PATIENT TRANSPORT IN AUSTERE SETTINGS

In normal times, your main goal upon encountering an injured or ill person is to transport them to a modern medical facility as soon as possible. In cases where there is a risk of spinal or neck trauma, you will read that the victim should not be moved until emergency personnel arrive.

That’s all well and good in situations when the ambulance is just a few minutes away, but what about when you’ve been knocked off the grid due to a disaster?

Even in normal times, there are circumstances where a victim must be moved despite the risk. These mostly involve common sense judgements, such as when there is an immediate danger from, say, a building on fire or in danger of collapse.

When help is not on the way, however, you will have to decide whether your patient can or cannot be treated for their problem at their present location. If they cannot, you must consider how to move the victim safely.

Before deciding whether to transport, a patient must be stabilized as much as possible. This means assuring open airways, controlling bleeding, splinting orthopedic injuries, treating hypothermia, and more. If you are unable to do this with the materials at hand, consider having a group member get the supplies needed to make transport safer. If possible, gather a team to assist you before you move the victim. Knowing the amount of help available allows you to choose a method of evacuation that will cause the least trauma to both patient and medic.

MOVING THE VICTIM ONTO THE STRETCHER

When moving a trauma patient, you should be concerned about the possibility of a spinal injury, especially if there is:

• Head or neck trauma
• Altered mental status
• Pain in the head or neck
• Weakness, numbness, or paralysis in the extremities
• Loss of bladder control

A person with a possible spinal injury should be “logrolled” onto a stretcher as a unit without bending their neck or back if at all possible. A cervical collar and supportive blocks with straps can be used to secure the spine of at-risk patients. An unstable neck, especially in an unconscious victim, could easily be traumatized even if not involved in the original trauma. Keep the head in alignment with the spine during transport.

If you have several helpers, transporting the patient is easier but requires coordination. You, as medic, will serve as leader of the transport team. This entails making sure the patient is transferred to the stretcher safely, but also that all team members lift and move at the same time. Simple “Prepare to Lift”, “Lift”, and “March” commands should suffice to get everyone on the same page.

To move a patient onto a stretcher, the medic positions the casualty next to it on his back with his arms at his side. Then, one helper slips his arms under the casualty’s back and waist and another helper does the same under the hip and knees. Your job is to support the head in alignment with the spine throughout. Upon your command, the team lifts and places the victim on the stretcher. An alternative would be to have two helpers “logroll” the patient on their side facing them rather than lift. You would then slip the stretcher underneath. For this, the casualty’s arms are placed across their chest.

GETTING BACK TO BASE

In normal times, you have the luxury of emergency medical personnel, gurneys, and ambulances to move a victim. Without these resources, transport is more difficult. Despite this, there are a number of methods available to move the injured patient back to camp. These include many commercially-available litter systems, but stretchers can be improvised with a little ingenuity. Even without one, there still exist ways that will allow one, two, or more to achieve their transport goal.

TRANSPORT USING MATERIALS AT HAND

In austere settings, an injury will likely occur without a commercially- made stretcher readily available. However, abandoned residential buildings in urban or rural settings will contain a number of found materials that can serve the purpose. An inside door, blankets, or even a sturdy ironing board may be options. All of these can function as a litter or backboard as long as enough helpers are present to stabilize the victim.

While certifying as AWEPs (Advanced Wilderness Expedition Providers), demonstrations of effective transport using folded-over blankets, sticks, and rope or paracord showed that many household items can be used to serve as handholds and to prevent hanging extremities. Indeed, these items can, in and of themselves, become stretchers.

Another example of an easily found item in an abandoned building is a chair. If you have a conscious casualty, a sturdy chair can be used by itself as a reasonable litter. In this method, the patient sits or is placed on the chair. One transporter stands in back of the chair, grasping it from the sides and tilting it back. The second transporter grasps the chair legs in front and both lift using their legs. For short distances, the second transporter can face the victim, but it would be easier for longer distances to face forward.

Four Person or more blanket stretcher: Even if there is no backboard, having a blanket and/or sturdy poncho in your backpack can help move a casualty. Simply place the victim on the stretched-out blanket and then roll the sides inward to form handholds to lift and carry. Remember to stable the victim head and neck.

Two person blanket stretcher: With fewer assistants, you’ll need some additional support. If you have two long poles or sticks about 6 or 7 feet long and 2 inches or thicker, you could make a litter by placing the sticks so that the blanket is divided into thirds. Fold one of the outer thirds over the stick and then the other outer third over the other stick.

The “jacket stretcher” is variation of this method. You’ll need two buttoned jackets or shirts, preferably still on the rescuers. While the first transporter is grasping the litter poles, a second pulls the first’s garment off, inside out. The jacket automatically moves onto the poles, forming a “bed” for the stretcher. The transporters then reverse roles with the second jacket. It should be noted that this method should only be used if the weather is such that rescuers can tolerate the loss of the clothing item during transport.

One person blanket pull: Sometimes, you might find yourself alone with the victim and can’t wait for help to move them. In this case, the blanket can be placed under the patient. Grasp the blanket at one end with both hands and position your forearms to cradle the head. Use your legs to pull instead of your back to avoid injury. Alternatively, you can drag the victim out by the shoulders of their shirt or jacket. Grasp the back of the clothing under the shoulders, and use your legs to pull. If done correctly, your forearms should be cradling the head.

TRANSPORT USING NO MATERIALS

There are circumstances where you might have absolutely nothing at your disposal to help evacuate a patient other than your own muscles. Here are methods to transport a patient without any equipment:

Three person team or more: With a number of assistants, you can form “hammock” that will make for easier lifting and transport. In this method, rescuers kneel on both sides of the victim. You’ll reach under the victim to grasp the wrist of the person across from you. Upon command, rescuers will get on one knee, and then stand.

Sometimes, you might have to get a patient onto a higher level than a stretcher on the ground, such as a gurney or an operating table. For this purpose, the “3 person carry” is useful to lift a victim for short distances. The transporters, on one knee, roll the patient to his side, facing them. He is then lifted onto their knees, and the team stands on command. The casualty is held on the transporters’ chests and they all start the evacuation using the same foot.

2 persons: When it’s you and one assistant, you have a number of options. All versions start with the transporters squatting on either side of the victim, using their legs to lift instead of their backs.You can make a “four-handed seat” with interlocked wrists if your casualty is conscious and can hold onto your shoulders. With all four wrists interlocked in a square, a wider, more stable seat is formed. If one of the rescuers needs a free hand, 3 wrists can form a triangular seat.

The “two-handed seat” is meant to provide a seat with a back for victims that might be less alert. Each rescuer interlocks one wrist to form the seat and uses the other arm to grasp his partner’s far shoulder. This forms the back support.

Another two person lift is the “crutch” method. For the conscious victim, this carry allows the victim to walk using the rescuers as a pair of crutches. Each rescuer grabs a wrist and puts the crook of the arm on the back of their neck and over the shoulder, with the other arm around the victim’s waist. The victim can then stand with assistance. If unconscious, the waistband or belt can be pulled to help lift the casualty with their legs dragging behind as you move.

The “fore-and-aft” technique can serve effectively as a long-distance transport method for conscious or unconscious victims. The first rescuer, from behind, puts his arms under the shoulders of a victim lying on his back and locks his hands around the chest. The second rescuer, facing front towards the feet of the victim, uses both arms to grasp underneath each knee. It’s more comfortable if the taller transporter is at the patient’s head.

One Person: There are situations where it’s just you, there’s no equipment, and you have to evacuate a patient. If you are alone with a patient, the “Fireman’s Carry” is effective and keeps the victim’s torso relatively level and stable. To achieve this maneuver: While squatting or kneeling, grasp the person’s right wrist with your left hand and drape it over your shoulders. Keeping your back straight, place your right hand between their legs and around the right thigh. Using your leg muscles to lift, rise up; you should end up with their torso over your back and the right thigh resting over your right shoulder. Their left arm and leg will hang behind your back if you’ve done it correctly. Adjust so as to cause the least strain.

Another option when you are the lone rescuer is the “Pack-Strap Carry”. With your patient behind you, grasp both arms and cross them across your chest. If squatting, keep your back straight and use your legs and back muscles to lift the victim. Bend slightly so that the person’s weight is on your hips and lift them off the ground.

Certainly, carrying injured victims long distances is an obvious recipe for injury to the medics themselves. Therefore, it’s important to remember this simple acronym when pulling or carrying a person: B.A.C.K.

Back Straight – muscles and discs can handle more weight safely when the back is straight.
Avoid Twisting – joints can be damaged when twisting.
Close to body – avoid reaching to pick up a load; it causes more strain on muscles and joints.
Keep Stable – the more rotation and jerking, the more pressure on the discs and muscles

Joe Alton MD

Find out more about patient transport and 150 other medical topics in the award-winning third edition of the Survival Medicine Handbook, plus all you need to know about antibiotics and infectious disease in the brand-new Alton’s Antibiotics and Infectious Disease: The Layman’s Guide to Available Antibacterials in Austere Settings. Also, fill those holes in your medical supplies with kits and supplies from Nurse Amy’s entire line at store.doomandbloom.net.