ER Doctors Often Face a Shortage--of Patient Info
The hunt for important medical and personal information was well underway by the time paramedics wheeled the semiconscious 78-year-old construction worker into the emergency room. They already had logged his vital signs, learned his name and assessed injuries he suffered in a 10-foot fall from a ladder.
The patient was unable “to tell us where he hurt or any subtleties of his mental status,” said Dr. Edward Newton, co-director of the emergency room at Los Angeles County-USC Medical Center’s General Hospital.
So the doctors and nurses did what they usually do when patients arrive in the ER with no medical history and unable to communicate: They flew blind, relying on standard procedures and experience.
Expressing some reluctance with his own analogy, Newton likened the task of evaluating a patient who can’t tell doctors what’s wrong to “a veterinary exam.”
On this particular night, they studied a gash on the patient’s head and looked for indications of a broken neck or back. Under a spotlight’s eerie bluish glow, technicians performed X-rays that could reveal damage or why he fell.
Having medical information in hand is often a luxury in hospital emergency rooms. This is especially true at inner-city hospitals such as County-USC, which treat large numbers of uninsured, working poor and transients, who may lack regular medical attention. Yet such information could speed the doctors’ job--or possibly save a life by averting drug reactions or other complications.
For example, if doctors knew a patient with chest pain was severely allergic to aspirin, a standard treatment, they might choose a substitute and save the time involved in reversing a potentially deadly reaction. If they knew a patient with an inflammatory disease such as colitis was taking steroids, they could avoid medicines that further compromise the body’s fight-or-flight system, Newton said.
Both private industry and the medical profession have begun some small-scale efforts to address the problem.
And a handful of doctors and hospitals are encouraging patients to carry at least a bare-bones health record and an emergency contact, even if it’s scribbled on a scrap of paper.
“As an emergency physician, if I can get anything with a patient’s history on it--an old chart, a write-up from a board-and-care, or a medical information access card, I am already five minutes ahead of the game,” said Dr. Robert Realmuto, medical director of Orange Coast Memorial Medical Center in Fountain Valley, which provides a plastic card with medical history, emergency contacts and insurance eligibility free to the community.
The American College of Emergency Physicians supports medical information cards and wants parents of special-needs children to keep medical histories at school and on the refrigerator where baby-sitters and others can grab them. If doctors knew a child with breathing trouble had an underlying heart condition, they might avoid antihistamines that make the heart race, said M.J. Fingland, a spokeswoman for the organization.
Without a medical card or other information, hospital workers scramble to gather what they can about a patient. If paramedics haven’t yet searched the patient’s clothing and wallet, social workers or ER staff may track down next of kin. They’ll check hospital records. They may ask law enforcement to visit the neighborhood where the person was found, in hopes of locating a friend or neighbor.
For sure, an engraved medical alert bracelet--hard to miss during the physical examination, can reveal drug allergies or conditions such as epilepsy or diabetes that might explain a coma or seizure. The bracelet links emergency health workers to a phone number they can call to get more information on the wearer. But fewer than 5% of people passing through County-USC Medical Center’s emergency rooms wear one, says Dr. Gail V. Anderson Sr., emergency department chairman.
Only the rare patient carries a wallet-sized card with medical information that might reveal dementia or other conditions that could explain the patient’s difficulties communicating.
As Anderson and others say, you can’t make people tattoo the information on their foreheads. Requiring that everyone’s medical records go into a large database raises privacy concerns. High-tech solutions that link personal medical histories to the Internet or scannable cards that reveal sensitive data could compromise careers or insurance if the information fell into the wrong hands.
“Everybody is worried about Big Brother,” said Dr. Gail V. Anderson Jr., medical director of Harbor-UCLA Medical Center in Torrance and the son of County-USC’s Anderson. A spokesman for the emergency physicians’ college, he thinks the group needs to push voluntary ways of providing access to medical history, such as bracelets and medical information cards, until privacy issues can be addressed.
Advocates of high-tech databases say a good information system could make emergency health care more efficient and eliminate redundancies in the often overburdened health care system. Dr. Marie Russell, an ER attending physician at County-USC, favors a card in which doctors could quickly learn what medical tests patients have had and their results: “Has somebody had a stress test before? Do they have coronary disease?”
A few organizations have fledgling efforts to provide such information. Precis Smart Card Systems of Oklahama City is test-marketing a wallet-size card in which the patient’s medical record is embedded on a microchip. The product, called the Instacare Emergency Card, must be read with a portable hand-held device. And the Medic-Alert Foundation, a Turlock, Calif.-based nonprofit group that provides identification bracelets and pendants for people with serious allergies and medical conditions, is collaborating with San Diego-based Humetrix.com on an electronic card that would allow doctors to obtain members’ medical records through the Internet.
Meanwhile, some hospitals and doctors are encouraging the simpler solutions, such as alert bracelets or printed cards. But even those methods require verification. Some drug abusers obtain diabetic alert bracelets to try to fool police in case they are ever detained, said Dr. Chris Johnson, a resident at County-USC.
Nearly 100,000 patients who live in Los Angeles and Orange County communities now are carrying medical information cards provided by Memorial Health Services, a Fountain Valley-based health care company that operates five hospitals in the region, including Long Beach Memorial and Orange Coast Memorial Medical Center.
The wallet-size cards are printed with basic personal and medical information and also have a magnetic strip that can be swiped to show information about the patient’s medical insurance and medical history--data that the person has provided voluntarily.
A Beverly Hills cardiologist has taken that idea a step further by including a miniaturized tracing of a patient’s electrocardiogram on a wallet-sized card. If a heart patient is treated by an unfamiliar doctor, the card provides a critical piece of information.
“The EKG can show, for example, that a patient with atypical chest pain isn’t having a heart attack because it provides a baseline for what’s normal in that patient,” said Dr. Yzhar Charuzi.
The card contains the name of the patient’s doctors, along with allergies, other medical conditions and a list of past medical tests and procedures. Charuzi, who charges patients $20 to cover the cost of the cards, said one of them recently came in handy for a patient who became seriously ill during a trip to Romania.
As the medical system sorts out long-term solutions for the sharing of medical information, his card-carrying patients are prepared. In a health crisis, he said, what matters is “whatever you have on the spot.”
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Residents of Los Angeles and Orange counties may order a free emergency information card from Memorial Health Services through its web site at https://www.memorialcare.org or by calling toll-free, (877) 446-4406, regardless of whether they use its hospitals.
* A free Medical I.D. Pocket Pal, as well as a blank personal medical history, consent-to-treat and emergency-information form for children with special health care needs, can be obtained by writing to the American College of Emergency Physicians at 1111 19th St. NW, Suite 650, Washington, DC, 20036, by calling (800) 320-0610, Ext. 3006, or by going to https://www.acep.org.
* To obtain MedicAlert tags, contact the MedicAlert Foundation at (800) 432-5378 or go to https://www.medicalert.org.
