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It's sad, really: Handling patient and provider obesity in the future

What will EMS look like in 2030? What resources will be required to move an increasingly obese population?

The year is 2030, in Jackson, Miss. You just finished lunch at the local BBQ joint. You and your crew are now waiting for your next call.

Odds are it will be one of the so-called "OS" (obesity syndrome) diseases. It seems like that's all you get anymore. It's no surprise. Since 2012, the number of cases of Type 2 diabetes, heart disease and stroke has more than tripled. If you think about it, it's sad, really.

Weight is not the only thing going up. In 2030, the world's population will be 8.2 billion (currently 6.9 billion). It's not just the increased burden on already taxed EMS agencies, ERs, hospitals and insurance companies; there is also a lot more work.

It's just that, well, there really is no good way to move these people safely. In newer homes, hallways and doorways are wider. In older homes they have the same width as ones built in the last century.

Close to a decade ago, your agency changed over to all three-person crews to help deal with the problem. But even with this change and various powered apparatus, moving overweight patients is still not quite safe and effective. One reason the change didn't help is that as the weight of the general population increased, so, too, did the overall weight of EMS providers. And it's been increasingly hard to recruit and entice people into EMS. It's sad, really.

You could put you and your crew shoulder-to-shoulder with any other provider group in the nation — for dedication, for competency — on every level, including health and fitness. Your partner Jennifer has Type 2 diabetes. She manages it pretty well. There are hardly any on-the-job episodes — hardly any!

Your other partner, Mike, has really bad knees. At just under 30, he needs bilateral knee replacement. He needs to lose weight for the anesthesia so he can have the surgery. So far, it's a no-go. It's sad.

In Miss., you are at the epicenter of the U.S. epidemic. In 2030, close to 67 percent of the entire state population is obese, with a body mass index (BMI) greater than 30. It's sad.

When the inevitable happens

Unit 458 respond, 21-year-old complaining of chest pain, history of heart disease.
458 respond, details to follow.

Call and routing information appear in the vehicle's "heads-up" display. All traffic lights along your path are changed to green in the appropriate sequence at the correct time.

"Rumblers" are engaged in all other vehicles along your path as an additional warning. Additional manpower is also dispatched for lift assist per current protocol.

Mike is driving on this response. Your vehicle is a newer type 1. There are no more type 2, van-style ambulances; they simply did not offer enough payload. The newest vehicles have far more robust suspension and tires along with heavier-capacity brake systems to carry additional weight.

Upon arrival, you find your patient up a flight of stairs in a fair amount of distress with both pulse and blood pressure elevated. A 12-lead ECG confirms anterior wall MI. Automatic notifications are made to the closest cath lab, and the on-call cardiologist reviews the complete telemetric data on her tablet.

On-scene stabilization is complete. Using the latest motorized stair chair, your crew and helpers move the patient, miniaturized ECG device and all to the waiting stretcher and ambulance.

You follow up with the equipment bags. Just as you hit the top of the stairs, you grab your left arm and experience dizziness and a crushing pain in your chest. Your last thought is of falling down stairs.

Your last thought, ever, is the image of your newborn daughter.

You are eulogized by the kindest, most heartfelt words you could ever have wanted. There is not a dry eye in the place. More people turned up than you would have imagined. Your wife and newborn daughter are there. Of course she will grow up never knowing her real father. Your eight black-ribboned pallbearers carry you to the black-shrouded ambulance for your last ride. At the cemetery is your final call. The crowd slowly leaves.

At only 33, it's sad, really.

Could this happen to you?

According to research and a new report issued by Trust for America's Health, that scenario is a real possibility. Not only does Miss. have the highest obesity level today, but by 2030, that number is also expected to grow to 67 percent of the population.

By 2030, 39 states are expected to have obesity levels of more than 50 percent. The obesity levels and the increase in disease, especially Type 2 diabetes, stroke and coronary disease, are accurate as described above, as well as the impact on healthcare costs.

What will EMS look like in 2030? What resources will be required to move such a population? What will providers' roles be? What should they be?

EMS agencies and individuals have played key roles in working to prevent drownings, improve safety in ambulances for ambulance providers and increase seatbelt use and child car seat compliance. One medic I know began a program for a high school student body to prevent teenage drunk driving fatalities, showing gruesome scene photos and speaking frankly with them about yearly graduation night alcohol-related deaths — and it worked.

We can and should make a difference. We should play a role. 

Be a leader. Be an agent for change. It does not have to be sad, really.

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