Addressing the problem

To address the issues of obesity and manual handling, we set up a bariatric working party with representatives from Acute care, Fire, Police, Ambulance (this included the private sector) and community care services in an attempt to work in partnership with outside agencies. The ultimate aim of the group was to work in partnership, sharing experience, skills, knowledge and equipment through effective communication.

Practical mock up exercises
The group wanted to work proactively so over the past few years a number of practical exercises have been organised to establish how each discipline worked, what equipment they used and how they could improve the service to benefit everyone and give the patient the dignity they deserve.
    
Manufacturers of equipment were invited to bring some of their products along to enable members of the group to have the opportunity to see what is available to them. Scenarios were developed to enable participants to practice taking a bariatric patient from a mock situation and eventually deposit them into a waiting bespoke vehicle. The scenarios have included working in confined spaces, retrieving a patient from a first floor flat with the assistance of the fire service, who removed a window to allow the patient to be evacuated on a cherry picker with the assistance of the ambulance service.

Moving obesity forward
The group have been working together successfully in partnership for four years with the support of their organisations. It was now time for them to invite senior people from those organisations to take things to the next level. An awareness day was organised and invitations sent to chief executives and board members of each disciplines organisation. The aim was to encourage the attendees to sign up to sharing information, equipment and expertise to improve the management of the bariatric person in crisis. At present there is resistance to the idea of sharing equipment. These range from legal issues such as who is responsible for the equipment to who has the confidence and expertise to use it.
    
On the day a number of presentations were given in an effort to give the audience a better understanding of the difficulties the disciplines experienced when the patient is bariatric. The first presentation was ‘scene setting’ from the ambulance service and examples were given to demonstrate the sort of problems the group had identified when attending an emergency call. This was followed by a video clip of a patient’s perspective of being handled in this sort of situation. The patient told the audience how they had felt about being handled by an ambulance crew and their worries about possible injury to staff that had been forced to carry them at the time. They also revealed their feelings on how they felt when attending a clinic and the embarrassment it caused. A representative from the Health and Safety Executive went on to tell the audience that they had a duty of care to this patient group and they would be expected to provide the appropriate equipment etc. They also said that the client group was foreseeable and there was a need to plan, communicate and train staff for those occasions these patients required healthcare.
    
The final presentation informed the audience of the need to escalate. The group had done a lot of work over the past three years but they were unable to take this forward without input from the right people. There were lots of benefits to signing up to working in partnership and sharing equipment and information. The group wanted to be proactive rather than reactive. Resources needed to be cost effective. Hiring equipment can be very costly to an organisation and there is the added risk it will not be available when it is needed. This could create a risk to staff and patients if someone is injured when equipment is not there.
    
Essex County Fire and Rescue Service have the highest number of calls to bariatric people in distress or at risk in the UK. If equipment were to be shared this may reduce the number of occasions the fire service needed to respond to provide the manpower to assist with patient type. The ambulance services need to provide more re-enforced specialist vehicles for transporting this patient group. The private sector currently provides the bariatric ambulances in the county and this service goes a long way in improving the dignity and care of these patients. There are an insufficient number of vehicles for the number of patients and more are needed. This would reduce the length of stay in hospital for some patients who remain for longer periods when appropriate transport is not always available when they are ready for discharge. This would reduce costs of bed blocking for Trusts.
    
The day also allowed attendees to view some of the equipment the group had used during their practical exercises. This was to persuade those with responsibility for funding of the importance of these items in their organisations area of work. The purchase of equipment could be either for total use by the organisation or with a view to sharing the cost with other agencies.
    
Ergonomics and working in partnership can make a difference to a patient’s dignity and reduce the risk of injury to staff. As the nation becomes larger more solutions are required to manage situations while maintaining dignity and safe systems of work. More manufacturers are listening to professionals and working with them in an attempt to problem solve.
    
The project has been a learning curve for all those involved. The group are still enthusiastic and are contributing to the improvement of the service. There is much work still to be done if they are to complete the project. It is comforting to know they have the support of their organisations to take things forward.

References:
Rush, A Use of specialised equipment to mobilise Bariatric patients. International Journal of Therapeutic Rehabilitation. Jun: 12(6): 269 2005
Bourne J Tackling obesity in England National Audit Office Report (2001)
Palmer, R Moving and Handling Bariatric patients safely: a case study. International Journal of Therapeutic Rehabilitation. Jan: 11(1): 31 2004
Health Services Administration. Avoid Risk from obese patients with specific policies. Healthcare Risk Management. Jun 28(6) 65 2006
Pheasant S (1991) Ergonomics, Work and Health 4 – 6
Pepper C (2010) Corpes too heavy for the morgue Sunday Mail South Australia Feb 06 2010
Randall S, Pories W, Pearson A, Drake D, 2009, Expanded Occupational Safety and Health Administration 300 log as a metric for bariatric patient handling staff injuries. Surgery for Obesity and Related Diseases, Vol 5, Issue 4 July – Aug 2009, 463-468