Straight Lift

If a person is seriously injured, profoundly weak, or unconscious, he should be lifted so that he remains motionless and with his spine in as straight an alignment as possible. This can be accomplished by five rescuers. The first kneels at the head, controls the victim’s head and neck, and calls out commands. The other four rescuers kneel at the victim’s sides, one at chest level and one at hip level on one side, and the others at lower back level and leg level on the opposite side (Figure 232). In this way, they can slide their hands under the victim in a staggered fashion to provide a continuous chain of support. If necessary, the rescuer closest to the legs can free a hand to position a pad, backboard, or litter underneath the victim. The rescuers should lift the victim straight up into the air, taking care not to injure their backs.

Figure 232 Proper hand positioning for straight lift.

Logrolling the Victim (See Figure 25)

The best way to carry and immobilize a person who may have an injured spine is to use a scoop stretcher, or to slide a backboard underneath the victim. However, when these are not available and a spine-injured person must be turned, logrolling is the best alternative. It is also the preferred method to turn a victim on his side in order to slide a pad, board, or litter underneath him.

Carries

If the victim has suffered an injury that does not allow him to walk out, mechanical transport must be improvised. A single person who cannot walk but who does not need to be on a litter (one with, for example, a broken ankle, mild exhaustion, or acute mountain sickness) may be carried on the back of a strong rescuer using a rope seat. This is fashioned by passing a long 1 in (2.5 cm) rope or strap across the victim’s back and under his arms, then crossing the rope in front of his chest. The victim is loaded piggyback onto the rescuer’s back, and the rope ends are passed forward over the shoulders of the rescuer, under his arms, and around to the rescuer’s back, then between and through the victim’s legs from the front, and around the outside of the victim’s legs just under the buttocks, to be tied snugly in front of the rescuer’s waist (Figure 233). Such a rope seat is far preferable to a standard fireman’s carry, which is very fatiguing (Figure 234). A blanket drag (Figure 235) is only good for very short distances, such as to pull a person quickly away from an immediate hazard.

Figure 233 Fashioning a rope (webbing) seat.

Figure 234 Fireman’s carry.

Figure 235 Blanket drag.

Other simple ways to carry a victim include the four-hand seat, backpack carry, ski pole or tree limb backpack carry, and coiled rope seat. In the first method, two rescuers interlock hands. Each rescuer first grasps his right wrist with his left hand. Holding the palms down, each rescuer then firmly grasps the left wrist or forearm of the other rescuer with his right hand, interlocking all four hands (Figure 236). The victim sits on the four-hand seat. In the second method, leg holes can be cut into a large backpack, so that a victim can sit in it like a small child would in a baby carrier. In the third method, two rescuers with sturdy backpacks stand side by side. Pack straps are looped down from each pack, and ski poles or tree limbs are slung across through the loops, or the poles are placed to rest on the padded hip belts. The poles should be padded so that the victim can sit on the rigid seat, steadying himself by draping his arms around the shoulders of his rescuers (Figure 237). The split-coil rope seat is created by coiling a rope, then fixing the coil at one segment. The coil’s loops are split and used to position the victim on the rescuer’s back (Figure 238). A two-rescuer split-coil technique is also useful (Figure 239).

Figure 236 A, Overlapping hands to create a four-hand seat. B, Carrying the victim.

Figure 237 Fashioning a ski pole seat. A, The poles are slung between rescuers wearing backpacks. B, A victim can sit comfortably on the padded ski poles.

Figure 238 Creating a coiled rope seat. A, The rope is coiled and the loops secured. B, The loops of the coil are divided into equal sections at the point of fixation. C, The victim can step through the split loops. D, Thus, a single rescuer can carry the victim.

Figure 239 Two-rescuer split-coil rope seat.

Litters

The safest anatomical position for an injured victim (from a transport perspective) is supine with his back straight, eyes forward, and arms and legs straight with his hands at his sides. If the victim might vomit or is unconscious, he should be on his side, cushioned to protect against undue motion and to ensure an open airway.

If a specialized litter or stretcher (such as a Stokes basket or split scoop frame) is not available, an improvised litter can be constructed from a blanket or sturdy drop cloth and two 6 to 7 ft (1.8 to 2.1 m) poles or sturdy tree limbs (saplings). Separate the poles by slightly more than the width necessary to carry the victim. Fold the blanket over one pole, then fold the edges over the other pole sequentially and back again over the first pole (Figure 240). Secure the outside blanket flap with safety pins or stitches of cord. Test it to be sure that it can support the victim. Carry the victim so that his body secures the outside (free) blanket flap. Be sure to immobilize the victim on the litter, and cushion his head and neck.

Figure 240 Blanket-pole litter.

Litters resembling ladders can be fashioned from tree limbs or ski poles fastened with twine, rope, clothing, or pack straps. Two backpack frames can be fastened together with tape or rope (Figure 241) to form a ladder-like platform for a sleeping bag or pads and blankets. A “parka litter” can be created by running two skis or long tree limbs through zipped jackets that are aligned bottom-to-bottom (Figure 242).

Figure 241 Construction of a backpack frame litter. Pads or a sleeping bag are placed on the litter.

Figure 242 Parka litter.

A rope stretcher is constructed by stretching a 150 to 200 ft (46 to 61 m) rope on the ground and determining its midpoint. At the midpoint, fold the rope back on itself. Measure 3 ft (91 cm) from the bend, and fold each half of the rope back again to the outside. This creates the central “rungs” of a “ladder” that will be 3 ft wide. Repeat the process of folding the rope back on itself in 3 ft segments, moving away from the central rungs in each direction and laying out a series of evenly spaced parallel loops. About 16 or 18 loops (rungs) should create a ladder approximately the same length as the victim. Take the two remaining long ends of the rope and lay them perpendicular to the rungs, alongside the bends in the rope (Figure 243). Use the long ends to secure the loops together (completing the long sides of the ladder) by tying a clove hitch (see Figure 259) or other secure knot onto each consecutive bend in the rope 2 to 3 in (5 to 7.5 cm) inside the bend, so that a small loop remains to the outside of the knot. Each pair of knots should be separated by 3 to 4 in (7.5 to 10 cm). After all the knots are tied, the rope ends are threaded through the small outside loops as the remaining lengths are circled around the outside of the stretcher and finally tied off.

Figure 243 Making a rope stretcher. A, Having laid a series of parallel loops, lay the lengthwise segments perpendicularly alongside. B, Use a clove hitch to secure the loop ends. C, The remaining long ends of the rope are passed through the outside loops to form the perimeter of the stretcher, and are tied off to complete the process.

A mummy litter (also called a daisy chain or cocoon wrap) can be constructed of a long climbing rope, large tarp, sleeping pads, blankets or a sleeping bag, and stiffeners (skis, poles, tree limbs, or the like). The rope is laid out with even U-shaped loops (Figure 244) that are roughly twice the victim’s width. Tie a small loop at the foot end of the rope. Lay a tarp on the rope. On the tarp, lay down foam pads, then lengthwise stiffening rods, then another layer of pads. Lay the victim on the pads, and cover with the sleeping bag or blankets. Pull the sides of the tarp up to wrap the victim. To secure him, bring the first untied loop above the tied end (foot) loop through the tied loop, and pull it toward the center. Moving toward the head, feed the next loop through the preceding loop, and so on until the armpits are reached. At this point, bring a loop up over one shoulder and tie the rope off in front of the victim after bringing the rope end over the opposite shoulder.

Figure 244 Mummy litter. A, Lay out the rope in even loops. B, Lay blankets or tarps over the loops, and then long, rigid objects for stability. C, Place a sleeping bag or blanket in the center to hold the victim. D, Pass the first nontied loop through the tied loop and work your way to the top. Bring the finishing loop and rope end over the shoulders, and tie off.

Test any litter on an uninjured person before trusting it to bear the weight of the victim. Be certain to fasten the victim securely into the stretcher or litter, so that he doesn’t fall out. Pad all injuries, and the head and neck in particular, to make the victim as comfortable as possible. Positioning on a litter is very important. In general, keep the injury uphill, to keep extra weight (pressure) and jostling from causing pain. If the chest is injured, keep the victim lying on his side with the wounded side (lung) down, to allow the good lung to expand more fully. If the victim has altered consciousness, is nauseated, or is vomiting, he should be kept on his side, to protect the airway (see page 24). If the victim has suffered a face, head, or neck injury, he should be transported with his head slightly elevated. Victims with shock (see page 60), bleeding, or hypothermia (see page 305) should be carried with the head down and feet elevated. Victims with chest pain and/or difficulty breathing, which might indicate a heart attack or heart failure (see page 47), should be carried with the upper body elevated.

All victims should be covered above and below with blankets, clothing, sleeping bags, or whatever else is available for warmth. Handle all suspected hypothermics gently. A victim secured to a stretcher should never be left unattended. Constantly reassure the victim. If the terrain is steep, keep his feet pointed downhill. Litter transport is exhausting for the rescuers and should not be entertained if the distance to be covered is more than a few miles.

If possible, position at least one rescuer at the head of the victim, one at each shoulder, one at each hip, and one at the legs. This allows a litter to be carried and facilitates a quick action to turn the victim, should that be necessary. A leader should call out all activities of the team.