August 22, 2002

Issue

Patient transferring and handling injuries typically represents at least 50% of health care providers Worker’s Compensation annual costs. Such tasks continue to become more difficult because of the on going health crisis of obesity. The transportation of patients weighing in excess of 500 pounds poses serious challenges to our EMS crews, from the medical management of the vast array of health problems these patients present with, to physically moving the person from one location to another. Request to move patients weighing 500 to 800 pounds or more, can overwhelm the best-prepared EMS provider.

AAA Position

The American Ambulance Association advocates the creation of policy and procedures, the use of training, continuing education, the use of the most appropriate equipment available to meet the needs of the patient and minimize the chance of injury to workers. Community involvement, pre-planning and request for lift assistance, which assures that EMS personnel are transporting these patients safely and effectively, while providing appropriate care in a respectful manner.

Medical and mechanical skills must be balanced to ensure that patient accommodations offer effective and appropriate treatment and timely extrication. Training of EMTs and Paramedics for rendering emergency care to the morbid obese patient with airway and pulmonary problems, medications and/or IV therapy problems must be provided to any personnel who may be called upon to treat and transport such patients. Training curriculums should minimally cover Obese Patients by stating that accommodations may be necessary and include, using appropriately sized diagnostic devices, maintaining professionalism and that the Paramedic may require additional assistance.

Background

Morbid Obesity is a serious disease process, in which the accumulation of excessive fatty tissue interferes with, or injures the bodily organs, causing life-threatening health problems. Weight charts consider a person morbidly obese when at least 100 pounds heavier than recommended.

Recognized since 1985 as a chronic disease, obesity is the second leading cause of preventable death, exceeded only by cigarette smoking. Obesity affects 58 million people in the U.S. and its prevalence is increasing. The potential for our crews to be called for a person weighing more than 500 pounds is real. According to the National Institutes of Health, an increase in body weight of at least 20 percent above one’s recommended weight is the point at which excess weight becomes an established health hazard.

Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on nearly every organ, and produce secondary illnesses which may be life threatening. Severely obese persons are approximately 6 times as likely to develop heart disease, and 10 times more likely to develop Diabetes and Kidney failure. The obese person’s lungs are decreased in size; the chest wall is heavy and difficult to lift, yet their demand for oxygen is greater with physical activity. This condition can be completely disabling and prevent the patient from assisting with getting themselves into an ambulance at the time of an emergency.

Conclusion

It is important for the AAA to publicly recognize the unique challenge EMS personnel have to treat and transport a morbidly obese patient.

The AAA can provide the educational focus to significantly influence the EMS personnel who are transporting these patients safely and effectively, while providing appropriate care in a respectful manner.

The AAA has identified the following as best practices to be considered when called upon to treat and transport morbidly obese patients:

  • Company Policy that addresses the concerns; identifies strategies and sets limits on how few people may attempt to move a specified weight without additional manpower or the assistance of other available heavy object moving equipment.
  • Routine training and annual continuing education of all EMS personnel should address new findings on providing emergency medical care to the morbidly obese patient in both emergency and non-emergency situations.
  • Proper equipment that meets the needs of the patient population being served in a cost sensible manner must be obtained.
    • Such types of equipment may include:
      • Heavy rated stokes baskets or scoop stretchers lined with layers of blankets to be used as cushion and additional padding to elevate the patient’s head as necessary to accommodate the patient’s condition and airway.
      • Expandable / connectable flats made from extra heavy-duty materials for the over-sized patient.
      • High or medium-pressure inflatable air bag sets or a patient handling air cushion that assists in the lateral transferring of a patient.
      • Equipment for securing stokes basket apparatus to floor of ambulance.
      • Ramps used to slide the patient with the least amount of lifting during egress from a building and/or loading into the ambulance.
  • Company Policy that insists on personnel calling for lift assistance whenever confronted with a patient that exceeds the logical lifting limits of the crew on scene.
  • Pre-planning amongst responders to assure team effort, and professional behavior. The goal of all involved must be to minimize patient discomfort and embarrassment. All involved need to be reminded to remain nonjudgmental and offer creative problem-solving suggestions for consideration.
  • A commitment of continuing to stay abreast of advancements made in the treatment and transportation of morbidly obese patients must be realized by all EMS Managers.

 

Board Action: Approved on August 22, 2002