Preventing EMS Injury Associated with Bariatric Transport

The increasing rate of obesity (34% of adults in 2004) poses a challenge for emergency medical personnel. Emergency medical services may need to provide transfer and care for patients weighing more than 500 pounds. Mobilizing the appropriate equipment and personnel through dispatch, utilizing special techniques and protocols and maintaining patient dignity are necessary to provide safe, quality prehospital service to individuals in our communities.
 
Personnel
 
Planning is essential. Many times there is only one bariatric transferring device, stretcher or ambulance in a region. It is important to know who has the equipment and how long it will take to have it delivered. To respond to the needs of injured or ill obese patients and prevent injury to EMS personnel, an adequate number of EMS and fire rescue staff must be available to extricate and/or move patients. Involve the patient. They may be able to provide suggestions for transfer. If possible, let the patient assist with transfer.
 
Appropriate Type and Size of Equipment and Weight Limits
 
Use the correct size blood pressure cuffs, cervical collars, intravenous catheters and back boards. Be aware of equipment weight limits. Many stretchers have higher weight limits in the lowest position.
 
EMS transport deviceTransferring and Transporting Devices
 
A variety of transferring devices are now available to move the patient from the floor, bed or cot to the transport stretcher.
  • The HoverTech HoverJack is an air patient lift for moving the patient from the floor to a bed or stretcher through a series of inflatable cushions. The device lifts the patient to the proper height.
  • The HoverMatt by HoverTech is an air patient lateral transfer and positioning device. It has no weight restrictions and has handles sewn on the mattress and around the perimeter for easier transfer.
  • The Fresno Manta Rescue Aid/ Transfer Sheet can be used to transfer patients up to 800 pounds. It is compact, fire retardant and lightweight with holes at each end to allow water to drain and pockets at both ends to hold the patients head, feet and backboard.
  • The Stryker Transfer-Flat and Graham Mega Mover Plus Handling & Transport are compact transfer devices for moving patients to stretchers or other transfer devices. They have maximum weight limits of 1600 and 1500 pounds respectively.
Large Body Surface Boards and Bariatric Wheelchairs and Stretchers
 
Bariatric stretchers provide wider frames and mattresses, oversized wheels, winch attachments, and push-pull handles for safer transport. Heavy-duty bariatric wheelchairs provide an option for transporting obese patients.
  • The Ferno LBS and LBS Jr. Bariatric Boards mount on Ferno stretchers which hold 700 pounds in the raised position to 1000 pounds in the lowest positions and include 5 extension spots to secure the patient.
  • The Stryker MX-Pro Bariatric Transport holds 850 pounds raised and 1600 pounds in its lowest position. It includes a towing package and rigid handles.
  • If the patient is in a bariatric wheelchair, metro systems with wheel chair lifts can be relatively quickly mobilized to aid in transport.
Bariatric Ambulances
 
Bariatric ambulances and care units are designed with the obese patient’s needs and EMS personnel safety in mind.
  • The ambulances generally have a wider wheel base, heavy-duty suspension and air shocks.
  • Winch systems and motorized pulleys assist with loading and unloading.
  • Specialized ramps that attach to the rear of the ambulances provide a safe method for loading patients. Some ambulances are being fitted with hydraulic lifts. As an alternative for patients who can be placed in a bariatric wheelchair, metro handicapped buses can be used.
  • The specialized ambulances provide extra width for improved workspace around patients.
Remember, morbid obesity is a disease. Genetics, physiology, sociocultural, environmental and individual behavior contribute to obesity. Advanced planning to mobilize the appropriate equipment and personnel and education on patient movement strategies are essential for treating and transporting morbidly obese patients effectively, safely and with dignity. Around the country, bariatric special response teams are being formed to provide care and transport for morbidly obese individuals.