Dealing with Obese Patients
EMS personnel responded to a male patient complaining of difficulty breathing. On arrival, they were directed to a bedroom where they found the patient lying on the bed with several pillows under his head and upper torso. Initial assessment showed:
- Pulse of 130, regular
- Respirations 26; shallow, non-labored
- Oxygen saturation 97% room air.
Health care personnel are increasingly called upon to deal with overweight people. An entire branch of medicine, bariatric medicine, is dedicated to dealing with the causes, prevention and treatment of obesity. Obesity affects patients as well as health care providers.
Definition: Traditional height-weight charts are being used less frequently than a newer formula called body mass index (BMI). BMI measures body fat. BMI is calculated by taking a person's weight in kilograms and dividing by height in meters squared.
A BMI calculator can be found at www.cdc.gov/nccdphp/dnpa/ obesity/defining.htm
Prevalence: The Centers for Disease Control (CDC) began monitoring the prevalence of obesity in 1985 by using a Behavioral Risk Factor Surveillance System (BRFSS). It involves monthly telephone interviews conducted by state health departments. Of states participating in 1990, 10 states had a prevalence of obesity less than 10% and no state had a prevalence of obesity greater than 15%. By 2007 only one state (Colorado) had a prevalence of obesity less than 20%; 30 states had a prevalence of obesity greater than or equal to 25%, and three states (Alabama, Mississippi and Tennessee) had a prevalence of obesity greater than or equal to 30%. In 2007, the prevalence of obesity in Wisconsin was 24.7%.
Causes of obesity: A person's body weight is the result of several factors — genetics, behavior, environment, culture and socioeconomic status. In addition, some disease states or medications may be factors in obesity. The most controllable factors in weight gain are behavior and environment. Being overweight or obese is the result of an energy imbalance. If a person consumes more calories than he or she expends, weight gain will occur.
Health issues: Obesity can lead to other medical problems. These include:
- Type 2 diabetes
- Coronary artery disease
- Sleep apnea
- Respiratory problems
Case conclusion: On scene time to arrival at the hospital was 1.5 hours as EMS and fire personnel brainstormed several ideas for transporting the patient. The 911 center was asked to find a bariatric ambulance. One was not available. The local bus service was contacted and provided a full-size bus. However, it was determined the door was not wide enough for the patient. The bus company was able to locate a paratransit bus with a hydraulic lift. The receiving hospital was alerted early so a properly sized bed could be obtained. The patient was able to walk only into the living room and then out the front door. He was then lowered onto a tarp and dragged to the paratransit bus. Vitals were reassessed en route with no significant changes.
Dealing with overweight patients can tax the problem-solving abilities of health care providers. Knowing one's resources and planning ahead can alleviate some of the obstacles involved.