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
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.
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!
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!