Patient evacuation

  • By foot
  • By carrying
  • By bush stretcher
  • By sled
  • Improvised stretchers
  • One-person carry
  • Two-person carry

On well-prepared trips the likelihood of accidents requiring evacuation is low, but if a mishap that disables a party member does occur then several decisions need to be made: Is it possible, perhaps after a period of rest, that the casualty could walk out? Do the casualty's injuries prevent him or her from being moved at all? If the casualty can be carried out without seriously aggravating the injury, is the party collectively strong enough to do so? Should a fast, forward party be sent off to obtain medical assistance and or other outside assistance (e.g. stretcher bearers) as soon as possible? If it is decided that the party will evacuate the casualty, the most appropriate of the methods discussed below should be chosen.

By foot

Many injuries leave the sufferer perfectly capable of walking out, perhaps after a period of rest. No matter how fit the casualty seems, however, do not neglect to make a thorough examination before the person is allowed to walk. Many people keep going strongly through a crisis but suffer a sudden collapse when they no longer need to continue. The possibility of hypothermia, exhaustion or shock needs to be considered. The first step in an assessment should be to ask the patient how he or she feels. It is prudent to divide the patient’s belongings among the rest of the party and to station a strong party member on either side in case support should be necessary. Continue to monitor the person’s condition, usually by engaging in conversation. Unusual quietness and slurred speech often accompany exhaustion, shock and hypothermia.

By carrying

If the patient’s injuries do not allow walking, then carrying may be necessary. The leader should consider the needs of the rest of the group. Sometimes the circumstances that led to the injury may have affected others to a greater or lesser extent, particularly for hot- or cold-related conditions. Carries are hard work and a strong party will be needed.

The method chosen will depend on:

  • the condition of the patient
  • the terrain
  • the distance to be carried
  • the number and strength of the party.

For example, four strong people could carry a lightweight injured person a short distance to a sheltered campsite using one of the improvised carries. The same party would not be capable of an extended carry by any method.

By bush stretcher

A carry of any length, especially in rough terrain, requires eight stretcher bearers at any one time and two relief crews. Many newcomers to search and rescue regard this number of 24 carriers per casualty as excessive until they have first-hand experience of a long carry. Few walking parties will have sufficient numbers, but it may be possible to obtain assistance from members of other parties.

After organising sufficient carriers, a stretcher will need to be made. In spite of its crude and rustic appearance, it is difficult to improve on the bush stretcher (Figure 40.1) for a long carry. It is reasonably rigid for a comfortable ride, but not so rigid as to put a large stress on any part. It can be quickly made from readily available material. Most important of all, it allows eight people to share the load. Its building requires a suitable cutting tool (a saw is most convenient, but it has been done with a pocket knife) and a good supply of cord.

Stretcher carrying is easier with a fair degree of organisation. A ‘scout’ should go ahead to pick the best route, marking it if necessary. Next should come a group clearing a path for the passage of the stretcher. The stretcher will be carried by eight people on the bearers’ shoulders unless traversing, when it is usually best to carry on shoulders on one side and hands on the other. There must be one person in charge of the carry to synchronise lifting and lowering, to organise relief parties and to generally manage the carry. The patient should always be comfortably but securely attached to the stretcher, usually with rope over ample padding, such as clothing or sheets of bark.

One designated person, usually with first-aid skills, should monitor the patient’s condition and comfort, including arranging for toilet stops and making sure that branches do not scratch the patient’s face. Motion sickness, which is generally worse when the patient cannot see the horizon, can be a problem during long stretcher or sled trips. Turning the patient’s head to one side can sometimes ease the problem.

If the bush is reasonably open and not too steep, the stretcher can be carried continuously at about 2 km per hour. If the going is hard the pace will be much slower. When obstacles such as rocks or large logs are encountered, it will usually be best to position people over and beyond them and to pass the stretcher across hand to hand without the carriers moving their positions. This is usually faster and much more secure than trying to clamber over with the stretcher. When ascending or descending steep slopes, particularly if the ground is loose or slippery, it is wise to belay the stretcher to a tree or rock. It may then be possible for the carrying party to move down with the stretcher, using it to check themselves if they slip. In many cases, moving directly up or down the fall line is easier and safer than traversing.

Making a bush stretcher
The stretcher is shown in Figure 40.1:

  • Obtain two firm, straight saplings, 5–6 m long when trimmed, and four shorter pieces, approximately 4 cm in diameter and 1.2 m long. Assemble all available cord in the party.
  • Place long saplings on the ground, with their butts at opposite ends and about 60 cm apart. Lash crosspieces as shown, using diagonal and square lashings. All crosspieces must be placed on top of the stretcher poles and sprung down into position as required. Bottom sides of stretcher poles must be trimmed as cleanly and smoothly as possible for comfort on bearers’ shoulders.
  • Trim the ends of the crosspieces carefully, leaving no sharp edges. Lace across the stretcher with cords, fairly loosely, as shown. Secure each turn with a half hitch.
  • Carefully pad the stretcher with groundsheets, sleeping bags, spare clothing, etc., or if unavailable then sheets of bark covered with bracken make a very good substitute.

It is generally recommended that the patient be lashed to the stretcher, placing clothing or sheets of bark under the lashings to prevent chafing.

By sled

Patient evacuation in snow country may have to be performed by stretcher in exactly the same way as outlined above, but the use of sleds is usually much easier if the terrain allows. A ski sled (Figure 40.2) can be constructed as quickly as a stretcher and is a perfectly practical arrangement. Experience suggests that if soft snow is possible during the haul, a sled with three or four skis works much better than a sled with two. However, this also means another group member will have to walk. A sled is pulled and controlled by means of ropes attached to each corner. In suitable terrain, the pulling may be done most quickly on skis. In steeper country, light rope or cord should be attached to the sled pullers’ skis (light rope criss-crossed and knotted under the soles of the skis) to provide additional grip. In awkward, scrubby country snowshoes are probably best. Sleds have little lateral stability so they must be steered by the ropes. The issues with belaying stretchers apply equally to sleds.

Making a ski sled
Materials required:

  • Two, three or four skis—use skis with three-pin bindings, and the largest and heaviest skis available. In soft snow, sleds with three or four skis work much better than sleds with two.
  • One set of ski poles for each ski to be used.
  • Five or six pieces of wood, 3–5 cm in diameter, 60 cm long for crosspieces (snow-shovel handles or tent poles could be used, but these may be expensive to replace if lost or broken).
  • Large quantities of cord.
  • 15–20 m of rope.

Method of construction:

  • Lay the skis parallel, all tips in the same direction.
  • Place the ski poles over each ski, with both handles near the bindings.
  • Hook the pole basket of the front pole over the ski tip, and lash in place, keeping the lashing as high as possible to reduce drag. Adhesive tape is useful for this if available. The points of these poles can be a danger to the sled haulers, and should be covered with cloth or tape.
  • Hook the basket of the rear poles through the skis, if the baskets will fit. If not, lash to the skis.
  • Place the crosspieces over the ski poles, and lash to the ski poles only.
  • Lash the centre crosspiece, and ski pole handles to the toe binding of the ski.
  • Attach pull and rear guide ropes to the toe bindings, and then thread through the pole baskets.
  • Pad the sled as for a bush stretcher.

If only two skis are used, no able member of the party (if all are skiers) is left without skis, although two have only one ski pole each. This sled if carefully constructed is light, strong but may not be easy to pull in soft snow.

Improvised stretchers

Many improvisations are possible, depending on materials available.

Clothing stretcher
It is possible to make an improvised stretcher when no rope is available by using two strong jackets, such as parkas. The sleeves are turned inside out into the jackets that are then done up. Two poles are then slipped through the sleeves, as shown in Figure 40.3

Tent or groundsheet stretcher
A groundsheet (of sufficient size) or tent can be wrapped around two poles (body width apart) to overlap at least twice. The casualty’s body weight holds the tent or folded groundsheet in position, as shown in Figure 40.4.

Figure 40.4 Tent/groundsheet stretcher

Pack stretcher
Packs can be used to reinforce stretchers, or be lashed and splinted together to create a stretcher. These improvised stretchers are usually only suitable for short carries and there is little doubt that long carries require a well-built, rigid stretcher, as described previously.

One-person carry
One-person carries can be used when the casualty is light and small, but they are effective only for short distances. The carrier must obviously be strong.

Crossed slings and pole carry
Two slings of rope or strapping are worn across the body in bandolier fashion, with a short, well-padded pole passed through the back of the ropes on the carry, as shown in Figure 40.5. The casualty is carried piggyback with the legs resting on the pole.

Figure 40.5 Crossed slings and pole carry

Two-person carry
This is less strenuous than a one-person carry, but is limited to wide tracks and even terrain.

Two-person sling and pole carry
A pole is passed through slings (as in the one-person carry) or pack straps worn by two people. The pole is padded and the carriers link arms to provide a backrest, shown in Figure 40.6.

Figure 40.6 Two-person sling and pole carry

The pack may also be used—one way is to lengthen the straps of an empty pack, and sit the casualty with legs through the straps of the pack, which is worn in the usual way. Padding is required.

Anyone who has participated in any sort of patient evacuation will tell you that it is surprisingly hard work, even with a large group over short distances. Before attempting an evacuation with available group resources, consider the practical implications of whether you have the resources necessary to complete the task. It may be that patient transfer to a more accessible or comfortable intermediate location may be the better option, or perhaps seeking external assistance. Emergency personnel will always say that evacuating people is what they are trained and paid for, and would prefer to be called when not really required than to have their absence contribute to a tragedy.