Handling Bariatric (Morbidly Obese) Patients

[Chrisclark]

^ yeah but there is a big difference between a peron who says it is not my fault wile they are munching on Bacon and the peroson who takes in 1000 calories a day and still gains weight.

[Jess]

Lol I know that.

[NREMT-Basic]

The only "severely" barriatric I have been on so far involved removing a solid core door from its frame in the pts house, using it as a not very comfortable back board and tranporting in fire/rescue. I also agree that we should watch the comments about morbidly obese patients. Even those patients who have eaten themselves into that condition deserve care and respect. That is a serverely unhappy person. And contrary to popular belief, you dont just wake up one day, start over eating and then find that you weigh 1000 pounds. Thats a severe metabolic problem of one sort or another. A recent study in the Lancet (I think) show that most people would vomit or stop eating from discomfort long before the calorie intake necessary to get them 1000+ pounds. I have a neighbor that will either soon die, or become a patient who has to have the side of their house taken off to get her out of their, or to take her to the morgue. My feeling always has been that whether its a drug OD, a gang related GSW or a 1000 lb pt, EMS responders shouldnt be in the business of making judgements. We are here to help people as they are, no judgements involved. ALL patients deserve the same respect and level of care and to be treated without the rolled eyes and whispered comments on scene. If you must say something, bit your tongue until you get back in quarters. For me the same was true of the patient I helped with that was dying from anorexia/bulemia based cardiac failure. She is still human and gets our best effort and compassion.

[Chrisclark]

Agreed, but when you watch the biggest looser, you realize that people who are very, very big aare capable of being a very healthy weight.

[Timmy]

My feeling always has been that whether its a drug OD, a gang related GSW or a 1000 lb pt, EMS responders shouldnt be in the business of making judgements. We are here to help people as they are, no judgements involved. ALL patients deserve the same respect and level of care and to be treated without the rolled eyes and whispered comments on scene.

So True!

[weasel 108]

We have numerous "large" Pt's in our area( must be something in the air :roll: ) For a 911 call for one of these people,we will usually have our 2nd medic unit or one of our BLS units assist (even our chief/administrator comes out and helps). If we need more help or the other units are not available,then we call for the BRT(big red truck).

[emtpsaveu911]

Well I'd call the paramedics and let them deal with it; once they arrive I'd run around the corner and laugh at this poor pts misfortune and the facial expression the medics are giving each other... Joking...!

This kind of attitude is unacceptable. Not only is it immature but it is unprofessional. If you were on my truck and i caught you acting in such a way you would be sent home immediately/fired after the call. You can't even begin to know what it is like to walk in another person shoes. Now I know you said you were just "joking" but unfortunately this attitude is prevalent in EMS or society especially the male vs. female. It is more acceptable for a man to be more overweight than a woman.

I think this is like any other call that requires sensitivity such as mental illnesses your not going laugh at someone who says their going to kill themselves right in front of their faces or "around the corner".

You have no idea what it took for this person to get this big maybe it genetic, medicines, depression, overeating, or something like abuse.

My husband told me a story he heard in one of his classes (he has Master Social Work Specialty in mental health).

There was a girl who kept coming to school dirty and all the kids in the class made fun of her because she smelled. Finally one boy asked her why she didn't ever take a bath. And she simply told him it keeps him off me at night.

You never know why someone is why or how they are so don't judge so harshly.

sorry rant off/

[Timmy]

emtpsaveu911: Well what can I say… The obese patient I attended was treated in an extremely professional and timely manner taking into consideration the circumstances that presented. At no time did myself nor any of the crew ever criticize or make fun of the patient under our care in any way. We did our best to help this person in an effort to save there life. That patient received the same, if not more care than any other patient.

The crew I was working with even went above and beyond the call of duty, my crew was only the standby team so once the paramedics arrived and a handover was given we have no legal responsibly to stay with this patient, but we did. We even helped transport this patient to hospital which most certainly is not a volunteer first aid teams reasonability.

The comment I made in a previous post was out of twisted humour/sarcasm and I am deeply sorry if this has offended you in any way. Just for the record I would never do such a thing, it is cruel and inhumane.

Immature maybe, but I do not claim to be professional, just not yet anyway.

[NREMT-Basic]

Agreed, but when you watch the biggest looser, you realize that people who are very, very big aare capable of being a very healthy weight.

I think you might be oversimplifying the whole morbidly obese situation....alot. First of all, someone who cannot move out of their bed, or even off their backs, is not going to be out running hills with a personal trainer. Even if they could, it would probably kills them. Secondly, many of them cannot do medical weight loss simply because most MDs arent trained to deal with someone in that condition. Furthermore, the mental and emotional ramifications of being 1000 pounds are inconceivable to anyone who isnt there. Why do so many men that get to be that weight let their hair grow long? Because they are embarrased for anyone except their spouse or live-in caretaker to see them. Then rely on someone else for everthing? Yes, the food they eat. But also, their hygiene needs, actually figuring out a way to change their bedding and keeping them from get compression sores and just plain trying to keep them alive. Besides these folks are generally not celebs and so can afford all that goes along with supervised weight loss and arent going to be asked to on Biggest Loser, so thats just a silly comparison, like saying that we treat somebody with 95% blocked arteries the same as someone who ate the wrong thing as christmas dinner and has some treatable angina. There are so many stigmas and misunderstandings and misinformation that go along with being that heavy that most of the morbidly obese would rather die in bed due to a massive MI than call 911 because they have done that before and have heard the snickering and gotten the weight loss talks from EMS (many of who shouldnt talk about weight to anyone) and heard the insults "around the corner." They are patients. End of story. If you dont like dealing with them then get out of EMS because as sure as you are running calls, you will get a massive bariatric call one of these days soon. The one I got was during my clinicals. And guess what, you darn well better think about the complications of trying to resus a patient with morbid obesity because they are quite likely to crunk from the effor they expend trying to help the rescuers move them. These fine folks deserve out most complete compassion. Their lives are already hell. The one I have gone on so far hadnt been out of the house in 9 years. That would be enough to get most of us to put a bullet through our heads. So when you eventually roll on one of these, talk to your patient, ask them their name, and how they are doing today (besides rotten for having to call EMS). Believe me they feel bad that you have to try to get them out of there. The pt on my call kept apologizing all the way to the ER. They may be an obese person, but they are a person. Be happy that they called for help instead of laying there dying. I may be just a basic but I have a rule about patients: they all deserve our help even if they call us during a mental crisis mostly so somebody in their lives hears them and so they all deserve the best we have. Of course we all use black humor to relieve tension from time to time. We have to. But never, ever in the presense of a patient. I agree with the poster that said that he would fire somebody that made jokes or flip comments about a patient. I would go one further and say that I would find room for my morbidly obese patient by throwing a smart a** under the wheels of the rig. Keeping up on a call doesnt just mean moving fast and anticipating the needs of patient and medic. It also means re-adjusting your attitude for every single call, even if it means a boot in your butt from your Ops Manager to do it. WHen i was in EMT school, we were shown a bunch of slides of patients with embarrassing problems of all sorts (mocked up of course). My medic preceptor told us at the end, if you cant control your snickering and see the patient and not just the problem that they may or may not have gotten themselves into "leave now." A recent patient of mine had his hand stuck in a counter mounted meat grinder because he tried to push the last of the hamburger through with his thumb. Dumb move I will grant you, but I bet he knew that before we arrived. A sense of humor is vital. A sense of humor at the expense of your patients dignity is not. One of our biggest jobs is patient advocacy and you cant properly advocate if you think your patient is a circus act. Sorry for the rant and rave, but I have no tolerance for disrespect of patients. Not just a little bit, not ever. If I never advance past Basic, I will be proud to have brought respect and dignity to the work I do. Put yourselves in their position. FOr me, thats part of scene size up: ok this really sucks and even looks stupid, but how would I want to be treated if this were me, because for alot of types of calls, it could be you anyday. Remember, be kind to your webfooted friends, for a duck may be somebodys mother.

[emtpsaveu911]

Timmy--if you read my post clearly i recognized the fact that you were just joking, I was merely addressing this on a higher level of insensitivity among caregivers and the regular public. I'm glad that the crew you were on handled this well. I'm sure this pt will remember you for your kindness.

I was mainly addressing some of the negative remarks that i was reading about obese pts and the statement you made, although just joking, seems to be how a lot of people feel about these types of patients. And not just patients, obese people in general.

I was using your quote to make a point but my point was not necessarily at you. But anyone who might treat or have neg. attitudes about patients like yours. So i'm sorry if i sounded like i attacked you i really didn't mean it to sound that way. Just take as it was meant to be -advise.:wink: