Improvised Litters and Carries
SCENE Size-Up
1. Scene safety is the initial priority.
2. The necessary evaluation, called the scene size-up (Box 57-1), involves a (usually hasty) determination of whether the patient, rescuer, or both are immediately threatened by either the environment or the situation.
3. Proper immobilization and patient packaging are always preferable, but sometimes the risk for aggravating existing injuries is outweighed by the immediate danger presented by the physical environment. In such a situation, the rescuer may choose to immediately move the patient to a place of safety before definitive care is provided or packaging is completed.
4. Evacuation options are limited by three variables:
5. Carrying a patient, even over level ground, is an arduous task. At an altitude where walking requires great effort, carrying a patient may be impossible.
6. Complex rescue scenarios requiring specially trained personnel and special equipment are called technical rescues and often involve dangerous environments such as severe terrain, crevasses, avalanche chutes, caves, or swift water. To avoid becoming patients themselves, rescuers must realistically evaluate their abilities to perform these types of rescues.
7. When a patient is transported in an improvised litter, especially over rough terrain, he or she should be kept in a comfortable position, with injured limbs elevated to limit pressure and movement.
8. To splint the chest wall and allow full expansion of the unaffected lung, a patient with a chest injury generally should be positioned so that he or she is lying on the injured side during transport.
9. For a person with a head injury, the head should be elevated slightly, and for a person with dyspnea, pulmonary edema, or myocardial infarction, the upper body should be elevated.
10. When the patient is hypotensive or appears to be physiologically in shock, the legs should be elevated and the knees slightly flexed.
11. Whenever possible, an unconscious patient with an unprotected airway should be positioned so that the person is lying on his or her side during transport to prevent aspiration.
12. When time permits, practice constructing the improvised litter first with an uninjured person, to “work out the kinks.”
Drags and Carries
Blanket Drag (Fig. 57-1, A)
1. This can be performed on relatively smooth terrain by one or more rescuers rolling the patient onto a blanket, tarp, or large coat and pulling it along the ground.
2. This simple technique is especially effective for rapidly moving a person with a spinal injury to safety because the patient is pulled along the long axis of the body.
Two-Hand Seat
1. Two carriers stand side by side. Each carrier grasps the other carrier’s wrists with opposite hands (e.g., right to left).
2. The patient sits on the rescuers’ joined forearms.
3. The carriers each maintain one free hand to place behind the back of the patient for support (support hands can be joined).
4. This system places great stress on the carriers’ forearms and wrists.
Four-Hand Seat (Fig. 57-4)
1. Two carriers stand side by side. Each carrier grasps his or her own right forearm with the left hand, palms facing down.
2. Each carrier then grasps the forearm of the other with his or her free hand to form a square “forearm” seat.
3. With the forearm seat the patient must support himself or herself with a hand around the rescuers’ backs.
Ski Pole or Ice Ax Carry (Fig. 57-5)
FIGURE 57-5 Ski pole seat. A, Ski poles are anchored by the packs. B, The patient is supported by the rescuers.
1. Two carriers with backpacks stand side by side with four ski poles or joined ice ax shafts resting between them and the base of the pack straps. The ski poles or ice ax shafts can be joined with cable ties, adhesive tape, duct tape, wire, or cord.
2. Because the rescuers must walk side by side, this technique requires wide-open, gentle terrain.
3. The patient sits on the padded poles or shaft with his or her arms over the carriers’ shoulders.
Split-Coil Seat (“Tragsitz”) (Fig. 57-6)
Two-Rescuer Split-Coil Seat (Fig. 57-9)
FIGURE 57-9 Two-rescuer split-coil seat.
1. The two-rescuer split-coil seat is essentially the same as the split-coil Tragsitz transport, except that two rescuers split the coil over their shoulders.
2. The patient sits on the low point of the rope between the rescuers (Fig. 57-10). Each rescuer maintains a free hand to help support the patient.
Backpack Carry
1. A large backpack is modified by cutting leg holes at the base. The patient sits in it like a baby carrier.
2. Some large internal frame packs incorporate a sleeping bag compartment in the lower portion of the pack that includes a compression panel. With this style of pack, the patient can sit on the suspended panel and place his or her legs through the unzipped lower section without damaging the pack, or the patient can simply sit on the internal sleeping bag compression panel without the need to cut holes.
Nylon Webbing Carry (Fig. 57-11)
FIGURE 57-11 Webbing carry. Webbing crisscrosses in front of the patient’s chest before passing over the shoulders of the rescuer.
1. Nylon webbing can be used to attach the patient to the rescuer like a backpack.
2. At least 4.6 to 6.1 m (15 to 20 feet) of nylon webbing is needed to construct this transport.
3. The center of the webbing is placed behind the patient and brought forward under the armpits. The webbing is then crossed and brought over the rescuer’s shoulders, then down around the patient’s thighs.
4. The webbing is finally brought forward and tied around the rescuer’s waist. Additional padding is necessary for this system, especially around the posterior thighs of the patient.
