Eye-catching headlines such as ‘Six-hour wait as 20 stone woman is trapped in home’ or ‘The very small world of Paul Mason, the world’s heaviest man weighing in at 70 stone’ are becoming increasingly frequent. Emergency services and healthcare staff need to be able to deal with these clients safely and efficiently when they become ill and need access to care, while maintaining their dignity and privacy.
In 2000, there was complacency concerning the issues surrounding moving and handling of bariatric patients. It was accepted that these patients were more difficult to move than the average patient and because of the increased weight, alternative methods were used. A blind eye was turned to the patient’s dignity when they arrived at hospital on the floor of an ambulance because they were over the safe working load for the equipment in the ambulance. Sadly, when transport home was being considered it was thought appropriate to go home the same way. Equipment capable of hoisting such a patient was not routinely bought as it was usually purchased for the majority rather than minority.
By 2004, there was a growing awareness and acceptance that bariatric patients should be afforded the same degree of respect and dignity as any other patient. Southend University Hospital NHS Foundation Trust began investing in equipment for the larger patient.
In 2006 a patient weighing 47 stone was admitted to the Trust with a history of respiratory distress. During their stay the patient managed to use the hand control to tip themselves out of bed. As this incident occurred during the night, staff felt justified in contacting the fire service to assist them in getting the patient back to bed despite the fact that the correct equipment was readily available.
When trying to organise a dignified discharge there were a number of problems to overcome. The ambulance service at that time needed the person to be sufficiently mobile to get into the vehicle independently. This meant delaying the discharge and blocking a bed space with someone who was well enough to go home but not sufficiently mobile to manage the distance they were required to walk. When approaching other transport companies there were still difficulties as their equipment was not designed for the transfer of patients of this weight. The dilemma the Trust was then faced with was how to get the client home in a dignified manner.
In an effort to address these issues and improve the service provided for bariatric patients, the Bariatric Working Group was set up. Representatives from acute care, fire, ambulance and community care services were invited to join the group in an attempt to work in partnership. The group looked at the care pathway of a bariatric individual through pre-admission, admission, internal transfers and discharge. It concentrated on ways of improving communication between multidisciplinary teams that consisted of transport staff, medical and healthcare staff, specialist advisors, the emergency services, equipment providers and social services. A practical exercise was organised as the group needed to establish how each discipline worked and what equipment they were able to access. Manufacturers of equipment were invited to bring products along as some of the difficulties were due to lack of access to appropriate equipment. This was due to a number of reasons:
- Lack of awareness of the existence of some of the equipment
- Lack of space on vehicles to store some of the items
- The cost of supplying items that may only be used occasionally was prohibitive
- There was little competency to use equipment
Another group exercise focused on confined spaces such as stairwells and bathrooms. The group were very grateful to the 35 stone volunteer who spent the day participating in various scenarios. This allowed the group to problem solve and use a lot of different equipment to evacuate the patient from the house onto a stretcher. A number of diverse methods were successfully tried and tested.
A third exercise was arranged by the group with the emphasis this time on the fire service. The aim was to remove a patient from a first floor flat. There were a number of willing volunteers to be the patient, however, due to health and safety reasons the volunteer on this occasion was a bariatric manikin. The manikin mimics the movements of a bariatric person and can be weighted to 159 kgs (25 stone). The fire service removed a window to allow the ‘patient’ to be evacuated on a cherry picker with the assistance of the ambulance service. This gave everyone the opportunity to problem solve together as the access to the building was difficult and some of the equipment was only used occasionally.
An awareness day was organised in an effort to provide a better understanding of the difficulties experienced when a patient is bariatric. Invitations were sent to chief executives and board members of each discipline’s organisation with the aim of encouraging agreement to sharing information, equipment and expertise to improve the management of the bariatric person in crisis. At present there is a lot of reluctance to sharing equipment for a number of reasons. These range from legal issues such as who is responsible for maintenance of the equipment to who has the expertise to use it. However, attendees had some very positive feedback and some were very keen to sign up to the prospect of sharing resources. The plan now for the working group is to work out:
- How to share equipment successfully
- Who purchases which items of equipment
- Where equipment is stored to give access to various disciplines
- Who is responsible for monitoring the use of the equipment
- Who is trained in its use and how
- Which other organisations do we need to include
Progress is steadily being made in this very sensitive issue.
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