Morbid Obesity: Considerations for the EMS Provider

Dispatched for a diabetic emergency, you arrive to find a 45-year-old female lying on the living room floor experiencing shortness of breath. The patient, who weighs 725 lbs. and is unable to move, states that she has been unable to take her insulin for several days. As you begin basic assessment, you and your partner determine that the patient needs additional medical assistance and ponder how to move and transport her.

Not long ago, this scenario was considered an exceptional call and intuitive creative ideas were needed to accomplish the task of moving and transporting a patient of this size. Today, EMS organizations, and specifically their providers, are increasingly being confronted with handling the morbidly obese patient. Although still important, intuitive creativity must be expanded into policy and guidelines that enable personnel to follow a specific path of assistance when dealing with these situations.

Overview and Challenge

Type in “morbid obesity” on any Web search engine and you may get more than 200,000 hits on the topic. The Centers for Disease Control and Prevention (CDC) states that obesity has become an epidemic over the past 20 years. The CDC predicts a reduction in obesity by the year 2010, but current data demonstrate an increasing concern that this reduction may not occur. Experts agree that until multiple forces address this issue and any proactive solutions show results, emergency service providers are going to experience a growing involvement in dealing with the morbidly obese patient.

The term morbid obesity implies excessive accumulation of fatty tissue to a point where the fat impedes and/or injures surrounding organs. Patients who weigh more than 100 lbs. over their recommended weight, based on height, are categorized as morbidly obese. This effect causes serious illnesses and disease that may potentially lead to death. Often, this is where EMS becomes involved. When responding to medical emergencies or nonemergent transports for medical evaluation, EMS is confronted with the task of moving, lifting and transporting these patients.

Add the ever-increasing medical assist calls from mutual aid departments, and you add fuel to the need for EMS organizations to address this growing challenge. EMS organizations and governing agencies need to establish policy on dealing with these situations and be creative in how they address the operational issues.

Southwest Ambulance in Tucson, AZ, has taken bold steps to address the challenge with a new “bariatric ambulance” specifically designed to transport the morbidly obese. Being equipped with a special stretcher that is 11 inches wider than traditional stretchers permits easier transport of these patients.

The stretcher in the Southwest ambulance is equipped with a cable and winch and is capable of handling a patient up to 1,000 lbs. According to a USA Today article by Steve Friess, other ambulance services, like American Medical Response, have similar bariatric ambulances. The fact remains that only a very few of these specialty units exist in the nation. The certain reality is that, even in areas where specialty ambulances are available, they are generally used for nonemergency transports, thus their availability for emergency incidents cannot be guaranteed. EMS providers in these services will continue to face the challenges the rest of the industry faces.

The cable and winch rigging, coupled with special stretchers, represents engineering controls for patient loading, but getting the patient out of the structure and onto a stretcher remains a challenge. Resting with the challenge of patient movement are the risks associated with emergency service provider injury. As Ken Bouvier, National Association of Emergency Medical Technicians vice president, told Friess, “equipment does little to alleviate the challenges of removing patients from upper floors or from cluttered homes.” Creativity must still play a role in how providers move obese patients from their environments.

EMS providers must view the whole picture when dealing with the obese patient. From the time they arrive to patient contact, EMS providers should take in their surroundings and determine whether they have enough equipment and person-power to move and transport efficiently, effectively and, most important, safely. This information is essential to mapping the extrication plan.

If the hazards associated with moving and transporting the morbidly obese patient cannot be controlled through engineering, the next two options are administrative and work-practice controls: policy, procedures and guidelines. Although management cannot move the patient for you, they can and should provide the needed resources. Preplanning is essential for resource allocation. Mutual aid/lift assist agreements should be predetermined and set forth in organizational policies.

Summary

Emergency responders cannot pick and choose their patients, who come in all shapes and sizes. As lifestyles continue to change, EMS can expect the number of obese and morbidly obese patients to increase. Now is the time to plan. Innovate, initiate and implement engineering controls and safe work practices for providers to use when the everyday call is anything but everyday. Until next time…be safe!

Bibliography

• Beefed-up Bariatric Unit at: www.defrance.org/artman/publish/article_943.shtml. Accessed September 3, 2004.
• CDC website: www.cdc.gov/nccdphp/dnpa/obesity/. September 3, 2004.
• Friess S. Technology to the rescue. USA Today, March 22, 2004.
• Lifting & Moving Done Right, VFIS, 1999.