The stretcher, or gurney, has come a long way from braided rope strung between two pieces of wood. From removing combatants from battlefields and early sporting events to more modern applications and considerations that are now based on patient needs and EMS safety, transporting the sick and injured endure. The method of lifting and moving patients has changed drastically just in the last 50 years. Gone are the pole and canvas loop stretchers that served as a battlefield staple. While stocks of these are on disaster rigs to manage and transport a large number of individuals, generally these are not in everyday use. Aluminum was much, albeit not all, of the saving grace for stretcher innovation.
When I got into the EMS game, the X-frame stretcher (see fig. 1) was already the workhorse of the industry. Without the rear-load collapsibility popular with coroners and even funeral directors, early X-frame gurneys had to be dead-lifted into the back of the rig. Combining that with the need to move large individuals resulted in many back injuries and disabled EMS providers. The X-frame was really a step back as slightly earlier versions were designed as “H” frame with collapsible rear loading. The problem remained as to how to best manage patients with the best safety for all parties. From about 1958 until the late 1980s to early 1990s, the deadlift X-frame models continued to thrive until safety considerations demanded action.
The most current ambulance stretchers come down to all aluminum alloy tubing (still utilizing X-frame design, see fig. 2) to keep the static weight down, and all having rear load, collapsible design. Still, contemporary models increased the weight carrying capability (from approximately 120-150 kg to a whopping 320 kg), and therefore increased the static load. So the gurney, depending on the model, went from approximately 40 pounds to 65-90 pounds without the patient (weights are approximated without mattress and restraints). As a result, the total load (patient + gurney+ equipment) became almost unmanageable, often requiring more trips to complete the transfer. Solutions were not readily available.
The issue of bigger patients is troublesome. Responders have always had obese patients and, in the past, improvised in the management of large individuals. My largest patient tipped the scales at 690 pounds (about 315 kg.) and was 6 feet 10 inches in stature. While she could not fit on the gurney, we managed her on doubled tarps with six men on each side. She went on the floor of the rig after we removed the stretcher. This was less than an optimal solution, but we got her to the hospital. The problem has not only been how to handle this size of patient safely and with the most reasonable comfort, but how to protect providers from injury. Remember, do not get hurt just because someone is too big for the crew to manage alone. Know your limitations and call for help.
In response to size issues bigger gurneys, some even motorized, have been developed. The concept of a Bariatric Transport system involves bigger, wider gurneys, some with power assist for raising and lowering. The need for beefier ambulances with increased suspension and width, most equipped with ramps or even hydraulic lifts, have come to the forefront. The Ferno POWERflexx+ is one of the power assist models. While the power-assist (fig. 3) is a nice addition it takes the gurney to a whopping 133 pounds (60kg.) of static weight and the maximum load is no more than other current stretchers (700 lbs/315kg). The ramps and lifts available for these large patients store under the floor of most bariatric rigs and offer reasonable solutions to transport issues. There is even a bariatric gurney that can carry upwards of 1,600 pounds (725 kg.)
Stretchers aside, the real issue is safety of the providers. No one says to get hurt, over extend yourself or place one’s health in jeopardy. Movement of patients that are morbidly obese should be a calculated, pragmatic and well-practiced operation. The criticality of the patient has no bearing on safe operations. A patient’s survival is never assured. Pay attention, know your limitations and call for help.
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