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.