Tuesday, September 14, 2010

Being Fat in an Emergency

We recently discussed Community Emergency Response Training (CERT), how I took CERT training this year, and what an excellent program it is. 

However, I also wanted to share one negative realization I had, not about the program, but from the program.  And that was how fat people might get discriminated against during an emergency.

In an emergency, some rescuers might be less likely to help us, based on our size alone.  Or we might be seen as less likely to recover and so moved down the priority list for treatment. Or, like during Hurricane Katrina, "caregivers" might be unwilling to evacuate us and maybe even willing to do worse. 

I saw this lesser willingness to help fat people among some people in our CERT class.  Not all, but some, and it really shocked me.  Call me naive, I guess, but it was a surprising lesson for me.

It's also a lesson I've debated blogging about, but in the end decided it was better to open a dialogue about it than to let the incident pass without remark.

Too Fat To Deserve Help?

During our second-to-last class, we did a paper simulation of a disaster as practice for the real-time simulation the following week. We divided the class into two groups, set up our organizational structures, and then pretended to be the Command Center for organizing emergency response to a flood. They gave us index cards with emergency scenarios on them and we had to decide how to prioritize assigning help, how to manage volunteers, and how to get/distribute emergency equipment needed.

In one of those index-card scenarios, a downed tree blocked road access to a 300 lb. man having a heart attack. An ambulance was on its way to him but couldn't get through.

Can you guess how the Incident Commander responded?

Yup. She completely wrote him off and sent the ambulance somewhere else rather than have a volunteer go over with a chainsaw and cut away the tree. She didn't say it literally but basically implied that it was survival of the fittest at that point.

I was so angry I could hardly see straight. As soon as she heard his weight, she wrote him off and didn't even try to brainstorm ways to help him. Augh.

This was not an obnoxious fitness fanatic, mind.  She was just an ordinary person, a little plump herself, with her own physical challenges from past injuries.  I would have thought she would have been more empathetic, not less --- but she completely wrote off this man without even trying to find ways to work the problem.

If it had been a matter of saving greater numbers of people, I would understand not making this man a priority. In an emergency, you have to help the most people possible, and a scene involving many victims in mortal danger is going to get priority over a scene involving only one victim in mortal danger.

But most of the multiple-victim events we were given were not life-threatening, this was clearly one of the most life-threatening events presented, and there was plenty of volunteer help to go around.

It was clear that she didn't choose to abandon him because he was only one person or because we had limited resources; she chose to abandon him because he was fat.

If it was simply a matter of not being able to lift him, I would even understand that up to a point too. Larger people are harder to lift and can injure their rescuers. In a really pressing, life-and-death, every-second-counts evacuation situation, hard choices might have to be made about who could be most easily transported and saved. While I wouldn't like it, there are some physical limitations that can cause hard choices to have to be made under the most pressing circumstances.

But this wasn't one of those. All that had to be done was to send someone over to cut away the tree. It would only take up the time of one or two volunteers, and chainsaws were available for use in our scenario

Ordinary volunteers would not have to lift this man because an ambulance was almost to his location.  Most ambulance crews have equipment and experience in dealing with larger patients. They do it frequently enough that they have learned how to do it as safely as possible.  It's not their ideal but they generally have experience with it. And unless he had passed out, the patient probably would have been able to help; many heart attack victims can move around to some extent. Furthermore, the crew was already almost there -- they just needed help to get the last couple of blocks there.  It's not like extraordinary measures would have to be taken to get to him or to get him into the ambulance.

I pointed all these things out during our paper simulation and fought for this theoretical guy's life....to no avail. I argued several times.....she wouldn't listen. Her mind was made up when she heard "300 lbs." As soon as his weight was said, she had an audible negative reaction and immediately decided not to send help. 

The ironic thing was, the patient wasn't all that large.  Yes, 300 lbs. is no lightweight but the public has a distorted view of what "300 lbs." looks like.  They think of the headless fatties photos in the media, or they think of the "super-super-obese" person who is bedridden and can't get out their door. In reality, they probably know several 300 lb. people but have no idea that these acquaintances weigh about that much.  Their view about what 300 lbs. "must" look like distorts their judgments about helping.

My husband is about the size of the man in the scenario, but he is tall, built like a linebacker, and carries it well enough that most people would never guess he weighed that much.  I wonder if our Incident Commander realized that someone else sitting in that very classroom was that size, and she was basically denying help to one of her classmates?  I thought about telling her that in essence, she had just decided to let my husband die, but in the end I decided that was too potentially embarrassing for my husband and son to bring that up, so I didn't.

In the end, I had to remember my CERT training, which is that sometimes you have to go along with a decision you don't agree with when you are not the one in command. If I'd created a big argument, needed help would have gone unassigned while people bickered, and theoretical victims might have died in the interim. I had to look at the big picture and move on, but I made sure she knew I disagreed first.

(In a real scenario, I hope I would've found a way to get this guy help even if I had to take the damn chainsaw and go myself.)

Post-Incident Reflections

When we discussed our decision-making process afterwards, no one else protested denying help to the person of size.  I mentioned my disagreement but didn't make a huge deal of it because it would lead to unpleasant places I knew my husband and son weren't ready for.  (No one is as easily embarrassed as a teenaged boy whose mother is putting up a fuss, and my husband wasn't really ready to have his weight discussed in a public forum like that.)

In retrospect, I wish I had been more vocal in pointing out the discriminatory nature of her decision.  I feel I dropped the ball by not making it an opportunity for dialogue, and I'm still kicking myself over that.

The supervisor did note another alternative no one had thought of -- instead of trying to get the ambulance to the heart attack victim, we could have tried getting the heart attack victim to the ambulance. The big guy's loved ones could have put him in a rolling chair and rolled him down the street to the ambulance. That wouldn't have needed any volunteers assigned to the case and wouldn't have required special equipment other than a rolling chair (which many people have in their home offices).  Its success would have depended on the condition of the roads but it was worth giving a shot. He said rolling chairs are excellent alternatives that are often overlooked in emergency scenarios.

However, I still felt like this was a clear case of discrimination. If the patient had been average-sized (or no specified weight), the Incident Commander would have found a way to get a volunteer with a chainsaw to the tree and gotten that ambulance to the victim. She was working the problem till the moment she heard his weight.

The one bright spot in this was that the bias wasn't universal.  The other team made the big guy a priority and he was one of the first people they helped. Weight didn't seem to influence their decision process.

It was good to know that not everyone would discriminate against larger patients during an emergency....but it was quite upsetting to realize that some would, even when there was a relatively easy fix.

Closing Thoughts

At this point, I should remind folks again that the CERT class was excellent.  In no way did it promote discriminating against fat people, and the skills it taught would be very valuable to people of any size.  It is certainly a class well worth taking, for people of all sizes.

But the "community" nature of the program means that the community responders may reflect many of the biases of society. Some of those people might see fat people as less worthy of saving than others, or as too much trouble to waste resources on.  It was frustrating to see that in action, even if it was "just" a theoretical scenario. 

The lesson I took from this disturbing incident was not to specify someone's weight in an emergency call unless it's really relevant (i.e. special equipment is needed), and to know that I, as a person of size, might have to be more assertive about getting myself or other fat loved ones equal care.

*Comments?  Thoughts?  Experiences?


Heidi said...

Oh. My. God.

I think I weigh around 300 pounds (I haven't weighed myself in about seven years).

This is me, with my son, last autumn: http://www.flickr.com/photos/sioneva/4436700077/

If you have contact with that person again, please show her that photo. Tell her that the 300-pound person in that picture is a REAL person, with a real child, with whom I was playing on that beach.

When my building managers organized a safety workshop for floor wardens (I work in a downtown high-rise) and they were talking about emergency aid, I concluded very early on, especially after having seen the story on the Hurricane Katrina victims, that if I were incapacitated in an earthquake or fire, I would die.

How scary is that? Looking at my (mobile, reasonably healthy) self in the mirror and thinking: If you are in a massive catastrophe, you will probably DIE because people think your life is less valuable.

And people claim fat discrimination doesn't exist...

Cassandra said...

I'd like to see what they would do if there was someone overdosing on drugs, especially if information about the person's race was given. Or if they don't speak English. Communication barriers take up time.

Meowser said...

I wonder if the 300-pound man was someone like Yao Ming, the 310-pound, 7-foot-plus NBA star, if his life would have been written off too. Probably yes, if they didn't know he was a celebrity and all they knew was his weight. But being famous (or for that matter, very tall) doesn't make you any easier to lift, does it?

Mrs. Gamgee said...

The distorted view of size is something I encounter regularly. As I was reading your post, the linebacker analogy immediately came to mind. I am 300lbs and I know that my weight on my 5'4'' frame looks much different than what the same weight looks like on my dad who is 6'0''. People hear the number and make assumptions and determine value. It's very sad.

Anonymous said...

If you want to pursue this, an example "300lb man" could be a pro athlete. (Since pro teams often publish height and weight information you can even calculate BMI.) For many people, "Decided not to rescue defensive tackle Brendon Mebane" (304 lbs) would be a wake-up call.

(Historical info on 300lb American football players is here.)

Raine @ Mama Rants said...

A lot of emergency volunteers have no clue what a 300 pound person actually looks like, or how easily they can be moved using the techniques volunteers are trained in. In one of the classes I took a few years ago, we were trained to roll and unconscious person onto a sheet to drag them out of a fire or dangerous situation. One of the guys in my team made some remark afterward about how it "wouldn't work with some 3 or 400 lb guy", so I told him I was 320 lbs and they'd just moved me (I'm 5'11 and fairly active, so people assume I'm lighter). A little awkward, but got the point across.

I deployed as a Red Cross volunteer after Katrina, and I will say that I didn't see any size discrimination firsthand that I remember, but I wouldn't doubt it occurred. We do have anti-discrimination and bias training, but it doesn't address size discrimination. I will say that I was presently surprised by my own assignment. I figured, as a large woman, I'd be assigned to one of the more sedentary positions, but ended up helping the police and investigating and assisting with shelter security, because I was working in law enforcement at the time.

Tami said...

I would wonder why the man's weight was even mentioned--that fact indicates some fat bias right there, don't you think? How about "father of 4 young children having a heart attack?" That description would surely get aid rushed to him, wouldn't it? (That would be my husband...)

Laureen said...

I am so glad you posted this. I'm sure you're quite aware of this article: http://www.propublica.org/topic/deadly-choices-memorial-medical-center-after-katrina

Here's the bit that kills me:
The physician, Anna Pou, defended herself on national television, saying her role was to ‘‘help’’ patients ‘‘through their pain,’’ a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view.

In the four years since Katrina, Pou has helped write and pass three laws in Louisiana that offer immunity to health care professionals from most civil lawsuits — though not in cases of willful misconduct — for their work in future disasters, from hurricanes to terrorist attacks to pandemic influenza. The laws also encourage prosecutors to await the findings of a medical panel before deciding whether to prosecute medical professionals. Pou has also been advising state and national medical organizations on disaster preparedness and legal reform; she has lectured on medicine and ethics at national conferences and addressed military medical trainees. In her advocacy, she argues for changing the standards of medical care in emergencies. She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina."

So not only is fat bias a problem, someone who used it to justify euthanasia is now training other organizations to use it too.

So it's good that you see it, but it'd be better if you fought it harder. I'm sorry about your husband and son's (potential) embarrassment, but their willingness to speak up might well save lives down the line. Were I you, I'd follow up with the CERT folks, ensure that the Pou madness has not infected them, and keep swinging.

Anonymous said...

Before his recent illness, my husband was just over 300lbs. He's also 6'8". Honestly, his height was more a problem than his weight in the hospital. He could get chairs/beds for heavier people & when he needed to be moved, they'd get 4 or 5 nurses to slide him, but they did NOT have beds long enough for him; which is one of the reasons he needed to be moved so often.