Bennett said hazards arise for both the patient and EMS responder when weights exceed 300 pounds, including injuries to both parties that for some EMS workers means near career-ending injuries and long-term time out of the job.
From 2003 to 2012, Ohio firefighters submitted an average 435 claims each year for back sprains on the job, according to 10 years of data from the Ohio Bureau of Workers’ Compensation. In 2012, more than 40 percent of firefighters’ injury claims were due to overexertion or repetition, according to the data.
Among injuries and illnesses to EMS workers, sprains and strains were the most common diagnosis, according to the most recent Centers for Disease Control and Prevention data from 2012. The greatest portion of injuries/illnesses involved bodily reactions and exertion — with almost half of the overexertion and bodily reaction events specifically identified as overexertion during lifting.
While the rate of obesity has remained stable in recent years, those patients are becoming “more and more frequent,” said Fairfield Twp. Fire Chief Timothy Thomas.
Weight that is higher than what is considered healthy for a given height is described as overweight or obese — often measured by a Body Mass Index of greater than 30, according to the CDC. Nearly 35 percent of adults — 78.6 million people — and 17 percent of children — another 12.7 million people — are obese, according to the CDC.
The Fairfield and Fairfield Twp. fire departments are just two examples of local departments that have pursued grant funds to purchase more specialized equipment for lifting and treating bariatric patients, including power cots and power stair chairs to limit the amount of lift for firefighters and paramedics.
“We want to get to as much as a zero-lift as possible; it’s hazardous to us and the patient,” Thomas said.
Thomas said his department has garnered more than $64,000 in grant funds for specialty equipment, including three power cots with a weight capacity of more than 700 pounds and about eight extra inches of width. The power cots are a loading system with ramp that uses a 12-volt motor to pull the cot up.
“People don’t come with handles,” Thomas said, adding some patients in a residential setting are in tight settings and unable to assist in their own movement.
Edith Evans, 59, of Hamilton, said at her heaviest she weighed more than 350 pounds. In the past five years, she’s averaged at least one trip a year in a life squad due to severe asthma and blood clots.
“The gurneys are not compatible,” Evans said. “Part of you is there, but the rest of you is hanging off. You’re squeezed into it and can’t move, and it can be miserable.”
Evans said she’s even been refused help from a private ambulance that arrived to pick her up once — something she said hurt her a lot.
Evans said she would like to see more ambulances better equipped to transport patients of all sizes by having larger gurneys, more room and greater stability inside the ambulance.
“I know it’s going to cost more money, but we’re just as entitled to help as a thinner person,” Evans said, adding ambulance rides are covered by her insurance.
The Fairfield Fire Department has spent $25,000 from the city’s capital improvement fund to purchase three powered stair chairs, Bennett said. He’s also waiting for the delivery of three power cots through a $125,000 Assistance to Firefighters Grant.
Bennett said his department now experiences more lost-time injuries from moving patients than responding to structural fires. He said he’s seen near “career-ending injuries” that are typically orthopedic, involving wrists, shoulders and knees.
“Previously we used a friction brake to get people down (stairs), but we couldn’t use it to get up,” Bennett said, resulting in the need to physically lift the patient.
When a firefighter or paramedic is injured on the job, recuperative pay is available for up to a year, which includes full benefits and pay. Bennett said one time three workers were injured moving the same bariatric patient.
Evans’ daughter Sarah Keller said her mother has a few steps leading out of her home and the paramedics would sometimes have to carry her mother down the steps.
“The wear and tear on their bodies and they can have back-to-back calls,” Keller said.
Evans said she’s dropped 108 pounds since a bariatric weight loss surgery in March 2014.
“Since I’ve lost the weight I can do a lot more,” Evans said, especially activities with her grandsons, ages 3, 6 and 8. “I was like a prisoner in my own home.”
Shared resources
Thomas said in order to be the most economical with taxpayer dollars, a Butler County Bariatric Squad Collaborative was formed in 2014 through the Butler County Fire Chief’s Association.
The fire departments in Fairfield, Oxford, Hamilton, Middletown, Monroe, Fairfield Twp., Ross Twp., Liberty Twp., West Chester Twp., and the St. Clair/New Miami life squad now share in the cost and use of an ambulance equipped with nearly $30,000 in specialty equipment.
“There’s no substitute for having the right equipment to take care of a patient 600 to 700 pounds,” Thomas said.
He said because the equipment is not needed on a daily basis, it would not have been economical for each fire department to individually purchase the powered cots and stair chairs.
“How do we provide the service in an economical way? Buy the specialty equipment and share it,” Thomas said.
The 10 participating departments each paid $1,451, which covers the cost of ambulance maintenance, Thomas said. The unit has been on 26 calls since January.
Along with a bariatric cot and stair chair, the ambulance also has two bariatric stretchers that are flexible and have multiple handles; transfer sheets with additional handles; and a transfer ramp.
“The less lifting the safer,” Thomas said, adding the average patient is lifted at least twice by crews. The equipment alone weighs about 70 pounds.
Thomas said one of his part-time firefighters sustained a twisted back lifting a bariatric patient and was off work for a year while healing. He’s also seen torn rotator cuffs in the shoulder, wrist injuries, strains, disc sprains, and pulled muscles.
West Chester Hospital recently donated $20,000 to the collaborative group to purchase a Hover Jack Air Patient Lift and EZ Glide Evacuation Stair Chair.
The new equipment will be utilized to lift patients onto gurneys, hospital beds, and up and down stairs without injuring the patient or EMT, according to the hospital.
“It’s something that’s truly needed in the area,” Bennett said of the county-wide bariatric unit.
Those 10 departments can request the bariatric unit through emergency dispatch. Every time it’s dispatched out, the requesting department pays a $25 maintenance fee.
Thomas said if a non-member fire or EMS squad requests the unit, they pay the basic EMS call fee of $450. If a non-member requests the unit enough times to add up to $1,451, they will automatically become a member.
Hospitals also face challenges
Area hospitals — including West Chester Hospital, Mercy Health - Fairfield Hospital, Fort Hamilton Hospital and Atrium Medical Center in Middletown — have access to bariatric patient beds and other equipment.
“It is a challenge a little bit more to assess and treat patients markedly overweight,” said Dr. Kevin Joseph, president, chief executive officer and emergency physician at West Chester Hospital.
Joseph said anything from the physical examination to moving the patient from a cot or gurney to a CT scan or other machine is a challenge. He said it’s also harder to start an IV line or reduce a fracture because the typical landmarks used on the body are harder to distinguish.
At West Chester Hospital, bariatric wheelchairs, mechanical lifts and even an ultrasound can all be used to find veins to treat larger patients, according to Joseph.
The hospital has a mobile lift that can be moved from room to room and across departments, depending on the need. The hospital staff also gets advanced notice from the responding EMS crew when a larger patient is on the way.
“We have additional experience and certification working with these patients,” Joseph said. “As technology advances, the equipment will be upgraded.”
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