Best way to clue EMTs to medical facts?

what do you think is the best way to wear or carry something to clue EMT's into your medical facts, conditions, allergies, etc.?

Medic Alert bracelet or necklace.
http://www.medicalert.org/home/HomeCatalog.aspx?Catalog=Standard

A medic alert tag AND one of those pill fob holder things with the basics and a 24-hr source of complete info.

Or tattoo of all details inside both arms.

My friend's mother was going in for a mastectomy. The morning of the surgery, she went in and wrote on the good breast with a Sharpie marker: "Not this one, Stupid!" Afterward, the doctor said it was an excellent idea -- 'accidents' happen.

Sue

Best bet: Plain metal bracelet with prominent colored "medical" symbol (red or blue swiss cross, star of life or caduceus), that doesn't look like jewelry, worn on the left wrist (since most US pre-hospital IV's are started in the left arm, and American ambulance designs usually allow more working room on the patient's left side, it is more likely to be quickly noticed there).

All it really needs to contain is your main medical conditions or allergies, but the details should be in an easy to find location in your wallet or purse, usually immediately in front of or behind your driver's license, clearly labeled on the outside, on both sides, as "medical info" or some such, and not just some folded up scrap of paper.

A red dog tag is fairly noticeable, too, while also protecting your privacy. Sorry, but I won't be plugging any unknown usb drives into the ambulance's computer, although such a device can be tremendously useful to the patient in managing and documenting their own care.

Lastly, don't worry overmuch. The paramedics typically check things such as blood glucose routinely on any patient with altered mentation, and won't miss a diabetes related condition. Also, they should be able to recognize and effectively manage any life-threatening allergic or adverse reactions.

However, a cop or bystander might mistake a low-glucose diabetic for a drunk, or you may be in an area without advanced life support ambulance service, and, of course, the earlier we know about your condition, the better. So if you need a medical alert, wear it all the time, even at home. It does help.

Here's pretty much everything I want to know from every patient, beyond information about the current complaint:

Many prudent or experienced patients keep this information on their computer for easy updating, with printed copies to carry, give to family members, new doctors, etc. Be sure to include a "current as of __" date. I frakking love it when a patient or family member whips out one of these and hands it to me.

full legal name, and any aliases, former or nicknames that be used on older medical or insurance records
address, permanent and current temporary local for "snowbirds" and long term visitors
telephone number(s)
date of birth
SSN
emergency contact or legal guardian/health care surrogate name, address, telephone number
full name, address, and contact information of your primary care physician and key specialists
list of all current, recurrent or chronic medical conditions
list of all current or frequently used medications, including prescription, OTC and herbal (the latter two can be very significant)
list of all medical and food allergies or adverse reactions
list of all prior surgeries, hospitalizations and major illnesses or injuries
all medical insurance, Medicare or Medicaid information (photocopy of both sides of card preferred)
If incident is job related - name, address and contact phone number ofemployer and/or worker's comp carrier

That's funny

In pre-op for my last time under the knife, I had to sign my name to the arm they were to work on. They even required a family member as a witness,

Yep - you should see the happy looks when I used to bring Mom/Dad to the hospital, and handed them that, and the times I've had to go in, or go to a new MD, and I hand them the "The list"

Makes for a very happy triage nurse

RoadID.com. Mine's a Road ID Original in bright yellow. The interactive version with online database seemed a bit much for a guy with no medical issues.

Ditto everything Jeff said. In the list of info, a copy of the DNR or living will is good if you have one. Just saying "He's got a DNR" means jack-ship. No paper, no DNR. If you're needing this one, check your local regs. Some places need specific documents that are EMS approved, so a hospital form doesn't technically work if out of the hospital.

When I get old and decrepit, I'm getting "NO CODE" tatto'd down my sternum.

That's a Windows problem, not a USB issue.

The real problem is what kind of file is there, and what kind of reader is needed. I've billed many hours to clients who call and say "I was sent a FOO.XYZ file, how do I read it?". I've had to take apart files and extract data by hacking it out ($$$).

Even if Windows is banned from ER and ambulances to fix the security/virus problem, there's no way to expect anyone to know what to do with any material other than printed English text.

Thank Cthulhu I am not allergic to anything common, or I'd probably carry around a huge dog tag with NO PEANUTS scribbled into it.

As it is, it's just a flash drive listing ways to identify my (?) corpse, the fact I am allergy-free and a "return to" address.

Dogtags are a good idea, although I haven't worn one since getting out of the military. A blood patch could be useful at least to tell them your blood type.

I like the sharpie idea when going in for an operation. Good thinking.

When I go cycling, I carry my spare D/L which has a sticker on the back, not interfering with the magnetic strip, with wife's cell/ofc numbers, blood type, allergies, other pertinent info, then a piece of clear packing tape over the sticker to keep it more or less waterproof. Thankfully I've never needed to use it, but like all my other EDC, I'm prepared. Also have dogtags I were when going into the wilderness, mostly for body ID, not medical reference.

I wear no jewelry or watch and have been resisting the medical alert / dogtag / wrist band solution. Is there a practical alternative?

A prominently visible "medical info" card in your wallet.

yup..i don't carry much in my wallet but i do have my Vets Hospital ID in there.back in the 70's we would have a clerk fetch a medical record from the file room and the ER MD would read out stuff over the phone,now it's by computer link.

+1
+1
+1

RoadID is the best IMHO. They even have very sturdy dogtags if you want to keep that style. I have always purchased the ankle bracelet for my cycling and running. They just came out with the 'elite'. A gel wrist band. I will be getting that for Christmas.

Tattoo.

If you have a significant medical condition, then you need to quit resisting getting a MedicalAlert device. That is the practical solution.

Pete

I'm glad to hear some positive experiences with that. Every time I've given a doctor or pharmacist such a list they treat me like I'm a hypochondriac anal-retentive freakshow to be regarded with suspicion. Instead of what I am: a responsible patient who is trying to make their job easier, or trying to make sure I don't get the wrong treatment due to their laziness. *eye roll*

Not excusing anyone Y T but many people who start listing their various ailments and meds to medical providers are at least mildly hypochondriacs...not that it's a bad thing to be.

I hear it a lot, I'm trying to help a pt. with some first aid/bandaid and the next thing I know they're giving me their families medical history...;^)

But you're right, it really is better to be more prepared than not.

I think a lot of folks who get negative reactions from healthcare as well as fire and rescue personnel when they appear to be prepared are really just seeing simple shock on the part of the provider. ;^)

Under the circumstances the difference between being informed & articulate and being a hypochondriac should be obvious to any competent professional. I mention my own experience here because it pertains to the "how to communicate to EMTs/professionals" subject -- if they're not willing to be respectful or listen, you're at a loss.

I'm sure there are plenty of pretenders, but I'll venture that the number of legitimate patients far, far exceeds them. I mean, most people don't like to visit a doctor (and in fact will avoid it). In addition, most people don't have the money to be treating healthcare like a social expenditure.

What you've described in your post doesn't apply in my case. First, my info was only offered upon a doctor's visit, hospital visit, or in the case of a medical emergency. And in nearly all cases, when they'd start asking about medical history or specifics. If someone gave me a bandaid, I didn't feel the need to tell them about my gastrointestinal problems.

Second, all of my conditions had been documented and verified as legitimate, some of them are clearly related (so if you had condition 1 it was reasonable that you also had condition 2), and all of them were under doctor treatments. Managing the care is/was challenging and involved juggling a lot of information. So it made sense for both myself and my doctors that I tracked what what the various conditions were and which doctors were treating what, as well as what meds I had been on and if they had caused problems/allergies .

This was partly done to make their job easier, particularly in event I was unconscious or unable to communicate. And partly done for my own benefit: it saved me from having to recite the same damn info over and over (potentially omitting an important detail), and it helped prevent one doctor from prescribing drugs or treatment that were counter to that of another doctor.



Unfortunately, I didn't get the "pleasantly shocked you made this so easy" reactions. I got the "let's treat you suspiciously or condescendingly, or just outright accuse you of being untrustworthy or unstable" reactions.

Honestly, most of what I experienced was just medical professionals assuming any patient was a lobotomy victim, so being aware of one's own medical care was viewed as a sign of being crazy instead of being smart. When medical professionals (whether they are doctors, nurses, or EMTs) view their patients as natural born idiots it hinders proper care. It also creates an adversarial relationship that makes care more difficult for both parties. Of course a patient should not attempt to step in and direct care, but they should be allowed to (and welcomed to) be a partner in care. Particularly since the patient often needs to continue treatment on their own afterward.

Unfortunately, the health care field deals with a lot of "natural born idiots." They're bound to get jaded. I mean, you can only tell someone so many times that their obesity is causing their arthritis, blood pressure problems, and heart disease before you get tired of trying to get them to listen. Just like cops think everyone has done something wrong or assume everyone wants to shoot them.

Now I can't speak for the docs out there, but some folks in health care feel certain conditions are not "true" diseases but more psych related. One well publicized example is fibromyalgia - not everyone agrees on what it is, or if it's a disease or a somatic reaction fo some sort. Not saying you have it, but just trying to point out that some people clump. Give a doc a patient with fibromyalgia, irritable bowel syndrome, and 7 abdominal surgeries, and most will have on their differential "Psych patient." Not a good thing, but it happens.

There are a lot of overworked, undercompensated, highly stressed individuals in health care. Some are plainly burned out, and others are just jerks, or worse. An awful lot of people in the health care field find they don't actually like taking care of other people, but remain miscast in the role of care-giver, anyway. We can teach clinical skills, but it's not really possible for us to teach adults courtesy, compassion or respect.

Today, patients absolutely must be well informed, vigilant, and organized to survive any major voyage through the byzantine world of health care. Remember, we only kill 100,000 or so people per year with our medical errors. You are your own best, and often only, advocate. Don't accept excessively rude or demeaning treatment without complaint, but also be sure to express your appreciation to those who serve you well.

Health care professionals can get treated like cogs in a wheel, too. I recently switched the dr's office I go to, because the doctor left. I followed the doctor to a different practice. My doctor was a little surprised that I did that - I guess most people don't? My answer was simply that "you listen to me". When my doc explained the switch between offices, it was in part because of the way they were treated by the old office.

Bringing this back around to the original question, if whatever leads you to a hospital isn't trauma, having your primary doctor's name on you probably wouldn't be a bad idea? Baring some sort of large scale emergency, they would have access to your medical records, and might provide some other insight as well as potentially being an advocate for you.

I have always appreciated receiving a current list of meds and medical conditions, it makes recording the information so much easier and more importantly I can scan the list and try to make connections to the current reason they called for ambulance/medic unit.

I have the privilege of knowing and attending classes taught by a long time paramedic, who instilled the precept that we always keep in mind, we are there for the patient and needed to treat each individual we come into contact with respect and compassion. In his many years of experience and in reviewing complaint cases, he found that EMTs/Paramedics who had interacted with patients and/or family with attitude, regardless of the adherence to protocols and successful outcomes had a much higher rate of being charged with malpractice. EMTs/Paramedics who may have not have adhered to protocols or had unsuccessful outcomes, but treated the patients/family with respect; compassion and understanding were almost always given high marks by the patients and families and had a very low incidence of malpractice and complaints filed against them.

Pete

Shortest answer: No.

Look, I've done my share of dealing with medical emergencies. We look for the bracelet, the necklace and the tatoo. If we don't find those, we're not going to play 20 guesses to find out if you're diabetic or have an allergy - at that point, the symptoms tell you all you can know.

How often does that search succeed?

Nobody I have ever known has ever done any of these. The tattoo is out-of-the-question for all but a couple, and a necklace is banned in many work environments.

I currently do not have a medical bracelet. I do have a generalized anxiety disorder for which I carry Lorazepam in my purse. Should I get a medical bracelet mentioning I have a generalized anxiety disorder?

Jeanette Isabelle

No, unless for some reason you would not be able to explain that yourself during an acute anxiety episode.

I'm sure my EMS brethren will correct me but unless you're being treated by a military health care provider , no one is gonna believe that your blood type is XYZ, without typing it, nor will you be getting any blood products in the field anyway so I wouldn't bother putting that info on any sort of medic alert tag.

As for what to put on there, if you suffer from any sort of ailment that can/could leave you unconscious or otherwise unable to communicate, if you're allergic to any common medicines, if you are taking any prescription meds that could put you into a coma or unable to communicate, if you suffer from epilepsy, autism, parkinsons, hemophilia, cancer, asthma, hypertension, latex or any food allergies.

Lorazepam/Ativan is being used to treat seizures by EMS personnel. If you're taking it regularly already, I'd get a tag that stated this. Might theoretically stop an overdose in a worst case scenario. You don't need to spell out why you take it.

The search succeeds 100%, if one is looking for a Medical Alert device. I will be honest that looking for a Medical Alert tattoo has not been on my radar screen and considering the number of tattoos some individuals have, I don’t think I would expend an enormous amount of time trying to decipher tattoos. Now if a Medical Alert symbol was tattooed in the usual places ones looks for a Medical Alert device, I would obviously pay heed.



Not quite sure if mean EMS personnel not looking or if you mean people are not wearing a Medical Alert device. If you mean EMS personnel are not looking for a Medical Alert device, they are not performing a proper patient survey. If you mean people are not wearing a Medical Alert device, well then they are endangering their own life.



I would think that a Medical Alert bracelet or necklace would be covered under the Americans with Disabilities Act. A breakaway chain would address any entanglement/safety issues.

Pete

I would agree, to the best of my knowledge there is no jurisdiction in the US, where EMS personnel are giving whole blood in the field, so blood type information is pretty useless. If a transfusion is necessary at the hospital, they are certainly going type and cross match the patient before starting a transfusion.




Yes and no. While it might be nice to know the patient is taking Lorazepam, if the patient is actively it might suggest the current dose is not having its desired/intended effect. The EMS administration of Lorazepam/Ativan should be administered to effect, so the risk of an overdose is minimized.

Pete

I am taking other medications for depression and anxiety on a daily basis. Lorazepam is taken only as needed which is not often but is always with me just in case. I've never heard of a case in which EMS was called due to depression whereas an acute anxiety attack can cause the patient to pass out. If EMS were to find me unresponsive, what is needed on a medical bracelet to clue them in on what is a likely reason I am unresponsive?

Jeanette Isabelle

The same things myself and others have listed in earlier posts.

EMS can be called on cases involving depression, whenever an individual may attempt to hurt either themselves or others.


A patient’s unresponsiveness may have nothing to do with the their history of anxiety attacks and will not significantly change the course of treatment.


The standard treatment for any unresponsive patient is going to focus on the ABCD’s. If you’re not breathing or not breathing adequately (too fast or too slow) we will assist or correct the problem. If you have no pulse, CPR, heart beating, but not providing adequate perfusion, then electricity or drugs. Diabetic, a check of blood glucose levels will allow for the appropriate treatment. Active, prolong or multiple seizures, then drugs and respiratory support (or other treatment (i.e. OD) to correct the cause of the seizures).

Personally, based upon the information you are providing, I do not think a Medical Alert device would be of much assistance in determining why you may be unresponsiveness. Knowing you suffer from anxiety attacks and take meds for such, is not going to alter my course of evaluation and treatment.

Pete


P.S. Other EMS personnel may have a different take on your question.

Look at it these way Jeanette, if your unconscious or otherwise unresponsive, your probably not anxious. I'm sorry, I kid.

But I will say this to alleviate your concern. Unless I am horrible misunderstanding the use of anxiety medication, even if your unconscious or unresponsive, you would not need the medication until you or a family member can communicate with hospital staff.

For example, if your taking a daily medication for hypothyriodism or high cholesterol, that wouldn't need to be on a medical bracelet or RoadID. If you had a pace maker or need insulin regularly then that might be important.

What Pete said...

This is true. If I am unresponsive then I do not need my medication. My reason for bringing this up is to know if a responder would need to know this information if I am unresponsive.

In the event of an acute attack my breathing would be fast and shallow which in turn would cause a drop in oxygen saturation. Though unlikely it is still possible for my oxygen saturation to drop to where my brain is oxygen deprived. In that event I would need oxygen, not medication. Of course if a responder did find me unresponsive with fast shallow breathing, he or she would check my oxygen saturation.

It seems I answered my own question.

Jeanette Isabelle

Jeanette, you're overthinking this.

Anxiety attacks are quite easy to diagnose, as a rule. Even more so if you tell the provider "Hey, I have anxiety!" or "I take Ativan!" As far as I know, no EMS agency allows their medics to give Ativan for anxiety only, so being in an acute attack wouldn't change most treatment options.

If your attack does get to the point you pass out, well, you'll have stopped hyperventilating, and likely awoken, by the time EMS arrives.

As for your drugs, if you feel it's a potential issue, then get the tag with your meds. If you've got concurrent depression, then concievably you could OD on them. It won't help EMS (they don't carry the antidote) but it may help the ED. Assuming you don't have someone with you to tell them what you take.

Ditto Pete - he's pretty much spot on in my experiences.

No, I meant how often does anyone wear one. The search only succeeds if there is one to be found.

Is this an HHS standard?

Breakaway chains are overrated and don't prevent incidents (useful but insufficient). ADA only requires reasonable accommodations: you don't have to create a safety hazard for it.

I retired from the relevant job at ten years ago and medical necklaces never came up. It's hard to say now but had it come up I likely would have required that the card be strapped around the ankle or such, with the necklace removed while in the lab. It's the necklace that's the problem, not the card.

I may be misunderstanding what we're talking about here since the word "device" is being used: I have visions of a necklace with what amounts to a large dogtag with more text. If this is an actual _device_ of some sort that's different (and even worse given the lab EMI setting), but a necklace itself still wouldn't fly in the lab.

It is hard to calculate, if the patient is conscious and alert enough to answer questions, it is not generally necessary to look for a Medical Alert device, so whether they have one or not is hard to determine. If they are unconscious, the only way to know they don’t have one, is if a family member tells you that have XYor Z condition and you fail to find a Medical Alert device. It is hard to come up with a validated number, but I have encountered many diabetic, cardiac and patients with an allergy with a Medical Alert device.



The Medical Alert devices I have observed generally have a red Start of Life, medical caduceus or the staff of Asclepius, along with the medical condition(s) i.e. diabetic, cardiac, allergy.



I work in a bacteriology lab and encounter Facility - Maintenance - Engineering staff routinely; we are all required to wear our ID badge around our necks. Some use a breakaway chain; others (myself included) use a soft-corded breakaway lanyard to address entanglement issues.

If the safety issue is from heat, using a Nomex shoelace Nomex Shoelace and a piece of shrink tubing, one could fashion a heat resistant breakaway lanyard, the dog tag could be suspended from the lanyard and worn atop a fire resistant t-shirt. If the concern is a magnetic signature, I belive Medical Alert devices are available in silver, gold, titanium and plastic.



I may have been somewhat misleading I my use of the word device. My intention was to use the word device, simply to cover dog tag; bracelet and charm style Medical Alert items.


Pete

Keep in mind this was before I was diagnosed with a generalized anxiety disorder and the first time this has happened. I was at a stoplight, conveniently beside a gas station, waiting for the light to turn. My heart started beating fast followed by shallow, rapid breathing. I pulled into the station, turned off the engine and opened the door thinking whatever it was would go away on its own. It got worse. I went inside and collapsed on the floor but remained conscious. Through the shallow, heavy breathing, I did manage to indicate to the attendant that I needed an ambulance.

The ambulance arrives. I'm at least somewhat conscious with some difficulty to adequately respond. The medic checks my oxygen saturation. It was at 88%. He tells me he will put an oxygen mask on me and I nod, acknowledging I understand.

By the time I get to the emergency room, I'm fine. My oxygen saturation is back to normal. However neither the ambulance crew nor the E.R. staff figured that what I had experienced may have been an anxiety attack. I can now say, with a hindsight perspective, that it was most likely an anxiety attack.

Now if I experience those symptoms again, I know what to do. Nevertheless, would there have been a difference if the medics had a reason to believe I was experiencing an anxiety attack?

Jeanette Isabelle

No. Your treatment will be based on your symptoms and clinical findings of the medics. They (hopefully) will not just assume anxiety is the cause of the problem.

This is my experience only and should not be considered definitive for you or any other individual. All novel shortness of breath (SOB) / troubled breathing (TB) events should be fully checked out and the presumptive diagnosis of respiratory or cardiac involvement must be considered until ruled out by a complete respiratory/cardiac workup. To assume SOB/TB is the result of anxiety disorder is asking for trouble.

Again, other EMS providers may have different experiences than mine, but I cannot think of a call I have had where an individual experiencing hyperventilation syndrome resulted in a lower O2 saturation. Generally, hyperventilation will “blow” off excessive CO2, since most individuals (not individuals with COPD/asthma) rely upon hypoxic drive to stimulate the desire/need to breath, without this stimulus, the body wants to slow or stop breathing, which can result in additional panic. When you hyperventilate the CO2 levels reduce and O2 levels tend to remain the same (98-100%). Decreased CO2 levels can result in respiratory alkalosis, leading to other medical issues. The signs and symptoms of hyperventilation syndrome often cause the individual to feel tingly, experience numbness in fingers, hands and feet, palpitations, cause muscle spasms and syncope (fainting).

A pulse oximeter can give a faulty reading if the patient is wearing nail polish or if blood vessels in the fingers are clamped down due to being cold. An O2 sat of 88% is pretty low for normal (non-COPD) individual and would have prodded me to consider causes other than hyperventilation syndrome.

In the old days, the individual would be asked to breath for a while in a paper bag, which would break the cycle. This practice is no longer recommended and should not be utilized. I have great success with simply calming the patient, asking them to breath with me, as I slow down my breathing, lower my voice and talk slowly, having them breath in through their mouth slowly and slowly exhale through their nose. I would say within 5 minutes most, if not all individuals experiencing hyperventilation syndrome would break the cycle.

Pete

I learned this technique just last year at the Citizens Fire Academy. I specifically asked what is done in this situation for the obvious reason.


Faulty readings from pulse oximeters are perplexing considering the warm weather (it was around spring) and, to the best of my recollection, I did not have a cold drink or handle anything cold. Of course this was seven years ago so unless I was aware of something that is significant, I most likely would have forgotten it. If fingernail polish was the cause of the faulty reading then wouldn't the pulse oximeter in the emergency room also give a faulty reading?

Anyhow, as I said, I was fine by the time we arrived at the emergency room and I have attributed that to the fact I was given oxygen on the way to the hospital.

Jeanette Isabelle

Pete,

Can I get you to be my personal emergency responder? You come across as such a professional with a great attitude towards your patients.

The leaves are pretty here in SE PA right now. And the Phillies are back in the World Series.

Think about, I know where to get some great cheesesteaks...

That's why any files that have to be opened (and most of the rest as I can convert them) are in effectively universal formats. Rich Text Format files will look similar on effectively any word processor. It's even readable with notepad. The text shows up with formatting added. Other than that, html, pdf, & jpg.

Pulse Oximetry is the most over used tools in the EMS toolbox. They are finicky and sometimes just don't get a good reading regardless of perfect conditions. If I can't see a good waveform I don't trust the number they give period.

I teach my students that a pulse oximeter is a tool that should be used to see how your treatments are working not if or how you should be treating a patient.

As for anxiety attacks, I work in an area where we run more then our fair share. I have less patients then I can count on one hand where I have had to use medication to treat the patient. Usually what Pete recommends works, although some patients require a sterner approach and removing stimuli (like the 18 family members that are trying to "help" be either hugging or yelling at the patient) is helpful.



Oxygen doesn't help the typical anxiety attack, nor will it hurt. It is simply time and getting "control" over breathing that will lead to retaining normal levels of CO2 which will eventually lead to control over the feeling.

Do EMTs go through your pockets in an emergency so that an EDC prominently marked card or tag would work to alert them to your conditions, etcetera?

Not as a rule, I'd be very wary of going thru a patient's pockets.

No. Good way to get stuck with their heroin needle.

Having watched this thread, I have come to a conclusion.....


Got a pre-existing medical condition that EMS might need to know about? Stop trying to re-invent the wheel and get the Med-Alert jewelry.

Keep a paper ID information card in one's wallet with all the info the fine EMS folks have listed here.

Maybe keep a USB drive with the entire medical history on your person, but DO NOT expect someone to plug it into the laptop on the bus in the field.

If you don't want to comply with those simple rules, hope your EMS crew is omniscient or deal with the consequences to you own health.

Hi Andy,

Thank you for the kind words , I always try to act professionally and do whatever is in the best interest of the patient (I also think it is critical to treat family members of the patient with the same respect). I became an EMT-A in 1975 (EMT-A doesn’t even exist any more) and an ALS provider in 1994, so I have been around and witnessed both good and poor patient interaction. I had many excellent instructors over the years and the best ones always stressed the following motto: Be Nice, Always Do the Right Thing, Always do what is Best for the Patient, and when you make a mistake, tell someone .

Unfortunately you will need to look for another provider , as is highly likely I will be relinquishing my Paramedic license (EMT-P) next year and downgrade to an EMT-B. The increasing recertification requirements in not only EMS, but on the Fire/Rescue side is forcing me to make some hard choices, but feel the time has come to relinquish my license. Since our team in involved in several technical rescue disciplines, maintaining proficiency in each while balancing work and family has become too much of challenge to do it all. Our Technical Rescue Team membership is 100% volunteer and since our community has gone from 100% volunteer ALS providers to 99% career ALS providers, the need to maintain my Paramedic license is not critical.

Pete

Generally, no, we don't dig in pockets unless you're unconscious or dead and there's nobody around. This is mostly to notify family. I don't recall ever looking for any medical info.

And we move another step closer to the end of volunteer emergency services in the USA. Pete, you're out for the same reasons I'm out. One of the long list of things that pushed me out the door was a class that I had to take - again - for "Rural Water Supply Operations". In 50 years, rural water supply has been the same. Bring Water to the Fire in Tankers. There's about 5 valid ways to pull from a water supply (pond, river, lake, etc.) and move that water to another place and unload it and spray it on a fire. Really, there's almost nothing new in the basic operational principals, and even so-called Big Innovation (like Vacuum tankers) are still loading water at point A and moving it and dumping it at point B. So why do I need another 40 hour class in this when I've taken Rural Water Supply 3 times before?

Then there's all the medical training, the auto extrication updates, the NIMS 64,354 level of training. The fire service is a dumping ground of regulations to prevent All Bad Things That We Wish Would Not Happen.

I miss helping people. I don't miss 400 hours a year spent in training.

Yep. We were supposed to be a combined, dual EMS/Fire department, built on a county-wide consolidation of the county EMS agency (paid) and the local VFDs. But our thankfully recently fired management managed to drive off essentially all the volunteers during the merger. We are running some one-person engines now as a paid department, and really need volunteers. But we are having a hard time recruiting new ones. After decades in EMS, I went through the fire academy at age 47. What fun!

Ugh. I did IFSEC national firefighter certification at age 38 and it was brutal. I'm almost 45 now, and I'd have a hard time with it if I didn't have 4 days a week steady training.

The thing that makes me worry is as I drive near my home on rain-slicked roads covered with leaves I realize that the most qualified person for an auto extrication within 12 miles of where I'm driving is ME. They are having more and more 911 runs scratch. In 2007, when I was a member, it was about 15 scratched calls. In 2008, it was 20. I've heard - anecdotally, but I have no reason to doubt the source - that there were 25 incidents this year where the station was dispatched and nobody was around to respond.

Now, between 4 stations there is about $20,000,000 worth of apparatus and equipment sitting in the barn - and nobody to drive/ride/respond. A one-person crew would be a step up.

You want to talk about big taxes, consider the cost for all-hazards response in rural areas if you needed a staff of 12 to 16 to run under 300 calls a year.

If you can figure out a way to scrounge up some volunteers, please let me know!

You may recall that I joined my local volunteer ambulance service about a year ago. I was an EMT in college (just had my 15h reunion) and I have been working my way through the recertification class over teh last six months. It's been a bear.

That said, at age 37 I am without a doubt one of the "young guys" around the station. I can think of one member who regularly shows up who is younger than me. While I like the idea that I'll probably be a chief in this department someday (who else is there?), this does not bode well for the future of volunteer EMS response a decade from now.

We're starting a major recruitment drive, but have not been able to come up with any really creative ideas on how to get people to vounteer.

If any other volunteer responders want to have a longer discussion of this issue, I'd love to join in.

Edit: BTW, I was approached this weekend by a retired FDNY firefighter asking me why we didn't do fire suppression so that his taxes could be lower. How are we supposed to safely staff an engine when we can barely staff an ambulance?!? I tried to recruit him, but he's in his 60's and felt that he "did his time" in The City.

Jesselp

Why don't we start a new thread over in Campfire.

Pete

To get back to the original thought of the thread, I ordered and recieved my new RoadID . I got the wrist elite this time, its a made of gel like the ubiquitous wrist bracelets and I choice the color orange.

I have wore the red ankle ID for years and its been great. Because I want to wear something more often than training and because I wear long pants when hiking, I wanted a wrist set up that wouldn't be hidden under pants.

Every time I've worked a scene as an EMT that has a patient with a well-documented medical card, it makes my life and the life of any ALS responders easier.

Admittedly, plugging an unknown storage device into a mission-critical system, regardless of operating system, is dangerous. Nevertheless, if a Windows system is configured properly, there's no reason why it is any riskier than plugging into any other OS-based system. But I digress...

Plain old .TXT files can be read on any OS. JPEG is natively supported on all OS's for image files. These days, Adobe PDF is ubiquitous enough to also be a universal standard for documentation. If you are concerned about Adobe Reader's security flaws, the free FoxIt PDF viewer is a simpler, and accordingly safer, alternative.

I just had a thought. What if ambulances and emergency rooms had a laptop with a duel BIOS and no hard drive? USB drives would need to include the DOS command.com and a text file. Without a hard drive the laptop is OS independent, hence not venerable to viruses.

If by some chance a USB drive has a malicious code to wipe out the primary BIOS, the secondary BIOS can restore the primary BIOS.

Jeanette Isabelle

It's easier just to have a separate laptop or PC in the emergency room that's off the network and keep an image backup of the disk on a CD or USB drive for quick restore. What your talking about is possible but would require a lot of custom development and have limited capability if limited to BIOS/embedded OS.

I don't think that EMT's have any time to be dealing with that stuff in an ambulance or first response situation. For that purpose, a necklace or bracelet sounds like the best solution.

I'm not suggesting an embedded OS. The laptop would be OS independent and USB drives would have their own tiny OS (DOS) and a text file with medical information. Without its own OS, the laptop would be immune to viruses. Though highly unlikely, it is still possible for a USB drive to contain a program to disable the BIOS. This is where a secondary BIOS is handy. I'm simply suggesting that there is a safe and easy way to plug a USB drive into a laptop. The hard part would be to set this up as a standard procedure.

Anyhow, I have a medical ID bracelet on my left wrist and a medical information card in my wallet, front and center.

Jeanette Isabelle

I'd rather prefer a cell phone application for med/id data storage and exchange. Almost everyone carry a cell phone these days. And it's a powerful enough computer for the task. I remember I loved the idea of ICE entries in the phone book for EMT use - such a simple but very useful idea!

By the way, the bootable Windows XP OS is available as just a 78Mb disk image.

The 'high tech' documentation is a good idea but often in emergency situations there isn't a quick/easy way to access it. To be really helpful it has to be RIGHT NOW. That's why an ID bracelet, necklace, watch fob or whatever is still the best way to go. Put the key info on a printed card in your wallet and that's what will work. EMS can spot the ID and know of an issue and the wallet card or even an info card on a necklace will be the emergency data needed for the first few minutes and/or that initial hour.

Go ahead and keep a full history and all sorts of supporting info on an SD card, USB drive or whatever too for every day carry but, the key info (diabetic, heart condition or whatever) is time critical and that's minutes - not until somebody can find a computer to look up your info. Just saying...

Paul -

There's an App for that!

But would you put that data on your phone and then not secure your phone with a password?

How long should a first responder delay treatment to check different places for emergency information? Necklace? Bracelet? Arm tattoo (difficult and painful to keep updated)? Wallet? USB Stick? Cellphone? PDA? Laptop?

My opinion on carrying data on a USB stick has changed. It wouldn't be any more useful for emergency treatment than a necklace or bracelet that says "NO PENICILLIN" or whatever and then "MORE DETAILS IN WALLET".

-------
I want an alert bracelet that says "IF FOUND, RETURN TO BELLVIEW PSYCHIATRIC HOSPITAL".

I think you hit the nail on the head. Sure, carry a USB, card, tattoo, whatever. Personally, there's no way I'm going to let you have your heart attack/bleed out/stop breathing while I'm rifling through your pockets checking every electronic doo-dads there. I'm starting treatment.

If I see a bracelet, necklace, or tattoo (not my first choice, cuz I don't always undress a patient), I'll read it, cuz it's quick, simple, easily seen, and most importantly, easily accessible.

The horse is dead, let's stop beating on it........


The true professionals have given us what we asked for, the answer.

Keep the primary info on the universally accepted method(s), and anything else however you wish. Failing that, don't expect it to be useful to your medical care in an emergency.


I will admit to recently receiving a USB drive/business card from a salesman that will be formatted for my medical info, and have the really important on-scene / ER stuff printed on the outside in a fold-out paper label.

The USB/flash drive devices would be much more practical for storing data that might be needed after being evacuated than they will ever be for an emergent medical situation.

I'm with Pete, if I have an unresponsive patient the last thing I'm gonna do is start looking for their flash drive to see if it can diagnose the problem for me.

You're gonna get appropriate treatment on the scene and if warranted, you'll be getting a ride to the hospital where you can show off your thumb drives, your BIOS, your tattoos, your cell phone, your whatever to your heart's content.

I have a dogtag on my keyring with allergy and emergency contact phone numbers. It has my allergy, wife's allergy and 2 phone numbers. Bright red, medic alert symbol/caduceus on back.
She carries same.

That may go unnoticed on your keyring. Normally, your keyring isn't something that often gets looked at in an emergency by medical folks. A LEO or tow truck operator might notice it, or you could get lucky if the distinctive color or symbol catches someone's eye.

But if you don't have a major medical problem to worry about, it might come in handy. Do you sometimes leave your wallet but always carry your keys? I do that myself occasionally.

To keep beating a dead zombie here, 'cause I like beating dead zombies, the best flat out method is having someone you know with you. Next is a med-alert bracelet bracelet of some kind. I use a RoadID, currently the wrist elite, its like a thick liveSTRONG bracelet with a steel med alert tag on it. (YMMV) but it is the most comfortable and noticeable I have worn and I wear it daily.

Hey Jeff-

Should have quantified that- both my keyring and my wife's are not used in the ignition, rather, her's is in her purse, attached to her wallet, and mine always lays on the floor or in the drink holder.

So hopefully, even upside down, it would be somewhere near and obvious.

I did this since I am also not a jewelry wearer but felt that since both of our allergies are life threatening (penicillin and latex, respectively) they should be accessible in some fashion.

amen, brother. I learned this at a meeting, when hearing a sound like a ripe melon hitting a tree, I looked up to see my assistant and very good friend in the throes of a grand mal seizure.

When the paramedic arrived, he surveyed the scene and made a very appropriate conclusion - "Ah, forgot to take your medication, I see."

My friend was comatose and I piped up "I've worked with Joe on a daily basis for the past two years, and this is unprecedented. We need to get to the ER." Which we did.

Even there I was able to provide all kinds of information, and contact Joe's wife, etc. etc (we were way out of town).

I have had to handle unresponsive victims and that feature alone makes it a whole lot more challenging. If you have a medical situation, follow the advice of the experienced medical professionals already given here and wear a device on your person - make it easy for the practitioner who will have your life in his/her hands.

These should be on your person, not sitting in the cup holder or in your wife’s purse attached to her wallet. Wear them, wear them, wear them- enough said.

Pete

Road ID is not jewelry.

If I had a life threatening allergy I wouldn't keep a notice of it anywhere but on my person.

You guys who keep trying to reinvent the wheel seem to have a tiny problem with reading comprehension, at least 2 people here who work in EMS have written numerous times what we look for and what we don't look for when confronted with an unresponsive patient. EMS providers are not, for the most part, going to change their procedures or their TX protocols because an individual uses what they think is a neat method of medical ID.

If you have a life threatening condition/allergy, use the methods to notify EMS personnel that already work or run the risks of not having your information shared as needed, it's really that simple.

Yikes, hit a nerve, eh?

Sorry, not an EMT, and I'm certainly not privy to their "established protocols", in fact, I assumed that was why the original question was asked.

Take a deep breath, just mentioning what I do, not trying to start a movement.

No nerves hit, just wondering in print why it seems so hard for some folks to understand what is a very simple concept.

Don't need to take any deep breaths either but thanks.

You've been made privy to some EMS "established protocols" by myself and by other EMS professionals who have posted in this thread numerous times, we've tried to tell the original poster as well as those who've chimed in what the best solution is for the given situation. Instead of using what's been offered by those in a position to know better, some folks think that they've come up with a better alternative, the purpose of my post above was to reaffirm again that they're wrong in their assumptions.

Anyone who feels that making up their own medical alert system in the hopes that it will improve their treatment if they're found in an unresponsive state is gonna be in for a rude surprise if they ever regain consciousness.

There are times and places for opinions and there are times and places for actual factual knowledge. But hey, do your own thing, hope it works out for you.

Yikes again- and ouch-

I come to this forum for opinions, and would never take anything I read as empirical data without first checking it out with a vetted source. As far as I know, there is no vetting process in signing up to trade information or opinions on this forum.

I don't know you, don't know your background, don't check profiles nor would I believe the data contained therein.

So again, all I did was mention what I have and what I do, not looking for validation or to change anyone's mind- in fact, I appreciate the feedback as to other folks' opinions as to what works best..

I will end my part in this silliness by referring you to the question posed by the original poster, to wit, "what is the best way to clue EMT's to medical facts?" Note they didn't ask what are some methods that other people use.

The best way, as requested by the original poster is the way that myself and others who actually work in the emergency medical services is the use of the Medical Alert system.

Any other method is less effective.

Jakam, when you find your vetted source, they will agree with the above statement.

I sincerely hope that you and your family never have occasion to need a medical alert system of any kind.

You caught 'em. These guys are pretending to be paramedics as a ruse to trick people into wearing "jewelry" and other accoutrements. Jeff, in particular, is actually the finest tailor in Dublin, Ireland, and is world famous for introducing the western suit to the Kingdom of Jordan back in '32, and the age of 22.

It would be more obvious if they hadn't deleted the thread on the survival necktie and cufflinks set.

There is no emergency medical "system" in the U.S. There are several thousand systems, each with it's own practices and procedures. So there is no definitive, single, established, standard protocol or methodology for obtaining patient data in the pre-hospital environment.

But, on this subject, there is a body of professional knowledge and practical wisdom that has been accumulated and validated over and over by hard won experience. Have you noticed a certain uniformity of opinion and lack of disagreement here, as to the "best way to clue EMTs to medical facts," among all the people who have actual hands-on experience in the field? That, my friend, is the collective voice of the real world sharing it's wisdom with you.

We aren't trying to tell you what to do; we're just telling you what works for us.

Jeff
paramedic/firefighter, 30 years experience

These are not the Paramedics you are looking for...;^)

In the interest of full and complete disclosure, I am only a lowly EMT. However I did stay in a Holiday Inn Express last night.

Ever since I bought a medical alert bracelet and had it engraved, which is nearly two months ago, I have been wearing it every day. Given its location, my left wrist, any rescue personnel will quickly discover it and yet as a bracelet it looks fashionably acceptable for everyday situations.

Jeanette Isabelle