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Why Bariatric Response Needs to Rely on Research and Best Practices

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Editor’s Note: This article is based on the author’s capstone thesis project required to complete his graduate degree in Public Administration.

By Douglas Skinner, alumna, Public Administration (MPA) at American Public University

Emergency medical service (EMS) agencies must regularly consider new ways to improve patient care and transport. Some agencies determine they need to invest in new equipment and technology while others add new programs or revise existing policies and procedures. However, the way many agencies make such decisions is often based on wants or perceived needs. As a result, many agencies choose programs or equipment that are unable to evolve with the agency and are not in line with nationally established best practices.

In order to improve patient care, agencies need to conduct in-depth assessments of current systems, use evidence-based research to evaluate new programs or equipment, and properly assess the needs and demographics of the community served. The key to obtaining successful funding for any project is to show the medical community, as well as the community at large, why there is a need for equipment purchases or the addition of a specific medical policy or procedure.

Evaluating Bariatric Care

One of the more pressing changes needed nationwide is how EMS agencies deliver bariatric care. Most agencies consider a bariatric patient to be someone who weighs more than 350 pounds. According to the U.S. Center for Disease Control, 66 percent of the U.S. population is overweight and 30 percent are obese (Berger, 2007). Obesity has exploded over the last 40 years, which is partially attributed to poor nutritional activity and reliance on technology for comfort (Berger, 2007).

As a result, EMS agencies are dealing with a major increase in bariatric patients and must adopt new programs and policies, as well as purchase new equipment, in order to properly care and transport them. Although many agencies have made efforts to enhance their bariatric programs in recent years, many still do not have the necessary resources or procedures in place.

[Related: Budget Cuts Threaten EMS and Emergency Management Agencies]

To change that, EMS agencies must strategically assess and research the specific needs in their community and determine how they can improve bariatric care and transport services. Some agencies may determine they need to invest in new bariatric equipment and develop a stronger internal program. Other agencies may need to establish mutual aid agreements and partner with other local EMS agencies to provide bariatric-care services. In order to determine how to improve bariatric services, EMS agencies must properly assess their existing assets and protocol and conduct research on best practices of other agencies around the country.

How to Develop a Bariatric Program

EMS agencies need to review their capabilities on a regular basis to ensure that they are providing care and transport as stated in their specific mission. When doing an analysis based around bariatric patient needs, agencies should try to address specific points about how to proceed with a bariatric program. Such points might include:

  1. Define an obese or bariatric patient. ICD-10 coding guidelines and EMT personnel positon descriptions can help to set weights limits of bariatric patients (CMS, 2015). Based on ICD-10 and position descriptions of EMT’s best practice agencies use 350 pounds as a marker for bariatric patient response (San Francisco EMS, 2014).
  2. Show that there is a need for bariatric response based on national statistics and local demographics. Find the statistics on obesity in your locality and compare them to national and regional numbers. Also find data on how many bariatric patients the agency has transported over the last two to three years.
  3. Research means of funding for equipment purchases. Look at internal funding or grant funding to help the agency purchase equipment.
  4. Define levels, types, and quantities of equipment that should be included in a response plan based on local needs and national best practices. Document the agency’s current bariatric-specific equipment. Research and test specific transport equipment designed for bariatric patients. In addition to proposing equipment purchases, also provide information about potential mutual aid with other local agencies and associated costs of doing so.
  5. Define the proper dispatch procedure. Work with the dispatch center to set up a specific guideline for bariatric response. Establish a dispatch algorithm for resource requests or automatic dispatch based on local needs and geographic placement of assets. This procedure could include the dispatch of bariatric equipment as well as additional personnel to help lift the patient.
  6. Define the criteria for which patients require a bariatric automatic response based on national statistics, best practices, and local data.
  7. Define what expectations are needed for the community served, in reference to bariatric EMS response.
  8. Define the training needs for agency personnel. The amount of training depends on the agency’s current level of care for bariatric patients. If it is determined the agency needs to purchase new equipment, additional training must be provided. Most equipment dealers have training programs and this is often the best solution for an agency.
  9. Define standard operating guidelines for bariatric response. Set up a SOG for bariatric response based on the agency and the community’s demographics.
  10. Set a timeline to accomplish this plan.

Addressing and researching these specific points will provide clear direction on the needs of the community, procedures for how to set up a bariatric transport program, and how to fund the purchase of new equipment.

It’s also important that a bariatric program properly address the safety of EMS personnel. There are unique problems regarding the logistics of lifting these heavy patients in a manner that is safe for both the patient and the care provider. Agencies must ensure that its bariatric-care program includes protocol and training on safety measures to prevent employees from being injured while transporting bariatric patients.

[Related: Building a Strong EMS Team: Overcoming Conflicts]

It is the mission of all EMS agencies to safely and efficiently treat and transport any and all patients in need. Being able to provide safe and efficient bariatric transport is a critical service that agencies across the country need to fulfill in order to accomplish that mission.

To learn more about Douglas Skinner’s thesis capstone project, watch this 3-minute video.

bariatricAbout the Author: Douglas P. Skinner, MPA, NRP, NCEE has been an EMS practitioner for more than 32 years and an EMS educator for more than 25 years. He is currently a Lieutenant with the Loudoun County Volunteer Rescue Squad, in Leesburg, Virginia and is also an adjunct professor in the paramedic program at Prince Georges Community College in Largo, Maryland. Skinner graduated from American Public University with a master’s degree in Public Administration (MPA) with a concentration in Disaster Management. He is also a co-owner of SCS Safety Health and Security Associates, LLC, a safety and health business.



Berger, E. (2007). Emergency departments shoulder challenge of providing care, Preserving dignity for the “Super Obese”. Annals of Emergency Medicine, 50, (4). October 2007. 443-445.

CMS, (2015). Medicare Claims Processing Manual, Chapter 15 – Ambulance.

San Francisco EMS Agency. (2014). Bariatric Patient Transports. Policy Reference No.: 4072.


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