Bariatric Transport Challenges: Part 1
The tones jolt you awake early in the morning: "Medic 18, respond to 16 Mountainside Lane for a fall victim." En route to the scene, dispatch informs you that the patient, a 500-pound man, slipped while moving from his bed to his commode. Your immediate thoughts turn to patient movement. You radio dispatch to add an engine company for additional lifting support.
The Centers for Disease Control and Prevention estimates among Americans 20–74, obesity rates increased from 15% in 1976 to 32.9% in 2004. In children 2–5, the obese population increased from 5% to 13.9%; in children 6–11, it's gone from 6.5% to 18.8%. Among the 12–19 age group, rates more than tripled—from 5.0% to 17.4%.1 You are likely aware of these numbers. You have seen the rise in call volume for obese patients with hypertension, non-insulin-dependent diabetes, coronary heart disease, CVA, gallbladder disease, osteoarthritis, respiratory problems and some cancers. That you become adept at the movement of these patients has become an industry necessity.
When responding to a call like the above, you must consider the logistics of bariatric transport. Are there enough people to effect a safe move? Do you have the transfer equipment to move the patient to your cot? What is the weight limit on your cot? Is your cot wide enough to make the patient comfortable? A safe movement that preserves the patient's dignity is our ultimate goal when equipping and planning for the emergency care of bariatric patients.
When you arrive at the side of the fall victim, you find a morbidly obese 52-year-old male who says he's unable to move from his lateral recumbent position on the floor. The patient states that he has been on the floor for several hours, but was unable to activate 9-1-1 for help until his mother found him. The patient has only minor cuts and abrasions from the fall, but requires transport for treatment at the local emergency department.
FLAT MOVES
The first order of business is to safely move the patient to a carrying device that will help you get him to your stretcher. There are several devices available to accomplish this.
The Stryker Transfer-Flat is constructed with heavy-duty vinyl and reinforced with two-inch polyester webbing, providing a maximum weight capacity of 1,600 pounds. Twelve rigid lift handles provide maximum operator comfort and ample lift and leverage points for superior versatility. The Transfer-Flat can be used alone to transport a patient or as a means to move a patient to another transfer device.
The HoverJack from HoverTech International is a result of safe-patient-movement guidelines that are becoming the norm in hospitals and outpatient facilities. It utilizes a series of inflatable cushions to lift the patient on a bed of air to the proper height for transfer to a rolling cot or movement device. No lifting is required; you simply center the patient on the device and attach the air pump. As you fill one section at a time, the patient is lifted to proper height for transfer to a cot. Providers can use the HoverJack's companion device, the HoverMatt, to move the patient laterally across to the litter once at height.
The Manta Rescue Aid/Transfer Sheet from Ferno has an 800 lb. weight capacity and multiple hand holds for additional staff to assist with a lift or move. Pockets at both ends can hold a backboard or the patient's feet and head. The Manta is useful for transferring or lifting patients between surfaces and can also be used in conjunction with restraints to "wrap" bariatric patients and hold their bulk in a more secure way.
GETTING TO THE AMBULANCE
Once you've gotten the patient to the stretcher, there are several options for the subsequent movement to the ambulance.
The Stryker MX-PRO Bariatric Transport offers a 1,600-pound weight capacity in the lowest position and maximum weight capacity of 850 pounds in all other positions. A wide patient surface and wheel base provide stability during transport. Accessories for the MX-PRO Bariatric Transport include tow package, side lift handles, rigid push/pull handles and patient security handles.
Ferno offers the Ferno LBS and LBS Jr. bariatric board system. These convenient boards mount on newer style Ferno stretchers using pins and clips. The LBS (Large Body Surface) system can be used with the POWERFlexx and the 35X PROFlexX stretchers. These stretchers have been designed to handle up to 700 lbs in raised positions and up to 1,000 lbs in their lower positions. Be aware that the chest strap may not be long enough to secure the patient; Ferno addresses this by including five extension spots on their LBS. A strap extension may be used to adequately secure the patient for transport.
Both the LBS and the MX-PRO bariatric stretcher provide increased width, which helps to increase the patient's comfort level, as well as the stability of the stretcher. The LBS Jr. includes "wings" that fold up for easier passage through narrow doorways.
Side Bar: Planning for a Bariatric Encounter
LOAD AND GO
After the patient is safely packaged on the stretcher, he must be loaded into the ambulance for transport. This complex operation should be undertaken by more than two people so make sure you've requested adequate resources. It is advisable to have, at minimum, four people to make the movement less dangerous for both the patient and rescue personnel. The stability of the litter and patient is greatest when the stretcher is at its lowest point, so work with the stretcher at this position if possible. Both Stryker and Ferno have large handrails to make it comfortable for rescuers to work in this position. Have a crew member scout the easiest route of travel out of the scene to the ambulance—you can minimize problems with good planning.
If you have a spare person on scene, perhaps an engineer from an engine company, have them assemble the equipment required to load the patient once they've arrived at the transporting vehicle. An experienced operator can have the ramps set up and the winch deployed, ready to attach to the stretcher, by the time the crew arrives. This makes the operation seamless.
The stretcher has an attachment point on a cable fastened directly to the frame. Once the stretcher is attached, loading is a two-person operation, with one rescuer operating the winch and the other guiding the patient into the ambulance. Once the patient is in the ambulance, he can be locked into the usual stretcher restraint system. The rails are then dismantled and stowed. Patients should be made as comfortable as possible, with at least a 30-degree angle on the head of the stretcher to reduce shortness of breath.
Your receiving facility will need some advance notice to prepare for your arrival. Provide this, but with attention to the patient's dignity. In several transports done by my local bariatric unit, the patient cried during the transport because of embarrassment. It is difficult for a sobbing patient to communicate wants and needs during the journey to definitive care. It is in our best interests, from both humanitarian and patient care standpoints, to do all we can to preserve patient dignity and modesty. Moves like this are complicated, but at no time should they ever become a show.
Once you arrive at definitive care, complete the earlier steps in reverse. The ramps attach to the rear of the ambulance, and the stretcher is lowered using one rescuer to control the winch and one to guide the stretcher. Adequate help should be available at the facility to transfer the patient to the facility's stretcher or bed.
Moving a bariatric patient involves special techniques and equipment available in most jurisdictions. You should know from where to request equipment and how to utilize what is available to your department prior to the need arising. An ounce of prevention is truly worth a pound of crisis management on a scene. Knowing what to do can be the difference between a good patient/public encounter and a poor showing.
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Next month: Difficult transport scenarios.
Christopher B. Haber, EMT-P, is owner of MEDPRO EMS Education, an EMS training and education center headquartered in Langhorne, PA. He has over 16 years of experience in a variety of EMS systems. Contact him at chaber@medproems.com.
Reference
- Obesity and Overweight: Introduction. www.cdc.gov/nccdphp/dnpa/obesity/index.htm.
