By Tracey Barron
A presentation at the Research Forum power session held at NAVIGATOR 2014 demonstrated a forward-thinking principle behind protocol development.
The topic—one of five briefly discussed in the two-hour session moderated by IAED Director of Biomedical Informatics & Research Chris Olola, Ph.D.—was one near but-not-so-dear to an increasingly larger segment of the world’s population. The magnitude of the problem has been described by the World Health Organization (WHO) as one of the most significant health problems and, consequently, directly affects the delivery of emergency medical services.
I’m talking about the bariatric (morbidly obese) patient. Greg Scott, Brett Patterson, and Dr. Jeff Clawson gave the presentation, “Challenges with Bariatric Patients in Dispatch,” during the Research Forum power session.
Measure of obesity
Body mass index (BMI) is a simple index of weight-to-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight divided by the square of his height. According to WHO1:
- Worldwide obesity has nearly doubled since 1980
- In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these, over 200 million men and nearly 300 million women were obese
- 35 percent of adults ages 20 and older were overweight in 2008, and 11 percent were obese
The increasing number of bariatric patients admitted to health care facilities for chronic illnesses—cardiac disease (mainly heart disease and stroke, the leading cause of death globally in 2012)—are tending to be more common among the obese patient, presenting a direct challenge to responders striving to give dignified care that is safe and effective for both the patient and the responder.
The more mobility-dependent the patient is, the greater the risk for injury for those providing the care, which in ambulance transport can lead to strains, sprains, and musculoskeletal injuries.2
Bariatrics and the Medical Priority Dispatch System (MPDS)
Bariatrics is the science of providing health care for those who have extreme obesity and, as you know, the MPDS is a product dependent on validated scientific research evidence.
Nothing is added to the MPDS without rigorous research, including case studies, and that often begins at the level of a Proposal for Change (PFC) prompted by a user’s request and moved higher on the list of Council of Standards priorities depending on the prevalence—the number recommending the PFC—and the impact on dispatch.
The Council of Standards sends select PFCs to the IAED Council of Research to identify the core of the concerns and provide any cogent scientific evidence supporting an addition to the MPDS. In the case of the bariatric patient, the Council of Research sent out a survey with questions that included frequency (number of bariatric patients handled each month); tracking (does EMS agency track injuries that are due to at-risk patients); what is currently available (special equipment such as higher weight-bearing beds and stretchers); and, without a scripted question in protocol, is there a method used in dispatch to identify the bariatric patient (such as family providing information at the time of the call).
The survey produced mixed results. Yes, the frequency of calls involving an obese patient does seem to be increasing and so has the frequency of injuries among responders due to these at-risk patients. The need for universal protocol questions specifically targeted to the patient’s weight, however, was not substantiated. Dispatchers provide PAIs related to the condition that might be related to the patient’s weight—such as CPR for the patient in cardiac arrest—but, at this time, survey results did not indicate the urgency of a specific question that takes into consideration the extra response power or equipment that might be necessary.
Patterson, IAED Academics & Standards associate and Medical Council of Standards chair, said the survey also raised concerns about sensitivity.
How do you address issues of weight and at what section of protocol do you inquire? If dispatchers are wary about sometimes asking a patient’s age, would they be keen asking what some consider a much more intrusive/personal question? Would the question be asked no matter the situation or reserved for medical conditions correlated to obesity?
Clawson said survey results showed the issue was “much more diffuse than we anticipated” in contrast to the pervasiveness of obesity and the potential and real impact on EMS.
If the issue does trend to suggest further study, a subsequent survey would be in order. If results warrant a change in protocol, the weight question could take any number of forms, such as protocol-specific filtering through a turn on/off feature in ProQA software.
1 World Health Organization, Obesity and overweight, Fact Sheet No. 311, Reviewed May 2014 (accessed June 26, 2014); http://www.who.int/mediacentre/factsheets/fs311/en/
2 Marylou Muir, RN, Gail Archer-Heese, BEd, O.T.Reg (MB) BMR, Essentials of a Bariatric Handling Program, The Online Journal of Issues in Nursing, 10.3912/OJIN.Vol14No1Man05 (accessed June 26, 2014)