Ambulance Transport Bariatric

Standard Operating Policy
TRANSPORT OF BARIATRIC PATIENT

Document No.
File No.
SOP2012-002
11/1542 (D12/1416)
Date issued
8 February 2012
Contents
Policy Statement
Author Branch
Branch Contact
Division
Transport of Bariatric Patient
Operations
(02) 8752 0444
Operations
Summary
This policy specifies the process to be followed when responding to bariatric

patients, in the determination of transport requirements and response of resources.
Applies to
This policy applies to All Ambulance Service of NSW Staff

including Regional Operations, Metropolitan Operations and Control Centre Division
Review Date
Previous Reference
Status
Approved by
Related Documents
31 January 2014
NIL
Active
Chief Executive
RCA 129 Recommendation for a Bariatric SOP
SOP2010-018 Paramedic Referral to ECP
SOP2009-066 Delayed Ambulance Continuation of Care
SOP2009-049 Transport Decision Patient Request
SOP2008-021 Clinical Assessment and Referral (CARE)
SOP2006-061 Hospital Notification System MIST
PD2010-021 NSW Critical Care Tertiary Referral Networks & Transfer of Care
(Adults)
Revision History
Version (Circular #)
Amendment notes
8 February 2012
(SOP2012-002)
Final endorsement by Chief Executive

New Policy no existing policy to replace
Compliance with this policy directive is mandatory
SOP2012-002
Page 1 of 7

Introduction
Transport of Bariatric Patients by the Ambulance Service of NSW requires the use of
specifically designed equipment and vehicles, capable of transporting patients
whose body dimensions and/or weight is not suitable for transport on standard
patient carrying equipment or vehicles.
Only staff trained and qualified in the use of bariatric equipment and vehicles are
authorised to use this equipment. This may be exclusively or with the assistance of
other suitable people under the direction of a bariatric trained person.
This policy also includes patients requiring specialised medical equipment which is
essential for patient treatment during transport and cannot safely be transported in a
standard ambulance vehicle, such as ECHMO patient transports.
Criteria
The term bariatric comes from the Greek term barros, meaning large or heavy. For
the purpose of this policy, bariatric is used to include a wider meaning. Obesity is a
medical condition in which accumulated excess body fat exceeds the recommended
Body Mass Index (BMI) against a measurement of weight and height.
Bariatric in this policy refers to any person whose weight or physical dimensions
exceed the capability of standard equipment in use by the Ambulance Service of
NSW.
Response Co-ordination
A Zone Manager will be appointed by the Metropolitan Director of Operations to
manage Bariatric Coordinating activities and will;
Maintain currency records and listings of staff trained in the use of bariatric
equipment and vehicles.
Coordinate response requests for bariatric transports that are not urgent and
are not suitable for an MRU response.
Maintain such records as necessary for efficient bariatric response
operations.
Appoint 24 hour DOM coverage as the first point of contact to coordinate the
response of staff and vehicle/s to each request for bariatric transport.
Provide information to Control Centre/s in relation to responding staff and
vehicle details and estimated time of arrival at the point of patient pick up.
Identify and advise the Control Centre of patients and their details, which may
require future or ongoing bariatric transport.
SOP2012-002
Page 2 of 7

Mapping Patient Pathway
Request for transport A booking request identifying bariatric patient transport will
be received by the Control Centre. Following MPDS triaging, the case will be
referred through the following pathway (chart 1);
Response <1 hour MPDS categorised urgent or time critical responses will
receive an appropriate response in accordance with Control Centre
guidelines. An ambulance resource will be responded to the patient to assess
the patients clinical needs and confirm the transport mode using the bariatric
assessment tool (PD2010-021).
Response <6 hours (Metropolitan) Referred to the Bariatric Coordinator to
co-ordinate appropriate staff and vehicle response. An ambulance resource
will be responded to the patient to assess the patients clinical needs and
confirm the transport mode using the bariatric assessment tool (PD2010-021).
Response <6 hours (Regional Inter-Hospital Transfers Only) Referred to
the Medical Retrieval Unit (MRU) for a clinical review of the case. MRU will
determine the mode of transport and an appropriate time frame and advise
the referring Control Centre. If medical retrieval is not required the transport
will be referred to the Control Centre. If a medical retrieval is required the
MRU may seek assistance of ambulance resources from the Control Centre
as required.
Response >6 hours (Statewide) Referred to the Bariatric Coordinator to
co-ordinate appropriate staff and vehicle response. An ambulance resource
will be responded to the patient to assess the patients clinical needs and
confirm the transport mode using the bariatric assessment tool (PD2010-021).
Responses not managed by the MRU, a DOM or supervisor should attend the
patient at the initial point of contact (i.e. scene/health care facility), provided this
resource is reasonably available and does not delay the patients transport or clinical
treatment. The attendance of a DOM or supervisor is to confirm the need for
specialised bariatric transport, using the Bariatric Assessment Tool and the
appropriate clinical response for patient treatment using the Between The Flags
(BTF) Guide (R14).
Bariatric Assessment Tool
The Bariatric Assessment Tool described in PD2010-021 requires a measurement of
the patient to determine the patients width and girth, measured at the iliac crest, the
patients height and the patients actual weight.
Estimates of patients weights are generally underestimated and should be verified
by the patient or patients treating medical officer. Be aware that patients may
underestimate their own weight.
A DOM or supervisor attending an incident or facility will undertake a patient
transport mode assessment (Chart 2). This will be based upon BTF guidelines, the
bariatric assessment tool and any relevant information to make an informed decision
as to the need for a specialised vehicle to undertake the transport.
SOP2012-002
Page 3 of 7

In situations where a DOM or supervisor is unable to attend or are delayed in
attending the attending trained Bariatric staff will perform the patient transport mode
assessment.
Rosters
Sectors will provide a bariatric staff roster to Control Centres and the Zone Manager
coordinating bariatric activities each week. A B should be placed against staff
shown on daily roster staff sheets forwarded to Control Centres to identify on duty
bariatric trained staff.
Control Centre/s
Any request for a bariatric transport that is urgent or requiring a response less than 1
hour, will;
Respond an ambulance in accordance with MPDS guidelines for patient care

and initial confirmation of a bariatric response.
Respond a DOM or supervisor where reasonably available, to attend and to
take command of the incident, maintain communications and perform
assessments to confirm an appropriate bariatric response.
Note: On-scene responses should not be delayed waiting for a bariatric vehicle to
arrive at the scene.
Responses not requiring an immediate or urgent response, will be referred to the
MRU or the Bariatric Coordinator in accordance with response guidelines.
Control Centres will maintain a record of patients requiring future or ongoing bariatric
transports to reduce any potential delay in providing a bariatric transport response.
Risk Assessment
A risk assessment must be carried out on each occasion a bariatric patient is
transported, considering the following factors in relation to the likelihood and
associated risk to staff. This risk assessment is the responsibility of all staff involved
with the patient transport and should form part of a pre-transport checklist. The
responding Bariatric trained staff are responsible for ensuring a risk assessment is
performed prior to patient transport.
Patient Factors pain, weight, shape/size, mobility, co-operation, privacy,
comfort, dignity
Space & Design buildings and vehicles; space, clearance, doors, stairs,
corridors, floor surface and safe working loads (SWL).
Equipment & Furniture Availability, fit for purpose, compatibility, size, effort
to move.
Communication Effectiveness, accuracy, regularity.
Organisation Trained staff, timeliness, resources.
SOP2012-002
Page 4 of 7

Mitigation of identified risks must be undertaken prior to patient movement for the
safety of the patient, Ambulance Service staff and others. This may require the
assistance of other emergency services or resources to ensure safe handling
practices are employed at all times.
Staff Welfare
Staff responding on bariatric transports exceeding rostered shift hours or requiring
overnight accommodation must conform to the requirements of industrial awards and
agreements. Staff must manage fatigue appropriately in accordance with Ambulance
Service policies and directions.
Transports requiring extended periods, may require overnight accommodation. This
should be determined as required with the Bariatric Coordinator, who will make any
notifications as required to Control Centres, Sector Office/s for rostering and the
patients medical support.
Any staff issues identified, should be escalated to the coordinating DOM or Zone
Manager as soon as practical in order to manage potential situations in an
appropriate and timely manner.
Driving & Vehicles
Driving specialised bariatric transport vehicles may involve long distances and
extended driving times. Ambulance Service staff operating a bariatric transport
vehicle must comply with Ambulance Service policies and award conditions and
Australian Road Rules and Road Transport Regulations.
Long distance drivers should use the driver fatigue guidelines as outlined in the NSW
Road Transport (General) Regulation to assist in managing driver fatigue.
Due to the nature of bariatric transport and distances which may be involved, it is
recommended that bariatric transport vehicles are not driven under emergency
response conditions for extended periods.
SOP2012-002
Page 5 of 7

Bariatric Response Pathway (chart 1)
Booking Received
via Control Centre
MPDS Categorised Response
<1 hour or
Urgent
Response
Response per
MPDS Category
>6 hours
Response
Metro
1-6 hours
Response
Bariatric
Coordinating
Manager
Regional
3
Ambulance
Response to
Scene/Hospital
(patient location)
Scene Assessment for:

Bariatric Transport
Clinical Requirements
BTF / MISTO
Response Urgency
Risk & Resources
4
MRU
Arranged
Response &
Transport
DOM / Supervisor
Response for
Command &
Communication of
patient &
destination details
(DOM / Supervisor
response where
reasonably available &
will not delay patient
transport or treatment)
MRU
Review
Advise Control Centre of
NO Transport
Advise of details
MRU coordinating
response
Unsuitable for MRU

response
Staff/Vehicle/ETA
Destination offload
& return to base
NO Transport
further treatment
ECP or LMO
attendance
Patient Requiring
future transport
SOP2012-002
3 Information
4 Patient & Resource

Details
Patient details for

future transport
Page 6 of 7

Bariatric Patient Transport Mode Checklist (chart 2)
Item
Action
Bariatric Assessment
Girth Measurement
Weight (Estimate/Weighed)
Between The Flags (R14) Assessment
Red
Yellow
Green
Risk Assessment
Patient Factors
Space & Design
Equipment & Furniture
Communication
Organisation
Resources Required
Ambulance
Other Emergency Services
Health/Medical
Other Factors
SOP2012-002
Page 7 of 7

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Standard Operating Policy

TRANSPORT OF BARIATRIC PATIENT

Transport of Bariatric Patient

This policy specifies the process to be followed when responding to bariatric

This policy applies to All Ambulance Service of NSW Staff

Final endorsement by Chief Executive

Standard Operating Policy

Standard Operating Policy

Standard Operating Policy

Respond an ambulance in accordance with MPDS guidelines for patient care

Standard Operating Policy

Standard Operating Policy

MPDS Categorised Response

Scene Assessment for:

Advise Control Centre of

Unsuitable for MRU

4 Patient & Resource

Patient details for

Standard Operating Policy

Between The Flags (R14) Assessment

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