Fat people, stairs and backs

The EMS Theory of Weight: The weight of a patient that you are about to transport increases by the square of the sum of the number of floors which must be ascended to reach the patient plus the number of the floors which must be descended while carrying the patient.

• Corollary 1: Very heavy patients tend to gravitate towards locations which are furthest from sea level
• Corollary 2: If the patient is heavy, the elevator will be broken, and the lights in the stairwell are out
• Corollary 3: The further the distance from sea level, the iller the patient will be

"48 year old female, keeps fainting, patient is obese, weighs 35 stone"


On receiving this job, and physically hearing our backs scream 'Nooooooooo!'three things were going to be absolutely certain about what was going to happen.

1. This was going to take ages
2. This was going to hurt
3. She was without doubt, going to be upstairs

As predicted the patient was upstairs, and not just upstairs, up 4 flights of stairs. The corridors in her flat were winding and narrow so extrication as predicted would take ages.  I've never seen someone so large in person. Ive seen people on the usual TV programmes but this was absurd. How can anyone let themselves get like this? She was pale and sweating, and looked ill. She was indeed fainting, every time she sat up in fact. Her list of ailments was as long as my arm and exactly what you'd come to expect from someone that size. Heart failure, diabetes, hypertension, high cholesterol, bed sores, the list goes on and on. It transpired that she hadn't left her bedroom for 4 years. Well, that was about to change!

After giving her the full MOT including ECG (I will be scarred for life) it was clear she had to go to hospital. The problem being was how? She was too big and heavy for our chair (and impossible to lift) and was too heavy for our trolley bed. She also a) couldn't walk and b) fainted when she sat up. We contacted control and arranged for the bariatric ambulance to be dispatched. The bariatric ambulance has special chairs and beds for such situations but cost a lot of money. For the ambulance alone it's about £100,000, special cushions cost about £2,500, stretchers are between £7,000 to £10,000 while reinforcing vehicle tail-lift costs about £800 per time. Heavy duty wheelchairs cost at least £400 and hoists are £4,500 a time, however, all of this was useless as she needed to be kept flat, so there was only one thing for it. The fire brigade and a crane!

This is obviously not our patient!!! That would break the rules!!

In all their glory the fire brigade arrived, kitted up, erected cranes and ladders, removed the double glazed windows and then assisted us to get the patient into a bariatric scoop. Inevitably, by the time she was craned out the window a rather large crowd had gathered. Obviously, I was thriving on this but it was mortifying for the patient. With strict instructions as to how I wanted her removed she was craned down to us, and onto the aforementioned £10,000 bed. To cut a long story short, we got her to hospital, my back still in one piece and the patient still alive, but at what cost? We had been on scene for over 5 hours, as had the FRU. We had the bariatric ambulance and the fire brigade as well of the cost to put her windows back. I'd imagine the fact that she was in a 2nd floor council block and hadn't left the house for so long meant she was on all the benefits available to her. The only cost to her today was her dignity and health. 

At what point did society allow gluttony to become a disability? I am NOT talking about those among us, me included who are overweight or even obese. Those who live to excess, enjoy the nicer things in life and don't care. You can do all that and still be relatively health. You don't need a crane though. When your size means you cannot work THAT is to much. At what point will something be done to stop this growing trend? Do we just throw specialist equipment at the problem? Whatever next? Call in the Army with a Chinook helicopter to replace the inadequate air ambulances? The only way people will learn is in their pockets, if the NHS doesn't fund obesity treatments and stops offering gastric band surgery like paracetomol maybe there will be an incentive to self-help. There is also a financial cost in sick leave to staff. Every single day, ambulance staff go off on long term sick due to back injuries from lifting obese people up and down stairs. This isn't an assault on the overweight. Far from it. People can function being overweight, they can do most jobs and can be self sufficient but it becomes a problem when the ability to do every day functions is compromised. When someone becomes reliant on others due to greed and excess that is where the line has to be drawn. Being classed as disabled, not being able to work, walk, shop or wash because of indulgence is not acceptable, nor is relying on ambulance staff to carry you up and down the stairs.

I'm sure some people will be offended by this stance but quite frankly, I don't care. I know that morbid obesity is an illness, like alcoholism, but they are both avoidable & they are both lifestyle choices. People are born with all sorts of incurable diseases, cancer can grip anyone at anytime but no one is born morbidly obese. It's nature vs nurture where nurture has won. There may well be social and psychological reasons behind peoples obesity and I look at that in 'Obesity: The cause, the cost, the solution'. but that doesn't exempt them from blame or responsibility. I'm not suggesting they don't deserve the same high standard of treatment everyone else gets, I'm saying we must find a prevention rather than a cure.