As of lately our Ambulance Association has seen a increase in obese patients compared to years past. Some of these patients we take 4 or 5 times a year. We are a volunteer ambulance association. So as with everybody, finances are tight. We have looked at getting ramps and a winch system that is removable. We are looking at $4500.00+. So we are looking into grants. I throw this discussion out there for ideas, experience, suggestions, and just general discussion. Tell me how you handle your patients when they are unable to assist you at all when moving and loading them. How do you handle them when they have every problem in the book and the slightest exertion on their part may throw them into a massive MI? Waiting to hear from you all.

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Mark, I would send Brian Wiegand a message on here. When he worked my dept he came up with a ramp, cart and winch style system. We don't use it now, due to the low accurance of >500lb pts now, so I can't give you too many specifics, but Brian, I am sure, would be happy to help you.
Mark, We have also seen a HUGE increase in bariatric patients in the last few years. 400-600lbs... not uncommon. We had one of our Medic Units specially outfitted with a 1500lb weight limit Stryker cot, a winch system and ramps that are removable. I'm not sure what the total cost was but it paled in comaprison with the amount, or even prospective amount of job related injuries we were looking at, let alone that its just not safe to move these people any other way! It takes alot of time and patience, and a couple of Fire Companies to get it done right. Tarps specificaly designed to carry large amounts of weight are normally utilized to slide the patient's over to the cot. We even carry extra medications and the really long I/O needles in an effort to think ahead. Whatever happens with these patients, MI, trauma, etc.....you just can't move fast, you have to think every single move through, that's just the way it has to happen for everyone's safety. We always try our best to preserve the patient's dignity in the process, I find that they are normally horrified that they are going to hurt someone and apologizing continuously throughout the process. I encourage you to pursue the grants, its not a cheap upgrade, but a neccessary one for sure. Good luck!
Mark,
I can tell you how we did it when I was at Medix. We had a sudden increase in the mobidly obese and were forced to come up with some way to move them "safely", both for our crews and the patient. Apparently we were ahead of the curve at that time because there were no other systems out there for that particular job. Now there are. I have seen the system on Annette's truck and it is a very good system. My only complaint with their system is everybody does not know how to work the winch. I have seen the winch cable trashed at least twice now from inexperienced users. However, it is still the best I have seen. If you want to email me about the Medix alternative way I will be glad to help you with that.
Thank you for your suggestion Jasen. I see Brian must have seen the discussion or you got in contact w/him because he sent me a comment. Again thank you for your comment. Stay in touch and stay safe!

Jasen Adam said:
Mark, I would send Brian Wiegand a message on here. When he worked my dept he came up with a ramp, cart and winch style system. We don't use it now, due to the low accurance of >500lb pts now, so I can't give you too many specifics, but Brian, I am sure, would be happy to help you.
Annette, Thank you for your response to this discussion. The system that you are referring to (Stryker) is one of the ones I was talking about. I will have to go back and look again, but I believe in the demo video online, they show only two people handling the cot w/a pt. on it. (the stryker 1500# cot). Are the hydraulics that good on these cots that it seems almost effortless to use? I also have to agree w/you that its just not safe to move patients w/out the proper equipment. Its like any other job out there, you need to use the right tools and equipment to do the job safely and efficiently. I know we could save ourselves a lot of time and frustration. When you don't have the proper equipment, it doesn't make you look very professional and makes the patient very uncomfortable. Ditto on your next to last sentence! The tarps are a great idea and probably a whole lot cheaper. Thank you for comment and will use it for further discussion with our dept. You have a great weekend and stay safe. Keep in touch.

Annette Smith said:
Mark, We have also seen a HUGE increase in bariatric patients in the last few years. 400-600lbs... not uncommon. We had one of our Medic Units specially outfitted with a 1500lb weight limit Stryker cot, a winch system and ramps that are removable. I'm not sure what the total cost was but it paled in comaprison with the amount, or even prospective amount of job related injuries we were looking at, let alone that its just not safe to move these people any other way! It takes alot of time and patience, and a couple of Fire Companies to get it done right. Tarps specificaly designed to carry large amounts of weight are normally utilized to slide the patient's over to the cot. We even carry extra medications and the really long I/O needles in an effort to think ahead. Whatever happens with these patients, MI, trauma, etc.....you just can't move fast, you have to think every single move through, that's just the way it has to happen for everyone's safety. We always try our best to preserve the patient's dignity in the process, I find that they are normally horrified that they are going to hurt someone and apologizing continuously throughout the process. I encourage you to pursue the grants, its not a cheap upgrade, but a neccessary one for sure. Good luck!
Brian, Thanks for your comment and willingness to help out. I see by the demo video on the Stryker system that if the cable isn't positioned properly it could really mess things up. By the way, thank you for serving our country! Right now it probably seems like we are fighting for nothing at times. I believe if we don't put the brakes on this administration, we are no longer going to be the sovereign nation and world power that we once were! I know that I was very fortunate to serve under Reagan when I was in the Navy. Have a great weekend! I'll get back w/you if we decide to pursue the system you were talking about. Stay in touch.

Brian Wiegand said:
Mark,
I can tell you how we did it when I was at Medix. We had a sudden increase in the mobidly obese and were forced to come up with some way to move them "safely", both for our crews and the patient. Apparently we were ahead of the curve at that time because there were no other systems out there for that particular job. Now there are. I have seen the system on Annette's truck and it is a very good system. My only complaint with their system is everybody does not know how to work the winch. I have seen the winch cable trashed at least twice now from inexperienced users. However, it is still the best I have seen. If you want to email me about the Medix alternative way I will be glad to help you with that.
Mark,

Here at my full time job we have two bariatric facilities in our 911 area. We have seen patients as large as 1400 lbs. We currently do not have the ramp and winch system, although that is currently in the works. What our system did was to purchase the ferno cots through grants with the Large Body System (LBS). This cot will hold up to 1600 LBS in the lowered position. We also have invested in a Mega mover tarp rated for 1400 LBS for transfer of patients. The nice benifit to this system is we are not locked into having a baratric cot all of the time. When we do not need the LBS it is unpinned from the cot and stored in a compartment on the squad. When we do need it the mattress of the cot comes off, the LBS system unfolds and is pinned into place with six pins. This all can happen in about a minute if the people putting it together are familer with it. We also use the facilities bariatric hoyer lift. So we only need to drop the cot one click and they can transfer the patient onto the cot with the hoyer lift. We then also use the nursing staff to assist with the loading of the cot into the squad. The bad part is we also have several large patients living in apartments for that we modify the system by using the local FD and another squad. We just attempt to plan out every move ahead of time so the patient only needs to be transfer a minimal amount of time.
Michael McGinnis said:
Mark,

Here at my full time job we have two bariatric facilities in our 911 area. We have seen patients as large as 1400 lbs. We currently do not have the ramp and winch system, although that is currently in the works. What our system did was to purchase the ferno cots through grants with the Large Body System (LBS). This cot will hold up to 1600 LBS in the lowered position. We also have invested in a Mega mover tarp rated for 1400 LBS for transfer of patients. The nice benifit to this system is we are not locked into having a baratric cot all of the time. When we do not need the LBS it is unpinned from the cot and stored in a compartment on the squad. When we do need it the mattress of the cot comes off, the LBS system unfolds and is pinned into place with six pins. This all can happen in about a minute if the people putting it together are familer with it. We also use the facilities bariatric hoyer lift. So we only need to drop the cot one click and they can transfer the patient onto the cot with the hoyer lift. We then also use the nursing staff to assist with the loading of the cot into the squad. The bad part is we also have several large patients living in apartments for that we modify the system by using the local FD and another squad. We just attempt to plan out every move ahead of time so the patient only needs to be transfer a minimal amount of time.

We also purchased the LBS from ferno and found that it wasn't practical in a residential enviroment. The doorways aren't designed for its use.
In the Wake County EMS system, we are moving a patient in excess of 300 lb. at least once per day. We've started a multi-part program to improve our capability to compassionately and safely move large patients.

1. We've replaced some regular Stryker stretchers with Powerlift stretchers and deployed them around the county.

2. We've deployed the "tarp" patient movers, but they're not our favorites. They are OK for the EMS and fire personnel but not very nice for the patient.

3. We've added some medium-duty trucks with more room and carrying capacity.

4. We have a Stryker 1200# stretcher available for special-call.

5. One of our medium-duty trucks has a power-lift on the rear (see photo) so that crews don't have to lift a very heavy patient. This truck will be centrally located for special call.

6. Where we know that bariatric patients live, we've flagged the address in our CAD system. An ambulance call to that address gets, in addition to the usual response (ambulance plus fire first response engine), a ladder company, a rescue company, and an EMS supervisor. That way we have enough hands to safely move the patient, plus the tools and skills to make structural modifications that might be necessary.

Bariatric patients present another "technical rescue problem" with a twist - a "gold standard" agency will handle the patient with respect and compassion as well as with clinical excellence.

Skip
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Skip, Thanks for your reply. It sure would be nice to have the Bari-lift on our rig. But I believe our frequency of these types of calls wouldn't justify it. At least not for this type of set up. I see this as another catch all for the salt, sand,dirt, and mud around our area. The Powerlift stretchers we have ruled out, because they would cause us more headaches than good due to our territory. The other suggestions you have mentioned though are worth looking at. I believe the simplest and easiest solution would be having a Bariatric Unit flagged to this address when dispatched. The only problem w/this is there's only one in our area, and our chances of it being available are slim. The "Tarp" mover is something we can look into. I believe we have something similar to it that we call the "Big Boy". The Stryker 1200# stretcher is more along the line that we might look at. As far as man power, we usually make sure we have enough or we call for more. Thanks for taking time to post these suggestions. This will give us some food for thought! Have a great and safe week!
All great suggestions. I think we'll look at what the Ferno (LBS) system has to offer compared to the Stryker. Sounds very convenient. Thanks for the suggestion. Stay safe!!

Michael McGinnis said:
Mark,

Here at my full time job we have two bariatric facilities in our 911 area. We have seen patients as large as 1400 lbs. We currently do not have the ramp and winch system, although that is currently in the works. What our system did was to purchase the ferno cots through grants with the Large Body System (LBS). This cot will hold up to 1600 LBS in the lowered position. We also have invested in a Mega mover tarp rated for 1400 LBS for transfer of patients. The nice benifit to this system is we are not locked into having a baratric cot all of the time. When we do not need the LBS it is unpinned from the cot and stored in a compartment on the squad. When we do need it the mattress of the cot comes off, the LBS system unfolds and is pinned into place with six pins. This all can happen in about a minute if the people putting it together are familer with it. We also use the facilities bariatric hoyer lift. So we only need to drop the cot one click and they can transfer the patient onto the cot with the hoyer lift. We then also use the nursing staff to assist with the loading of the cot into the squad. The bad part is we also have several large patients living in apartments for that we modify the system by using the local FD and another squad. We just attempt to plan out every move ahead of time so the patient only needs to be transfer a minimal amount of time.
Hello!
Knowing that i come from a completely different system, i just want to tell you how we handle this case in austria. If you already know - excuse me. Our stretchers are installed with a roll - in mechanism and are adjustable in height, so its easy to first transfer the patient without exertion to the stretcher (eg with a spineboard). Then its possible to bring the stretcher on its rolling height and load it into the ambulance without having to lift it again. Price per unit of an actual ferno model (EFX - MAX)is about 8800€, certified for 230 KG (507 lbs?), but im not sure if it complies to american standards concerning certification.
We also thought about loading them with their beds and winches, but theres no possibility to keep this in law concerning crash certification rules.
In case of more there can be ordered a special car equipped with a LBS system, with a little time span advance in operation time.
Best Regards Markus
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