Handling Bariatric (Morbidly Obese) Patients

[Richard B the EMT]

Recently, the New York City Council was asking about specialty ambulances for the bariatric patients, basically, a larger ambulance with bariatric streacher, ramp, and possibly an onboard winch to assist in loading/unloading. They felt that there should be at least 2 in each borough (New York City consists of 5 boroughs or counties, for our 8 million residents and 2 million daily transients).

A high level FDNY EMS person stated that there's no need, if we had a large patient, we'd transport in a fire Rescue vehicle. We have one rescue in each borough.

When attempting to move bariatric patients, primarily from skilled care or nursing homes, what I've seen is, we use the crews of 2 ambulances (4 persons), and an Engine crew (5 persons including the apparatus officer) with an EMS supervisor (one, usually). One ambulance puts it's streacher into the second, everyone grabs as best they can on the patient's mattress, and move the patient on the mattress to the floor of the transporting ambulance, then with a "notification" to the receiving ED to have a bariatric bed standing by, we transfer the patient, mattress and all, to the bariatric bed in the ambulance loading dock at the ED.

Transport by Rescue? The units used by the FDNY have an isle down the middle of the back that is only a little bit wider than most conventional "lift-in" or "roll-in" streachers, and the doors are nowhere near as wide as our type one ambulances, big as those vehicles usually are; we'd be all over each other trying to get the patient/mattress "package" into or out of the truck, and the mattress wouldn't be able to fit the isle.

I am aware that several non 9-1-1 ambulance services in New York City have the specialized equipment for bariatric patients, but, as I just said, they are not a part of NYC 9-1-1.

Aside from the obvious of the patient having to wait for either a bariatric ambulance, or an FDNY Rescue, I'm sure that you can come up with other disadvantages.

Now the questions: How do you handle the morbidly obese patients in your area's jurisdiction, and under your local protocols? What would you do differently if you felt you could or should change the rules/vehicles currently in use?

[strippel]

We have a bariatric truck. Obviously, it is not regularly staffed, but during the day we can get it on scene relatively rapidly. Nights and weekends slightly longer due to less staffing.

We use it pretty often, and it has assisted other agencies. It is accessable to any who need it (except our "competitors", whose supervisors won't allow it to be called). There are only 2 others in our region (6 county EMS district).

We will usually wait for it to arrive, as most bariatric patients are in ECFs. In a life threatening situation, the time factor would be considered.

We have a Ford F450 Type I. It has a ramp and winch, with a wide Ferno PowerFlex, which is rated more than 700lbs. There are also extra staps, and a wicked cloth-type slider. (Feels like it's made out of Teflon). We modeled the truck and equipment after Southwest Ambulance.

There is a replacement in the works. I don't know any details, there will be a lift mechanism which will lift the entire litter.

[rat115]

We're a rural area. We don't have access to a bariatric unit. It would be nice, but not likely. We just ask dispatch to page for a lift assist and we get other EMTs or some of the FD guys over to help us move the patient.

[Dustdevil]

We need a thread on handling bariatric partners.

[JPINFV]

One of our 3 24 hour cars (all 3 of the 24's are in type 3's) is equipted with a Ferno Large Body Surface (LBS) board that can be added to the gurney. Unfortunately we don't have the LBS mattress to go with it, so I imagine that the patient won't be very comfortable. We don't have any ramps or anything, but we do send lift assits if needed and will automatically send several crews for patients with scheduled calls (dialysis, wound care, etc). The 24's are also upgrading soon to power cots making it easier for the crew(s).

[johnrsemtp]

We have a Stryker Bariatric cot; nice cot can be used in any ambulance, but better in the box trucks. It is 26" wide can hold 850lbs in any position and up to 1600lbs in the lowest position. (which of course is lower than any hospital bed, so that will be a fun transport). The truck that it is normally in goes out on the street every day and night. the cot will lock on the normal Stryker catch, and the left front wheel goes into the left 'V' and the right wheel is on the out side of the 'V'. but locks in securely.

we used to have a custom built cot in a large box truck that was good to 2000lbs (its record was 1380lbs; which I was on that run and it sucked, even with 4 fire crews).

[AZCEP]

We need a thread on handling bariatric partners.

No trips to McDonald's, and as little "handling" as possible.

But on topic, I'm curious how the Stryker bariatric gurney can be considered secured if both guide wheels aren't in the catch. I've not seen the design, but that doesn't sound like a good idea.

Bariatric equipment is a myth in west AZ. No one has it, and no one wants to consider getting it. Sorry guys, Southwest doesn't count. They are in metro Phoenix, and most don't consider them a leader in anything.

[Richard B the EMT]

4 questions:

1) Dustdevil: Is this not a string on handling bariatric patients? (Yes, I saw the smiley face)

2) JPINFP: A 24 hour car? Is this simply a full time unit, not one runs, say, day and evening tours, but not overnight, or something similar?

3) Strippel: Is an ECF an "Extended Care Facility"?

4) Everyone who writes additions to the strings: Could you please remember that the initials you use commonly to state a condition, situation or location might not be used outside your jurisdiction? Remember that to some, "WNL" might not mean "within normal limits" re a blood pressure, to them it means "we never looked"!

[JPINFV]

2) JPINFP: A 24 hour car? Is this simply a full time unit, not one runs, say, day and evening tours, but not overnight, or something similar?

It's a unit that's on for 24 hour long shifts. My company schedules most shifts in 12 hour blocks, but we do have 3 24 hour shifts each day. The unit with the LBS boards is given calls like a normal 24 hour car but in the rare cases when the extra surface area is needed then this unit is dispatched.

[johnrsemtp]

Be careful with the LBS boards; A service here in Indiana was using those and the instructions stated that they are good for up to 1,000lbs: but they go on top of a cot that at the best is only good for 650-700lbs. they dropped a 900lb patient when the cot broke under the weight.