Michelle Kowalski is a diabetic and a blogger at dLife.com – a nice blog for diabetics. She e-mailed me a question that I thought was pertinent enough to put up as a post. I’m curious to see what other people think.
Michelle asked me “What are your thoughts on wearing “fashionable” medical ID bracelets? Does it matter what the jewelry part looks like?”
I never thought much about the question before.
Michelle gave me the link to a site that sells medical ID jewelry. As I looked through some of the styles, I kept wondering how I would respond if I saw an unconscious patient wearing them.
I don’t believe that many emergency providers are aware of different forms of medical ID jewelry. In an emergency, I know to look for a silver plate/red emblem/silver chain. If I saw some elaborate jewelry, depending on what it looked like (see example above), I might think it is just another piece of jewelry – especially if the plate with the medical information is hidden under an unconscious person’s arm.
My point to Michelle was that the medical ID is for one purpose – to talk for you when you can’t talk for yourself. The more the purpose changes to become decorative or stylish, the greater the chances that the information will be missed.
I compared it to going to a foreign town and having each McDonalds store in the town with a different logo instead of every one having the “golden arches.” Or going to a supermarket where each cereal brand had multiple different boxes. We all know to look for the light blue box with Snap Crackle and Pop or the dark blue box with Tony the Tiger. What if the Frosted Flakes box was brown and had an aardvark? Would we notice?
What does everyone else think?
I’ve been diabetic since the Reagan administration and I tend to get REALLY hypoglycemic when I’m drinking/dancing, ie at the bar downtown, etc. I would hope that the insulin pump would clue people in, but an EtOH-on-board 20-something may not be presumed to be diabetic right away. I think the “fashion” medic ID bracelet may be better than nothing in those situations. At least, if I was semi-conscious, I could fling my wrist in someone’s direction and hope they read what’s on the bracelet. There have been a few situations where I’ve been semi-conscious but not able to talk due to hypoglycemia. The one time I tried to tell a cop I was diabetic by crying and showing him a purse full of syringes made him think I was high on heroin, but it at least got the ambulance there.
I don’t wear any medic alert bracelets because they’re buttugly and I DON’T want people knowing I’m diabetic. I didn’t know “fashionable” ones existed. Maybe I’d put it on before I went downtown.
I know to look for the necklaces, and the bracelets, maybe even pinned on the center of the bras. Decorative would still be okay, I feel. I just hope they don’t start dangling them from purses, cell phones or anklets.
My dad wears a plain necklace and a diabetic watch (basically it has two plates above and below the timepiece that says he’s diabetic). When I had to wear a bracelet during my pregnancy, it was a plain and obvious one, as I think it should be.
I see the temptation for fashionable medical alert bracelets. I’m an epileptic, but I’m also a medical student. On the one hand, if found unconscious, I would want the health care providers aware that I have known epilepsy; on the other hand, I don’t need my attendings and patients seeing the bracelet and asking (and they will ask — patients are very averse to doctors with disease!) This seems like an acceptable compromise.
I think it is nice to have the option. I shopped around quite a bit for a bracelet for my young daughter who has a peanut allergy. We settled on the plain-jane bracelet, because it was the most affordable, and kids lose stuff. But she really hates and and slips it off when she can. It is nice to have the option of a fancier bracelet. But there is no substitute for verbal communication with folks who need to know, like teachers, etc.
I’m extremely observant. I missed a “fashion diabetic” bracelet on a 23 yo a few months ago, brushing it off as jewelry. Thankfully, I checked her sugar anyway. My point is, we brush off jewelry that doesn’t look vaguely medical.
If you don’t want your alert tag to show, wear a necklace and keep it tucked in your shirt.
I totally agree with WhiteCoat (See! I knew it wouldn’t take long to get back on track). I bought a very nice sterling medic alert bracelet that had the emblem but not the red marking. First, it was missed during an Addisonian crisis — which is hard to diagnose. We all have angels, I guess, because someone decided to give me a good dose of hydrocortisone which brought me around enough so that I could help them help me. Second, the engraving wore off very quickly — and I bet medics, nurses, and doctors love having the bracelet but illegible information!
Well, fool me once, shame on… whatever…
I now have a butt ugly necklace and like EE suggests, I wear it hidden.
Another question — What are the thoughts on the medical jewelry that provides a number to call for up to date information versus the engraved jewelry? And… part of the package for joining a so-called Boutique practice is receiving a cd-rom to carry in the wallet — have you seen those yet? (From MDVIP)
Thanks!
Why not create a PHR on Google Health and save a copy to a small USB flash drive you keep on your keychain?
There are some tiny flash drives available – I have a 2GB one the size of a fingernail.
You could put an “ICE” label on the flash drive – same principle as having ICE listed in your cellphone’s address book.
K the problem with flash drives is that most hospitals disable the usb ports to keep the systems from becoming virus infected.
ICE sounds like a good idea and I will occasionally look for it. The bracelet has to be blatantly obvious and worn where I can find it right away. I got other things to do than search your person for a mystery medical bracelet with information.
We’re gonna check your blood sugar if your unresponsive, we recognize signs of a seizure, and we know if you’ve been drinking.
If you have a peanut allergy and your having a reaction I don’t need your bracelet info. The fact that your face is 3 times it’s size and your body is covered in hives gives it away.
I do like the idea that Bianca had about a phone call to get a persons medical history from a number. Not so much for me but for the ED it would be great. The problems I can fix I have to tools to diagnose, for the rest I just need to make sure the patient maintains a patent airway and the blood continues to go round and round else I’m getting the story so the charge nurse knows if she can put the patient in the waiting room. In Biancas case I wouldn’t be the one giving you steroids ans I only use them for severe respiratory cases. I would give you Zofran for your N/V, some fluid since you might be hypotensive, and I’d check your blood sugar, but if you were unresponsive I would make sure you have a patent airway and keep you on the monitor.
If you want me to know you have Addison’s write it on the back of your ID because I can’t write my chart for billing until I know who you are. I look for that first.
Good point. How about putting the info on an implanted chip, similar to those veterinarians use for dogs, or some kind of smart card? Only problem I can see is updating/maintaining the information.
K,
This is still too reminiscent of numbers tattooed on forearms. While the concept is exquisitely utilitarian, there is a recent negative history with similar information.
Now…. Now I could easily see a medical alert card (much like modern military ID cards). That could be a good thing as long as there is a standard format in place (local, state, national, whatever) EDs were provided readers to see the information. When carried with the drivers license this could work very well.
William sends
I don’t know, I might miss an oramental bracelet and assume it was simply a bauble and not something telling me inportant info.
Are medic alert bracelets even necessary anymore? When I’m on the ambulance, I check the BS of every patient who is unresponsive or altered, even if there is a seemingly obvious etiology (EtOH, trauma, etc.). In fact, I check the BS of every patient unless they are competent to say “don’t do that.” FSBS really ought to join SPO2 as another vital sign. It’s a simple and easy test for a potentially life-threatening condition that can present in many ways but is usually easily correctable. Yet still, I hear regularly of hypoglycemic patients getting head CTs and a whole crazy, expensive workup in the ED before someone thinks to run a chemstrip. What gives?
How do you feel about ankle-bracelets?
I have a traditional looking medic alert bracelet, but wear it on my ankle so it’s not readily visible (if I wear it at all, which is not common).
Would that get noticed?
Hit or miss for me.
The work for an unconscious patient almost always gets done from the waist up.
What if your socks didn’t get removed during a code?
Matt-
please come work in my area. FDNY doesn’t check a blood sugar on ANYONE- not even the ones they start a line and empirically give an amp of d50 to. it drives me crazy.
and to echo your statement- everyone please check a blood sugar before you intubate for ams!!
I saw a suggestion once to create an ICE entry in your cell phone directory, so I went and did that, with list of chronic meds, medical conditions and (lack of) allergies. Is this useful, or will anybody think to look in there?
ICE (“In Case of Emergencies”) entries in cell phones and ICE information stuck to refrigerators are helpful, but again, not everyone looks for them. And what if you don’t have your phone with you or you aren’t at home?
ICE can definitely help and shouldn’t hurt, but don’t count on it if you’re somewhere that the information isn’t.
When I had my EMT training we were told to look on the wrist, ankle, neck, waist, and wallet for medical information/alerts. We were also told that more and more of the alert tags are becoming jewelry. With the variety I have seen on people that does not surprise me.
Shalom- I would recommend putting a list of any medications and alergies (if any) on a card in your wallet (near your ID as well as on your phone because if you are uncontious your wallet will be checked for identification, but if you are uncontious and alone they will want a contact at some point. I have mine in both places.
This is very good advice.
I have personally opted for the plain-jane medical alert bracelet, simply because it is so hard to miss. I practice in a non-hospital setting, but I am not sure I would recognize a fancy bracelet or other jewlery as an alert.
I think that honestly with everything being fashion forward these days that medical practitioners could take 2 seconds to flip a wrist and see if a bracelet is regular or medical. I am reading a lot of these nurses who say they don’t have time to distinguish it but I’m quite certain a pulse is taken in every patient that is unconscious and that is right where the ID would be on any bracelet fashionable or not. Have we become so lazy that the simple act of flipping a wrist is a task far to complicated to bare? I hope I never end up at any of the hospitals that you nurses work at… Some people are VERY private about their medical issues and don’t want a bunch of people feeling sorry for them or judging them and this is a way to help conceil the bracelet in a way that makes the wearer feel comfortable in their every day life.. I don’t think flipping a wrist takes more than a fraction of a second and can most likely be done while doing something else with another hand…I understand people are used to certain things but you need to open your minds to the fact that the patient has to live with this bracelet and you don’t, and perhaps take that fraction of a second to make sure you’re not endangering their lives.. I don’t think that’s asking much.
Given that most pulse/vital sign information is gathered using non invasive BP machines/SpO2 monitors etc, it not that we are too lazy to flip over the wrist – its reasonable that the nurse/emt/dr isn’t spending 30seconds holding your wrist to even have that option. If there is an emergency, things are moving quickly. People look for infomration quickly. Medical alert info that looks like jewelry can be mistaken for jewelry, simple as that.