Equipment Woes

[JChernov1977]

To Whom It May Concern:

Writing this letter for me is two fold. I was an EMT and Paramedic student when my life was thrust in a different direction all together. On the night of March 20, 2012 I was involved in an MVA when a semi-truck driver hit me on the driver's side of my truck at 35 mph. This left me unable to work in my field as I had a compound fracture of my left leg and a pretty severe head injury.

After speaking with one of the responders and a friend of mine, I soon found that almost none of the equipment worked on me because of my size at the time. Although my life was spared by the people who responded and the care that I received it should be known that this happened. My friend told me that the C-Collars where to small even the "no-neck" size, and they tried using a towel with tape but because of the amount of blood this didn't work either. My friend also informed me that they had to have people ride in the back of the ambulance to hold traction on my leg, as well as hold C-spine manually.

Given these factors I would like to work with someone to help develop a class of equipment that will fit everyone and not just be a one size fits all. While I have been working diligently on reducing my size and making myself more fit there are those that simply don't have the drive or the ability to do the same thing, along with that even when I do lose more weight I am sure that given my natural size there will be some equipment that still won't work on me.

I am at a loss of who to write or who to let know about this so I have written this letter in hopes that it might reach the right people. I am not looking for compensation out of this I simply want to make sure that when a Paramedic responds they have the ability and equipment to handle every situation they might come across.

Remembering that I have worked in various places myself where the population was different in sizes ranging from the smallest infant to people well over 600lbs, I want to work together with a manufacture or someone in the business of developing equipment used in life saving emergencies to ensure that this doesn't happen to anyone else.

Given this letter is indirect to whomever might be able to assist in this I ask that if you find yourself wondering more about my story or would want to work on this feel free to email me at jlchernov1977@gmail.com, this is my personal email and I will respond to all who might ask.

Thank you for taking the time to read this letter and hopefully we can work together to make sure that all patients can be helped efficiently.

Sincerely,

Jacob Chernov, AZ EMT -Basic

[Chief1C]

The problem is, it is almost 100% impossible to perfectly fit any item, to any patient. Nothing is an absolute fit. Hell, different manufacturers "no neck" or "neckless" aren't even the same size. Back in the day, they had vacuum splint collars. I bet that could be used well and good, but I bet you could also accidentally kill your patient with one. The only thing I could recommend, is having a few soft collars, eg Philly Collars, the foam ones. And a few of the really soft ones, the white soft foam filled ones.

The solution won't be simple, because of neck width, so the collar will have to be longer. And many spine boards have a 500lb cut off, I've seen some bent to their limit. So I'd suggest building up with a board on like a Reeves.

Edited July 20, 2012 by 1 C

[Bieber]

I hear you man and I sympathize with you and share your concerns as a provider who frequently attends to patients who have simply surpassed the size limit we are typically equipped to deal with. We don't like to think or talk about it, but the truth is in many EMS systems across the country, there are patients who, due to their size, will suffer adverse outcomes because we simply do not have the ability to provide the same level of care to them as we do others. We've all been in the situation where we could not get an IV on an obese patient; and some of us have even been in the situation where not even our IO's are large enough to deal with it. As we as Americans increase in size, we will have to work faster to find solutions to this difficult problem.

The most effective solution would be for everyone to be more conscientious about their weight and health, and to take preventative measures to avoid obesity and to get help for it if they have already crossed that bridge. Unfortunately losing weight--especially a lot of weight--is a lengthy and arduous process and while I haven't seen any numbers, I don't imagine that the rate of obesity is slowing down anytime soon.

We in EMS can be proactive in tackling this problem by first and foremost recognizing the need for bariatric equipment and making sure that we have access to it. We can also be a force of good by implementing community health initiatives designed to identify, prevent, and treat obesity within our communities.

The sad fact is that people have and will continue to die not for lack of effort on the part of EMS agencies, but due to the simple lack of ability to deal with severely obese patients. That should frighten people. That should mobilize EMS providers and their medical directors to immediately take actions to address the problem; it should also frighten those patients, and make them realize that their obesity can not only cause them to have serious and life-threatening emergencies, but also prevent them from receiving the needed care due to equipment and provider limitations.

I commend you for taking steps to make yourself healthy, as well as for your recognition of the need to take a proactive stance in preventing future patients from experiencing the same issues as you did. I would suggest to you to approach your local EMS system and to talk to them about what their capabilities are for bariatric patients, and where their weaknesses are. From there, you can help mobilize your community to provide whatever support the service may need to ensure that they are properly equipped to handle patients of every size, no matter what their emergency is.

Take care,

-Bieber

[chappy]

First, let me say that I am replying from a point of view where I weigh in excess of 300 pounds. So, I am not picking on anyone.

As you said, it would be impossible to have a "one-size fits all" solution. So, that would leave us with the burden of carrying equipment to fit anyone from an infant to a morbidly obese adult. So, this would beg the question: how do we balance the need to provide for any contingency with the financial reality? With the space limitations of a modern ambulance?

Let's take the example to an extreme: What do you do when the morbidly obese (>500 lbs) arrests? Will a Lucas device work? Is there room for a bariatric stretcher and three or four crew members in the back of your ambulance? How will you perform CPR?

Can we reasonably expect to be prepared for every contingency on the ambulance?

[JChernov1977]

I thank all of you for taking the time to reply to this. I am not throwing out the idea for a one size fits all, or anything of that nature. However, there should be some kind of recognition by the companies that provide both the care and the supplies to those providing the care that this is a real problem. Since my accident I have lost quite a bit of weight, however being still of a larger stature and never seeing myself being a "normal size" on the BMI charts (what a joke) there is a definite need. I know when I worked on the Native American communities we did have the gear for all the patients those who were 600+ Lbs to the infants, so why not in the mainstream areas such as the big cities? Granted our ambulances in some of these areas were bigger than most in the city, but we were able to provide the needed care to all, with the proper gear. That is the question I pose to all companies.