Treating and transporting a bariatric patient can require coordination with outside agencies, as well as specialized lifting and monitoring equipment. Bariatric patients have the right to expect professional and timely emergency care, with consideration given to their unique assessment challenges, and providers have the obligation to deliver such care without risking their own health.
Learn more in this EMS1 Special Coverage series, “Bridging the gap in bariatric patient care: Pathophysiology, assessment and transport solutions.”
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Bariatric calls present us with unique challenges in the field – both in terms of equipment and personnel needs. Without even considering the stability of the patient, seemingly simple tasks, such as moving the patient from the floor to the cot, or even from the cot through a doorway, can become compounded with challenges (and added weight is only one of them).
Bariatric patients are typically defined as those patients who are either 100-200 pounds overweight, or who have a total body weight over 300 pounds. In some settings, bariatric protocols are not actually activated – and appropriate equipment deployed – until crews encounter a patient weighing at least 350 pounds.
Considering these parameters, let’s focus on lifting, moving, and the operations and logistics behind bariatric transports.
Sizing up the bariatric patient situation
First off, there’s no guarantee that your crew will be dispatched considering, or even notified en route, that you’re going to be caring for a bariatric patient. This may, in fact, be the first time you’ve ever encountered this particular patient, or even the first time they’ve ever had to call 911. So, regardless of their condition, complaint or circumstances, let’s set the pace off to a good start by treating our patient with the compassion and empathy they deserve.
Depending on where your patient is physically located – and again, not even considering the medical or traumatic events related to this call – this is likely your starting point for determining how you’re going to safely move or extricate your patient. If you’re providing simple lift-assist services, then maybe all you need is a specialized lifting belt that offers multiple grabbing and access points for you to gain support.
If your patient is on the floor, then various lifting sheets and skeds on the market can be tucked underneath the patient as you assist them in rolling from one side to the other, and have multiple grabbing handles situated to allow multiple rescuers to safely (and ergonomically) lift your patient into a new place or position. These lifting sheets may also be disposable, too.
What do you have available on your ambulance to safely lift and move bariatric patients? Do you have enough personnel available to navigate through the maze of a home? Who can you call when you need additional help?
Follow stretcher manufacturer guidelines
From here, your next move is likely through the house, to your cot, and into your ambulance. Sounds like an easy objective, right?
Again, the term bariatric can encompass a wide range of patient weights, from 300 pounds, to 500 pounds, to 750 pounds or even more. Take a look at half of the linemen on your favorite football team and they’ll likely fall into this category (based off of its simple definition). On the other end of the spectrum, however, you may be encountering a patient that hasn’t left his or her home, let alone bed, in years.
What seems like a standard-sized hallway in a ranch home or two-story residence may not actually be wide enough to accommodate the transfer of your patient. These situations, although rare, present with their own set of challenges.
What is the weight capacity on your stair chair and your cot? Does the weight limit on your cot reflect its loading height weight limit or its collapsed weight limit? Check your manufacturer’s details.
Use tools, extra hands to lift bariatric patients into the ambulance
Once you’re outside of the residence, your job isn’t done; you still need to safely get your patient into the ambulance for transport. Assuming that your patient doesn’t exceed the weight restrictions on your cot, and assuming that you have long enough straps to secure your patient to your cot, let’s break down your options to safely move your cot from the outside to the inside of your ambulance.
While a battery-powered cot, or even a boom-arm designed to load your cot at the push of a button will certainly make a heavy lift easier, an extra set of hands – or several – can still be useful.
Four- and six-person lifting techniques should be utilized to not only spread the weight amongst many people, but to also provide stability in order to prevent tipping as you lift your patient upwards. Using a ramp – and even a winch – may be necessary to accomplish this task.
Unique to our market, and resembling that of the cargo industry, some agencies have incorporated an actual lift that is mounted to the exterior of the ambulance, extends outward (toward the back of the ambulance) when you’re ready to use it, and lifts (or lowers) your cot to an appropriate height.
This isn’t the end of the road quite yet; you must also notify your receiving hospital of your specialized circumstances because they, too, need to make accommodations once the patient arrives. Providing a five-minute heads-up seems a bit lackluster on our part, so please try to provide your receiving hospital with much more notice than this so that they can make necessary internal equipment changes. After all, they’re a 24/7 operation, too (and this isn’t the only patient that they’re caring for in their facility, either!).
Keeping both patient and provider safety at the forefront of our mind (and operations) should be our top priority.
