An article in EMJ confirms a very valuable lesson I once learnt from a veteran paramedic. Fat people are more prone to suffering serious injury or death in car accidents.
Fat Female Fiesta (Festiva in Australia…)
A few years ago, me and an experienced paramedic responded to a road accident. A lone female driver had for some reason driven her tiny Ford Fiesta off the suburb street and hit a tree.
The patient was incredibly obsese and it took a while for the fire department and the paramedics to have her taken out of the tiny car. During that time she was awake and talking with normal vitals. She said she was a bit sore but denied being in any great pain.
After extrication she was put on a stretcher and we made our primary assessment in the back of the ambulance. We found some minor lacerations over the thorax and abdomen, likely from the seat-belt. Other than that we found pretty much nothing. A GCS of 15, normal vitals, minor discomfort on palpation over the thorax or abdomen but nothing localised nor dramatic.
There was no need for any interventions other than inserting a few lines and maintaining immobilisation. So we started discussing where to send this lucky old lady. Did she really need to go to the level 1 trauma centre? There was a mid-tier hospital only five minutes away.
My paramedic wasn’t too keen on that. Instead, he suggested we should take her to the trauma centre.
He told me ´you need to watch out for fatties in small cars. There is always more to the picture with them.´
It was my call. Then again, this was a guy who had an incredible talent for sounding like he was suggesting when we all knew he wasn´t suggesting at all. He also had some 30 years worth of experience responding to MVAs. Better listen to him. The patient was delivered at the big trauma centre.
A few hours later she was in the ICU after having an emergency laparotomy.
The study in EMJ is a matched-pair cohort study demonstrating how risk ratio for death in persons with BMI > 35 is 1,8-2.0!