Wednesday 2 November 2011

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. 








8 comments:

  1. Interesting post. As a size 20/22 and nearing 40, I'm getting more worried about my health than ever before. I've crash dieted, lifestyle changed and exercised maybe around eleven stone in my adult life (skinny as a teenager) and put on around 13. I'm tall, so even at a size 12 I was around 11 stone. I'm one of those girls who wore their weight well, remained active and enjoyed life. I eat too much. Some weeks I will eat very healthily, some weeks I will binge on junk but I always just eat too much of whatever is going. I haven't attended a gps surgery since 2007, when I had a chest infection. I'm very careful as far as dangerous activities as I know there aren't many people around to help me if I fell. I don't feel weight is an economic issue, look at Queen Victoria, a right pudding. Its a support issue. We used to live in communities, where noone got away with much, as there was the Sunday scrutiny of church or the Social Club. People didn't have much, but what they had was shared and the single person phenomenon is a relatively new one. When nobody's watching us, whether its a Mum who can't say no, because she's lonely or an isolated gamer with no-one to say, 'enough' nothing is forbidden and too much is never enough. There isn't a damned thing that can be done about this at a government level, because its environmental, but they will try, with penalties and taxing an already taxed out society..wonderful thought provoking post. Just my opinion of course

    ReplyDelete
    Replies
    1. I think most people do what you do and what I do! Enjoy the niceties in life, good weeks, bad weeks, each crap, drink to much and have fun but all the while remaining relatively active and healthy. Like you say, no really government policy will change it, just make it more expensive! Thanks for the comment!

      Delete
  2. If it wasn't for fat people and their associated illnesses (though I am not convinced they are any more than 'thin' people who drink, smoke, play sports etc) using the NHS, people like you wouldn't have a job. Don't bite the hand that feeds you.

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    Replies
    1. I'm guessing you are the same 'anonymous' who posted on my other post. There is a big difference between being overweight and being clinically obese to the point of being craned out of a window. It is ignorant and irresponsible to suggest fat people are keeping me in my job. RTCs, cardiac arrests, heart attacks, strokes, maternity, elderly fallers, trauma, diabetes, asthma, COPD, anaphylaxis, work injuries, meningitis, chest infections, broken bones. Do you REALLY want me to carry on?! Alcohol, drug overdoses, drug users, collapsed behind closed doors, GP referrals, hospital transfers, assaults, stabbings, shootings, sexual assaults, sepsis, D & V, UTIs, urine retention, CA patients, burns. Do you REALLY need more?! I will stop, but my point is, there is plenty of work for me to be doing. That is if my back holds out. People can eat what they want, when they want, be whatever size they want. It is personal choice just like smoking and drinking but when those personal choices directly effect others and cause unnecessary expenditure to the already struggling NHS then it IS a problem.

      Delete
  3. When it comes to the point where a fat person loses mobility to shop etc. and has to stay in bed most of the time, then someone must be feeding them. I have even heard rumors that social workers get involved in this. So the blame is not always on the fat person but also on other people as well. If you don.t stuff them they wouldn't get to the crane stage.

    ReplyDelete
    Replies
    1. You are right, it's not always just the patient. There are 'feeders' to who get a thrill from seeing them eat.

      Delete
  4. One of the problems with obesity is the govt (and NHS) advice:

    "Base your meals on starchy foods"

    Even back in 1863, William Banting knew that starchy foods led to corpulence. In 1983 Britain followed the USA's advice and 'u-turned' its dietary advice.

    Net result - Obesity has skyrocketed.

    The biggest problem is, the starchy foods that we are told to eat are pretty addictive and affect the brain in the same way that opiates do.

    I used to be a fatty who lost 3 stones by cutting out processed crap and eating real food that doesn't require ingredient lists.

    There is no money in telling people to just eat real food though - less markup due to less processing. And whilst the government and, by association, the NHS are in bed with the junk food manufacturers and pharma, it will always be the case that we will get fatter and more ill and thus cost the NHS more money.

    Absolutely loving reading your blog! Just found it today and started at the beginning!

    ReplyDelete
  5. One of the problems with obesity is the govt (and NHS) advice:

    "Base your meals on starchy foods"

    Even back in 1863, William Banting knew that starchy foods led to corpulence. In 1983 Britain followed the USA's advice and 'u-turned' its dietary advice.

    Net result - Obesity has skyrocketed.

    The biggest problem is, the starchy foods that we are told to eat are pretty addictive and affect the brain in the same way that opiates do.

    I used to be a fatty who lost 3 stones by cutting out processed crap and eating real food that doesn't require ingredient lists.

    There is no money in telling people to just eat real food though - less markup due to less processing. And whilst the government and, by association, the NHS are in bed with the junk food manufacturers and pharma, it will always be the case that we will get fatter and more ill and thus cost the NHS more money.

    Absolutely loving reading your blog! Just found it today and started at the beginning!

    ReplyDelete

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