North Carolina Responders Strain to Care for Obese Patients

Oct. 15--CHAPEL HILL -- As North Carolina waistlines expand and people get heavier, emergency medical service workers feel the strain.

EMS agencies are treating growing numbers of obese patients and answering more "lifting assistance" calls. To cope, they're having to use extra personnel, buy special equipment and reinforce training to prevent injuries.

Neither the state Department of Labor nor the Office of Emergency Medical Services tracks injuries to EMTs. The National Association of Emergency Medical Technicians doesn't either, but in 2005 it surveyed 1,356 of its members. Nearly half had suffered a back injury on the job.

"We have some morbidly obese patients, 500 pounds," said Kim Woodward, Orange County EMS operations manager. Often a two-person ambulance crew has no choice but to call for extra help, she said. In some jurisdictions, a dozen people may be sent in response to a morbidly obese person's need for emergency help. But for some older EMTs, those measures may be too late.

Marcia Adams, a 28-year veteran of Orange County EMS, has been on light duty for months. She is in physical therapy to treat lifting-related shoulder injuries accumulated over her decades on the job.

"When I first started out, you didn't have any special equipment for lifting people," said Adams, a paramedic. "We ran into quite a few patients in excess of 350 pounds. And we lifted them. We didn't have a choice."

After Adams fell at home in February, X-rays revealed old shoulder injuries that had worsened. She is eager to return to field work, but her doctors have said surgery won't help.

"I want to continue doing it," she said. "Right now, it doesn't look like my shoulders are going to allow me to do it any more."

Adams comes from an older generation of EMTs, from an era when literally pulling your weight was important -- especially for women struggling to earn the respect of male coworkers, she said.

"They send a lot more people nowadays," she said. "It's not so much of a macho game, where if you couldn't lift them you couldn't do your job."

But waiting for extra help delays getting a person to the hospital.

In Wake and Durham, where fire companies respond to medical calls as first responders, EMS agencies have taken additional steps to speed things up.

Wake County's new dispatch system "flags" addresses where EMTs have needed extra help to move someone. If a second call goes to that address, extra help is sent automatically. Durham has a similar system.

On normal medical calls, an ambulance and firetruck are sent, said Jeff Hammerstein, Wake EMS district chief. The response for a bariatric patient adds a ladder truck, an EMS supervisor and a technical rescue truck with tools and a tarp to move patients. That level of response puts 10 to 12 people on the scene, and it's not too many, he said.

Wake's dispatch system has sent out that extra help for obese patients 37 times this year, Hammerstein said.

But deploying extra personnel means those people are not available for other emergencies. While not a major concern, that has to be taken into account when allocating resources, officials said.

In Durham, emergency services treated at least 489 bariatric patients last fiscal year, though complete figures are not available, EMS director Mike Smith said. Durham EMS classifies anyone over 250 pounds as a bariatric patient.

"We've been paying attention to it for a while, because it got to be really an issue," Smith said. "I only have two people responding on the trucks."

In some cases, Smith's agency might spend as long as three hours getting bariatric patients out of houses, all while treating them. One person within the last five years weighed more than 1,000 pounds, he said.

"In that case, we had to call the fire department, two ambulances, a supervisor, [I] was on the scene, four firetrucks, a tactical rescue truck.

"We had to tie backboards together and take a window out."