(Continued from Part 3. This concludes the article.)
HOW TO CARRY A STRETCHER OVER BROKEN GROUND OR RUBBLE, OR UP / DOWN STAIRS, LADDERS, SLOPES
– If you have enough people, assemble a minimum of six stretcher bearers and a team leader for even the shortest move- in dark and confined spaces use at least one person to light and / or guide the way
– avoid hurry
– wear safety helmets and work gloves and protective ‘work’ boots
– drape the patient with a heavy blanket if moving / waiting in cold weather and exposed places but leave eyes / face exposed so patient can breathe
– at all times when stretcher is not level keep patient’s head above the level of his feet unless instructed otherwise by a medical / nursing professional
WHEN A STRETCHER IS NOT AVAILABLE OR CANNOT BE USED
Note that these next carry methods are NOT recommended when the patient has not (yet) been checked and cleared by medical staff as free from any injury or condition which careless handling could make worse, such as a spinal injury. However, in the event of a fire or similar emergency when to save the patient’s and your life you must evacuate the patient immediately from where you find him, these techniques may be appropriate.
TWO-PERSON CARRY
If necessary, two rescuers can carry/drag a semi-conscious or even unconscious patient from the scene of life-threatening danger; there are different ways to do it, and they’re quite obvious:
– one person each side of the patient with the patient’s arms around your necks and hands grasping their wrists
– one person at the head of the patient holding the patient under their armpits, one person between the patient’s knees holding their knees
– a two-handed seat carry ( which I do not recommend because it’s counterintuitive, clumsy and very unhelpful for fat* people, *remember them from the start of this briefing?)
see also here (13) if you like pictures not text
‘BACK CARE’ WHEN LIFTING
The spine is made up of 33 small bones = the vertebrae. 24 of these are mobile, they can move on each other. The remaining 9 are immobile, they can’t. Because of these numerous segments and joints the spine has a high potential of injury. Therefore we all need to understand and practice good ‘body mechanics’ to prevent injury.
The 5 commonest causes of back pain in order are:
– poor posture
– faulty body mechanics when lifting
– stressful living and work habits
– loss of flexibility
– poor physical conditioning
So, Rules for Safe Lifting of patients are the same as Rules for Safe Lifting of Everything:
– use the powerful leg muscles and the large hip and knee joints while lifting.
– lighten the abdominal muscles to stabilize the spine and pelvis, tuck the buttock under, then bend your knees and lift.
-keep the person you are lifting close to your body when lifting. This makes the work easier and minimizes the strain on the lumbar spine.
– avoid shoulder injury to the patient; do not grasp the patient under the armpits.
– avoid neck injury to the lifter; do not allow the patient to hold you around the neck.
– avoid back injury to the lifter; move your whole body in the direction of the lift; do not rotate or twist your spine.
Getting Ready for a Lift:
THINK
– check for the most appropriate lift and number of lifters
– check the environment
– obtain help if necessary
TALK
– allow the team leader to direct the lift
– discuss the lift with the others involved
– tell the patient what you are going to do and what they may need to do to help (e.g. ‘cross your arms over your chest and lie still’)
PREPARE THE AREA
Remember to set and /enforce’ a personal lifting weight limit based on your height / weight – NEVER exceed 50 lbs per person if you can avoid it.
That 50 lbs is not actually not a large amount of weight. For example, had you been called upon to lift Fat Oprah in the 1990s that would have been 237 lbs plus about 40 lbs for stretcher and equipment which means you definitely needed six people. Even fit older Arnold Schwarzenegger is 220 lb or so. So – THINK AGAIN!!! about what you are going to do. NEVER RUSH INTO A LIFT!!!
Best ways to not stress your lower back when you’re helping people or indeed lifting anything at all:
– keep your back straight
– be upright with good balance – which is why you will have good shoes or stout boots, won’t you?
– hold the object to be lifted close to your body – which is why you walk close to the stretcher or litter, right?
– avoid twisting – which is why you move your feet and not your upper body!!!
Okay, after all of that, we are now going to go and do it.
(Hint: if you can’t afford an expensive stretcher, it is absolutely possible and indeed an excellent Return On Investment to make your own stretchers out of well-polished forest-hardwood – make sure there is no bark on the shafts where you are holding and carrying them – and canvas and an industrial-strength sewing machine).
Over the years I have seen tens of different types of improvised litters / stretchers used to transport patients by people who made the best of what was there.
The most memorably successful one I saw in Flores, where two large bicycle wheels had been mounted one either side at the midpoint of a repurposed domestic door, the patient lying on the door with an ordinary bed pillow and a semi-inflated camping mattress for comfort; and two broom-handles sawn in half with one half attached at each corner of the door-stretcher to push, pull or turn.
You too can scavenge and repurpose…
For a rigid flat-surface stretcher: plywood, marine plywood, doors, shutters, benches, ladders, cots, tables…
For a ‘soft’ stretcher: shelter halves, tarpaulins, sun umbrella canvas, jackets and shirts and trousers, ponchos, mattress covers, cut up a camping tent…
For padding: foam, duvets, winter weight curtains, skiing suits and padded motorbike jackets and trousers stuffed inside a sleeping bag, a bulky sleeping bag…
For poles: broomsticks, long gardening tools, check out a gardening supply shop or Home Depot if they are still functioning, tent-poles, awning supports, skis… ideally you want poles about 3″ diameter and 12′ long.
I’ve seen a few, a very few, litters constructed entirely out of rope in villages in Asia and in Africa but you need a large amount / length of rope and excellent knotting skills. I’d go back to Plans A and B.
I have seen on a number of occasions, large garden carts repurposed for paediatric casualties. Very smart, and protective. but remember, for children as well as adult patients, if you put them in a cart / on a stretcher, remain aware of the potential for problems such as sunburn.
Getting it done
Okay, we’ve safety’d the site, mobilized our volunteers, and collected enough appropriate equipment to move the patient 10 yards or maybe 10 miles (40+ years ago I did manage with three colleagues to carry a patient in a stretcher/litter for slightly over 10 miles in broken mountainous terrain; yeah, I don’t advise it).
If you need to go far then you’ll need four teams of 4 people, plus a couple of team leaders who can rotate in and out of the people-porter-group. That’s one team of four people to carry the patient for 20 or 30 minutes (with one team leader); one team who have just finished carrying and will do well to rest while walking if they can still walk at all; one team who are ‘next up’ having recovered; and at least four spares for the day’s journey to account for injury, incapacity, and desertion. You may well think I’m a pessimist. Nope, a realist.
The longest journey always begins with explaining to a patient whether entirely conscious, semiconscious or apparently not conscious at all, what we are going to do to them. Hearing is the last of the senses to disappear under the influence of pathology whether trauma or illness; it is a courtesy to brief your patient on what you are gonna do with him / her, and why. And at the same timeyou say it loudly and calmly enough so that everybody around understands what all of you are gonna do as well. I learned within the first couple of cardiac arrests I attended that the best way I could fake staying calm and remember to do what I needed to do in sequence was to talk about it out loud as if I did indeed have a plan and was not quietly panicking inside…
You need to designate a team leader. And you shouldn’t always be the team leader even if you are the best* leading the team during training most especially because you need to train your replacements, you may need them sooner than you think. *And if you think you are the best team leader ever then you probably need some nebulized humility.
The team leader will do both the basic things like making sure that for every four stretcher bearers we / he / she assigns people to front and rear and left and right depending on height and ability. It’s better for the patient, if you don’t have people of uniformly the same height, to have the lighter less-weight-capable people at the feet, and the taller high-capacity people at the head end. Patients are more comfortable a little bit head up than a little bit head down.
A couple of comments on what to not do…
- Do not try and move fast whether the terrain is smooth or broken. Carrying a person on a stretcher is hard work and it is too easy to damage the stretcher-bearers.
- Do not walk on concrete. Even tarmac seal is preferable to sidewalks.
- Do not try and carry people by piggyback unless you’re doing it a very short distance in the same circumstances as fireman’s carry. Your neck and back will thank you.
- Do not switch your four-person stretcher/litter to a one-person travois unless you have minimal material (for example, you’re above the tree line of a mountain). A travois does work esp. going downhill; but it’s uncomfortable for the patient and the geometry of a travois makes it difficult to comfortably support that patient while we’re dragging them. Oh all-right if you must know: you need two 10 to 15 foot poles with at least four cross poles, and the cross poles being at least the width of your patient’s shoulders.
You need to remember high school geometry because you want to make a triangular framework in an isosceles configuration = two equal long sides, with the patient’s head in the cavity just before where they join at the apex. (14)
If you really want to do this, you had better practice it, know how to lash wood together and not only at right angles, and there really has to be no better option. Ask me how I know.
Good luck!
***
Notes:
(1) The Golden Hour is a medical approach to resuscitation, referring to the first hour after a traumatic injury, when appropriate emergency treatment started in that hour is most likely to be reflected in positive long-term patient outcome. The Tarnished Day is a cynically-inspired corollary from my late 20s when I first started working in out-of-hospital medicine especially but not only after natural and man-made disasters; patients in these circumstances are lucky if they get any treatment at all in the first 24 hours…
(2) Continental United States. Alaska you’re in; Hawaii and Guam etc., YOYO.
(3) Shanks’s Pony means using MkI legs as the means of transportation. (Word origin likely from shank (in the sense of lower leg) and a pun on that name.)
(4) About two in five women born in the 1960s were obese by age 45, but the same proportion had become obese by age 30 for those born in the 1980s. Plus, teenage obesity rates more than doubled in the United States between 1990 and 2021, from 9% to 23% in boys and 10% to 29% in girls. An additional 3.3 million children and teens and another 3.4 million young adults will be overweight or obese by 2050 – with highest levels among young adult men in Oklahoma (43%), Mississippi (39.8%) and West Virginia (37.7%) in 2050, and affect at least half of young adult women living in Mississippi, Arkansas, Oklahoma and Alabama, results show. However, the largest numbers of young obese adults will continue to be in California (1.53 million) and Texas (1.49 million) in 2050. Unless something happens first. Which is likely.
(5) Napoleon’s chief medical officer, Baron Larrey, introduced hôpitals ambulants – literally ‘moving hospitals’ on the battlefields of Europe back in the day to bring patients to the care they needed, much more quickly and to a certain extent, more comfortably. Before that the wounded and dying were left where they were, sometimes being treated by camp followers, but usually not, until after the battle when they were picked up in a rather desultory fashion and without any triage. His innovation lives on as what we now call ambulances.
(6) Irish Republican Army. They had 150 years of developing skills with IEDs before the Taliban were pulling petals off their first opium poppy.
(7) A fireman’s carry is well illustrated and described at this link.
(8) Link to show you various litters and stretchers used by mountain rescuers, over time.
(9) Stokes-style litter.
(10) Ferno basket stretchers 71 & 71s.
(11) Vacuum mattress.
(12) Baofeng transceivers. (Link is to Amazon but for your info only, I have zero commercial relationship with Amazon other than I have bought stores and a radio from them.)
(13) 4 Ways to do Two-Person Carry.
(14) An emergency travois to move a patient: if I had to, I try and do the one on the absolute last page/bottom right corner of this very helpful scouting pamphlet from the Irish Scouts. Note the repurposed bicycle wheels and the crossbars are replaced by a net, and the simplified “X” framework pattern. Well done, Scouts!