Oversized patients a dilemma for emergency crews

As obesity continues to be a growing problem, one area county decided to get a supersized ambulance.


Published: Thursday, January 13, 2011 at 8:31 p.m.
Last Modified: Thursday, January 13, 2011 at 11:25 p.m.

About 15 years ago in northwest Gainesville, paramedics struggled to move an obese patient out of a home and into an ambulance.

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Levy County Paramedic Cpt. Clayton Drew, left, and EMT Matt Brannan demonstrate features of a bariatric patient transport system including the wench and ramps used to load patient into ambulances Wednesday, December 8, 2010.

Doug Finger/ Staff photographer

Facts

Obesity in Florida

In less than 20 years, obesity in Floridians rose from less than 10 percent to nearly 30 percent.

1989 - less than 10 percent

1994 - 10 percent to 14 percent

2003 - 15 percent to 19 percent

2008 - 20 percent to 24 percent

2009 - 25 percent to 29 percent

Source: Centers for Disease Control and Prevention

Body Mass Index

A person's BMI is a measure of body fat based on height and weight that is used as an indication about who might have weigh-related health problems

* Underweight = less than 18.5

* Normal weight = 18.5–24.9

* Overweight = 25–29.9

* Obesity = BMI of 30 or greater

To have your BMI calculated, go to www.nhlbisupport.com/bmi/

Alachua County Fire Rescue Chief Bill Northcutt was on that call and remembers how he and others labored to get the patient into the ambulance.

"We ended up removing the stretcher mounts from the floor of the ambulance, and then 11 of us slid the patient on a mattress from an open front porch onto the floor of the ambulance," Northcutt said.



At the time, moving an obese or bariatric patient was a rarity, Northcutt said. However, over the past 20 years, ambulance crews have found themselves called on to move more and more oversized patients.

According to the U.S. Centers for Disease Control and Prevention, less than 10 percent of all Floridians were obese in 1989. However, by last year, the percentage of obese residents statewide had risen to nearly 30 percent. Florida is not alone. Federal researchers found that at least 18 percent of residents in all states are now considered obese.

Obesity is defined as having a body mass index of at least 30. The index is a calculation based on a person's weight and height and gives an indication of the person's percentage of body fat and, therefore, his or her susceptibility of developing health problems such as cardiovascular disease, diabetes or some form of cancer.

Earlier this year, Levy County spent about $20,000 to specially equip an ambulance to accommodate bariatric patients. It's an expense several other counties now are considering.

Levy County Emergency Medical Services Director Trish Seibold said her crews transport bariatric patients at least once every two weeks.

"We have at least 10 patients in the county that weigh more than 400 pounds, and some of them are over 600 pounds," Seibold said. "We have been seeing back injuries (suffered by EMTs), and the average injury was costing us $15,000 in back wages and some of them were up to about $80,000."

In some instances, when a bariatric patient had to be transported, volunteer firefighters were available to assist with getting the patients into an ambulance, but that is not always the case.

"We knew there had to be a better way," Seibold said. "We want our crews and our patients to feel comfortable and safe."

Seibold said having someone who weighs several hundred pounds ride to a hospital on a regular-sized stretcher would be like an average-sized adult riding on a pediatric stretcher.

For its $20,000, Levy County got a specialty stretcher, 12-foot long ramps and a winch mounted inside the truck to pull the stretcher up the ramps.

The stretcher has a 1,600-pound capacity and is capable of accommodating patients who are more than 26 inches wide. The stretcher is never raised but is pulled or pushed by handles that are mounted on the head and foot of the stretcher.

The ramps are locked into place with both back doors wide open. The head of the stretcher then is hooked up to the winch and pulled into the ambulance.

EMS Capt. Clayton Drew said spotters stand on both sides of the stretcher as it is being pulled into the ambulance to help guide it along the ramps.

"When a unit gets on scene, if they see they need it, they will call us," Drew said.

Emergency Medical Technician Matt Brannan said mounting the ramps and using the winch are not a speedy process, but it is much safer for the patient and the ambulance crew.

"Also, the handles on the stretcher make it easier for us to maneuver a patient out of the house without having it flip over," Brannan said.

Drew said that the specially outfitted ambulance is stationed in Bronson and is often used on routine calls, too.

Northcutt said a similarly outfitted ambulance is on his wish list.

"As soon as we can come up with the funds because we are encountering large patients more frequently," Northcutt said.

The county used to rely on stretchers with a 400-pound maximum capacity but has upgraded them to 700-pound capacity stretchers in recent years.

Siebold said she knows her agency is one of only a handful statewide that has a bariatric-equipped ambulance, so she has notified other counties in the region that she is willing to share it with them as needed and as available.

"We haven't had any calls yet, but it's here if another county needs it," Seibold said.

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