The problems created by the increasing obesity of the world population has always been present but over recent years it is becoming more and more of an issue to the First Response Emergency Services when being called out to attend a Bariatric Client.
Modern lifestyle, the availability of food and lack of exercise all contribute to the problems they face. In this modern lifestyle we tend to drive everywhere complain if we don’t have a TV remote and have to get up off our comfy chairs to change channel and because of our wonderful technology there is a lack of manual physical work which in the past kept all of us lean, fit and healthy.
The term Bariatric is a medical term used to describe obese clients these are usually persons who are in excess of 25 stone (159kg), is classified as Morbidly Obese with a body mass index of 40kg/m2 or with a BMI of 35kg/m2 with other additional co - morbidity problems.
Illness or accident historically were the main contributor to becoming Bariatric but as mentioned our lifestyles are now the main factor and the weight gain gradually creeps up and we gain weight over a period of time to a point of being obese without any major alarm bells ringing but then with a blink of an eye the weight gain can accelerate and suddenly from being obese we become bariatric and this is when the manual handling issues to first responders becomes an issue. The problems of obesity fall in to two categories. Firstly there are changes of the anatomy and physiology that affect the obese. These create problems in airway management, ventilation, circulatory access and drug dosage. Then there are the effects of the sheer physical bulk and weight of the person.
By the time the BMI reaches 40 the person’s mobility and health is being affected by their body fat. They will now begin to present problems of extrication once a person exceeds 20 stones they may be pushing the limits of the design load limit of the rescue equipment and the crew/teams will have to be looking to use specialist equipment to be able to safely move this person to protect the casualty and the staff members involved.
In the last 10 years there has been a mixed response from the emergency service providers with your main ones being the ambulance, fire and police as to what level of service they provided this ranged from well-funded, well equipped specialist teams down to the prejudices in the services who were in denial to the issues and problems that the obese/bariatric persons presented this in turn caused inter agency friction. Positively and more recently there is an acceptance of the issues and necessary steps are being taken to be responsible and find solutions to provide professional services and that the same level of service needs to be provided to all sectors of the community from tiny to large and to provide a safe working environment for their employees.
Providing a safe working environment is broken down into 2 sections the provision of suitable equipment and the correct training and safe systems of work for their staff.
There is now a wide variety of equipment available to assist moving a bariatric person these range from a simple slide sheet up to lifts and hoists, stretchers, evacuation chairs etc. The ProMove is an ideal solution if you are extricating a larger person from a RTA or aircraft etc. as this will carry up to 60 stones in weight. The EvacMat and Bariatric Rescue kits are also ideal choices as they provide the solution to keeping the person’s body weight still whilst be able to slide them away to safety or taking them down stair cases without any physical lifting involved and because of the moving handles the crews involved can all be in a good working position.
In dealing with any bariatric incident the equipment is only a small part of a successful result of the situation the bigger picture is the knowledge, understanding and training of the personnel attending. It is important that the first responders have the knowledge both of the medical/physical and emotional conditions of the bariatric casualty. If the first responder understands these conditions then they will be able to provide and demonstrate empathy to the casualty. Often this person will be living their lives to their emotional physical and emotional extremes and won’t have any reserve to cope with trauma you often find that this person may be depressed, agoraphobic, have low self-esteem, have panic attacks and may be suffering from embarrassment and shame.
You will often find that this person has respiratory problems due to the fat corset and their body weight pushing down onto their ribs and their diaphragm being pushed up, they have to work hard just to breathe and become deoxygenated when they are lay down. These persons are frequently difficult to intubate and popping a towel or folded blanket under the shoulders and head can help.
Because of the strain on the circulatory system cardiac arrest is more likely this presents problems with cannulation because the fat layer obstructing major blood vessels. Expert knowledge is required to administrate drugs due to the person’s body weight. Defibrillators are not used in the normal way for a bariatric client again due to the lack of effectiveness because of the fat layer. Staff need to be trained on the correct moving and handling techniques of a bariatric client so that minimal disruption is caused to the person and all personnel attending are protected from injury.
’Out of Scope Factors’ need to be taken into account - for example structural issues and floor loadings. Do floors need propping? Will there be a need to deploy the Urban Search and Rescue Team (USAR)? Are staircases and equipment available are they all fit and have the weight limit for the task ahead?
Planning of the rescue before implementation is vital for example looking at the route out is there any pinch points where you may get a larger person stuck in tight corners identifying any potential hazards, requesting specialist equipment and more personnel if required are all important factors when handling a bariatric person and not forgetting the all-important ‘empathy’ because this person could be your mother, father, brother, sister, son or daughter and you would want them moved in the safest kindest way.
The future of the Bariatric response will rely more and more on specialist response teams e.g. Ambulance HART, USAR or rope rescue because of their experiences and in depth knowledge and their range of bariatric equipment available to them. Financially it is not viable to kit every vehicle out with a full range of equipment. We are seeing more of the main service providers outsourcing bariatric incidents to specialist bariatric providers. One thing is for sure this is not going to go away and increasingly first responders will be being called out to larger persons but with the correct and training and equipment available hopefully this will be manageable.
Originally published in International Fire Fighter Magazine, September 2013.