Does the Public Expect Too Much From Medical-Alert Technology?

By: James Careless / EMSWORLD

Even in its simplest form, a medical-alert bracelet can be a powerful lifesaving device. Wearers can plainly display their allergies and/or medical conditions on the bracelet’s metal nameplate. This information can help prevent EMS and emergency personnel from administering the wrong treatment when the wearer can’t speak for themselves.

In recent years the medical-alert concept (note that MedicAlert is a brand name for the organization that pioneered this warning system) has moved far beyond the plain metal bracelet. Consumers can now buy a range of fashionable bracelets, necklaces, charms, and watches branded with their medical information—many of them so fashionable, it isn’t obvious they contain data. (This range is even offered by the MedicAlert Foundation.)

At the same time, the medical-alert concept has expanded to include wearable medical-alert USB keys that contain the wearer’s medical history in digital form. The idea here is that first responders will see this flash drive, plug it into a laptop, and have the patient’s medical particulars at their fingertips.

That’s not all: “The Tap2Tag medical-alert key fob uses NFC (the same wireless communications ‘tap-and-go’ credit cards use) and QR code technology to provide paramedics and other health professionals access to your medical information quickly and efficiently,” says www.tap2tag.me. “It can also be used with any device that has access to the Internet anywhere in the world.”

Such technology represents an enormous breakthrough, capable of providing a noncommunicating patient’s full medical history before treatment begins. The problem is that EMS personnel are not likely to avail themselves of this information beyond potentially spotting an obvious bracelet during treatment. They may not even see that.

“When EMS arrives they are going to manage critical issues first: basically airway, breathing, and circulation,” says Carol Cunningham, MD, FAAEM, FAEMS, state medical director for the Ohio Department of Public Safety’s Division of EMS. “If they find a medical-alert bracelet, that’s great. But we don’t mandate them to search the patient for one.”

A Patient’s Expectation

Beth Vasil is a firm believer in medical-alert wearables for herself and her family. “My cousin, nephew, and I are all cancer survivors (Hodgkin’s lymphoma), and one of the elements of our treatment was bleomycin,” she explains. “Recently it has been shown that administering oxygen to these patients could be toxic.”

Not a fan of traditional MedicAlert jewelry, Vasil recently purchased a MyID-brand sleeve, “which allows first responders to scan a QR code or log in to the website with a unique ID number and PIN,” she says. “I got my kids ones that are like watchbands, with the plate stating their issues and my phone number. My nephews all got black dog tags with a red cross on them and info on the back.”

After doing so, “someone told me an EMS friend told her they aren’t trained to look for anything but the old-school silver bracelet or necklace, and a lot of responders don’t even really look for that,” says Vasil. “This boggled my mind. There needs to be a protocol for all first responders to do a brief scan of the jewelry people are wearing. I understand time is of the essence, but a quick jewelry scan—maybe while taking vitals, since most are at the wrist or neck—can help prevent a disastrous outcome from using a treatment that is benign for most people but could be deadly to others.”

EMS’ Hard Reality

Protocols that direct EMS personnel to search patients for medical-alert wearables are indeed rare in the U.S. And despite Vasil’s hopes, this isn’t likely to change. Though she’s sympathetic to Vasil’s concerns, Cunningham says looking for medical-alert wearables—especially when there are so many styles—just isn’t feasible.

“In a critical situation EMS shouldn’t be tasked with searching for that,” says Cunningham. “They are there to initiate acute lifesaving care and transport the patient to the nearest appropriate medical facility. My primary job is to save your life, not to search for a computer chip while delaying emergent lifesaving treatment.”

A two-person crew has too much to do to search for medical-alert wearables first. Plugging in USB keys, using NFC wireless communications, and scanning QR codes to access patient data is just not currently practical. Many ambulances do not carry computers or have reliable wireless connections. For those that do, the wide variety of operating systems installed in medical-alert devices can be incompatible with the software utilized by the EMS agency.

“Even if they had the time, EMS crews cannot count on having Internet access, let alone having the technology on hand to read these devices,” says Cunningham. “While this may work in the hospital, where there are lots of practitioners and high-end technology, it’s really not very useful in the field.”

A Tricky Dilemma

Clearly there is a growing disconnect between the kind of patient protection promised by medical-alert wearables—particularly the high-tech ones—and how much EMS personnel actually seek and access these wearables during care.

“This is why I advise people that the original, basic MedicAlert bracelets are still the best,” Cunningham says. “They are relatively easy to see, and EMS personnel are accustomed to recognizing them.”

For someone in Vasil’s position, Cunningham recommends alerting local EMS agencies to her and her family’s conditions. This way their critical information will already be available should the family ever need emergency treatment.

If there is a moral to this tale, it is that consumers should not count on medical-alert wearables to deliver on the promises they make—at least not without checking with their local EMS agency first.

As for the improved EMS awareness Vasil seeks, it might make sense to settle on a single medical-alert standard that is interoperable throughout all EMS and healthcare systems, and actively promote it to consumers, manufacturers, and local EMS agencies.

By doing so, consumers could buy medical-alert wearables more likely to be noticed by first responders.

James Careless is a freelance writer and frequent contributor to EMS World. 

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