The rationale for studying resuscitation readiness in dental settings is more compelling than it might first appear. Cardiovascular disease remains the leading cause of death in Iran, accounting for nearly half of all fatalities, with ischemic heart disease alone responsible for roughly a quarter of deaths. Although medical emergencies in dental clinics are uncommon, they do occur, sometimes among patients, sometimes among dentists and staff, and sometimes among accompanying companions. Previous research has quantified the risk: in the United States, the annual incidence of cardiac arrest in medical and dental practices has been estimated to range between 0.008 and 1 per 133 practitioners, while the United Kingdom reports an incidence of 0.002 per dentist per year. In Germany, 57 percent of dentists report encountering at least three medical emergencies annually. These figures, while modest, underscore a simple truth: dental offices are healthcare environments, and emergencies can and do happen there.

What distinguishes the new study from earlier surveys is its scope. Most prior investigations focused exclusively on dentists, overlooking the assistants and office secretaries who might be the first to recognize a collapse, call for help, or begin chest compressions. Because all members of a dental team are healthcare providers who should be capable of performing basic life support, the researchers designed a cross-sectional survey covering the entire team. Between October 2021 and April 2022, they sampled clinics and offices across Isfahan, the largest city in central Iran, using stratified simple random sampling that divided practices by type, public versus private, and by geographic district, then selected clinics at random within each stratum to minimize selection bias.

The instrument itself was built for rigor. A 27-item structured questionnaire was developed by emergency medicine faculty, each with more than a decade of experience running CPR workshops, and aligned with the American Heart Association’s 2020 guidelines. It covered three domains: demographic information, nine items of theoretical and practical CPR knowledge, and fourteen items on attitude and experience, including prior exposure to cardiac arrest, workshop participation, and willingness to pursue future training. A pilot study of 20 dentists, excluded from the main analysis, confirmed clarity and reliability, with Cronbach’s alpha values of 0.82 for the knowledge domain and 0.79 for the attitude domain, both within the accepted range for psychometric consistency. Ethical approval came from Isfahan University of Medical Sciences, and written informed consent was obtained from every participant.

The findings were stark. Of 201 valid responses, including 101 dentists representing an 81 percent response rate among those approached, the median CPR knowledge score was just 3 out of a possible 9, with a mean of 2.61 and a standard deviation of 1.75, and the distribution of scores was positively skewed, clustering heavily at the low end. Participants had a mean age of 31.75 years, and 62.2 percent were female. Only five participants, 2.5 percent of the entire sample, had ever encountered a cardiac arrest in dental practice, and just eleven individuals, 5.5 percent, reported having personally performed CPR. Perhaps most striking, only 12.9 percent had attended a CPR workshop in the previous two years, and a mere 13.4 percent considered themselves competent to perform resuscitation at all.

Buried within the data was a counterintuitive and potentially important pattern: knowledge declined with age and experience. The analysis revealed a significant negative correlation between dentists’ age and CPR knowledge scores (r = −0.184, P = 0.009) and between years of professional experience and knowledge (r = −0.231, P = 0.020). This mirrors a finding from Kuwait, where younger dentists and those with fewer than ten years of experience outperformed their senior colleagues, but it contradicts studies from India and among oral and maxillofacial surgeons in which experienced practitioners knew more. The authors propose a plausible explanation: most participants in the current study had not received recent refresher training, so whatever knowledge older dentists once acquired has simply eroded. They also caution that recency of formal education may confound the relationship, since younger graduates may have been trained under more current guidelines, and they recommend that future studies control for graduation year and timing of the last CPR course.

The strongest positive signal in the data came from training itself. Dentists who had participated in CPR workshops within the past two years scored significantly higher on the knowledge assessment than those who had not (P = 0.007), a result consistent with findings from Iran and Kuwait, and one that aligns with the well-documented kinetics of skill decay: theoretical knowledge declines markedly within about 12 months, and practical competence deteriorates substantially after 18 months without reinforcement. Encouragingly, the appetite for remediation is already there. A striking 84.1 percent of respondents said they wanted to attend future CPR workshops, and among dentists specifically the figure exceeded 88 percent. Gender, meanwhile, made no measurable difference in knowledge scores (P = 0.124).

The study’s limitations are acknowledged candidly by its authors. Competence was measured only through a self-administered questionnaire, capturing theoretical knowledge rather than hands-on skill, and no simulation-based practical testing was performed. The cross-sectional design, the single-city setting, and the sample of 201 participants restrict causal inference and generalizability, and self-reported data are always vulnerable to recall and social desirability bias. Non-response was analyzed as a potential source of bias and appeared minimal, with no significant differences between respondents and the 19 percent who declined, most commonly citing lack of time or lack of interest. Still, the convergence of these findings with an international literature spanning Brazil, India, Turkey, Kuwait, and earlier Iranian surveys, which found, for example, that only 37 percent of Iranian dentists in a 2007 study possessed adequate CPR knowledge, strengthens the conclusion that preparedness deficits in dentistry are systemic rather than local.

The implications reach beyond clinical performance into patient safety and law. Previous reports have documented deaths from cardiopulmonary arrest occurring in dental settings, and inadequate resuscitation capability carries potential legal consequences for practitioners, alongside the more intangible costs of insecurity among dental teams and eroded patient trust. The authors argue that a single CPR course, however well taught, is not enough, and they call for mandatory, periodic CPR training woven into both undergraduate dental curricula and continuing professional education, explicitly extending the requirement beyond dentists to assistants and office staff. Given the strong expressed willingness of the workforce to train, they note, structured recurrent programs are not only medically necessary but entirely feasible. In a field where minutes decide survival, the study’s central message is hard to ignore: readiness must be renewed, not assumed, and the whole dental team, not just the person holding the drill, must be ready to act.

Subject of Research: Knowledge and attitudes toward cardiopulmonary resuscitation among dental teams in Isfahan, Iran

Article Title: Life-saving skills in dentistry: knowledge and attitude toward cardiopulmonary resuscitation among dental teams

Article References: Heydari, F., Nasr Isfahani, M., Masoumi, B., Esmailian, M., Khosravi, H., & Nasr-Esfahani, M. (2026). Life-saving skills in dentistry: knowledge and attitude toward cardiopulmonary resuscitation among dental teams. Journal of Emergency and Disaster Medicine, 2(1), Article 15. https://doi.org/10.1007/s44467-026-00018-9

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00018-9

Keywords: cardiopulmonary resuscitation, CPR, basic life support, dentistry, dental teams, cardiac arrest, emergency preparedness, medical emergencies, dental education, Iran, American Heart Association guidelines, continuing professional development

The mixed-methods study was conducted at NPHA between February and August 2025, three years after the agency was established under Sierra Leone’s National Public Health Agency Act. Researchers invited all 214 employees to complete a structured readiness survey, and 180 responded, an 84.1 percent response rate. The survey assessed 11 domains on a five-point scale, including surveillance, laboratory systems, information management, risk communication, emergency operations, logistics, emergency finance, coordination and two distinct workforce areas: internal human-resource management and outbreak surge capacity. The researchers also conducted 28 interviews with key informants and four focus-group discussions involving 32 participants. Staff were selected across senior leadership, technical and programme roles, operations and finance, and district-facing positions. Finally, the team reviewed institutional and operational records covering a 12-month period. This convergent design allowed perceived readiness to be compared with administrative evidence and with descriptions of how decisions, personnel, money and supplies moved through the emergency system.

Overall perceived readiness averaged 2.8 out of 5, with a standard deviation of 0.7; only 30.4 percent of respondents rated overall readiness at four or five. Internal human-resource management received the lowest score, averaging 2.1, and just 12.8 percent of staff gave it a high rating. By contrast, coordination with partners and the Ministry of Health averaged 3.6, surveillance and early warning 3.4, and risk communication 3.1. Workforce and surge capacity averaged 3.0, placing it above internal human-resource management. The distinction between these domains was central to the analysis. Surge capacity refers to the people and arrangements available to expand response during an outbreak, while internal human-resource management includes recruitment, induction, performance appraisal, career development, retention, payroll integration and routine personnel information systems. An agency may therefore possess trained responders and still lack the organisational machinery needed to recruit replacements, document responsibilities, support professional development or retain experienced staff after a crisis has passed.

Administrative records reinforced the survey results. NPHA had 214 employees in post against an approved establishment of 286 positions, an overall vacancy rate of 25.2 percent. The gaps were particularly pronounced in functions exposed to operational delays: finance and procurement positions were 60.0 percent vacant, district-facing posts 51.4 percent vacant, and human-resource and administration posts 44.4 percent vacant. Technical and programme positions were comparatively better filled, at 82.2 percent. Among 41 people appointed during the preceding year, only 13 had a documented induction record. The median interval from vacancy approval to appointment was 118 days, while only 13.1 percent of all staff had a completed annual appraisal on file. Updated job descriptions were present in 42.5 percent of personnel files, and documented continuing professional development during the previous year was available for 31.8 percent of staff. These figures suggest that individual expertise has developed faster than the systems needed to maintain and distribute it.

The agency’s response workforce is a significant asset, shaped by investments made after the 2014–2016 Ebola epidemic. Sierra Leone has developed a Field Epidemiology Training Programme, emergency operations infrastructure, electronic disease surveillance and response, laboratory resources and national and district Rapid Response Teams. Staff also carry experience from Ebola, COVID-19 and successive mpox outbreaks. The study found, however, that this strength remains vulnerable because much of it depends on a small, experienced cohort and informal personal networks. A national surge list included 74 staff, but it had not been updated for nine months; documented emergency roles or terms of reference existed for only 43 of those people. Just 26 had taken part in a simulation or drill during the preceding year. At district level, nine of 16 districts had updated Rapid Response Team lists, and five had conducted a documented simulation. The researchers interpret surge capacity as real but only partly institutionalised: staff know how to respond, yet the system does not consistently record who is responsible, how roles should be activated or how readiness should be rehearsed.

This concentration of capability was also visible in the statistical analysis. Technical staff with previous outbreak-response experience had substantially higher odds of reporting strong readiness than would be expected from the separate effects of technical training and experience alone. The adjusted odds ratio for their combined profile was 3.41, with a 95 percent confidence interval from 1.62 to 7.18. In practical terms, experienced technical personnel may be compensating for weak organisational systems through knowledge, relationships and the ability to improvise under pressure. That is useful during an emergency but creates institutional risk if those individuals leave. Of the 24 staff who exited during the preceding year, 15 were technical or programme staff, and 11 departures were recorded as movement to nongovernmental organisations, donor-supported projects or international agencies. Partner- or project-supported employees represented 40.7 percent of the workforce. Researchers say parallel employment arrangements can strengthen short-term capacity while complicating retention, reporting lines, career progression and the development of a unified agency identity.

Finance, procurement and decentralisation created additional delays between recognising an event and acting on it. Emergency financial systems averaged 2.3 out of 5, while logistics and supply-chain readiness averaged 2.4. The median time from approval of an activity to release of funds was 21 days, and emergency procurement took a median of 46 days. Sixteen of 43 reviewed emergency procurements, or 37.2 percent, exceeded their planned timelines. Records also documented seven episodes of reagent or personal protective equipment stockouts, while 18 staff advances required a median of 36 days for reimbursement. The agency’s national coordination was stronger than its documented district reach: only eight districts had designated NPHA focal persons, six had records of surveillance feedback to district teams, and deployment from a district request took a median of three days, increasing to five days for remote districts. These bottlenecks matter because outbreaks begin in communities and districts, whereas authority, financing and much of the coordination remain concentrated in Freetown.

The clearest operational signal came from examining the 7-1-7 framework, which separates detection within seven days of emergence, notification within one day of detection and completion of early response within seven days of notification. Across 12 priority events, the median time from emergence to detection was five days and from detection to notification was one day. Yet the median interval from notification to completion of early response was 18 days. Eight events met the detection target, nine met the notification target and only four completed early response within seven days. Delays were most often associated with specimen transport, laboratory confirmation, release of funds, field deployment, supplies and district logistics. The agency could therefore see and communicate public-health signals faster than it could turn them into completed field interventions. The study’s authors argue that this sequence reveals why legal authority, trained personnel and strong partnerships cannot by themselves demonstrate preparedness. For Sierra Leone and similar emerging public health institutes, durable readiness will depend on building integrated human-resource systems, documented surge roles, emergency financing, faster procurement and district routines that continue to function when projects end or experienced responders move on.

The findings also clarify how preparedness should be measured. A high-level assessment may confirm that surveillance, trained personnel or partner coordination exists, while missing the organisational steps that allow those resources to be activated under pressure. Reviewing personnel files, deployment records, procurement timelines and event histories alongside staff accounts therefore provides a more operational test of readiness. In this case, the agreement between perceptions and routine records strengthens the interpretation that administrative systems were not merely viewed unfavourably by employees; they were producing observable gaps in how the agency functioned.

The interaction between technical expertise and outbreak experience is particularly important for interpreting the regression result. The association does not show that either characteristic causes readiness, nor that experienced technical staff can substitute indefinitely for institutional systems. Rather, it suggests that expertise and practical exposure may reinforce one another, enabling a small group to navigate procedures, contacts and decisions more effectively. That pattern can make an organisation appear more capable during familiar emergencies while leaving it exposed to turnover, simultaneous events or threats outside the experience of its established responders. Readiness testing should consequently examine whether procedures work for less experienced staff, not only whether highly experienced personnel can deliver results.

For emerging public health institutes, the practical implication is to treat routine administration as part of the response architecture. Clear job descriptions, induction, appraisal, maintained rosters, delegated authority and documented district links create the conditions for expertise to be transferred and repeatedly used. These measures are less visible than laboratories or emergency operations centres, but they determine whether those assets can be connected into a timely response. Because this study examined one national agency over a defined period and used perceived readiness as one component of its analysis, its associations should not be treated as universal effect estimates. Its value lies instead in identifying testable institutional mechanisms that comparable agencies can examine through their own records, event timelines and role-specific accounts.

Subject of Research: Sierra Leone’s national public health emergency management capacity and operational capability

Article Title: A study of public health emergency management capacity and capability of Sierra Leone’s national public health agency

Article References: Ikoona, E. N., Namulemo, L., Sinnah, M. M., Vandi, M. A., & Sahr, F. (2026). A study of public health emergency management capacity and capability of Sierra Leone’s national public health agency. Journal of Emergency and Disaster Medicine, 2(1), Article 16. https://doi.org/10.1007/s44467-026-00020-1

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00020-1

Keywords: Sierra Leone, public health emergencies, outbreak response, national public health institutes, health workforce, emergency preparedness, human resource management, surveillance, health systems, public, health, emergency