Emergency Health Information

How: Tips on Completing Emergency Health Information

When completing your emergency health information (forms included at back of this guide) be sure and include:

Disability/Conditions affecting emergency care (if you are not sure, list it):

Examples:

• Epilepsy, heart condition, high blood pressure, diabetes, respiratory problem, HIV positive.

• My disability, due to a head injury, sometimes makes me appear confused or drunk. I have a psychiatric disability. In an emergency, I may become confused or overwhelmed. Help me find a quiet corner and I should be fine in about 10 minutes. If this does not happen, give me one pill (name of medi-cation) located in my (purse, wallet, pocket, etc.).

• I have diabetes. If I lose consciousness or my behavior appears odd, I may be having a reaction due to my diabetes. If I can swallow, give me sugar in some form such as candy, syrup, cola or a beverage that contains sugar like orange juice. If my breath smells fruity, don't give me anything to eat and make sure I get medical help.

• Chemical sensitivities:  I react to......., my reaction is......., do this......... (these sensitivity conditions may not be commonly understood by emergency personnel and therefore explanations should be detailed and specific).

Medications: If you take medication that cannot be stopped without serious side effects, make sure this is clearly stated in your emergency health information and includes:

• Medication(s) names,

• Dosage,

• Times of day taken,

• When started taking and how long you have been taking the medication.

Allergies (sensitivities) such as:

• Penicillin, Sulfa drugs, or other antibiotics,

• Morphine, Codeine, Vicodin or other narcotics,

• Novocain or other anesthetic,

• Aspirin, Tylenol, Ibuprofen, or other pain medications,

• Tetanus or other vaccine reactions,

• Insect bites, bee stings,

• Latex, adhesive tape, iodine, or betadine,

• Detergents, fabric softeners,

• Pesticides,

• Eggs, milk, wheat, or other foods,

• Environmental sensitivities or sun exposure,

• Other.

Examples:

• Diesel exhaust can be dangerous to me. Do not put me in or near idling emergency vehicles.

• I can speak when provided with fresh air and away from things I am sensitive to.

Immunization (shots) and Dates:

Examples:

• Flu,

• Pneumonia/Pneumococcal,

• Tetanus/diphtheria,

• Polio (IPV or OPV),

• Measles-mumps-rubella (MMR),

• H. influenzae type b (HIB),

• (Chicken Pox) Varicella,

• Hepatitis A,

• Hepatitis B,

• Rubella.