BehindTheMedspeak: 'Super-size my medical transport equipment'

Excerpts from Mary Pat Flaherty's February 8, 2010 Washington Post Metro section front page story follow.

Pictured above on the right is a standard gurney; one suitable for patients over 450 pounds (in yellow) is on the left.

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Local paramedics and firefighters don't need to follow television shows about a half-ton teen or biggest losers to track the obesity trend.

They carry that knowledge with them.

Calls for patients weighing 350 pounds come daily in the District. A patient between 400 pounds and 600 pounds is part of every workweek for many crews throughout the region. Patients topping 600 pounds are transported by emergency teams every few months.

Nationwide a few communities, including some near Topeka, Kan., charge nearly double to transport patients over 350 pounds.

Sales of stretchers designed specifically for very large patients were expected to reach $50 million in 2012, up from $29.6 million in 2004, while sales of specialized lift systems were projected to rise from $75 million to $193 million.

Reinforced brackets, hydraulic lifts, extensions for belts, harnesses and blood pressure cuffs, and equipment designed so as many as a dozen people at one time can lift a patient are in use in the District and Prince George's, Montgomery and Fairfax counties, as well as many smaller departments. So, too, are cots widened to about 30 inches, which provide increased surface area while still being able to pass through most internal doors.

But those improvements are not enough once a patient reaches about 700 pounds, a group that has become a new focus.

Patients that large must be moved with extra staff and in specially rigged ambulances. Some have a ramp and winch that can pull in a 1,600-pound patient on a cot and is built with a chassis the size of a lumber truck.

Local EMS officials can recite the types of challenges driving their discussions:

The 1,300-pound patient in Prince George's whose illnesses require regular trips to a skilled nursing facility.

The patient more than 600 pounds who hadn't been off the third floor of his Montgomery townhouse in years. Before emergency crews could move him, they needed to check that the floors and stairs would hold up under him, the crew and its equipment. He had to be moved in a panel truck and taken through the wider doors of a nursing center's laundry room entrance.

There is attention to "the logistics of all of this, and that's important, but it's a small component," compared with safety or sensitivity, said Assistant Chief Michael McAdams of Montgomery County Fire and Rescue.

"The last thing you want is everyone surging to pull and pull, and you have someone fall off the cot or have something degrading happen," McAdams said.

"Watching maybe a dozen people file in is enough to raise a patient's anxiety all by itself. And many of these people start out by apologizing to us and asking us to be sure we don't hurt ourselves or them," said James Augustine, medical director for D.C. Fire and EMS until his recent resignation.

Given the hundreds of thousands of EMS calls annually across the D.C. area, very large patients account for a sliver of calls. Fairfax had 56 patients weighing more than 400 pounds last year among its roughly 63,000 calls. Montgomery fire officials estimated they moved a dozen patients in that weight range last year among 58,000 transports. Prince George's handled about 100 among its roughly 100,000 EMS calls last year. "But while they're a small portion, they require a lot of resources," said Maj. Dennis Wood, who oversees paramedic operations for Prince George's Fire and EMS department.

For now, Wood said the Prince George's department uses a general rule — aimed at reducing back injuries — that "for every 50 to 100 pounds over 250, you need to add another set of hands on the call."