The CDC reports that over a third (36.5%) of the adults in the United States are obese.[1] One of the most serious health problems this century faces, obesity is responsible for some of the leading causes of preventable death in the U.S., including heart disease, type 2 diabetes, strokes, and some kinds of cancer.[2] While many Americans are aware of these risks, other dangers bariatric patients – as well as their caretakers – face come in the form of an inability to accommodate for them in hospital or emergency medical settings. This article will highlight three of the biggest challenges both bariatric patients and medical staff face today when dealing with the repercussions of this very prevalent disease.
Difficulties with Emergency Medical Services
Emergency medical vehicles and teams are frequently not equipped to handle bariatric patients properly. Though there are special, larger ambulances intended specifically for transporting bariatric patients – equipped with a ramp or hydraulic system to remove the need for personnel to lift the patient and stretcher into the ambulance – there are not many, leaving the responders and patient to chose between waiting or using a vehicle that doesn’t safely accommodate the patient and EMTs.[3] Additionally, if EMTs are not properly trained in accommodating for the morbidly obese, they might have difficulties moving them, finding a pulse, inserting an IV, and resuscitating them.[4] Landmarks are difficult to identify during all procedures, and CPR is particularly difficult. [5] Airway management during resuscitation presents a particularly big challenge due to the increased soft tissue around the neck of bariatric patients, an enlarged tongue, and the potential for neck edema (swelling caused by fluid buildup) or subcutaneous emphysema (trapped air beneath the skin), which cause difficult intubations.[6] It will also likely require three people to ventilate a morbidly obese patient – two to hold the mask in place while the third ventilates – and will take much longer due to their decreased functional oxygen reserve capacity.[7]
Difficulties in the Radiology Department
When it comes to x-rays and imaging, most hospitals are simply not capable of fulfilling the needs of bariatric patients. A 2008 national survey found that only 28% of academic hospitals and 10% of nonacademic hospitals with emergency departments were equipped with CT scanners designed to accommodate bariatric patients.[8] Many cross-sectional imaging suites are not built to fit or safely maneuver morbidly obese patients, meaning longer turnover times and an increased risk for occupational injury to medical personnel.[9] Magnetic resonance imaging equipment (MRIs) have an even lower weight limit and smaller gantry than CT machines, and while an ultrasound can be used for immobile patients, they can’t guarantee a good image.[10] When examinations are cancelled because of a patient’s inability to fit into conventional CT or MRI equipment, the results can mean delayed diagnosis and treatment, and might force doctors to perform exploratory surgery, which, as explained below, is also full of risks.[11]
Difficulties of Surgery
Bariatric patients often have underlying health conditions that increase their risk of complications during and post-surgery, such as cardiac complications.[12] Obesity compromises the technical aspects of a procedure and requires the surgeon to manage preoperative and postoperative phases much more frequently.[13] Surgeries usually take longer, the operating fields are deeper, and the spaces in which an infection can set in are often greater and blood flow in fat tissue less, causing slower healing; for instance, obese patients are nearly 12 times more likely to suffer a complication following plastic surgery than normal-weight counterparts.[14] The difficulty of evaluating heart sounds and dealing with respiratory abnormalities can also create complications for surgeons during different procedures on obese patients.
These are just a few of the troubles both hospitals and patients face when it comes to accommodating bariatric patients. How can these problems be solved? Our next post will focus on just that.
[1] “Adult Obesity Facts,” CDC.gov, Sept. 1, 2016, https://www.cdc.gov/obesity/data/adult.html
[2] Ibid
[3] Cone, David, Jane H. Brice, Theodore R. Delbridge, and J. Brent Myers, Emergency Medical Services: Clinical Practice and Systems Oversight (West Sussex, UK: John Wiley and Sons, 2015), 410.
[4] Mulvihill, Emma, “Guidelines for the Care of Bariatric Patients” (Operational Policy, NHS Trust, June 2006), 10-11.
[5] Long, Will, Brett McGary, and Edward Jauch, “EMS Challenges with Bariatric Patients – Part 1,” Carolina Fire Rescue EMS Journal, July 5, 2011, http://www.carolinafirejournal.com/Articles/Article-Detail/articleid/1586/ems-challenges-with-bariatric-patients
[6] Mulvihill, “Guidelines”
[7] Ibid
[8] Dzmitry Fursevich, Gary LiMarzi, Matthew C. O’Dell, Manuel A. Hernandez, and William Sensakovic, “Bariatric CT Imaging: Challenges and Solutions,” rsna.org, March 11, 2016, http://pubs.rsna.org/doi/full/10.1148/rg.2016150198
[9] Ibid
[10] Abrams Kaplan, Deborah, “Challenges in Imaging Obese Patients,” diagnosticimaging.com, March 26, 2014, http://www.diagnosticimaging.com/practice-management/challenges-imaging-obese-patients
[11] Ibid
[12] Phend, Crystal, “Severe Obesity Impacts Surgical Care at All Stages,” MedPageToday.com, June 15, 2009, http://www.medpagetoday.com/surgery/generalsurgery/14707
[13] Jackson, Richard A. and James D. Perkins, “Risks and remedies when your surgical patient is obese,” MDEdge.com, October 2007, http://www.mdedge.com/obgmanagement/article/62867/risks-and-remedies-when-your-surgical-patient-obese
[14] “Surgical Complications Twelve Times More Likely in Obese Patients,” hopkinsmedicine.org, June 29, 2011, http://www.hopkinsmedicine.org/news/media/releases/surgical_complications_twelve_times_more _likely_in_obese_patients