Administration and Leadership

Employees With Ink

There are plenty of great„EMS tattoos, like this one on arm of a firefighter/EMT that honors 9/11 responders. But will patients consider visible tattoos as art, or will they think your providers are unprofessional?

When I started working in St. Louis in 1977, there was only one tattoo shop in the city. Located in„south St. Louis, Trader Vic’s remained the sole tattoo parlor for years. Back then, not many people had tattoos, except for members of motorcycle gangs and those in the armed forces.

Since those days, tattoos and body piercings have increased in popularity and have become part of our modern American culture. According to a survey from Scripps Howard News Service and Ohio University, about 30% of Americans between the ages of 25 and 34 have tattoos. For those under age 25, the number is about 28%. If you think about the average age of your recruits, you’ll realize about one-third of them probably have tattoos.

And there are plenty of„EMS tattoos out there. Just go to, a Web site dedicated to firefighter tattoos, and you’ll find a whole section on EMS tattoos (among others). Some of them show a great amount of detail and, in my opinion, they’re beautiful.

But when we’re talking about EMTs and paramedics showing up at someone’s home to treat a patient, and the providers have visible tattoos up and down their arms and across their necks, it’s a different story. Are the patients and family members likely to consider the tattoos an art form or self-expression, or will they think the providersƒand the EMS agency are unprofessional?

Both Sides of a Policy
In response to this shift in American culture, some EMS agencies have developed policies that prohibit or limit tattoos, body piercings and other forms of body art. On the flip side, employees with tattoos and body piercings feel such policies are an infringement on self-expression and artistic freedom. There are legitimate points on both sides, and an EMS manager should consider all aspects and effects of implementing a policy.

What if a tattoo has a religious connotation? Is it a violation of their First Amendment right to the freedom of religion if you make them cover it up? What about the employee who proudly wears an EMS tattoo? Are you going to tell them to dampen their enthusiasm for their profession?

Because of these aspects, some managers contend that if it’s not an issue, we shouldn’t worry about it. But the trend of tattoos and body piercings isn’t going away, so every agency should have a policy in place to avoid potential problems. Thinking ahead is especially smart because tattoos and other body art are often permanent or difficult to reverse.

In general, policies regarding tattoos and body piercings limit their visibility and require that nothing about them is offensive. In 2006, the Army changed their policy to permit visible tattoos on the hands and on the back of the neck, as long as they aren’t ˙extremist, indecent, sexist or racist.Ó The Army apparently changed the policy because it feared qualified recruits were being lost.

One„EMS agency implemented a policy that addresses current employees with tattoos, current employees without tattoos and new hires. An EMT or a paramedic with an existing tattoo that’s visible while wearing a standard department uniform must somehow keep the tattoo covered at all times. If they have a short-sleeve uniform, they must wear a long-sleeve shirt underneath. No current EMT or paramedic will be permitted to get visible tattoos. No new EMTs or paramedics will be hired with any visible tattoos or with tattoos that may be covered but would be considered offensive.

The problem with the current EMS provider with a tattoo is that they have to wear a long-sleeve shirt at all times. Imagine if you worked in Florida; summers would be intolerable being covered to your wrists. This policy could become a source of agitation, so be sure to have a plan on how you’ll address any complaints.

Another type of body art that your policy should address is piercings. Many departments prohibit any type of jewelry in any form while the employee is on duty. This includes piercings in the ear, tongue, lip, nose, eyebrow and any other visible body part.

Because there could be legal challenges to your policy for religious or other reasons, your policy should be developed in consultation with your department’s attorney.

Bottom Line
As the saying goes, “Beauty is in the eye of the beholder.” But when it comes to body art on your employees, it’s best to limit who gets to do the beholding. In the process of developing any policy on tattoos or body piercings, keep in mind that you want all of your employees to be viewed as professionals and role models. But at the same time, you don’t want to interfere with an employee’s freedom of speech and expression. And by the way, I don’t have any tattoos or body piercings and don’t plan on getting any.

Gary Ludwig,MS, EMT-P, is a deputy fire chief with the„Memphis (Tenn.) Fire Department. He has a total of 30 years of fire and rescue experience. He is chair of the EMS Section for the International Association of Fire Chiefs and can be reached at