One area of patient assessment that I know I need to improve is looking for bracelets or tags that patients wear that might be simple identification, alerts to EMS professionals about known medical conditions like diabetes or seizures, in case of emergency contact information, or end of life instructions for making resuscitation decisions. Is it part of your history or physical exam routine to check every patient for a bracelet or identification? Do you encourage patients to wear a medical alert tag if they have a condition like diabetes?
The detailed or rapid physical examination, depending on the patient’s level of consciousness, is the most logical time to look for a bracelet or tag on a necklace. Here are some ideas I am committing to ensure that I check every patient:
1. Do a quick scan of the patient’s ankles, wrists, and neck as I introduce myself. I will look for the tell-tale shapes of a medical alert tag.
2. Review the current information on how Wisconsin Do Not Resuscitate orders can be transmitted. The bracelet in Wisconsin, where I live and work, has a distinct set of information.
3. Always look for bracelets during any patient physical examination. Specifically checking jewelry worn on the wrists, ankles, and neck.
4. Ask patients with known illness, like diabetes and allergy, if they have a bracelet. If yes I will encourage them to start (or continue) wearing it to benefit lay and professional responders that may see the bracelet and take appropriate action. If they don’t I will encourage them to get and wear a bracelet or other type of identification.
5. For unresponsive patients, without compromising efforts to assess and treat ABC life threats, I will either check or direct another responder to check the patient’s wallet, cell phone, handirecords, and other locations (refrigerator for a file of life) for emergency medical and contact information for the patient.
I also intend to stay current with types of identification that patients are wearing. As a runner and cyclist I rarely carry identification with me, but I do wear a RoadID.com wrist band. It includes my name, address, and emergency contact. At the 2009 EMS Expo I was impressed at the large array of options available from the MedicAlert Foundation.
By checking every patient I feel I will develop the habits necessary to see important identification when it is most needed for an unresponsive patient.
Use the comments to share how you remember to look for bracelets and tags. Also tell me about a time use of a tag made a difference.