EMS Providers Strain to Care for Obese Patients

CHAPEL HILL, N.C. — As North Carolina waistlines expand and people get heavier, EMS workers are feeling the strain.

EMS agencies are treating growing numbers of obese patients and answering more lifting assistance calls. To cope, they re having to use extra personnel, buy special equipment and reinforce training to prevent injuries.

Neither the state Department of Labor nor the Office of Emergency Medical Services tracks injuries to EMTs. The National Association of Emergency Medical Technicians doesn t either, but in 2005 it surveyed 1,356 of its members. Nearly half had suffered a back injury on the job.

We have some morbidly obese patients, 500 pounds, said Kim Woodward, Orange County EMS operations manager. Often a two-person ambulance crew has no choice but to call for extra help, she said. In some jurisdictions, a dozen people may be sent in response to a morbidly obese person s need for emergency help. But for some older EMTs, those measures may be too late.

Marcia Adams, a 28-year veteran of Orange County EMS, has been on light duty for months. She is in physical therapy to treat lifting-related shoulder injuries accumulated over her decades on the job.

When I first started out, you didn t have any special equipment for lifting people, said Adams, a paramedic. We ran into quite a few patients in excess of 350 pounds. And we lifted them. We didn t have a choice.

After Adams fell at home in February, X-rays revealed old shoulder injuries that had worsened. She is eager to return to field work, but her doctors have said surgery won t help.

I want to continue doing it, she said. Right now, it doesn t look like my shoulders are going to allow me to do it any more.

Adams comes from an older generation of EMTs, from an era when literally pulling your weight was important especially for women struggling to earn the respect of male coworkers, she said.

They send a lot more people nowadays, she said. It s not so much of a macho game, where if you couldn t lift them you couldn t do your job.

But waiting for extra help delays getting a person to the hospital.

In Wake and Durham, where fire companies respond to medical calls as first responders, EMS agencies have taken additional steps to speed things up.

Wake County s new dispatch system flags addresses where EMTs have needed extra help to move someone. If a second call goes to that address, extra help is sent automatically. Durham has a similar system.

On normal medical calls, an ambulance and firetruck are sent, said Jeff Hammerstein, Wake EMS district chief. The response for a bariatric patient adds a ladder truck, an EMS supervisor and a technical rescue truck with tools and a tarp to move patients. That level of response puts 10 to 12 people on the scene, and it s not too many, he said.

Wake s dispatch system has sent out that extra help for obese patients 37 times this year, Hammerstein said.

But deploying extra personnel means those people are not available for other emergencies. While not a major concern, that has to be taken into account when allocating resources, officials said.

In Durham, emergency services treated at least 489 bariatric patients last fiscal year, though complete figures are not available, EMS director Mike Smith said. Durham EMS classifies anyone over 250 pounds as a bariatric patient.

We ve been paying attention to it for a while, because it got to be really an issue, Smith said. I only have two people responding on the trucks.

In some cases, Smith s agency might spend as long as three hours getting bariatric patients out of houses, all while treating them. One person within the last five years weighed more than 1,000 pounds, he said.

In that case, we had to call the fire department, two ambulances, a supervisor, [I] was on the scene, four firetrucks, a tactical rescue truck.

We had to tie backboards together and take a window out.

Smith said his EMTs treat bariatric patients with the same sensitivity as they would anyone else.

Everybody has an opinion. Ours is, we have a job to do, that s why we re in this business, to treat patients no matter who they are, he said.

Special equipment

Some patients test the capabilities of ambulance equipment.

Wake EMS uses stretchers rated for 650 pounds when fully upright, Hammerstein said.

Though rare, the agency sometimes has patients heavier than that, he said. It is working to purchase ambulances designed for bariatric patients, larger trucks with ramps, a winch system and wide stretchers.

I m afraid we are going to need them more and more, he said.

Other special equipment exists to help EMTs move people, some of it rated for many hundreds of pounds. But it is costly.

In Orange County, Woodward wants to purchase stair chairs rated for 500 pounds, wheelchair-like contraptions that have long treads on the back and roll along the tops of stairs.

They cost $2,200 each, she said.

We need 12 to outfit our entire fleet, she said. We have one.

But, she points out, the cost of the equipment pales in comparison to the cost of losing an experienced staff member.

It s about a million dollars when someone goes out on a workers comp injury and they re on permanent disability, over the lifetime of that injury, she said.

And back or shoulder injuries can end careers in a job that requires hauling heavy equipment, let alone patients.

Wake EMS is noting what equipment other agencies are purchasing and how the equipment performs before Wake makes major investments, officials said.

No end in sight

The number of overweight and obese people in North Carolina is growing.

And with the number of overweight children growing as well, emergency medical services will probably face moving heavier and heavier people for generations.

These days different equipment, new ideas about patient care and a change in mentality among emergency workers have lessened some of the chances of work injuries, said Marcia Adams, the injured paramedic.

But, she added, there are still going to be injuries on this job, because of the obesity factor, some of it because of the construction factor of homes, and where people want to live now.

Since her injury, Adams has been working in the Orange EMS office, answering phones and doing other administrative tasks. But that is not what she wants to be doing.

I d love to get back to my job, she said. I ve always loved doing what I do.

samuel.spies@newsobserver.com or (919) 932-2014

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