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Home > Topics > Community Awareness

Medical tattoos offer important health information

Some patients choosing to have DNR, other messages permanently imprinted

By Maria Sudekum
Associated Press

KANSAS CITY, Mo. — Tattoos have long served as fashion statements, but a small number of Americans are now relying on them for a more practical, potentially lifesaving purpose: to warn first responders about important medical conditions.

Some medical tattoos are being used to take the place of bracelets that commonly list a person's allergies, chronic diseases or even end-of-life wishes.

"Bracelets are nice, but something as strong as a tattoo ... that is a strong statement," said Dr. Ed Friedlander, a Kansas City pathologist who has "No CPR" tattooed in the center of his chest, where a paramedic would see it.

Friedlander, 60, got the tattoo to emphasize his decision to forgo CPR if his heart stops.

Medical tattoos don't appear to carry much legal weight. It's unclear whether an ambulance crew racing to treat a gravely ill patient could honor a request such as Friedlander's based on the tattoo alone.

But the markings do offer a simple and permanent way to give rescuers important health details.

Melissa Boyer, of Nashville, Mich., wore bracelets for years to identify her as a diabetic, but she kept losing or breaking them. The 31-year-old decided months ago to get a 3 1/2-inch tattoo on her left forearm that includes the medical symbol and identifies her as a Type 1 diabetic. It also declares her allergies to penicillin and aspirin.

"It's been 29 years that I've had (diabetes), and I went through I-don't-know-how-many bracelets," she said. "I went and got the tattoo, and it made life easier."

The American Medical Association does not specifically address medical tattoos in its guidelines. But Dr. Saleh Aldasouqi, an endocrinologist at Michigan State University, hopes that might change.

Aldasouqi, who has written about the tattoos, has seen them among his diabetic patients and feels they are becoming so popular that the medical profession needs to help guide their development.

"My intention has been to bring this issue to the surface so that medical organizations can have a say in that," he said. "When you just Google it, you're going to find hundreds of stories and discussions, but no medical say. So I feel we leave our patients kind of afloat."

It would be helpful, for instance, if the tattoos were uniform or placed in the same area of the body so responders would know where to look, he said.

"My perspective is that we as physicians need to be involved in this," he added.

Aldasouqi does not advocate for or against the tattoos, but he says patients and doctors should discuss the idea beforehand.

If one of his diabetic patients sought a tattoo, Aldasouqi would recommend using a licensed tattoo artist and carefully controlling blood sugar during the procedure.

The National Tattoo Association, a nonprofit that raises awareness about tattooing, does not track the numbers or styles of tattoos. Sailor Bill Johnson, a spokesman for the association, said he does about one medical tattoo a year at his shop in Orlando, Fla.

"Nine times out of 10, it's either allergic to something, penicillin or peanuts," he said.

Still, it's questionable whether medics or doctors would be under any obligation to honor end-of-life instructions in a tattoo, unless they could be sure the patient also had signed legally binding papers.

Laws on do-not-resuscitate orders can vary widely from state to state. Missouri law does not address medical tattoos at all.

"What we can tell you is what the law says. What we can't tell you is what assumptions people are going to make," said Gena Terlizzi, spokeswoman for the state Department of Health and Senior Services.

However, emergency professionals are always on the lookout for information about a patient's condition and treatment preferences, and that includes looking for medical tags, bracelets and possibly tattoos, said Dr. David Tan, medical director of Washington University Emergency Medical Services in St. Louis.

"It's something I have not seen a whole lot of, but it's out there," Tan said. "I think tattoos just aren't that conventional. But I don't think it makes it any less useful."

A tattoo alerts "any medical professional to stop and think a moment," he added.

Tattoos are unlikely to replace medical alert jewelry, said Ramesh Srinivasan, spokesman for the MedicAlert Foundation, which sells more than 100,000 pieces of jewelry a year that have medical conditions on them.

Unlike tattoos, MedicAlert jewelry also provide information that gives a "complete snapshot" of the person's health that can be accessed by professionals.

"Tattoos are totally different," Srinivasan said. "What's the validation behind it?"

Friedlander encourages patients to make their own medical decisions and to spell out their wishes ahead of time. He has paperwork outlining his preference to avoid CPR, but the tattoo, he explained, will "make people a whole lot more comfortable about honoring my known wishes."

"In pathology, you think a lot about the end of life," he said. "Nobody would ever accuse me of not loving life. ... When this thing stops beating, it's time for me to move on."

Associated PressCopyright 2013 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Copyright 2012 Associated Press

Comments
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Andrew Kolstad Andrew Kolstad Monday, February 27, 2012 2:49:07 PM Great idea but not leagally binding. An ambulance crew would have to do CPR unless the family produced legal documentation stating he was DNR.
Angela Heimbach Angela Heimbach Monday, February 27, 2012 3:32:15 PM andrew's right, I don't care if "DNR" is tattoo'd on a patient's forehead, unless I have legal and up-to-date paperwork IN MY HANDS, then CPR will continue, no matter what anyone says. without the proper legal paperwork, I'll ignore wives, husbands, siblings, parents, and everything else. it makes EMT's too liable to do otherwise.
Diane Dunkle Prutsman Diane Dunkle Prutsman Monday, February 27, 2012 4:06:02 PM I agree with Angela and Andrew, I am an EMT and I would have to see the legal paperwork as well.
Alan W. Rose Alan W. Rose Monday, February 27, 2012 6:37:08 PM Obviously the laws need to change to recognize these tattoos. If the law allowed it, I have no problem DNRing someone who took the trouble to have it tattooed on their body.
Suzy Red Suzy Red Monday, February 27, 2012 9:22:05 PM I have a friend that did that to identify her diabetes.
Suzy Red Suzy Red Monday, February 27, 2012 9:25:41 PM Its smart, but not really legally binding. I mean for a DNR order I'm gonna want paper work.
Angela Heimbach Angela Heimbach Tuesday, February 28, 2012 5:20:43 AM definitely agree with you guys, for some things, it's very helpful, but its not the first thing that I'm gonig to look for. for someone who is diabetic, allergic to something, has asthma, or something in which treatment has no contraindicstions, I'll go with it if it's where the symptoms are pointing. but for something with which life and death is depentant, I need the legal documents. a uniform system would be really great, but I do think we are far from such a thing. first things first though, and as we all know from training, my safety as an EMT comes first, legally and ethically, not just physically.
Richard Cooper Richard Cooper Tuesday, February 28, 2012 12:20:51 PM As a medic who was constantly hampered by a medic alert bracelet when giving CPR, I finally had COUMADIN tattooed on my wrist. I also recommend it to my patients when I know they have a life long disease, e.g. IDDM or will be on a blood thinner for life (as I am).
Jim MacKay Jim MacKay Tuesday, February 28, 2012 6:51:20 PM My wife and I had this idea several years ago but not for Medical Alerts or DNR - we thought more of Organ Donation. We envision a heart in the middle of a recycle symbol or something along those lines with the words "My Wish - Organ Donor"... Now here's the problem, what is it one must do to ensure their wishes are carried out in a timely manner? Even if you tattoo yourself and have the sticker or signature on your license you STILL need next of Kin permission for organ donation. This IS a delicate situation to be sure but come ON... if I go through the trouble of having my wishes TATTOOED on my body... what more can I do?
Rani Hamid Rani Hamid Tuesday, February 28, 2012 7:10:38 PM Yes Angela, I got the same idea with you :-)
Heather Lee Heather Lee Tuesday, February 28, 2012 8:16:00 PM I like the medical alert idea for Hx and allergies.... But DNR... no way.. I want the papers or a bracelet... A tattoo you can't change your mind about last min.. a bracelet you can cut or slip off....
Stephanie C Webber Stephanie C Webber Tuesday, February 28, 2012 9:17:21 PM If you are looking at someone's tattoos when you're trying to save a life, then there's something wrong with your focus. I KNOW I'm not alone in this, I don't notice someone's ink. I notice their mental status, their skin color/temp and condition, their respirations and pulse and the surroundings I find them in. Unless their medical tattoo has big arrows pointing to it and a 46 font message that reads: "MEDIC, READ ME!", I'm not going to care what someone put on themselves. Everyone has tats these days. Don't expect me to suddenly notice your special notation that you have a sz do. Bracelets are a better idea. Necklaces. Things that people wear in the same place. A tat can be anywhere.
George Beltz George Beltz Wednesday, February 29, 2012 3:44:17 AM I am required to perform CPR unless I see a Current and legal DNR order.
John Greenaway John Greenaway Wednesday, February 29, 2012 10:42:50 AM If your dealing with a person who tattoos it's good idea but only draw back is the person with tattoo all over there bodies. Where do you start at the end of the dragen tail.
Patricia Zeiger Patricia Zeiger Wednesday, February 29, 2012 6:31:23 PM That is a good idea..never thought of that
Gail Lord Gail Lord Thursday, March 01, 2012 7:30:41 AM I too have considered having a medical tatoo, but know of a nurse who had D.N.R. tatooed to her chest and was told that it would not be honored. I think it is time to re-think the issue and agree with the article, get it in specified place and have the tatoo registered with the medical community.
Bob Dellinger III Bob Dellinger III Thursday, March 01, 2012 9:52:20 PM I like it when people have their medical Hx readily available nearby in case they are unconscious, one assisted living has all of the residents info on a sheet on the back of the door when you enter which helps out tremendously when the Pt has coded. A tattoo of allergies would be great, a Hx might be to extensive. Having a DNR request should have a specific symbol to reflect what their legal papers show and be universal for all agencies. It should be a symbol that can be constructed onto as the DNR changes. Only specified Licensed tattooist do the work after seeing the paperwork and photocopying it to a file folder.
Michael Eburn Michael Eburn Friday, March 02, 2012 4:53:55 PM Whether or not a DNR tattoo is legally binding, it would certainly put everyone on notice that they need to make inquiries about appropriate paperwork; and, as with organ donation, it would make it easier for treating practitioners to have the discussion with relatives that terminating resuscitation or donating organs 'is what he/she wanted'.
Ginnie Linville Eburn Ginnie Linville Eburn Friday, March 02, 2012 6:51:10 PM Interesting subject!
Michael Eburn Michael Eburn Friday, March 02, 2012 11:12:07 PM For further commentary and an Australian perspective see http://emergencylaw.wordpress.com/2012/03/03/medical-tattoos-offer-important-health-information/
Sue Pigdon Sue Pigdon Sunday, March 04, 2012 5:17:01 PM If someone goes to the trouble of having a tattoo saying 'Do not recussitate' or No CPR - especially in the absence of any other tattoo - then you'd have to think they were pretty serious. And the decision was made in sound mind and to specifically address the situation where they are NOT conscious and NOT breathing. I think the legal risk of ignoring this is greater and only surpassed by the moral and ethical obligation of hounouring the persons wishes. Depends where you live and what laws apply. Often legistation lags behind the greater community will. I believe it is starting to catch up. On a heavily tattoed body I accept - the message may be lost...
Angela Heimbach Angela Heimbach Thursday, July 19, 2012 8:46:19 PM Seriously, who gave you a certification? You're a moron, so what do you do when you see my phoenix tattoo? Set me on fire? I don't mean to offend, but you do a pretty good job yourself. Where do you define that a legally binding TATTOO be placed on the body? As an EMT, I've got plenty other important things to do than search a body for a tattoo. Also, no one would agree on placement (plus, I think it's my own personal business what my DNR states specifically, and I don't want it to come into speculation in conversation with anyone other than my attorney or an EMT/MD). You have fun DNRing someone based on a tattoo, because I can GUARANTEE you, they will never be legally binding (tattoo's begin to fade immediately after they are inked, not to mention... what if someone changes their mind and then cannot afford to pay for removal [the state/feds are NOT going to opt for things like this]). Let's also remember, there is a high percentage of tattoo's that are done while the tattooed is drunk, or under some influence. Like I said, DNR whoever you want based on a tattoo dumb-nut, but I hope your reputation, house, financials, and certification aren't important to you, because they won't last long with your type of thought. Thank goodness people like you aren't on the council (if you even know who/what I am referring to)
Angela Heimbach Angela Heimbach Thursday, July 19, 2012 8:48:48 PM There is no way to prove that the person with the tattoo was of sound mind at the time of the tattoo unless you were the person that tattooed them. I'm not prejudice of people with tattoos, if I were, I wouldn't have a full back piece of 7, and two more on each hip). However, I think that those of you for this idea completely fail to consider the legal, political, and cultural ramifications of this subject.
Angela Heimbach Angela Heimbach Thursday, July 19, 2012 8:59:40 PM Stephanie C Webber - Genius! Finally someone considers the aspect outside of "What is easier and takes less of my precious time" (EVERYONE has tattoos today ALL over the body). This isn't just about what is easier for you people as patients, in case you haven't noticed, EMT's get sued way to often for frivolous things (I'm not denying that we don't mess up, but the majority of lawsuits against EMTs are ludicrous). The subject of throwing whether or not we follow a f**king tattoo is just opening the door for more of us to lose our license because someone got pissed off that we didn't hold their hand like mommy. EMT legality is confusing enough as it is
Chris Yunke Chris Yunke Wednesday, November 21, 2012 11:08:05 PM Angela Tressie Heimbach You say you dont mean to offend immediately after calling them a moron. You are a bitch. Also, they said IF THE LAW ALLOWED IT. ALSO, If a next of kin such as a wife, husband or parents tell you they are not to be resuscitated, than you are legally obligated. Where the fuck did YOU get your certification?! And who the fuck do you think you are to go blasting people all over the internet with you nonsensical bullshit. I see by your profile photo you were recently married? God help your husband.
Claudia A. Chaffin Claudia A. Chaffin Sunday, April 13, 2014 3:43:14 PM no honor my DNR......no get paid for bills afterward, period!
Nicolette Yvonne Nicolette Yvonne Sunday, May 18, 2014 1:49:20 PM so, if a person carries that paper work in their wallet/purse do EMTs/Paramedics bother to look? I think it is a matter of dignity to honor DNR request.... especially if there is a tattoo, or medical ID.
Angela Heimbach Angela Heimbach Sunday, May 18, 2014 6:31:12 PM well, I guess when I come across you and you have no pulse, I'll just take my time to go through your shit, then wait for the lawsuit (youre the kind of person that's gonna be a pain in the ass regardless of what I do, so I'm just going to do what protects me best legally, if people like you weren't an issue, then yes, things might be different)
Nicolette Yvonne Nicolette Yvonne Monday, May 19, 2014 6:33:48 AM Angela Tressie Heimbach no need to get into a huff, Angela. I was really just curious if EMTs would look for anything in a purse if someone had a bracelet on. Because you'd want more info if there was no one around, wouldn't you? Anyway, no need to reply…. rudeness wasn't was I was looking for. Take care, and Keep the Scene Safe.

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