The harmful effects of excess weight on an individual’s health have been widely documented, but their extra kilograms can also have direct detrimental effects on the well-being of others. With more than one third of American adults suffering from obesity, the USA is at the vanguard of the bariatrics wave. However, it is still surprising to see the emergence of comments such as these from the Fire Department of Fairfield, Ohio:
Lifting one patient required six firefighters, two of whom were injured, one requiring knee surgery (Dayton Daily News)
The most recent statistics available from the CDC for musculoskeletal injuries occurring at work reveal that the rate for ambulance workers is over six times the national average at 238 injuries per 10,000 workers. The single greatest risk factor is manual patient handling and the heavier the patient, the greater the risk.
If bariatric individuals are immobile for whatever reason, moving them becomes a serious logistical problem for the care teams involved, requiring extra personnel for lifting and if possible special equipment.
Adapted mobility equipment
Bariatric patients often experience mobility problems and even in their own homes, mobility equipment needs to be adapted to help them move around. For the past 20 years, the Danish firm XXL-Rehab has specialized in the engineering and introduction of innovative products functionally designed to aid bariatric patients. Their XXL-Rehab Bariatric Walking Frame supports a maximum weight of 270 kg.
Similarly, heavy duty rollators such as the Drive Go-Lite Bariatric Steel Rollator are available, with a capacity of up to 226 kg.
Likewise, if the patient requires a wheelchair or a mobility scooter, current designs have a weight restriction on safe usage. Therefore, manufacturers have had to redesign models with the bariatric patient in mind. Companies such as UK’s Roma Medical now have a specialized heavy duty product line with chairs and scooters capable of safely transporting patients weighing up to 220 kg.
Adequate bariatric transport
While hospital departments might be able to invest in some of the aforementioned mobility aids to enable movement around the hospital, there still remains the difficulty of how to actually get the patient to the hospital for treatment and also, increasingly, how to provide inter-hospital transport between different hospitals.
Normal ambulances are capable of transporting patients weighing no more than 180 kg. A bedridden bariatric patient weighing around 200-240 kg will be on a specially widened and reinforced hospital bed; the combined weight will be too much for the vehicle’s suspension and be potentially very dangerous. WAS, a German manufacturer, provides specially constructed bariatric ambulances based on 10-ton trucks with a wide interior, so that the patient, bed and any other equipment can fit easily and still leave the care team with enough room to work around the patient.
Andreas Ploeger, Managing Director of WAS, explained that ambulance services have to seriously consider cost when deciding to invest in such highly specialised products. “A normal ambulance is on the road all day; a bariatric ambulance which is much more expensive may be used only once a week. The need is there but economically it remains a difficult decision for healthcare bodies”.
WAS also provides a hydraulic platform that can raise a stretcher or bed into a normal ambulance and supports up to 750 kg. Using it minimises patient lifting and thus reduces back strain on the paramedics. The platform comes with an integrated balance which is important because many bariatric patients do not know how much they weigh; domestic scales often only weigh up to 150 kg. Their accurate weight is not only important to ensure correct dosing but also, in the case of an emergency, to help find local hospitals equipped for >180 kg patients.
Often health services lease or contract bariatric vehicles. Lucy Godfrey, a paramedic based in West Sussex, explained how in London her private ambulance firm provided bariatric services for the NHS (UK’s National Health Service), with a fleet of bariatric ambulances that were used throughout the metropolitan area. “The problem in Sussex is there is only one bariatric ambulance for our area and it has to be booked in advance.”
“Without the necessary equipment, like wide stretchers or electronic carrying chairs that can go up and down stairs, it is virtually impossible to move a bariatric patient without hurting yourself or them”.
With the ever increasing rise in obesity, it seems that health services have little alternative but to invest in the necessary specialised equipment needed for bariatric transport.