Big Rig: A Profile of Memphis Fire Department’s Bariatric Ambulance

Bigger is not always better. Just ask any EMS provider who's had a back injury after trying to lift or carry a bariatric patient. And, unfortunately, there only seems to be increasingly more bariatric patients these days.

The Memphis Fire Department is just one system among many dealing with extra large patients, but it's been proactive in trying to better accommodate those patients and protect its providers. A little over two years ago Memphis Fire rolled out its first bariatric ambulance. Recently, a second bariatric unit was added, though it's yet to be deployed.

The need for another bariatric rig is certainly there. According to Deputy Fire Chief Gary Ludwig, the department's first truck is going on an average of three to four calls per week. The heaviest patient transported to date was a 1,165 pound woman. While the cost to retrofit the ambulance for larger patients was $7,500, but the department projects more than $150,000 in savings on workman's compensation claims, says Ludwig.

Read on for more information about how Memphis Fire utilizes its bariatric ambulance.

• All personnel are expected to maintain professionalism and the patient's dignity when dealing with bariatric patients.
• It's the responsibility of unit personnel to determine if the bariatric ambulance will be required for patient transport. Some indicators that may require a bariatric unit are:
  • The patient's weight exceeds 500 pounds.
  • Their physical condition as well as the abilities of the patient.
  • The capabilities of the available personnel.
• If the patient's size prevents them from being safely secured to a regular stretcher.
• The bariatric unit shall be utilized for patients with a stable medical condition. All unstable patients or patients whose condition warrants immediate transport to the hospital shall be transported as soon as possible.
• When requesting a bariatric ambulance, the on-scene firefighter/paramedic shall make the request through the incident commander. If command has not been established the firefighter/paramedic shall make the request from dispatch.
• Upon dispatch to an incident, the bariatric ambulance and an engine from the same station shall operate as task force and all responses to any scene shall be without lights and sirens, obeying all traffic laws. If the designated engine is out of service, the closest engine or truck company will be dispatched to pick up the bariatric ambulance and operate as a task force to respond to the requested scene.
• Upon arrival at the scene, the ambulance crew that originally responded on the call and initiated care will continue the patient care and transport the patient to the hospital utilizing the bariatric unit.
• The alarm office shall dispatch a company or companies for manpower as needed upon request from the incident commander or on-scene firefighter/paramedic.
• The designated engine, or if another company was dispatched to pick up the bariatric unit, will bring the original unit and the engine/truck to the hospital that the bariatric unit takes the patient to and assist with the unloading of the patient.
• Upon completion of the transport, the bariatric unit shall return to its base station to be re-stocked and returned to a response-ready state.

Patient Loading and Unloading Procedures

• Anytime a bariatric patient is on the stretcher, the stretcher will remain in the lowest position (loaded position), the mattress pad and a transfer device will be utilized and all patient straps will be secured.
• The loading ramps will be properly installed and secured before loading and unloading.
• Patient loading and un-loading utilizing the loading ramps will be accomplished using the loading winch only. The loading winch will be powered in and powered out during loading and un-loading of the patient, NO FREE-WHEELING.
• When loading and unloading the patient up or down the loading ramps, at least four personnel shall remain on the sides of the loading ramps (two on each side) to ensure the stretcher remains stable and aligned on the loading ramp.