In Response

We applaud the authors for incorporating the use of difficult airway bracelets into their practice and sharing this information through their editorial.1 Bracelets and wristbands have been used and are considered standard of care for identification and other types of alerts, such as patient allergy, do not resuscitate (DNR) status, and fall risk, but have not been widely adopted for difficult airway. Alert bracelets have the advantage of traveling with the patient and are clearly visible during an emergency, when there may not be time to access the patient record. The comprehensive difficult airway program at Johns Hopkins introduced difficult airway bracelets in 1996 and the alert bracelets have been in use since.2 In addition to the alert bracelets, an alert was created for the electronic patient record to clearly identify patients with a known difficult airway. Any patient with an electronic alert or who experienced a difficult intubation received a bracelet that was worn throughout their patient stay. Most electronic records allow for the creation of alerts that appear at the top of the computer screen, and we encourage departments to include a difficult airway alert as an option. The Medic Alert Foundation provides medic alert ID bracelets that are widely recognized as well as registries for patients, which include difficult intubation. Especially during the coronavirus disease (COVID) pandemic, with the increased risk of unplanned extubation and possible need for emergent reintubation, clear dissemination of information about previous difficult intubation is very important, not only due to the increased morbidity risk to the patient, but also because of potential increased aerosol exposure risk to the airway provider during emergent airway management.3 Airway alerts in the electronic medical record and alert bracelets are important steps to disseminate this vital information. Several international airway societies, including the American Society for Anesthesiologists, the Society for Airway Management, the Difficult Airway Society, and the Canadian Airway Focus Group Difficult Airway Society, recommend the use of difficult airway bracelets. These societies recommend, in addition to alert bracelets, electronic medical record documentation and chart flags, written letters to the patient, and the use of airway registries to disseminate difficult airway information.4 This will allow tracking and communication, not only during the acute hospital stay, but after discharge as well and for any future hospitalizations. During the COVID pandemic, identification of a previous difficult intubation at the time of admission would allow early recognition and planning for airway management and potentially reduce both patient and provider risk. Lauren Berkow, MD, FASAUniversity of Florida College of MedicineGainesville, Florida[email protected]Arthur Kanowitz, MD, FACEPAirway Safety MovementHighlands Ranch, Colorado

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