Medical Tattoos

[Fae Brin]

I came across this article and I thought it was really interesting.

Medical Tattoos

I'd like to know alternate perspectives to mine on the subject, if I could be indulged.

[Trieste]

Tattoos have been used in medicine for years to improve the precision of radiation treatments. This seems to be an extension of that, and not a big deal.

[Envious]

Unless the EMT is looking for it, and knows its purpose, it's not going to be taken into account. Doesn't seem like a bad idea other than that, though.

[SilentScreams]

I like the idea, in general. But Envious is right, unless it's a tattoo that states something that can wait for the hospital before it's discovered an EMT might not find it. I'm allergic to penicillin. Would I get that tattooed on me? Probably not. It's a depressingly small step from a good voluntary idea to a compulsory government program. 

[Trieste]

Kind of, but the logic doesn't wash. Medical alert bracelets remain voluntary, and I expect that government-mandated tattoos are a little too WWII to be anything but political suicide.

Besides, they're too busy legislating uteri. >.>

[Callie Del Noire]

It's an alternative. I think some sort of 'format' might be useful. It could be a very good option. but only an option.

[DarklingAlice]

I really really like that idea. Though more for things like medication allergies than for end of life wishes. The more information paramedics and ER doctors have, the better; and with a tattoo there is no risk of losing it (well...under a certain severity of accident I suppose).

[Revolverman]

I see the logic of it, but It would have to be really large to be reconised right away, and lord knows what happens when you get older.

[Serephino]

It's an interesting idea.  There would have to be a designated place for them though, so medical personnel would know where to look, and maybe designated symbols instead of words.  You can't lose a tattoo like you can a bracelet.   

[Autumn Sativus]

I remember reading an article a year or two ago about a woman with dextrocardia (her heart was on the opposite side to normal) getting a tattoo to the effect of "I have dextrocardia. My heart is on the right side." on her left so that anyone who needed to give her medical attention in the case of her being unconscious would be aware of her condition.

I think they are a really great idea for identifying life long conditions. I'm not so sure about DNR notices or No CPR notices, but for making conditions apparent I think they're great. Much better than a bracelet, which can easily be lost or forgotten.

[Valerian]

Luckily, I don't have a condition or allergy that requires a medical alert bracelet, but if I did, actually wearing such a bracelet wouldn't be an option for me.  I'm allergic to most metals -- they make me break out in a terrible rash -- so in my case I'd either have to figure out how to get a sterling silver bracelet made, or get the tattoo.  Mind you, I wouldn't like a tattoo at all, but better that than the hospital finding out the hard way that I have a fatal allergy to some medication when I'm unable to tell them.

[Caela]

I think it's an interesting option. It would be especially useful for people that break their jewelery often or people, like one of my brothers, who have skin allergies to most metals. The kid actually got special permission to hook his dog tags to his clothing instead of wearing them around his neck because the metal caused him to break out so badly, he'd never be able to wear a medical alert bracelet or necklace if he needed one. Thankfully he doesn't but I am sure there are others with the same sort of allergy that do.

I would agree that the medical community should make an attempt to get on top of this though and come up with recommendations for placement and what sort of information to include and will be honored. "NO CPR" on your chest sounds like good placement, but there is no saying that someone starting CPR will open your shirt to see it. It may not get opened until someone with training on a defibrillator cuts it open to place pads. I would think somewhere on your arm would be the best choice, easily seen in many shirts and long sleeves are easy to push up to check for them quickly.

[Oniya]

Luckily, I don't have a condition or allergy that requires a medical alert bracelet, but if I did, actually wearing such a bracelet wouldn't be an option for me.  I'm allergic to most metals -- they make me break out in a terrible rash -- so in my case I'd either have to figure out how to get a sterling silver bracelet made, or get the tattoo.  Mind you, I wouldn't like a tattoo at all, but better that than the hospital finding out the hard way that I have a fatal allergy to some medication when I'm unable to tell them.

Medic-Alert makes both a sterling silver and one with a leather band (the engraved charm is attached to the outside of the band with lobster clasps - there might be a small amount of the buckle that touches the skin, though.)  Edit - they also make a sports-band style that has a plastic buckle.

[Gracefulskai]

A good friend of mine has a tattoo on his right forearm stating that he's a Type 1 Diabetic. You couldn't miss the medical symbol, it just drew your eyes. If he ever clasped someone would surely notice that tattoo. I think that, maybe not a 'have to have one' sort of thing, but just like the bracelets, voluntary. Getting a tattoo is a painful process for some people. It'd be better if the EMT's were aware that some people might have a tattoo. If anything should mandatory, it should be that the tattoo is visible, like on the forearm or somewhere that the EMT's don't have to take more than a second to look at it.

[Oniya]

As I have a sister who is an EMT, I've just dropped her an email asking her what she thinks of the idea.  Who knows, maybe she'll come back with a story about how she's seen this in practice.

[Zakharra]

  I just had the weird thought of what would people think if they saw these people in swimsuits (assuming they are young enough to wear them and look ok) or somewhat revealing clothes and they could see the 'DNR' tattoo, or some other condition (allergies or some such) stenciled across or on the chest/shoulder.  If they do tattoos like this, they will have to take that into account.

[DarklingAlice]

As far as placement goes I like the idea of the wrist. It's already associated with medical bracelets and small writs tattoos could be fairly innocuous. I also think that instead of the actual words like: 'penicillin allergy' or 'DNR' there should be a universal symbol library adopted to ensure no confusion of meaning. Something like an NFPA code for common medical problems.

[Serephino]

That's why I said it should be some kind of symbol.  I'm allergic to penicillin, but I'm not sure I'd want to advertise that.  My boyfriend definitely wouldn't want the whole world knowing about his heart condition.  With official symbols, the person who has it will know what it means, and medical personnel will know what it means, but the average person won't.  I wouldn't make it mandatory, but it's a good option.

I wouldn't reccomend it for DNR orders though.  Getting rid of a tattoo isn't easy if you change your mind.

[Zakharra]

That's why I said it should be some kind of symbol.  I'm allergic to penicillin, but I'm not sure I'd want to advertise that.  My boyfriend definitely wouldn't want the whole world knowing about his heart condition.  With official symbols, the person who has it will know what it means, and medical personnel will know what it means, but the average person won't.  I wouldn't make it mandatory, but it's a good option.

I wouldn't reccomend it for DNR orders though.  Getting rid of a tattoo isn't easy if you change your mind.

Five minutes after the list is released, it would be splashed all over the internet. People would get to know what it means fairly quick.

[Oniya]

Okay - word from the field is that
a) If it's not on the left wrist, it's not likely to be seen (that's the arm that is used for starting IVs).  It's likely to be by accident, though - they look for the bracelet.  Tattoos might be better observed in the hospital when they remove the clothing to get the patient into a gown. 
b) She's seen a 'No CPR' on an 80-yr-old's chest - tattoos on 80-yr-olds are fairly uncommon at the moment, so they draw the eye.  Thirty, forty years down the road - not so much.
c) The medications that are given in the field (pre-hospital) are not common allergens.  That said...
d) ID is searched for in the field - if you have a list of your allergens paper-clipped to your driver's license, they'd call that a good day.

[Pumpkin Seeds]

As far as I'm aware, we would not honor a "No CPR" or "No DNR" tattoo on a patient.  Too questionable.

[DarklingAlice]

Which is why, if this were to actually be used there would need to be a well, characterized standard system of symbols. Just like we already use in many other areas of science and medicine.

So, I get why a person might not want to advertise their stance on end of life issues on their skin, or even certain medical issues; however, I am not sure why anyone would shy away from certain information relevent to emergency medical procedures (e.g. allergies, blood sugar issues, etc).

[Pumpkin Seeds]

I don't see tattoos being a viable option because they simply cannot be changed on a regular basis. 

[Serephino]

Serious medical conditions don't usually change.  I'll probably be allergic to penicillin the rest of my life.  I think I'm mildly allergic to the anti-nausea stuff they give you before surgery.  It makes my whole body itch like crazy for a few minutes.   

[DarklingAlice]

Serious medical conditions don't usually change.  I'll probably be allergic to penicillin the rest of my life.  I think I'm mildly allergic to the anti-nausea stuff they give you before surgery.  It makes my whole body itch like crazy for a few minutes.   

It is worth mentioning that allergies change, and that some allergies (especially amoxicillin) are often misdiagnosed. That said, tattoo removal procedures are only improving...so *shrugs*

[Trieste]

I'm lucky enough to be only mildly allergic to latex, so I don't suffer anaphylaxis when it comes into contact with my skin. Would I tattoo a DNR on my chest? I don't consider my views on the issue solidified enough to do so. However, I would tattoo on something like, "I am an organ donor", or a message that makes it clear that I don't want to be kept alive in a vegetative state. There is paperwork to back those things up, sure, but does it really hurt to let an emergency response team know that they should call the organ donation folks if I come in DOA from an accident? Probably not.

[DarklingAlice]

I suppose by the same token: I have been advised not to donate organs or blood due to an idiopathic auto-immune disorder. And honestly I can't think of anything that would let ER docs know that if I were to show up DOA in an emergency room. Maybe I should just get a biohazard symbol tattooed on me :P

I still think a code would be better than the words though. Again I will cite the NFPA code. Lots of info in a little bit of space.

[Pumpkin Seeds]

The application just does not seem practical or realistic.  There are simply too many things that can go wrong for me to trust a tattoo someone has on their body.  Special codes or not, people do crazy things with tattoos.  A listing of allergies might sound cool, but as the EMT stated this is probably not useful in that sense.  Allergies do change over time, are misdiagnosed, patients are misinformed as to what an allergy is and allergies are sometimes quite extensive.  I have seen people with a listing of over ten medications on their forms.  There are people that simply get Benadryl around the clock just because they have so many.

A DNR on the chest or “No CPR” on the body is just dangerous in my opinion.  If anyone has seen the actual sheet for that declaration there have to be two physician signatures on the form, the patient’s signature and a witness to the event.  As a medical professional, I have to know that my patient was advised of what this change in code status means to them.  Someone having a tattoo on their chest does not cover me if their wife decides to scream, “Oh my God save him.”  Then there is the fiasco if someone decided to change their mind.  If hospitals recognized the tattoo, then it would be hell getting that changed.  Whereas to go from DNR to full code is a matter of, “hey, I want to be a full code.”

For organ donation there has to be a previously established consent.  The staff at the hospital will contact an organ procurement agency once a patient’s glascow coma scale reaches a certain number.  A patient’s family member with the ability to make medical decisions can alter a patient’s status as organ donor.  The organ procurement agency will then send someone to evaluate the medical history of the patient and go from there.  A tattoo here really serves no purpose.  Those in the emergency room where someone might experience sudden death are not going to perform the organ procurement, that is unethical and illegal.

As for posting a medical diagnosis on a patient, this would be a violation of HIPPA.  Certainly people are thinking of type 1 diabetes, but in all honesty that is still a bit over kill.  Standard procedure is to check a blood sugar if someone collapses or is unresponsive.  The test is too simple and quick not to do.  The problem comes for people that have HIV or some similar disease.  These tattoos will become more of a brand than anything else.  People with genetic defects may also find themselves branded as the symbols or meanings become more publicized.  There is a reason medical records are treated as private information.

[Trieste]

If someone is HIV pos and wants to get it tattooed on their body somewhere, it is not a violation of their privacy to do so.

I could see it being useful for something like blood type, or something that doesn't change easily. "I have blood type A+" or "I only have one kidney" or "I am HIV+" or similar messages would be useful.

DNR messages on older patients, maybe, I could see. DNR messages on younger patients, I would be iffy about honoring, personally. I could see the conundrum that would cause.

[Oniya]

As I understand it, if the patient him/herself wishes to broadcast their diagnosis, that doesn't violate HIPPA.  The key thing here is the voluntary nature of the disclosure.  Again, though, it's not likely that the average EMT is going to go looking for these tattoos.  If you're unresponsive, they are more likely to determine why you're unresponsive, then bring you back to the point that you can tell them what's wrong.

[Pumpkin Seeds]

In a warzone knowing the blood type in a quick way is important, because in those areas there is not ready access to blood or labs.  At a major hospital there is the universal donor blood and also ready access to a laboratory to perform type and screens.  Policy for most hospitals is that a type and screen must be done on a patient regardless if the blood type is known.  I believe this has more to do with antibodies being developed but also due to simple error.  A patient cannot walk into an emergency room and state, “I am A+ blood type.”  The blood bank at the hospital will still want a type and screen to cover themselves and as a nurse I would want one on recent documentation to cover myself in case of a reaction.

Having “I am HIV+” does not actually mean anything so far as I can tell.  Standard precautions protect the workers.  All patients need to be treated as if they have an infectious disease if they are unknown to the practitioner. 

As for the HIPPA, I would avoid anything involving that doctrine.  Perhaps them getting the tattoo would be legal, but if a code were used then privacy might be implied through use of the symbol or placement of the tattoo.  HIPPA is a dangerous beast that I avoid at all costs.

Oniya is also correct, an emergecny medical professional does not care if someone has HIV or cancer or really even a heart condition.  Their task is to keep them alive until they reach a hospital.  Once in the emergency room, the goal is to keep them alive until tests can be done.  If along the way they can be brought back to consciousness, awesome!  If not, they need to be alive so that they can later be brought back.

[Trieste]

As I understand it, if the patient him/herself wishes to broadcast their diagnosis, that doesn't violate HIPPA.  The key thing here is the voluntary nature of the disclosure.  Again, though, it's not likely that the average EMT is going to go looking for these tattoos.  If you're unresponsive, they are more likely to determine why you're unresponsive, then bring you back to the point that you can tell them what's wrong.

No, I would think not. I know I would personally have a problem with a law that prevented me from disclosing whatever the hell I wanted on my body in the name of protecting my own privacy. However, I don't think that HIPPA works that way.

The average EMT won't go looking for it, but then the average person isn't necessarily going to get a medical condition tattooed on their body, are they? On the other hand, if you're working in a setting where medical care is routinely needed and there are routinely the same caretakers around, I would think it would cut down on work and on error. A patient in a nursing home, for instance. That, to me, would seem more comparable to the original connection I made between tattoos and radiation treatments. Random Joe Dirt off the street? Might not be useful at all. But then, medical alert bracelets aren't really useful to Joe Dirt, either.

[Serephino]

I believe privacy laws only keep medical staff from saying anything without your consent.  I'm still allowed to disclose whatever I want to whoever I want, because it's my privacy.  If I sit down in a tattoo parlor and ask for it, that's my business.  If it was a symbol put, say, on the left wrist where a bracelet would usually be, then it would be easier to find, solving that problem.

These things wouldn't only be of use in a hospital with labs.  I still remember my psychology teacher telling a story of being brought into a police station as a psychological consultant on a man they brought in.  It was a simple traffic stop, but the guy up and lost his mind.  He was swearing and being violent, and causing all kinds of trouble.

She was able to figure out he was diabetic.  I don't remember what tipped her off, but she got him some orange juice, and he became a completely different person.  Had they known much sooner they could've avoided lots of trouble.  He was being erratic and violent because he'd forgotten to eat.  Been there, done that, it's not pretty.

[Pumpkin Seeds]

Well, for one the tattoo artist would have to be licensed to perform this procedure since this would be part of a medical document.  Someone could not go to “Bubba’s Ink” and simply get the tattoo put on their body since that would have no significance.  People self-diagnosis themselves all the time for a variety of reasons and a variety of conclusions, rarely are they good.  A tattoo artist would need to have exclusive ability to mark the patient in a particular area, with a particular symbol after reviewing a condition verified by a physician.  They would also then have to sign that the correct tattoo was done and submit the paperwork to the patient’s physician.  This would not simply be a trip to the tattoo parlor.

Also, HIPPA is not just about medical workers conversing about someone.  This covers any availability of medical records including those that can see the medical record.  If a code is put into place, such as the one discussed, the patient may be considered to have an expectation of privacy.  The code is considered an act to conceal the symbol’s true meaning from the public.  The placement in a “concealed” part of the body such as behind the inner lip could mean an expectation of privacy.  HIPPA is rarely black and white.

Also, I have a feeling the man did not know or was a recently diagnosed diabetic.  People that know they have diabetes, at least those that would know long enough to have their body tattooed, know when their sugars are low.  They would be able to say, I need juice or something of that nature.  I have taken care of many diabetics, seen their sugars drop rapidly and never had one “lose their mind.”  Typically they become violent after we introduce sugar into their system. 

[Serephino]

The guy knew.  He apologized profusely once he was back to his old self again.  Just because you have never seen it doesn't mean it doesn't happen.  He was pulled over on the PA Turnpike, and had been on the road all day.  I can't remember the details because this was years ago, but he lost track of time or something.

It happens.  I've done it.  I'm pre-diabetic.  I don't have to take medication yet, but I do have to watch it.  I've gotten busy and not felt hungry, so I forgot to eat.  My allergy pills kill my appetite.  I have a lot to do every morning.  Once I just felt tired and took a nap.  I woke up, and hadn't eaten since that morning.  I figured I should, but first I wanted to turn on the TV.  I couldn't find the remote, so I started throwing furniture.

Once I tired myself out and calmed down I noticed that I was lightheaded and shaky.  At first I thought it was just aftermath from losing it, but then it eventually dawned on me I needed to eat.  Once I finally got something to eat I felt a million times better.     

[Pumpkin Seeds]

That is not diabetes what you are experiencing, that is hunger.  If you do not eat for a long period of time then there will be an episode of being cranky.  The body does not like being deprived of food.  Typical symptoms of being hungry are irritability, headache, anxiety, shakes and so on.  Your body is demanding fuel.  More specifically the brain is demanding fuel since sugar in the blood is for the brain.  This is not a diabetic condition, but one where the body wants food.  An unchecked diabetic does not have a low blood sugar, but a high one.  Hypoglycemia tends to be more from the treatment of diabetes than from a natural occurrence.  Certainly a diabetic can have a sudden drop of sugar, any normal person can in fact without being a diabetic.  More often than not the drop in sugar for a diabetic is related to the administration of insulin or some other diabetic medication.

I understand that if I have not seen something, it does not exist.  The signs and symptoms of hypoglycemia can be confusion and agitation.  What I am saying is that an established diabetic, someone that has had the condition for long enough time for an established diagnosis and treatment should have felt the sugar drop.  There is a lot of education that goes into treating a diabetic before medication administration.  A diabetic would also have some sort of candy or juice on hand to drink from.  I understand that  all of this is a “typical” situation, but that is to show how small a moment the medical tattoo might come in handy.  Even in this case, once someone with some sort of medical training and/or familiarity with diabetes arrived there was recognition and treatment given.

[Pumpkin Seeds]