The memory still bothers Ken Keller: A panicked ambulance crew had a critically ill patient, but the man weighed more than 1,000 pounds (454 kilograms) and could not fit inside the vehicle. And the stretcher wasn't sturdy enough to hold him.


The crew offered an idea to Keller, who was then an investigator with the Kansas Board of Emergency Medical Services. Could they use a forklift to load the man — bed and all — onto a flatbed truck? Keller agreed: There was no other choice.

"I'm sure it was terribly embarrassing to be in his own bed, riding on the back of a flatbed with straps tying him down, going to the hospital, and then have a forklift at the hospital unload him," Keller said.

As the nation battles the obesity crisis, ambulance crews are trying to improve how they transport extremely heavy patients, who become significantly more difficult to move as they surpass 350 pounds (159 kilograms). And caring for such patients is expensive, requiring costly equipment and extra workers, so some ambulance companies have started charging higher fees for especially overweight people.

The move to modify ambulances is just the latest effort to accommodate plus-sized patients. Some hospitals already offer specially designed beds, wheelchairs, walkers and even commodes.

Ambulance companies say it's time for insurance providers, Medicaid and Medicare, or patients themselves to begin paying the added costs, which are cutting into their razor-thin profit margins.

In the past, ambulance companies often absorbed the extra expense of serving the obese. Now they are adding charges similar to those already imposed on intensive-care patients, people requiring multiple medications and patients on ventilators.

"In order for these systems to survive and continue to provide their service, there has to be some way to recover those costs," said Jim Buell, a director at the American Ambulance Association.

Transporting extremely heavy people costs about 2½ times as much as normal-weight patients. It takes more time to move them and requires three to four times more crew members, who often must use expensive specialty equipment, Buell said.