Bigger patients mean bigger ambulances and emergency medical responders are having to rely on larger gear to get their jobs done.

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Lower the truck and install the plate. That’s the latest routine for the crew of a bariatric ambulance unit.

“Bariatric is just another term for obese. It's a medical term for obese,” explained Marc Burnham, Operations Manager for American Medical Response.

AMR is now using a super-sized gurney and a larger ambulance on 700 emergency calls a year.

Why the $4,000 power lift system?

Why the $3,000 ramps?

Why a cot that's eight inches wider than normal?

The reason is because patients are simply getting larger.

“People are not fitting comfortably on these and if someone's not comfortable it's not safe,” said Burnham.

Portland Fire & Rescue Lt. Allen Oswalt has designed a special tarp for firefighters saving the lives of obese patients.

“It's become more commonplace to have the larger patients -400, 500 pounds and even more than that,” he said.

The tarp has handles around its perimeter, each strap capable of bearing 1,500 pounds of weight.

“And we can transport them in a sitting position,” said Oswalt. “Like a sling.”

According to stats from the Centers of Disease Control, in seven years of recent data collection, Oregon led the Western U.S in rising obesity rates.

The latest statistics show the state's population is now up to 24 percent obese.

Oregon's yout mirror the trend, according to the Oregon Department of Health Service. One in four eighth graders are overweight or at risk of it. And the number of overweight 11th graders has increased 63 percent since 2001.

“Some of the patients are so large we can't get them in our regular ambulance. We can't use the regular gurney,” said Lt. Oswalt.

AMR says five percent of their calls require the larger gurney. With that number increasing, AMR is about to acquire a third bariatric unit for its fleet.

AMR’s Operations Supervisor Jason Jensen says even the blood pressure cuff onboard the unit is larger. “More accurate blood pressure with our bariatric patients; it's wider and longer so it can fit around a bariatric patient's arm.”

“It means that I get to go home with less aches and pains,” he added.

The principle of leverage now has a more prominent role in the expanding world of ambulance care.