BARIATRIC PT ON REGULAR STRETCHER

[UGLYEMT]

MAKING PT CONTACT:
AS ME AND MY PARTNER GET ON-SCENE, WE OBSERVE OUR PT'S LARGE SIZE. HE WEIGHED 375 LBS, IS AN AMPUTEE(BKA-ONE LEG), IN A WHEELCHAIR, NON-AMBULATORY. WE LOAD HIM ONTO THE STRETCHER, SECURED WITH APPLICABLE SEAT\BELTS X5, AND RAILS X2, ENSURING A POSITION OF COMFORT. PT WAS CENTERED, WITH 6 INCHES OF HIS BODY EXTENDED PAST APPLICABLE RAILS. PT IMMEDIATELY COMPLAINED OF BEING PINCHED BY THE RAILS. MY PARTNER AND I ALSO NOTICE THAT THE PT'S RIGHT SIDE WILL BE PRESSED WHEN SECURED INTO THE RESCUE, CAUSING ADDITIONAL DISCOMFORT.

CONTACTING SUPERVISOR:
WE IMMEDIATELY MAKE CONTACT TO ADDRESS THE PROBLEM. MY CREW CHIEF IS VERY SHORT ON THE PHONE, AS MOST ARE. I BRIEFLY DESCRIBE THE ISSUE, MAKING IT CLEAR THAT I DO NOT FEEL COMFORTABLE TRANSPORTING THIS PT. ALSO, I STATE THAT THE PT NEEDS A WING STRETCHER OR BARIATRIC STRETCHER. THE STRYKER STRETCHER EXTENDS NICELY TO ENSURE PT COMFORT/SAFETY. MY SUPERVISOR IS FURIOUS, QUESTIONING HOW THE PT BEING "A LITTLE UNCOMFORTABLE" IS REASON TO DENY TRANSPORT. I EXPLAIN FURTHER THAT IT'S THE PT COMPLAINT OF BEING UNCOMFORTABLE(ALTHOUGH PT HIMSELF DID NOT PERSONALLY REQUEST THE LARGER STRETCHER/PT IS KIND AND EASY-GOING). MY SUPERVISOR EXPLAINED THAT HE HAD MUCH MORE EXPERIENCE, AND HAS LOADED LARGER PT'S ON A REGULAR SIZED STRETCHER, WITHOUT ISSUE. HE STATES THAT AS LONG AS THE RAILS WERE UP, AND LOCKED, THE PT WAS SECURE. CREW CHIEF GETS TIRED OF THE BACK-AND-FORTH, AND TELLS ME TO DROP THE CALL, AND MAKE MY WAY TO THE STATION FOR STRETCHER TRAINING.

THE QUESTION:
UPON ARRIVAL AT THE STATION FOR STRETCHER TRAINING, MY SUPERVISOR OBVIOUSLY CHEWED ME OUT. HE SAYS THERE SHOULD HAVE BEEN NO REASON NOT TO TRANSPORT THE PT, AND THAT PT COMFORT IS NOT MOST IMPORTANT. PERSONALLY, I UNDERSTAND THAT THERE WILL BE SITUATIONS WHERE YOU "GOTTA DO WHAT YOU GOTTA DO", AND GET THAT PT LOADED. ON THE OTHER HAND, THIS WAS NOT AN EMERGENCY SITUATION. IT WAS A SLOW DAY. OTHER UNITS WERE POSTED NEARBY TO SWITCH EQUIPMENT, WHICH COULD HAVE PROVIDED THE MORE APPROPRIATE SIZED STRETCHER. WHAT IS THE POINT IN RAILS ON A STRETCHER?? IS THE PT SECURE BECAUSE TWO RAILS ARE UP AND LOCKED? I THOUGHT THAT RAILS WERE USED TO SECURE PT'S BY CREATING A BARRIER?

 

[NPO]

I'm not really sure what you're asking.

You're upset because your supervisor isn't a very good one. But he's also not entirely wrong.

375lbs isn't very large (ugh, that's the reality we live in). Would a bariatric gurney be nice, yeah. Is it needed? Probably not.

Most morbidly obease patients are aware of their size and limitations and appreciate minor accommodations and efforts being made, but realize that not everything is going to be perfect.

Bottom line;
We're you wrong for asking for bariatric equipment?
No.

Do you NEED bariatric equipment for this patient?
Probably not.

Could your supervisor have handled things better?
Yes.

 

[Jim37F]

Largely agree with NPO....but I just gotta say, the Caps Lock key is not your friend here...

 

[StCEMT]

Pretty much gonna echo NPO. Yea, it's not comfortable, but that comes with the territory of being that size. If you can accommodate or do little things, by all means do so. But if you can get them on the stretcher reasonably then...if it fits, it ships. We have all had to do it. I've had patients who were so obese, their legs pointed off the sides simply due to the sheer girth of their legs...and that was on a regular stretcher.

 

[NomadicMedic]

And you may want to change your user name to something a bit more anonymous.

 

[hometownmedic5]

It’s not the weight so much as the shape. A 400lb, 6’5” person is in a different class than a 400lb 5’00”. You can be 375 and still spill over the rails if you dont have the height to stretch it out. If the patient was being transported emergently for a real live “right now” problem, then they go on the narrow stretcher and deal with it. If they’re being transported routinely for a scheduled appointment, then they can wait for a bari stretcher. It’s a sad indictment of the status of the country, but height and weight need to be added universally to the booking questionnaire. Then, dispatch could plan for things like bari stretcher, lift assists and so on.

Ive written this before here and I’ll repeat it as it bears on this conversation. Never, ever, ever forget that no patient, no job, even the career path itself is worth your personal welfare and safety. Don’t risk your back(and all the rest of you) to make your boss money. If your employer refuses to provide the required equipment and manpower to safely move large patients, quit. It isnt worth it.

I wish somebody had told me that. I grew up in this business with the culture of “man up and do it” where there wasn’t a second truck coming and there never would be. No bari stretcher, no tracked stair chairs or power cots. Just back pain and Advil and if you *****ed, you suffered all the more for it. I have four blown discs because I was too stupid and weak willed to demand the proper resources to do the job safely and I never refused to do the calls, to my own personal detriment.

 

[Bullets]

This patient isnt a bariatric patient at 375. All my standard cots in my service are rated to 700lbs without any special equipment. If the patient was unformatable with the rails being up, then dont put them up. im not aware of any cot that needs the rails up to secure inside int the ambulance. The styrkers either have a wing that folds out or a rail that folds down. Same with the Fernos, the rails can stick out and sideways to make it more comfortable. Unless you have a policy that says the patient cant be transported unless the rails are locked in the fully upright position

Could your supervisor handled this maybe more professionally? Probably. Could you have adapted this and made the transport in a way that was safe and comfortable? Most likely.

 

[hometownmedic5]

This patient isnt a bariatric patient at 375. All my standard cots in my service are rated to 700lbs without any special equipment. If the patient was unformatable with the rails being up, then dont put them up. im not aware of any cot that needs the rails up to secure inside int the ambulance. The styrkers either have a wing that folds out or a rail that folds down. Same with the Fernos, the rails can stick out and sideways to make it more comfortable. Unless you have a policy that says the patient cant be transported unless the rails are locked in the fully upright position

Could your supervisor handled this maybe more professionally? Probably. Could you have adapted this and made the transport in a way that was safe and comfortable? Most likely.

Its not the weight, it's the shape.

By your logic, a 699 pound patient isn't a bariatric, but I assure you they are. If they are wide enough that you can't close the rails, they need a wider stretcher.

What weight qualifies as a bariatric call differs by state and even within by service. In Massachusetts, the job description of the EMT states each member is expected to be able to lift and carry 125lbs, which sadly doesn't account for equipment. So by regulation, a 251lb patient qualifies for a second truck. They may not need the barri stretcher, but they will still be treated to the bari service.

If your service doesn't give a single damn damn about their employees or the patients and just wants to get paid, disregard all of the above and expect to stair chair 350lb patients up at least three flights of winding rickety stairs with a single crew.

 

[UGLYEMT]

THE REPLIES ARE MUCH APPRECIATED.

AS FAR AS WHAT QUALIFIES A BARIATRIC PT, I'M GOING BY MY COMPANY'S PROTOCOL. WHEN WE GET A PAGE, IT LISTS INFO ON THE PT(INCLUDING WHETHER OR NOT THE PT IS >300LBS). BY THEIR OWN RULES, WE ARE TECHNICALLY SUPPOSED TO HAVE A LIFT ASSIST ON 300+. MOST DOUBLE MEN CREWS DO IT ALONE WITHOUT QUESTION, BUT OTHER UNITS ARE LEGITIMATELY NOT CAPABLE. BUT THIS WASN'T A MATTER OF BEING TOO HEAVY, IT WAS THE DIMENSIONS OF THE PT.

BOTTOM LINE: CAN A PT THAT SIZE FIT THAT STRETCHER TO MAKE THE TRANSPORT? MOST LIKELY.
BUT IS IT THE MOST SECURE/ COMFORTABLE?
I WAS MERELY ASKING TO FIGURE OUT IF I WAS IN THE WRONG FOR ASKING FOR MORE SUITABLE EQUIP.
OUR PROTOCOL IS TO HAVE THE SIDE RAILS UP AND LOCKED, WHICH THEY WERE.

MY COMPANY IS THE TYPE TO SEND OUT RATTIER/LESS EQUIPPED TRUCKS OUT, FOR THE SAKE OF SAVING MONEY. WHICH IS COUNTERPRODUCTIVE BECAUSE THEY'LL SEND US OUT TO A CALL, AND END UP SENDING US BACK TO THE STATION BECAUSE THEY DIDN'T PROPERLY PLAN/EXECUTE THE RESCUE THAT SHOULD HAVE BEEN TO THAT CALL.

 

[DesertMedic66]

Please hit that button on the left side of your keyboard that says “caps” or “cap lock”.

Yes I have placed many patients who are 350+ pounds on a normal gurney with the side rails and not the wings. It’s not going to be the most comfortable for them but I have not had any issues. Yes the side rails do help keep the patient in place as do the seatbelts.

 

[VFlutter]

It is not necessarily wrong to request a bariatric unit if one is readily available however I am assuming that it is a limited resource and should probably be utilized for patients whom can not be transported by other means not just for increased comfort. Pad the railings with a blanket and make the patient as comfortable as possible. Unless it is a LDT and the patient will be on the stretcher for a prolonged period of time then you work with what you have.

I have flown many truly bariatric patients on a standard Stryker stretcher.

 

[hometownmedic5]

I'm not even going to read that wall of caps. Get with it or get going.

 

[NPO]

There are also many commercially available bariatric products available.

The Stryker gurneys have the optional XPS or eXpandable Patient Surface. The Ferno has the ironically named LBS, or Large Body Surface.

My service has Ferno gurneys, and as such, we have the LBS at one of our central stations. I've never used it for 911 calls, it's mostly for transfers. For 911 calls we use the BearPod.

 

[johnrsemt]

I don't know if it has changed but back when we used to do a lot of Bariatric transports; Ferno came out with an adaptor that went over their stretcher that made it capable of transporting a 1000lb patient. One of the services out where I used to work actually believed Ferno and put a 750lb pt. on the stretcher with the adaptor. No one thought it through and realized that the adaptor was on a stretcher that was still only rated for 500lbs. 8 people lifted the cot outside of the ECF, and went to put it in the truck, the cot collapsed, pt. was hurt. I have no idea how much money the patient got out of the company and Ferno over that goof.

My service actually had a custom cot, made long before Ferno and Stryker came out with the Bariatric cots. That, ramps, and winch in 2 trucks did a nice job.

My personal best was a little over 1300 lbs. 700lbs plus happened a few times a week.

Earlier comments about it isn't the weight but the size is totally true. 350lb patients when they are short need wider cots; 500lb patient at 7'8" can fit (width) on a standard cot, length good luck.

 

[DrParasite]

No one thought it through and realized that the adaptor was on a stretcher that was still only rated for 500lbs.

This was the first thing that came to mind when you mention the adapter..... the weakest point on the stretcher is the bolts in the legs that go up and down; no adapter is going to change that......

for the OP (who still has his name listed as his forum title, ugh, apparently you didn't understand why the suggestion was made to change your username) take away lessons should include the following:
1) know the weight limit of all your equipment. This is set by the manufacturer, not your company. If the patient exceeds the weight limit, don't take the patient.

2) know your company's rules and regs regarding bariatric patients
2a) if your company says you get a second crew at X lbs, get a second crew.
2b) if your company mandates a bariatric stretcher, get a bariatric stretcher
2c) if your company doesn't, than consult your supervisor for direction. if you don't like what your supervisor says, you can either go higher up the chain of command, or advise the patient of what your supervisor directed you to do, and make the best of a bad situation (pad as much as you can), and document it as appropriate.

3) If your company is the type to send a unit without the proper equipment on a patient, than you have two options: schedule a meeting with management (not a crew chief or field supervisor, an actual administrator who works business hours during the week in an office), discussing your concerns and asking for advice on how to handle those situations in the future, or quit and find a new job. There are plenty of crappy agencies who operate like that, and many of us have found that if the company refuses to change, it's best to find a better company to work for.

 

[Bullets]

Its not the weight, it's the shape.

By your logic, a 699 pound patient isn't a bariatric, but I assure you they are. If they are wide enough that you can't close the rails, they need a wider stretcher.

What weight qualifies as a bariatric call differs by state and even within by service. In Massachusetts, the job description of the EMT states each member is expected to be able to lift and carry 125lbs, which sadly doesn't account for equipment. So by regulation, a 251lb patient qualifies for a second truck. They may not need the barri stretcher, but they will still be treated to the bari service.

If your service doesn't give a single damn damn about their employees or the patients and just wants to get paid, disregard all of the above and expect to stair chair 350lb patients up at least three flights of winding rickety stairs with a single crew.

Out policy is anything over 500lbs is a "bariatric call" however our staff are given wide latitude to request additional resources for lifting.

Also we're a 911 agency, so we rarely go up stairs, only down them and we have a powered stairchair for those largest of patients. We also have the Ferno LBS for those people as well. Copd and FD are used for lifting assistance and i encourage the staff to call for additional units, not only and most importantly for safety, but also because there are additional fees associated with that type of response.