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45 Degrees North: The Big Problem We Don’t Talk About [1]
['Donna Kallner', 'The Daily Yonder', '.Wp-Block-Co-Authors-Plus-Coauthors.Is-Layout-Flow', 'Class', 'Wp-Block-Co-Authors-Plus', 'Display Inline', '.Wp-Block-Co-Authors-Plus-Avatar', 'Where Img', 'Height Auto Max-Width', 'Vertical-Align Bottom .Wp-Block-Co-Authors-Plus-Coauthors.Is-Layout-Flow .Wp-Block-Co-Authors-Plus-Avatar']
Date: 2025-01-10
Local government officials in rural areas are tasked with making decisions that impact our communities directly. In Wisconsin, people are collecting signatures or attending caucuses to get on the ballot for the April election. That’s when we have a chance – and a responsibility – to choose how we want to be represented. So now is the time to be asking questions about issues that matter where we live. That can include library services, garbage collection, road maintenance, property taxes and more – including public safety.
How does obesity fit into that? Believe it or not, it can be a public safety concern.
First, a confession: Like more than a third of the US population, I’m officially classified as obese. My weight has crept up past the body mass index classed as Overweight into the range for Class 1 obesity. That puts me at greater risk for cardiovascular diseases, diabetes, sleep apnea, early decline in cognitive function, and increased challenges to living independently in a rural area. I’m working to remedy that, and can totally understand the inclination to say a person’s weight is nobody else’s business.
But obesity does pose risks to our communities when it progresses to Class 3 or Severe obesity. What used to be called morbid obesity is a complex, chronic medical condition – a disease of excess energy storage. Many things can contribute to the disease progression, including genetics, hormones, exposure to chemicals that can disrupt normal metabolism, age, race and ethnicity, and cultural, geographic and socioeconomic factors. A high-fat, high-sugar, highly processed Western diet can certainly contribute to weight gain, but so, for example, can medications prescribed for other medical conditions.
As Class 3 obesity progresses, it can impact the activities of daily living and impair a person’s ability to walk, to drive, to ride in a vehicle. As going out gets more difficult, they may become housebound. In some cases, a severely obese person may be limited to lying face-down in order to breathe because face-up their weight prevents movement of the diaphragm. Other than telehealth (if they have internet), access to health care becomes extremely difficult once a person no longer fits into a private vehicle.
Rural emergency medical services personnel in our communities deal with severely obese patients more often than you might think. It’s hard to even imagine these situations. We don’t talk about them for a variety of reasons, not least of which are HIPAA privacy rules. But rural municipalities need to better understand the challenges facing responders who have a duty to act, and the potential liability concerns that come from improvised solutions.
For example, a standard ambulance cot might have a maximum load capacity of around 300 pounds. Some can support up to 600 or 700 pounds. In a specialized bariatric ambulance, on the other hand, the cot might bear up to 1600 pounds on a wider surface with a wider base for greater stability, plus longer straps for patient security, and it might have a power ramp or lift or even a boom arm for loading. You’ll need to have an Automatic External Defibrillator handy when you see the price tag. But for low incidence/high risk situations like this, it’s good to know where the nearest bariatric ambulance is and better yet, to have some kind of regional mutual aid agreement that could get it to your area in a timely fashion.
Without that, rural first responders may turn to a volunteer fire department for additional manpower and help with McGuyvering a solution. That solution may look like removing part of a wall to gain access to the interior of a structure, raising a purpose-built pallet with a forklift to a suitable height for sliding the patient onto it, then securing and transferring the patient (pallet and all) to a waiting vehicle that can accommodate more than 1000 pounds and still meet (or come close enough to) requirements for patient and responder safety. (Tactical EMS apparatus might work and even be available from local law enforcement without the need for endless pancake breakfast fundraisers.)
Sadly, many people don’t seem to know or care where emergency services come from or how they are funded. But when they dial 911, they expect help to come. Increasingly, that expectation includes lift assist calls that don’t result in transport – and therefore can’t be billed to insurance.
The elderly, infirm, mobility-impaired, and severely obese in our communities rely on lift assists. Sometimes it’s because of a one-time event like a fall into an awkward place or position and other people in the household and/or neighbors are unable to get them up. Often, though, EMS will get multiple lift assist calls to an address as a person weakens or their condition deteriorates before they consent to transport to the hospital.
Many years ago when I lived in a city, I called 911 for a medical emergency at a second floor apartment. A fire department engine crew arrived with the ambulance to help move the patient down the stairs. Both crews came from a station located a few blocks away that was staffed 24/7/365. Where I live now, the ambulance comes from 25 miles away with a crew of two. If they anticipate needing extra manpower, they request a response from the local volunteer fire department.
My local volunteer fire department is an agency of local government. As such, volunteers are considered employees of the municipality when they’re on a call. So if someone is injured while on a call, the municipality’s insurance covers it. For what volunteers save municipalities, providing insurance is a small price to pay.
Lifting other people is hard on bodies. When my late mother went into assisted living, it was made clear to us that she was eligible as long as her needs did not exceed two helpers for transfers to and from the bed, chair or toilet. Mom was 140 pounds, but her movements could be unpredictable. Nurses and CNAs learn about safe lifting and teamwork and they still suffer back injuries in their work.
The protocol for Emergency Medical Technicians and paramedics might be two people to lift up to 300 pounds, with an additional person for each 100 pounds. That might work up to a point. But those responders may not know until they are on the scene just how large the patient is, or what additional challenges are presented by the environment.
Standard-width doors and hallways can be completely blocked in a fall, making it even more difficult for responders to access positions conducive to safe lifting. Multiply the complexity by stuff piled up in and around the paths needed for ingress and egress.
This might be a good time to assess how an ambulance crew would get a cot into the back bedroom of your own home for a patient of any size. When I was an EMT, we once had to remove a window and pass a stretcher out over the bushes outside because the patient’s back pain was too severe to use a stair chair in the narrow hallway. She wasn’t that big but it was a memorable experience. Now imagine doing that with someone who is 600+ pounds when the frost is going out and the ground is too soft to position the ambulance right outside. Now imagine doing it at night. In rain or snow. From a second-story bedroom or bathroom.
These are the kinds of situations responders in your community face. Some of them could earn more working at McDonald’s without the risks associated with heavy lifting, unpredictable behaviors, and high speed travel on country roads.
This is where I come back to local government. I appreciate fiscal responsibility. But I want to live in a community where skilled responders have the resources and training to safely provide pre-hospital care for my family and my neighbors. Even the ones whose extreme obesity is a lot to wrap my head around.
So I want to know where candidates for county and municipal offices stand on public safety funding and other local issues.
A hot button local issue in my community a few years ago was whether or not the school district should build a new gym and locker rooms. The measure passed, and the project also included construction of a fitness center. Recently, I got a lifetime membership ($10) and a key fob that gets me inside. Except for a short window during the school day when it’s used for physical education class, I can use the recumbent bikes and treadmills and eventually (I hope) the elliptical and the weight machines.
With too little snow cover to snowshoe and too much ice for walking on side roads, that fitness center 6 minutes from home is my best bet for getting enough exercise to make some headway on my health. I hope to be just Overweight again by spring.
Donna Kallner writes from Langlade County in rural northern Wisconsin.
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