November 2012, Barcelona (ITIJ conference)
- David Sinclair (medical supervisor, European Air Ambulance) began by explaining that obesity can be defined as having mass index (BMI) of over 30. When a patient has a BMI of over 35, or is obese with a comorbidity, an air ambulance provider must carefully consider whether the patient is fit to fly, and whether the air ambulance company has the right aircraft, medical staff and equipment to safety complete the transport.
In terms of equipment, suitably sized continuous positive airway pressure (CPAP) masks should be available, and ultrasound for assisting with venous access should be considered. As well as various obvious issues such as the width and load capacity of stretchers, the patient’s size may mean that standard blood pressure cuffs, fingertip pulseoxymeters and splints will not fit and alternative solution must be found.
There is no standard measurement for width of a patient, David noted, adding that in European Air Ambulance aircrafts, the patient is oriented in a diagonal position as they are loaded into the aircraft, so the limiting factor is the shoulder-hip diameter-on EAA’s Learjet 45 aircraft, this is a maximum of 73 cm (29 inches). The capacity of the stretcher loading and retaining systems also impose a limit of 200 kg (400lb). Loading restrictions into the smaller Learjet 35 are about the same. This stage of the transport can be problematic, David noted, recalling two occasions when a patient was injured during the loading.
The obese patient typically has an increased metabolic basal rate, resulting in higher oxygen consumption, said David. They tend to breathe heavily, and to prefer to sit upright to make breathing easier. However, in some aircraft this may be difficult to achieve due to insufficient headroom above the stretcher.
However, fitting into the aircraft is only part of the picture - every stage must be safe - and David asserted that he has refused to use ground ambulances on occasions where they were not suitable for the patient. The receiving hospital bed must also be adapted.
David added that the air ambulance provider must have good information on the patient’s condition - not least their weight and diameter - before accepting a transport, in order to accurately assess whether they can be flown. However, this is rarely given clear enough, he noted.
Biography: Dr David Sinclair graduated from medical school in 1998 having studied at the University of Tubingen (Germany), Dartmouth Medical School (NH, USA) and UC San Diego (CA, USA). He finished his specialization in anesthesiology in 2004 and sub specialized in critical care medicine and emergency medicine. He is also certified in ATLS and travel medicine. He began working for Luxembourg Air Rescue (LAR*) in 2002 and was nominated medical supervisor in 2007. Dr Sinclair is board certified in Germany, France and Luxembourg.
*LAR and DRF Luftrettung are founders of European Air Ambulance.