Research shows that the number of Americans classified as morbidly obese is growing twice as fast as the number of Americans who are simply obese or overweight. According to the American Obesity Association, morbid obesity afflicts approximately 9 million adult Americans, twice the number of individuals suffering from Alzheimer's and equal to the population of the state of Virginia. According to researchers, the rate of morbid obesity has increased in the last decade from 1 in 200 adult Americans to 1 in 50.

The rise in this segment's numbers brings special challenges for fire and EMS departments. For instance, the Fresno (Calif.) Fire Department responded in May to a medical call for a non-breather at an old residential hotel in a run-down area. When crews arrived, they found the victim — a 51-year-old man who weighed more than 800 pounds — already deceased.

The engine company returned to service, and Capt. Mile Alforque contacted Bttn. Chief Richard Cabral to advise that the coroner probably would request the fire department's assistance in removing the body.

Cabral encourages his captains to advise him immediately when they foresee a situation. Based on Alforque's information, Cabral contacted Fresno's USAR team, which is well-versed in the use of pulleys and low-angle rescues, as well as breaching and breaking through building construction.

Once on scene, Cabral implemented the department's Incident Command System and contacted multiple agencies for assistance. A USAR team and tactical unit responded with rescue and breaching equipment. Cabral also called for a public information officer to handle the increasing media presence and a safety officer to monitor firefighters' heavy lifting and possible strain. Police officers helped evacuate hotel residents, and police and public works restricted access to the area surrounding the hotel. A representative of the coroner's office was present to approve the method of removal, and a mortuary van was there to transport the body.

“This was not an emergency event,” Cabral said. “We were in recovery mode and we didn't want to injure a firefighter's back or knee. I wanted a safety officer to ensure we were taking care of the personnel.”

Specialized Equipment

The body was in a 10-foot by 10-foot room on a double bed, off of a doorway that led to a narrow hallway on the second floor. A single bathroom was located down the hallway. The crew had to determine whether to breach the exterior wall and remove the victim by forklift and pallet from outside, or enlarge the doorway, tightly wrap the body and move it down the hallway to the stairs, and then slide it down the stairwell. USAR team member Chuck Leach suggested constructing a Z-rig system to help the crew slowly lower the body down the stairs.

“We communicated with the hotel owner, and he agreed we could do whatever we needed to remove the body,” Cabral said.

One crew began working on a makeshift litter or sled — a 4-foot by 8-foot sheet of 9/16-inch-thick business-grade plywood with cutouts for straps. The crew measured the width of the body and decided to wrap the victim in a salvage cover, using straps to reduce the width.

The USAR crew removed the room's contents and breached the wall with the door. After removing the wall debris, multiple firefighters then rolled the wrapped body into the 42-inch-wide hallway, and then slid the victim 40 feet down the wooden floor to the top of the stairwell. As the victim had been dead for several hours, the crew requested a fan for odor control.

“The Z-rig was a 4×4 across the door with a pulley and a brake, and with an anchor and pulley at the head of the stairs,” Cabral said. “We slid the body onto the stairs and let the brake stop the litter and body. We allowed gravity to do its thing and lower the body down the stairs.”

Cabral said that he was particularly proud that the firefighters could perform the recovery in a dignified manner. Aware that the media was waiting outside, firefighters made sure the body was covered and secured.

He added that this was not the first time he's been faced with difficult situations. “I think a key focus is that the fire service is always going to be confronted with challenges that we may only face once or twice in our careers,” he said. “We have to communicate with each other and — in our districts and regionally — we have to preplan and consider our resources.”

Cabral identified two factors that led to the success of this incident: the company officer who foresaw the challenges and communicated them to the battalion chief; and a USAR team and truck company that was prepared to handle this type of problem.

“We approached the incident in a methodical way and considered the potentials, for each of our possible solutions and resources to carry our objectives forward,” Cabral said.

Metropolitan departments may have special operations and USAR teams to rely on, but smaller departments may have more of a challenge in dealing with the morbidly obese.

“It was sad that this man got into that condition, but this was a human being we were dealing with,” Cabral said. “I unfortunately think that this is a problem we are going to see more of.”

Sidebars

Obesity and Swine Flu?

Dr. Arlene King, Ontario's chief medical officer of health, reported ther researchers are studying a new link between obesity and the H1N1 virus. Based on data from the province's intensive-care units, morbidly obese people who contract the H1N1 virus are more likely to suffer serious complications or death.

U.K. Companies Create Training Aids

A company in Wales has created special oversized mannequins to help responders train for handling and transporting morbidly obese patients.

The mannequin weighs about 400 pounds in bariatric mode and is designed for training with four to six crew members.

The mannequin's inner body is weighted to human proportions — about 220 pounds — with steel shot. Then five weighted layers of liquid and foam cushioning are added to simulate fluidity of movement for a realistic training experience. The additional girth is distributed around the body in weighted packets in such a way that slumping of the weight is prevented, yet side-to-side movement is realistic.

The company also offers a bariatric kit that consists of washable, reinforced PVC and heavy polypropylene webbing: one large carrying sheet with 12 handles and a 880-pound capacity; one half-sheet with 10 handles and 880-pound capacity; and one casualty strap.

Another Welsh company has created a sling for moving incapacitated or disabled individuals weighing up to 630 pounds and in confined spaces where a hoist cannot be used.

For more information, visit Ruthlee.co.uk.