European Ambulance Services Handling Large Patients

Ambulance services face special difficulties when rescuing extremely overweight patients from Europe's blocks of flats, especially from old-fashioned tenements with narrow doorways and no lifts.

Every minute counts when the patient is unconscious or has had a stroke or heart attack, but getting a 300-kilogram man out of an upper-storey apartment into a waiting ambulance can take hours.

"A few years ago, we only dealt with such cases maybe once a year," says Peter Braun, spokesman for the emergency service in the port city of Hamburg, population 1.7 million. "These days, such missions have built up to an average of once per month."

Mostly, the emergency crews are seeing the patient and the apartment for the first time, and have to figure out a solution fast, when death may otherwise be imminent for the patient.

"Very large patients usually need five times as long to be brought out of their homes," says Braun. "The problem is not so much carrying the great weight as the sheer volume of their bodies."

Standard stretchers are only designed for patients with a maximum weight of 160 kilograms. Staircases are often too narrow. And the ambulances themselves are often too small for the patient to fit into.

"Often the crews only realize that there are special requirements when they reach the scene, and have to call for heavy-duty equipment, costing extra time," says Braun, whose service has stocked up with items that can be used in rescue of very large patients.

"We have some home-made methods. They're not particularly elegant, but they get the job done," Braun says.

Usually the rescue service sends round a mobile crane, a truck carrying a sturdy hospital bed and an extra-large ambulance.

The bed is loaded onto a steel platform which the crane hoists up to the window-ledge of the patient's apartment.

"We carry the patient out the window and put them on the bed," Braun explains. But sometimes a crane cannot be driven close enough to the window or the window is too small. Then the ambulance crew has little choice: the patient must be dragged out.

"We slide them on special tarpaulins," says Braun. Being squeezed through a doorway can be painful for the patient, and manhandling a stout patient down stairs can be heavy going for an ambulance crew.

Elevators are usually only installed in high-rises or the more modern apartment buildings.

In another German city, Hanover, rescuers tried this year to recover a collapsed, 300-kilogram man from a fourth-storey apartment using a fire-brigade ladder truck, but had to give up and call in a 60-ton-capacity crane.

Rescue services are conscious of fact that they must be respectful towards heavy patients and not discriminate against them.

"There are significant ethical issues we have to work through," says Silvia Darmstaedter of the German Fire Brigade and Ambulance Federation in Berlin.

There are also concerns over the increase in the number of these difficult missions.

"We don't have any precise figures. But it seems to be mainly a phenomenon at big-city services," says Darmstaedter.

City of Berlin rescuers discuss their call-outs in an internet forum and swap ideas on how to handle very large patients.

In Germany, rescue services are paid a fixed price by health insurers for each call-out and cannot recover the enormous extra costs of deploying several crews for a single patient along with all the heavy-duty equipment.

Braun in Hamburg forecasts a further rise in the number of these call-outs.

"Obesity is increasing generally in the population," he says.

World Health Organization (WHO) figures show that between 25 and 75 per cent of Europeans are to some degree overweight, or nearly 400 million people. While few tip the scales at 300 kilograms, the trend is there. dpa jbp

News stories provided by third parties are not edited by "Site Publication" staff. For suggestions and comments, please click the Contact link at the bottom of this page.