THE INFORMED PATIENT AUGUST 31, 2010

The Wall Street Journal

By LAURA LANDRO

It's a simple step, but one many doctors forget to remind patients to take: Wear a medical-alert bracelet.

A growing number of American adults and children face complex medical conditions like heart disease and

diabetes. They may have drug or food allergies, suffer from disorders like autism, or take medications like the

blood thinner coumadin that medical staff should know about in an emergency.

New bracelets and other medical-identification systems can fill in first responders on practically a patient's complete health

history. They're a far cry from the simple identification bracelets of the past, which with a few engraved words informed medics

that a person was, perhaps, allergic to penicillin. They can steer first responders to a secure website or toll-free phone number,

or initiate a text message, to get the medical and prescription history of a patient who may be unconscious or unable to talk

about their condition.

Of course, wearing the traditional clunky metal medical-alert

bracelets might be a turnoff to some, and too visible a reminder

of a disease or condition. That's one reason a number of jewelry

companies make bracelets, necklaces and watches that look like

real bling—Tiffany & Co. has a gold bracelet for $2,250, for

instance—and some pendants can easily be hidden under

clothes.

But unless these are linked with membership to a medical-information service, such as the nonprofit MedicAlert

Foundation, emergency responders' knowledge will be limited to what's engraved on the accessory. People who

don't want to wear jewelry can carry a specially marked USB flash drive loaded with emergency data that medics

can read from any computer in an emergency. Whatever identification system is chosen, doctors say, it should

provide a way for responders to access as much information as possible quickly.

F. Martin Ramin for The Wall Street

Journal

"Many patients have situations that are so much more complex

than just the penicillin allergy that can be noted on a bracelet,"

says Robert Pearl, chief executive of the Permanente Medical

Group, part of nonprofit health system Kaiser Permanente. "We

also have to look for drug-drug interactions, drug dosages, or

compare an old EKG against a new one if you are having chest

pains," he says. Kaiser last year began offering members in

Northern California a $5 flash drive loaded with personal

information that can be regularly updated from Kaiser's

electronic medical-records system.

As the recipient of a bone-marrow transplant for leukemia 18 years ago and three related procedures since then,

I recently learned the hard way that I should be wearing a medical-identification bracelet myself. One morning

in May I ended up in the emergency room after an internal injury resulted in heavy blood loss. When I was told I

was going to need a blood transfusion, fortunately I was alert enough that a red flag went up in my head.

People who have received a bone-marrow transplant, or are in

treatment for blood cancers, typically need a form of blood

treated with radiation to kill off certain white blood cells that

can cause a potentially deadly reaction. My husband called one

of my transplant doctors to confirm this, and the transfusion was able to be put off a few hours until irradiated

blood, which isn't always readily available, could be located.

During an annual checkup last month at Seattle's Fred Hutchinson Cancer Research Center, where I received my

original transplant, I informed my doctors about my emergency transfusion and they suggested wearing a

bracelet in the future. Though transplant patients are told after discharge that they should receive only

irradiated blood, the center is now formulating a policy to also advise them to wear a medical-alert bracelet.

Anyone with a medical condition that would not be obvious to medics or doctors if they were unable to

communicate should consider some form of medical-identification program, says Alfred Sacchetti, a member of

the American College of Emergency Physicians who worked with MedicAlert on guidelines for children's

emergencies. Dr. Sacchetti, an emergency physician at Our Lady of Lourdes Medical Center in Camden, N.J.,

says he often encounters children with complex medical conditions like endocrine disorders whose parents say

they were never told their child should wear a bracelet.

Christie Iannucci, Dr. Sacchetti's 28-year old daughter, has worn a MedicAlert bracelet that says "heart disease"

since she was in fifth grade. Ms. Iannucci, a teacher in Medford, N.J., says in the event of an emergency, first

responders need to know that her heart rate, which might not sound normal, is normal for her. To dress up the

metal bracelet, she says she wears it with her grandmother's diamond tennis bracelet.

Engraved on bracelets issued by MedicAlert are a patient's member number and a toll-free number to access a

24/7 hot line for information. The service costs adults $39.95 for the first year and $30 annually after that;

children's fees are less. MedicAlert has added services like notifying family members in an emergency.

Ramesh Srinivasan, MedicAlert's executive vice president, says the organization has seen a growing number of

parents signing up kids with food allergies and autism spectrum disorders. There is also interest in bracelets that

say "no known medical conditions" so treatment won't be delayed in an emergency, as well as more demand

from younger adults who are active athletes with medical issues, he says. Nearly half the group's 2.3 million U.S.

members are over 65.

Privacy is a concern to some people considering wearing a medical-alert bracelet. When Kaiser Permanente

loads a patient's data onto a flash drive, it encrypts the file and protects the contents with a password.

For people whose doctors don't keep electronic medical records, companies like MedInfoChip sell software

programs for about $50 that help consumers set up their own health records on a computer and load them onto