The Centers for Disease Control and Prevention says over 30 percent of Alabamians are obese. Obesity can cause a whole host of health problems, from diabetes to high blood pressure. Treating obese patients can be a challenge, too. Many obese patients require specially designed medical equipment, including ambulances.

Arether Griffin lives in a small house on west side of Tuscaloosa. Obesity and other health issues keep her confined to a hospital bed. She has routine doctor appointments every month, and the only way she can get there is with the help of an ambulance.

'They remove me from this bed, put me on their stretcher and take me down the ramp.'

It's a delicate dance to get Griffin out of her bed, on to a stretcher, down a special ramp on her front porch, then onto the ambulance. Patients like Arether Griffin won't fit in traditional ambulances, according to Tony Smelley. He's the president of the Tuscaloosa-based ambulance company, NorthStar EMS.

'We have had to take the stretcher out of the unit and literally transport the patient lying on the floor in the back of the truck.'

That can cause a patient discomfort, or even an injury if an ambulance makes a sharp turn or hits a bump in the road. Smelly says it also created a unsafe situation for his paramedics and EMTs.

'Lifting injuries are extremely common in paramedics and EMTs and that's one of the primary issues we decided to go with this option of bariatric truck because it removes most of the opportunities for an injury to occur.'

But NorthStar thinks it's found a solution to this problem. Arether Griffin saw it first-hand, when she was leaving the hospital a few months ago.

'One day they carried me to the hospital on a small stretcher. When I got ready to leave they said "look what you're riding in now."'

NorthStar's newest vehicle is a bariatric ambulance. It's designed to transport obese patients. It has a strechter that can hold up to 16-hundred pounds. The stretcher is guided on the truck using a ramp and an electric winch.

NorthStar EMS doesn't charge extra for the bariatric ambulance. The company's standard rate is 425 dollars, plus mileage. Insurance, including Medicare, will usually pay for the service if a doctor says it's medically necessary. But getting doctors and insurance companies on the same page is tricky, says Ken Heinrich. He's a physician in Chicago who specializes in treating obese patients.

'I've heard anecdotally from our patients that it's very difficult to get insurance reimbursement for any of their needs specific to obesity or morbid obesity.'

The tension between obese patients who need special care and insurance companys who want to keep costs down will only get worse, says Tom Campanella. He leads the Healthcare MBA program at Baldwin-Wallace College in Ohio.

'And if they're going to need to control the cost trend, they need to be that much more sensitive to what services are being covered. So I see overall, if anything, the policies are going to become more restrictive in some areas.'

NorthStar EMS' bariatric ambulance cost about 12-thousand dollars. The company already had a large truck that it retrofitted with special equipment, like the larger stretcher. NorthStar president Tony Smelley says the ambulance will pay for itself, and even save the company money in the long run.

'In the past, we might have had three or four units to go to the patient's house. We might have had eight or ten people on the scene, taking that patient, putting them in the ambulance, then going to the hospital, and going out of the ambulance. When those trucks are out of service taking care of one patient, obviously they're not available for other calls.'

Smelley says he's already considering a second bariatric ambulance.

~ Bradley George, March 2, 2011