How Obesity Impacts Patient Health and EMS

EMS systems need to know how to handle the increase in bariatric patients


This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) for 1 CEU. To take the CE test that accompanies this article, go to www.rapidce.com to take the test and immediately receive your CE credit. Questions? E-mail editor@EMSWorld.com.

Objectives

  • Highlight the epidemiology of obesity in the United States
  • Discuss the phsysiological changes associated with obesity
  • Explain obese patient treatment tips and strategies
  • Review safe patient transport techniques

An EMS crew was asked to transport a morbidly obese patient back to his residence.

When they arrived at his bedside in the hospital they found a 50-year-old male weighing 672 pounds lying in the bed—200 pounds heavier than what had been dispatched. Transport was delayed while the crew coordinated to have a bariatric cot brought to the hospital. During this time the crew discussed the patient with the discharge planner, who explained that she attempted to arrange for the patient to be taken to rehab to regain his strength and become compliant with his CPAP, which he needed for sleep apnea. He refused to go and was also non-compliant with his diabetes medicines. He instead wanted to go back to his residence, but she first wanted to make sure he could function safely at home. However, in order to do this he would have to ambulate first to the crew’s cot and later to his wheelchair at his residence.

Eventually the stretcher arrived, and with four people the crew assisted him to his feet and he was able to pivot to the cot. He struggled quite a bit, though, and became transiently short of breath. Despite this, he still wanted to go home. After securing him to the cot and moving him to the ambulance, he was loaded with an electronic lift that can raise the cot into the ambulance. When the crew arrived at his home he fortunately had a ramp to get up to the front door; unfortunately the cot barely fit on it. Crew members weren’t sure the wooden ramp would support the weight of the cot, but surprisingly it did. It took 25 minutes of maneuvering to get the cot positioned correctly on the porch to go into the front door. In the living room the crew assisted the patient into his wheelchair, which barely fit through any door inside the home. Despite the crew’s concerns about the man’s ability to move around his house, he insisted on staying. When the crew left they shared their concerns with one another about what would happen if he went into cardiac arrest at home. There would be no way to move him out of the house safely, nor would there be any way to effectively perform chest compressions on him.

The next morning when the crew arrived at work they discovered that less than 60 minutes after they had taken the patient home, EMS was called back to the residence for severe respiratory distress. It took two hours, and two ambulance crews and an engine crew, to move the patient via Stokes basket out of the residence. By the time he arrived in the emergency department he had expired.

Epidemiology

Obesity is a growing problem, with 32.2% of men and 35.5% of women classified as obese with a body mass index of greater than 30.0.1 Between 1985 and 2010, the prevalence of obesity rose exponentially, changing from a time when every state had less than a 15% obesity rate to the present day when no states have a prevalence under 20% (Figure 1), and this data doesn’t even reflect the worrisome trend of obesity in children. Roughly 17% of children between ages 2 and 19 are considered obese.

Obesity is determined based on an individual’s body mass index (BMI) which is derived based on their weight and height. Table 1 highlights how a BMI is used to determine obesity; essentially, the higher a BMI the more overweight or obese an individual is. A BMI under 25 is considered normal, or healthy.

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