Curtis W. Neill
As reported by the CDC, more than one third of U.S. adults—more than 72 million people—and 16% of U.S. children are obese. Since 1980, obesity rates for adults have doubled and rates for children have tripled. Obesity rates among all groups in society—irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region—have increased markedly. Therefore, it is critical that EMS become adept at responding to not only the unique medical needs of the bariatric population but to be equally well prepared to transport them as well.
When responding to a call that involves morbidly obese patients , one must consider many logistical challenges. Are there enough personnel available to affect a safe move? Do you have the proper transfer equipment to move the patient to your stretcher? What is the weight limit on your stretcher? Is the stretcher wide enough to make the patient comfortable? Having a tactical plan in place before you receive this 911 call is critical to the success of your department to be able to deliver safe, humane and effective treatment and transport to the hospital.
Development of a tactical plan or standard operating guideline (SOG) is strongly recommended. Several EMS agencies utilize their safety committees in concert with the EMS medical director to review and develop SOGs. Once an SOG is adopted, it would be important to conduct periodic trainings on bariatric transports, including new strategies for moving morbidly obese patients in both emergency and non-emergency situations. This type of exercise should also include fire and police and agencies if they are used to augment EMS staff in your community. In addition to highlighting the manpower demands, the training exercises will also identify any equipment needs or deficiencies.
Standard sized and weight-rated carrying devices carried on the majority of ambulances will not be adequate to safely treat and transport the bariatric patient. In recent years, several manufacturers have developed specially engineered patient-moving systems that include portable heavy-duty vinyl stretchers and bariatric stretchers able to handle weight payloads of up to 1600 lbs., Portable air-powered lift systems as well as polycarbonate ramps- and- electric winch systems have also been engineered and are being installed in ambulances throughout the world.
Additional personnel, bariatric transport equipment and an ambulance properly equipped to provide this type of specialized service may be cost prohibitive for most EMS agencies. Perhaps forming a cooperative agreement between multiple services may be a more cost effective means of having the equipment and trained personnel available when needed. The following websites will be useful in getting you started in developing a plan for your service:
http://www.the-aaa.org/about/positionpapers/morbidlyobese.html
The obesity epidemic is predicted to continue throughout the United States while the cost of providing EMS is escalating and the percentage rate of reimbursement is declining. Therefore, EMS leaders of today must think smarter and be more efficient by reaching out to local and often neighboring resources at their disposal. It’s not a matter of if you will be faced with the challenge of caring for the bariatric patient; it’s a matter of when.
