Care for Gang Members

There are some situations and outcomes within the healthcare industry where it is important to pay attention to what happens, what could be done, what should be done and why all of the above is true. Indeed, one of those things would be the treatment of gang members in emergency room and similar situations. When gang members engage in violence with knives and guns, they commonly end up in emergency rooms seeking treatment. As part of that eventuality, the healthcare staff present at the time is supposed to keep an eye out for visits to their facilities that are indicative of criminal and/or gang activity occurring. This idea would mostly include the physicians. However, the nurses and other important personnel present would matter as well. Gang members showing up with shooting or stabbing wounds would be an obvious example of this. While there can be a steep learning curve and keeping on task can be daunting, physicians and other professionals in such a happenstance need to know and study the tattoos and other signs of these gang members as it can be indicative of their background and why they are in the situation that they are in.

Analysis

One of the more seminal and important works on the subject in question came in 1999 with the work of Malton and Russell. Indeed, they noted that emergency physicians that service areas with a high amount of gang violence should be well-versed on gang tattoos and what they mean. This can be very important for when the information is relayed to law enforcement personnel. It can also be data that is clinically relevant and important for healthcare workers to know (Malton & Russell, 1999). Since the work of Malton and Russell, there have been many other scholarly works and treatises that have helped inform the best practices and procedure that emergency room physicians should complete. For example, the work of Urdang, Mallek and Malton (the same Malton as before) in 2011 says much the same thing. However, that work references both tattoos and piercings as being important when it comes to any inventory of a patient in terms of their markings and body characteristics. Obviously, their health status and injuries matter greatly. However, the tattoos and piercings matter as well. Both tattoos and piercings are commonly classified in the medical community as body modifications, or BM. As the body modification movement, especially among gangs, as evolved and changed, it is important for physicians to know how these changes and patterns are important. This is true from an inventory/summary perspective as well as the medical implications that are created from these bodily alterations (Urdang, Mallek & Malton, 2011).

Even with the fact that the inventory and consideration of tattoos and other body modifications is important, it is also wise to not react too much or too extensively. Indeed, there are some parties and agencies that use a great amount of discretion and create a number of problematic consequences. While this mostly pertains to immigration enforcement agencies more than any other body, the same could be true of emergency room physicians. Regardless of the forum, there should be a focus on defining what is called for, what is required and why. After all relevant incidents and outcomes, there should be a review and summary of what happened. In other words, there should be a post-mortem, if you will. Even if it is just a verification that everything was done correctly, doctors and administrative/legal executives in power should ensure that there is no abuse of the above protocols or lack thereof. For example, not every tattoo is a gang-related tattoo. It might be but many people that get tattoos are not criminals or in gangs. Further, there are some symbols and patterns that are fairly common and ubiquitous. To use religion as an example, a pentagram could be the sign of a person that is wiccan or pagan. However, it could also be the sign of a person that believes in Satanism or something similar. That often comes down to which way the pentagram is pointing, up or down. Other people use pentagrams for entirely different reasons, and that would include gangs. The lesson is that documentation and review is important. However, jumping to conclusions is less than wise. Again, there should be an adherence to proceeding with due diligence that is present along with a bit of caution before reacting in a way that is incorrect or over the top (Hufstader, 2015).

A part of the point made above is echoed in another source reviewed for this report, that being the concept of assuming someone that is tattooed (or pierced) is a criminal. It can be an indication of gang or other criminal activity. Indeed, there are many that hold that tattoos among teenagers is a possible or probable indication of a problem. With teens in particular, this is mostly because teenagers must generally have the consent of their guardian to get a tattoo and it is perhaps not all that common for the valid guardians for a teen to get that consent in the first. place. Even so, there are exceptions to the rule. Just as there are teenagers that are emancipated from parental control as well as teenagers that are granted to get married with the permission of their parents/guardians, there are teens whose parents allow them to get tattoos. Obviously, if a teenager riddled with tattoos enters an emergency room with a gunshot or stab wound, then the documentation of the tattoos is important as it is possible probable that there is a gang aspect to the incident, or at least the victim. In many countries, the presence of tattoos makes it all the more likely that the teenager is involved with assault, fraud or drug abuse. However, nothing should be assumed unless there is concurrent and corresponding evidence to indicate as such. Beyond gunshot and knife wounds, examples would include teenagers who will not identify where they live or who their parents are, teenagers who will not identify who they are or that are obviously giving a fake name and so forth. Criminal activity is not the only reason such things happen. However, it is certainly one of the reasons that such things tend to occur. Other possibilities include inability to pay and sexual abuse (Liao, Chang & Su, 2014).

 A complement to physicians being in the know and otherwise prepared when it comes to gangs and their tattoos would be that not all gangs fit the same mold. Further, just because a hospital or other such place is not in an “urban” area does not mean that gangs are not present and doing what gangs do. Even if the scope and size of the gang problem in a given area is smaller, especially as compared to other places, that does not mean that doctors should be less than vigilant. A good example of what is meant by this is illustrated by Ludeke (2007) when he talks about the gang that is known as Malibu Locals Only, or MLO. MLO is a gang that is clearly and provenly not as violent and pervasive as the gangs seen in other areas of Los Angeles such as Compton. However, they are a gang nonetheless and they engage in many of the activities that are associated with gangs. Treating them any differently from a procedural standpoint is an example of bias even if the potential or proven violence is further down the scale. Regardless of how ruthless or violent a gang happens to be, the best practices related to detecting and tracking the tattoos of people that pass through the emergency room should not change. There can and should be the proper adjustments for perceived or proven threats of violence. However, protocols and standards related to review, reporting and summary should not change based on the perceived threat of violence against medical staff or the nature of what happened before the victim came to the emergency room (Ludeke, 2007).