United States (Pennsylvania) - As recently as two decades ago, ambulance service crews rarely encountered patients who were overweight or obese. These days, it's not unusual for paramedics, both here and nationally, to transport patients who weigh 300 or 400 pounds -- sometimes even in the 600- to 700-pound range. Or more.

That's because obesity rates for Americans have more than doubled since 1976. As the waistlines of Americans have grown, so too have the challenges for EMS personnel in cost, personnel, equipment, training, safety and transport protocol.

In the United States, 34 percent of adults and 17 percent of children were obese, while more than two-thirds of adults and almost one-third of children were overweight in 2007-2008, according to findings released in January by the Centers for Disease Control. Height and weight calculations determine who is considered to be overweight or obese.

Because being overweight or obese can lead to or exacerbate serious health problems, it's no surprise that Emergency Medical Service crews are caring for more of those patients.

"We've seen an absolute increase," said Todd R. Pritchard, operations director for Medical Rescue Team South Authority, which serves Baldwin Township, Castle Shannon, Dormont, Green Tree, Mt. Lebanon and Whitehall.

"Obviously this is not a scientific measure, but years ago patients who were 250, 300 pounds were rare. Now it seems every patient weighs 250, 300 pounds. We occasionally run into patients who are 500, 600, 700 pounds but they are few and pretty far between," he said.

"It definitely is a burden on the EMS system from a resources standpoint. It is not something we're not capable of dealing with, but it does take extra resources."

Pittsburgh EMS Chief Robert McCaughan, who has been in the emergency medical services field for 35 years, said that decades ago, bariatric patients "would be something we would see periodically but not with the frequency we are seeing these days."

In recent years, he said, the issue has become a regular topic of discussion and concern at EMS professional conclaves.

"This is a challenge the EMS industry is facing across the country and obviously not just locally," the chief said. "The bottom line is this is nothing specific to Pittsburgh or Allegheny County, but it's nationwide."

To deal with increasingly heavy patients, EMS equipment manufacturers have designed everything from higher weight-rated and wider stretchers to air-assisted lift devices to ambulance ramps and winches. The equipment makes moving and transporting bariatric patients more efficient and safer for them as well as for medics, who otherwise might suffer back and muscle injuries from lifting.

These changes aren't cheap.

Retrofitting an ambulance to accommodate obese patients can cost between $20,000 and $40,000, so services throughout the state have entered into cooperative agreements for use of bariatric transport equipment, said Joseph Schmider, director of Pennsylvania's Bureau of Emergency Medical Services. The bureau is part of the state Health Department.

Because of the increasing numbers of bariatric patients, Mr. Schmider said, upward of 50 specially equipped ambulances are in use throughout Pennsylvania, spread among 16 EMS regional councils. That gives the 1,017 state-licensed ambulance services access to them through cooperative agreements between agencies.

Ambulance services in Pennsylvania respond to 1.8 million calls a year -- or one call every 18 seconds -- but the commonwealth does not track the percentage of those calls that involves overweight or obese patients. Nevertheless, Mr. Schmider said, there are more than enough reports coming in from local ambulance services to know there has been a steady increase in the weight of patients.

"I've been in this business since 1978 and we never had bariatric ambulances back then. If there wasn't an increase, there wouldn't be a need for these special ambulances," he said.

"Bariatric patients are a challenge obviously because of their size. With the equipment we have now it is getting easier [to transport them] once we get them outside. Usually the hardest part on any call is getting the patient outside."

Chief McCaughan said his bureau spent an additional $12,000 in 2008 to retrofit an ambulance for bariatric patients because city EMS crews were caring for more of them. Purchases included ramps, a winch and a motorized, wider stretcher with a capacity of 700 pounds. Crew chiefs decide at scenes whether the specially equipped ambulance is needed.

"We saw the trend starting to increase and recognized the increased demands on personnel and the challenges the situation presented and certainly the potential for injury," he said, noting the bureau has responded to calls for patients in the 400- to 600-pound range.

The bariatric-equipped ambulance averages about 100 calls a year -- a small portion of the 57,000 calls handled annually by the bureau. Nevertheless, the expenditure was necessary and cost-efficient, Chief McCaughan said.

"It may seem like a lot of money, but the reality is with the potential savings in injuries and people being off work for shoulder, back, knee injuries it more than pays for itself. The key is, it's much safer for the patient and the crews," he said.

Southbridge EMS has spent about $20,000 to buy air-assisted lifting equipment and cots with 700-pound capacity and lifting capability. Operations manager Dan Miller said the equipment is needed in about 5 percent of the 4,500 calls the agency responds to in Bridgeville, South Fayette and Cecil.

"I've been in this field for 25 years now, and you used to have a particular patient or two you would encounter who were heavy," Mr. Miller said. "Now we see this more often in the category of needing lifting assistance.

"Typically, in the overweight area, we see people from 250 to 400 pounds. Every once in a while we may get someone over 400 pounds. Definitely the equipment has addressed the change."

Crews are trained to use specialized equipment and to lift safely. They also are advised to call for additional manpower from the agency and from fire and police departments if moving a patient is beyond their capability, he said.

Mr. Pritchard said over the last five to eight years, MRTSA has purchased stretchers with weight rates of 650 pounds, up from previous models that had a capacity of 450 pounds. The agency has entered cooperative agreements with Southbridge and Baldwin EMS for use of special equipment.

Usually, overweight patients can be transported simply by summoning additional personnel, he said. In the last year, special equipment was needed in only three of the 9,000 calls the service responded to; one of those calls was 500-pound patient's trip home.

"From a logistical standpoint, more resources are involved in moving an [obese] person. Maybe we'll need four people on the scene instead of two," Mr. Pritchard said. "It definitely adds some additional challenges.

"The average home is not designed for moving a patient under the best situation. In this area, there are a lot of steps. Sometimes the stairs are not wide enough," he said, requiring the service to use its special stair chair, equipped with tank-like tracks.

Regardless of the challenges, EMS officials said, their crews must treat overweight and obese patients with the same respect they would show any other patient.

In a 2007 article, the Journal of Emergency Medical Services provided "10 Tips for Transporting Obese Patients." No. 1 on the list: "Always treat the obese patient with dignity."

"You don't want to turn it into a spectacle by any stretch of the imagination," Mr. Pritchard said. "If dealing with someone over 500 pounds you may need to call the local fire department for additional manpower, but you don't want to make it into a neighborhood spectacle.

"You want to respect the patient's privacy and dignity so you keep it as low-profile as possible."

Many obese patients are embarrassed by their weight, he noted.

"They know they weigh a lot and know the challenges that presents us and some of them apologize," Mr. Pritchard said. "We tell them, 'Don't you worry about a thing. We'll get you there. We're here to help you."

Written by Pittsburgh Post-Gazette