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Air Ambulances Address Issue of Obese Patients

SEATTLE -- Bigger backboards, sturdier gurneys, ambulances with a wider entrance - the growing girth of the American public translates to a bigger patient for medical service providers.

Now, Airlift Northwest is the latest such agency to announce new policies to deal with obese patients.

"There's been a real increase in the size and girth of some of the patients we've been asked to transport," said Mardie Rhodes, a spokeswoman for the nonprofit air ambulance service.

Beginning Friday, Airlift Northwest began asking hospitals to fill out a special form when requesting transport for anyone weighing more than 250 pounds. The form asks for more information in such cases, including the measurements of the patient's abdomen when lying down.

For calls out in the field, Airlift Northwest dispatchers are now asking paramedics at emergency situations to estimate the same information.

Jeff Richey, a regional manager for Airlift Northwest, said the information is critical for two reasons.

First, the flight crews, consisting of a pilot and two nurses, need to know if they will physically be able to move the patient safely or if they're going to need help.

"None us want to injure our back lifting these patients," Richey said.

Second, crews need to know whether patients will be able to fit into the helicopters.

If a crew arrives and finds out only then that a patient can't fit into the helicopter, or will take up too much room once inside, waiting for another mode of transportation only delays the move, Richey said.

The new policy, he said, is meant to avoid such surprises.

At least once in the past year, a Northwest crew arrived to find the patient was too big to fly out. They ended up loading the patient onto an ambulance and having the flight nurses accompany them, he said.

"In our business, we're called to move the patients quickly," Richey said. "We're delaying the transport if we can't take them physically in the aircraft."

The federal Centers for Disease Control and Prevention reported in November that between 2005 and 2006, a third of all American adults, roughly 72 million people, were considered obese. And obesity rates in general among U.S. citizens have generally been on the increase for the past 25 years.

Given that length of the time the trend has been growing, some agencies have already taken measures to transport bigger, heavier patients.

In 2003, American Medical Response put a bigger ambulance in the field around the Portland area with heavy-duty equipment strictly to move obese patients, spokeswoman Lucie Drum said.

"Certainly it's an issue that AMR has had to deal with," she said.

Dubbed a bariatric unit, the beefed-up ambulance has a larger patient compartment, carries a gurney capable of supporting 1,000 pounds and sports a ramp for patient loading.

There are now two operating in Portland, the company is considering getting a third, and it already has two of these bariatric units in Seattle and another in Tacoma, Drum said.

The Seattle Fire Department also has taken measures to accommodate large or obese patients, Lt. Sue Stangl said.

Crews now carry a device called a Mega Mover, a tough, fabric sheet with a dozen handles that can support 1,500 pounds.

Stangl said it can be used to reach patients in confined spaces and to get a better lifting position.

Seattle firefighters now also have use of wider backboards, 32 inches wide, to augment the standard, 18-inch-wide boards they have traditionally used.

But the problem of big patients is particularly acute for air transport, say those in the field.

"Weight is crucial when you're talking about transporting by air," said Blair Beggan, spokeswoman for the Association of Air Medical Services.

Pilots have to balance the weight of the aircraft, the equipment, the fuel and the patient when judging how much weight they can carry, she said.

Sometimes, Richey said, if a crew arrives and finds a patient is larger than expected, a pilot will fly to burn off fuel in order to safely transport the patient.

But the increase in average patient size has been climbing along with the size of the average American, he said, and the new policy should surprise no one.

"It was a trend that everyone could see," he said.

P-I reporter Hector Castrom can be reached at 206-448-8334 or hectorcastro@seattlepi.com

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