If I’ve seen one… then I’ve seen one. That is all that means. But did I learn anything from it?
CASEVAC
Casualty Evacuation: what we need to know and do, when we need to move the immobile ill or badly injured with our own resources?
Disclaimer One
The following article relates entirely to retrieving and moving casualties both ill or injured, when the situation is such that no one is gonna come and help you anytime soon: not within The Golden Hour, nor even within The Tarnished Day. (1) ‘Cause at the time of writing, 99.5% of serious injuries and illness in CONUS (2) are more quickly accessible by rotary, fixed-wing or wheeled transport (or any combination the than you and me with Shanks’s Pony. (3). But that may not last.
Disclaimer Two
Following on from the above, please don’t practice this at home on homo sapiens – or large pets for that matter. You could I suppose take the Heinlein view and practice on false prophets and tax collectors, but you’ll be doing that entirely at your own risk.
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And a necessary caveat before we get really going: at the beginning of a Grid Down (GD) event or however you wish to call it, it is very likely that most of us learning to do this ‘for real’ will not be particularly fit, and very likely that most of the people we may need to try and move, will be particularly fat. Risky all-around.
If you’re in CONUS, as of 2021, nearly three-quarters of the adult population was overweight or obese; Obesity in particular has increased rapidly, doubling between 1990 and 2021 in both men (19% to 42%) and women (23% to 46%). (4) Researchers found the highest levels of obesity are in the South, and that trend is expected to continue into the future. Two-thirds of men in West Virginia and Kentucky and two-thirds of women across 12 states are expected to be obese by 2050. Especially high rates of obesity are predicted for Mississippi, West Virginia, Arkansas, and Illinois.
So, if you going to do this, you need to be prepared at least in the early days after GD, to be moving very heavy people for which you are almost certainly (with many honorable and well-trained exceptions) physically lacking the stamina. Beware!
Editor’s Note: This article is presented in the format of what you would hear and see if you attended a hands-on training session. The footnotes are all listed at the end of Part 3.
I got a very early grounding in moving people without ‘hôpitals ambulants’ (5) first in Army training and then in episodic environments such as after-the-event-of earthquakes, lahars, avalanches, bombings, tsunamis, and general humanoid and natural mayhem – when it wasn’t possible and/or safe to get these ‘wheeled field hospitals’ up to where the patients were. I learned quickly there is a fairly understandable cascade of reactions to such events – we wanna / we gotta help now! – and move these patients away from the sources of imminent danger to better care; but you got to put yourself first, because if you get struck down by whatever that patient was hit by, then you’ve just added to the casualty count and you are of no use to your patient. So, before you rush in, take a good look and tread a little carefully, okay?
The exception is of course when you decide that this time is exceptional. The follow-through from the avalanche is grinding its way towards you and the patient; the occasional bullet is still being fired in the direction of the patient and your precious self; the gas leak is becoming increasingly hard for both of you to overlook; and the Bomb Squad has not had time to secure the area (the IRA (6) were especially adept at hiding leftovers…); so you decide you going to run there, pick up the casualty in a fireman’s carry (7) or similar, and make a run for it. I hope it works out for you and your patient, I truly do, but, sometimes it does not.
Once you are sure it’s safe to approach your patient(s) because external threats have gone or been neutralized, remember that the patient themselves may be a threat, not just because they are confused and may fight you, but because their pathology / disease / problem, may be able to affect and infect you even if they don’t wish it so. This does not mean you run away again, although those of us who took an oath to attend the sick and dying regardless of infectious and similar risks won’t criticize you for it. Lord knows we are not especially happy about the possibility, we just hide it with dark humor. Just understand what you are doing, and call for volunteers.
Training for it
You need people. And while it is fine to offer training to everybody who wants it – and it’s a good idea to extend the possibilities in case you might one day need to be moved by distant neighbors and relative strangers – the training needs to consist of Doing. The. Actual. Hard. Work. Not reading this.
First, Work at retrieving inanimate loads to start with, and then (as long as everybody gives their informed consent and you are fully insured, and don’t think I’m joking) retrieving volunteer-casualties from difficult places – and then loading them into a stretcher (8) or Stokes-style litter (9) or Ferno stretcher (10) or vacuum mattress (11) or whatever you’re going to use.
Next, carry that load / person on the platform of your choice or availability, as far as you think you can carry it until before you must stop and rest, and then repeat the process.
Then, train on crossing rivers / lakes / fences / ditches and rubble. And on how to load that load in and out of a vehicle if you ever have the luxury of getting to one. All the while safely not dropping people. And switching the volunteers who are being carried so that everybody has the experience what it’s like to trust your bodily integrity and continued survival to a bunch of other people who you may not even be able to see because you’re face up looking at the sky or facedown looking at the ground, on that stretcher.
Whew! That was a run-on data-dump. So let’s break it down.
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I would like to start by reminding you to be safe and don’t do anything that you feel is beyond your capacity and don’t – please don’t – attempt to exceed your safe capacity because you’ve got an audience!
We are going to be learning to do and practice something which is very uncommon these days, which is the safe movement of a casualty whether ill or injured with only our own resources. So, no helis, no planes, no ambulances or any vehicles to help us at this stage. In case things get bad and we are our own and only first responders.
Whether we have been directly involved, or just watched what’s been happening in North Carolina and Florida in recent months, we have all just had an object lesson and a sharp reminder that even very close to large cities with a lot of resources, bad things can happen very quickly, and while an initial incident itself may not kill people, the response to the incident can do so.
Our active participation in retrieval and transport drills is also, I would like to advocate, part of our civic and community duty.
This training will focus on the rapid and safe extraction of a patient from where they are to a staging area where they can – and you can – rest, they can be made more comfortable, they can be treated, and they can be prepared for any next movement(s) to upgrade the medical care they need.
IN THIS TRAINING… we will cover
– how to act as a unit under a team leader
– how to assemble and disassemble a stretcher quickly
– how to safely lift a patient into a stretcher in case of spinal injury, fractures etc.
– how to secure patient inside a stretcher
– how to lift and carry the stretcher as a team
– how to move patients up and down stairs, slopes, vertical ladders
– how to carry a stretcher over broken ground and rubble, and through or around trees, bushes, and pipes / machinery
– how to slide a stretcher under or through a ‘tangle’
– fireman’s carry when a stretcher is not available or cannot be used
– self ‘back care’
First. You’re going to need (if you have not already done so) to identify a group of people who will be your colleagues in this move, this isn’t a solo effort.
HOW AND WHY WE ACT AS A UNIT UNDER A TEAM LEADER
The safe movement of a patient relies more on careful coordination than strength. To coordinate the care of a case requires a team leader can provide leadership and effective coordination while remaining aware for risks and dangers that team members cannot readily appreciate as they are focused on the patient whose safety is literally in their hands.
There can be only one team leader at any time!
You’ll see a close and at times wordy focus more on injured patients than on sick / ill patients. This is because when moving the injured we don’t want to make their potentially unstable injuries worse and more painful to them; when moving the ill the processes of moving them doesn’t tend to make their illness worse other than via the passage of time.
(To be continued tomorrow, in Part 2.)