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Naturally, people with diabetes want to avoid labels that imply that there is something wrong with them. Because of this, many in the diabetes community are hesitant to wear medical ID. While this aversion to being labeled is understandable, ID provides medical workers with valuable, potentially life-saving information in an emergency.
To get an idea of just how prevalent medical ID is among people with diabetes, interviews were conducted with eight police, fire and paramedic workers, and five doctors and educators. A group of 18 men and women with insulin-dependent diabetes were also surveyed. Of six men and 12 women, only eight said they wear I. D., while the other 10 said they did not.
While this is not an exhaustive scientific survey, the comments from these health care professionals and people with diabetes offer insights into the importance of wearing ID, how they are used in emergency situations and the barriers to wearing ID people with diabetes face.
Design Is Key
If you're careful, and lucky, it's possible that you'll never end up in the emergency room. Many people with a chronic medical condition prefer to hope for this best case scenario rather than wear visible medical ID. This is especially true for people with diabetes and others whose condition isn't obvious to others.
Others may carry an inconspicuous wallet card listing their medical conditions. This practice, however, begs the question: Are emergency workers going to treat your wounds first, especially if you are badly hurt, or are they going to rummage through your purse or wallet?
"If you think you're going to identify a medical condition by stashing a card in your wallet, you're wrong. People don't always walk out with their purses or wallets," says David Roth, director of communications for MedicAlert, makers of medical ID bracelets and necklaces. "A purse is not a body part. It may take a day or two to show up at the emergency room or your house," he adds.
So what should medical ID consist of?
Roth refers to ADA and AMA guidelines - it has to be a piece of body-worn ID, something that's readily visible.
There are many other forms of ID advertised, watch tags, lockets, iron-on labels and tags for shoelaces to name just a few. But it's important to keep emergency personnel's basic training and standard operating procedures in mind when deciding on an ID.
For example, there is an attractive ad on the Internet for personalized iron-on clothing labels showing a police officer peeking in the back collar of a boy's shirt. However, none of the emergency personnel interviewed for this article mentioned being trained to do this.
But procedures can change.
Many community emergency responders in the San Francisco Bay Area are currently being trained to use Stanford University Hospital's "Vial of Life" program. Patient representative, Joan Raiter, said the program was adapted from similar programs being used in other parts of the United States.
Aimed particularly at seniors, Raiter reports that Stanford has distributed 20,000 of the Vial of Life kits since January 1997 to interested groups that provide services to seniors.
The kits contain a medical information form, a vial to house the form and a corresponding sticker to be placed on the outside of the user's refrigerator. The system requires that users maintain current information and that emergency personnel are trained to look for and locate the vials. While the system has its benefits, it is only truly effective if the emergency happens at home.
What Really Happens In an Emergency?
There is some doubt in the diabetic community as to whether emergency workers even pay attention to bracelet and necklace ID. "Do emergency personnel really look for them?" asked one survey respondent who chooses not to wear ID.
They do and they don't.
Tom Godbier, a San Leandro, Calif. firefighter was vehement about it, "Bracelets are lifesavers." He claims that up to 90 percent of his emergency calls are diabetes related. Unfortunately, few if any wear medical ID.
Godbier once found a man passed out in the back of a pickup truck not wearing ID. Was it a case of drug overdose, or a drunk? Luckily, a neighbor came over and explained that the man was diabetic. He was treated and released on the spot.
Other firefighters and police personnel confirmed that without ID, the first suspicion in such a situation is intoxication.
If a person is unconscious, paramedics are trained to perform a "primary," says Bonnie Terra, secretary of the Santa Clara County Fire Department Operations Division. A primary consists of a head-to-toe sweep, checking for blocked airways, pulse, etc., and includes a hand check of the wrists and neck.
Some emergency medical personnel say they "usually" only look at the wrists. Others say they cover all the bases. Steve Mozingo, of the Milpitas, Calif. Fire Department, who is training a new group of paramedics for his city, says he checks a wallet last.
Who Makes the Call?
In addition to listing basic medical information and chronic conditions, some ID offer toll free numbers to call to get more detailed medical information. But, will emergency personnel actually call the numbers in an emergency?
The police contacted for this article said they rely on firemen and paramedics to call. In turn, firemen and paramedics said they don't call, but assume the receiving hospital will.
Mary Teague, RN, CDE, medical resource specialist at MedicAlert, concedes that emergency medical workers could make better use of the numbers, but she says that MedicAlert receives calls from emergency personnel "very, very often." She claims that emergency medical technicians (EMT) and paramedics are trained to look for ID and call the numbers listed. Choosing to use this resource is another matter, however.
Teague also points out that the 800 number on medical ID is one of the most valuable aspects of wearing ID. When the 800 number is called, MedicAlert can fax a patient's full emergency medical record directly to paramedics in an ambulance or to doctors and nurses in the emergency room.
Regardless of whether or not the 800 number on ID ever gets called, ID's immediate function is probably most important. "The information listed on a tag gives enough understanding to provide immediate care," says Mozingo.
Of those surveyed who'd had an emergency, four said that their ID had helped them, even multiple times. MedicAlert was the name mentioned almost universally by the educators, doctors and people with diabetes surveyed. Roth, MedicAlert's director of communications, was ready to provide many more testimonials to the efficacy of MedicAlert's emergency ID. But he's also frank about the numbers that don't wear them.
"There's a huge gap between the number of people who wear ID and the number of people who should," says Roth. Individuals with diabetes represent the single largest category of MedicAlert's 25 million members. But, "even if there were another ten organizations that had the same membership numbers as we do, it would still be small relative to the number that need to wear ID," he adds.
From Roth's experience with focus groups, he claims that most people don't address the issue of wearing ID until they are in an emergency situation. "Once people get into a serious scrape when their life may be threatened," he says, "that's when they do something."
Survey respondents gave a wide variety of reasons for not wearing identification, but there definitely was a common theme. Most don't want to be labeled by ID, despite that fact that it might save their life one day.
"I use a wallet ID card. I can update it and fill it out myself, it costs nothing and I don't feel branded by diabetes," claims a male respondent.
"Medical ID is not attractive, and it's psychologically labeling" says one woman.
Edward J. Meyer, MD, an endocrinologist who also has type I diabetes, believes that those without diabetes, especially the physicians who recommend wearing ID, don't fully appreciate the visibility issue. "They're not one of the 'lepers,' so they just don't think of these things." He added that he wears a MedicAlert necklace that he feels would be noticed by emergency personnel, but is intentionally not apparent in day-to-day interactions.
Roth agrees that there is a powerful stigma attached to wearing medical ID. "People don't want to be identified because if you're sick in America that means you have a character flaw," he says.
In addition to the aversion to being labeled, many don't want to wear ID because they feel it's just plain ugly. Not everyone agrees, however. One woman who wears a gold bracelet from MedicAlert likes the look of her ID. "It's like a piece of jewelry," she says.
Attractive or not, one has to remember that the primary purpose of wearing medical jewelry has always been to protect, and the basic no-nonsense bracelet or necklace is designed to get the attention of strangers, especially medical workers.
Now More than Ever
Despite the fact that medical personnel stress the importance of medical ID in an emergency, ID is still grossly underutilized by people with diabetes. Unfortunately, there doesn't appear to be any quick fix for this discrepancy between utility and utilization.
To compound the problem, ID may now be more important than ever. "More people will be trying to achieve blood glucose levels in the normal, non-diabetic range especially with the new guidelines stressing tighter control," says Mike Arcangeli, MS, a researcher who works with people with diabetes. As a result, more people are likely to run into trouble with hypoglycemia.
Persons with diabetes, and the rest of those 90 million Americans suffering from chronic medical conditions, may be hearing a whole lot more about medical identification very soon. According to Roth, the MedicAlert Foundation is making a big push to reach people with diabetes. Hopefully this strategy will convince more individuals in the diabetes community to play it safe and wear ID.