father, good husband, goodspouse and supportive, and it
was present for them.
You know, that is important.
I think that gets lost in ourprofessional life, but that is
(31:01):
important, very important to meand professionally that I
actually had some impact.
I actually could save a life.
You know, the one thing aboutbeing an anesthesiologist is an
anesthesiologist can do greatwork.
We can literally as someoneputs it, we literally put
someone close to death with ourmedications and our skillset is
(31:22):
bringing someone back right.
A lot of people can drug drugs.
The question is do you have theskillset to bring them back
after you've given those drugs?
Right?
That's, in a very nutshell,what an anesthesiologist does.
But I want to make sure I'mtrying to make an impact beyond
just me, right?
I want to make an impact beyondjust one-to-one and that's what
I'm hoping that if I can havean impact that saves lives
(31:46):
beyond my direct clinical care,that would be awesome, that you
can put in my gravestone,besides being a fantastic spouse
and father and dad.
So I think that's what I'd liketo kind of leave with.
Deb Tauber (32:03):
Thank you.
Thank you so much.
And if our listeners want toget a hold of you, where would
they reach out?
Tell us a little bit more aboutyour company.
Do a little plug for Sure.
Dr. Richard Marn (32:15):
Number one, I mean, if you want to connect,
look me up on LinkedIn.
I'm the only Richard Marn Ibelieve on the planet.
And number two you can alsolearn more on own risk.
We'll give that link to thatemergencyscorapp.
com.
My clinical work right now isthe mobile sedation service,
(32:47):
where I provide sedationservices for dentists and
families, as well as the riskmanagement company that we
talked about, blue Pacific.
It's just a way to deliver onour mission to help keep
practices safe and life safe, soI think that's the best way to
go about it.
Deb Tauber (33:02):
Thank you, Perfect, thank you.
Thank you for sharing and happysimulating.
Dr. Richard Marn (33:08):
Thank you.
Disclaimer/ SImVS ad/ In (33:09):
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(33:31):
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Welcome to The Sim Cafe, apodcast produced by the team at
Innovative Sim Solutions, editedby Shelly Houser.
Join our host, deb Tauber, andco-host Jerrod Jeffries as they
(01:11):
sit down with subject matterexperts from across the globe to
reimagine clinical educationand the use of simulation.
So pour yourself a cup ofrelaxation, sit back, tune in
and learn something new fromThe Sim Cafe.
Deb Tauber (01:33):
Welcome to another episode of The Sim Cafe.
Today's guest is Dr RichardMarn, a board-certified
anesthesiologist and pediatricanesthesiologist with over two
decades of experience in patientcare, medical education and
simulation-based training.
He's the founder of BluePacific Medical Simulation.
(01:54):
Dr Marn has worked in topinstitutions like Mount Sinai
and now specializes in pediatricdental anesthesia across New
York.
He's here to share his insightsfrom his unique medical journey
and how he's helping shape thefuture of healthcare education.
Thank you, dr Marron, and yousaid that I could call you
(02:15):
Richard, so I will call youRichard.
Unfortunately, Jerrod is notgoing to attend this episode
today, so it's just going to bethe two of us, but we've got a
lot in common and I'm lookingforward to it.
So why don't you tell ourlisteners a little bit about
yourself?
Dr. Richard Marn (02:29):
Well, thanks for having me, Deb.
So yeah, I'm a board-surfer.
Anesthesiologist, pediatricanesthesiologist.
I live in the New York metroarea and I specialize in
pediatric dental sedations.
I basically have two main waysto deliver.
Safety for dental world is oneis the mobile sedation service
that I do, as well as a riskmanagement company called Blue
(02:50):
Pacific Medical Simulation,which essentially improves,
addresses team alignment forwhen it matters the most.
So we help improve the teamalignment that is stress tested
for medical and sedationemergencies, and so that's kind
of like where I am right now.
Deb Tauber (03:07):
Thank you and Richard.
How did you get involved withthis?
What started you down this path?
All of a sudden, you'rethinking dental emergencies.
How did you come up with that?
Dr. Richard Marn (03:17):
It was in a direct linear route here.
So I guess it kind of startedwhen I was.
I mean, I didn't even want tobe an anesthesiologist, Deb, I
wanted to be a surgeon way backwhen, but anyway.
So I was at Mount SinaiHospital, I had finished my
training at NYU and JohnsHopkins and my first job was at
(03:39):
Mount Sinai Hospital Thank you,David Rich who was the chairman
at the time and I spent 11 yearsthere and during that time I do
my traditional medicalpediatric sedation and
anesthesia cases tonsils,adenoids, circumcisions and such
, and some liver transplants andcraniotomy and premature kids.
(04:01):
But we'd also do in the hospitalgeneral anesthesia for
pediatric dental cases and thesekids who had needed full mouth
rehabilitation so they have like10, 8, 10, 12 cavities and
they'd be under anesthesia forone, two, three hours for their
care.
And my wife is actually apediatric dentist and so we do
(04:23):
cases together and the topicwould come up hey, why don't we
consider start doing cases inher office?
And so I really wasn'tcomfortable for that until maybe
about 10 years or so after Icut my teeth in academic
medicine and then about 11 yearsat Mount Sinai, I left academic
medicine and went to privatepractice with the goal of
(04:44):
helping what I thought was anunderserved community, if you
will, for in-office dentalsedations in the New York area.
And so that was back in 2016 iswhen I left Mount Sinai, and
I've been trying to address thatsince then, and so that's kind
of how I got into dentalsedation.
So my wife was my first client,if you will.
So she's kind of like my bossat work and at home and then and
(05:09):
so, yeah, that's how I got intothe dental world.
Deb Tauber (05:14):
Well, thank you, and I was really interested in
hearing your story and hearingwhat you're doing.
I remember back in the 80s whenI worked in the emergency
department I will never forget Ihad taken care of a young woman
.
She was probably mid between 25and 30.
(05:34):
And the dentist had given herVersed and Talwin intravenously
and she went into full arrestairway.
And she went into full arrestairway, stopped breathing and,
uh, they brought her into theemergency department and I'll
never forget this.
I was just, you know, 25, maybe26, myself taking care of this
(05:56):
woman and we were unable toresuscitate her and it was just
it left.
It just left.
You know something inside of me, something Something like how
could this, how could thishappen?
Right, but you know, you knowthis does happen.
This still continues to happenwith airway compromise, and are
we taking all the precautions weshould?
Dr. Richard Marn (06:18):
Right, right and unfortunately this is.
You have to kind of livethrough that, that situation.
This is.
You have to kind of livethrough that situation.
I tell dentists and dentalteams that the one event in all
that they do whether it'sclinical care in their dental
office, whether it's dealingwith patient complaints, whether
it's trying to keep up with thelatest regulations or CE
(06:42):
knowledge in their dental worldor making sure they make payroll
the one singular event thatwill shatter their practice, put
them under regulatory light intheir dental world, affect staff
morale, possibly even decreaserevenues and provide for
terrible reviews, is a medicalor sedation emergency that goes
(07:03):
wrong.
One event, and that will takeplace within a course of
literally minutes, that willliterally bring your practice to
a halt, more than any othersituation that they can think of
.
The way I look at it is youwant to be prepared for that.
Not just you, the whole teamneeds to be prepared for it, and
(07:24):
so the reason I got into it isbecause you know I'm doing
sedation for my dental clients.
You know dentists, oral surgeons, pediatric dentists and my wife
one day brings up this articleabout a bad event and she says
you know, I think this needs tobe addressed in my dental right.
I don't think it's properlyaddressed.
So you know, I honestly this isaround 2021, 22.
(07:48):
And I didn't know much,honestly, I didn't know much
about it, but I started lookinginto it and it is really a
problem bigger than we realizeBecause the late press you get
some late press that comes outin these catastrophic events,
but it's a much bigger problem.
So the data points to the factthat about one person per day in
(08:10):
this country one person per daydies due to a medical event
that starts in a dental practiceDies.
Okay, so that's about 350people per year.
The near misses account forabout five to eight times that
number.
So that's when you account fornear misses and actual deaths,
(08:31):
that's about three 4,000 events,not events people in this
country per year that are goingthrough that and that has a
trickle effect on the patientbut also the dental team and
their practice.
And so I said I must be in aposition to help address this.
And that's where I startedlooking into therapy, medical
(08:55):
simulation and how that canaddress this problem.
And eventually that led me toCenter for Medical Simulation
and I took their training.
I eventually became one oftheir adjunct faculty and I
teach basically what I teach atthe Harvard Hospitals through
Center for Medical Simulation tothe dental practices not only
(09:15):
that I work with, but any otherpractice that wants to learn
about this, and we're still kindof a young, young organization
in the risk management realm,but the mission is to improve
safety systems that protectlives and practices so that, you
know, no one dies, especially achild, in a dental office, ever
again.
Deb Tauber (09:35):
Right.
Dr. Richard Marn (09:36):
And so that's, that is what kind of led me to
where I am right now from thisrisk management simulation
standpoint.
Deb Tauber (09:44):
Right, I think you're looking at high risk, low
frequency events but I know now, even to this day, when I go to
the dentist, I get so anxious Ithink, oh my gosh, what if my
airway occludes, what if theyknow?
What if they?
I don't know, I just can't,can't stand being there.
Dr. Richard Marn (10:05):
Well, I think, the way I look at it, it's like
it's a numbers game.
You're most people would dolike they do thousands upon
thousands of cases every everyday across the country without
event.
And so what you have to do isyou look at the high risk groups
country without event.
And so what you have to do isyou look at the high risk groups
.
So the high risk groups formedical emergencies that go
(10:25):
wrong, when you really look atthe data, is typically going to
fall into the extremes of age.
So the young or the very old,or even just children.
So 12 and under, choose somearbitrary number but basically a
child or young adult tosomebody in their elderly age
60s, 70s, 80s or up, especiallyif they have underlying health
(10:46):
issues.
So that's number two.
Right, if they have underlyinghealth issues.
Number three is sedation.
Sedation seems to be a verystrong risk factor for these
emergencies in their office.
So people who don't really fallin those categories.
Yes, could emergency happen?
Yeah, of course it can happenwith any patient, but those are
really the strong risk factorswhen you actually look at some
(11:08):
of these reports in the dentalworld.
So I don't want you to feellike you should be too anxious,
deb, because I don't think youshould be, but I think it's
smart to be cognizant and aware.
That is your wellbeing properlycared for.
Have the dental team thoughtabout contingency plans should
you get a little bit too muchepinephrine in the local
(11:30):
anesthesia you give or you startto get an allergic reaction or
God forbid an anaphylacticreaction to one of their
supplies that they're using totreat the teeth Right right.
And also you could get ananaphylactic reaction to some of
the local anesthesia they getas well.
So, yes, it's always a riskfactor and so, again, we're
trying to address my team and Iare trying to address what we
(11:53):
see as a gap in theirpreparedness.
Deb Tauber (11:55):
No, I appreciate that.
Let's talk a little bit aboutthe current state of the dental
industry.
The beehive versus the lungwhat does that mean?
Dr. Richard Marn (12:05):
So for a long time I was trying to envision
what I couldn't put my finger on.
It.
Like, the way the dentalindustry prepares for a medical
emergency is very different thanwhat I'm used to in the
hospital setting.
It's very different than whatI'm used to in the hospital
setting.
So if you look at the medical,typical medical response in a
(12:27):
medical for a medical emergencyin a hospital setting just an
average hospital it's a veryteam-based approach and
especially the top tierhospitals where they use
simulation a lot, there's athere's this team alignment that
they they have.
That's that's very clear.
Like, for example, someoneknows what their airway, who's
responsible for the airway chestcompressions.
Leadership.
There's communication.
There's useful use of resources, very good use of crisis
(12:50):
resource management, crm.
Not to say everybody's perfectno, medical emergency management
is perfect but there'sdefinitely this sense of
teamwork.
And, by the way, if someonecan't perform that chest
compressions or airwaymanagement or IV placement,
someone comes in and takes overthat role, much like a beehive
right.
If somebody is not performingin that role, most teens I have
(13:14):
seen in most hospitals are ableto adjust on the fly and perform
well to help keep that patientalive as best as possible.
There's a sense of teamwork.
In the dental industry it's muchmore of a top-down approach and
it comes from the mentalitythat I feel a lot of dentists
(13:36):
have and I think this isindustry-wide and this idea that
me, as a dentist in in mypractice, has to do everything
on my own If there's a medicalemergency.
I have to remember what to doin an anaphylactic reaction.
I have to remember all the drugnames, the drug dosages.
I have to tell people what todo.
I have to tell them to call 911.
I have to tell them to drop themedications.
(13:57):
I have to tell them to drop themedications.
God, I have to drop themedications, I'm going to have
to do everything.
And this idea that they have tocarry this burden on their own,
I hear it in their voices.
They say I don't know what todo in an emergency.
I have to feel like I have to.
They literally say I feel likeI have to do everything on my
own Because they don't know how,or they haven't been taught how
(14:22):
, to utilize their team,leverage their team in those
critical moments, because it'snot taught in the dental world.
It's not taught.
They think basic life support,bls, cpr is enough.
They literally say, well, Imean, I have BLS.
Well, not to say that's notimportant, that's very important
(14:42):
.
But quite frankly, if you haveto use BLS, something went wrong
.
There could have been somethingthat before that happened, so
you never got to BLS.
Bls, to me, is your last skillset you want to use.
There's all these little thingsalong the way to potentially
delay the use of BLS or preventit from even happening, because
(15:06):
we already know out of hospitalCPR life expectancy outcomes are
very poor it's like what?
10%.
So we don't want to count onthat as a skill set.
And so what can you do inadvance of that to either delay
that from happening until 911does come and help you out or
other resources come and helpyou out, or what can you do to
(15:26):
again negate that from evenhappening at all.
And so again, that's where wetry to help people kind of
recognize that.
But again, that's a differencein mindset and mentality, the
sense that I have to doeverything on my own and
therefore I have to learneverything on my own.
And therefore this idea that,oh wait, we'll figure it out as
a team, but they don't know howto bring their team together
(15:49):
because they have not actuallyaligned their team in prior to
that event.
Deb Tauber (15:54):
Well, I mean, I think, if you think about I love
baseball, I love watchingbaseball, and you think you know
other professional sports.
Football is a little rough forme to watch sometimes, but
counts where lives are on theline.
Have we practiced?
Have we prepared?
For game day.
Dr. Richard Marn (16:26):
Agreed, agreed , and I will tell you medical
emergency sedation, emergencypreparedness and readiness is
not top of mind.
These are dentists that youknow, honestly.
They come in, they do theirclinical work and they want to
clock out at five o'clock.
They're done.
They literally tell me that,hey, you know this is going to
go, this is going to happenafter what time, and that's OK.
(16:48):
But this is not top of mind.
They're worrying about makingsure their patients are happy,
making sure they're doingclinical care, making sure
they're keeping up to date withtheir clinical knowledge, making
sure their staff is happy.
If their practice ownerspayroll regulations, I mean,
that's on their mind, I get that.
So, therefore, how can youintroduce what this is an
(17:11):
important topic into theirpractice and that is a bit of a
challenge how can you honestlychange the culture?
They're thinking that teamworkneeds to be a priority for these
crisis, versus thinking thatdentists have to do it on their
own?
Deb Tauber (17:24):
Yep, yep.
What are the four pillars ofsedation?
Emergency readiness that's agreat segue.
What are the four pillars ofsedation?
Dr. Richard Marn (17:29):
e That's a great segue.
So when I was looking atpreparedness and readiness for
emergencies, I was trying tostruggle to put it into
categories and these fourpillars or categories I found is
what you need.
It is essential in bestpractices I believe in dental
sedation, emergency readiness.
(17:50):
In best practices, I believe indental sedation, emergency
readiness.
But I also found that this isprobably holds true with really
any medical emergency, no matterwhere you're at.
So the four pillars, I'll justname them and then kind of talk
about them separately, if that'sokay, deb.
Yeah, all right.
So first is infrastructure,number two is competency, number
three is culture, number fouris habit.
Deb Tauber (18:12):
Yeah.
Dr. Richard Marn (18:14):
I think that addresses all the issues.
So what is infrastructure?
Infrastructure is the physicaltools and items or the
facilities that you're at.
Does it support your ability tomanage that medical emergency?
All right, so I came up withthis acronym.
Right, it's called MESV,m-e-s-v Medications, equipment
(18:36):
supplies, visual aids orcognitive aids.
Okay, that's what we all need.
Then there's also the physicalrealm with which you live in.
Is there ingress, egress?
Does 911 get into?
Can they get into your facilityor not?
Do you have a proper lighting,you know?
Is there enough space to workin that space should a medical
or sedation emergency happen?
(18:56):
I'll give you an example of whythat's so critical.
A few years ago there was aoral surgery practice that had a
sedation emergency on anelderly woman on, like I don't
know, their eighth floor, 16thfloor of their practice.
There was a delay in 911showing up because they went to
the wrong floor.
And then, when they got to thewrong floor, they went to the
wrong door.
(19:16):
Thank God, someone eventuallyescorted the 911 to the right
door, but that delayed care.
That delayed care.
Because the infrastructurewasn't set up properly.
No one thought about that.
Okay, so that's number oneinfrastructure.
(19:38):
Number two is competency.
Now, competency is kind of whata lot of us tend to focus on
and, quite frankly, the dentalindustry tends to focus on the
first two a lot.
So competency in the dentalworld is like BLS, cpr, acls,
pals.
It's kind of going to yourtypical one hour seminar and
reviewing anaphylaxis or MIs orseizure management.
It's competency, but in thereit's also competency.
(20:02):
Does your team know how to usethe tools that you actually have
in your infrastructure?
Do they know how to use whatyou actually have?
And there's sometimes adisconnect between competency
and infrastructure.
People assume that just becauseI have it, I know how to use it
.
And unfortunately, a lot ofthese dental offices, when we go
to them for the first time andwe actually go through a
simulation, they have theseemergency kits, these pre-made
(20:25):
health kits that have some basicmesvie in it.
You know an ambu bag and a maskand epinephrine and Benadryl
and such.
I kid you not, it is sometimesthe first time they're open in
it and it's still in the wrapper.
I literally there are EpiPensthat are literally in a wrapper.
They've never even opened it,and thank God we do this
(20:47):
simulation practice because itallows them to actually have
their hands on with theinfrastructure, the equipment,
the supplies, the medicationsfor the first time, as opposed
to, as you know, during anemergency.
Deb Tauber (20:59):
Right, that's ideal.
Dr. Richard Marn (21:00):
Right.
So now, in that competency isnot only just the individual
skills but also the teamworkskills.
Do they have teamworkcompetency skills?
Do they know how to assignroles?
Do they know how to call forhelp?
Do they know how to assignroles?
Do they know how to call forhelp?
Do they know how to assignleadership or take on leadership
that takes practice?
So that's again competency.
It's more than just I know CPR,again, even anesthesiologists.
(21:23):
It's more than, oh, I know howto give drugs.
All right, well, do you knowhow to communicate with your OR
team and do you practice that?
Have you been taught that?
Okay, so that's competency.
Number three culture.
Do you have a culture that insome way, this addresses
teamwork?
Do you have a culture thatallows for your teamwork to
(21:45):
perform at a high level?
So, do you actually have a bigpsychological safety?
That's a big one, right?
I know a lot of us talk aboutthis in simulation.
World is an area, of course,that is extreme importance.
But putting it into practiceand actually practicing is
another item, right?
It's one thing, knowing about,it's another one on executing on
(22:06):
it.
So, culture, shared mentalmodel is another aspect.
Do you have that shared mentalmodel?
Another aspect.
Do you have that shared mentalmodel?
Do you know how to communicatethat shared mental model when a
crisis happens?
So that's the cultural aspectof teamwork Because, as we know,
if someone doesn't know how tospeak up and they think the
dentist will know everythingbecause they talk about how they
have to manage everything ontheir own if the pulse oximeter
(22:27):
is not reading correctly andmaybe it fell off, but the
dental assistant doesn't want tospeak up because they don't
feel psychologically safe to doso, or they think that, oh, the
dentist will figure it out, I'mnot going to say anything,
they're not going to speak up,and so that's something that
needs to be addressed, of course, and that's the cultural aspect
(22:49):
of it.
The number four is habit.
I mean, I think it seems that'sself-explanatory, but again,
it's one thing to talk about,one thing to execute, and the
idea is have you madepreparedness and readiness for
an emergency a habit?
The habit that a lot of dentalteams have is oh, we have our
(23:10):
habit of every two years doingBLS.
Yeah, that's their habit,because, honestly, that's how
the dental industry as a wholekind of looks at it.
Yes, there's some niches, suchas the oral surgery, where there
are state requirements, tellingthe people that do sedation in
dental office that you have todo a little bit more, the people
that do sedation in dentaloffice that you have to do a
little bit more.
(23:30):
It's more, how should I say?
It is still not a strong habitfor the majority of dental
practices, even the ones that dosedation.
And so the habit is do you makeit a habit in your practice,
whether it's on a daily, weeklyor monthly or even a quarterly
or yearly basis, and what arethose habits and does your team
(23:50):
participate in that habit aswell?
It's not just, oh, more burdenon your dentist.
How can we offload some of thatburden so your team can support
you during a crisis?
So those are the four pillarsand, as I mentioned, a lot of
the dental team just kind oftends to focus on the first two,
and really it's the fourpillars that really prepare you
(24:10):
for those emergencies.
I mean, if you look, deb, atthe best teams, right, the teams
that are in lay press, right,the Navy SEALs, the Formula One.
When you look at Delta teams,or you look at the top
responding teams in any medicalfacility, all right.
Or you look at I also look atother safety systems as well,
(24:31):
whether it's like engineering ornuclear power or even other
automotive industry, oh, airlineindustry, they essentially do
these four pillars.
They are addressing these fourpillars in their own way.
I'm just kind of looking atthat and trying to say, okay,
how can we take those fouressential pillars and address
them in the dental world andmake sure they're addressed?
(24:53):
But that's what all these bestteams do.
Deb Tauber (24:57):
I want to say there's even a handful of dental
programs that have beenaccredited by the Society for
Simulation in Healthcare.
Their programs have actuallygone the distance to recognize
how important and how valuablesimulation is and being prepared
.
Dr. Richard Marn (25:15):
Do you know the names of those organizations
?
Deb Tauber (25:18):
Not off the top of my head.
Okay, all right, thanks.
Dr. Richard Marn (25:21):
I'd like to learn more about that.
We can talk about that later on, but I think that's definitely
the step in the right direction,you know, and hopefully it's
more than just checking offboxes the right direction, you
know, and hopefully it's morethan just checking off boxes,
right, absolutely Checking offboxes.
Deb Tauber (25:39):
Now, how do you think dental and oral surgery
can get better prepared forsedation emergencies.
Oh well, there's two simpleways, right?
I already talked about how youknow when we do simulations, deb
right, and we can make it likea small little micro simulation,
or it's like a half day or fullday.
Yep, that's a big ask for adental team new to sedation
(26:01):
readiness or medical emergencyreadiness, right.
And so for me and also keep inmind my wife's a pediatric
dentist they have a lot of otherthings they have to worry about
, and so how can we introducethis Still important, but how
can we introduce it so itdoesn't become another burden to
them, and so what I usuallyrecommend is start small, and so
there's two things I usuallyrecommend.
(26:24):
One is assess your current risk,and so I actually developed an
online tool.
It has about 20 questions or so.
It takes eight minutes, maybe10 minutes to take, and what it
is.
These questions address each ofthe pillars I just talked about
, and it helps you to as adentist, when you go through it.
(26:44):
It helps the dental team.
It could be the dentist, couldbe the hygienist, could be the
office manager Literally.
Take it and see where you scorein each of the four pillars,
and then also get a cumulativescore.
Furthermore, if you complete it, we send you a PDF and it's
like 10 to 15 pages, and what itis?
It gives you recommendations onhow you could address some of
(27:06):
your weaknesses in those fourpillars.
And I'm sure there's a lot of low hanging fruit
because again, you mentionedhabit.
People just get into these youknow habits and they're
overlooking things that arereally simple, and so it sounds
like by taking your assess, yourrisk test, you can find out
what some of those things areand implement them easily.
Dr. Richard Marn (27:29):
Yeah, yeah.
And if you take the scorecardand, by the way, it's free, it's
online I'll give it to you alink as we can put the show
notes.
It's actually emergencyscoreapp.
com Very professional, Looksgreat.
You can actually trend, see howyou do.
You take it now, do it sixmonths later after you execute
on some of the actions and seeif you actually improve your
score.
Even you can see theirperspective of how they think
(27:57):
your team is prepared for aemergency not just you as a
dentist.
I do want to highlight it's aonline scorecard that initially
was designed for pediatricdentists who do sedation, but
it's really.
The principles are the same.
Anybody could take it.
As long as you're a dentist andyou're worried about medical
emergency preparedness, it stillapplies.
(28:19):
So that's, that's just ameasurement tool.
It's not perfect, but it getsyou in the right mindset and
framework and gives you theideas to start getting not just
you but also the dental teamprepared for a medical emergency
.
The second thing talk aboutlow-hanging fruit is I usually
recommend start with a simplehuddle.
It doesn't cost anything buttime.
(28:40):
Do it once every day, Do itonce a week as a topic.
I mean, if you have huddlesevery day, great, but you don't
have to necessarily do thisevery day.
You may want to do it initially, but have a huddle where you
literally bring up the topic, ifyou're a dentist and just ask
hey what are we doing?
(29:00):
great right now for a medicalemergency.
What do you think we're notprepared for?
Right, you can do a little plusdelta if you really want and
really just kind of get thepulse of your team.
And I would say, havingrecommended this, the team has a
lot of insights that thedentist does not have, and
(29:22):
simply having that starts aconversation.
You're starting to create somepsychological safety by even
asking your team their thoughts,and that's easy.
That takes literally fiveminutes for one huddle just to
get the conversation going andit will reveal a lot.
Deb Tauber (29:37):
But it gets back to habit.
So if you get in the habit ofdoing it, you're going to be
breaking the barrier, you'recreating a psychologically safe
environment, you're creating ashared mental model for
improvement and to think aboutwhat's the worst thing that
could happen and how would we beprepared for it.
Dr. Richard Marn (29:53):
Yeah, and simple things.
You don't need a fancy degreefor this type of huddle.
It's really like, hey, what iseverybody's thoughts?
Should we have a medicalemergency?
And once you get through thatemotional like, oh my goodness,
okay, well, what would you do?
What do you think your rolemight be?
And again, you don't need tobring someone like me into to do
(30:21):
that.
That's a simple thing to getthings started and then you know
, once you get momentum, thenyou can start thinking as a
dentist hey, what else can we do?
How can we get to that nextlevel?
Deb Tauber (30:29):
yep, absolutely now.
We're getting ready to wrap upright now.
Um so, when you look back atthis phase of your life and
career, what are the coreachievements you'd hope to be
remembered for?
Dr. Richard Marn (30:40):
Ah well, I would just simply put it.
If I could break it up in twoparts, deb, I would say
personally, I would just saythat I was a good dad, a good
father, good husband, goodspouse and supportive, and it
was present for them.
You know, that is important.
I think that gets lost in ourprofessional life, but that is
(31:01):
important, very important to meand professionally that I
actually had some impact.
I actually could save a life.
You know, the one thing aboutbeing an anesthesiologist is an
anesthesiologist can do greatwork.
We can literally as someoneputs it, we literally put
someone close to death with ourmedications and our skillset is
(31:22):
bringing someone back right.
A lot of people can drug drugs.
The question is do you have theskillset to bring them back
after you've given those drugs?
Right?
That's, in a very nutshell,what an anesthesiologist does.
But I want to make sure I'mtrying to make an impact beyond
just me, right?
I want to make an impact beyondjust one-to-one and that's what
I'm hoping that if I can havean impact that saves lives
(31:46):
beyond my direct clinical care,that would be awesome, that you
can put in my gravestone,besides being a fantastic spouse
and father and dad.
So I think that's what I'd liketo kind of leave with.
Deb Tauber (32:03):
Thank you.
Thank you so much.
And if our listeners want toget a hold of you, where would
they reach out?
Tell us a little bit more aboutyour company.
Do a little plug for Sure.
Dr. Richard Marn (32:15):
Number one, I mean, if you want to connect,
look me up on LinkedIn.
I'm the only Richard Marn Ibelieve on the planet.
And number two you can alsolearn more on own risk.
We'll give that link to thatemergencyscorapp.
com.
My clinical work right now isthe mobile sedation service,
(32:47):
where I provide sedationservices for dentists and
families, as well as the riskmanagement company that we
talked about, blue Pacific.
It's just a way to deliver onour mission to help keep
practices safe and life safe, soI think that's the best way to
go about it.
Deb Tauber (33:02):
Thank you, Perfect, thank you.
Thank you for sharing and happysimulating.
Dr. Richard Marn (33:08):
Thank you.
Disclaimer/ SImVS ad/ In (33:09):
Thanks to SimVS again for sponsoring
this week's episode.
To learn more about their newIV infusion pump simulators,
check out www.
simvs.
com.
Thanks for joining us here atThe Sim Cafe.
(33:31):
We hope you enjoyed.
Visit us at www.
innovativesimsolutionscom and besure to hit that like and
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