Tips for Creating an Emergency Health Information Card
This fact sheet is designed to provide a check list for activities for Creating an Emergency Health Information Card to improve your emergency preparedness in an earthquake. It is designed to be used in conjunction with Independent Living Resource Center San Francisco's general EARTHQUAKE TIPS FOR PEOPLE WITH DISABILITIES, EARTHQUAKE TIPS FOR PEOPLE WITH A SPECIFIC DISABILITY (i.e., Mobility, Visual, Communication, Cognitive, Psychiatric, Hearing, etc), and TIPS FOR COLLECTING EMERGENCY DOCUMENTS. Without all four tip sheets you do not have all the information you need to be prepared Preparation may seem like a lot of work. It is. Preparing does take time and effort. So do a little at a time, as your energy and budget permit. The important thing is to start preparing. The more you do, the more confident you will be that you can protect yourself, your family, and your belongings.
DATE COMPLETED / ACTIVITIES
__________ Complete and/or Customize Health Card
__________ Keep copies in wallet, purse and all emergency supply kits
An emergency health information card communicates to rescuers what they need to know about you if they find you unconscious or incoherent, or, if they need to quickly help evacuate you. An emergency health information card should contain information about medications, equipment you use, allergies and sensitivities, communication difficulties you may have, preferred treatment and treatment-medical providers, and important contact people.
Copies of Card
Make multiple copies of this card to keep in emergency supply kits, emergency carry-with-you kits, car, work, wallet and purse (behind drivers license or primary identification card) wheelchair pack, etc.
Put these items on the front:
- Street Address
- City, State, Zip
- Phone (Home, Work)
- Fax No
- Birth date
- Blood Type
- Social Security No.
- Health Insurance Carrier and Individual and Group #
Put these items on the back:
- Emergency Contacts
- Conditions, Disability
- Assistance Needed
- Immunization Dates
- Communication/Equipment/Other Needs
Instructions for filling out the card:
Name, address, phone: home, work, fax birth date, blood type, social security number, primary physician(s), insurance carrier, local and out of town emergency contacts and personal support network.
- (12) Conditions which a rescuer might need to know about (if you are not sure, list it): i.e. diabetes, epilepsy, heart condition, high blood pressure, respiratory condition, HIV positive.
- "My disability, which is due to a head injury, sometimes make me appear drunk. I'm not!"
- "I have a psychiatric disability, in an emergency I may become confused. Help me find a quiet corner and I should be fine in about 10 minutes; if not give me one green pill, (name of medication) located in my (purse, wallet, pocket, etc.)"
- "I take Lithium and my blood level needs to be checked every ______ ."
- Multiple chemical sensitivities - these conditions may not be commonly understood therefore explanations may need to be detailed. "I react to..., my reaction is...... do this...."
If you take medication that cannot be interrupted without serious consequences, make sure this is stated clearly and include:
- times taken
- other details regarding specifications of administration/regime; i.e., insulin, etc.
- Instructions: i.e.: take my gamma globulin from the freezer, take my insulin from the refrigerator.
Name, address, phone and fax numbers of pharmacy where you get your prescriptions filled.
- (14) Anticipated assistance needed.
- "I need specific help with: walking, eating, standing, dressing, transferring."
- Walking - "best way to assist is to allow me to hang on your arm for balance."
- (15)Allergies and sensitivities:
History of skin or other reaction of sickness following injection or oral administration of:
- Penicillin or other antibiotics
- Tetanus, antitoxin or other serums
- Morphine, Codeine, Demerol or other narcotics
- Adhesive tape
- Novocain or other anesthetics
- Iodine or methiolate
- Aspirin, emperin or other pain remedies
- Foods such as eggs, milk chocolate, or others
- Sulfa drugs
- Sun exposure
- Insect bites, bee stings
- (16)Immunization Dates (self explanatory)
- (17a)Communication or a speech-related disability:
Specific communication needs (examples):
- "I speak using an artificial larynx, if it is not available I can write notes to communicate."
- "I may not make sense for a while if under stress, let me alone for 10 - 15
minutes and my mind should clear."
- "I speak slowly, softly and my speech is not clear. Find a quiet place for us to communicate. Be patient! Ask me to repeat or spell out what I am saying, if you cannot understand me!"
- "I use a word board, augmentative communication device, artificial larynx, etc., to communicate. In an emergency I can point to words and letters."
- "I cannot read. I communicate using an augmentative communication device. I can point to simple pictures or key words which you will find in my wallet or emergency supply kit"
- "I may have some difficulty understanding what you are telling me, please speak slowly and use simple language."
- "My primary language is ASL (American Sign Language). I am deaf and not fluent in English, I will need an ASL interpreter. I read only very simple English."
- (17b)Equipment used:
- motorized wheelchair
- suction machine
- home dialysis
- Instructions: take my oxygen tank, take my wheelchair.
- (17c)Sanitary needs:
- indwelling catheter
Developed and Distributed By
Independent Living Resource Center San Francisco
70 10th Street, San Francisco, CA 94103
415-863-0581, TTY 415-863-1367, FAX 415-863-1290
In cooperation with June Kailes, Disability Consultant
through a grant from The American Red Cross
Northern California Disaster Preparedness Network