FL Rescue Workers Adjust For Obesity

Interesting story from Tampa Bay Online:

Todd Stepp remembers an unusual call for help his family-owned towing company received more than a decade ago.

An 1,150-pound Tampa woman needed to get to a hospital, but there was no ambulance that could accommodate her.

"She was having cardiac arrest," recalled Stepp, 40, of Stepp's Towing Service.

The Tampa firefighters who responded called Stepp, and a crew removed the exterior wall of the woman's bedroom in her first-floor apartment.

Several men, including paramedics, emergency medical technicians and tow-truck staff, rolled the woman onto four stretchers they had fashioned together using heavy-duty straps.

A tow truck with a boom attached maneuvered and parked sideways as close as it could get to the woman, who was either in her late 30s or early 40s, as far as Stepp can recall.

Then the boom was moved above her and, with the help of cabled winches, she was lifted up and carried outside. Her mattress was moved to the waiting flat-bed truck and she was gently placed on it and strapped down. Paramedics joined her and police escorts surrounded the truck for the 10 mph ride to St. Joseph's Hospital, where she died later that day.

Another method needed

There's nothing dignified about being hoisted onto a flatbed truck because you're too large fit in an ambulance.

But that was the method resorted to for many years in emergency situations. With obesity on the rise in this country, however, ambulance companies, both public and private, are catering to the needs of the morbidly obese - or bariatric patients, as they are called in the industry.

Obesity affects more than one-third of American adults, or about 72 million people, according to The Obesity Society. In Florida, 24 percent of the adult population is obese, according to 2008 statistics. More than 60 percent of the U.S. population is considered overweight.

The obesity problem continues to grow and is considered an epidemic. In 1995, the Centers for Disease Control and Prevention reported that no more than 20 percent of the population in each of the 50 states was considered obese. In 2008, only one state - Colorado - could make that claim.

In recent years, fire rescue departments and private medical transport companies have been addressing the needs of these patients.

Some are purchasing larger ambulances while others have been acquiring larger-capacity stretchers.

About five years ago, American Medical Response's west Florida division started turning its attention to bariatric patients. Of their 43 ambulances serving Hillsborough, Pasco, Hardee and Highland counties, four are larger bariatric units, said Tom Diaz, general manager for that division.

"We were looking for a safer and more dignified way of transporting bariatric patients," he said.

The bariatric units are outfitted with specialized equipment, such as larger blood-pressure cuffs, larger stretchers and winches to maneuver patients.

"It was a really tough challenge moving larger patients, and we all have horror stories about it when time is of the essence," Diaz said. "That's what drove us in this direction."

For several years, American Medical Response ambulances were called on from several Tampa Bay area counties when bariatric patients were in trouble. They still receive some calls but they come less frequently now that public ambulance services are getting their own equipment.

In 2008, American Medical Response sent out bariatric units about 1,300 times. This year, the number has decreased, said Diaz, but they have been used more than 1,000 times. Many of those calls, however, aren't emergency situations.

"These patients have more medical concerns, so they get moved frequently," Diaz said.

Three years ago, Tampa Fire Rescue purchased a bariatric unit, now known as Rescue 20, based in Tampa Palms.

Since then, it's been requested 88 times - 57 times in the city, 16 times in Hillsborough County and 15 times by Plant City, said Capt. Bill Wade.

Before American Medical Response created its fleet, anyone weighing more than 400 pounds had to be transported on a flatbed truck, Wade said, "providing no dignity for the patient and no safety for the paramedics."

"The flatbed was a poor option, but at the time it was the only option," he said.

Rescue 20 was purchased for about $200,000, about $30,000 more than a typical rescue unit, Wade said. The unit also has a bariatric stretcher which can hold about 400 pounds more than the standard 300-pound capacity gurney.

A cost-effective option

In Pasco County, fire rescue officials decided to go the more economical (but perhaps more readily available) route. Instead of purchasing a special transport unit, Pasco has placed bariatric-capable stretchers on all 21 of its rescue units.

"We don't have to call private companies now," said Pasco Rescue Chief Duncan Hitchcock.

As part of a mutual-aid agreement, the county wasn't charged a fee when it called the private company, but it was an inconvenience.

Besides providing safety for the patients, paramedics and emergency medical technicians, having bariatric stretchers in each ambulance speeds up calls by eliminating the need to wait around for a specialized ambulances to arrive from other jurisdictions.

"The sooner we can get the patient to the hospital, the sooner we can get back in service for the next call," Hitchcock said.

Pasco Fire Rescue started introducing the heavy-capacity stretchers to its fleet in 2002. The stretchers easily lifting up to 650 pounds and some accommodate as much as 1,000 pounds in their lowest position. The newer stretchers have wider bases, too.

"We started seeing more patients that were the bariatric type," Hitchcock said. "We just realized there was a need."

The bariatric-capacity stretchers cost between $1,000 and $1,500 more than regular stretchers, Hitchcock said, with the ones Pasco Fire Rescue is standardizing cost about $5,000 apiece. He said some have been paid for by grants.

Obesity was rarer

Hitchcock, who is a paramedic and a registered nurse, recalls working in St. Petersburg in the 1970s, and said that on the rare occasion they had obese patients, they had to place them on ambulance floors and prop them up with blankets and pillows.

"Years ago, we would pretty much use a tarp or salvage cover to pick them up and put them in the ambulance," hesaid.

In Pasco County, the need wasn't as great as in Hillsborough County. Hitchcock estimates that they used to call for private transport about 10 times a year. Now that all of the ambulances have the stretchers, they don't track bariatric calls, he said, but they seem to have increased.

"It seems to be more prevalent and instead of trying to make do with what you get, we're trying to make a concentrated effort that the patients are getting bigger so we've trying to get the stretchers that handle the weight," Hitchcock said. "Dignity issues are also something you consider."

Before the bariatric equipment, several paramedics, EMTs and firefighters would be called to the scene to help move the patient. Typical crews on bariatric units in most jurisdictions are three people rather than the standard two-person rescue-worker crew.

"You have to have more hands for the safety of the patients and the safety of the caregivers," Hitchcock said.

Rescue workers say the patients are the No. 1 concern, and paramedics say they like giving them back their dignity.

"We've actually had some patients who were like, 'Oh, please don't drop me.' And now they actually have more confidence in us," Crook said.