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April 12, 2011

Obesity forces changes in medical equipment for Fla. EMS

By Sonja Isger
Palm Beach Post

PALM BEACH, Fla. — Last year, Palm Beach Gardens Fire Rescue counted at least five patients it had been dispatched to help who weighed more than 400 pounds. Two tipped the scales at more than 600 pounds.

It was a logistical challenge that required extra trucks to be dispatched to provide enough manpower to move each patient.

It was a medical crisis for those who had to be moved.

It was even a risk for the 10 or so firefighters who had to find ways to safely get the patients onto stretchers not meant to hold that kind of weight and lift them into ambulances without hurting themselves.

So Palm Beach Gardens Fire Rescue did what other departments and hospitals across the country are doing: It invested in bigger, stronger equipment for bigger, heavier people.

"We're not talking about an obscure population," said James Zervios, spokesman for the Obesity Action Coalition in Tampa. "We're talking 93 million people."

That is to say, 93 million Americans are overweight. According to the U.S. Centers for Disease Control and Prevention, nearly one in three Americans is overweight and another one-third is obese, and about one in 20 is at least 100 pounds heavier than he or she should be, or "morbidly obese."

Zervios and others say many emergency responders and hospitals aren't prepared to care for such patients, though they are starting to make changes.

"Facilities in the last couple of years are being caught off guard by the number (of patients) coming through the door who are morbidly obese," said Amanda Biedess, head of U.S. marketing for Kinetic Concepts, a Texas-based supplier of medical equipment made specifically for those patients.

Demands on rescuers
To move a 6-foot, 180-pound man if he's unconscious or can't help takes about five strong people. That's about how many will respond from the Palm Beach Gardens fire station after any medical call. But Capt. Thomas Murphy said one patient required 10 rescuers.

No longer. With the help of an $8,700 county grant, the city retrofitted one of its five ambulances with a more powerful automated stretcher that holds more weight and has a wider bed, a ramp to roll the stretcher onto the ambulance and a winch to haul the patient up the ramp.

Because a county grant paid for it, other departments from West Palm Beach to the Martin County line can use it when their ambulances won't do the job, said Chief Keith Bryer, the department spokesman who wrote the grant request.

The ambulance rolls on all calls, not just bariatric ones. The crew can load the special ramps and prep the larger stretcher top in less than three minutes when the need arises.

"We don't use it a lot, but when we use it, we need it," Bryer said. "It's definitely safer for the patient, safer for the crews."

Chairs, beds, wheelchairs

And when large patients arrive at the hospital, they're finding larger waiting room chairs, bigger wheelchairs, sturdier beds and sometimes even larger bathrooms. Some examples:

  • St. Mary's Medical Center in West Palm Beach has bought four beds that can hold up to 1,000 pounds and extend to 48 inches wide, a foot beyond the standard hospital bed. The hospital also uses special mattresses that can be inflated in specific places for turning or shifting a patient in bed.
  • Palm Beach Gardens Medical Center upped the weight limit on its CT scanner from 275 pounds to 350 pounds. And patient privacy curtains now bow out on the sides, said Dr. Scott McFarland, emergency department medical director.
  • Bethesda Memorial Hospital in Boynton Beach has bought one plus-size operating room table, spokeswoman Lisa Kronhaus said. And because the hospital has a bariatric program that guides a patient through surgical weight loss, it bought a van that can transport larger patients on doctor visits.

According to the 2011 Bariatric Buyers Guide, the products that account for the highest supply costs for extra-large patients are beds, electronic lifts, wheelchairs and walkers.

Upgrading can be pricey. Bariatric hospital beds can cost $20,000 more than standard-size ones. Bariatric wheelchairs cost seven times the standard.

Lifting without injuries
Hospitals and fire departments are looking out for not just the patients but also themselves. Companies such as Kinetic Concepts have developed training programs to teach hospital staff how to move patients without hurting the patients or workers.

"Moving bigger or more difficult patients requires more people and a strategy to do it," said Joey Bulfin, chief nursing officer for St. Mary's. "Having the right equipment and the right training is a standard of care. If you don't have it, it would be caring for patients below the standard. You have to have this equipment."

In its application for the ambulance grant, Palm Beach Gardens quoted a national survey: Of 1,300 emergency service providers, 47 percent were hurt on duty, a majority in lifting incidents.

From 2002 to 2007, 20 Palm Beach Gardens Fire Rescue employees filed workers compensation claims for incidents involving lifting or moving patients, Bryer said. Two of those patients were obese. The cost to the city, not including one early retirement, was nearly $128,000.

Said firefighter Murphy: "It really does save our personnel from injuries."

Copyright 2011 The Palm Beach Newspapers, Inc.

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