(Transcript is automatically generated)

Erik: [00:00:00] Not just the, the, the weight that creates the issue. When you have the increased weight, now you've got dimension problems. 

Matt: Yes, but my dad ate whatever he wanted and never gained weight.

Narrator: You are listening to EMS with your hosts, Erik Axene and Matt Ball. 

Erik: But actually speaking of airplanes. I was in the middle. I'm a big, I'm obese actually. We'll talk about that later. 

Matt: Well, so am I compared to BMI? Yeah. Right. [00:00:30] I think, yeah. 

Erik: That's why I'm, I'm in the middle and I'm a little frustrated 'cause I'm like so uncomfortable.

Matt: Why didn't you pay?

Erik: But in airplanes though, being obese is a hard thing. Yeah. Or just a bigger guy, you know, and, and broader shoulders, you just, you feel like you're in everybody else's business. Yeah, yeah, yeah, yeah. Especially when you're in the middle. 

Matt: Yeah. 

Erik: Um, but, uh, so obese patients, they, when we treat them in the EMS environment mm-hmm.

There are some challenges we're gonna talk about today.

Matt: And we treat them very often. Yes. We very often have patients that are obese. 

Erik: Yes. [00:01:00] Um, so we'll break this podcast into three sections. Mm-hmm. First, we'll talk about some of the physiologic and anatomic considerations of an obese patient Yep. That we should think about.

Yep. And the second objective was, 

Matt: we got it right here. Oh yeah. Uh, we've got demonstrate safe lifting. Uh, moving and transport techniques. Right. So obviously a little bit of patient safety. 

Erik: Yeah. Right. Is how do those anatomic and physiologic things affect the way we handle. Handle these patients. Right.

Matt: And talk about like innovating these patients, like how to [00:01:30] approach that. That's right. 'cause you have to do things differently with that. You really do. IV access. We'll talk about that

Erik: physical exam too.

Matt: Yes, exactly. 

Erik: And then the last one is the stigma of these patients and really treating them with dignity and respect.

Then we'll talk about some of how that can affect, uh, this patient population too. 

Matt: That's right. So if you don't already like and share a podcast, please like our page. Mm-hmm. Uh, whether you're watching on YouTube or Apple Podcasts or wherever. Yeah, definitely. Please follow our, our stuff if you like our stuff.

'cause you can get CE content for stuff through the website. Yeah. Uh, [00:02:00] if you like this podcast you wanna get content for, or uh, credit for it, you gotta go do that through our, our website. 

Erik: Www. Do you say www anymore or did you say axenece.com?

Matt: I think you just say axenece.

Erik: Axenece. That's charlie echo.com anyway. Uh, 

Matt: so obese patients, it is definitely a problem. 

Erik: It is. It's in our country's a common problem. Yes, we are. Go, we've all seen them. They're all, it's very common.

Matt: Well, you can't not see them, unfortunately.

Erik: True. Yes.

Matt: Uh, they, yeah. [00:02:30] It's a, it's a. Yeah, it's, well, what do we say over 40% of the US population

Erik: is obese?

Matt: Is obese, and some statistics say up to 70%. 

Erik: Well, three quarters of patients are either overweight or obese. It's all based on BMI. 

Matt: Yeah, there's exactly, and BMI, like we talked about, that's not the greatest measure of actual fat because it's just meant like I'm a shorter guy. 

Erik: Yep. 

Matt: But like, like you're a muscular guy.

Like guys that have, or like a lot of firemen, first responders, they're pretty muscular. [00:03:00] Well, they're gonna say, well, you're, you know, I'm five foot five, 150 pounds. Well, your ideal, ideal body weight, it max is like 135. 

Erik: Right. 

Matt: I'm like, well 135 pounds i'm skin and bones, like, I'm tiny. 

Erik: Yep. 

Matt: You know, it's not that I'm huge at 150, but, 

Erik: well, no, but you and I have a similar body type.

We're, we're, we're, uh, muscular. We kind of, you know. 

Matt: Yeah. 

Erik: We're not those, uh, those ectomorphs, 

Matt: ectomorphs or meso Yeah. 

Erik: That are real. You know, like, like, um, um, uh. Violin player. I, I'm just, my mind is, yeah. [00:03:30] No, that's, he's cello on our, our staff, uh, oh, 

Matt: yeah. Luca. 

Erik: Luca. Yeah. He, he's ectomorph, you know? Yes. Very fair.

And so a guy like that weighs 135 pounds and he is almost six feet tall. 

Matt: Right. And will never struggle with weight, probably his whole life. 

Erik: No. Yeah. And then, um, and anyways, but you and I are, are more, either more of a mesomorph. Mm-hmm. 

Matt: Yeah. 

Erik: If I'm not careful. Uh, yeah. I will balloon in fact. You know, I, I used to weigh, got a 

Matt: little bit of a weight, 

Erik: a bit of a weight problem.

I love food, right? So we all, yeah, it's easy for me to, to gain away, but I've [00:04:00] lost 50 pounds, but I'm still obese. 

Matt: Good job. 

Erik: And, and, uh, and that, that BMI is not a real accurate reflection. No, it's not, uh, of me. And I still am a overweight, I could lose some more weight, but I'm not morbidly obese like my BMI would say.

Right, exactly. Um, but the point is, though, in this talk today, we're going to talk about those obese and morbidly obese patients that create some challenges for us in the pre-hospital environment. Mm-hmm. So let's talk a little bit about anatomy. Yeah. Maybe go head to toe. 

Matt: Yeah. Well, I mean, [00:04:30] just to think about it like the, like I'm, I'm five foot five, right.

I'm not a big dude. Yeah. Right. So my body. And all the parts of my body Yeah. Are made to operate a body that is five foot five. Correct. So if you took my heart and put it in your body, yeah. Right. That pump is probably not gonna be big enough. Right. Yeah, to operate your body. 'cause your heart's probably a little bit bigger than mine.

Erik: It's gonna create some strain on it. Exactly. That's right. 

Matt: So when you gain, if I weighed [00:05:00] 400 pounds. 

Erik: Mm-hmm. 

Matt: Right. Well, the structures that make my body work are not meant to do that. It's like, 

Erik: yeah, 

Matt: driving a Ford Ranger pickup truck and expecting it to do the job of an F-350 and pulling a horse trailer or something with it.

It's not made to do that. 

Erik: And I think what. And part of what you're talking about is more of the musculoskeletal challenges of an obese patient, um, where the knees are gonna give out faster. Uh, you fall down, you're gonna be more apt to well even have injuries. 

Matt: Well, but even the lungs, the heart, 

Erik: right? Yeah. But the, the thing is though, [00:05:30] it's interesting, is that there's a big difference between visceral fat and subcutaneous fat, 

Matt: right? 

Erik: So, uh, you know, you could have a patient with a, like a normal. Skinny body mm-hmm. Within a bunch of subcutaneous fat. Those people actually tend to be more healthy.

Actually. Their numbers look good with, you know, their, their diabetes risk goes up, but they're relatively healthy. Mm-hmm. It's the ones with the visceral fat that's the damaging fat that creates a lot of comorbidities. And, and it's not up to [00:06:00] us to know which is which, you know, they're, they're just obese patients for us in the prehospital environment, and they create challenges.

But just so we're clear, I, I think, uh, that that patient with a lot of subcutaneous fat isn't going to have a huge. It's not gonna have a huge impact on their overall eyes, directly on the heart and the lungs. Yeah. Um, indirectly it does because they're moving so much more weight around. Right. So it requires more, you know, effort Right.

And more cardiac output and to, [00:06:30] to move. Right. So, uh, those are certainly issues, but, um, like you said though, the, the, uh, the, these patients are going to have a, a bigger demand on the cardiovascular system. Yeah. Yeah. That's, that's huge. So, and as far as even the fat, um, around the neck. Mm-hmm. And, uh, you know, around the airway, the face, the neck, even the head actually, I mean, a lot of fat, uh, can create positioning problems.

Mm-hmm. Can create airway difficulties, breathing [00:07:00] difficulties. Uh, one of the major causes of sleep apnea and those snoring respirations you might hear in that patient that's unresponsive. And an obese patient in particular is that, that. The, the, the soft tissue gets in the way of air movement. 

Matt: Mm-hmm.

Erik: These people need that chin lift. 

Matt: Yeah. 

Erik: And the head tilt, right? Yep. 

Matt: One of the best reasons to get off, or not reasons, but one of the best ways to get off CPAP is lose weight. Lose weight. If you lose weight. Then you could a alleviate having to use CPAP for the rest of your life. 

Erik: Huge, huge part of it.

Matt: Yeah. 

Erik: Um, um, [00:07:30] I think that, I think along along those lines, um, if you had to do a crike on a patient that was obese, be prepared. Know your anatomy. We talk about this in our airway course, right? I mean, um, you may not see anything. It's all by feel potentially, but the, the. The extra tissue creates some challenges Absolutely.

In, in, in all of those things. Um, 

Matt: talk a little bit more about stuff like that, like IV stuff in section two. 

Erik: Oh, yeah. Oh yeah. Of the different, yeah. Oh, oh, for sure. 

Matt: Treatment management problems. 

Erik: Yeah. Because of all the extra [00:08:00] subcutaneous tissue. There are, there are a lot of challenges. We'll get to the specifics, like you said on that, but there's, um, what, not just iv, but we'll talk about the physical exam with all the extra tissue.

Mm-hmm. Uh, but if you think about it, the, there's a lot of challenges. I mean, even the EKG leads mm-hmm. The EKG leads on the surface of the skin are trying to pick up the electrical activity of a heart. And the further the leads are away from the heart, the shorter the amplitude. So you may actually have.

A STEMI going on and you can't go, but because of the [00:08:30] distance, you can actually impact. Some of the, the amplitude of some of the EKG morphology, you gotta be very careful in treating a patient with a lot of subcutaneous tissue. Mm-hmm. A lot of distance between the electrode on the skin mm-hmm. And the heart.

Yeah. That's something that we have to consider. Uh, we also have to remember too, so all that. That extra tissue on top of the skin creates difficulties in auscultating structures. Mm-hmm. Palpating, sru, we'll get to that when we talk about physical exam, but these are, these are big [00:09:00] problems, a lot of acreage.

Yep. In moving and trying to try to assess and try to find signs of disease. 

Matt: Mm-hmm. 

Erik: Um, that's, it's a big, big issue. 

Matt: So head to toe, we, you talked about a little bit about the head and some issues there as far as from the patient standpoint, what they struggle with being an obese patient. Now you move towards the chest and obviously we talked a little bit about the heart and the weight on the heart and the pumping ability.

It's, you've got all this extra weight. Right. Which is creating a higher demand because [00:09:30] now it takes more energy to move this larger body. 

Erik: Yep. 

Matt: And so this pump that's not designed to, to pump and carry all this stuff, the engine almost mm-hmm. It's gotta work just double as hard. And so that's creating cardiac problems.

Yep. So on top of the obese part, uh, problems, now you're dealing with cardiac issues. Right? Yep. And then we already talked about the lungs. Lung capacity. My lung capacity is made for somebody that's, you know, my lungs don't grow as I get fatter. No, I 

Erik: know. You got the same lungs no matter how big [00:10:00] you are.

And the problem too isn't just the, it's not just all the subcutaneous tissue on top of your chest, that's gravity's pulling on top of the lungs. Yeah. Which makes it difficult to breathe. Right. But there's also all of that visceral fat that's actually pushing up, uh, on your diaphragm and decreasing your, your lung volumes, even though you're right, the lungs don't change anatomically.

Matt: Mm-hmm. 

Erik: But the functional residual capacity of your lungs will change with all that extra fat. So you're not able to take that full [00:10:30] deep breath 

Matt: change for the worst, not for the better. 

Erik: The worst. That's, that's what I'm saying. Yeah. Just like a pregnant woman, she can't take that full breath that she used to take before she She's pregnant.

Yeah. Now these obese patients aren't getting the full lung capacity, so when they do need to dip into more breathing, they don't have the capacity to increase their lung volumes, 

Matt: and so they have, they need more. But can provide less. 

Erik: That's correct. 

Matt: And so that's, you know, again, these are all reasons that if people are struggling with weight issues 

Erik: Yeah.

Matt: Like we kind of talked about in our health and wellness podcast, it's [00:11:00] a huge reason why losing weight is so beneficial for your health. Mm-hmm. Because it just compounds being obese and overweight just compounds all these underlying health problems. 

Erik: Yep. 

Matt: Not that you just, you know, I just don't look, it's not about looking good or whatever.

You're literally causing your body to work harder with less ability to do so. 

Erik: Yep. You're decreasing your longevity. Yes. You, you are gonna die earlier if you carry around a whole lot of extra weight. Yep. That being said, um, it's, it's, you're at risk with [00:11:30] obesity to so many diseases. Mm-hmm. Obesity creates a, a risk, we call it a comorbidity.

Mm-hmm. Equal to smoking half a pack a day. Mm-hmm. Which is interesting. There's other things too, they're called risk equivalence. Mm-hmm. And obesity carries. Regardless of what you think, I mean, the, the data shows it, the data doesn't lie. It's not, there's, there's a negative health consequence to being obese.

Yeah. Um, you know, um, so moving, keep moving down. Yep. You know, you get down to the gut, right? Mm-hmm. Um, when you're [00:12:00] dealing with a patient, um, that's got a lot of visceral fat, um, you know, these, these patients are at increased risk for diabetes. Mm-hmm. Which creates lots of problems. 

Matt: GI issues. Mm-hmm. Liver problems, kidney problems.

Yep. All these different things. Yeah, 

Erik: that's right. 

Matt: Diabetes is the other thing that we've Type two Diabetes is rampant through the US right now. And O obviously we've talked about it before, that a lot of it is. We're sitting a lot more, we're not walking as much. Sedentary. Yeah. Sedentary lifestyles and we're eating processed fast [00:12:30] foods.

You know, not to get into the whole health and wellness thing, but that's the contributing factors. These are contributing factors. People are exercising less and eating worse than they probably ever have in history. Yep. And that's why we're having all these issues. 

Erik: Yep. Um, I think we talked a little bit about this though, just moving down the body, the musculoskeletal issues.

Mm-hmm. I mean, the, the further down the body, you go to the knees and the ankles, you, you got all your body on top of that. 

Matt: Ankles depending, 

Erik: but you can't forget about the shoulders and the elbows because these folks are getting up outta chairs or. Falling and all that weight [00:13:00] is, is causing, causing musculoskeletal damage.

Yep. And then, you know, you're overweight and you're in the hospital with a broken hip. 

Matt: Yeah. 

Erik: It's the creates whole other set of issues. Whole bunch of problems. Yes. Um, I think the last part, I, I, unless you can think of another one, is that there's a higher rate of, uh, depression. Uh, in, in the obese population, the body image stuff, there's a, it's in our society, there's a stigma.

We'll talk about that with the last section, but I think that's another real thing that we'd have to mention is sometimes these patients have, uh, they struggle more [00:13:30] with depression. 

Matt: Yeah. And, well, and I mean, it's proven that like exercise. Gives you a better mood, improves your move. And so if you're not exercising at all and you're eating garbage, and most of the time people are probably stress eating or they're eating, you know, to get that dopamine hit to make themselves a little bit happier.

Yep. Well, I don't wanna go work. They don't wanna do the hard things. They want to do the easy things. Yeah. And it's just this terrible cycle that just keeps compounding. The more and more you get into it 

Erik: and the more overweight you get. And the more obese you get, the more difficult it is to really get into the [00:14:00] gym.

Yes. And the bigger the problem becomes, the more daunting the solution becomes. Yes. 

Matt: Losing 10 pounds is a lot easier than losing a hundred pounds. 

Erik: Right. But the process for losing 10 pounds, as we've talked about, is the same. Same. It's just, it's just may take longer, but it's one step at a time. It's one decision.

The one micro decision you can make that's positive for weight loss over time, those accumulate. And if you could accumulate. So if you can do something small mm-hmm. That, that you enjoy doing mm-hmm. That's something you could implement into your daily [00:14:30] routine. Mm-hmm. That's a very powerful thing. And you look back over the year and Wow, I lost 20 pounds this year.

Yeah. This is great. You know, 

Matt: just by making some small changes Right. To my lifestyle. Yeah. 

Erik: So the, the, the physiologic, the anatomic, um, realities of an obese patient create a lot of challenges for us in the pre-hospital environment. And in our next section, we're gonna break down, uh, some of the specifics now.

Mm-hmm. Of, of some of these problems. One thing we didn't talk about, which we're gonna get to, which is [00:15:00] kind of cool, and I don't think a lot of people appreciate the impact that ideal body weight versus, uh, actual weight, actual body weight has on medications. Huge. We'll talk about that along with some other things.

Yeah. So we talked about the anatomic and physiologic. 

Matt: Mm-hmm. Changes and 

Erik: changes in obesity. 

Matt: Impacts of obesity. 

Erik: Yep. Um, I think, uh. So now we've talked about that. I mean, just in general, just having a 500 pound patient Yeah. Creates some challenges 

Matt: Yes. [00:15:30] For us as prehospital providers, right? Yeah. 

Erik: So if we're gonna deliver the care for them, just the sheer size creates some issues.

Um, just, I mean, physics, uh, not only are they harder to lift and move, they're also, they create a very top heavy situation on a gurney. 

Matt: Mm-hmm. 

Erik: And you get a 500 pound patient. Falling that you're gonna break a bone, you're going to, you could really hurt. Get hurt. 

Matt: Yeah. Don't try to stop the cot, unfortunately, because, oh gosh.

Yeah. That would be bad. 

Erik: Well, when you're moving a patient, just you, you know, have. [00:16:00] You've gotta, you've gotta be careful. You watch our cot safety. 

Matt: I was just gonna say, yeah, our stretcher safety lecture. Where we go over how to properly 

Erik: Yep. 

Matt: And I mean, a lot of people don't know that when I'm teaching our new hires, you know, I take 'em through because nobody taught me how to do that.

Yeah. I just saw a video the other day of some, some kids coming on, some private ambulance guys, they were coming off a porch with a cot, and they get down and they're doing the, oh no, you don't, you go laterally with the cot as opposed to move it and f. Cot flips right over you. So, yeah, hugely important Uhhuh.

Then [00:16:30] if you have a, you know, these, uh, cots nowadays, they say they're rated for 700 pounds. One good thing I will say is that when I started, you know, the old Inferno Cot that we had in our video Oh yeah. That was what you used to have, right? And think about, you watch the old shows, right? Yeah. People weren't as heavy.

So these, so two normal size, 170, 180 pound guys could easily carry or pick up most patients, and everything was manual. Yeah. 

Erik: Right. 

Matt: And people have gotten so big that now, thank God [00:17:00] that we have power loaders in all of our ambulance. That's nice. We've got fully hydraulic power cots that has saved unlimited amount of careers in RMS and 

Oh, 

Erik: for sure.

Matt: I mean, back in the day, 'cause again, I'm not a tall guy and so when I'd have a heavy patient and I'm trying to lift that cot up high enough. Oh man. I mean I had to do that for close to 10 years before we got power cots. 

Erik: Oh yeah. 

Matt: So yeah, the invention of those things has been a game changer for EMS. 

Erik: No, that's huge.

Matt: And I think part of it is because of this overweight population that [00:17:30] we're seeing this, this, um, increase in the overweight population here in the States. And so they had to create hydraulic cuts, STIC carry, I mean, it's sad but true. You know, that's true. So that is one thing. Yeah. Lifting and moving these patients, so many back injury risks for us as pre-hospital providers, we've gotta be careful with how we're lifting and moving these patients.

Yeah. Uh, that's a huge concern. And then once you get into the actual management and treatment of these patients. 

Erik: Yeah. Them being obese causes all sorts of other issues too. Yes. [00:18:00] One other thing with the weight, you have to think about the hospital capabilities. Yeah. Bariatrics, some ct if you know you've got a big patient.

Right. A chest pain patient, maybe they're, you know, you're thinking, boy, this patient's got a history of blood clots or whatever. If you, if you think there's any chance there could be something going on where they need a CT scanner, calling ahead and, and figuring out what the weight limit is on a CT scanner at one hospital, 

Matt: do you know off the top of the head what the normal CT scanner?

Erik: I knew my hospital. And I think it was, we [00:18:30] had a, we had one, pretty big one. We received a lot. Yeah. Well we were a, 

Matt: yeah, 

Erik: yeah, yeah, yeah. A level one trauma center. But we, we could take a lot more weight on our CT scan or, so oftentimes what we would do is we would actually take a transfer from a lump from some, yeah.

And get the CT scan and then transport them back. 

Matt: Yeah. 

Erik: Um, and then, uh, we've even, um, transported patients to the zoo, uh, to use the zoo CT scanner that they would, you know, normally use large for elephants or, yeah. Right. [00:19:00] Really, really? Yeah. Those, those, 

Matt: that's, I, they, that's crazy. They would transport them to a zoo to get a CT skate that's.

Crazy. 

Erik: Yeah. Interesting. But the gurneys, I mean just, just the sheer weight, you know? 

Matt: Yeah. Like our cots, about 700 pounds for the, the power load cots. That's about average, I think, across the different manufacturers. But they do have like a sister city. Yeah. They have a bariatric ambulance, they have a bariatric cot, like in the ER.

Bariatric beds, you know? And those are typically for patients. Yeah. When you're getting up 6, [00:19:30] 7, 800 pound patients. Mm-hmm. Yep. They're gonna need those bigger cots. I actually, when I was in paramedic school a long time ago, back, what do you say, when the earth was young, uh, or 

Erik: it was dust on the mountains?

Matt: Yes. We had a, a large patient came from a facility and she would not fit on the cot. 

Erik: Yeah, 

Matt: she, she, we had the old little cots and so we actually had to remove the cot 

Erik: mm-hmm. 

Matt: And remove all the hardware off their floor of our ambulance. And we had to take our, what we [00:20:00] call a man sack, which is just a huge tarp with handles.

Yeah. And we would, we had to lift, that was the only way we could transport her. Yeah. And so it was like, we don't have any other options. Back then, they didn't have bariatric ambulance, they didn't have any of that. No, no, no. So it was like this was our only option 'cause she needed to go to the hospital.

Yep. And so, yeah. Creates some unique situations. Uh, we've had had to cut walls out of houses to get patients out. Well 

Erik: see, that's what I was gonna say. It's not just the, the, the weight that creates the issue. When you have the increased weight, now you've got dimension problems. Yes. Uh, [00:20:30] yeah. And so, uh, doorways Yep.

All that stuff. Yep. Um, the other thing, CT scanners, I've had patients actually, actually because of their body habitus, that it wasn't the weight actually that created the problem. The weight, actually they were fine. It's just that they were so short. 

Matt: Oh, 

Erik: it created a diameter issue where they couldn't fit in the CT scanner.

Matt: Oh yeah. Okay. 

Erik: So it's not just weight, it's also diameter. Yeah. You need to, that some CT scanners are different. They can carry higher, you know, patient diameters. 

Matt: Yeah. 

Erik: So, and weights. Yeah. So, uh, you know, some [00:21:00] of these things you just, you know, just, it, it might be a good idea just to have an idea mm-hmm. Of, of what the dimensions are capacities are for your local hospitals and their CT scanners.

Just to know where to take that patient. 

Matt: Yeah, I would say if you're in a more urban area, you probably got lots of options. Know what your options are. But yeah, if you're out in a rural setting, 

Erik: you may not have that option. Yeah, 

Matt: you might. And, and then that brings up another point. You've got a critical trauma patient that weighs 500 pounds.

You might not be able to fly that patient because of their weight. 

Erik: Oh yeah. So that's a whole 

Matt: other factor [00:21:30] because everything with flight is based on weight. 

Erik: Yeah, you're right. Right. 

Matt: And so that brings up a whole other issue that if you're in a rural area, this patient that normally, man we, this is a level one trauma, we gotta fly out.

Can't do that. It's not an option. That's interesting. So what do you do? You know, does the flight crew come out and ride with you on ground for an hour? I mean, I don't know. But you need to have a plan. That's our point, is that you have to have a plan in place because that you will, I mean, it doesn't have to be a trauma.

You could have a STEMI patient out in the county. Oh yeah. A stroke patient that normally you would fly out. Now that's not an [00:22:00] option. 

Erik: Yep. 

Matt: So you really gotta. Preplan and think about those kind of things. 

Erik: That's good. Very important. Well, we talked a little bit about the subcutaneous tissue. That makes a cry difficult.

It also makes IV access difficult too. 

Matt: We had a patient one night, it was a breathing, came in as a breathing difficulty, and we got there and the patient actually coded on us Uhhuh, um, in a, in a, it was a smaller country house. Yep. Uh, in bed. The patient was in bed coded in front of us. So, but you know, the old house is built like in the thirties and forties.

Yep. Small, [00:22:30] little, small, right. Yeah, because. People size. Right. Well, we couldn't. I'm sitting here looking and I'm like, we can't get her down on the floor because then we have no room to work. Right? Yeah. Yeah. And we've to try to get her down and then take her down this long narrow hallway to get her into some, an area where.

This is not so the, I just made the decision. Let's just get a backboard under her. Yeah. So we can perform compressions appropriately. Yeah. We can start bagging and do the best that we can. And so that's what we did, [00:23:00] but we could not get a line on her. Yeah, bet. We stuck her and stuck her. And then obviously I went right to the IO.

Mm-hmm. The yellow 45 millimeter io needle would not reach her bone through her tissue, even on t tibia. Even the tibia wouldn't, even the tibia, 

Erik: usually the tibia doesn't have a lot of fat. 

Matt: That's why I went, I tried the humal head. It wouldn't reach. Yeah, I put that whole yellow needle. Yeah, buried it. I got a little bit of the bone.

I felt like a little bit, so I went to drill it and I'm like, okay, I think I'm in. As soon as we tried to hit, hook the IV up. Catch it. Didn't catch because she [00:23:30] was so. Yeah, large. There was so much tissue 

Erik: in the hospital. We do these things called venous cutdowns, or used to anyway, where we could take, uh, and dissect down into the tissue, like a minor surgery to get down.

Matt: Just like doing a crank. Yeah. 

Erik: Yeah. So, 

Matt: well now we got ultrasounds or, you know, and that's, 

Erik: I was gonna mention that. Yeah. The ultrasound now creates this ability for us to do a better job of finding those veins, uh, because. Anomic, we should have brought this up in the last one, is vessels. The vessels are within the adipose tissue, typically on the surface of the [00:24:00] skin.

Mm-hmm. Uh, the arteries tend to be deeper. Yes. Which is good to protect those arteries, right? Mm-hmm. For an injury. Mm-hmm. Mm-hmm. And then it's also good having the venous blood out in the periphery as opposed to Right one. Yep. Um, but that creates some difficulties though with an obese patient with all the extra tissue.

It could be really hard to palpate that. Oh yeah. It's very difficult, you know? About where the vein might be, but if you can't feel it, it creates some difficulty. An ultrasound. 

Matt: Yeah, ultrasound changes that and, and two, like the depth, again, [00:24:30] like with that needle. Mm-hmm. Your standard, you know, one and a quarter or one inch IV catheter might not reach.

So that's why like with our ultrasound, we got, I think they're one and a half or two inch. There's varying sizes you can have. Yeah. Um, so you gotta have bigger needles to be able to reach through that tissue to get to that vein. 

Erik: And those, those veins tend to get closer to the surface in the acs. Mm-hmm.

There's less fat there. Right. Um, but, but either way it's, the ultrasound will help you find them. 

Matt: Yes. Ultrasound is a good tool for, for these kind of patients. Airway. Let's talk a little bit about airway. Oh my gosh. [00:25:00] Considerations. Yeah. I mean, these are scary patients and typically, you know, C-H-F-C-O-P-D, the, they're probably gonna have an airway problem.

And you may have to take an airway and so you're not gonna be positioning. This is where patient positioning is so important. Yeah. If you're trying to intubate these patients flat, a patient that weighs 3, 4, 500 pounds, you are doing yourself and your patient a disservice. That's right. 'cause you're decreasing your chance of getting that tube.

Erik: Yeah, that's right. When you're supine, your obese patient is supine. They've got a a ton of [00:25:30] weight. I mean, depending on how big they are, right? It could be 40, 50 pounds of subcutaneous tissue on top of the lungs that you're trying to bag. Yes. 

Matt: And lift. They're already in respiratory distress. Now you just made it worse.

Erik: Yes. That's why it's so important and I'm, I'm not talking about airway positioning, but this does benefit airway positioning too. Yes. But ramping your patient and getting them up Yeah. Takes a lot of weight off those lungs. Now they're easier to bag preoxygenate and get 'em prepared to intubate. Yep. And then once you ramp a patient up too.

Puts them in a good position. That's right. Um, for the actual [00:26:00] passing of that tube to the courts and whether you're a LS or BLS, it doesn't matter. No. Putting your patient in a good position, it's so important to elevate the head of the bed with these obese patients. 

Matt: Yeah. If you're, if you're a BLS provider and you're putting your patient on oxygen, 'cause they're struggle, don't lay 'em flat.

Think of like that C HF patient, you know, sit 'em up. Yeah. You know, how did we learn that in paramedic and EMT school? Right? Yeah. You know, they sleep with pillows behind them. This is why. Right? 

Erik: Absolutely. 

Matt: So, yeah, even if you're a BLS provider, if they're having any sort of an airway issue, never lay these patients flat.

Yeah. So [00:26:30] bad for them. 

Erik: Well, speaking about a LS things now, the BLS providers, I, regardless of whether or not they're giving medications or not, this is a good thing to know. Yeah. Medications, when you have a patient with a lot of fat tissue mm-hmm. There are some pharmacologic problems with that. 

Matt: Yep. 

Erik: That, well, not problems necessarily, but just the reality of having a lot of fat tissue.

Mm-hmm. So there are two categories of medications. They're either hydrophilic, mm-hmm. Or lipophilic. 

Matt: I'm glad you didn't say phobic. 

Erik: I know. 

Matt: Like you guess. 

Erik: Well, you know, in medicine we would say hydrophilic. [00:27:00] Hydrophobic. 

Matt: Yeah. 

Erik: As water loving or water hating. Right. Um, but I think what we're gonna say today, pharmacologically with, with obese patients, 

Matt: yes.

Erik: Uh, some medications are, uh, um, hydrophilic or water loving, and some are lipophilic or fat or oil or, you know. Uh, lipid loving, right? Mm-hmm. Mm-hmm. So, uh, what's interesting about this is a medication. Um, in fact, uh, we've got a list, but we'll go over the details of it. I'm just thinking of one, [00:27:30] just off the top of my head.

Um, a, a, a medication like adenosine 

Matt: mm-hmm. 

Erik: Uh, adenosine is hydrophilic. Mm-hmm. So when you inject it into a vein, it's not gonna do much leaking out into the fat tissues. Thank it. Doesn't like that. 

Matt: 'cause we need to get it. Yeah. Where it needs to go. Yeah. 

Erik: Straight to the heart, do its job. Right. Whereas a, a lipophilic medication is going to, is actually going to get out into the fat tissues and sequester or get stored out there and multiple doses, you're gonna continue to increase the amount of that medication in the fat [00:28:00] tissues.

Matt: Yeah. 

Erik: Because when, when medication gets into the fat tissues, it doesn't get metabolized. It just sits there. Mm-hmm. 

It doesn't get metabolized until it's in the blood supply. And gets to go through the liver or the kidneys, wherever it's metabolized. Right. Uh, to actually for the body to get rid of it, so.

Right. So, um, I guess the reason I bring that up is that, uh, some medications you need to consider the fact that, uh, this, this lipophilic medication gonna get spread out all over the body. Right. Especially with an obese patient with a ton of lipids. Right. Whereas a [00:28:30] hydrophobic, sorry. Hydrophilic, um, medication, like you were saying earlier.

Mm-hmm. You know, your lungs aren't gonna change size. Your heart, your blood vessels, your, your, you know, an obese patient still has five liters of blood just like you and me. 

Matt: Yeah. 

Erik: Right? Yeah. Um, and that, that hydro, the hydrophilic, uh, medication is gonna just get dissolved in the. You know, that you put into the iv, it's just gonna go into the blood.

Right. And stay there. 

Matt: And we're gonna do a whole nother podcast on this, right? Because it's important to put this in. Ditch [00:29:00] Doctor Talk. Right. Street Ditch Doctor. That's right. Street Paramedic Talk. Yep. Is what? What is, what does this matter for us? Right? Ideal body weight. Everybody's heard. Ideal body weight versus actual body weight.

Yep. When do I change my dosing? Based on ideal, based on the size of my patient. Or when should I use ideal body weight? Yeah. And break it down real simply. If it's a hydrophilic, uh, water. If likes water, you want to use ideal body weight. 

Erik: Correct. 

Matt: If it's a lipid or fat liking medication, lipophilic, [00:29:30] lipophilic, you want to use, uh, the actual body weight.

Weight. Actual body weight. Actual body weight, yeah, because that will have a huge impact. Like if you're trying to take somebody's airway, you gotta make sure that the medications you're giving, you're dosing 'em correctly. Correct. So that your patient is fully sedated, fully paralyzed in order to get the tube or whatever you're trying to do.

Erik: And if you're looking in the drug manual and you're looking for dosing, that's all based on ideal body weight. Yes. And so you have to think about these things. 

Matt: It's very important. And like I said, we'll do a whole separate podcast. We're gonna come out with a list and stuff of common medications we do, just to make it simple because it's [00:30:00] complicated.

Yeah. And there's no way you're gonna memorize it with all the things that we have to memorize. You know, it's, it's just have a list. You can pull it out and just get to know those things. So 

Erik: good. 

Matt: So we talked about IV access, we talked about airway, the different challenges for pre-hospital providers. We talked about oxygenation.

Erik: Yep. These 

Matt: patients are, have a higher oxygen demand. 

Erik: Yep. 

Matt: So you've got to be aggressive with your oxygen therapy. You know, if you're gonna take these patients airway, position them appropriately, get those high flow nasal cannulas on, get those, you know, if you're bagging 'em, you know, they're. It's just they [00:30:30] take, they have a high oxygen demand.

And so it's very important to watch what their SATs are doing, what their entitles are doing. 

Erik: And I think to close this out, we talked a lot about patient safety. Mm-hmm. With obese patients. Yes. 'cause there's a lot of things that we should consider. 

Matt: Yeah. 

Erik: But there's also the crew safety. Yeah. There's, you know.

We gotta really look after ourselves. You mentioned a few things. Yeah. But, uh, these, these patients aren't normal patients. You're gonna need to have a group of people Yes. Potentially. To move them, move them around, whatever. Yes. So 

Matt: that's true. So we'll talk more, keep yourself safe a [00:31:00] bit more about that.

Keep um, in. The next part. Yep. And we'll talk about, you know, keeping their dig. Dignity. Right? Dignity. Yeah. We don't wanna be rude to these patients, right? We get it. Like, you go on somebody that's eight, 900 pounds and they've been laying in bed for, you know, three months or whatever. Like we still have to show them they're still human beings.

We still have to be polite and do our job to the best of our ability and protecting their privacy and all those different things. So we'll talk more about that in the third part. 

Erik: Yeah. We got a great story to tell. 

Matt: In the third part or now 

Erik: in [00:31:30] the third part. 

Matt: All right. 

Erik: Unless you want me to tell it now. I can tell it now.

Matt: No, I want, let's, let's build some suspense. All right. Here we go. Alright. Alright. So last part of our Obesity Patients podcast. Mm-hmm. This is the part we're gonna talk about, uh, protecting our patients. 

Erik: Yeah, that's right. And not just, not just their. You know, their safety, but also their dignity. 

Matt: Yeah. Their physical safety, but their emotional safety, their right, yeah.

Their dignity, their privacy, uhhuh, all those kind of things. Very important to do that. And that can be [00:32:00] challenging at times. 

Erik: Uh, my, uh, my dad struggled with his weight, uh, his whole life. Mm-hmm. And I remember, uh, he was in the hospital once and he was very sick. Mm-hmm. And, um, I, I was in residency at the time.

Mm-hmm. So I was wearing my scrubs when I got the call that my dad was in the hospital. I knew he was sick at home. He had the flu. Mm-hmm. Um, and he got so dehydrated, his kidneys shut down. Mm-hmm. And he got pretty sick. And so he decided obviously, to go to the hospital. [00:32:30] When he went to the ER as a good son would do.

I went, drove up from where I was in residency at the time, fortunately close to where my dad was. Um, I went to the ER in my scrubs. And, uh, with my, 

Matt: you were gonna show 'em. Listen. Okay. Right. You see this? I got my white coat on. You see who I am? 

Erik: You know, it's funny, the, the more the, the further along. In medicine, you get the less and less you want people to know you're a doctor.

Yes. Right. But I love my dad and I was there. I I didn't waste time to [00:33:00] change. I just got Yeah, yeah, yeah. Because normally I don't like to be in places with my scrubs on. Right. But this was different. Yeah. So I got there and, and, um, talking to my dad and making sure he is okay, he's getting admitted. Um, gonna go to the ICU because his kidney function was.

Not so good. Mm-hmm. The kidneys had shut down. 

Matt: Mm-hmm. 

Erik: And uh, I wanted to go see some of the other blood tests and check out some pictures. They got a CT scan and they're doing other stuff and so I went back to the doctor's area and then we're in scrubs with badges and like you look [00:33:30] kind of Yeah.

Matt: Nobody's looking at you. You like, who's this guy? 

Erik: Yeah. So I was talking to our. Doctor in the doctor area and, uh, looking at some of the labs results and mm-hmm. Whatever. And these other doctors or PAs, nurses or whatever, they were on the side here saying some of the worst things mm-hmm. About my dad. 

Matt: Oh no.

Erik: Oh, and I, it was heartbreaking to me to hear my. Uh, professionals. Yes. Colleagues, yes. [00:34:00] Speaking in this way about, uh, that obese patient in room 11 and to me that, um, I, I stood up for my dad and I told him, that's my dad. You're talking about Yeah. This. I appreciate you showing some respect. 

Matt: Yeah. Before I throw you through a window.

Erik: I, that was nice. Yeah. Yeah. Because they, they didn't know, and I've been there because in the ER sometimes we get these obese patients. Yes. And we, we tend to, and I don't think it's any different in the firehouse. No. I mean, you, that's probably [00:34:30] worse than the firehouse to be honest. So it, you know, 

Matt: well, and because these patients also come in a lot, like they come into the er, they call 9 1 1 all the time.

So it's not just the fact that, you know, it's an obese patient, but it's somebody that like, because. We're human, right? Yeah. Medical providers. We're human. And it's like, bro, like take some control of your own life. Yeah. And so that can be very frustrating when you're constantly running all the time on somebody and everybody's telling 'em, look man, you gotta start changing your lifestyles.

And they don't do it. You're right. And so that's [00:35:00] creating more work for you that gets frustrating. Does get frustrating. And that can lead to these situations. 

Erik: Exactly. Me what's interesting, and this is not the same with everybody, but every individual has a story. 

Matt: Yes. 

Erik: There's, uh, there's all sorts of different sorts of trauma and, and all sorts of different reasons why obesity might manifest in a patient.

Right. Uh, I can say from my dad's perspective, the reason he's been obese and we obviously we talked about this mm-hmm. And he wouldn't mind me sharing this. Mm-hmm. Unfortunately, it's to a lot of people. [00:35:30] But is that, uh, he, he was. So advanced in school. 

Matt: Mm-hmm. 

Erik: That he skipped a bunch of grades and he ended up graduating and going to college at age 14.

Like he wasn't even able to drive when he went to college. This. Anyway, my dad tells a story better than I do, but when you're that. Uh, behind physically with your peers, you really can't do sports. 

Matt: Mm-hmm. 

Erik: And so my dad never really had a chance. He loved sports. Yeah. And he did sports, but he never got to [00:36:00] really compete.

Sure. Like maybe he wanted to being behind everybody physiologically. Mm-hmm. Academically he was advanced. 

Matt: Mm-hmm. 

Erik: My dad's the smartest man. I know. 

Matt: Yeah. 

Erik: Um, but he, um. My dad, my hero. Mm-hmm. Really struggled with his weight. He never had, I don't think, this is my opinion, and we've talked about this, but never established those exercise sort of habits.

Right. Right. And things that he enjoyed. Yeah. My dad loved to ski and he loved to water ski, and he loved to do active things. Mm-hmm. [00:36:30] But when you start to combine, uh, love for food and, and lack of mobility, now my dad travels all over the world. Mm-hmm. Doing what he does. He's a healthcare expert. Mm-hmm.

He's really, he is an amazing man. Mm-hmm. But when you're traveling like that, you're eating out all the, the time. Oh, yeah. Yeah. And my mom is from, we're from Iowa, so we, we've, there's no, there's no meat on the plate. It's a snack. Right. You know, it's like we eat a lot of good food, 

Matt: meat and potatoes and Yeah.

The carbs and rich food. Yeah. Buddy. Rich, rich food. Hard, 

Erik: all that to say. [00:37:00] So my dad has the, that's his history. True. And, and so, so the comments that were being made, a lot of. People assume just lazy sluggards and all sorts of terrible things they were saying, and I had to straighten 'em out. It's like my dad is not lazy.

Yeah. He may not exercise like he should. 

Matt: He probably smarter than all three. You combined. Yeah. Right. 

Erik: And he's not, he's such a hard worker too. Yes. Yeah. I could tell you stories. Yes. But anyway, all that to say. Our patients deserve dignity. Yes, the jokes shouldn't be done. No. Don't care who your patient is or what it is.

We should never joke [00:37:30] about our patients. Sometimes I will say though, that when a patient's getting coded and there's a funny tattoo or there's something we say that's crass, it's not meant to 

Matt: no 

Erik: degrade a patient or whatever. They're even unconscious, but you have to be. Careful to always give your patient dignity and sometimes in a code or a stressful situation.

As providers, we may sound callous to the public if they were there. Yes. We walk a fine line with those things. Yeah. 

Matt: Because we used dark [00:38:00] humor sometimes as a way to cope with some of the things that we deal with, you know? For sure. And it's just an unfortunate reality of what it is. And, and it's never going to change.

Yeah. I mean, you can have whatever, you know, that is never going to change. 

Erik: Right. 

Matt: Um, so I mean, it's just part of it. It's not meant to be offensive, it's more of us trying to cope with it. But another thing on your dad, like the other thing, like we don't know what people are going through. Like my dad's saying, my dad was.

Grew up in Pennsylvania, Uhhuh, so it was the same kind of thing, but his [00:38:30] genetics. Yeah. Now my dad was a runner. Yeah. He was big. He liked to run, so he did kind of have more of an exercise regimen. But my dad ate whatever he wanted and never gained weight. Yeah, right. So like, and that's kind of the same way I am now that I'm getting older, it's a little bit more difficult, but I mean, yeah.

For most of my life, I could eat whatever I wanted and I wouldn't gain a pound where like you as a bigger guy, you probably have always had to watch. Struggled. Yeah. So every, you know, it's very easy for me to say, oh, well you're fat and outta shape. Well, you [00:39:00] might actually be eating a whole lot better than me, but because of your genetics and my genetics, I just stay thinner.

And so that's another reason. Just 'cause somebody's overweight doesn't mean that they're lazy or, that's right. You know? Their genetic makeup, they might be a vegetarian or whatever. You know, eating really healthy and trying and yeah. So just, we never know what somebody else is going through. Be mindful of that.

You know, certainly don't embarrass your patient, uh, while you're, you know, when while you're handling them and dealing with them. Don't do anything that would [00:39:30] embarrass them. Um. Uh, that's super important. 'cause you know, know, a lot of times they're living in apartments, you know, if they're upstairs, we're having to get chairs out or, you know, different things to move them.

And that is, I've had patients that you can tell they're visibly embarrassed by the fact that this is happening to them right now. Right. You know, that we're on the third floor of an apartment complex and we gotta get out the stair chair because they can't walk. 

Erik: That's right. 

Matt: And so now we've gotta take 'em down and, and.

So it doesn't cost you anything to be nice and kind to somebody. 

Erik: And I think, and I really [00:40:00] believe that we should probably make an even, well, we should always make an effort to try to empathize with our patients. Yeah. Here we are in their home. We just had to tear the door apart so we can get 'em out of the room.

Yes. That, just think about traumatic, how hard that would be to watch. It's like, ugh. 

Matt: Yes. 

Erik: You know? Now my problem's really public. Yes. And now I like in the privacy of my own home and this is a mess, and this is this. I couldn't get to the bathroom this time. 

Matt: It's just one more thing. I'm overweight, I'm outta shape.

I'm not happy. I'm depressed. Nobody loves me. People make fun of me. Now I [00:40:30] had to call 9 1 1 and they had to come in and because I'm so big, they had to. Take the door off or cut a hole in my wall. Yeah. Or whatever the case may be. And yeah. Like it just compounds the problem. 

Erik: Remember when we talked, we had a, a podcast we did not too long ago.

We talked about verbal deescalation. Mm-hmm. And I think that SAVE mnemonic Yeah. Is wor, it works. It works across the board. Oh yeah. Right. For any patient supporting is the s Yeah. Showing like. Man. Um, it's an honor to serve you today. Yeah. You know, I'm sorry this is happening. I'm sorry that, [00:41:00] you know, you're feeling well and then acknowledging it.

Acknowledging, yeah. It's like, I can see this would be very difficult if it was me in this situation. I'm so sorry. We tore your door off. Yeah. To get you out of this room. That must be really tough. And Yeah. And then validating it. Mm-hmm. I would feel that way too. I'd be very embarrassed. Mm-hmm. And I just want you to know we're here to serve you.

We're part of your team. Everybody here wants to help you. And then emotion naming is the E. Mm-hmm. And being able to say to that patient, you know what, I can see that you're angry. Mm-hmm. And, and I would be angry too. This is really difficult. [00:41:30]

Matt: Yeah. 

Erik: You know? Anyway, so that SAVE mnemonic, I think can go across the board.

Right. We kind of gave it credit just for verbal deescalation, but I think it's good with any patient. For sure. And I think it's especially here, these patients that are experiencing something really embarrassing and really tough to experience and, and, and being sick on top of the social stigma. Yeah.

They need to hear us do those things. Yeah. 

Matt: Oh, it's very important. Yeah, for sure. 

Erik: Huge. 

Matt: Yeah. We gotta be mindful of that. Um. So, and then, you know, you get to the hospital, you know, you, [00:42:00] like I say, you might have to call out. We've had situations where we've had to call out a bariatric ambulance, Uhhuh, you know, to transport those patients, uh, or the cots or just, anyway, be mindful of that.

Erik: Yeah, and I think a couple more things that we should probably talk about. I, I, I like crash worthiness. Crashworthiness, these patients. Uh oh, very unsafe. That kind of crash. If you have a bad Yeah. You know, a fall off the cot, uh, you know. 

Matt: Oh, that kind of, I thought you meant crashing, like coding crashing.

Oh, you mean crashing? Like [00:42:30] actual, I guess that too. Yeah. You know, it's like the trauma NVA crashing, yeah. Trauma. These 

Erik: patients, uh, they carry some, there's some difficulties in, in treating diseases. I mean, uh, chest compressions are not going to be as, oh. Effective? 

Matt: No, you're trying to push through a lot more tissue 

Erik: and they may not even f fit the, the, uh, whatever you're using the device.

Yeah. 

Matt: Lucus device. Or device, whatever. Device. Device, yeah. Yep. 

Erik: So there's, there are a lot of different factors at play here for, for patient safety. Yeah. And when you bring them to the hospital, that, um, what we have in [00:43:00] our notes here was, uh, the, uh. The system readiness. So not all, not all EMS systems have those bariatric beds.

Yeah. Not all systems have the CT scanner we talked about. Yeah, we talked about that before. Yeah. CT capabilities, not just weight, but dimensions we talked about. 

Matt: Right, right. 

Erik: So, um, anyway, they're taking care. It's hard enough to get woken up at two in the morning to take care of the EMS call comes out.

Right. But then when you have the extra efforts that we have challenges we have to go through and challenges of taking care of a 500 pound or 600 [00:43:30] whatever pound patient, it's harder to have a good attitude. 

Matt: Yeah. Yeah. Especially when that person calls every night at 2:00 AM 

Erik: Right, 

Matt: right. Or, you know, multiple times.

Yeah. Difficult. It's really easy to lose your patients. Like I say, we're all human uhhuh. Right. And that it's really easy to lose your patients. So just, 

Erik: yeah. 

Matt: You know, take a deep breath. Go through it and and do what you gotta do. But it's always important for any of our patient populations. We've talked about special needs, obese patients.

Homeless patients. Yeah. You know, [00:44:00] patients that struggle with addiction or alcoholism, all these different things that are a large majority of our calls as first responders. Yeah, right. We deal with patients that don't take care of themselves. That's right. A lot of the times. And that can be frustrating. 

Erik: And we deal with rude patients.

We deal with patients that are totally disrespectful and say awful things to you. Yes. And they may be obese, they may be a transient, they may be one of these patient populations, 

Matt: and it's kinda like your mama told you. Just if you don't have anything nice to say, just don't say anything at all. Yeah.

We're not saying that you have to sit there and be like, okay, well they're somebody's cussing and screaming at you, but just don't say anything at all. [00:44:30] Yeah. Get 'em on the cot. Do your job, do your job, get 'em to the hospital. Whatever you have to do, just keep your mouth shut and move on, because those would be the same patients that will complain on you too.

Erik: You know, we talked about the SAVE acronym as being good for all patient populations. Mm-hmm. I think this is another thing to remember and I, I love, I love to think about this as a husband, for example, 

Matt: uh, 

Erik: when, when, when there's a tension in the marriage. 

Matt: Mm-hmm. 

Erik: And when you say you love your wife in the midst of tension mm-hmm.

Or maybe things aren't going so [00:45:00] well. 

Matt: Mm-hmm. 

Erik: And you choose to say, I love your wife, or you choose to. Even be kind or whatever it might be. Mm-hmm. Mm-hmm. That's a better measure. 

Matt: Mm-hmm. 

Erik: Of a husband, I think. 'cause when things are going really well and you're at Disney World, it's easy to be that good husband maybe.

Right? Right. 

Matt: Yeah. When you're drinking margaritas on the beach, everybody's happy. 

Erik: Yeah, exactly. 

And I think the same thing is true here. So it's almost like across the board in life, are 

Matt: you saying I should tell my patients that I love them? What? What are you getting in here? 

Erik: No, just drink tequilas. No, no.

What I'm saying is when you have that difficult patient [00:45:30] population that you're treating, let's just say, because it's. We're talking about obesity. Yeah. You get that 600 pound patient that you've seen a bunch of times, just keeps calling 9 1 1 and you're, you know, you're frustrated and you could feel that you're, yes.

Right. That's an opportunity to have a good attitude. Mm-hmm. And to try to be a. A positive sort of a paramedic, an optimistic patient, and of a provider. Yeah. Remember we talked about this at the beginning? Yeah. Pessimism is actually bad for your health. Yes. If you can find a way to be optimistic in [00:46:00] these patient situations, whether it's whatever the patient demographic is, if you feel yourself getting a little angry 

Matt: mm-hmm.

Erik: That's an opportunity for you to really be a good paramedic or EMT or whatever. 

Matt: Focus on your job. Yeah. Focus on the good, like I just had four days off. I'm about to get four more days off. They're paying me right now. They're paying me. 

Erik: That's right. Sometimes we gotta pick paper. 

Matt: Yeah, exactly. Like this is what you kinda signed up for.

So try to find the good in it. Mm-hmm. You know, 

Erik: that's, I love being a doctor. When my patient says something like, man, you're the best doctor. You, I just love you, doctor [00:46:30] Axene. And it's easy for me to treat those patients Nice. 

Matt: You know, and, and speaking of the nice thing, just one last thing is. Uh, I have found in my career that you could be not the greatest paramedic in the world, but if you're nice to people, you're never gonna get complained on.

Yeah, it's true. You know, you're never gonna get complained on. Where I've had paramedic partners that were phenomenal. Very good clinical paramedics. They could start an IV on anybody. Yeah. But they were always rude to people and they would get [00:47:00] complained on all the time. Yeah. On the flip side, I've worked with guys that were not that good of paramedics.

Right. But they were always nice to people and people loved them and they, so for no other reason than just to alleviate complaints and problems, just be nice to people. Makes it so much easier. 

Erik: Here's a great story. You got two guys. Yeah. One guy graduated at the top of his class in sales. The other guy was kind of just mediocre.

Yeah, right. The guy at top of his class in sales gets to this first sale call ever. Gets to the door guy slams the door in his [00:47:30] face. He's crushed. He quits. Yeah. He gets the other guy that was kind of mediocre door, gets slammed in his face, faced the adversity before I'm gonna go to the next door, and the next door he doesn't give up.

Right. And then he makes the, he makes he, he becomes successful. I think the same thing is true in as a provider. Mm-hmm. I don't care what your test scores are. Yeah, no, a hundred percent. That's like, that's like weight room strong. Yes. I've seen football players that can't perform on the field. Yes. There's weight room strong.

Well, I think the same That's right. Is true in our field. That's a good story. [00:48:00] Uh, I think that. The, uh, the same is true though with us. Yeah. Because I think that people underestimate the power of kindness. Yes. Especially in a patient interaction. Mm-hmm. If a patient feels safe around you, they're gonna give you more information, you get more information, you get a better diagnosis, you provide better care.

Yep. That, that patient interaction where you've built trust and communication is, is huge to patient care. So I, and it has been proven. One of the best ways to defend yourself from a lawsuit in medicine at least, is studied, [00:48:30] is to have, uh, a patient experience that's positive. 

Matt: Mm-hmm. 

Erik: To have high press Gaines.

Matt: Yep. That's what I'm saying. Best thing you could do to not get sued. Yep. So if you don't wanna get sued, be nice to people. Yeah. 

Erik: That's not quite what we want. 

Matt: That wasn't really our take home. That was the last part of our, 

Erik: they can be difficult. 

Matt: They can be in a lot of different ways.

Physically moving them. They might be angry. There's a lot of different factors that play into how they can be difficult patients to deal with. Yeah. And so. In the midst of that [00:49:00] difficulty, just, you know, try to keep your cool, be nice and move on. 

Erik: And I think this is a great discussion about the anatomic challenges, physiologic challenges, 

Matt: treatment challenges, 

Erik: size and all that.

Uh, and the stigma. Um, these patients deserve dignity just like anybody else. And they have disease just like everybody else. They need care. They called 911 for help. Yeah, and we need to deliver that care in an excellent fashion as best we can.

Matt: Agreed. See you the next one.

Erik: Be safe out there.[00:49:30]

Narrator: Thank you for listening to EMS, the Erik and Matt Show.