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November 2018
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Bariatric transfer ' behind the scenes of a specialist health service

In as little as the last 25 years, obesity in the UK has increased 400 per cent, pushing the issue to the forefront of the healthcare debate. It has become a very topical subject for the current administration, which is under increasing pressure to reverse a trend which could result in a third of British adults being obese by 2020.

Aside from the impact on government policy, NHS reforms and the public debate around the issue, the obesity epidemic provides a medical and logistical challenge. This is being highlighted by a six-part documentary – `Big Body Squad` – that is currently airing on Channel 5 television.

For the most severely obese, the inability to move freely, and the associated health risks involved, makes leaving the house and even bed impossible. Weight can impact on many aspects of life, from social skills to the things that we take for granted such as going to the toilet unaided, or picking up something off the floor. In the extreme, a morbidly obese patient is classified as ‘bariatric’ when somebody who is unable to take care of themselves, and relies on groups of specialist paramedics and nurses to assist them with everyday tasks. At times, bariatric patients need to be moved from place to place and travel substantial distances to receive treatment in hospital. In many cases these transfers can be time critical and the process itself potentially life threatening.

Moving a bariatric patient involves numerous dangers and difficulties. When of a certain size, movement or increased stress can trigger a stroke or heart attack and, should a patient be shifted in the wrong direction, the movement can tear skin, crush organs or break bones. Moving a bariatric patient requires the same level of planning and preparation as a complex military logistics operation, but one where the patient is removed from their house and delivered to hospital in a safe and dignified manner. This will usually include measuring the entire interior of the location through which the patient is to be moved, calculating weight and pressure, as well as predicting the effects of gravity on the patient and ensuring smooth transfer over a range of surfaces from narrow carpeted stairs and smooth floors to lawns and gravel drives.

In the UK, quality bariatric care is hard to source. This is often because medical service providers lack the training facilities to prepare staff for the unpredictable situations bariatric transfer throws up. To prepare for this, Westhouse Medical’s AST Ambulance Service has a dedicated training centre at its head quarters in Surbiton. Here, there is a full scale mock-up of the interior of a typical house and a 35 stone manikin for staff to practice on in a variety of scenarios. Substantial equipment is also needed for many situations, especially if a patient is of a very large size. Specially manufactured hydraulic lifts and hoists, as well as outsize stretchers, are used to assist staff and enable them to complete transfers safely. This is supported by medical training of specialist paramedics and ambulance personnel and the use of modified ambulances that are capable of safely moving someone of up to 100 stones in weight.

There is also a human side to bariatric care. As with all forms of patient care and transfer, decency and privacy as well as safety are of upmost importance. When a patient is much larger than average, it is important to go to great lengths to avoid additional stress or embarrassment for a patient, such as creating a public spectacle over the extended periods of time such operations require, as a relaxed patient is beneficial for the smooth completion of the task at hand.

As obesity levels rise, the need for bariatric services will increase. While reversing this trend is of great importance, it is also crucial that measures are put in place to ensure our health service is capable of effective and safe bariatric care and transfer in the coming decades.

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