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Unconscious Patients Can Talk
Why paramedics should pay attention to MedicAlert
Blair Bigham, MSc ACPf
Cheri Nijssen-Jordan MD FRCPC MBA
The reflection of your strobe lights off the snowflakes is almost blinding. It’s cold and dark and windy, the most chilling shift of your set. You have been dispatched to that small house on the large corner lot, you know, the one you didn’t think anyone actually lived in. As you pull up to the driveway a ghost-like figure appears in front of you, waving arms to draw your attention, confidently standing behind the mailbox as if it offers protection from your vehicle. You slowly pull along side, cautious of the slick roads that make your ambulance more difficult to navigate than a transatlantic cargo ship. You plow your stretcher up to the front porch and lug your gear into the house. The man who flagged you down blurts about how he came to collect rent from his tenant only to find her passed out on the floor of the kitchen. She must be dead, you assume. As he leads you through the narrow front hall, you get a glimpse of the patient and quickly abandon your initial impression: this patient is alive, but for how long is anyone’s guess. “What happened here” you ask, but the landlord doesn’t know. The typical questions all come up without answers... medications, allergies, past problems... “She’s a really nice lady” he tells you. Great. You turn to your patient and, for a moment, consider asking them aloud what led them to be on the kitchen floor. Alas, we all know unconscious patients can’t talk.
Oh, but they can. For over 50 years the Canadian Medic Alert Foundation has been offering patients and paramedics alike the opportunity to communicate during emergencies. Every college student is taught to check an unconscious patient’s body for the iconic MedicAlert ®emblem to gain insight into the patient’s plight. Known mostly for displaying allergies, MedicAlert offers much more: diseases, devices, medications and special information are all available on the back of the bracelet, necklace, or watch bearing the MedicAlert emblem, and a wallet card is supplied to each MedicAlert member. Also available is the little-known phone number paramedics can call. Answered within 5 seconds, this number connects you to the patient’s MedicAlert emergency medical file 24 hours a day, 7 days a week, 365 days a year. An agent will quickly share everything you want to know about your patient, and even offer to fax their file to your receiving hospital.
With these services it’s no wonder over one million Canadian’s trust MedicAlert with their emergency medical profiles. Surprisingly, though, there are a number of stories where health care providers – paramedics included – have failed to recognize the Medic Alert bracelet. Sometimes the consequences are tragic. Other times, misfortune is avoided only by pure chance. Recently, much attention has been dedicated to patient safety. Ensuring that health care providers utilize all available information to make the best decisions for patients has been a topic of great national focus, and in the same spirit we present case studies involving the MedicAlert emblem with the hope that paramedics can improve system safety through diligence and advocacy.
Case Study 1: The Good
An unconscious elderly patient was picked up by paramedics a block away from a children’s emergency department and brought in to be resuscitated as it was the nearest hospital. The medical staff and paramedics both noted that the patient was wearing a MedicAlert bracelet which identified him as having diabetes mellitus. Glucose was immediately administered and the patient awakened and was able to be discharged home within hours.
Case Study 2: The Bad
A patient recently wrote to MedicAlert to complain about her emblem being ignored. MedicAlert has had several of these letters in the past, but this one jumped out. When the patient mentioned to the paramedics that they hadn’t noticed her bracelet, they replied “Oh, no one looks at those... they’re useless.” The patient was upset: she had been under the impression that if she couldn’t speak, those trained to help her would pay attention to her MedicAlert bracelet. At the hospital, she mentioned this to a nurse, who replied “Yeah, those things are garbage”. She actually used the word “garbage”. Twice, in the span of an hour, the patient was told her MedicAlert bracelet has no value in communicating her health condition.
Understandably disheartened and frustrated, she wrote to the MedicAlert Foundation, and with her story she included her bracelet. She no longer wanted it.
Case Study 3: The Ugly
An ambulance was dispatched somewhere in Ontario last year for a patient presenting with signs of stroke. The paramedics rushed the patient to the local emergency department. On the patient’s wrist was a bracelet with the easily recognized MedicAlert emblem. On the back, engraved in capital letters, were the words NO HEPARIN. Rare is it we come across a patient with heparin-induced thrombocytopenia… even more rare would be for the patient to identify such a condition. But in this case, the patient didn’t have to – their bracelet spoke for them. If only those called to help had listened.
The paramedics didn’t note the bracelet, and the emergency department staff didn’t either. Over a dozen well trained and caring health care providers were involved in the care of the patient, and not one of them spoke up before the heparin was administered. The patient died a few hours later.
Why did this happen? The patient had taken every precaution to help themselves by being members of MedicAlert and wearing the bracelet. Any one of the twelve or so caregivers had the opportunity to recognize the MedicAlert bracelet and communicate the information to the team. In this case, an emergency department tragedy could have been averted had the paramedics highlighted the critical history to the ED team
YOU can make THE difference!
Paramedics do more than just take people to the hospital. They collect valuable information about the scene, the patient and their course during patient care. Perhaps paramedics assume that hospitals will discover these same things, but as we’ve seen information can sometimes slip through the cracks. Paramedics have a special role to play in ensuring that as care is transferred to emergency departments, accurate information is transferred as well. Look for the MedicAlert bracelet, watch, necklace, tags and wallet cards. Call the MedicAlert Hotline for additional information and records that are available. After all, you can probably save more lives by communicating important information clearly than you ever could with your defibrillator.
About the authors
Dr Nijssen-Jordan is a pediatric emergency physician at the Alberta Children’s Hospital in Calgary and current Chair of the Canadian MedicAlert Foundation.
Blair Bigham is an advanced care paramedic working land and rotor wing in Ontario. He has completed his Masters of Science in Medical Science at the University of Toronto and Synnybrook Health Sciences Centre and is now an Investigator at Rescu, the resuscitation research program of the University of Toronto where he specializes in knowledge translation and patient safety related to cardiac arrest.
