When lifting and moving an obese patient, make sure to have more than enough assistance. There is no reason to rush a move and cause a medical provider a career-ending back injury. This includes when loading patients into ambulances. While many stretchers now have automatic wheel lifts, bariatric stretchers do not. Two separate systems have been designed to help load obese patients into the ambulance. Both systems require stretchers to be in their lowest position, which means either moving the stretcher in the lowest position with the patient on it, or lowering the stretcher before loading the patient.
Ramp systems utilize a cable and winch to pull the stretcher up secured ramps and into the ambulance. Another available system is the hydraulic lift, which can lift the stretcher to the level of the ambulance floor to allow it to be slid directly in. While both of these systems can lift as much as 1,300 pounds into an ambulance, it is important to remember that this includes the weight of the stretcher, the patient and any equipment attached to the patient.
Obesity is a serious disease that poses many problems for EMS. Morbidly obese patients do not fit on standard EMS equipment and the need for the safe transport of obese patients is rising. In addition to posing many logistical dilemmas, obese patients are prone to many serious medical conditions that are likely to increase their exposure to EMS systems. Prepare yourself and your program for the management and transport of obese patients by designing a safe patient transport model and policy with protocols geared toward the obese patient.
1. Flegal K, et al. Prevalence and trends in obesity among U.S. adults, 1999–2008, JAMA 303(3):235–241, 2010.
2. Centers for Disease Control and Prevention. Adult Obesity. www.cdc.gov/obesity/data/adult.html.
3. O’Donnell CP, Holguin F, Dixon AE. Pulmonary physiology and pathophysiology in obesity. Journal of Applied Physiology 108(1):197–198, 2010.
4. U.S. National Library of Medicine. Pickwickian Syndrome. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001149/.
5. Bunemof J, et al. Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1mg/kg intravenous succinylcholine. Anesthesiology 87(4):979–982, 1997.
6. Dargin J, Medzon R. Emergency department management of the airway in obese adults. Annals of Emergency Medicine 56(2):95–104.
7. Poirier P, et al. AHA summary statement, obesity and cardiovascular disease. Arteriosclerosis, Thrombosis and Vascular Biology 26:968–976, 2006.
8. Dudina A, et al. Relationships between body mass index, cardiovascular mortality, and risk factors: A report from the SCORE investigators. European Journal of Preventive Cardiology 18(5):731–742, 2011.
9. Lea JP, et al. Obesity, end-stage renal disease and survival in an elderly cohort with cardiovascular disease. Obesity 17 12:2216–2222, 2009.
10. Boyd R, Leigh B, Stuart P. Capillary versus venous bedside blood glucose estimations. Emergency Medicine Journal 22:177–179, 2005.
11. Shearer A, et al. Comparison of glucose point-of-care values with laboratory values in critically ill patients. American Journal of Critical Care 18 (3):244–230, 2009.
Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the performance improvement coordinator for Vitalink/Airlink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at firstname.lastname@example.org.
Sean M. Kivlehan, MD, MPH, NREMT-P, is an emergency medicine resident at the University of California San Francisco and a former New York City paramedic for 10 years. Contact him at email@example.com.
Scott R. Snyder, BS, NREMT-P, is the EMT program director for the San Francisco Paramedic Association in San Francisco, CA. Scott has worked on numerous publications as an editor, contributing author and author, and enjoys presenting on both clinical and EMS educator topics. Contact him firstname.lastname@example.org.