On January 13, 1995, at 0200 hours, the Baltimore County (MD) Fire Department was dispatched to a local hospital to assist a patient back into bed. I wondered why the hospital did not have sufficient personnel to accomplish this task. I soon found out.


On arrival, we found an 800-pound man lying on the floor, unable to get up. The attending nurse told us the man had gotten out of bed to use the restroom but didn`t make it in time and urinated on the floor. He slipped on the urine and now was on the floor with a possible fractured pelvis.

We began to formulate an initial plan for moving this much weight. Our medic unit arrived at the emergency room on an unrelated case, so we requested that the unit proceed to our location with the nine-foot straps normally used for backboard immobilization. The victim told us that he had pain mainly in his right leg and that with assistance he might be able to place weight on his left leg and spin around back onto the bed. We hoped that we could provide him with the necessary support by placing the straps under his arms and buttocks.

The bed was specially made and could be adjusted to form a chair. Once he was on the bed, the motors would allow the bed to be lowered to a supine position. The bed/chair was placed on the patient`s left side to accommodate his ability in that leg. We worked the straps between a mattress that had been placed behind the man and his body. Two of us then tried to help the man move. He didn`t budge. We had a real problem.

We reassessed the situation and looked for alternatives. We asked the staff if any other devices to help us lift the victim were present in the hospital. The only possibility was a hand truck used for lifting and moving loaded pallets. However, this idea was quickly abandoned: The lift height of the unit was only a few inches, and the lowest height to which the bed could be adjusted was 36 inches.

Then company personnel asked whether air bags could be of assistance. The idea had merit, so we requested a rescue squad. The first-due squad carried high-pressure bags, but again, the height of lift was a factor. The next-due squad, from the Pikesville Volunteer Fire Company, carried low-pressure bags with a substantially higher lift and thus was dispatched.

While awaiting the arrival of the air bags, we formulated other plans in case the air bags did not work. We considered using a tripod with a chain hoist for lift, but questions arose about the strength of the tripod. Also, we were unsure about the tripod`s height vs. the ceiling`s height. Personnel examined the ceiling to locate support beams. We hoped the chain hoist could be attached to the beam.


The air bags and associated equipment arrived on scene and were brought to our location. At this time, the victim was in a semireclining position with a mattress between him and a wall. (The mattress was merely providing comfort.) Our next job was to position the air bag. We removed the mattress and replaced it with the air bag. Our initial placement was not sufficient, because once inflated, the air bag would have moved the man across the floor, not lifted him as was needed. We removed the bag and rolled the man on his left side, being conscious of his possible pelvic injury. We placed the bag under him much as we would have placed a backboard. We could not attain optimum placement of the bag for an even lift. Our attempts to use the handles attached to the bag to further pull the bag into position were futile due to the victim`s weight.

We slowly filled the bag with air. We quickly realized that we would need a second bag under the man`s legs. We positioned it and inflated it to meet the level of the first bag. Our next problem was soon evident. The air bags were designed for a wider load-to-weight ratio as might be expected in lifting a large vehicle. Simply put, the bags wanted to kick out from under the patient. So personnel attempted to use their own body weight against the two bags to keep them in place. As the bags were inflated, personnel had an increasingly difficult time keeping the bags in place. Fearing that the bags would kick out from under the victim, causing him to further injure himself, I asked whether we should instead lower him and rig the chain hoist as an adjunct to the bags. Personnel felt that since we were within inches of the needed height, we should continue current operations.

As we reached the height of the bed (approximately 36 inches), we noticed another problem–a gap between the bed and the air bags. We could not move the bed any closer, so a member grabbed the backboard that had been brought into the room earlier. We used the board to bridge the gap, but we still were concerned about whether the board could withstand the weight. Having little choice, we quickly rolled the man, hoping the bed would not move, the backboard would not break, and the bags would not kick out. As the man successfully rolled onto the bed, our final concern was for the two nurses positioned on the opposite side of the bed. Could they get the man to stop his roll? They could, and the job was completed.

* * *

This incident posed a unique set of circumstances. We, as most departments, have responded to incidents involving patients weighing nearly 500 pounds. However, no previous incidents had involved this kind of weight. If you have had a similar situation and have used other tactics successfully, our department would like to hear from you. n

DENNIS R. KREBS is a 16-year veteran and captain of the Baltimore County (MD) Fire Department Fire Suppression Division. He is a certified cardiac rescue technician. Krebs co-developed the Medical Emergency Defense and Incident Control (M.E.D.I.C.) Seminar and coauthored the book When Violence Erupts, A Survival Guide for Emergency Responders. He currently is a faculty member in the Counter-Narcotics Tactical Operations Medical Support Proj-ect funded by the Department of Defense.

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