Green Bottle Scheme Wales — How Paramedics Find Your Medical Wishes

What the Green Bottle Scheme Is

The Green Bottle scheme — also called "Message in a Bottle" — is a physical emergency discovery protocol used by the Welsh Ambulance Services NHS Trust (WAST). The concept is deliberately low-tech: you store copies of your critical medical documents inside a container in your fridge, and place a small green sticker on the inside of your front door. Paramedics arriving at your home check for the sticker, locate the fridge, and retrieve the documents.

The scheme predates digital health records and remains essential because NHS Wales's digital infrastructure — the Welsh Clinical Portal — isn't always accessible to ambulance crews in real time, particularly in rural areas with poor connectivity. In Powys, Ceredigion, and parts of Gwynedd, the Green Bottle may be the only way a paramedic team finds out you've refused CPR before they start chest compressions.

What Goes Inside the Bottle

The standard scheme uses a small plastic green bottle in the refrigerator. It should hold:

• A copy of your ADRT — your legally binding treatment refusals under the Mental Capacity Act 2005
• A copy of any DNACPR form — the All Wales form completed by your doctor
• Your current medication list — drug names, doses, and prescribing GP
• Emergency contact details — name, phone number, and relationship for your LPA attorney, next of kin, or the person you want contacted first
• A brief medical summary — key conditions, allergies, and any implants (pacemaker, insulin pump) that affect treatment decisions

Keep it current. A medication list from two years ago with discontinued drugs wastes time and can lead to dangerous interactions if a paramedic team tries to work around medications you're no longer taking.

How to Get a Green Bottle Kit

Green Bottle kits are distributed free through several channels in Wales:

• Community pharmacies — many independent and chain pharmacies in Wales stock them; ask at the counter
• Lions Clubs — the scheme was popularised by Lions Clubs International, and local Welsh clubs often have kits available at community events
• GP surgeries — some Welsh practices hand them out alongside advance care planning discussions
• Fire service home safety visits — South Wales Fire and Rescue, Mid and West Wales Fire, and North Wales Fire and Rescue often include the scheme in their Safe and Well visits

If you can't find a kit locally, ask a community pharmacy, Lions Club, GP surgery, or fire service about availability. The standard bottle and front-door sticker are the critical components that tell the paramedic team to check the fridge.

Where to Place the Sticker

The green sticker goes on the inside of your front door, at eye level. Placing it on the outside invites break-ins (it signals an elderly or vulnerable occupant). Some people also place a second sticker on the fridge door itself, though the front-door sticker is the primary trigger for WAST crews.

If you live in a flat with a communal entrance, place the sticker on the inside of your flat door — not the building's main door.

The Digital Side: Welsh Clinical Portal Registration

The Green Bottle handles the physical scenario — paramedics in your home. For hospital admissions, out-of-hours GP services, and secondary care referrals, your ADRT also needs to be visible on the Welsh Clinical Portal.

Take the original ADRT to your GP surgery and ask the practice manager to scan it to the Welsh Care Records Service (WCRS). Once uploaded, a "Future Care Plan discussed" flag appears at the top of your patient record on the Welsh Clinical Portal. This flag is visible to:

• Emergency department clinicians
• Ambulance clinicians (when they have WCP access)
• Out-of-hours services
• Hospital ward staff

The physical Green Bottle and the digital WCP flag serve different access points — one for home emergencies, the other for clinical settings. You need both.

Keeping Everything in Sync

When you update your ADRT — whether because of a new diagnosis, a change of mind, or a routine two-year review — update every copy:

1. New document to the GP for WCP rescanning
2. New copy in the Green Bottle
3. New copies to your LPA attorneys and family

An outdated ADRT in the Green Bottle creates a conflict with the newer version on the Welsh Clinical Portal. Clinicians should follow the most recent valid document, but in a fast-moving emergency, any ambiguity delays decisions.

Our Wales ADRT planning guide includes a printable document distribution log, a Green Bottle contents checklist, and a GP registration script — everything needed to make your treatment wishes findable whether you're at home, in an ambulance, or in a hospital bed.

Get the complete planning kit and close the gap between having an ADRT and having it found when it matters.

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