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Tat Tapestry: Patients' skin gives us clues into their well-being and lifestyle

EMS is one of the few professions that allows its employees to gain rapid visual access to a perfect stranger's integumentary system (skin casing)ƒassuming they're our patient, of course. The cutaneous membranes of those we serve give us an initial window to their homeostatic well-being, along with a surface to apply all our various medical technological equipment and needles.

Independent of any temperature, color, texture or moisture changes that may result secondary from an acute or chronic medical or trauma emergency, we see skin as just skin. This perception is unlike the media-hyped models the rest of society seesƒsculpted, waxed (ouch), pretty people steeped in flawless youth, face cream, body lotion and moisturizer, toner, blush, face powder, lipstick, lip balm, eyeliner, mascara, Botox and steroids.

Prehospital care sees skin for what it really isƒan epidural surface randomly covered with moles, warts, freckles, birthmarks, stretch marks, wrinkles, scars, nodules, flakes, tumors, vesicles, papules, bullae, cysts, acne, telangiectasias (don_t ask), keloids, fissures, ulcers, lesions, corns, calluses, fungi, colicilestubotuliousmulous (I made that one up to see if you were paying attention), goose bumps and tattoos.

I mention tattoos because I didn_t see many of them when I first entered EMS. The ones I did see were usually found on patients who were highly intoxicated, suffering from LMCS (Low Marble Count Syndrome). I see 10 times as many patients with tattoos now. Times have changed. And what does that tell us? There must be a lot more alcoholics than ever before. Just kidding. It_s not my place to judge how people express themselves in a permanently inked way, and it can keep things interesting when assessing a patient_s epidermal well-being.

I_ve always found it ironic: The more tattoos a patient has, the more they whine about how much an IV needle hurts. Behind all those tattoos is a story, some of which are touching. But the ones I don_t want to hear are from patients who are adorned with gangbanger tats. I_m usually too busy looking over my shoulder at bystanders, searching for rival gang tats, to hear their story anyway. Another irony: Most of these tats get ruined by bullet holes and stab wounds. So, I think they should help law enforcement by inking the words "Taser zone" somewhere on their chest. And IV drug abusers should replace the barbed wire designs around their upper arm with a cool tourniquet tat that serves as a helpful visual indication to EMS of their lifestyle choice. Two birds, one stone.

What I find particularly noteworthy are patients with chronic illnesses who wear tattoos in harmony with their disease. I can only assume one lady who inked a diabetic medic alert bracelet on her wrist didn_t have much faith in a cure for type 1 diabetes being discovered during her lifetime. The best one I saw was a small, red heart on a female patient_s upper left chest. She had a heart pacer illustrated on top of it.

I won_t even go into genital tattoos (self-esteem through self-mutilation), because I view these people as just trying to have an excuse to be exhibitionists without getting arrested since there_s nothing better for gathering a crowd in an ER. Too bad nobody can focus on treating the patient, because they_re too busy pulling out their digital cameras.

Lots of EMS and fire folks have tattoos depicting their chosen field. Many portray images of unity, pride and honor. Some of the most moving ones pay homage to fallen colleagues. This can bring comfort and symbolize that the deceased will always remain with them. Too often after an EMS comrade dies, people are afraid to talk about them, and such a tribute invites others to speak openly of this person_s legacy.

From a public perception standpoint, I believe tattoos should be covered while wearing a uniform. Perception is reality until changed and, like it or not, Grandma Smith does not need to see the words "I electrocute people for a living" on your arm.

I often hear of medics saying that someday they_ll get a "No Code" or "DNR" tattoo placed on their chest. Obviously, this doesn_t speak highly of their faith in our profession_s ability to resuscitate them. But what about those who want to be resuscitated? Maybe they should have dotted outlines of where the 12-lead ECG pads go along their lower chest wall. Don_t bother tattooing the ACLS guidelines anywhere on your bod, because you_ll just have to revise them every two years.

My best tattoo experience was of a drug abuser who had very little peripheral venous access for an IV. He pointed out that the only good vein he had left was on his anterior forearm. He_d been avoiding it because it had a tattoo of a beautiful nude woman. I was able to easily thread the IV catheter as we arrived at the ER. The triage nurse asked me why I had placed the IV directly on the tattoo. I told her the naked lady needed a Foley catheter.

Until next time, be safe.JEMS

Steve Berryhas been a paramedic for the past 25 years in the southern Colorado region. He_s the author of the cartoon book series I_m Not An Ambulance Driver and invites you to join him and others of the EMS community to ride in the 2009 National EMS Memorial Bike Ride (www.muddyangels.org). Visit his Web site atwww.iamnotanambulancedriver.com „to purchase his books or CDs.

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