TO: All service providers

RE: ____________________________________

The above named patient has a condition known as Multiple Chemical Sensitivities (MCS). Kindly read this carefully and do your best to comply as fully as possible. You may already know that hospitals and service providers are required to accommodate special needs under the Americans with Disabilities Act. Please note that MCS can be life-threatening even though the usual signs of a medical crisis aren't always apparent until extensive damage has already been done.

BASIC STEPS TO ENSURE THIS PATIENT'S SAFETY DURING TREATMENT:

Pure air

Assign patient to a secluded room or small enclosed area as quickly as possible, isolated from other people, and when

possible, a small room with a window that opens to fresh air. An isolation room is often a good choice.

Avoid new furnishings, paint, freshly shampooed carpet, air fresheners, new plastics and latex. Avoid alcohol.

(Zephiran is the preferred alternative to alcohol for skin antisepsis; hydrogen peroxide is sometimes adequate).

Anything with fumes or odor that you can smell will most likely be problematic for this patient.

Assign staff to this patient who are not wearing cologne or after-shave and tend to use fragrance-free.

Make oxygen available as soon as possible. (Patient may have brought tubing; if not, older tubing is preferable to newer.)

Expedite treatment.

MCS patients are seriously compromised in public buildings.

Don't judge patient based on your own sense of smell.

Healthy people often can't smell chemicals that harm MCS patients.

Write down any instructions you want the patient to remember.

Chemicals impair brain function and memory in MCS patients. Don't expect the patient to

remember, no matter how clearly you give the instructions.

Approach the patient in a calm and supportive manner.

Chemical exposures can cause MCS patients to become anxious, depressed, confused, or even

panicky and disruptive. Pay attention to what the patient tells you about immediate needs.

Repeat back the main points of what you heard and explain what is being done to accommodate

the situation.

Flag patient's chart as an MCS reactor.

If patient is to be hospitalized or undergo surgery, assign a patient advocate or social worker

to coordinate the extremely daunting preparations for ensuring optimal safety from chemical

assaults.

PRIMARY DRUG SENSITIVITIES:

__________________________________________________________________________

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Physician's signature Date_____________

Heal HEAL of Southern Arizona Use of the MCS Accommodation Letter,

Suggestions Regarding the MCS Accommodations Letter from HEAL of Southern Arizona –

Not for the Physician

To the MCS sufferer:

The MCS Awareness Letter was written primarily for use in outpatient and even non-medical situations.

it is designed to be copied onto your physician’s stationery. Feel free to adapt the format to whatever

the letterhead requires. You may also wish to modify the content if your MCS requirements are

different from those listed. Some suggestion things to consider including n the modifications are listed

below, in addition

Although the doctor’s letterhead lends more credibility, it isn’t absolutely essential. The doctor’s dated

signature gives the document the power of Doctor’s Orders, and most people recognize and honor the

importance of a physician’s instructions.

For Best Results:

The best results are usually obtained by making a telephone call in advance. Explain briefly that you

have a disability that will require advance planning, and find out to whom the doctor’s instructions

should be addressed. Then send the letter (a fax machine is ideal for this). Once it has reached its

destination, call the addressee to schedule an appointment. Most people are gracious and helpful with

this approach.

Prepare for the Unexpected:

For your safety and convenience, make several copies of the original signed letter from your physician

and send copies to the service providers as needed. Keep the original, along with one or two copies, in

your home flies in a packet of health-related information for emergencies. Keep a similar packet in your

car in case of accident or emergency, and also carry a copy of the physician’s statement in your purse or

wallet. You’ll find it useful for requesting accommodations in a variety of situations.

Along with the MCS Accommodations Letter, your health information packet could include:

• a fairly current list of drugs, nutritional supplements and herbs you take regularly

• lists of drug and chemical intolerances, and a list of drugs you know you can tolerate. It would be

helpful to list them under headings “extremely reactive, moderately reactive, tolerated.”

• more extensive written protocols for situations such as emergency transport, hospitalization,

surgery, etc.

If this seems like an overwhelming project, just start with the MCS Accommodations Letter and add

the other items when you’re able.

For El’s From a Non-medical Background:

Be aware that health care workers are more overworked, understaffed, and under-appreciated than at

any time in recent history. Our special needs require extra time and mental energy, and may reduce the

amount of time and attention available for other deserving patients. Be assertive, but use good manners

to the best of your ability. If you receive good service, make an effort to send a simple thank-you note.

You will become memorable as a positive influence in spite of your limitations, and you will smooth the

path for fellow El’s to receive good care in the future.

The MCS Accommodations Letter and these accompanying suggestions

were prepared by a HEAL member who has a clinical background in a/lied health. March 2002.