NAPLES, Fla. - The first time Jimbo Carriero died, it lasted only a few minutes.
"I didn't see the white lights everyone talks about, but I sure got an overwhelming feeling of total bliss," Carriero said of complications following a stent procedure after a heart attack in September 2008. "It was beautiful, just a beautiful feeling, like all my bills had been paid."
So the next time, he wants to stay there.
The 52-year-old owner of Body Branding Tattoo Emporium in Naples had "Do Not Resuscitate" tattooed on his chest a year later.
He is among a growing number of people who want a more permanent medical alert. The Canadian Medical Association Journal reported in May that medical tattooing appears to be increasing, partly because the often-pricey medical alert bracelets can be lost or broken, some people prefer tattoos, and others can't wear jewelry at work. The journal detailed tattoos for diabetes, blood types and end-of-life wishes.
Like Carriero, Spencer Cootware nearly died. After a day of fishing on Dec. 29, the 50-year-old Naples bail bondsman felt the worst pain he'd ever experienced, "like an alien crawling out of my back." Clutching his cellphone, he dialed 911 and shouted for help as he fell to the floor at home.
He'd suffered a ruptured aorta. After that, he bought a medical alert card for his wallet and a bracelet and dog tag with his medical information stored on a USB device.
"I don't want them to do unnecessary surgery," Cootware said of emergency medical technicians and doctors, adding that it was corrected with medication.
Last week, he took a more permanent step: A medical tattoo on his right wrist with the words "Medical Alert: Type B Thoracic Aortic Aneurism."
"If I'm incapacitated and can't talk, they would do a screen of my body and see the aneurysm and think it just happened," he said of his fear.
This spring, Pennsylvania-based Hope Paige, which makes medical ID bracelets, began offering a free temporary "in case of emergency" tattoo with a bracelet purchase to let people "get their feet wet before making the leap to permanent tattoo."
The increase in demand for the new method of alerts is seen on the Internet. Type "medical tattoo" into Google and numerous diabetic tattoos pop up, including Insulin Dependent and Type 1 Diabetic.
Such alerts can be life-saving, but as more people turn to medical tattoos, doctors say guidelines are needed to specify what they look like and where they're located.
American Medical Association guidelines don't address medical tattoos, but first responders now are trained to look for a medical bracelet or a medical alert necklace.
"There have to be more standards if medical tattoos become a more common practice," said Dr. Saleh Aldasouqi, a Michigan State University endocrinologist who began studying the issue four years ago and writing about it in medical journals.
"With a tattoo, would you see it?" he asked during a telephone interview. "You really have to be focused on saving a life. We want to make the job of emergency personnel easier. Seconds and minutes count when saving a life."
A medical tattoo could help if someone lost a medical alert bracelet or necklace during a car crash, he said, adding, "If someone has a tattoo, we would say check that person's blood sugar immediately. It could be a lifesaving intervention, to give them blood sugar through an IV."
Although Aldasou1i doesn't advocate tattoos, he leans more toward those that could be lifesaving, alerting medics to diabetes, hemophilia or rare blood types.
"The medical alert purposes are valid and make sense to me, but the issue got a little clouded by folks who decided to put DNR on their chests," he said of end-of-life directives.
With a Do Not Resuscitate tattoo, Aldasouqi said, doctors and EMTs would still begin resuscitation while others searched for a legal, medical directive as confirmation.
"Otherwise, if you take the other option, it's not going to be reversible," he said. "A tattoo may help as guidance, but not for decision-making because people do change their minds. The first thing we look for in their charts is a directive."
Jeff Cleary, vice president of MedicAlert Foundation, contends tattoos can't replace what the 56-year-old nonprofit organization does through its 800-number, which is staffed 24/7 with employees who speak to EMTs and medical staff or contact relatives in emergencies.
The foundation manufactures bracelets and necklaces for medical conditions, including diabetes, hemophilia, Alzheimer's, dementia and autism -- and has roughly 1.1 million members who pay for the service.
"We can release information and we can contact the loved ones while the EMT is working on them," Cleary said, noting there are no standards for tattoos, but MedicAlert is known for its standards and lifesaving work.
"With a tattoo, each time you get a new condition, you'd have to go back to a tattoo artist ... and you'd have a tattoo crawling down your body," he said. "With us, a member can call our hotline and provide updated information."