It’s no secret that obesity is on the rise nationwide. This trend is problematic for many reasons, and it affects the fire and EMS community in a specific way: Obese patients are challenging and in some cases dangerous to move and transport. Even putting aside the difficulties in getting the patient to the ambulance, once there, providers face the issue of how to lift the patient into the vehicle.
As a result, some manufacturers offer bariatric options that make lifting and transporting obese patients safer and easier. Recently, Orange County (Fla.) Fire Rescue (OCFR) placed one of those vehicles into service.
After having past experiences with transporting obese patients, the OCFR conducted a study. It found that 30% of patients who called 9-1-1 in Orange County were obese. Of that 30%, a few dozen weighed more than 500 lbs.
According to John Mulhall, the department’s public information officer, OCFR was sending upward of seven or eight firefighters to help first responders lift the obese patient into a waiting rescue unit. After arriving at a local hospital, the providers would use hospital staff to help unload.
“The biggest problem we were trying to solve was reducing injuries to our personnel,” Mulhall says. “By staying with the old way of providing service, our people were at risk for back and knee injuries. This is something we thought that we could prevent. Not only were we worried about our people getting hurt, but we also wanted to be able to treat and transport our patients with dignity.”
About two years ago, the OCFR’s research and development committee, along with the chief of fleet services, began to study the problem and potential options. “A type of pull-out ramp was the first option, but we later scrapped that for the lift gate that was eventually used,” Mulhall says. “To save some money, we took a reserve ambulance and had Wheeled Coach, who currently builds our rescue units, modify the vehicle with the rear lift gate—an off-the-shelf unit that can lift up to 1,300 lbs.”
The new ambulance, called Bariatric 1, is a “special-called unit.” “It will only be used where a patient exceeds the weight restrictions of our current stretchers,” Mulhall says. “The way our response works is that the local rescue unit will respond. If it is decided that Bariatric 1 is needed, a special call through our dispatch center is made. Bariatric 1 is housed at Station 73, which is located in the south central area of the county near major highways. The unit will respond with a trained operator from Engine 73. To keep continuity of patient care, the paramedic who initially worked on the patient will get in the back with the patient and ride with Bariatric 1 to the hospital.” In addition, all providers at Station 73 and Battalion 4 are trained in the unit’s operation.
The ambulance is equipped with a power Mac-Lift that can lift up to 1,300 lbs. The stretcher in this unit is a Ferno 93X bariatric stretcher that, in the lower position, can hold up to 1,100 pounds. The vehicle also carries a Hoverjack Patient Mover, which allows the crews to use an airbag device to move the patient to the stretcher. The stretcher itself has extenders that make it 10 inches wider than standard stretchers.
“The new unit went into service March 2013 and we have been evaluating it as we use it,” Mulhall says. “I think in the long run it will be a great asset to the department. Time will tell whether we put additional similar units in service.”
The OCFR faced a regional and national problem thought outside the box for a fix—something for which they should be commended. By doing so, they made patient care and dignity a priority while also focusing on injury prevention for their personnel. That, in turn, will reduce costs and ensure providers can work longer in the field.
If transporting obese patients is a challenge for your agency, it’s worth investigating whether the OCFR’s approach would work for you. And if your providers face other patient care issues, brainstorm together to come up with potential solutions. Like the OCFR, you might discover something that not only solves the immediate problem, but also reduces costs. It’s better to be proactive than to just sit back and let the status quo prevail.