About Bariatric Patient Transport by Air
Ornge is the provider of air ambulance services for the province of Ontario. Transportion of complex patients is an important part of our mandate. However, providing safe, quality transport to the bariatric population can be challenging for Ornge in some instances because of operational limitations in our equipment and vehicles. Ornge is committed to safely minimizing service gaps to this patient population.
The purpose of this document is to:
Ornge’s Planning Process and Operational Limitations
- explain how Ornge plans for safe transport of bariatric patients, including our operational limitations
- provide guidance for health care partners, including a checklist for sending facilities
>>>Vehicle selection made by Ornge
- What level of care is required?
- Which aircraft are available at that level of care?
- Can the aircraft’s stretcher accommodate the combined weight (patient + equipment)?
- Can the aircraft itself accommodate the total weight and the patient’s width?
- Level of Care
Ornge’s Transport Medicine Physician determines level of care required by the patient. Ornge provides three levels of care:
- Primary Care Paramedics (PCP) provide a basic level of care directed at symptom relief.
- Advanced Care flight Paramedics (ACP) and Critical Care Paramedics (CCP) are capable of advanced resuscitation, and are also able to transport patients on mechanical ventilation and on multiple infusions.
- CCPs are capable of using a broader scope of medications than ACP, including propofol and epinephrine infusions, and treating more complex patient populations (e.g. neonatal, obstetrical, ECMO, intra-aortic balloon pump).
- Type of Aircraft Available
Depending on the level of care required for transport, Ornge can use its fixed wing aircraft (PC-12), its helicopter (AW-139) or several fixed wing aircraft types as operated by contracted Standing Agreement carriers. Ornge’s dedicated aircraft function at the advanced and critical care levels, while its contracted carriers function primarily at the primary care level.
- Weight Limitations of Stretchers
Each type of stretcher is rated to a maximum weight. The weight of the patient plus the weight of the equipment needs to be taken into consideration.
Patients requiring ACP/CCP level of care typically require more medical equipment. As a consequence, the maximum allowable weight for an ACP/CCP patient is typically less than that of a PCP patient. The following illustrates how equipment can influence the maximum patient weight:
||PATIENT #1 PCP
||PATIENT #2 ACP
|Stretcher Weight Limit
||500 lbs (227 kg)
||500 lbs (227 kg)
||23 lbs (10 kg)
||23 lbs (10 kg)
||23 lbs (11 kg)
||23 lbs (11 kg)
||20 lbs (9 kg)tape
|Infusion pumps x2
||12 lbs (5 kg)
|IV fluids (2 bags)
||4 lbs (2 kg)
|Patient Maximum Weight
||454 lbs (206 kg)
||418 lbs (190 kg)
Bariatric stretchers have varying weight limits, ranging from 500 lbs (227 kg) to 700 lbs (318 kg). Availability of bariatric stretchers varies across the province, including by aircraft and land ambulance.
- Weight and Size Limitations of Aircraft
Not all aircraft have the same operational capabilities. Weight and balance considerations are important for aircraft safety. For this reason, accurate patient weight is essential.
For bariatric patient transports, accurate patient width is also essential.
The size of the aircraft door and/or cabin configuration may present an issue, particularly if the stretcher is mounted against the cabin wall. Ornge will ensure that a vehicle with appropriate capabilities is assigned.
Key Points for Health Care Providers
All patient transports should be requested through Ornge’s Operations Control Centre (OCC) or, in the case of a Life or Limb patient, through the One Number to Call process.
Process for Sending Facilities
- For bariatric patient transports, OCC will use patient information provided by the sending facility (specifically, the patient’s weight, width and condition) to send the right aircraft.
- “Width” is a one-dimensional measurement, straight across the patient at their widest point when supine. Width is not to be confused with “girth” which is the circumference at the patient’s largest point, and is not needed for arranging patient transport.
- Transporting safely by air adds an extra layer of complexity. Capabilities vary with aircraft. Many factors need to be taken into consideration when Ornge makes a vehicle selection. For this reason, the timeline for arranging these transfers may be longer than a typical transfer request.
- Providing Ornge with accurate information about the total weight and width of the patient, and the type of equipment needed during transport, is essential.
- Determine if your patient meets bariatric criteria. For transport purposes, any patient with a weight >120 kg and/or a width >27” is considered a bariatric transport.
- When choosing a destination, consider whether the Receiving facility has the ability to meet the bariatric patient’s needs (e.g. bariatric capability for diagnostic imaging).
- Initiate transport request. OCC will ask for the following, which is needed for the total weight calculation:
- weight of the patient
- width of the patient and
- identify what medical equipment will be needed during transport. Ornge will estimate the weight of the medical equipment.
Ornge will determine the patient’s level of care and the combined weight of the patient and medical equipment, and will assign an appropriate vehicle and crew to the transport.
Ornge will also liaise with the local paramedic service to plan logistics and determine any operating limitations it may have.
It is essential that weight and width measurements be as accurate as possible so Ornge can assign the right vehicle and crew. Inaccurate information can lead to lengthy delays.
What Happens If Air Transport Is Not Possible?
In some cases, air transport will not be possible, leaving land transportation as the only viable option. If the patient still cannot be moved (e.g. the patient is in an air only location), Ornge will work with health care partners to determine how we can offer support and what extraordinary means are available.
Want more information?
Want more information? A Communications Officer is available 24/7 in our Operations Control Centre: 1.833.401.5577