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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.
Blood pressure couldn't be assessed because of the patient's size. Upon questioning, the patient said his weight was approximately 770 pounds.
 
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.
 
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:
  • Hypertension
  • Osteoarthritis
  • Type 2 diabetes
  • Coronary artery disease
  • Stroke
  • Sleep apnea
  • Respiratory problems
Concerns for health care workers: Overweight patients present difficulties for health care providers in all areas. Pre-hospital workers must know the weight limits of their equipment. This includes long boards, cots and stair chairs, as well as the ambulance itself. Specially designed bariatric ambulances are now being manufactured. They include design features such as a heavy duty chassis, ramps for access and a wider interior. If the ambulance is not able to accommodate the weight of the patient and crew, an alternate mode of transportation to the hospital should be considered. Another concern of all providers is the moving of patients. Many obese patients face mobility problems. Walking, use of stairs and climbing into an ambulance may not be options. Adequate personnel must be on scene to limit the risk of injury to patients and staff. Proper body mechanics while lifting cannot be over emphasized. Specially designed air mattresses are available to assist in moving the patient.
 
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.