Frequent news reports have focused on the issue of overweight Americans, and beyond the daily work of lifting heavy patients, we have to deal with patients of spectacular weight.
Lifting patients who weigh between 200 and 300 pounds requires conditioning and safe practices to ensure our safety, as well as their safety. Patients who weigh 400 or 500 pounds require more than some of our gear or vehicles are prepared to handle, posing risks to emergency crews.
Considering reports that nearly 50 percent of our ambulance personnel have at one time sustained back injuries, safer practices and equipment for overweight patients are needed.
Bariatric refers to the study and treatment of obese patients. It is a specialization that includes both surgical and non-surgical procedures for weight control, as well as the study of how obesity affects our ability to care for patients. The development of bariatric equipment gives us an opportunity to provide for greater safety for our personnel and our patients.
Some departments have taken to acquiring bariatric units. These ambulances are outfitted with equipment designed for obese patients. The Anchorage Fire Department, for example, has a plan to create two bariatric response units that will have specialized gurneys, ramps and removable winches. These units can be pricey at around $250,000.
Many departments don't have the luxury of purchasing this type of unit and have to adapt their equipment where possible to provide for greater safety when handling bariatric patients. Fortunately, there are innovations that can help us.
Ambulance cots have been greatly improved over the years to be more stable with weight in the elevated position and to be able to handle heavier patients. Specialized bariatric models are available with board devices, powered lifting devices and special push and pull handles.
Up To 1,100 Pounds
Ferno, for example, produces the PROflexX. This cot can handle up to 1,100 pounds in the lower position. It can be augmented by a removable LBS bariatric board, bariatric pull cables, push and pull handles and Manta patient transfer sheets.
Stryker offers its 6083 model cot in 850 pound and 1,600 pound versions with oversized wheels, optimal patient surface and push and pull handles. Bariatric boards and sheets can also be used to assist with these cots. Be prepared to pay about twice the typical ambulance cot price for these specialized versions.
Once obese patients are loaded onto the cots, we need to get them up and into our ambulances. A variety of ramps are available, from aluminum channel ramps made by Handi Ramp to lightweight polycarbonate ramps, such as the ones provided by TranSafe. These can be deployed when needed, attaching to the ambulance floor. They can be augmented further by winches to pull cots up a ramp and into an ambulance. The ramps cost between $3,000 and $4,000, and you can get winches for around $400.
Whether you have specialized units for bariatric patients or add equipment to your existing units, a protocol for handling patients that pose risks to our personnel and themselves is required to have safe outcomes.
Bariatric protocols should cover the benchmarks that will determine the need for special procedures. They should detail the number of personnel to be used and the manner in which they move patients onto cots and from buildings to vehicles. Quality assurance and improvement programs should monitor reports to ensure that protocols are deployed appropriately and that personnel perform within the guidelines.
We are skilled at responding to situations that challenge our creativity in getting patients out of seemingly impossible situations. In order to make sure we are able to do this in the safest possible manner, we should use the best resources available and police our performance to prevent injury.
Editor's Note: Will Chapleau, who has more than 30 years of EMS experience, is the Advanced Trauma Life Support (ATLS) program manager for the American College of Surgeons. He is the former chief of the Chicago Heights (Ill.) Fire Department, has served since 1996 as the chairperson for the Prehospital Trauma Life Support (PHTLS) program of the National Association of Emergency Medical Technicians and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.