Obese and Super Obese Patients Challenge Emergency Medical Care Providers

From ACEP:

Obese patients are presenting new challenges in emergency care, from burdening patient transport systems to complicating diagnosis and treatment. As rates of obesity and super obesity accelerate, emergency departments struggle to cope (“Emergency Departments Shoulder Challenges of Providing Care, Preserving Dignity for the ‘Super Obese’”).

“Higher levels of obesity will lead to more people getting sick with heart disease, hypertension or diabetes and coming to the emergency department,” said Dr. Theodore Delbridge, chief of emergency medicine at Pitt County Memorial Hospital in Greenville, North Carolina. “Clearly the obesity epidemic is having an effect on emergency department care. The steady increase in obese and super obese patients creates pressures across the entire spectrum of patient care, from ambulance capacity to proper drug dosing.”

A survey cited in the article finds that the emergency department has been the most affected area in hospitals by the growing population of obese patients.

Super obese patients present the greatest difficulties to emergency medical care providers, from pre-hospital care through hospital admission. Patients who weigh more than 400 pounds may require bariatric ambulances, which are rare due to their high cost. In addition, EMS workers typically only lift 100 pounds, meaning a larger patient will require extra personnel. Nearly half of surveyed EMS workers reported back injuries related to lifting extremely heavy patients. Global sales in bariatric stretchers and lift systems are expected to soar in the next five years.

In addition, super obesity may create complications in diagnosis and treatment because of difficulties with blood draws, lumbar punctures or imaging machines such as CT scanners. Drug dosing poses additional dilemmas since, for most drugs, there are few clinical studies on proper dosing for very large patients.

Between 1986 and 2000, the prevalence of super obese patients has increased by a factor of five, from one in 2,000 to one in 400. Seventy-eight percent of hospitals reported an increase in the admission of severely obese patients in the last year, a trend that seems likely to continue.

“The bottom line is that this trend is not going away and emergency care providers will have to find ways to optimize care,” said Dr. Delbridge. “Emergency physicians adapt to all kinds of changes in our patient population and this is no different.”