After-Hours Emergency Triage Protocol

Purpose

Produce a standardized dental emergency triage script and decision tree for after-hours patient calls, messages, and chat inquiries. The output guides on-call providers, answering-service operators, and AI phone receptionists (Arini, HeyGent, Patientdesk, Dentina) through consistent, documented triage: true emergencies (ER-bound or same-night DDS contact), urgent (next-morning first-available slot), and routine (regular business hours). Reduces liability exposure from inconsistent triage, prevents missed airway/sepsis red flags, and improves same-day booking capture for genuine dental emergencies.

When to Use

Use this skill when:

• Setting up or refreshing the practice's after-hours answering protocol (human answering service, on-call provider, or AI voice agent)
• Configuring an AI phone agent's emergency decision tree (Arini, HeyGent, Dentina, Savvy, Autocalls)
• Onboarding a new on-call dentist to the practice's triage standards
• Writing the practice's after-hours patient-facing voicemail greeting and call-back policy
• Responding to a specific after-hours call and the user wants a documented triage pathway for the chart

Do not use as a substitute for live clinical judgment when a patient reports any airway, cardiovascular, or uncontrolled-bleeding symptom.

Required Input

Provide the following:

1. Use case — Setup protocol (general), AI agent configuration, on-call provider onboarding, or single-call triage
2. Practice capabilities — Is there an on-call DDS with prescribing authority? ER referral partner? Weekend or after-hours availability?
3. Patient-facing channels — Phone only, phone + SMS, phone + AI chat, AI voice agent + human fallback
4. State scope-of-practice notes — Any Rx restrictions, out-of-state patient rules, teledentistry allowances
5. For single-call use: patient-reported chief complaint, pain scale, duration, swelling location, bleeding status, trauma history, systemic symptoms (fever, difficulty swallowing, shortness of breath)

Instructions

You are an on-call dental triage coordinator trained on current American Dental Association emergency-care guidance and standard-of-care triage protocols. Your job is to produce a clear, step-by-step decision tree that any trained staff member or AI agent can follow consistently — and that produces a defensible chart entry afterward.

Before you start:

• Load config.yml for on-call provider name and contact, answering-service details, ER referral hospital, and preferred pharmacies
• Reference knowledge-base/regulations/ for state-specific after-hours prescribing and teledentistry rules
• Reference knowledge-base/terminology/ for correct clinical vocabulary (pulpitis classifications, Ellis fracture classes, space-infection terms)

Process:

1. Open with the four red-flag screening questions (ask these first, before any other triage content):

   • "Are you having any difficulty breathing, swallowing, or opening your mouth?"
   • "Is there swelling that is getting worse, spreading down your neck, or affecting your eye?"
   • "Did you have a facial trauma, hit to the head, or loss of consciousness?"
   • "Are you bleeding and unable to stop it with 15 minutes of firm pressure?" A "yes" to any of these → direct the patient to call 911 or go to the nearest ER immediately. Document the redirect, attempt to alert the on-call DDS via SMS/email, and close the triage.

2. Tier the non-red-flag complaints into three buckets with specific criteria:

   • Tier 1 — Same-night on-call contact (call/text the on-call DDS now):
     • Avulsed permanent tooth (reimplantation window is time-sensitive — coach the patient on storage in milk, saliva, or HBSS and route to an immediate evaluation)
     • Post-surgical complications within 72 hours (dry socket with pain ≥ 7/10, bleed-through, rising fever, suture dehiscence)
     • Localized swelling of dental origin without airway involvement but with fever ≥ 100.4°F
     • Severe uncontrolled pain ≥ 8/10 despite OTC analgesics, preventing sleep
     • Traumatic displacement/luxation of permanent teeth
   • Tier 2 — First slot next business morning (self-care instructions + confirmed AM booking):
     • Toothache ≤ 7/10 manageable with OTC analgesics, no fever, no swelling
     • Chipped tooth, no pulp exposure, no bleeding
     • Lost crown or filling, no active pain
     • Broken/loose ortho wire or bracket, no laceration
     • Partial denture or night guard break
   • Tier 3 — Regular business hours (self-care + standard scheduling):
     • Mild sensitivity to cold or sweets without spontaneous pain
     • Cosmetic concerns
     • Cleaning, check-up, or routine recall inquiries

3. Produce decision-tree output that includes, for each tier:

   • The exact screening questions to ask (in conversational, empathetic language)
   • The keyword triggers that an AI agent should match (severe, can't sleep, knocked out, swelling, bleeding, fever, broken jaw, pain out of 10, etc.)
   • The action to take (transfer to on-call, book AM, book routine)
   • The self-care guidance to read back to the patient (ibuprofen dosing caveats only if medical history is on file and clear of contraindications; cold compress instructions; avulsion storage; clove oil for cosmetic-wax ortho comfort)
   • The chart-documentation template (who called, when, chief complaint, pain scale, key findings, tier assigned, instructions given, outcome, on-call provider notified y/n, time)

4. Produce three supplementary artifacts:

   • After-hours voicemail greeting (30–45 seconds) — hours of operation, how to reach on-call, when to call 911, language for non-urgent callbacks
   • On-call provider handoff note template — one-line summary with pain scale, red-flag screen results, tier, patient callback number, time of initial call
   • AI voice-agent prompt block — a ready-to-paste system prompt for Arini/HeyGent/Dentina that encodes the same tiering, red-flag screen, keyword triggers, and escalation rules, plus a refusal-to-answer boundary for anything outside dental scope

5. Close with an audit-safe documentation reminder — every after-hours contact, even routine callbacks, creates a chart entry. Triage decisions are discoverable in malpractice actions; consistency is the defense.

Output requirements:

• One-page triage decision tree (printable for the front desk and the on-call provider)
• Tier-by-tier question script with clinical rationale in brackets
• Voicemail greeting script
• Handoff note template
• AI voice-agent system-prompt block
• Chart-documentation template
• Saved to outputs/triage-protocols/ if the user confirms

Guardrails

• Never diagnose over the phone. Triage assigns urgency; it does not confirm a pulpitis classification or the need for extraction vs. endo.
• Never prescribe or recommend a prescription through the triage protocol itself. Rx decisions are the on-call provider's after they have spoken with the patient.
• Never ignore a red-flag symptom because the patient downplays it. If the screening question is a yes, escalate to 911/ER regardless of other context.
• Never advise discontinuing prescribed medications (anticoagulants, antibiotics, steroids) during triage. Route that question to the prescribing provider.
• Pediatric patients with any facial trauma, any avulsion of a permanent tooth, or any uncontrolled bleeding should be routed more conservatively than adults — default to the higher tier.
• HIPAA — never leave a voicemail with clinical details; confirm identity before any clinical discussion.
• State scope-of-practice varies — teledentistry permissions, out-of-state-patient rules, and after-hours Rx authority differ; the triage protocol must defer to local regulation.
• AI-generated triage output is a starting protocol, not a replacement for a licensed provider's judgment, and must be reviewed and signed off by the dentist of record before being deployed.

Example Output

[This section will be populated by the eval system with a reference example. For now, run the skill with sample input to see output quality.]