Section 9: Stretchers
9
Stretchers
9.1
Objectives
On completion of study and/or instruction on this chapter of the General Rescue
Manual individuals should be able to:
• Describe the characteristics of the four main types of stretcher used,
And with other similarly trained people:
• Load a person into a stretcher using four rescuer, blanket and clothing lifts
• blanket and lash people into the folding, board and basket stretchers
9.2
Introduction
The four categories of stretchers in most common use are:
• Folding or pole stretcher - commonly referred to as NATO or Mk II stretchers
• Board rescue stretchers
• Basket stretcher - often referred to by brand names of Stokes Litter, or FernoWashington
• Wrap-around stretchers
9.3
Folding or pole stretchers
WARNING NOTE:
These stretchers are not suitable for lowers, and are only appropriate for
casualty movement on the flat.
The folding stretcher must be set up as follows before a casualty can be transferred
to it:
• Unfasten the straps that hold
the stretcher closed.
• Spread open the stretcher
and lock the spreaders in
place by pushing on each bar
with your foot, from the side
to avoid standing on the bed,
until it locks into place.
• Do not use your hands as
they can be pinched by the
hinges.
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Section 9: Stretchers
•
•
9.4
Where it is possible that the centre hinge of the spreader bar may be snagged,
causing the hinge to unlock and collapse the stretcher, a securing rope should
be used.
A short length of rope can be tied from one stretcher handle to the centre
hinge and then to the other stretcher handle in ‘V’ pattern.
Board rescue stretchers
Many organisations have Board rescue
stretchers available. This type of stretcher
has a number of advantages for the rescue
environment:
• Providing protection for the patient
from underneath.
• A number of handholds.
• Relatively inexpensive.
• This stretcher is suitable for patient
transport
and
some
rescue
techniques.
• A footplate is usually used to prevent
the patient sliding downwards if the
stretcher is tilted towards the vertical
position.
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Section 9: Stretchers
WARNING NOTE:
A rope lashing system should be used at all times other than when the
stretcher is moved over smooth and flat ground.
Care must be taken if this stretcher is used for lowering as the high centre
of gravity can cause the stretcher to invert, particularly when using the twopoint suspension method.
9.5
Basket stretchers
There are two types of basket stretcher commonly in use. The older type has a
strong tubular aluminium frame covered with ‘chicken wire’, whereas the newer has a
formed plastic, fibreglass, or aluminium basket attached to a tubular aluminium
frame.
The newer designs have an advantage in that they are less likely to be snagged or
penetrated than the wire model.
Other than the very old wire designs, these stretchers can accommodate a ‘scoop’
style stretcher, or spinal board, thus making the transfer of a spinal casualty easier.
Basket stretchers provide good protection for casualties and are ideally suited to a
range of rescue techniques. The main drawback is the relative expense in
comparison to other types of stretchers.
9.6
Wrap-around stretchers
Wrap-around style stretchers such as the Sked and the Fallright Evacuation Splint,
whilst quite different in design and construction, share the same critical feature in that
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Section 9: Stretchers
they conform very closely to the casualty’s body, thus adding very little width or bulk
for confined space operations.
• Each of the wrap-around style stretchers has its own advantages and
disadvantages that must be weighed up prior to use.
• Each has its own individual casualty securing system. Manufacturer’s
recommendations about methods of attaching lowering and guide ropes must
be followed.
9.7
Blanketing the stretcher
Before a casualty is placed on a stretcher, it should be covered with a blanket. This
adds to comfort, keeps the casualty warm, and to a large degree helps immobilise
any fractures that may have been sustained. In very warm weather a cotton bed
sheet or sheets may be used instead of blankets.
Single blanket method
Lay one open blanket diagonally down the
stretcher with the corner of the blanket in the
centre of the top of the stretcher, and about
150mm overlapping.
• Place the casualty on the blanket with the
head level with the top.
• Fold over and tuck in the lower half of the
blanket.
• Do likewise with the top half.
9.8
Blanketing - Lateral/Recovery position
In addition to warmth, comfort, and immobilisation, the blanket is used for padding to
keep the patient in the required lateral/recovery
position.
The following is the recommended method:
Before folding the blanket around someone :
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Section 9: Stretchers
•
•
9.9
•
•
•
Roll a blanket end to end and position it on the stretcher so that the roll is used
to pad the patient’s back.
A second blanket is placed on the opposite side of the stretcher to support
arm and stop patient rolling onto stomach.
Loading the stretcher
Loading a stretcher is an important part of casualty handling.
Correct methods are essential for the well-being of the casualty to prevent
aggravation of injuries.
Final checks must be made by hand to ensure that a casualty is actually ready
to lift before a lift is executed.
WARNING NOTE:
The casualty’s head and neck must be supported at all times.
Casualty reassurance is important in all techniques to reduce the anxiety of
the casualty, and reduce the risk of them panicking which increases risk to
rescuers.
9.10 The four rescuer method
When using four rescuers to load a stretcher and where spinal injuries are not
suspected, the following method can be used:
•
•
•
•
•
•
The stretcher is made ready and placed near
the casualty’s head or feet.
The leader instructs three other rescuers to
kneel down on one knee on one side of the
casualty (casualty lying flat on their back). They
all have the knee closest to the casualty’s head
elevated.
The leader kneels near the casualty’s head to
support the neck.
The other three place their hands and arms
underneath the casualty. Usually under the
shoulders, small of the back, thighs, knees and
calves.
The leader gives the order: Prepare To Lift and,
if no one dissents, follows it with Lift,
whereupon all four lift.
If necessary, the casualty can be briefly
supported on the rescuers’ knees. The stretcher
is then placed under the casualty.
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Section 9: Stretchers
•
•
Final orders are Prepare To Lower, then Lower.
The three rescuers, assisted by the leader, lower the casualty on to the
stretcher.
9.11 Blanket lift (four or six rescuers)
This is an effective method for loading or moving a casualty in a restricted space.
• Make a stretcher ready using one blanket.
• Roll a blanket lengthways for half of its width
and lay the rolled section along the side of the
casualty (casualty flat on back).
• The leader then directs two (or three)
rescuers to kneel down on each side of the
casualty.
• The rescuers on one side ease the casualty
over on one side and the rolled section of the
blanket is pushed well underneath the
casualty.
• With the rolled up section of the blanket now
under the centre of the casualty, the casualty
is eased over in the opposite direction and
the blanket is unrolled. The casualty should
now be lying flat on their back.
• The sides of the blanket are rolled up close to
the casualty’s body to provide handgrips for
the bearers. They cross arms to help keep
the lift even and the spine aligned.
• On the order from the leader, the casualty is
lifted waist high, and carried to the stretcher.
• On the order from the leader, the casualty is
lowered onto the stretcher.
• The blanketing is then completed with one blanket, leaving the lifting blanket in
position.
• This ‘blanket carry’ can also be used as an improvised stretcher for carries
over moderate distances.
WARNING NOTE:
Suspected spinal injured casualties can be safely transported by this
method with correct immobilisation of the spine and with particular attention
paid to the head and neck.
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9.12 Clothing lift (Three rescuers)
This is an emergency method which can be used when the casualty’s injuries are not
severe and time is critical.
• Blanket a stretcher and place it
close to the side of the casualty.
• Tie
the
casualty’s
hands
together with a triangular
bandage or similar material, or
place in pockets/under their belt
if unconscious.
• Grab the casualty’s clothes
along the centre of the body,
and roll any loose fabric to form a hand grip.
• Three rescuers take up the position on the opposite side of the casualty to the
stretcher and position their hands.
• The normal commands are given (Prepare To Lift, etc) and the casualty is
gently lifted, then lowered onto the stretcher.
9.13 Webbing bands (Five rescuers)
In some cases it may be necessary to transport
a casualty some distance to a place where they
can be loaded onto a stretcher. Webbing bands
can greatly assist this operation. While there
are many configurations that can be used, one
suggestion is:
• The bands are placed in position by
pushing the long steel handle under the
natural body hollows and see-sawing the
bands into the required position, i.e.
under the buttocks and shoulders.
• After bands are correctly positioned, the
five rescuers take up position, crossing
bands to help keep lift level and align
casualty’s spine. The normal commands
are given (Prepare To Lift, etc) and the
casualty is gently placed on the
stretcher.
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Section 9: Stretchers
9.14 Specialist lifting/loading devices
Specialist lifting/loading/extraction devices such as timber or synthetic spinal boards,
scoop stretchers, and spinal immobilisation devices or harnesses are readily
available from rescue equipment suppliers.
These devices should always be used in compliance with manufacturer’s
specifications and recommendations, and following appropriate specialist training.
9.15 Summary of stretcher types and uses
Folding
Board
Basket
Wraparound
Advantages
Large quantities
available.
Compact.
Easy for one
person to move.
Comfortable.
Moderate
quantities
available.
Protection from
below.
Back and side
protection.
Comfortable.
Lightweight.
Less bulky than
other types.
Disadvantages
Little protection for
casualty.
Need to secure
locking
mechanism.
Relatively scarce.
Cost.
Bulk.
Cost.
Limited access to
casualties to
monitor/treat.
Usage
Moving casualties
over level ground.
Make good beds in
mass casualty
situation.
NOT to be used
for rescue from
height.
High center of
gravity when used
for lowers.
Uncomfortable for
long periods of
time.
Spinal injuries.
Rescue from
heights using
General Rescue
Techniques.
MUST use lashing
line when moving
over uneven
ground or lowersDO NOT rely on
webbing straps.
All purpose.
Restricted or
confined space.
Special notes
Use additional
“lacing” when
used for rescue
from height.
9.16 Lashing the casualty to the stretcher
In many cases, casualties will have to be firmly secured to the stretcher to enable it
to be handled in different places. In all instances, except movement over a short
distance on even ground, the patient should be lashed to the stretcher. If in doubt,
lash the casualty in.
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9.17 Lashing the folding stretcher
The ideal size and length for stretcher lashing is 12 metres of 11mm or 12mm rope.
• Commence the stretcher lashing by forming a Figure 8 on the Bight around
one of the top stretcher handles.
• From this point take three Half Hitches around both the casualty and the
stretcher, first in the region of the chest, the second in the vicinity of the wrist
and the third hitch just above the knees.
• A round turn is then taken around the feet and three Half Hitches applied to
those already formed on the opposite side of the casualty’s body.
• The lashing is finished with a Round Turn and Two Half Hitches on the
remaining stretcher handle.
•
•
The position of the three securing Half Hitches can be varied according to the
location of the injuries that the casualty has sustained. In the case of a female
casualty, the top securing hitch should be placed just above the breast line.
Bricks or timber placed under the stretcher D’s before lashing commences, will
enable the rope to be passed under the stretcher more easily.
9.18 Lashing - Lateral/Recovery position
The lashing of the stretcher differs from the normal method in that the rope does not
pass around the feet.
• The middle lashing is positioned
under the casualty’s buttocks to
prevent movement downwards.
• Instead of passing a loop around
the casualty’s feet, the line is
Half Hitched around each handle
at the foot of the stretcher.
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Section 9: Stretchers
9.19 Lashing - Board rescue stretcher
The patient should be lashed to the board rescue stretcher whenever it is going to be
lowered or moved over uneven ground, eg: rubble, confined spaces. Where nylon
straps come with the stretcher, they can be used, but not as the primary way of
securing a casualty to the board rescue stretcher.
A 12m rescue line, or climbing tape, is used to lash the board rescue stretcher.
The process is as follows:
• Begin with a Rethreaded figure 8 through the topmost handhold or hole.
• Pass the line down the side of the board.
• Take a complete turn under the board and back
across the casualty’s chest.
• Form a hitch and tighten gently.
• This is repeated across the casualty’s wrists and
again just above the casualty’s knees.
• A complete round turn is taken around the feet.
• The rope is then taken up the other side of the
board forming hitches on each turn of the lashing.
• Complete with a round turn and 2 Half Hitches on
the handhold opposite where the lashing was
started.
Some board rescue stretchers have runners underneath with slots in them for the
rope to pass through. This has the advantage of minimising ropes being scraped on
the ground or building edges.
9.20 Alternate Board rescue stretcher lashing
An alternate method for lashing the board rescue stretcher where there is insufficient
room for the rope to pass through the runners, and there is a risk of the ropes being
damaged or caught is:
78
•
Begin the same as lashing the basket stretcher (see
9.22 below) with a hitch around each of the bottom
handholds.
•
Criss-cross up the stretcher coming from the outside of
the stretcher, then up through the handhold and
diagonally across to the other side other the casualty.
Working this way minimise pressure on the handholds.
•
Finish with a Round Turn and 2 ½ hitches adjacent to
the casualty’s shoulders.
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Section 9: Stretchers
When this lashing is used and the stretcher is going to be lowered consideration
should also be given to the Improvised Casualty Harness shown in 9.23.
Note: This technique is shown without a blanket for clarity- a blanket would normally
be used.
9.21 Securing a basket stretcher with securing straps
Some basket stretchers are supplied with securing straps with seatbelt buckles or
‘Fastex’ clips. These should be used in conjunction with a lashing, whenever the
basket stretcher is used for anything other than moving the stretcher over even
ground.
• When the patient is small there will be gaps between the patient and the sides
of the stretcher. It is not improbable that a casualty could slide out from under
the straps if the stretcher was tilted. Gaps between the casualty and the
stretcher sides may be filled with blankets, clothing or pillows etc. before the
straps are snapped in place.
• Remember that the purpose of strapping or lashing is to combine the patient
and the stretcher in a solid manageable unit capable of being carried over
hazardous terrain, or for rescue.
9.22 Securing a basket stretcher by lashing
•
•
•
•
The casualty can be lashed securely to a basket stretcher with a 12m length of
11mm rope, or tape, with the lashing pattern dictated by the casualty’s injuries
and size and by the attitude through which the stretcher will move.
If the basket stretcher has no foot plate, the casualty’s feet should be secured
to prevent them from sliding down the stretcher.
If the casualty is to be shifted in a vertical position the head of the patient must
be secured. Pack soft material on either side of the casualty’s head and tie a
length of bandage to one lower rail, lay it over the casualties head (not
covering the eyes) and tie the other end to the opposite lower rail.
It is important to continually reassure any casualty who is secured to a
stretcher in such a confining manner.
One option for the securing the casualty is shown below:
•
•
•
•
General Rescue Manual – March 2006
Find the middle of the tape or 12m line
Hitch through hand-hold at feet end
Criss-cross up stretcher
Finish with round turn and 2 ½ hitches around
handholds adjacent to the patient’s shoulders
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Section 9: Stretchers
9.23 Improvised casualty harness
An improvised casualty harness can be fitted to either the basket stretcher or board
rescue stretcher. It is useful whenever the footplate is not used/secured e.g. small
people, lower leg injuries, alternate board rescue stretcher lashing (9.20)
This harness can be made using rope or tape.
•
Form a loop in the middle of the rope
•
Bring this between the casualty’s legs
•
Bring the tails around the buttocks and pass
through the loop
•
Ties off to hand holds on the side of the stretcher
using Round Turn and 2 ½ hitches.
Note: This technique is shown without a blanket for
clarity- a blanket would normally be used.
9.24 Moving a stretcher over uneven ground
The technique for moving over rubble is covered in the USAR Awareness Student
Manual, and the principles remain the same for any uneven ground. A stretcher
should, wherever possible, be carried in the horizontal position or slightly ‘head high’.
When moving over debris or uneven ground, this may prove to be difficult, but risks
to both casualty and rescuers can be reduced to a minimum by adopting the
following procedures:
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Section 9: Stretchers
Using six rescuers
Moving a heavy casualty over difficult debris
conditions for any more than 10 or 15 metres,
will almost certainly require 6 rescuers.
•
The leader should position three on
each side of the stretcher.
•
On the order Prepare To Lift, the
rescuers stoop and grasp the stretcher.
When all is in readiness, the leader
gives the order Lift and the stretcher is
raised to waist height.
•
The next order will be Prepare To
Pass. Any member of the team who for
any reason is not ready should inform
the leader.
•
Good footing on debris is hard to find,
and care should be taken in this regard.
•
On the command Pass, the stretcher is
passed until such time as it is
supported by four rescuers, leaving two
spare.
•
These two then climb carefully around
the stretcher and take up positions at
the other end of the stretcher.
•
The process is then repeated until the
stretcher arrives on clear, solid ground.
•
It is stressed that this operation calls for
a high degree of teamwork and that the
leader must retain control throughout.
•
The leader must ensure that while the
stretcher is being passed, no member
of the team is moving on the debris.
9.25 Moving a stretcher in restricted spaces
In small spaces, if there is sufficient height and the casualty has been lashed to the
stretcher, it may be stood on end and moved around sharp corners.
•
•
Where the height is insufficient to permit this method being used, a
compromise between the vertical and horizontal positions is necessary.
The casualty should be carried feet first as far as the middle of the right-angle
bend, then the foot of the stretcher is placed on the ground and the head end
lifted as high as the situation will permit.
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Section 9: Stretchers
•
•
•
The stretcher can be worked around
the bend, one rescuer easing the
foot end and the other the head.
Under these conditions the stretcher
should not be tipped on its side. To
do so would only increase its height
and also the difficulty in handling it.
‘Wrap-around’ style stretchers are
specifically designed for confined
spaces and that these should be
used wherever possible.
9.26 Improvised stretchers
In any disaster, there may be insufficient stretchers immediately to hand for the
number of casualties involved. Such situations will normally be multi-agency
responses and the resources of all involved agencies should be utilised.
There are many methods of improvisation and some imagination should be used
when confronted with the problem. A number of the more commonly used methods
are described here.
WARNING NOTE:
Improvised stretchers should never be used for rescue techniques, other
than moving over flat ground.
Platform stretchers
Improvised platform stretchers can readily be devised from doors, sheets of
galvanised iron, or bed frames.
Pole stretchers
These stretchers are very simple to make and require two poles about two metres
long. Stout broom handles, water pipe or 50mm x 50mm timber are quite appropriate
for this job.
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The poles should be laid parallel on the ground and about 600mm apart. The bed of
the stretcher can be formed from a blanket, sacks, overalls or coats. The weight of
the casualty will hold the blankets in place.
Ladders
Where for any reason, a very narrow
stretcher is required, such as for passing
through small window openings, tunnels
etc. a small ladder or one half of a small
extension ladder can be used to an
advantage.
A decking of boards should be placed on
the ladder (if available) and it is then
blanketed in the normal way.
The lashing line is attached to a ladder
string using a rethreaded Figure of eight,
and then the lashing done at same
positions as board rescue stretcher.
Chairs
A strong style kitchen chair can be used for carries
of casualties without serious injuries.
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Section 11: Non-stretcher based rescue techniques
10 Stretcher based rescue techniques
10.1 Objectives
By the end of studying and undertaking training on this chapter of the General
Rescue manual individuals should be able to, with other similarly trained people:
• select appropriate and perform safely a variety of low and steep angle rescue
techniques including a stretcher lower/raise in a low angle situation
• Single, Two Point and Four Point Lower in the limited high angle environment.
• Ladder Slide
• Ladder Hinge
10.2 Introduction
In any disaster occurring in an urban environment, it is likely that large numbers of
casualties could be trapped in upper floors of buildings, in basements or other
depths, or in many other difficult or inaccessible areas. In each case, the method of
rescue will be dictated by the circumstances. This section attempts to provide some
of the alternative methods of rescue for the low and steep angle situation. The simple
option of carrying a casualty up or down an inside stairway must not be overlooked.
10.3 Definitions
Low angle rescue
Low angle rescue techniques are used to undertake rescues on slopes of less than
30 degrees, e.g. gentle slope or rubble pile. They are used when the person’s injuries
require them to be in a stretcher. The main weight of the patient is taken by the
rescuers positioned on the side of the stretcher, but allows control in the event that
the rescuers may slip or trip.
Steep angle rescue
Steep angle rescue techniques are used when the situation requires the lowering, or
raising, of the stretcher in an angle generally between 30 and 60 degrees. In this
situation the weight of the patient and stretcher is taken by the lowering lines.
Because of their specialist nature, steep angle rescue techniques are not covered in
this manual. Anyone interested should consult the USAR Best Practice Guideline:
Rope Rescue Tier Model.
High angle rescue
High angle rescue is used for rescues above 6 metres and or where the angle of the
incline exceeds 60 degrees. It requires specialist equipment and highly trained
rescuer. Because of their specialist nature, high angle rescue techniques are not
covered in this manual. Anyone interested should consult the USAR Best Practice
Guideline: Rope Rescue Tier Model.
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Limited high angle rescue
This refers to rescue techniques that can be used for the high angle environment,
where the section of high angle (over 60 degrees) does not exceed 6 metres. This
can include natural terrain or buildings, provided it does not exceed 6 metres.
10.4 Additional equipment
Some of these techniques will be made easier by the use of additional equipment,
now often carried by General Rescue Team, for example Karabiners, descenders,
and climbing tape. Teams are encouraged to train for all circumstances.
10.5 Low angle rescue techniques
HAZARD ID AND CONTROL
HAZARD
CONTROL MECHANISM
Slipping/unstable rubble
Rescuers to wear all standard PPE
Use scouts to select and mark most stable and safe
route for stretcher
Surface hazards
Use Basket Stretcher in preference due to side
protection offered
Injury to rescuers
Use of ergonomic lifting and handling techniques
Rope breaking
Use standard 11mm static lines
Low angle rescue techniques have two main components: the attachment of a line to
the stretcher, and the creation of friction to allow the stretcher to be “caught” in the
case it is dropped, or builds up too much speed.
10.6 Attachment of the line
A line should be attached to the head of the stretcher, encompassing the aluminium
frame in a basket stretcher, or spreading the weight on a board stretcher.
There are two main options.
Option one: This option is very easy and very strong but does require the use of an
additional line. It is created by tying a figure 8 on the bight in the centre of a 12m
line. It is then ½ hitched around the top handles and then thread down the sides
taking a turn around each handle location. It is finished with a round turn and 2 ½
hitches. A second line is then attached to the figure 8 using a Karabiner or
rethreaded figure 8 knot.
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Option two: This option works well for small distances and when you only have one
rescue line.
Make a large loop by tying a Figure of eight on the
bight.
Divide the loop and place each end through the
stretcher handhold and then bring back together
overlapping.
Bring the Figure Eight on the Bight up through the
cross over.
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10.7 Creation of the friction/“catch”
The type of friction or catch used in the low angle situation will depend on factors
such as the risk, equipment available, personnel available and height of the slope.
Body belay
The body belay is the most simple and involves using a rescuer sitting down on
stable ground and placing the belay line around their lower back.
This method should never be used if there is any risk of a rescuer/rescuers
being required to hold the whole weight of the stretcher.
Simple friction
This method involves wrapping the belay line around a solid object such as a pipe or
“I” beam creating a round turn. The number of round turns can be increased if more
friction is required. This method does not create a “catch” and will only work if the
attendant is able to maintain the friction. Therefore it should only be used where the
friction is used to assist holding the load as rescuers re-position themselves and
would normally not be expected to take the whole stretcher load.
Tandem Prusiks
A tandem Pusik system can be used independently or in combination with simple
friction (although this will require two people looking after the system)
Tandem Prusiks are attached to a solid object using a sling/s and Karabiner. When
applied to the belay line, they are kept loose until such time as there is a “jerk” on the
system and they “catch” the load.
10.8 Limited High angle rescue techniques
Single, two and four point lowers
These lowers are named by the number of points of suspension on the stretcher.
The choice of lowering technique will depend on the structural limitations, casualty’s
injuries and equipment available. In the majority of cases wherever possible, it is
recommended that casualties be recovered in a horizontal position.
HAZARD ID AND CONTROL
HAZARD
CONTROL MECHANISM
Rope failure/not long enough
Only 11mm static Kernmantle lines used
(see Chapter 4)
Line lengths checked before each lower,
after passed around hard belay point
Rescuer falling from height
All rescuers to be tied off if within 2m of
edge, or to be behind fence or solid
barrier no less than 900mm high
Losing rope control
Use hard belays whenever possible
Stretcher breakage
Use only Board Rescue or Basket
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stretcher
Loss of control of lower
Use of series of standard commands for
lower control
Failure of straps on basket stretcher
Additional lashing line or tape used
General scene control/safety
For the Single and Four Point Lower
there should be a rescuer at the bottom
to receive the stretcher
10.9 Guide lines
Guide lines may be attached to stretchers during lowering operations to prevent the
stretcher from spinning and in order to clear obstacles. These guide lines are
attached to the head and/or the foot of the stretcher, normally using a re-threaded
Figure 8. Rescuers controlling guidelines should wear gloves.
10.10 Single point lower
The single point lower can be used to maintain the stretcher in the horizontal position
and works well when you have a high anchor point to run the main lowering line
through. A pulley or karabiner is desirable for this.
A mechanical descender can be used to control the rate of descent. If this is not
available friction needs to be created by the use of round turns or a Friction Hitch.
A safety line should be attached to the head of the stretcher as per 10.6.
A 12m line is used to create the bridle on the stretcher and then the main line is
attached to the lifting point using a Rethreaded Figure 8.
To create the bridle:
Put a figure 8 on the Bight in the center of a 12m line
Place that on approximately the casualty’s chest
Form a hitch around the top handhold on each side of
the stretcher
Pass the line along the side of the stretcher and form
another hitch on each side at one of the bottom
handholds
Bring the running ends up to the centre and connect to
the first figure of 8 on the bight by either:
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Tying a figure 8 on the bight in each of the running
ends and attaching the main lowering lines by means
of a Rethreaded figure of 8, or:
Using a Karabiner - in this case you can attach the
running ends with a round turn and 2 ½ hitches which
is more easily adjusted to balance the stretcher.
10.11 Two point lower
This method is used for raising or lowering a stretcher over relatively short distances
and where the casualty’s injuries allow for transport vertically.
The casualty is blanketed and
lashed to a stretcher in the normal
way, with the possible addition of
a bandage tied across the
forehead to prevent the head
flopping forward should the
casualty become unconscious.
• Two lowering ropes are tied
to the head of the stretcher,
one on each side, by
means of a rethreaded
figure 8, on the one but top
handhold, and a ½ hitch
around the top handhold.
• The same procedure is
used for the foot of the
stretcher and the bottom
lines are passed out to the
two rescuers on the ground.
• The Team Leader (or
leader of the “top team”)
checks if all rescuers are
ready, by calling “top team
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Section 11: Non-stretcher based rescue techniques
•
•
•
•
ready?” and waiting for a reply. This is followed by “bottom team ready?”. If all
rescuers are, the rescuers who are lowering the stretcher are directed to
“tension” their lines.
The leader of the top team, and or any rescuers at the top who are free to
assist, ease the stretcher over the edge of the wall with the tension maintained
on the lowering lines.
The two rescuers on the ground guide the stretcher clear of any obstruction
and walk in, while still pulling on the guide lines, to support the stretcher on
either side as it comes down.
This technique can be used equally well inside a building, using a hole found
or cut in the floor.
The minimum team size for this lower is six, but as the weight is taken by two
points a hard belays should be used rather than a waist belay whenever
possible.
10.12 Four point lower
•
•
•
•
•
•
90
Where it is essential to keep the casualty horizontal, the four-point lower can
be used. With four points of suspension it also is more desirable for very
heavy patients, particularly if hard belays are not available.
The stretcher is rigged and lowering lines are attached in exactly the same
way as for the two-point suspension, except that the guide lines may not be
required if the drop to the ground is clear of obstacles.
The casualty is then, or sometimes may already be, placed in the stretcher,
blanketed and lashed appropriate to their injuries.
Once all rescuers are ready, and lines are tensioned if the hole allows, place
the stretcher diagonally across the hole.
As instructed the stretcher is then “straightened up” and lowered evenly.
If the hole does not allow this the rescuers on the far side pull the stretcher
across until it is located over the centre of the hole.
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Section 11: Non-stretcher based rescue techniques
•
Four rescuers are required to lower and at least one at the bottom to receive.
NOTE: An alternate method of performing the four point off a ledge involves the
addition of two lines on the inside edge of the stretcher which are passed
underneath the stretcher to two rescuers on the ground who pull the
stretcher clear of the wall.
10.13 Ladder Slide
The Ladder Slide is very similar to a 2 Point Lower, with a ladder used to take some
of the weight of the stretcher. The Ladder Slide is the most practical option for raising
a loaded stretcher, e.g. out of a basement. It can also be used for lowering and is an
option if no hard belay points are available.
The process below describes use of the Ladder Slide for raising a stretcher - for
lowering, reverse the process (excluding the first two steps).
• The casualty is blanketed and lashed to a stretcher, and two lines are secured
to the head end using ½ hitch and rethreaded figure 8.
• The ladder is placed in position by three rescuers, and moved until it forms an
angle of approximately 45 degrees.
• One rescuer foots the ladder and/or secures the bottom to pickets, and one or
two rescuers act as human props.
• The lines are passed to rescuers at the top of the ladder and passed around
belay points if available.
• The stretcher is placed on the ladder.
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Section 11: Non-stretcher based rescue techniques
•
•
The stretcher is then pushed up the ladder by a rescuer who climbs up the
ladder, until such time as the head end passes clear of the opening.
Rescuers at the top who are not holding the raising lines can then pull the
stretcher in and move away from the edge/window.
WARNING NOTE:
In the ladder slide technique, the ladder is used in a manner other than that for
which it was designed and manufactured. This is an improvised technique.
As the load on the centre of the span will be close to 150kg, the span must be
propped by one or two rescuers, or shored.
Some specific points to be observed with the Ladder Slide are:
• Communication between the rescuer coming up the ladder and the top
team is very important.
• There should only ever be one person, either casualty or rescuer, on each
section of the ladder at any time.
• Where a timber ladder is used, it must be reinforced with wire or fibreglass
stile supports.
• Where a basket stretcher is used on an alloy ladder, there will be very little
friction.
• Where ladders are extended to provide sufficient reach, the overlap should
be lashed with short rope or cord to avoid stretcher catching on the pulley
and dragging the extension with it.
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10.14 Ladder Hinge
This is a relatively simple method of rescuing a casualty from an upper floor, when it
is desirable to keep the stretcher horizontal, or the upper building is so unstable that
it cannot be used to assist in the operation. It should be noted that the ladder is used
with its reinforced side away from the structure.
•
•
•
The casualty is blanketed and lashed to a stretcher in the normal way.
The ladder is placed vertically against the wall in front of the opening.
A rethreaded figure 8 is tied to one of the
handholds at the foot of the stretcher in the
same manner as for a Two Point Lower.
• The rope is then taken around the stile of the
ladder in a Half Hitch and the stretcher is
raised until it is about 250mm clear of the
window sill.
• Six to eight round turns are taken around the ladder rung, the rope is HalfHitched to the stile on the opposite side of the ladder, and finally secured to
the other side of the stretcher using a Round Turn and two Half-Hitches.
• Alternately, webbing and Karabiners can be used.
• Lowering lines are attached to the head end of the stretcher, and when all
is secure, the word is passed to the leader who gives the orders: Prepare
To Lower and then: Lower.
• The stretcher is passed out of the window by hand until the head end can
be supported by the lowering lines.
• One rescuer remains close to where the ladder has been footed, ensuring
no side-sway develops.
• 1-2 rescuers then walk
backwards, hand-over-hand
with each rung, controlling the
speed of the whole operation.
• The stretcher should finally
come to rest on top of the
ladder flat on the ground, from
where it can be quickly
disconnected
and
the
casualty removed to safety.
• For larger ladders additional
lines can be attached to the head of the ladder and used as guidelines,
controlled by people on the ground.
NOTE: this method can also be readily used to raise a casualty.
WARNING NOTE:
In the ladder hinge technique, the ladder is used in a manner other than that for
which it was designed and manufactured.
The ladder must have a reinforcing wire.
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Section 11: Non-stretcher based rescue techniques
11 Non-stretcher based rescue techniques
11.1 Objectives
On completion of training on the techniques described in this chapter individual
should be able to:
• Tie and fit to another person the Vertical Lift Knot
• With other similarly trained people, use this knot to safely lower someone
from height not exceeding 2 stories
11.2 Introduction
This chapter describes a technique, the Vertical Lift Knot (VLK), that can be used to
rescue casualties without the use of a stretcher. It can also be very useful for rescuer
entry into and/or exit from sites.
The advantages of the VLK is that it requires minimal equipment and is relatively
quick to set up. Often the same anchors can be re-used, meaning a large number of
people can be rescued quickly.
The main disadvantage is that it provides little or no protection for the person being
rescued. It may also worsen injuries, so it’s use is generally limited to the “walking
wounded”.
HAZARD ID AND CONTROL
HAZARD
Rope failure/not long enough
Rescuer falling from height
Losing rope control
Loss of control of lower
General scene control/safety
94
CONTROL MECHANISM
Only 11mm static Kernmantle lines used
(see chapter 4)
Line lengths checked before each lower,
after passed around hard belay point.
A safety line is used- a re-threaded figure
8 around the chest.
All rescuers to be tied off if within 2m of
edge, or to be behind fence or solid barrier
no less than 900mm
Use hard belays whenever possible
Use of series of standard commands for
lower control
Have someone at the bottom to receive.
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11.3 Vertical Lift Knot
The Vertical Lift Knot (VLK) is used to raise or lower casualties/rescuers in a vertical
position, sometimes in a restricted space such as a shaft. Originally used to rescue
workers overcome by gases in sewers, it is sometimes called the Sewer Knot.
The feature of the knot is that it can be tied in the bight of the rope without using the
ends. This in turn means that the two ends of the rope are available to haul on, and
to keep the casualty central in the shaft. The significant safety feature of the knot is
that there is no “knot” to slip undone. Remember at all times the comfort of the
casualty must be taken into account and padding should be used as necessary.
• The bight of the line is taken behind the casualty’s neck, run down their
front, passing between the legs front to rear and back up, their sides
towards the front, and then over the shoulders (with the running ends
closer to the arms).
CAUTION: Make sure that the ropes do not cross over between the legs.
• On each side a loop of the running end is passed under the first rope so
that the arm can be passed through the loop.
• The rope is adjusted to be securely fitted to the casualty. Starting at the
neck, adjust the ropes and padding on both sides of the body.
• A figure 8 on a bight, using both ropes, is tied behind the casualty’s neck to
complete the knot. The lowering line is then attached with a rethreaded
figure 8. The tails of the Vertical lift rescue knot can then be used as guidelines, or secured out of the way.
Note: An alternate method of tying the VLK is commonly taught and used, where
there is only a single twist on each side behind the neck. This method is safe
and acceptable. It is important that both sides are the same, and not a mix of
the two methods.
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Section 12: Improvised casualty movement
12 Improvised casualty movement
12.1 Objectives:
On completion of training on this chapter of the General Rescue Manual, individuals
should be able to:
Given a conscious patient, and acting alone:
• pack strap
Given a conscious patient, and acting in a pairs with other similarly trained
people:
• fore and aft
• two-handed seat
• four-handed seat
12.2 Introduction
Improvised casualty movement covers techniques using no rescue equipment.
It must be clearly understood that the following techniques are for use in an
emergency and that seriously injured casualties should, where possible, be placed
on a stretcher.
Conditions such as fire or imminent danger of building collapse, may however dictate
that removal from the scene is the first priority. In some cases this may even take
precedence over life sustaining first aid.
This subject is covered under two headings:
1. One Rescuer Handling Techniques
2. Two Rescuer Handling Techniques
12.3 One rescuer techniques
One rescuer human crutch
For this method to work, the casualty must be conscious and
capable of giving the rescuer some assistance.
• Note the position of the rescuer’s hands, one holding
the casualty’s wrist and the other taking a firm grip of
the clothes at the waist on the far side of the body.
• The injured side of the casualty should be closest to
the rescuer.
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WARNING NOTE:
All single rescuer techniques involve the risk of injury to the rescuer.
Pack strap carry
This is used on the conscious casualty with no fractures of the extremities.
•
•
•
•
Turn your back to
the
standing
casualty.
Bring their arms
over
your
shoulders
to
cross your chest.
Keep their arms
straight
as
possible,
the
armpits over your shoulders.
Hold casualty’s wrists, bend, and pull the person onto your back.
Firefighter’s crawl
This is an useful method for when a casualty has to be removed from a smoke filled
building in an emergency - noting that rescuers will not enter a smoke filled building.
• Both rescuer and casualty have their heads
low down where the clearest and coolest air
is found if the building is on fire.
• The entire weight of the casualty does not
have to be supported by the rescuer.
•
•
The casualty’s hands should be crossed
over and tied with a bandage or similar.
The Firefighters crawl method can be
varied according to personal preference.
Probably the most effective method is for
the rescuer to place an arm, shoulder and
head through the casualty’s arms.
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Section 12: Improvised casualty movement
Removal down stairs method
This method is used to recover a heavy
casualty down stairs, when the rescuer
cannot use the pack strap or other
methods. However, its use need not be
restricted to staircases.
• With the casualty lying flat, tie the
wrists together using a triangular
bandage or similar.
• Next, the rescuer comes to the head and lifts the casualty into sitting
position.
• The rescuer reaches though under the casualty’s arms and grasps the
wrists.
• The rescuer is then in a position to drag the casualty backwards, and if a
staircase has to be negotiated a large measure of support can be given to
the casualty’s trunk by the rescuer using a knee to ease over each
successive step, remembering that the strongest part of any staircase is
close to the wall.
12.4 Two rescuer techniques
Two rescuer human crutch
This method is similar to the one rescuer human crutch, except that the casualty is
supported on both sides with the arms of the rescuers’
crossed over on the casualty’s back and grasping the
clothing on the opposite sides of the body.
2 and 4 handed seats
These are a series of two rescuer techniques that involve
creating a “seat” from the rescuer’s hands. A number of
variations of the 2- handed seat are possible that give
you “free” hands to support the casualty from behind
and/or in front or leave hands free to open doors, or move
things out of the way. The method chosen will depend on
the terrain, weight and injuries to the casualty, and
possible obstacles.
Two-handed seat
• Rescuers kneel on either side of the casualty, get them into a sitting
position, lace one arm under the knees and link up with the hand to wrist
grip.
• Their forearms are then crossed over the casualty’s back, where they get a
firm grip of the clothing or link arms across casualty’s back.
• The leader should give the normal orders for lifting and lowering.
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Four-handed seat
• This is a method where each rescuer
grasps their left wrist and the hands are
joined up.
• This provides a comfortable seat for the
casualty and places a minimum strain on
the rescuers. However, the casualty must
be sufficiently conscious to hold on.
The ‘Fore and Aft’ method
This is perhaps the most suitable way in which two rescuers can handle an
unconscious casualty.
• The casualty is put into a sitting position.
• The first rescuer stoops at the rear of the
casualty. Reaching under the casualty’s
arms, the first rescuer grips the casualty’s
wrists.
• The second rescuer stoops between the
casualty’s legs grasping them underneath
the knees.
• The standard lift orders are given and the
casualty is lifted into the carrying position.
• Should the casualty have a leg injury, the
effects of this can be minimised by the
front rescuer crossing the casualty’s legs
over, then carrying them to one side. The
advantage of this method is that the
rescuer supporting the casualty’s feet has
a free hand with which to open doors,
clear debris, etc
It is again stressed that the one and two rescuer techniques are generally confined
to emergencies where removal from the scene is the first priority.
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