It was about 20 years ago when Larry Obst was at the bottom end, going backwards down a flight of stairs while trying to get a patient who tipped the scales at 300 pounds out of a home.
As the member of Prince George Fire Rescue was standing on one foot trying to make it to the next step while he and a paramedic on the other end struggled with the load, Obst thought "all this guy has to do is do something to throw my balance off and, on one hand, I could drop him, and on the other, I could end up with a knee, hip, back injury that could end my career."
Despite the trouble, they were able to get the patient into an ambulance without anyone getting hurt and Obst didn't think about it much more.
Back then, dealing with a patient that large "was a bit of an anomaly," Obst said. But over the years, patients that large and bigger have become more and more common.
"It used to be anybody over 200 pounds was considered a large patient and they still are," Obst said. "But it's not unusual for us to be moving patients that are three to five hundred pounds and occasionally we'll move some that are five to 800 in Prince George.
"The 500 to 800 (pounds), that will happen probably a few times a year whereas 20 years ago, that was international news."
As Obst began to notice patients getting heftier and heftier, the memory of just how close a call he experienced came back to him while he was preparing for daily training about five years ago.
By then a captain who specializes in training personnel in swift water, high angle and trench rescue, Obst decided it was time to find an answer. A search on the internet yielded nothing so Obst decided to "do a little problem solving" of his own.
"But every time I thought I had a better answer or a better solution, it just opened up more questions," Obst said. "So I managed to figure out why it was that there was actually nothing developed formally."
But Obst didn't give up and put to work his more than 30 years of knowledge to use.
Among the prevailing questions Obst had in mind: How do you get a 300-to-400 pound person, who's also 36 or 38 inches wide and 6-foot-four, not only out of a bathtub but out a door that's 30 inches wide and and make a 90-degree bend into the hallway that may also be only three feet wide.
It was usually a matter of "reaching in and grabbing underneath" and the patient is wet and slippery and there isn't room for more than a couple people. What's more, there are no anchors. Even for the fittest of firefighers, "the ergonomics of these moves are just dreadful."
Part of the answer to that specific problem is a portable tripod combined with webbing and a rope and pulley system that can be used to lift a patient out of that bathtub and onto a stretcher with a lot less strain on the rescuers. It's also easier on the patient and on the patient's home - there's a lot less risk of a hole being put in a wall.
While the bathtub scenario was showcased for The Citizen because it "shows a little bit of everything," techniques for other scenarios have been developed too, based largely on making use of existing rescue equipment or new equipment that can still be used in other situations.
"We can't buy equipment specifically to lift someone out of a bathtub," Obst said.
The National Fire Protection Association standard is equipment capable of lifting two people weighing 300 pounds each and the methods developed are designed to deal with one person weighing 600 pounds.
"Essentially, what this program is, is taking existing techniques used in the technical rescue disciplines and modifying them and still falling within the parameters of meeting the NFPA standards, but it's just doing things just a little bit differently," Obst said.
In developing what has become PGFR's "bariatric program," Obst was also fortunate enough to find someone within the department who could take a look at the techniques from the patient's perspective. Prior to becoming a firefighter, Wayne Weis worked for nearly 23 years as a primary care paramedic with the B.C. Ambulance Service attendant in the Lower Mainland.
Patients that size require special care because of the myriad health issues they tend to face, from infections to cardiac trouble to diabetes. Their bodies need to be positioned differently to lessen problems with breathing and to remain conscious.
"There are a lot of mobility issues that can come just because of their sheer size and weight," Weis said. "And then you get a diabetic issue like when they lose feeling in their feet, and that creates difficulties and that means we have to work a little bit harder.
"It just makes you more aware that you can't just make people get up an move."
PGFR has been using the new methods since February and while the numbers are not in yet, Obst believes it's made a difference in terms of lost time due to back strains and other related injuries.
He's also at the point where he and Weis are ready to deliver a two-day workshop to other fire departments and first responders around the country who have achieved at least a level 3 qualification.
It includes assessment, care and treatment of bariatric patients, recognizing hazards and risks that could lead to injuries, and using minimal equipment to deal with complicated extrications.
It's being provided through Carleton Rescue Equipment in Vancouver - a workshop is set for May 29. Other than the costs of travel and accommodation, Obst and Weis are only asking for a donation to a PGFR charity in compensation. (For more information, http://carletonrescue.com/course/bariatric-patient-transfers/)
In the meantime, PGFR is making ample use of the techniques on their own as heavier patients become more and more common.
"It's heavy lifts but more so it's awkward lifts, that's the bigger problem," Obst said. "And patients are just continuing to get bigger, taller, wider. It's not just obese, you could have a very fit athlete at 300 pounds; they're just big and muscular."
