A current and on-going challenge in the area of patient safety is the transport and treatment of bariatric patients. EMS providers are on the front lines of this issue, and EMS education should create a comprehensive curriculum for bariatric patient scenarios.
“The large patient who requires emergency care has the right to timely, effective, and safe care.”1 In order for EMTs and paramedics to provide that care, education that incorporates the special needs of the bariatric patient needs to be presented in EMS training programs.
Four areas to assess for the safety of bariatric patients and their healthcare providers are patient evaluation, patient extraction and immobilization, medical care equipment, and bariatric protocol.
Evaluation of the Bariatric Patient
The ABCs of patient evaluation (airway, breathing, and circulation) can be difficult in the obese patient because the physiology of the patient can be altered by their condition.
- Respiratory muscles are less efficient, putting obese patients at a greater risk of hypoxemia and hypercapnia.
- Breath and heart sounds will be difficult to auscultate.
- An abdominal exam will also be challenging because the usual anatomical landmarks will be hard to locate.
- Bariatric patients have a higher basal heart rate due to the increased cardiac demand, increased blood volume, and increased peripheral resistance.
Patient Extraction and Immobilization
Once a patient has been assessed to the best of the caregivers’ ability, it is time for transport. Bariatric patients should not be put into a cervical collar. Other options are to immobilize the head with towel or blanket rolls and pillows strapped to a backboard.
Patients can be moved via a slide or sling, rather than lifted from a bed to a stretcher. If the stretcher cannot accommodate a patient because of weight capacity or girth, sheets can be used instead.
Equipment
Use of specialty equipment needs to be considered. Students can train with large blood pressure cuffs, a Doppler sound probe if blood pressure sounds cannot be assessed with a stethoscope, and long-length IM needles.
Doses of emergency medicines may need to be increased on the fly.
Larger backboards, stokes baskets, slings or slides, and extra-large wheelchairs may need to be added to the inventory. Teaching students to use inflatable air bags or winch-driven lifting devices can be a good strategy as well.
Bariatric Protocol
EMS departments should put protocols in place for the care and safety of bariatric patients. More than one-third of Americans are overweight or obese, and regulations need to address how to safely and sensitively handle these patients.
- Establish a weight limit: A general rule is that any patient that exceeds 300 pounds should be considered for bariatric protocol.
- Appoint a safety officer: If bariatric protocols are enacted, an additional person should be appointed to supervise extrication and lifting efforts.
- Assessing the site for treatment: If moving the patient is simply not an option, because of a lack of staffing or equipment, medical control and a supervisor should promptly be contacted. A properly trained EMS team can provide patient care at the site, rather than risking further injury by attempting to move him or her.
- Pick the right hospital: If the patient is going to be transported, be aware of which hospitals in the area can accommodate larger patients. Give the hospital time to prepare for the patient’s arrival by respectfully communicating the needs of the patient.
For EMS education in this area, SimObesity® solutions from Pocket Nurse® can be a valuable training resource. SimObesity suits and shirts can add the realism needed to help EMS providers learn to manage bariatric patients.
1. Managing and Moving the Very Large EMS Patient, EMS1
EMS Challenges with Bariatric Patients, Carolina Fire Journal
