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.
In his article, Berger cites a survey of 1,356 members of the National Association of Emergency Medical Technicians that found that nearly one in two medics sustained a back injury while performing EMS duties. Most blamed their injuries on lifting extremely heavy patients.
The strains to the system are also financial. Hospitals have to invest in extra wide beds, wheel chairs, patient lifting devices and extra staff to help lift and transport patients. A special bariatric lifting device, called the Titan X, costs about $18,000. According to the press release, "global sales in bariatric stretchers and lift systems are expected to soar in the next five years."
"I'm not certain this is creating a crisis yet, but it is something we need to plan for and address with newer equipment," said Dr. Charles Emerman at the Department of Emergency Medicine at the Cleveland Clinic.
Goldman suggests that hospitals and EDs will need to have more gurney and CT capability for obese patients, new equipment and more staff -- all of which requires capital.
"Who will pay for this?" he asked. "Hospitals may need a new revenue source."
Another doctor, who requested to remain unnamed, urges individual responsibility.
"The American public must take more personal responsibility in taking care of their health," he said. "Our society needs a cultural shift where employers provide time to take care of oneself and one's family.
"Food portions in restaurants and other venues need to be halved. If we do not do these things, our children and their children will pay a heavy price."