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Can paramedics honor medical tattoos?

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Updated July 30, 2013

Question: Can paramedics honor medical tattoos?
There's a growing trend of tattoos that are intended to replace the use of medical jewelry in emergency situations. They might be a list of medical conditions on the wrist -- where you would normally find a medical bracelet -- or an admonishment not to attempt resusciation on a person's chest, where you would no doubt find the tattoo as you were placing your hands for CPR. Before you decide to dedicate some of your body's real estate permanently to the function of emergency medical notification, you should ask yourself: will the paramedics follow my wishes?
Answer: Maybe.

Paramedics and EMTs are familiar with medical jewelry. MedicAlert pioneered the idea in 1953 and there have been hundreds of companies copying them ever since. It doesn't stop with jewelry. Countless attempts to improve on the jewelry idea -- even by the MedicAlert Foundation -- have given us USB flashdrives containing one's medical conditions that can be inserted into any computer and RFID tags that can be read at the emergency department door as paramedics are wheeling you in.

Medical jewelry is quite popular and I advocate wearing it if you have any sort of medical diagnosis that might be important for emergency personnel to know about. However, I also think the list of medical conditions paramedics need to know about is pretty short. If it's a condition likely to affect you during an emergency, we probably rule it out as a matter of course.

Tattoos Instead of Jewelry

I don't get the fascination with tattoos instead of medical jewelry. Perhaps the draw of a medical tattoo instead of a medical bracelet is that it can't be forgotten at home or be knocked off in a car crash. Somebody sporting a medical tattoo is going to be sporting it no matter what.

Even on a date, which is a time when some medical jewelry wearers choose a more discrete necklace instead of a bracelet. Changing up your emergency accessorizing isn't so easy when it's buried skin deep in permanent ink.

But it's an emergency, right? You are probably screaming at the computer at this very moment trying to get into my thick skull that this is a life or death decision. We paramedics need to know when you are allergic to bee stings or taking blood thinners. It's the most important tattoo you will ever get.

YOU. COULD. DIE.

I suppose, but the presence -- or absence -- of a tattoo is not likely to make any difference. Paramedics don't look for tattoos. Truth be told: we aren't real great at looking for medical jewelry, either. Paramedics treat the patient based on the signs and symptoms of the medical condition. We don't need the jewelry or the tattoo to explain it.

Do Not Resuscitate Is Not that Easy

One of the most popular tattoos seems to be some form of Do Not Resuscitate (DNR) tattooed on your chest. CPR is used to treat cardiac arrest, a medical condition with a perfect track record of killing people unless there is treatment. Cardiac arrest is so dangerous, CPR is the only medical procedure that requires a doctor's order not to perform it. DNR orders have certain rules that make them valid. It varies from state to state, but in general a DNR must be signed by a doctor in order to be followed.

Not too many docs are going to sign a tattoo. They're not likely to be as convinced of the permanency of the decision as their patients are. People change their minds and that sucks if your decision was permanently engraved on your breastbone. It sucks even more if you really meant it but didn't go throught the channels to obtain a truly valid order. Paramedics aren't going to follow a DNR request (it's not an order) simply because it's not easily erased and requires some form of nakedness to read.

Having DNR tattooed on your chest is actually an old joke among paramedics and emergency nurses. CPR has a pretty dismal success rate (it's getting better) and those cardiac arrest patients who did survive were not likely to leave the hospital as productive members of society, returning to home to pay taxes. We emergency providers always vowed that we would have "No CPR" in Olde English emblazed under the muscle shirt in case of emergency. Don't you dare do CPR on me, we would collectively say.

In a completely informal and weak attempt at original research, I asked my colleagues how they would handle it if they were to come upon a "DNR" tattoo on a patient in cardiac arrest. All of the paramedics and EMTs I asked -- there were at least eight -- told me they would point out the tattoo to their partner for its novelty (and comedic) value, then promptly begin CPR. There's just no way we can legally follow a tattoo.

Besides, don't we all know someone who regrets a tattoo obtained at an earlier time?

Tattoos Make Better Art than Legal Documents

I appreciate really cool body art. In a profession where we often see our clients without most or any of their clothes, we get to see plenty of ink. Some tattoos are gang related. Some have names or writing. Most tell a story and all are deeply personal.

I and my colleagues do not look for tattoos to tell us about our patient's condition. They might provide clues, but I tend to take tattoos in as a whole look rather than inspecting each one. If a patient has more than one tattoo, I'm likely to miss that one of them is a list of emergency diagnoses. Even if the only tattoo is for medical emergencies, there's no guarantee I'll notice it or even need to see it if I do.

Tattoos can be beautiful forms of expression, but they're lousy at providing emergency medical information. Leave your ink for self expression and if you feel you need to let us know that you're allergic to latex while you are unconscious, buy a bracelet.

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