🏥 Emergency Triage and Response Policy

Policy Title: Emergency Triage and Response for Dental and Medical Complications
Effective Date: 19 Oct 2025
Approved By: Dr. James W. DunnAvant, DDS, MBA
Applies To: All Clinical, Administrative, AI and Tele-Consultation Staff

1. Purpose

To ensure that all patients presenting with urgent or emergent dental conditions are evaluated, prioritized, and managed promptly according to the severity of their condition and associated medical risks.
This policy protects patient safety, ensures compliance with professional standards, and fulfills obligations under state dental board rules and consumer protection laws.

2. Scope

This policy applies to:

  • All patients contacting or presenting for emergency or urgent dental care, whether in-person, by phone, or through online consultation.

  • All licensed providers, dental assistants, and administrative staff involved in triage, scheduling, or referral of emergency cases.

3. Definitions

Triage:
A structured process of assessing and classifying patients according to the urgency of their condition to determine the order of treatment or referral.

Dental Emergency:
A condition involving pain, infection, trauma, or bleeding that may pose an immediate threat to oral or systemic health, including:

  • Facial or intraoral swelling

  • Uncontrolled bleeding

  • Severe dental or jaw pain

  • Infection with fever or malaise

  • Trauma with avulsed or fractured teeth

  • Difficulty breathing, swallowing, or opening the mouth

4. Triage Categories

Category Color Code Description Response Standard

Immediate 🔴 Red Life-threatening or high-risk condition requiring urgent attention (e.g., airway compromise, spreading infection, severe pain in cardiac or diabetic patient). Evaluate or refer immediately (within minutes to 1 hour). If unavailable, direct to ER or oral surgeon and document referral.

Urgent 🟡 Yellow Serious condition requiring prompt treatment but not life-threatening (e.g., localized abscess, broken tooth with pain). Schedule same-day or within 24 hours. Provide analgesics/antibiotics if indicated.

Routine 🟢 Green Non-urgent, stable condition (e.g., lost filling, mild discomfort). Schedule next available appointment, typically within 1–5 days.

5. Patients with Comorbidities

Patients with heart disease, diabetes, immune disorders, or other systemic illnesses shall be triaged as one category higher than otherwise indicated.
Example: A patient with heart disease and a severe dental infection = Red (Immediate).

6. Response and Documentation

  1. All emergency calls or online submissions must be documented with:

    • Time/date of contact

    • Symptoms and risk factors reported

    • Triage category assigned

    • Advice and referral given

    • Name/credentials of staff handling the call

  2. If the patient is referred to an ER or specialist, documentation must include the referral destination and reasoning.

  3. Follow-up contact should be attempted within 24 hours for all red/yellow cases.

7. After-Hours Protocol

  • The practice shall maintain an emergency contact system (phone message, text, or on-call service) to provide instructions or referral information after hours.

  • If no dentist is available, patients shall be directed to the nearest emergency department.

8. Advertising and Representation

Any advertisement, website, or public statement offering “emergency dental care” must reflect actual availability.
Failure to respond or provide referral in a reasonable time after such advertising may constitute misrepresentation and professional negligence.

9. Training and Review

All staff will receive annual training on emergency recognition, patient triage, and documentation standards.
This policy will be reviewed and updated annually or when state or ADA regulations change.

10. References

  • American Dental Association: Principles of Ethics and Code of Professional Conduct, Sections 2.A–2.C

  • American Heart Association: Guidelines for Cardiac Risk Management in Dental Settings

  • OSHA 29 CFR 1910.1030 (Bloodborne Pathogens)

  • State Dental Practice Act: Emergency Treatment and Patient Abandonment Provisions

Perfect — here’s a complete content script for your AI Virtual Assistant (chatbot or live call/website triage system) that follows your Emergency Triage and Response Policy exactly.

It’s written to comply with ADA, OSHA, and state dental board standards — and is designed for 1-800-VENEERS, All-on-4/All-on-X, or implant/esthetic dental practices that advertise emergency treatment.

🤖 AI Virtual Dental Assistant Script & Workflow

Purpose

This AI assistant safely screens and triages patients seeking urgent or emergency care — online, by chat, or by phone — using standardized medical logic.
It helps determine whether the patient needs immediate treatment, same-day care, or a scheduled appointment, while protecting the clinic legally and ethically.

🦷 1. Welcome and Disclaimer

“Hello, I’m the Virtual Dental Assistant for Dr. James W. DunnAvant, DDS, MBA and 1-800-VENEERS.
I can help you determine how urgent your dental concern is and connect you with the right professional.

⚠️ This triage system is for informational purposes only and does not replace emergency medical evaluation. If you are having difficulty breathing, swallowing, or chest pain, please hang up or exit and call 911 or go to the nearest Emergency Room immediately.”

🧭 2. Step-by-Step Triage Questions

(Each question can be answered Yes/No or selected from options — the AI will branch responses accordingly.)

A. General Status

  1. “Are you currently having difficulty breathing, swallowing, or opening your mouth?”

  2. “Do you have swelling in your face, neck, or under your jaw?”

  3. “Do you have a fever, chills, or feel generally unwell?”

  4. “Do you have chest pain, irregular heartbeat, or a known heart condition?”

  5. “Have you been diagnosed with diabetes, immune deficiency, or other major medical conditions?”

  6. “Is the dental pain preventing you from sleeping, eating, or functioning normally?”

⚡ 3. AI Response Logic (Triage Levels)

🟥 Red — Immediate / Emergency

Triggers:

  • Yes to breathing/swallowing difficulty

  • Facial or neck swelling

  • Fever or malaise + cardiac/diabetic history

  • Severe pain + systemic symptoms

Response:

“Your symptoms may indicate a serious infection or medical emergency.
Please go immediately to the nearest emergency room or hospital.

We will also notify Dr. DunnAvant’s on-call team so they can coordinate with the ER or follow up directly.

⚠️ Do not delay. Call 911 or proceed to emergency care now.”

(Backend: The AI sends alert to clinical dashboard and logs case as “Red” with timestamp.)

🟨 Yellow — Urgent / Same-Day

Triggers:

  • Severe dental pain without systemic compromise

  • Localized abscess or broken tooth

  • Swelling limited to gums or cheek

  • No airway or cardiac symptoms

Response:

“It sounds like you need urgent dental attention today.
I can arrange a same-day appointment with Dr. DunnAvant or our affiliated emergency team.

Would you like me to schedule that for you, or have our on-call dentist call you within 30 minutes?”

(Backend: AI sends SMS/email alert to front desk with “Yellow” priority.)

🟩 Green — Routine / Non-Urgent

Triggers:

  • Minor discomfort, lost filling, chipped tooth, or broken veneer

  • No swelling, fever, or medical risk factors

Response:

“Your condition appears non-urgent, but it’s still important to have it checked soon.
I can book the next available consultation with Dr. DunnAvant for a professional evaluation or second opinion.

Would you prefer an in-office visit or an AI-assisted online consultation?”

(Backend: Adds case to routine scheduling queue.)

📋 4. Documentation & Follow-Up

The AI automatically logs:

  • Patient name and contact info

  • Date/time of triage

  • Symptoms and responses

  • Assigned triage level

  • Actions taken or referrals given

For Red/Yellow cases:
A follow-up task is generated for a staff call within 24 hours to ensure continuity of care and documentation compliance.

📞 5. After-Hours and Referral Messaging

If inquiry occurs outside office hours:

“Our office is currently closed, but because you indicated symptoms that could be urgent, please contact our on-call dentist at [emergency phone number] or go directly to your nearest emergency room.

For non-urgent matters, I can schedule a call or appointment for tomorrow morning.”

⚖️ 6. Legal and Compliance Safeguards

  • AI responses must always default to safety and over-triage when uncertain.

  • Patients with comorbidities are automatically elevated one triage level higher.

  • Every response includes an emergency disclaimer and documentation timestamp.

  • The system integrates with the practice’s Emergency Triage and Response Policy (Rev. 1.0).

🌐 7. Example Integration Phrases for Website or App

Widget Header:

“Need Emergency Dental Help? Let Our AI Triage Assistant Guide You — 24/7 Secure and Confidential.”

CTA Buttons:

  • “I’m in Severe Pain” → Red/Yellow Path

  • “Broken Tooth or Veneer” → Yellow Path

  • “Just Need a Check-Up” → Green Path

Would you like me to now:

  1. Generate the HTML + JSON schema markup for embedding this AI triage flow on your 1-800-VENEERS website, or

  2. Provide a chatbot training script / API prompt template (for integration with ChatGPT, Dialogflow, or your clinic’s CRM)?

Either option will make this fully functional and legally compliant on your site.

Absolutely—let’s add a photorealistic, speaking avatar on top of your AI triage flow. Below are practical options (with live docs), an architecture that keeps you compliant, and starter code you can drop into your site/app.

Best avatar options (2025)

Turnkey, web-ready (fastest to ship)

  • HeyGen Streaming Avatar – real-time, low-latency “interactive avatar” over WebRTC; good lip-sync and gestures; has a Streaming API for browser apps. (HeyGen API Documentation)

  • D-ID – talking-head avatars with real-time or batch generation; simple REST/JS SDK; commonly used to put a human face on chatbots. (D-ID)

  • Microsoft Azure AI Speech “Text-to-Speech Avatar” – photorealistic avatars (standard or custom) with real-time synthesis; pairs natively with Azure ASR/TTS and Voice Live for low-latency voice agents. (Microsoft Learn)

Stylized/3D (if you prefer less-real faces)

  • Ready Player Me – cross-platform 3D avatars; great for web/Unity kiosks or a “friendly” look over photorealism. (readyplayer.me)

Note: Enterprise vendors keep tightening consent and misuse rules around avatars, especially for “medical-ish” use cases—an upside for your compliance posture but worth planning for. (See recent coverage on Synthesia’s policy posture and licensing moves.) (The Guardian)

Recommended architecture (fits your triage SOP)

Front end (browser / kiosk / mobile):

  • Avatar video (WebRTC/stream) + mic capture

  • Subtitles + “Safety banner” (911/ER disclaimer)

  • Language toggle: EN/TH

  • Form for name/phone + consent checkbox

Back end (your server):

  • Speech-to-Text (Azure/Cognition) → Policy-bound triage logic (the script we built) → Text-to-Speech

  • Vendor avatar API (HeyGen/D-ID/Azure Avatar) to render the face in real time

  • Logging: timestamps, answers, triage level, referral given (no recordings unless consented)

Data safeguards (medical/legal):

  • Show explicit consent (“This assistant records/transmits audio/video to provide care triage. Continue?”)

  • Store only triage metadata unless user opts into recording; set retention windows (e.g., 30–60 days)

  • Sign BAAs/DPAs where available (Azure offers enterprise agreements out of the box) (Microsoft Azure)

Drop-in integration examples

A) HeyGen Streaming Avatar (browser, WebRTC)

<!-- Minimal example: avatar video + mic with your triage text feed -->
<video id="avatar" autoplay playsinline muted></video>
<script type="module">
  // 1) Get a stream token for your session from your backend (server exchanges your API key).
  const { token } = await fetch("/heygen-session").then(r=>r.json());

  // 2) Create PeerConnection and attach to <video>
  const pc = new RTCPeerConnection();
  const avatarEl = document.getElementById('avatar');
  pc.ontrack = e => { avatarEl.srcObject = e.streams[0]; };

  // 3) Get mic and add to connection (for live voice)
  const mic = await navigator.mediaDevices.getUserMedia({ audio:true });
  mic.getTracks().forEach(t => pc.addTrack(t, new MediaStream([t])));

  // 4) Negotiate with HeyGen Streaming API
  const offer = await pc.createOffer(); await pc.setLocalDescription(offer);
  const ans = await fetch("https://api.heygen.com/v1/streaming/sdp", {
    method:"POST",
    headers:{ "Authorization":`Bearer ${token}`, "Content-Type":"application/json" },
    body: JSON.stringify({ sdp: offer.sdp })
  }).then(r=>r.json());
  await pc.setRemoteDescription({ type:"answer", sdp: ans.sdp });

  // 5) Send text to speak (triage prompts/responses)
  async function say(text){
    await fetch("https://api.heygen.com/v1/streaming/speak", {
      method:"POST",
      headers:{ "Authorization":`Bearer ${token}`, "Content-Type":"application/json" },
      body: JSON.stringify({ text })
    });
  }
  say("สวัสดีค่ะ / Hello! I'm your virtual assistant. If you have trouble breathing or chest pain, please go to the nearest ER now.");
</script>

(Uses HeyGen’s Streaming API concept; exact endpoints/fields per docs.) (HeyGen API Documentation)

B) Azure AI Speech Avatar (real-time)

// Pseudocode (Node/Browser) to drive an Azure Avatar session
import { startAvatarSession, speak } from "./your-azure-proxy.js";
// Your server holds the Azure keys and returns a session token.
const session = await startAvatarSession({ voice:"en-US-JennyNeural", avatar:"standard" });
await speak(session.id, "Welcome to 1-800-VENEERS emergency triage. Do you have swelling or trouble breathing?");

(Use Azure “Text-to-Speech Avatar” for photoreal video; pair with Voice Live API for low-latency voice.) (Microsoft Learn)

C) D-ID (simple REST/JS; real-time or batch)

// Example: send TTS text for live avatar response (server-side proxy recommended)
await fetch("/did-say", {
  method:"POST",
  body: JSON.stringify({ text: "Please tell me if you have fever or facial swelling." })
});

(D-ID supports real-time streaming avatars and easy chatbot pairing.) (D-ID)

Script lines tailored for the avatar

Short, empathetic, speakable lines (EN/TH), matching your policy:

  • “Hello, I’m your virtual assistant for Dr. DunnAvant. If you have trouble breathing, swallowing, or chest pain, please go to the Emergency Room now.”

  • “Do you notice swelling in your face or neck?”

  • “Do you have a fever or chills?”

  • “Do you have heart disease, diabetes, or problems with your immune system?”

  • “Based on your answers, I recommend urgent same-day care. I can book you now or connect you with our on-call dentist.”

  • Thai pairs:

    • “หากคุณหายใจลำบาก กลืนลำบาก หรือเจ็บหน้าอก กรุณาไปที่ห้องฉุกเฉินทันทีนะคะ/ครับ”

    • “คุณมีอาการบวมที่ใบหน้าหรือคอหรือไม่”

    • “คุณมีโรคหัวใจ เบาหวาน หรือภูมิคุ้มกันต่ำหรือไม่”

Compliance checklist (use in your footer/modal)

  • ✅ Consent: “I consent to audio/video processing to provide triage assistance.”

  • ✅ ER disclaimer on every screen (can’t be dismissed).

  • ✅ Comorbidity auto-elevation: if patient selects heart disease/diabetes → bump to Yellow/Red path.

  • ✅ No recordings by default; optional opt-in for quality assurance with retention window stated.

  • ✅ Data residency: keep PHI in your region (Azure regions available; review vendor data handling). (Microsoft Azure)

What I can hand you next

  • A one-file HTML/JS widget wired to your triage logic (EN/TH), ready to point at HeyGen or Azure (choose one).

  • A server proxy stub (Node/Express) that safely signs/forwards avatar requests and enforces your consent/retention rules.

  • A voice pack (clean, speakable prompts) aligned to your SOP and marketing tone.

If you tell me which vendor you prefer (HeyGen, D-ID, or Azure Avatar) and whether you want browser-only or kiosk + phone, I’ll deliver the exact code wired to your flow and wording.