Do Medical IDs Save Lives?

The skeptical cardiologist recently received a package from American Medical ID, which loudly proclaimed that “Medical IDs Save lives!” The company suggested that I “Fully Open” my display and place it in a prominent location.
I’m sure you’ve seen these types of displays in your doctor’s office:
I really don’t like promoting products in the office waiting room that haven’t been proven to be helpful, so I began wondering if medical IDs really do save lives.
American Medical is one of many for-profit medical ID jewelry makers who engrave various forms of jewelry with the medical information a patient gives them, with the hope that it will provide crucial information if the patient is unable to provide it themselves.
The first organization to provide this service was the Medic Alert Foundation, which, according to their website:

is a non-profit, charitable, and membership-based organization dedicated to the well being of others. Founded in 1956 by Dr. Marion and Chrissie Collins, the foundation’s mission is to protect and save lives by serving as the global information link between members and emergency responders during medical emergencies and other times of need. As a non-profit organization, MedicAlert Foundation is governed by a volunteer board of directors, comprised of highly respected national leaders from the healthcare profession and business.

MediAlert jewelry is supported by a 24/7 call center which claims to have access to the users medical records.

While communicating with first responders, MedicAlert will retrieve your MedicAlert health record and provide your health history – including medical conditions, medications/dosages, allergies, past surgical history. We will also provide your personal identification and emergency contact information to ensure you are quickly reunited with loved ones. If you are being transported to a facility, MedicAlert will also fax your health record so your information is available upon arrival

Medical ID Jewelry Accuracy

I am unaware of ever providing MedicAlert with medical information on any of my patients, so I assume the information that they have available is provided by the patient themselves, and may or may not be accurate and up to date.
Actually, one has to be concerned whether the patient information on any medical ID jewelry is up to date and accurate.  If it’s not accurate, it could potentially confuse care providers and lead to more errors in care.
Given the potential downsides of medical ID jewelry, is there any evidence that it saves any lives, let alone millions?
There are, of course, anecdotes. And these dramatic stories help propel sales of millions of bracelets and necklaces.

Stylish Medical ID Jewelry

Lauren’s Hope is a Missouri company which a heart-warming story of its genesis: Lauren, a teenager with type I diabetes did not want to wear her medical ID bracelet because it wasn’t stylish. A new interchangeable bracelet was created.

Named after its inspiration, Lauren’s Hope quickly became a bustling kitchen-table business. In its first year, the company saw phenomenal success, particularly after the infinitely talented Halle Berry wore her Lauren’s Hope medical ID bracelet on the Rosie O’Donnell show when discussing her own Diabetes diagnosis. Practically overnight, people who had grudgingly worn, or even refused to wear, the standard, plain metal medical ID bracelets of the past suddenly had attractive, durable, stylish options they could enjoy wearing and change to suit their mood, outfit, or activity.
Today, more than 500,000 people wear Lauren’s Hope medical IDs every day, and we’re proud to say that number just keeps growing.

The compelling argument for a Type I diabetic to wear a Medical ID bracelet is that if they become confused or unresponsive from hypoglycemia, a paramedic or bystander can immediately recognize the situation, give glucose and save a life.
The problem with this seemingly apparent benefit is that the paramedic should not assume an unresponsive person who is a diabetic is hypoglycemic; other causes should be considered and evaluated. Likewise, hypoglycemia should be considered and tested for in an unresponsive person who is not known to be a diabetic.
(Before excoriating me for the above heresy, let me state that I am not advocating that insulin-dependent diabetics rip off their Medical ID bracelets)

What does Science Tell Us?

If you do a Google search asking the question “Do Medical ID’s Save Lives?” the vast majority of search results are various links to Medical ID company websites.
I was unable to find any scholarly article which addressed the question of lives saved by medical ID jewelry, but I found one 2017 British paper which questioned the benefits after a review of the scanty literature on the topic.
The paper begins with a table listing their suggestions for potentially appropriate and inappropriate inscriptions on alert tags:
From a cardiac standpoint, the relevant conditions are 1) the one medical implant they mention-an ICD (implantable cardiovert-defibrillator)  2) prosthetic heart valves, and 3) anticoagulants.
I have to say that in my 30 years of practicing cardiology I have never advised a patient with one of these conditions to wear a Medical Alert ID.
The same considerations I mentioned for the unresponsive diabetic applies to these cardiac conditions. For example, some patients with pacemakers or ICDs should not get MRIs. If an MRI is indicated on a patient that cannot give a history, it is the responsibility of the radiologists and technicians to make sure that the patient has not had an implant that would put them at risk. Thus, a careful search of the body for signs of surgery is warranted, with a standard Xray if an implant is suspected (see here).
The British paper authors conclude:

The striking result of our literature review is that there is an implicit assumption that medical IDs work, and themselves lead to minimal harm. Our commercial review revealed that these products are readily available for purchase from several companies, with no mandatory governance or minimum standards to ensure the accuracy or appropriateness of the information provided.

With regard to MedicAlert Foundation

The UK headquarters of MedicAlert Foundation has provided support for > 300,000 members (www.medicalert.org.uk/about-us/our-history); worldwide, this number rises to millions (www.medicalert.org/about/who-we-are/history). Membership with MedicAlert Foundation includes the checking of medical content displayed on the jewellery for appropriateness by a team of registered nurses (although it is unclear in which jurisdiction these nurses should be registered). The information provided to them is reliant on patient self‐reporting with no required input from the patient’s physician or access to their medical records.

They point out that “self-declaration” of patient illnesses and allergies may worsen outcomes:

. Bojah et al. describe an ‘allergy to anaesthesia’ inpatient wristband, that demonstrates how reliance on patient self‐reporting has the potential to cause dilemmas at a time when patients may be unable to elaborate 19. In an unregulated environment, mistakes or confusion of drug intolerances with allergies could mislead. For example, in the context of antimicrobial therapy, ~ 10% of the general population in the UK claim to have a penicillin allergy; however, only < 1% truly have an adverse immunological drug reaction 20. Many patients could thus be denied the most effective treatment for their infection through a misunderstanding.

And that medical ID information is not vetted by doctors:

The current validity of information on ID bracelets is also questionable; no company requires physician input into the wording on medical alert devices, although some recommend consultation with the primary care physician or healthcare provider for advice on what information to have engraved 21. Some companies advise a non‐mandatory (and chargeable) yearly update of information 3.

What have we learned?

There is no evidence that Medical ID jewelry saves lives.
The information on Medical ID jewelry is patient determined, and may or may not be accurate or up to date.
The medical ID industry is totally unregulated. Government should institute minimum standards to ensure the accuracy or appropriateness of the information provided.
I’m interested in readers’ experience with medical IDs, good and bad, so please feel free to share your anecdotes.
Has your life been saved by a medical ID?
What information is on your medical ID?
Any adverse experiences with medical ID?
Skeptically Yours,
-ACP
N.B. In the course of this investigation I realized that my iPhone has a “medical ID” function that can be activated when the phone is locked and will display relevant medical information.
I added information with my emergency contacts, my medications and a few of my illnesses (including hyperskepticism) into the Medical ID section of the Apple Health app.
So, if you find me lying on the side of the road, look for my cell phone, push the two buttons on either side, wait a few seconds for the below screen, and perhaps you can save my life!