Bariatric moving & handling- challenges and solutions

The moving and handling challenges presented to carers and professionals when supporting their bariatric patients can be considerable and numerous, depending on the environment they find themselves in and the relative weight of the individual requiring support. This article does not aim to be an ultimate resource for those looking for all solutions bariatric, rather as a signpost for points to consider and potential solutions. This article will discuss the following points: biomechanical forces, dignity, the fallen person & hoisting. However, what is meant by the term bariatric? This term derives from the surgical profession as a method of identify persons categorised over a certain weight. The rule of thumb for guidance is usually any person with a BMI of 40 or above or 300 lbs (Cambridge dictionary 2020). However, as we will discuss the weight is not the only problem that causes problems with moving and handling, but the body shape and size relative to that. Therefore, we have other terms such as “a person of size” or “plus sized”, that are also used to describe those historically referred to as “Bariatric”. The following segment on biomechanics will discuss this further.

Understanding the basics of biomechanics in moving and handling is key, especially when justifying often costly equipment to managers who are often lay people, or not inducted to the complex world of moving and handling. The main principle we will concern ourselves with is the principal of force. Explained very quickly; if you need to move 100lbs in weight, you will require more than that number to be able to move it. This basic principle come from Newton’s second law of motion (Khan Academy 2020). Therefore, for example if you have a 320 lb person collapsed on the floor and they are unable to get themselves up and require help to do so, they will need a force greater than 320lbs in lift to achieve that. This does not consider displacement of the weight. Similarly, when moving that same weight across a surface such as a room, in a mobile hoist, the same rules applies with the added friction of the hoist meeting the floor. Again, a person may not be deemed bariatric however their body shape might mean getting access to the person to assist safely or friction between themselves and surfaces, such as the side of chairs, may also increase biomechanical resistance.

Often when supporting our bariatric patients, to counter the biomechanical forces required to move them, for example to support them with personal care, can often require many carers. This can leave clients feeling exposed and vulnerable, not a dignified position to find yourself in. It is important that we understand this and do what we can to allay concerns and attend to support their dignity as far as is possible. Discuss with your client in advance your plans, what are their thoughts, concerns and wishes in that regard and how you can work together to achieve the handling aims, whilst taking into account your patient’s thoughts.

People fall for a variety of reasons, trips, slips, medical reasons, however if they are unable to assist in any way to get themselves up, we have to have available resources to enable this, and this to be done safely. Consideration of the client’s weight, dignity and safety of the individuals potentially supporting the fallen person are all equally important. Paramedics and care home personnel often find themselves in this situation where they are required to support a fallen person. However, with a bariatric person this is complicated by the amount of force that has to be counteracted and potentially need for them to lift themselves up, is likely greater than they have the strength to manage, requiring outside help. One potential solution for this is a Mangar Elk (Mangar health 2020). This Is a series of connected inflatable cushions that can be placed under a fallen individual and inflated gradually cell by cell. This allows carers to support the client posturally without having to manage the entire or majority of the patient’s weight, reducing the risks associated to all parties. These can be stored very easily in cupboards and are used widely by paramedic services in the UK for exactly that reason. With a maximum load weight of 980 lbs and easily stored they provide a very flexible and easy to store potential solution.

General hoisting is often compounded by the fact that bariatric patients create more biomechanical force when being moved. Hospitals and care homes often have policies which reflect a need for risk assessments to ensure wards and departments have the personnel on hand to turn a person for personal care for example. Mobile hoists can be purchased that have adequate safe working loads to lift a person from the bed for example to a special chair. The challenge arises due to the biomechanical force being created. In the case of a mobile hoist, it is not just the weight of the person being lifted out of bed for example, but the amount of friction being created by the weight of the hoist and the patient acting against the surface of the floor. In circumstances such as these hospitals, care homes and private residences generally opt to have specially designated rooms with ceiling track hoists (CTH) installed. If not installed when the building is being built or designed often need to be supported by a structural engineer at the planning stage, to ensure the building does not need to be reinforced. A CTH works by significantly reducing the forces not just in lifting the patient but moving them from surface to surface, for example, from bed to chair. The CTH removes the friction caused by the weight of the person against the floor. The CTH can also have a motorised carriage making moving the person even easier. This can potentially reduce the number of care staff required at every call to support a person, due to the reduced strain and effort now required. In conclusion therefore working with bariatric patients can lead to challenges in maintaining their dignity whilst being moved and counteracting the large biomechanical forces to be able to move them. However, through good communication we can improve a person’s dignity, and via modern handling equipment such as the Mangar Elk or CTHs we can counteract the biomechanical forces making it easier and safe to move them. Reference list Cambridge dictionary (2020) definition of bariatric. Cambridge University Press. https://dictionary.cambridge.org/dictionary/english/bariatric Khan Academy (2020) What is Newton’s second Law.2020 Khan Academy https://www.khanacademy.org/science/physics/forces-newtons-laws/newtons-laws- of-motion/a/what-is-newtons-second-law