Growing Obese Population Challenges Illinois EMS

It’s a sign of our times – Americans are getting fatter.

The Trust for America’s Health and the Robert Wood Johnson Foundation this month released the annual State of Obesity report, which shows that 68.5 percent of Americans are overweight with nearly 35 percent considered obese.

While the report says there’s reason to believe those numbers are stabilizing, the rates remain high, particularly among middle-aged people and among blacks and Hispanics.

In Illinois, nearly 30 percent of the population is considered obese. We’re certainly not the worst – Mississippi and West Virginia claim that title – but we’re a long way from the best (Colorado has a 21.3 percent obesity rate).

Except for a slight dip in 2011, Illinois’ rate has increased steadily over the past decade.

Though obesity has the greatest impact on those who suffer from it – causing health, mobility and well-being issues – a heavier population also has a ripple effect on many service industries, including those responsible for helping such people at their most vulnerable times.

First responders, hospital personnel and ambulance transport teams routinely struggle to stabilize severely overweight patients and get them from point A to point B safely.

JEMS: Treating and Transporting Bariatric Patients
How to treat & transport morbidly obese patients (Beebe, MS, RN, NREMT-P)

JEMS: Bariatric Patients Pose Weighty Challenges
How to treat & transport morbidly obese patients (Barishansky, MPH and O’Connor, BS, EMT-P)

“Obesity is an epidemic,” said Dr. Bernard Heilicser, emergency medicine doctor at Ingalls Memorial Hospital in Harvey and the head of South Cook County Emergency Medical Services.

He cited both limited access to healthy foods in some communities and Americans’ overreliance on junk food and refined sugars. As a result, he said, “we are seeing more and more really heavy patients. To weigh 400 pounds is not that unusual any more. But even to transport someone who is 300 or 350 pounds is difficult.”

Emergency medical technicians and paramedics have a higher rate of injury than the national average for all occupations because they do so much kneeling, bending and lifting, according to the National Bureau of Labor Statistics website.

Heilicser, who’s also a volunteer firefighter in Flossmoor, leads paramedic training classes. While most patient transports are manageable, he said, if a typical two-person ambulance team cannot lift an individual on their own, they must ask for help from another department or ambulance service.

One department that gets frequent calls for lift-assist is the Orland Fire Protection District. In 2009, it purchased a $10,000 bariatric unit, which consists of a wider-than-usual cot, winch and ramp system capable of lifting up to 1,600 pounds.

Because it’s one of the few such systems in the Southland, other rescue and emergency medical operations often call for Orland’s assistance when they need to move a particularly heavy patient. As I was chatting about the unit this past week with Lt. Mark Duke, emergency services administrator for the Orland fire district a call came in requesting it.

“I can tell you we have seen an increase in demand for this equipment over the last few years,” Duke said. “And we probably get a call from other towns once a month for the unit.”

Duke said the bariatric unit was initially acquired to be proactive about injury prevention. Paramedics and EMTs are prone to back injuries – not just because they have to lift heavy patients but because that lifting often is done in a less-than-ideal manner.

“When you’re getting a person out of vehicle, you can’t always bend your knees and lift with your legs,” Duke said. “A lot of times, you’re reaching and pulling while lifting.”

Increasingly, he said, fire officials began to realize that the unit also helped preserve obese patients’ dignity. In the past, if first responders could not lift a patient, the alternative might be to lay the person on the floor and treat them there, Duke said.

A normal transport cot can hold about 700 pounds. The bariatric stretcher can hold from 850 (while raised) to 1,600 pounds (while on the ground), Duke said.

He said it has a winch and a system of tracks that enables paramedics to mechanically roll the stretcher into the truck, but they still have to get the patient from the cot onto a hospital bed.

John Daley, president of Bud’s Ambulance, which serves many south and southeast suburbs, said the heavier population not only presents logistical problems for paramedics, it requires ambulance companies to purchase more-expensive equipment.

“You need equipment that can handle heavy people,” he said. “Otherwise, the alternative is to call for backup, and then you’re tying up a second ambulance crew.”

Bud’s uses stretchers rated for up to 700 pounds and also has a stair chair, which features a track system that enables paramedics to glide a patient down stairs without lifting.

“But that requires a patient to be able to sit in a chair,” Daley said.

For very large patients, he said, EMTs might opt for using a canvas tarp, which can be handled by several first responders.

“There is no delay in care,” he said. “The only thing that might cause a delay is if a patient is so big we have to remove a door, but that hasn’t happened in years.”

Daley said his company conducts physical agility tests for EMTs and paramedics, requiring two employees to be able to lift 300 pounds together.

Before you assume that all obese patients have made bad lifestyle choices, it’s important to note that some patients are obese because of a disease, Daley said, recalling a woman they transported who had an inoperable abdominal tumor that weighed several hundred pounds.

Kurtz Ambulance Service – which serves Flossmoor, Frankfort, New Lenox and other communities – uses stair chairs to help get patients to ground level. The company also recently purchased battery-operated powerlift cots to help decrease back injuries among EMTs and paramedics, chief operating officer Heidi Hermes said. The cots are rated to hold up to 1,600 pounds.

“We also teach our employees how to lift properly, using slider devices,” Hermes said. “We’ve had 900-pound patients. Even if you are able to lift them, you still have to be able to get them from one cot to another. Hospitals and nursing homes have the same issues.”

Just this past week, Christ Medical Center in Oak Lawn had a consulting company, ArjoHuntleigh, out to talk about its injury prevention program and assess the hospital’s lift equipment needs.

“Hospitals struggle with how to move patients safely all the time,” said Tricia McVicker, Christ’s director of patient safety. “Sometimes patients are obese, sometimes they’re contracted and sometimes they’re just dead weight.”

McVicker, a former registered nurse, said there’s a big joke among nurses that it is the only profession that requires you to lift more than 100 pounds, or more, on a daily basis.

Soon, she said, the consulting group will offer its recommendations specific to each department.

“In this day and age, we are not going to see an increase in staffing to assist with lifting patients, so we have to find another way,” McVicker said. “That way is with better lift devices, better equipment and better mechanics for lifting to keep both staff and patients safe.”

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