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How to use the Vial of Life properly

Follow these 4 simple steps to using your Vial of Life.

1. Print out and Fill out the Vial of Life form
- Print form.
- Fill out the vial form located on reverse side. Answer all or any pertinent questions.
- Make blank copies of this form to keep information current or go to www.myvialoflife.org to maintain and store updated information.

2. Place the decal on front of a plastic baggie
- Place the form you filled out in the plastic baggie.
- You may also consiter placing the following items in the baggie.
- Copy of EKG
- DNR ( Do Not Resuscitate)
- Living will or equivalent
- Recent Picture of self

3. Place the baggie on your refrigerator door
- Securely tape plastic baggie to front of refrigerator door.
- Place the decal on the side of your refrigerator or on the front door where anyone responding to an emergency could easy see it.

4. Place the second decal on your front door
- Place the decal on the front door so it can easly be seen by anyone responding to an emergency.

American Medical Response

Our mission is to reduce preventable injuries, loss of independence, costs and deaths associated with falls among seniors and people with disabilities by raising awareness and developing fall prevention programs in Contra Costa County.

The Vial of Life or Vial of L.I.F.E. (Lifesaving Information For Emergencies) is a program which allows individuals to provide medical information in advance that can be used by emergency personnel in the case of an emergency. Vial of Life programs are usually sponsored and promoted by Senior citizen's organizations, local fire departments, or hospitals, although it may be utilized by anyone.

The program consists of a vial (empty pill bottle, plastic bag or other container), labeled with a Vial of Life sticker, inside which is placed a medical form which has been filled out stating the health status of the individual and current medications being taken. The vial is placed in the refrigerator, usually recommended to be on the top shelf of the door, because it has been shown that the refrigerator's contents are preserved in the event of a fire. Stickers are placed in the front window of the home so that responding emergency personnel will know to look for the Vial.