







































Abstract: Medical bracelets can save lives, but o!en lack the necessary information for appropriate medical care 
in emergency scenarios. "e focus of this research was to determine whether a dynamic QR code medical bracelet 
connected to a Bluetooth carrying case allowed participants to react faster to a staged medical emergency when 
compared to standard medical bracelets, static QR code medical bracelets, or non-Bluetooth dynamic QR code 
medical bracelets.1 A mock medical scenario for anaphylactic shock was tested in which a staged practice dummy 
wore one of four medical bracelets (standard, static, dynamic, and dynamic/Bluetooth), and participants were 
timed in locating and properly administering a practice epinephrine auto-injector. Both dynamic QR code bracelets 
displayed the location of the auto-injector and how to use it, while the connected Bluetooth carrying case system 
emitted a buzzing sound, allowing participants to listen and look for the epinephrine auto-injector. "e static QR code 
informed participants of the need for an auto-injector. "e standard bracelet displayed only the medical condition. 
"e dynamic QR code bracelet with connected Bluetooth carrying case was faster and more precise in all trials 
(p<.0001). "is dynamic scannable-interface (QR code) medical bracelet is unique in its connectivity to Bluetooth 
and its aim in supporting bystanders (vs. medical professionals) in the case of a medical emergency. Continued 
improvements in medical bracelet technology could improve medical response time and care in emergency scenarios, 
leading to fewer hospital stays and lower mortality for those with medical conditions.

Aisthesis      Volume 11,  202035

“Anaphylactic Shocker!”: !e Use of a Dynamic QR Code 
Medical Bracelet to Administer a Practice Epinephrine Auto-
Injector During a Staged Medical Emergency

by Katelyn France

Introduction1

 More than thirty-two million Americans have 
some form of diagnosed food allergy. "e most 
common of these allergies are the “Big Eight”: 
milk, eggs, peanuts, tree nuts, soy, wheat, #sh, and 
shell#sh. "ese allergens make up approximately 
ninety percent of all food-based allergies and while 
not the most common, peanut allergies a$ect more 
than 15 million Americans (American Academy of 
Allergy, Asthma and Immunology [AAAI], 2001). 
 Peanut allergies are IgE-mediated allergic 
reactions, where side e$ects are triggered by 
an overabundance of Immunoglobulin E (IgE) 
antibodies. "ese antibodies are always present in 
the body in small amounts, but during an allergic 
reaction, they bind with mast cells, histamine-
carrying white blood cells, which trigger the 

1 Note: "e author is the owner and operator of Scien-
tists Making Your Life Easier%(SMYLE) LLC, the medtech 
company that produces all types (static, dynamic, and dy-
namic with Bluetooth) of the QR code bracelets used in 
this study.

cascading release of various chemicals that cause the 
symptoms of an allergic reaction (Kemp, 2008). 
 "e immediate symptoms of an IgE-mediated 
reaction can include runny nose, rashes, hives, itchy 
or tingly mouth or throat, digestive issues (diarrhea, 
stomach pains or cramps, nausea, or vomiting), 
tightness of the throat, or shortness of breath. If le! 
untreated, the pulmonary system could constrict, 
preventing a necessary &ow of oxygen to the lungs, 
or an overabundance of IgE-bound mast cells could 
cause organ failure, leading to permanent damage 
and possibly death (AAAAI, 2001). As stated by Song 
and colleagues in 2014, in these severe cases, known 
as anaphylactic shock, immediate care is required 
and is commonly achieved through the utilization of 
an epinephrine auto-injector. Epinephrine is a form 
of adrenaline that can narrow blood vessels and open 
lung airways, thus reversing some of the harmful 
side e$ects of these reactions (Baalman et al., 2016; 
Frew, 2011). 
 Emergency epinephrine treatments are not 
the only IgE-mediated allergy treatment plan. As 
stated by Moneret-Vautrin and colleagues in 2005, 



!e Use of a Dynamic QR Code Medical Bracelet

Aisthesis      Volume 11,  202036

immune systems are most sensitive in childhood 
and desensitization in childhood can mean lower 
reactivity in adulthood. Studies of children and 
adolescent populations have also found non-invasive 
treatment options instead of traditional mast cell 
injections (Hsiao et al., 2017; Anagnostou et al., 
2014), created comprehensive allergen management 
plans (Ewan and Clark, 2005), and have shown 
reduced sensitivity to allergens with early exposure 
for siblings of severe IgE-mediated allergy su$erers 
(Begin, et al., 2016).
 As for adults, most peanut allergy treatments are 
tolerance-focused, as these allergies are commonly 
“outgrown” (Leickly et al., 2018). "is is because as 
people age, their immune symptoms develop and 
become more desensitized to IgE-mediated allergens 
(Chafen et al., 2010; Fromer, 2016; Boyce et al., 
2011). One example of this comes from a 2016 study 
by Eigenmann and Zamora that found with lessened 
reactivity, non-severe adult IgE-mediated allergic 
reactions could be treated via an antihistamine, such 
as diphenhydramine.
 In addition to desensitizing and managing 
allergen exposure, an appropriate care plan for 
IgE-mediated allergies must consider all facets of 
the allergy. A commonly overlooked factor is the 
distribution of allergies and how socioeconomic and 
geographic distribution of disease can a$ect not only 
the severity of reactions, but also the ease of access to 
treatment for those with allergies (Gupta et al., 2011; 
Alpert, 2016). "e US does not have standardized 
healthcare and therefore does not have standardized 
access to care (Branum & Lukacs, 2009). "is can 
place additional strain on rural communities that 
lack access to close, reputable healthcare facilities, 
as speed and reaction to the emergency are key 
components of a shortened recovery time (Patel et 
al., 2011). In a medical emergency, these factors may 
be additionally compounded, as trained medical 
professionals are o!en not the #rst on scene of 
an allergic reaction in rural towns. "e need for 
basic yet comprehensive information to assist in 
time-sensitive medical emergencies aimed toward 
bystanders and non-medical professionals is critical.
 One common way to provide more access 
to information and assistance during a medical 
emergency is to wear a medical ID bracelet. "ese 
bracelets provide information that may allow 
bystanders to provide basic assistance before trained 

medical professionals arrive. "e question posed 
by Rahman and colleagues in 2017 was the actual 
e'cacy of these bracelets in emergencies. "e 
result of wearing a standard medical bracelet in a 
medical emergency had mixed results and room for 
improvement, as the study found that the lack of 
bracelet regulations caused substantial di$erences 
in the quality of care. In their 2019 study, Farhy 
and colleagues found that when more relevant 
information was provided in a medical emergency, 
better patient outcomes could be seen. "erefore, 
if medical ID bracelets are improved, appropriate 
medical response time and care could be provided, 
leading to better patient care in allergic reaction 
events, and possibly reducing the number of fatal 
severe anaphylactic shock events.
 In summary, many adults eventually become 
desensitized to IgE allergens as they age, as their 
immune systems develop and are able to produce 
appropriate responses to their allergen. Peanut 
and other IgE-mediated allergies can pose bigger 
problems in children and adolescents, as they lack 
the immune response necessary to avoid going 
into anaphylactic shock when encountering their 
allergen. While treatment options for careful and 
gradual desensitization do exist and are constantly 
improving, the case of severe reactions requires 
an immediate medical response, which makes the 
epinephrine auto-injector an integral component 
of treatment for these scenarios. "e use of an 
epinephrine auto-injector can signi#cantly improve 
the recovery of a person following an anaphylactic 
shock event largely due to its ability to react to a 
situation immediately, regardless of the sensitization 
levels or the type of allergen involved. As severe 
cases of anaphylaxis can result in permanent internal 
damage or death in a matter of minutes (AAAAI, 
2001), reduction of reaction time is the most critical 
goal of medical bracelets.
 While these auto-injectors are clearly bene#cial 
in the case of an allergic reaction, much can still be 
done to improve treatment in emergency scenarios. 
One way to improve treatment is to improve access 
of information to bystanders looking to help in an 
emergency by expanding the amount of information 
the medical ID bracelets provide for assistance in an 
emergency. By allowing bystanders to play a more 
active role in a medical emergency given the necessary 
information, some of the gaps and shortcomings of 



!e Use of a Dynamic QR Code Medical Bracelet

Aisthesis      Volume 11,  202037

the current technology could be ful#lled, possibly 
leading to fewer anaphylaxis-related deaths. "is 
study aims to compare the speed of response when 
using one of several di$erent types of medical 
bracelet and related medical equipment (standard, 
static QR code, dynamic QR code, and dynamic QR 
code with connected Bluetooth carrying case) and 
hypothesizes that the more information and access 
to equipment that is provided, the faster the response 
time.

Materials
Medical Bracelet Types
For additional materials, see Photo Annex.
• Standard: an engraved metal bracelet; typically 

uncovered by insurance and costing $100 
or more; includes name, date of birth, and 
allergy/key concern; one to two lines more of 
information are available for an additional cost 
(A)

• Static QR code: the small square QR code cannot 
be updated; if another allergy is discovered, 
a new bracelet must be made; information 
includes name, date of birth, allergies, and how 
to assist in the case of a medical emergency (B)

• Dynamic QR code: an updatable code linking 
to a webpage that allows for a nearly limitless 
amount of information to be stored; requires an 
internet connection (C, E)

• Dynamic QR code with connected Bluetooth 
carrying case: the QR code for this bracelet is 
the same as the other dynamic QR code, with the 
addition of an activation link to the Bluetooth 
module that activates a Piezo buzzer (D, F)

Method
 "is experiment tested four age groups (12/13, 
14/15, 16/17, and 18+) with four volunteers per each 
of the four medical bracelets categories (standard, 
static QR code, dynamic QR code, and dynamic QR 
code connected to a Bluetooth carrying case) for 
a total of 64 volunteers recruited from Hinckley-
Finlayson High School. All volunteers were shown 
a basic training video about epinephrine auto-
injectors before participating in the experiment. 
"e experiment was conducted in a private 
testing environment that consisted of a practice 
dummy in staged anaphylactic shock and a table 
with 5 backpacks on or near it with the practice 

epinephrine auto-injector stored in one of the bags. 
"e participants were timed on how long it took for 
them to locate the epinephrine auto-injector from its 
location within one of the #ve backpacks and then 
properly administer it on the practice dummy based 
on the information provided to them from their 
medical bracelet type.
 "e standard medical bracelet group was the 
control and was given the information on the bracelet, 
which was name, date of birth, and statement of the 
allergy. "e static QR code group was told to scan 
the code with a smartphone, alerting of the need for 
an epinephrine auto-injector. "e dynamic group 
was told to scan the code, which displayed a written 
description of where the epinephrine auto-injector 
was located as well as how to properly administer 
it. "e last group was told to scan a dynamic QR 
code that gave them the same written information 
as the non-Bluetooth bracelet and also activated the 
Bluetooth module, causing the carrying case holding 
the epinephrine auto-injector to produce a high-
pitched noise, alerting the scanner of the bag’s precise 
location. Each of the sixty-four participants were 
timed using only one of the bracelet types to avoid 
previous knowledge biases. All QR code medical 
bracelets and the Beetle BLE Bluetooth/Piezo buzzer 
carrying case were created by the researcher.
 Participants were timed in order to assess 
response to the staged emergency using the four 
bracelet types. "e average reaction time was 
graphed using one standard error bar (65% of the 
data). "e sub-trial times are de#ned as the time it 
took participants to locate the practice epinephrine 
auto-injector, but not to administer it. "e statistical 
computer program SPSS was used to analyze if the 
di$erences in reaction time was due to the treatment 
(type of bracelet) or due to chance. Signi#cance was 
determined using a p-value of p<0.05, indicating 
there was a #ve percent chance the di$erence was due 
to chance and a 95% chance due to the treatment.

Results
 "e experiment was conducted to see if a dynamic 
QR code medical bracelet connected to a Bluetooth 
medical carrying case would allow participants to 
react faster in providing appropriate medical care 
in a staged medical emergency than a standard 
medical bracelet, a static QR code medical bracelet, 
or a dynamic QR code medical bracelet that is not 



!e Use of a Dynamic QR Code Medical Bracelet

Aisthesis      Volume 11,  202038

connected to a Bluetooth medical carrying case. 
For test subjects, there were four groups, with four 
in each group, with four bracelets and/or modules, 
for a total of sixty-four participants. "e statistical 
program SPSS was used to run ANOVA tests on all 
collected data for the experiment. Error bar graphs 
were used with one standard error (65%) of the data, 
a p-value of p<.05 indicates signi#cant di$erences. 
All #gures were created by the researcher.
       

 Figure 1 compares the average time in seconds 
for human participants (by age) to address a staged 
medical emergency and #nd the practice epinephrine 
auto-injector. When all age groups were compared, 
the dynamic QR code and dynamic bracelet QR 
code connected to the Bluetooth medical equipment 
carrying case took signi#cantly less time to respond 
to the medical emergency than those using the 
static QR code or standard bracelet, with a p<.0001. 
"e dynamic bracelet connected to the Bluetooth 
carrying case took signi#cantly less time to respond 
to the emergency and locate the epinephrine auto-
injector than the dynamic bracelet not connected to 
the case (p<.032), except for the students ages 12 and 
13, years old whose response time was similar to the 
dynamic bracelet not connected to the Bluetooth. 
       Figure 2 compares the overall average time in 
seconds for human participants to address a staged 
medical emergency and locate a practice epinephrine 
auto-injector. "e standard bracelet participants 
took signi#cantly longer to #nd the auto-injector, 
with a time of 122.68±39 seconds when compared to 
the static QR code (p<.008) bracelet response time 
of 97.31±28 seconds. Using the dynamic bracelet, 

participants found the epinephrine auto-injector 
signi#cantly faster (p<.0001) when compared to 
participants that used static or standard bracelets, 
with a response time 52.12±17 seconds. Using 
the dynamic bracelet connected to the Bluetooth 
medical equipment carrying case, participants 
found the epinephrine auto-injector signi#cantly 
faster (p<.0001) when compared to just the dynamic 
bracelet, with a response time 30.81±4.11 seconds 
(p<.024). 

 Figure 3 compares the total average response 
time in seconds, for human participants (by age) 
to address a staged medical emergency and #nd 
the practice epinephrine auto-injector using a 
standard, static (QR Code), dynamic (QR Code), 
and a dynamic (QR Code) connected to a Bluetooth 
medical equipment carrying case and administer 



!e Use of a Dynamic QR Code Medical Bracelet

Aisthesis      Volume 11,  202039

the dose. When all age groups were compared, 
both dynamic types took signi#cantly less time 
to respond to the medical emergency than those 
using the static QR code or standard bracelet with 
a p<.0001. "e dynamic bracelet connected to the 
Bluetooth carrying case took signi#cantly less time 
to respond to the emergency and administer the 
epinephrine auto-injector than the dynamic bracelet 
not connected to the case (p<.004), except for the 
participants whose response time was similar to the 
dynamic bracelet not connected to the Bluetooth 
(p<.555).  

 

 Figure 4 compares the total average response 
time in seconds for participants to address a 
staged medical emergency and #nd the practice 
epinephrine auto-injector using a standard, static 
(QR Code), dynamic (QR Code), and a dynamic (QR 
Code) connected to a Bluetooth carrying case and 
administer the practice auto-injector.  "e standard 
bracelet participants took signi#cantly longer to 
#nd the auto-injector, with a time of 134.37±4.64 
seconds when compared to the static QR code 
(p<.021) bracelet response time of 111.37±30.38 
seconds. Using the dynamic bracelet, participants 
found the epinephrine auto-injector signi#cantly 
faster (p<.0001) when compared to participants that 
used static or standard bracelets, with a response 
time 67.5±17 seconds. Using the dynamic bracelet 
connected to the Bluetooth carrying case, participants 
found the epinephrine auto-injector signi#cantly 
faster (p<.003) when compared to just the dynamic 
bracelet, with a response time 67.50±21.25 seconds.

Discussion
 "e hypothesis and basis for this experiment was 
that a dynamic QR code medical bracelet connected 
to a Bluetooth medical carrying case would allow 
participants to react faster in providing appropriate 
medical care in a staged medical emergency than a 
standard medical bracelet, a static QR code medical 
bracelet, or a dynamic QR code medical bracelet that 
is not connected to a Bluetooth medical carrying 
case. "is was supported, as the dynamic QR code 
connected to a Bluetooth carrying case allowed 
participants to respond faster and more accurately 
than any other bracelet type (Figure 4).
 "e dynamic QR code bracelet and connected 
Bluetooth carrying case elicited faster response 
times as compared to all bracelet types. "ough 
information was provided in the form of written 
text, participants commonly did not take the time to 
properly read and comprehend instructions. As seen 
in Figure 2, this resulted in a high level of variability 
in response times for the dynamic QR code bracelet 
compared to the dynamic with the carrying case. 
 When using the dynamic bracelet with the 
connected Bluetooth carrying case, the participants 
were given both words and sound, allowing them 
to quickly locate and administer the practice auto-
injector. Periodically, a standard or static bracelet user 
found the epinephrine auto-injector fairly quickly, 
yet they were unsure how to properly administer it. 
"is resulted in a prolonged overall time trial, yet an 
expedited sub-trial (Figure 3).
 An intriguing result was found in the statistical 
di$erences in Figure 4. Because there was a di$erence 
in time when locating the epinephrine auto-injector 
when comparing the standard medical bracelet and 
the static QR code bracelet, this shows that even at 
the least comprehensive level, the more information 
provided in a staged medical emergency, the faster 
and more accurate the care.

Conclusion
 With access to more information in a staged 
medical emergency, faster and more accurate care 
was provided. However, determining which bracelet 
is the correct choice for the given allergies, diseases, 
or conditions requires the contemplation of several 
points, such as the need to update information stored 
on the bracelet, access to an Internet connection, and 
the use of auxiliary medical equipment.



!e Use of a Dynamic QR Code Medical Bracelet

Aisthesis      Volume 11,  202040

 For those with medical conditions that don’t 
require constant updates, as in the case of heart 
disease or epilepsy, the static QR code would be 
able to provide signi#cantly faster care in a medical 
emergency, without the need to connect to the 
Internet. "is could also be critical for care of those 
living in rural areas with limited Internet access.
 While the Bluetooth carrying case would be 
a wise investment for those needing emergency 
medical care with an accessory device, such as an 
epinephrine auto-injector for allergies or a glucose 
monitor for diabetes, the dynamic QR code medical 
bracelet still provides faster and more accurate care 
at a lower price point when the additional Bluetooth 
component is not required. It is also common for 
children who are diagnosed with peanut allergies 
to be diagnosed with another type of IgE-mediated 
allergy, as these are o!en diagnosed in tandem (i.e. 
general tree nuts with a peanut allergy) (AAAAI, 
2001). "erefore, the dynamic QR code medical 
bracelet would again be a good choice, as it allows 
for constant updates.
 Beyond these core considerations, a key 
component of this bracelet system is accessibility. By 
encoding features speci#cally for bystanders, better 
understanding and care can be provided during the 
critical #rst minutes of a medical emergency. Some 
of these features include auto-translating the written 
text of the instruction page to the language of the 
scanner’s phone, the use of a text-to-speech function 
where the care instructions are spoken aloud in 
addition to being displayed on the screen, and an 
updateable medication list that gives information 
about the wearer’s medications, possible side e$ects, 
and role within treatment plans.
 Beyond internal so!ware customizations, 
another critical feature of this system is the ability to 
make a truly customizable bracelet. Medical bracelets 
are not typically covered by insurance, as they are 
considered auxiliary medical accessories, and as such, 
are not regulated in the United States. Typically, they 
include an image of the Sta$ of Asclepius, a common 
indicator of medical technology in the healthcare 
#eld and something #rst responders are trained to 
look for when assisting in a medical emergency, but 
as there are no standards or requirements for what 
needs to be included for a bracelet to be considered a 
medical bracelet, some do not even include this.

 Many standard medical bracelets available today 
simply consist of a piece of metal, the Sta$, and a few 
lines of basic information and are also not commonly 
considered aesthetically pleasing. As such, this life-
saving medical equipment is severely underutilized. 
More customizable options will hopefully lead to an 
increase in use.  
 In addition to the re#nement of the medical ID 
bracelet, better epinephrine auto-injectors could 
also enhance care. Better accessibility, storage, and 
user-friendliness of the auto-injector component 
may also be a critical avenue of emergency care 
improvements. More advanced treatments for IgE-
mediated allergies are also being developed every 
day, yet until we can cure the body’s overreaction 
to an allergen, continued improvements in medical 
bracelet technology are critical to providing fast and 
accurate emergency medical care. "is enhanced 
non-professionally administered emergency care 
could lead to fewer and shorter hospital stays and 
thus help to save many lives.

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Photo Annex

42


