Pa. EMS Agencies Adapt for Heavier Population

May 28--As people get heavier, the strain on the backs of those who must lift them into ambulances and on the budgets of paramedic services grows with the waistlines.

"There's a lot of big people out there," said Bill Pasquale, director of operations for Medic Rescue in Beaver County. The ambulance service bought one specialty stretcher, a bariatric stretcher capable of carrying up to 1,600 pounds, a few years ago and purchased a second one this year.

"The problem is out there, but I don't know how you're going to slow it down," Pasquale said. "Some of these people, they just don't have the ability to change their position or change their lifestyle or their weight issues. I would have to say, given the current state of society, it's probably going to get busier."

Doctors consider more than a third of American adults to be obese, according to a report by the Centers for Disease Control and Prevention. That number is growing. In Pennsylvania, 28.6 percent of the population was obese in 2010, up from between 20 and 24 percent in 2000, according to CDC statistics.

Getting extremely large people to a hospital and treating them often requires expensive, specialized equipment.

Rick Wadas, chief of emergency medicine at UPMC Shadyside, said he has used ultrasound machines to locate veins in severely obese people, and the hospital in September bought a wide MRI machine to accommodate large patients. He said that during the past six years, substantially more obese patients arrive at the emergency room.

"I'll bet it's five a week that are well over 400 pounds," Wadas said. "I don't know ultimately what we do to change that trend, but I think it's unfortunately going to continue to grow. We really have not got a handle on managing the obesity problem in this county."

Increased patient weight prompted Pittsburgh EMS to retrofit two ambulances with bariatric stretchers capable of holding 700 pounds each. Each has a mechanical winch system that pulls the stretchers along a ramp into the ambulance.

The unit responded to about 40 calls in 2010 and 65 last year, said Anthony Weinmann, president of the paramedics union.

"Those numbers are increasing," Weinmann said. "Our regular stretchers just can't do it."

'We've cut a house apart'

Paramedics at the Rescue 2 station, Downtown, get creative when responding to the calls because the stretchers don't fit in many homes.

"We've cut a house apart to get a guy out," said paramedic Ed Carlino. "He was trapped in a bathroom. You had to really know building construction."

District Chief Ron Curry estimated it cost about $280,000 to set up a bariatric truck. He said the biggest challenge is getting the patient to the ambulance through narrow hallways and doors and down steps.

"Whatever has to be done, we do," Curry said.

Baldwin EMS paramedics once cut out a wall around a second-floor window because the stairs would have collapsed under the weight of the patient, Chief William Plunkett said.

"The family put in a sliding glass door in case we have to come back," Plunkett said. "It can become a very involved operation depending on the severity, where they are and their condition."

Baldwin bought a bariatric stretcher with a transport system about five years ago and for a while used it about once every four months, Plunkett said. Now paramedics use it every other week.

"Our reason was not only to take care of the patient, but also for the safety of our crew members," he said.

'Just a lot of manpower'

Most work-related injuries among Ross/West View EMS paramedics occur while they're moving patients to ambulances, said Greg Porter, assistant director. The ambulance service has a durable tarp with handles called the Man-S.A.C., which six to eight people can grab to lift a patient. Paramedics have access to a bariatric stretcher from UPMC Passavant in McCandless, Porter said.

Director Bryan Kircher estimated the frequency with which they've used the stretcher has increased by a couple of hundred times. They use the Man-S.A.C. about four times a year, he said.

"It's just a lot of manpower," Kircher said. "The more the merrier you get into lifting them."

Murrysville Medic 1 bought a bariatric truck with a stretcher that can carry up to 1,200 pounds about three years ago, said Darrick Gerano, administrative director. Since then, he said, the service has handled more bariatric patients, but that could be because of the more comfortable transport option.

"In the past, you hear those stories, 'We had to put a patient in the back of a pickup truck,'" Gerano said. "Someone goes through that experience once, they're going to think twice before the next time they call for help. Now that there is a humane way, I think more are more likely to go out."

Chief William Hess of Mon Valley EMS in Monessen said he relies on neighboring communities for use of a bariatric stretcher or makes do by using a rescue basket.

"To convert a truck to bariatric or just to buy the equipment is very expensive, and there's no recouping any of the cost of any of this stuff," Hess said.

Economy Ambulance in Beaver County bought three stretchers capable of holding 700 pounds with a battery-powered lift at a cost of about $12,000 each in the past three years. If the money becomes available, president Randy Dawson said he would like to buy a fourth stretcher so each ambulance has one.

"Years ago, we had patients that were so large, we ended up putting them on a mattress in the back of the truck," Dawson said. "Large patients have always been there. It's just how we're dealing with it today that's changed."

Bariatric gurneys, ramps, mechanical winch systems improve transport of obese

Overweight or obese?

Medical experts use Body Mass Index to classify people as underweight, healthy, overweight, obese or morbidly obese. The index estimates how much a person should weigh based on height. Here's how to calculate it:

--Multiply your weight in pounds by 703.

--Divide that answer by your height in inches.

--Divide that answer by your height in inches again.

For example, a woman who weighs 270 pounds and is 68 inches tall has a BMI of 41.0.

BMI: CATEGORY

Below 18.5: Underweight

18.5-24.9: Healthy

25.0- 29.9: Overweight

30.0-39.9: Obese

40-plus: Morbidly obese

Source: National Library of Medicine

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