LEARNING OBJECTIVE: Recognize the different patient-moving devices and lifting techniques that can be used inpatient rescues.
In an emergency, there are many ways to move a victim to safety, ranging from one-person carries to stretchers and spineboards. The victim’s condition and the immediacy of danger will dictate the appropriate method. Remember, however, to give all necessary first aid BEFORE moving the victim.
The following discussion will familiarize you with the most common types of standard stretchers. When using a stretcher, you should consider a few general rules:
STOKES STRETCHER.—The litter most commonly used for transporting sick or injured persons is called the Stokes stretcher. As shown in figure 3–27, the Stokes stretcher is essentially a wire basket supported by iron rods. Even if the stretcher is tipped or turned, the casualty can be held securely in place, making the Stokes adaptable to a variety of uses. This stretcher is particularly valuable for transferring injured persons to and from boats. As mentioned before, it can also be used with flotation devices to rescue injured survivors from the water. It is also used for direct ship-to-ship transfer of injured persons. Fifteen-foot handling lines are attached to each end for shipboard use in moving the victim.
Figure 3–27.—Stokes stretcher.
The Stokes stretcher should be padded with three blankets: two of them should be placed lengthwise (so that one will be under each of the casualty’s legs), and the third should be folded in half and placed in the upper part of the stretcher to protect the head and shoulders. The casualty should be lowered gently into the stretcher and made as comfortable as possible. The feet must be fastened to the end of the stretcher so that
the casualty will not slide down. Another blanket (or more, if necessary) should be used to cover the casualty. The casualty must be fastened to the stretcher by means of straps that go over the chest, hips, and knees. Note that the straps go OVER the blanket or other covering, thus holding it in place.
LITTER.—The litter, shown in figure 3–28, is a collapsible stretcher made of canvas and supported by wooden or aluminum poles. It is very useful for transporting battle casualties in the field. However, it is sometimes difficult to fasten the casualty onto the litter, and for this reason its use is somewhat limited aboard ship. The litter legs keep the patient off the ground. The legs fit into the restraining tracks of a jeep or field ambulance to hold the litter in place during transport.
Figure 3–28.—Opening a litter.
MILLER (FULL BODY) BOARD.—The Miller Board (fig 3-29) is constructed of an outer plastic shell with an injected foam core of polyurethane foam. It is impervious to chemicals and the elements and can be used in virtually every confined-space rescue and vertical extrication. The Miller Board provides for full body immobilization through a harness system, including a hood and two-point contact for the head (forehead and chin) to stabilize the head and cervical spine. The board’s narrow design allows passage through hatches and crowded passageways. It fits within a Stokes (basket) stretcher and will float a 250-pound person.
Figure 3–29.—Miller (full body) Board.
IMPROVISED STRETCHERS.—Standard stretchers should be used whenever possible to transport a seriously injured person. If none are available, it may be necessary for you to improvise. Shutters, doors, boards, and even ladders may be used as stretchers. All stretchers of this kind must be very well padded and great care must be taken to see that the casualty is fastened securely in place.
Sometimes a blanket may be used as a stretcher, as shown in figure 3–30. The casualty is placed in the middle of the blanket in the supine position. Three or four people kneel on each side and roll the edges of the blanket toward the casualty, as shown in figure 3–30A. When the rolled edges are tight and large enough to grasp securely, the casualty should be lifted and carried as shown in figure 3–30B.
Figure 3–30.—Blanket used as an improvised stretcher.
Stretchers may also be improvised by using two long poles (about 7 feet long) and strong cloth (such as a rug, a blanket, a sheet, a mattress cover, two or three gunny sacks, or two coats). Figure 3–31 shows an improvised stretcher made from two poles and a blanket.
Figure 3–31.—Improvised stretcher using blankets and poles.
Many improvised stretchers do not give sufficient support in cases where there are fractures or extensive wounds of the body.
Improvised stretchers should be used only when the casualty is able to stand some sagging, bending, or twisting without serious consequences. An example of this type of improvised stretcher would be one made of 40 to 50 feet of rope or 1-1/2-inch fire hose (fig. 3–32).
Figure 3–32.—Improvised stretcher using rope or fire hose.
Spineboards are essential equipment in the immobilization of suspected or real fractures of the spinal column. Made of fiberglass or exterior plywood, they come in two sizes, short(18" × 32") and long (18" × 72"), and are provided with handholds and straps. Spineboards also have a runner on the bottom to allow clearance to lift (fig. 3–33).
A short spineboard is primarily used in extrication of sitting victims, especially in automobile wrecks (where it would be difficult to maneuver the victim out of position without doing additional damage to the spine). The long board makes a firm litter, protecting the back and neck, and providing a good surface for CPR and a good sliding surface for difficult extractions.
The short and long boards are often used together. For example, at an automobile accident site, the medical tech's first task is to assess the whole situation and to plan the rescue. If bystanders must be used, it is essential that they be briefed in thorough detail on what you want them to do. After all accessible bleeding has been controlled and the fractures splinted, the short spineboard should be moved into position behind the victim. A neck collar should be applied in all cases and will aid in the immobilization of the head and neck. The head should then be secured to the board with a headband or a 6-inch self-adhering roller bandage. The victim’s body should then be secured to the board by use of the supplied straps around the chest and thighs. The victim may then be lifted out. If, however, the victim is too large, or further immobilization of the lower extremities is necessary, the long spineboard may be slid at a right angle behind the short spineboard, and the victim maneuvered onto his side and secured to the longboard.
The possible uses of the spineboard in an emergency situation are limited only by the imagination of the rescuers.
Emergency Rescue Lines
As previously mentioned, the steel-wire lifeline can often be used to haul a person to safety. An emergency rescue line can also be made from any strong fiber line. Both should be used only in extreme emergencies, when an injured person must be moved and no other means is available. Figure 3–34 shows an emergency rescue line that could be used to hoist a person from a void or small compartment. Notice that a running bowline is passed around the body, just below the hips, and a half hitch is placed just under the arms. Notice also that a guideline is tied to the casualty’s ankles to prevent banging against bulkheads and hatchways.
Figure 3–34.—Hoisting a person.
Rescue Drag and Carry Techniques
There will be times when you will be required to evacuate a sick or injured person from an emergency scene to a location of safety. Casualties carried by manual means must be carefully and correctly handled, otherwise their injuries may become more serious or possibly fatal. Situation permitting, evacuation or transport of a casualty should be organized and unhurried. Each movement should be performed as deliberately and gently as possible.
Manual carries are tiring for the bearer(s) and involve the risk of increasing the severity of the casualty’s injury. In some instances, however, they are essential to save the casualty’s life. Although manual carries are accomplished by one or two bearers, the two-man carries are used whenever possible. They provide more comfort to the casualty, are less likely to aggravate his injuries, and are also less tiring for the bearers, thus enabling them to carry him farther. The distance a casualty can be carried depends on many factors, such as
You should choose the evacuation technique that will be the least harmful, both to you and the victim. When necessary and appropriate, use a one-rescuer technique (several of which are described in the following section). Two-rescuer techniques and the circumstances under which those techniques are appropriate are also listed below.
ONE-RESCUER TECHNIQUES.—If a victim can stand or walk, assist him to a safe place. If there are no indications of injury to the spine or an extremity but the casualty is not ambulatory, he can be carried by means of any of the following:
Figure 3–35.—Fireman’s carry.
Figure 3–36.—Pack-strap carry.
Arm Carry: The technique for a one-person arm carry is shown in figure 3–37. However, you should never try to carry a person who is seriously injured with this method. Unless considerably smaller than you are, you will not be able to carry the casualty very far using this technique.
Figure 3–37.—One-person arm carry.
Blanket Drag: The blanket drag, shown in figure 3–38, can be used to move a person who, due to the severity of the injury, should not be lifted or carried by one person alone. Place the casualty in the supine position on a blanket and pull the blanket along the floor or deck. Always pull the casualty head first, with the head and shoulders slightly raised so that the head will not bump against the deck.
Figure 3–38.—Blanket drag.
A variant of the blanket drag is the clothes drag, where the rescuer drags the victim by the clothing on the victim’s upper body.
Tied-hands Crawl: The tied-hands crawl, shown in figure 3–39, may be used to drag an unconscious person for a short distance. It is particularly useful when you must crawl underneath a low structure, but it is the least desirable because the victim’s head is not supported.
Figure 3–39.—Tied-hands crawl.
To be carried by this method, the casualty must be in the supine position. Cross the wrists and tie them together. Kneel astride the casualty and lift the arms over your head so that the wrists are at the back of your neck. When you crawl forward, raise your shoulders high enough so that the casualty’s head will not bump against the floor.
TWO-RESCUER TECHNIQUES.—If the casualty is ambulatory, you and your partner should assist him to safety. However, if the victim has either a spinal injury or a fractured extremity, there are a number of two-rescuer techniques that can be used to move him to safety.
Chair Carry: The chair carry can often be used to move a sick or injured person away from a position of danger. The casualty is seated on a chair, as shown in figure 3–40, and the chair is carried by two rescuers. This is a particularly good method to use when you must carry a person up or down stairs or through narrow, winding passageways.
Figure 3–40.—Chair carry.
The chair carry must NEVER be used to move a person who has an injured neck, back, or pelvis.
Arm Carry: The two-person arm carry, shown in figures 3–41 and 3–42, can be used in some cases to move an injured person. However, this carry should not be used to carry a person who has serious wounds or broken bones.
Figure 3–41.—Two-person arm carry.
Figure 3–42.—Two-person arm carry (alternate).
Another two-person carry that can be used in emergencies is shown in figure 3–43. Two rescuers position themselves beside the casualty, on the same side, one at the level of the chest and the other at the thighs. The rescuers interlock adjacent arms as shown, while they support the victim at the shoulders and knees. In unison, they lift the victim and roll his front toward theirs. This carry must not be used to move seriously injured persons.
Figure 3–43.—Two-person arm carry (alternate).