Extra wide beds, stronger toilets and special patient lifting devices are becoming more and more common in emergency rooms. The reason for such new equipment? Hospitals across the United States are struggling to handle increasing numbers of extra-large patients.
And as the country's rates of obesity and "superobesity" continue to climb, many worry that such accommodations will put an increasingly heavy toll on an already strained emergency services system.
"The major burden on the emergency system is on prehospital care," said Dr. Jay Goldman, national medical director of Ambulance Services/EMS for Kaiser Permanente in California. "Extricating these patients from crashes takes longer, is more difficult, and moving them from their homes to the ambulance, down three flights of stairs, is dangerous to providers."
Eric Berger, whose article on the topic was published this week in the journal Annals of Emergency Medicine, described an extreme case in 2003 when 22 Cleveland firefighters and emergency workers spent two and a half hours removing a 772-pound woman from her townhouse through a door that was too narrow.
Some communities have had to invest in special bariatric ambulances -- trucks equipped with hoists and special stretchers to transport patients weighing up to 1,100 pounds.
"Occasionally the fire department may be called in to help remove a patient via cherry picker because they cannot be brought through the stairwell," said Dr. Shelly Jacobson, chair of emergency medicine at the Mount Sinai School of Medicine in New York.
The obesity epidemic sweeping the country affects children and adults alike. According to the American Heart Association, 16 percent of all children and teens in the United States are overweight and 65 percent of adults are overweight or obese. Since 1991, the prevalence of obesity among adults has increased by more than 75 percent.
This rise in obesity causes health problems in and of itself. Obese patients are more likely to have health problems such as heart disease, high blood pressure, diabetes and liver disease, all of which can be life threatening. Obese people are likely to become sick and present themselves to emergency rooms, threatening to exceed the capacity.
Diagnosis and treatment of obese patients is also a challenge.
"Imaging can be difficult, or at times impossible, as this patient may not fit into our CT and MRI scanners," said Jacobson.
CT scanners and MRIs have weight limits of around 250 pounds. Heavier patients are unable to access these scans prompting calls to local zoos for the use of their animal scanners. Patient size also limits the quality of the image obtained.
"Evaluations are further hindered by the patient's immobility and poor venous access for IV fluids and for obtaining blood samples," said Jacobson. Figuring out the appropriate drug dosage can also present a problem -- for most drugs there simply aren't good clinical studies on proper dosing for very large patients.
Obese patients are at risk for serious complications and poor outcomes not just because of their size but also because of the limitations obesity places on the ability of health care workers to take care of them. EMS workers and hospital staff suffer from back pain and other injuries sustained while attempting to move superobese patients.