Bariatric Assist

In 2007 a movie called “I Now Pronounce You Chuck and Larry” was released. Adam Sandler and Kevin James played firefighters. In one scene a mother rushes out of a burning building. She tells them to save her son. They rush in to find her son. He is upstairs lying in his bed. He weighs about 800 pounds. When they ask him if he can stand, he responds “I haven’t been able to stand in five years.

What follows is a comical rendition of them trying to evacuate him from a burning house. In the end they use a forklift to load him into an ambulance. The entire thing is played for laughs. Unfortunately, we have a lot of individuals who have morbid obesity. Emergency calls to aid them becomes no laughing matter.

A recent article from England looks at this issue. In 2023 the number of “bariatric assist” emergencies was at 2,342. Bariatric assists occur when a patient exceeds 300 pounds.

This creates a number of additional problems. For example, if there is a fire emergency like the one in the movie, rescuers might be tied up with one individual. That might not make them available to assist others.

Another issue is that transport may not be possible in a normal sized ambulance. Therefore, larger ambulances will have to be made available. The movie made fun of a forklift loading the patient into an ambulance. However, special lifting equipment for these individuals is a reality. Even loading them onto a normal stretcher might be a problem because of size.

The other set of problems occur because of the issue related to patient physiology. Patients who are morbidly obese are more likely to become ill. That means they are more likely to require emergency transport.

Their size presents some unique treatment challenges. One of those is that maintaining an airway can be more difficult. The excess tissue around the neck makes visualization of the airway more difficult. It can be difficult to get a good seal with a face mask if emergency oxygen is required. The position of the head to ensure adequate airway opening can be difficult. Thus airway presents special challenges in these patients.

Due to the amount of tissue on the extremities, veins are often very difficult to find. That might be even more likely in emergency situations. The veins collapse further when circulation is not good. Thus, getting adequate IV access becomes an issue.

Special training courses have been developed to help emergency responders provide needed care in bariatric assist emergencies.

In the movies we laugh at people who have problems because of their obesity. In real life the problems still occur but they are clearly not something to laugh about.