Transport of Morbidly Obese Patients

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Permalink Reply by Marlys Litchfield on April 5, 2009 at 8:03am

In the mid 1990's we had a family of bariatric patients that we took to the hospital on a fairly regular basis. We started out by placing the patient on the (Ferno) cot and securing the patient with long backboard straps. The cot was not raised off the pins as these patients exceeded the weight limit. We then got as many beefeaters as we could around the cot and raised it into the ambulance. Reverse procedure for out of the ambulance. Typically the patients would then be able to stand with assistance to get onto the ED beds.

As this family grew in girth it became apparent we needed to improve our process. We got a lifting tarp rated at 1000 pounds. We purchased the Minto Maxi Flat, a collapsible stretcher with a 1000 pound capacity that was used to support the patient on the floor of the ambulance during transport. The cot was no longer used at all. The Maxi Flat could have the head raised during transport, but had to be locked flat for moving the patient from the ambulance to the hospital bed, which was brought out to the loading dock and the patient moved directly onto the ED bed from the ambulance.

Then Stryker came out with the Bariatric litter. We got one, and ramps and a winch and have used that system for at least 5 years now. We have only one cot, but multiple ambulances are equipped with their own ramps and winches, so all we need to do is bring the bariatric cot to the scene.

No, the cot does not fit through regular doorways, but then many of these patients do not, either. We had to take an unresponsive, intubated 500+ pound patient out of a second floor window the other day because we would not have gotten him down the steps.

As we all know, these patients present numerous challenges and moving them requires pre planning and patience.

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Permalink Reply by Mark A. Duell on April 5, 2009 at 3:40pm

Markus, Thanks for your demonstration videos. It's greatly appreciated. How often do you guys run int obese patients? Stay safe.

Markus Gregory said:

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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Permalink Reply by Mark A. Duell on April 5, 2009 at 4:57pm

Marlys, we'll take a look at the Maxi Flat and see what it has to offer us. The suggestion of having the ER bring the bed to the rig may save some fingers also. Thanks for your suggestions. Take care!

Marlys Litchfield said:

In the mid 1990's we had a family of bariatric patients that we took to the hospital on a fairly regular basis. We started out by placing the patient on the (Ferno) cot and securing the patient with long backboard straps. The cot was not raised off the pins as these patients exceeded the weight limit. We then got as many beefeaters as we could around the cot and raised it into the ambulance. Reverse procedure for out of the ambulance. Typically the patients would then be able to stand with assistance to get onto the ED beds.

As this family grew in girth it became apparent we needed to improve our process. We got a lifting tarp rated at 1000 pounds. We purchased the Minto Maxi Flat, a collapsible stretcher with a 1000 pound capacity that was used to support the patient on the floor of the ambulance during transport. The cot was no longer used at all. The Maxi Flat could have the head raised during transport, but had to be locked flat for moving the patient from the ambulance to the hospital bed, which was brought out to the loading dock and the patient moved directly onto the ED bed from the ambulance.

Then Stryker came out with the Bariatric litter. We got one, and ramps and a winch and have used that system for at least 5 years now. We have only one cot, but multiple ambulances are equipped with their own ramps and winches, so all we need to do is bring the bariatric cot to the scene.

No, the cot does not fit through regular doorways, but then many of these patients do not, either. We had to take an unresponsive, intubated 500+ pound patient out of a second floor window the other day because we would not have gotten him down the steps.

As we all know, these patients present numerous challenges and moving them requires pre planning and patience.

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Permalink Reply by David Wardlaw on April 6, 2009 at 2:12pm

Hi all I am a member of the same service as mark. he is right we have seen a large increase in bariatric pt in our area and we need your help to safely tx these pt's. Thanks everyone for your ideas please keep them coming. Hay Mark what a great Idea to throw this out for discussion.

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Permalink Reply by Lane Doby on April 6, 2009 at 3:55pm

We use the Stryker system (with no hydraulics because we don't want to make the stretcher heaver than it already is and getting obese people down steps is already hard enough) effectively and safely with 4 people. It can be done with two people, but I wouldn't advise it. If you want more advice on the Stryker wench and ramping system, send me a private message and I'll give you my agency's office number. I'm sure my chief will be glad to give you further details about the system, as we currently have 3 of them.

Mark A. Duell said:

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!

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Permalink Reply by Michael Spuehler on May 30, 2009 at 8:34pm

Since we're dealing with emergency medicine, I have to label my input as "ancient history" since it occurred back circa 1992. I was dispatched to retrieve a morbidly obese woman from her home and transport her to the hospital. (As Paul Harvey would say, "the rest of the story": The scales they used upon arrival (at the hospital) topped out at 650 lbs, and she tipped the scales... so we'll have to label that "at least" 650 lbs.). Although I euphemistically told dispatch that she was "very" large, I guess they just couldn't get their minds around the picture I was painting. Although at that point I was an FTO, State Preceptor, and part-time Flight Paramedic, after several requests for more man power, dispatch began questioning my needs, so the dispatched a supervisor (Bill G.) first. I met him in the driveway with the much anticipated, "What the hell is going on?!". I didn't say a word... I just turned & motioned him to follow me. When Bill walked into the bedroom he looked at the patient... he turned and looked at me... then grabbed his radio and told dispatch, "Send them more help!"
Between FD, PD, neighbors, family, & the (only 2 that could be "spared" at the time) extra EMS crews, we numbered 16 (and I doubt we could have managed with less).
We used the (for want of a better term) old "changing an invalid's sheets" technique to get a huge canvas fire tarp under her. Surrounding her, all 16 of us would cadence off 12" shuffles to the patio door that led out onto a deck. Despite the wide patio door, when we got to the door, we had to go through the house, out the front, and circle around to the patio & pick up where we left off because there simply wasn't room to squeeze through. We had to dismantle part of the deck because that "doorway" & stairs were also too narrow. The one piece of luck we had was the height of the deck was magically the height of the floor in the unit. We removed the stretcher & brackets, and laid 4 stretcher pads/mattresses on the floor of the unit & slid her in. She filled the unit side to side, so I had to ride to the hospital laying on the bench beside her. I'm sure I looked silly laying there, but it worked to my advantage... I poked fun of myself "lying down on the job" and was able to eventually turn her tears of frustration & humiliation to smiles & laughter.

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Permalink Reply by Skip Kirkwood on May 31, 2009 at 9:45pm

There is a great video of a new bariatric system from somewhere outside the US on youtube.

Essentially, the stretcher is powered to the UP position, then is rolled in to a mount that extends backward from the ambulance floor. Then the wheels of the stretcher retract UP, and the patientis rolled in to the ambulance.

Custom built, for sure. It looks like in London they are going to all tail-drop lift gates on ther emergency ambulances. Prevent one workmen's compensation back injury and you've paid for the system of your choice!

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Permalink Reply by Mark A. Duell on June 1, 2009 at 3:51pm

Thanks Skip for the info. Take care and stay safe.

Skip Kirkwood said:

There is a great video of a new bariatric system from somewhere outside the US on youtube.

Essentially, the stretcher is powered to the UP position, then is rolled in to a mount that extends backward from the ambulance floor. Then the wheels of the stretcher retract UP, and the patientis rolled in to the ambulance.

Custom built, for sure. It looks like in London they are going to all tail-drop lift gates on ther emergency ambulances. Prevent one workmen's compensation back injury and you've paid for the system of your choice!

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Permalink Reply by Jeff Carrier on June 2, 2009 at 1:06pm

The problem I see with bariatric stretchers is they need to re-design the head end of the cot. At my service, we transport a good amount of obese patients. When we raise the head of the stretcher, there is a flex point at the bottom of the hydraulic arm. When we are in the truck and transporting, the point that i described actually flexes in toward the center of the cot. Has anyone else experienced this?

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Permalink Reply by max begetis on June 26, 2009 at 8:55am

I am not part of an ambulance service and operate at remote area events .i.e. down hill racing, rodeos motocross etc..I know, hear in Australia ambos look at me as a hack even though I've jumped through hoops at my own expense to do what I love and better myself. I'm just mentioning this to be honest with you all. for all of you out there who work from day to day through all the shit with no choices, I want to tell you that you are the cavalry, that come to the rescue and even though parres like me get no respect I respect you . My job in a remote setting is to keep the pt alive till the next echelon of care arrives. it could take 2hours or 2 days. in Australia only the state ambulance service can transport and that's law.as a builder I make 3 times as much money and as an engineer 8 times, so the question is why would I do this. answer I feel nothing is finer than affecting people in a positive way and the thought that one person I save may one day save me.
Again I am justifieing my self.

the question of mega pt is a growing prob world wide and in my line of work Im seeing it more and more not so much with the athletes but the spectators.
a ambulance stretcher and ambulance really struggle in mud.
I'm working on some ideas involving utilising existing equipment to be modified as multi functional specifications and also to save costs e.g. a standard stokes that can be used in its normal dimensions yet for bigger pt can be expanded to suite size. in terms of lifting, hear in aus I have never had a prob recruiting volunteers to carry and lift pt. the principals I'm working on can be modified to all stretchers and beds.
do you guys see any merit in what I'm proposing or am I just wasting my time.

in my mind bigger ambulances and bigger stretcher is a cost that can become unbearable and sacrifice on other equipment. in the case of the ambos, wages and trained crews.where dose it stop do we start using forklifts and cranes.
let me know what you think.

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