Internet Journal of Airway Management



Volume 4 (January 2006 to December 2007)


In-Hospital Medic Alert System for Patients with an Experienced Difficult Airway Starting with a Blue Color-Coded Alerting Wrist Band



Schirin M. Missaghi, MD1


1Staff Anesthetist and Intensive Care Physician, Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of Vienna, Vienna, Austria.


Address correspondence and comments to Schirin M. Missaghi.


Received from the Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of Vienna, Vienna, Austria.


Published: May 22, 2007.



The correct citation of this correspondence is:

Missaghi SM. In-hospital medic alert system for patients with an experienced difficult airway starting with a blue color-coded alerting wrist band. Internet Journal of Airway Management 4, 2006-2007.
Available from URL:
Date accessed: month day, year.


Last updated: August 14, 2007.


The experienced difficult airway (DA) is still an insufficiently communicated problem (1, 3, 6, 7), although considered as a reliable indicator of future difficulties with airway management (AM). In a large prospective study performed by El-Ganzouri and co-workers (2), information on a previous difficult conventional laryngoscopy was identified as the single most important predictor (information of the highest positive predictive value) of a DA during subsequent general anesthesia.


Mark and co-workers (4) postulated, that documentation and effective dissemination of the DA may reduce morbidity and mortality related to prolonged or failed securing the airway; any patient who requires special techniques for AM during general anesthesia or in a emergency medical situation may benefit from these activities. Effective dissemination of the experienced DA starts with an in-hospital medic alert system (5). In addition to the attachment of an adhesible DA alert label on the cover of the medical record and placement of the printout of the anesthesia record [with precise documentation of the experienced DA including the (un)successful techniques applied] right in front the medical record, we recently provided these patients with a blue color-coded DA alerting wrist band immediately after the incidence. Between January and April 2007, 12 patients requiring general anesthesia and tracheal intubation (mainly for elective thyroid surgery) received this color-coded wrist band alerting for the experienced DA; fortunately, they did not require repeat AM during their hospital stay.


Patients with a previously experienced DA (identified by patient information, notifications, and/or review of medical records) and those with an anticipated DA (based on physical examination during the preoperative evluation) are now also provided with the blue color-coded DA alerting wrist band immediately after hospital admission. The DA alert label will be attached on the cover of the medical record and the printout of the preoperative evaluation protocol [with precise documentation of the findings and test results, instructions for patient care and preparation (for the normal ward and the preoperative admission area)] and the informed patient consent for the planned strategies of AM will be placed right in front the medical record. Effective dissemination of DA information is essential, particularly at anesthesia departments and services where anesthetists often make a preoperative evaluation on patients which are later anesthetized by other operators, and should be implemented by all providers of anesthetic care. This preoperative DA alert system is now introduced at our institution and accompanies the patient during the entire hospital stay unless the DA information is disproved.




  1. Barron FA, Ball DR, Jefferson P, Norrie J. 'Airway alerts'. How UK anaesthetists organise, document and communicate difficult airway management. Anaesthesia 58:73-77, 2003.

  2. El-Ganzouri AR, McCarthy RJ, Truman KJ, Tanck EN, Ivanovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 82:1197-1204, 1996.

  3. Goldmann K, Braun U. Airway management practices at German university and university-affiliated teaching hospitals - equipment, techniques and training: results of a nationwide survey. Acta Anaesth Scand 50:298-305, 2006.

  4. Mark LJ, Beattie C, Ferrell CL, Trempy G, Dorman T, Schauble JF. The difficult airway: mechanisms for effective dissemination of critical information. J Clin Anesth 4:247-251, 1992.

  5. Mark LJ, Marsh BR. Medic alert, communication, confidentiality, and other medicolegal considerations. In: Norton ML (ed) Atlas of the Difficult Airway. St Louis, Mosby, 1996, p 17-34.

  6. Mellado PF, Thunedborg LP, Swiatek F, Kristensen MS. Anaesthesiological airway management in Denmark: assessment, equipment and documentation. Acta Anaesthiol Scand 48:350-354, 2004.

  7. Missaghi SM, Krasser K, Marian F, Zadrobilek E. Documentation, dissemination, and communication of difficult airway information at anesthesia departments in Austria. Internet Journal of Airway Management 4, 2006-2007. Date accessed: August 14, 2007.

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