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In a super-sized world, it was perhaps inevitable: Boston's Emergency Medical Services this month will begin deploying an ambulance equipped with a hydraulic lift to ease transport of the heaviest patients.
The ambulance retrofitting, which cost about $12,000, bears testament to the increase in morbidly obese patients and the wrenched backs and necks sustained by emergency medical technicians and paramedics straining to lift them. Most weeks, Boston rescue crews ferry two to four patients weighing at least 450 pounds.
"With a 300-pound patient, it's not too bad, or even 400 pounds,'' said Jose A. Archila, a Boston EMS captain. "But to be honest with you, with a 500-, 600-, 700-pound patient -- it's just too much for you.''
The vehicle, which at first glance doesn't appear different from the trucks routinely plying the city's roads, also carries a stretcher capable of shouldering 850 pounds. The stretcher costs $8,000.
The ambulance is the latest piece of medical equipment to be adapted for transporting and treating extremely overweight patients, a population that rose 75 percent nationally from 2000 to 2005. Already in Boston hospitals, the beds are bigger and so are the wheelchairs and, sometimes, even the hallways.
"I'm not surprised that the EMTs are seeing this firsthand,'' said Dr. Caroline Apovian, director of the Nutrition and Weight Management Center at Boston Medical Center. "They're going to be seeing this more than anybody else.''
Russ Smith, a Worcester paramedic, sees it regularly -- and has the aching back to prove it.
He displaced two vertebrae and strained muscles in his back while transporting a woman who weighed at least 400 pounds; he missed a month of work recuperating. And one of his colleagues, he said, recently ruptured two discs carrying an obese patient down the stairs of an aging Victorian residence.
"I would love to have that hydraulic lift Boston is getting,'' said Smith, president of Local 95 of the International Association of EMTs and Paramedics union, which represents rescue workers in Worcester. "That would save a lot of careers. And on top of everything else, it's safer for the patient.''
Smith, and the president of the company that retrofitted the ambulance, Autotronics, said they were not aware of any other public or private ambulance agencies in Massachusetts that have gone so far as to install a hydraulic lift. Some other vehicles in Boston and elsewhere have a heavy-duty stretcher and a ramp-and-winch system that make it easier to move patients, but the ramp has the disadvantage of putting patients at a potentially perilous angle.
The retrofitted ambulance, which was going to be pulled from the fleet because it was nearing the end of its lifespan as a high-use vehicle, will be kept at the Boston EMS special operations barn in Roxbury.
It will be dispatched only after an initial EMS team responds to a 911 call and confirms that the special vehicle is needed. Many times, though, dispatchers and crews know before they arrive at an address that the patient is severely obese: Because such patients tend to suffer from a constellation of conditions, their homes are often well known by rescue workers.
"Is this totally, 100 percent foolproof? Absolutely not,'' Boston EMS Captain Phil McGovern said. "We've still got to get them out of the house.''
To navigate rickety staircases on three-deckers, crews use reinforced rescue chairs.
If a patient's life is in imminent danger -- from acute respiratory distress, for example -- rescue crews won't wait for the retrofitted truck.
In Toronto, where Boston EMS authorities turned for advice, old ambulances are gradually being replaced with models that can "kneel,'' similar to transit buses with that feature, said Commander Peter Rotolo of Toronto EMS.
"The back of the ambulance lowers 2 to 3 inches,'' Rotolo said. "It makes such a big difference in the guys' backs.''