Vial of Life

Vial of Life logo

In the event you are unable to speak, this form will speak for you.

The Vial of Life Project is designed to provide an individual the means to communicate to EMS personnel during a medical or trauma emergency in the home. The Vial of Life is essentially a one-page form that summarizes the important medical information that can assist emergency responders in providing the proper medical treatment. Information on the form includes:

  • Name
  • Address
  • Current and past medical conditions
  • Current medications: dosage and frequency
  • Allergies to medications
  • Area for special instructions
  • Contact information for physician
  • Emergency contact information for family member/friend

Once completed, the form is placed in a plastic bag and affixed to the refrigerator door. Due to privacy, some prefer to place the bag inside the freezer.

You may view and print (PDF) the Vial of Life form and instructional page at no charge directly from their website. Once you complete the form, notify Lt. Koppa by phone, 214-559-9487, or email Lt. Koppa, and he will note your participation to dispatch personnel. It's recommended that you attach a Vial of Life decal to the outside of the plastic bag. These decals may be ordered from the Vial of Life Project or contact Lt. Koppa to check for local availability.