Four-hundred-, 600- and even 800-pound patients are presenting ambulance crews with some big challenges.

As obesity rates rise, paramedics in Nebraska and Iowa are faced with carrying more obese patients. In turn, paramedics find creative ways to move them, and some fire departments are looking to borrow or buy specialized equipment.

Lincoln Fire & Rescue, for example, is considering putting a construction crane and a forklift on call for patients who are too big to get out a door or down steps. Firefighters had to use a tarp to haul an 800-pound patient a few years ago.

It's another example of how obesity can strain the health care system, whether that's hospitals or ambulance crews. The Nebraska Medical Center in Omaha in recent years has purchased heavy-duty beds and wheelchairs for obese patients.

Adult obesity rates in Nebraska and Iowa have been rising.

In 2008, about 27 percent of the population in the two states was obese. That’s up from 23 percent in Nebraska and 24 percent in Iowa in 2005, according to a report by Trust for America's Health, a nonprofit group that focuses on preventive health.

Lloyd Rupp, a battalion chief in the Omaha Fire Department, said his crews encounter a 400-pound-plus patient every several days. Five to 10 years ago, crews would run into such patients every couple of weeks.

Paramedics in Omaha, Sioux City, Iowa, and elsewhere occasionally must call in an extra crew to help carry big patients, particularly up or down steps.

Fire departments emphasized that even though large patients can be tougher to move, they are treated with the same respect as other patients.

When paramedics don't have specialized equipment, they have to improvise.

"That is the trademark of firefighters," said Pat Borer, deputy chief of the Lincoln department. "They are resourceful."

Bill Lundy, volunteer captain with the York (Neb.) Fire Department, remembers a call several years ago involving a man who had suffered a heart attack in his basement apartment. The man weighed more than 350 pounds, and there wasn't enough room to get him and the stretcher up the basement stairs. There was also concern about whether the staircase could support the man and the firefighters carrying him.

Firefighters unhinged an interior door, put the man on it and slid it through a basement window.