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Watch That Jewelry

By CHELLE CORDERO, Correspondent | October 01, 2019 | NEW YORK

Story No. 072519110

Actress Jane Russell sang the song "Diamonds Are a Girl's Best Friend", but a medical ID bracelet or pendant can be a patient’s best friend when he/she can’t speak for himself.

When a patient is wearing a medical ID piece of jewelry it can give EMS providers an insight into what the medical emergency may be and can be a literal lifesaver. If the patient is unresponsive or incoherent and there is no one else to offer valuable medical history, the paramedic or EMT can easily learn about chronic medical conditions like diabetes, epilepsy, heart problems, asthma, or bleeding disorders. Drug allergies, bee sting allergies, current medications and contact information can also be listed on the medical IDs. This life-saving jewelry may be worn as a bracelet, a necklace, or sometimes part of a key ring, and the EMS crew should know to look for one of these, particularly in an unresponsive patient. The jewelry can be very attractive but almost always features a caduceus and/or a star-of-life.

Another important medical ID bracelet can prove invaluable to ensuring a patient’s quality of life wishes are followed. Some patients who have signed a DNR (Do Not Resuscitate order), have also chosen to wear a DNR medical ID just to make sure that their wishes are known. New York State has an approved standard Out of Hospital DNR form that is legally recognized statewide for DNR requests; Medical Orders for Life-Sustaining Treatment (MOLST) with end of life preferences may also contain a DNR directive. Patients with a valid Nonhospital DNR or MOLST form with a DNR order allows a standard metal bracelet to be worn by the patient, which includes a caduceus and the words “DO NOT Resuscitate.” EMS providers should assume that there is a valid DNR in place when a DNR bracelet is identified on a patient even if the printed DNR order is not immediately made available. NYS DOH requires that DNR and MOLST orders must be signed by a physician and should be honored by EMS agencies (DNR tattoos are not considered valid directives).

On the MOLST form there are two choices when patient has no pulse and/or is not breathing — "Attempt Cardio-Pulmonary Resuscitation,” indicates that the patient wants all resuscitation efforts to be made, including defibrillation and intubation; or "Do Not Attempt Resuscitation (Allow Natural Death),” indicates that the patient does not want any resuscitation efforts made, and the patient wishes to be allowed a natural death. This does not prevent treatment up to the point of resuscitation. Other boxes checked off on the form allow for advanced directives, and orders for other life-sustaining treatment and future hospitalization when the patient has a pulse and is breathing.

When a patient wears a DNR bracelet, it refers ONLY to the Do Not Resuscitate rules that apply to the non-hospital DNR order or MOLST with DNR. The MOLST form also provides the patient and his/her physician with the ability to give a Do Not Intubate (DNI) order to health care providers. If the EMS providers encounter an unsigned MOLST or DNA form they should:

1. Initiate rescusitation following applicable state and/or regional protocols;
2. Obtain clinical information on status of the patient;
3. Confirm the MOLST form is specific to the patient;
4. Consult with local medical control and relay the above information; and
5. Follow the direction of the medical control physician.

Checking for medical ID jewelry is important for every EMS responder. An ID can help avoid misdiagnosis and delayed treatment in a medical emergency, and checking for a DNR bracelet helps ensure that the patient’s wishes are being carried out.

This article is a direct street report from our correspondent and has not been edited by the 1st Responder newsroom.