Skip to main content

Developed and maintained
by the NFCC


Casualty with complex requirements

Hazard Knowledge

A casualty may be considered to have ‘complex requirements’ if they could be described as bariatric, or if they are dependent on medical equipment to maintain a condition or support life. These complex requirements can impact on the immediate working environment and emergency responders.

A rescue may be impeded due to the lack of available space, as well as the ongoing management of the casualty or their equipment. The rescue may have a detrimental effect on the condition of the casualty because of their complex requirements.

Bariatric casualty

A bariatric rescue should be determined by the casualty’s weight, size and the distance required to obtain transportation to medical care. This is due to the presence of increased and extended manual handling, and the physical pressures placed on a casualty and their immediate environment.

The size and weight of a casualty may also dictate the need for special measures to be considered in instances where the day-to-day casualty management equipment may not suffice, such as:

  • Vehicle size
  • Stretcher length or width
  • Access to and egress from a medical facility
  • Rescue equipment

A bariatric casualty presents a range of increased hazards for personnel and the casualty, including:

  • Manual handling more hazardous due to limited space or restricted access when moving the casualty
  • The weight, size, shape or mobility of the casualty
  • Crush injuries, such as hands or limbs pinned between the casualty and a hard surface
  • Fatigue due to carrying the casualty over a distance, or when using stairs
  • Appropriate lifting aids may not be available
  • Altered physiological condition of the casualty
  • Compromised casualty care due to pre-existing respiratory, airway or cardiac conditions

Further information can be found in the Health and Safety Executive, Risk assessment and process planning for bariatric patient handling pathways.

Casualty dependent on medical equipment

Fire and rescue services may be called to rescue a casualty who is dependent on medical equipment to keep their condition stable or support life, in a home or nursing home setting. Examples of such equipment are:

  • Ventilators
  • Oxygen treatment
  • Dialysis machines
  • Nebulisers

The hazards that exist when moving a casualty who depends on such equipment are largely the same when moving a bariatric casualty. However, the maintenance of a power source and the ongoing management of the casualty throughout a rescue may be impacted. Personnel also need to consider hazards including the presence of electricity and compressed gases, such as medical oxygen.

Structural stability when moving casualties

Normal domestic floors and staircases are designed with imposed and dead load rating equivalent to 1.5 kN per square metre or 1.4 kN for concentrated loads; this may be reduced due to the building’s age, condition or alterations.

The presence of specialist beds and other equipment for bariatric people may result in the floor load being near capacity. The addition of a large number of emergency responders could lead to structural failure.

A rescue may need changes to be made to the structure of the building, such as widening of door openings or creating new openings in structural walls.