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.