On a cold late-January evening, the emergency call lit up a phone line at the St. Louis Fire Department's dispatch center. A woman in her forties required immediate transport to a hospital. The patient was unresponsive. She lived in a second-floor apartment in south city. And she weighed more than 500 pounds.

[Editor's Note: A correction ran concerning this paragraph; please see end of article.] Jheree Coleman, a 26-year-old EMT, was part of the emergency team that arrived within minutes aboard one the city's thirteen ambulances. "That second floor made it complicated," she recalls. "It took me, my partner, my supervisor — and four others in the fire truck — to get her down those stairs. Must have taken us 30 minutes. This is dangerous work."

Tracy Barker has been an EMT with the city fire department for sixteen years and says the ranks of the grossly overweight are expanding at astonishing rates. She's seen it firsthand, and oh, yes, does she have stories to tell.

"We have a regular we're always transporting, a lady with an abdomen so large that she has to rest it on a footstool in order to breathe.

"We've had calls from patients — perpetually sick because of their weight — completely panicked because they can't reach the TV remote. That's how big they are. You wonder who's feeding them, enabling them.

"We see people so large that their skin can't stretch anymore, and so it cracks and begins to weep. Some wait to call until they're really, really sick because they know the ordeal of what it takes to carry them out and all the embarrassment of that. And when you get there, they don't smell so good. Oh yeah, the smell can be overwhelming."

Barker, 40, goes on: "We got patients too weak to walk, so we have to put several sheets under them and slide them down the stairs. We're afraid the stairs are going to collapse — and we wonder to ourselves, 'Why do you live on the second floor?'

"When I started, we had stretchers that accommodated 350 pounds. Then it went to 500 pounds. Now, it's 700 pounds! People are so big they can't even leave their homes. We never used to see that before. Never."

Mario Montero, captain of the city fire department's rescue squad, remembers a patient, his girth so vast, that the staff at Barnes-Jewish Hospital had to strap several mattresses together with duct tape in order to move him to another room.

Montero adds that it's not unusual for his three-person rescue unit — because the patients' living quarters are so tight or the stairway so narrow — to extricate the super-sized hulks from their second-story window in what's called a Stokes basket, a metal wire cage often used in search-and-rescue missions.

Ben Moss, a paramedic with Abbott Ambulance, a large medical-response company with a fleet of more than 100 ambulances operating in Missouri and Illinois, recalls a 1,000-pound woman they carted home from a hospital not long ago. The weighty chore couldn't have been accomplished without the help of Abbott's lone bariatric ambulance, a highly specialized vehicle equipped with reinforced shock absorbers and a motorized winch to lug a loaded gurney into the back.

Says Moss: "She was aware of her weight, and she, like a lot of bariatric patients, had a very great fear of being dropped."

At his peak, Robert Earl Hughes tipped the scales at 1,041 pounds, had a 122-inch waistline and a chest size of 124 inches. In 1958, when he died of congestive heart failure at the age of 32, Hughes was thought to be the heaviest person on Earth, according to the Guinness Book of World Records. Legend has it that the big man from Fishhook, Illinois, (a farm hamlet about 20 miles southeast of Quincy) was placed in a packing case made for a grand piano.

It took a crane to lower him into a grave behind a tiny church in Benville, Illinois. In June 2007 a four-foot-tall monument was dedicated to Hughes. It's located near the feed store on Fishhook's main street. There's a picture of him and an inscription that reads: "Robert Earl Hughes: The World's Largest Man."

Hughes was an oddity, of course, a freak of nature, who actually received celebrity treatment. Now, more than a half-century later, "the big ones," as medical responders have come to refer to the unpleasantly plump, are not at all uncommon — at least the ones weighing between 500 and 800 pounds.

Still, the problem is difficult to quantify, as there are a few hard statistics available. In St. Louis, for example, no one measures what percentage of the 60,000 to 80,000 calls to the fire department's Emergency Medical Services involve the morbidly obese, patients with a body mass index (a ratio of weight to height) of 50 or more. Most of the information is anecdotal.

As William Barnett, a paramedic since 1975, puts it: "All I know is that they're getting bigger and bigger. Some of them don't even fit in the ambulance. "

Beyond the sometimes nauseating testimonials from emergency crews, there are a number of indicators that do in fact point to a burgeoning number of hugely overweight people in need of near constant medical attention.

As a result, not only are backs being strained by hoisting hundreds of extra pounds of blubber, but so, too, are city and municipal budgets, as expenses to move society's most corpulent individuals to and from hospitals continue to spike.

Robert Hardy III, who heads up Emergency Medical Services, says the St. Louis Fire Department over the past five years has been forced to purchase expensive $6,000 stretchers, which can handle the heaviest of the heavy. At the same time, the department has all but mothballed its smaller, van-size ambulances in favor of full-size trucks.

From 2000 to 2005, according to a RAND Corporation study, the U.S. obesity rate increased by 24 percent. But the number of people with a BMI over 50 grew 75 percent.

The Washington Post reported last month that the sales of stretchers designed for the extra large were expected to hit $50 million in 2012, up from $29.6 million in 2004.

Meanwhile, in Independence, Missouri, American Medical Response, one of the nation's largest ambulance companies, recorded more than 60 transports in its bariatric ambulance in May 2009. That's double the number from May 2008 and triple the number from January 2008, the Kansas City Star reported last year.

The Star also noted that in 2007, MAST, the city's sole emergency medical services provider, carried only a couple of patients heavier than 400 pounds each month. In 2009, it averaged more than twenty such calls per month.

To all of this, EMS' Chief Hardy can only sigh. "I don't know what to think," he says. "Society is just getting larger. It's a problem we just got to deal with."

Correction published 3/9/10: In the original version of this story, we erroneously stated that the St. Louis Fire Department’s Emergency Medical Services operates 24 ambulances; it operates 13.