Va. rescue gear bulks up to handle large patients


By Matthew Bowers
The Virginian-Pilot

PORTSMOUTH, Va. — The woman weighed as much as 1,000 pounds, and that required a special blend of creativity and muscle from the city ambulance crew tasked with transporting her to the hospital.

They called for more help — two fire engines and a ladder truck arrived, increasing the people on hand to about a dozen. They needed more room — firefighters unbolted stretcher brackets and other equipment from the floor of the ambulance, which they backed up to the stoop of the patient's home.

They strapped together two backboards to create a ramp. Twenty-four hands grabbed the edges of a salvage tarp and, with the patient aboard, slid her out of the house and into the back of the ambulance. Lt. Chandra Dorsman propped herself against the woman's back to help her remain sitting up and able to breathe on the way to the hospital.

That was an extreme example of something city ambulance crews here and around the country are seeing more of: super-heavy patients.

To help accommodate them — and to cut down on the rash of back injuries suffered by paramedics and firefighters trying to lift them — agencies have invested in costly equipment and modified some of their practices.

Portsmouth in recent years has replaced its standard gurneys with battery-driven hydraulic "power stretchers," said Capt. Paul Hoyle, Emergency Medical Services manager. They're rated to safely hold 700 pounds and lift at the touch of a button, at nearly the cost of a small car: $8,000 apiece.

Virginia Beach rescue squads added electric lifts to fewer than a dozen of their stretchers, said Bruce Nedelka, EMS division chief.

Medical Transport, a private ambulance service, has added eight oversized stretchers to its statewide fleet, four of them in South Hampton Roads, said Elizabeth Beatty, district field supervisor. Her company also operates an oversized ambulance, based in Virginia Beach, that gets requests from across Virginia.

Back injuries from lifting patients is the Portsmouth department's top malady, but since it bought its new stretchers, the number has gone down, Hoyle said. He said the stretchers pay for themselves because lifting injuries cost the city more in worker's compensation.

"When you're dealing with someone like that, and you're using a rolled-up sheet - get real," he said.

Technically known as bariatric patients, the morbidly or clinically severe obese - typically 100 or more pounds overweight - are the fastest-growing segment of the rising obesity rate in the United States, according to a 2007 Rand Corp. study and Dr. Margaret Gaglione of Tidewater Bariatrics in Chesapeake.

In practical terms, Portsmouth Fire, Rescue and Emergency Services considers bariatric those patients weighing more than 350 pounds. In even more practical terms, "for us, bariatric patients are where the old procedures don't work," Hoyle said.

Excess weight contributes to more ailments — heart, circulation, breathing — which leads to more ambulance calls. Portsmouth transports about 20 extra-heavy patients each week, Hoyle estimated. Requests for lifting help occur almost daily in Virginia Beach, Nedelka said.

The issue has become a frequent subject for the profession's publications.

The online version of the Journal of Emergency Medical Services two years ago predicted sales of beefed-up stretchers would almost double between 2004 and 2012. Another article offered tips such as parking ambulances on slight down slopes to ease loading.

EMSresponder.com has recounted news coverage of debates in some areas over whether to charge higher fees for heavier patients, to cover the cost of special equipment and extra staffing. Portsmouth has no such plans, Hoyle said. The Web site also has discussed use of lifting apparatus and retrofitting or adding special vehicles, even larger-capacity helicopters, to get away from forklifts and flatbed trucks.

The publications and local rescue workers said it's about safety, for patients and themselves. They said it's also about patients' dignity.

Typically, the patients already are anxious — some might not have left their homes in years — and that can exacerbate their medical problems, said Beatty of Medical Transport.

"It's very stressful," Beatty said. "You're not moving furniture."

Sometimes, though, necessity nudges aside dignity. The Virginia Beach Fire Department installed a permanent ceiling anchor and hoist system in the home of one frequent patient who weighed more than 500 pounds, Battalion Chief Tim Riley said.

Once, a Beach ladder truck lifted a wire-mesh Stokes stretcher — like those used between ships at sea — to remove a patient through a second-story window, Nedelka said.

Chesapeake has used its technical rescue team to rig up pulley systems, Capt. Sam Gulisano said.

Along with too-narrow doorways and stairwells, paramedics must wrestle with other issues. Portsmouth ambulances carry extra- long blood pressure cuffs that can encircle wider arms, and canvas-like tarp carriers outfitted with multiple handles for tight spaces.

If they could find the funding, Hoyle said, they'd like to buy an even stronger stretcher his ambulances could share. Norfolk has one, which can hold 850 pounds sitting up and 1,600 pounds lying flat, plus a bariatric tarp, Battalion Chief Harry Worley said.

Beatty has given presentations at symposiums about moving larger patients and has fielded calls for information from as far away as Canada. It's an issue that doesn't appear to be going away.

"We're seeing an incredible, incredible increase in the number of patients who are super obese," she said.

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