Lifting assistance: Carrying bariatric patients over the gap in today’s healthcare

Community paramedicine communication with patients, their family members and the local crews can eliminate obstacles and improve patient care for bariatric patients


Treating and transporting a bariatric patient can require coordination with outside agencies, as well as specialized lifting and monitoring equipment. Bariatric patients have the right to expect professional and timely emergency care, with consideration given to their unique assessment challenges, and providers have the obligation to deliver such care without risking their own health.

Learn more in this EMS1 Special Coverage series, "Bridging the gap in bariatric patient care: Pathophysiology, assessment and transport solutions."

During my time with our mobile integrated healthcare program, the Birmingham Fire and Rescue Service C.A.R.E.S., we were very good at connecting the patients to primary care physicians, or finding affordable medications.

But when it came time to find an alternative to calling the fire department when bariatric patients needed lifting assistance, we were not so successful.

Why?

In this photo taken Aug. 7, 2009, American Medical Response operations manager Ken Keller talks about the specially-equipped ambulance used for obese patients at the company's Topeka, Kan. facility. (AP Photo/Charlie Riedel)
In this photo taken Aug. 7, 2009, American Medical Response operations manager Ken Keller talks about the specially-equipped ambulance used for obese patients at the company's Topeka, Kan. facility. (AP Photo/Charlie Riedel)

Because when a bariatric patient needs help to their car for a doctor’s appointment or up the stairs after they return home, there is no alternative.

What other agency can deliver a group of able-bodied men and women in less than four minutes completely free of charge?

So for now, mobile integrated health and community paramedicine programs are stuck in the middle, advocating for patients in need, while also trying to minimize the use of emergency services.

It’s a difficult position, but it is not without opportunity.

Here are 4 actions your MIH/CP program can take to improve care for bariatric patients in your community:

  1. Keep the patient on track with their care
  2. Communicate with the crews
  3. Improve routes of egress
  4. Prove the worth of MIH/CP service

1. Keep the patient on track with their care

The challenges bariatric patients face day to day can be overwhelming. Many spend their days alone, allowing depression to easily set in. This can lead to delaying necessary doctor’s appointments or missing them entirely.

Frequent phone calls and home visits are necessary to keep patients motivated about their care. When they do call for lifting assistance, it helps if a community paramedic attends along with the responding crew so the patient can see a familiar face. 

In the world of mobile integrated healthcare, sometimes patients need a friend more than they need a paramedic.

2. Communicate with the crews

After repeatedly responding to the same address for a lift assist, crews can become frustrated.

For every visit I made to a bariatric patient, I made another to the fire station serving the territory. Keeping the crews informed can ease their feelings toward the situation and build empathy for the patient. Even if I had no positive news to report, the crews still appreciated feeling included in the plan of care.

3. Improve routes of egress

One of the greatest concerns for medical providers treating bariatric patients is the risk of a career-ending injury. During an emergency call, responders are forced to contend with tiny bedrooms, narrow hallways and steep stairwells under extreme pressure.

During a scheduled home visit, encouraging the patient or their family to create a better means of egress can greatly reduce the risk of injury to providers as well as the patient.

If they are agreeable, it can sometimes mean moving the patient to another room. If they are not, then a good compromise can be moving a piece of furniture to clear the way.  

4. Prove the worth of MIH/CP service

I have yet to see an official study that explores the financial impact that providing lifting assistance is having on the healthcare system. But from what I have witnessed firsthand, I can imagine that the figure would be significant. 

As MIH/CP programs continue to push the boundaries as to what EMS providers are allowed to do, we need to bring recognition to the impact fire departments are already having by providing this simple service.

Perhaps this could lead to some sort of reimbursement plan that would allow for the investment in extra manpower or equipment designed to assist with lifting bariatric patients.

For those bariatric patients who can’t leave home without our help, it would be money well spent.

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