Litter Evacuation

TERMINAL LEARNING OBJECTIVE

Given a CMVS, immobilization splints and equipment and documentation forms. You encounter a casualty who requires medical treatment. Casualty must be extricated and removed from the immediate area. Initial assessment of casualty is not completed.

INTRODUCTION

A litter may be prefabricated or may be improvised from available materials. The Armed Forces use several types of standard litters. This standardization allows a patient to travel in various vehicles on the same litter; thereby, minimizing the possibility of further injury and saving valuable time.

Standard litters

(1) Standard collapsible litter is most widely used. It folds along the long axis only.

(a) Basic components of the litter

(i) Two straight, rigid, lightweight aluminum poles

(ii) A cover (bed) of cotton duck

(iii) Four wooden handles attached to the poles

(iv) Four stirrups (one bolted near the end of each pole) The stirrups support the litter when it is placed on the ground

(v) Two spreader bars (one near each end of the litter) These bars are extended crosswise at the stirrups to hold the cover taut when the litter is open

(vi) Two litter securing straps (one attached to each pole at the stirrup bolts) These straps are used to secure the litter when it is closed

(vii) Accessories such as patient securing straps

(b) Dimensions of the standard collapsible litters are as follows:

(i) Overall length is 90 inches

(ii) Overall width is 22 7/8 inches

(iii) Bed length is 72 inches

(iv) Bed width is 22 7/8 inches

(v) Weight is 15 pounds

(2) The patient securing strap is used to hold the patient in position on the litter

(a) Designed to fit the straight and folding aluminum litters as well as other standard litters

(b) Available in quantities of four per litter

(d) Made from 6-foot length of 2-inch webbing and a buckle with a locking device and spring

(3) Folding aluminum litter

(a) Folding lightweight aluminum poles

(b) Poles can be folded to one-half their length when litter is not in use

(4) Poleless semirigid litter

(a) Useful in evacuating patients from ships and in mountainous areas

(b) Holds the patient securely in position and facilitates the movement of patient in vertical position

(c) Dimensions of litter are overall length, 83 3/4 inches; overall width, 22 3/4 inches; and it weighs 18 3/4 pounds. Basic components are:

(i) Semirigid cotton duck with wooden supports

(ii) Four webbing handles (two at each end). These straps can be used when the litter is carried by four bearers.

(iii) Four loops - used to insert the poles for carrying

(iv) Headpiece - used to support casualty's head

(v) Seven patient securing straps - used to secure patient to litter

(5) Poleless nonrigid litter

(a) Folded and carried by combat medic

(b) Has folds into which improvised poles can be inserted for evacuation over long distances

(6) Stokes litter

(a) Affords maximum security for the patient when litter is tilted

(b) Dimensions and basic components and their functions:

(i) Composed of steel or aluminum tubular frame supporting a bed of wire mesh netting. Also has wooden slats to support patient's back.

(ii) Lower half is divided into two compartments to accommodate patient's legs

(iii) Four webbed patient securing straps for use in securing patient

(iv) Ropes, cables, or steel rings that can be attached to litter as required for vertical recoveries

(v) Dimensions are length, 84 inches; width, 23 inches; and weight, 31 1/2 pounds

(7) SKED litter

(a) Compact and lightweight transport system used to evacuate a patient over land

(b) May also be used to rescue a patient in water

Improvised litters

NOTE: There are times when a patient may have to be moved and a standard litter is not available. The distance may be too great for manual carries or the patient may have an injury that would be aggravated by manual transportation. In these situations, litters can be improvised from materials at hand. Improvised litters must be as well constructed as possible to avoid the risk of dropping or further injuring the patient. Improvised litters are emergency measures and must be replaced by standard litters at the first opportunity.

(1) Many different types of litters can be improvised, depending upon materials available

(a) Satisfactory litter can be made by securing poles inside such items as:

(i) Blanket

(ii) Poncho

(iii) Shelter half

(iv) Tarpaulin-Material such as waterproof canvas

(v) Mattress cover

(vi) Jackets

(vii) Shirts

(viii) Bedticks, bags, and sacks

(b) Poles can be improvised from:

(i) Strong branches

(ii) Tent poles

(iii) Skis

(iv) Lengths of pipe

(i) Doors

(ii) Boards

(iii) Window shutters

(iv) Benches

(v) Ladders

(vi) Cots

Chemical litters

(1) Cover fabric is honeycomb weave of monofilament polypropylene

(2) Will not absorb agent and is not degraded by decontamination fluids

(3) Flame retardant and rip resistant

(4) Treated to withstand weather and sunlight

(5) Aluminum poles, painted with chemical agent resistant coating

(6) Conforms to all NATO standards and weights about 15 pounds

Dress a litter

NOTE: A litter is dressed with one, two, or three blankets to reduce danger of shock and to afford warmth and comfort during transport.

Dress with one blanket

(1) Place blanket diagonally over litter

(d) After casualty is placed on litter, bring sides of blanket over casualty and tuck edges at head and feet

Dress with two blankets

(1) Place first blanket lengthwise across litter with blanket edge just beyond head end of litter

(2) Second blanket is folded in third, lengthwise, and placed over the first blanket - open folds about 2 feet from foot end

(3) After casualty is placed on litter, bring bottom of blanket up over casualty's feet. Leave a small fold between feet.

(4) Tuck two folds closely over and around feet and ankles

(5) Open folds on second blanket about 2 feet from foot end

(6) After casualty is placed on litter, bring bottom of blanket up and over patient's feet

(7) Leave small fold between feet

(8) Tuck two folds closely over and around feet and ankles

(9) Wrap casualty with one side and then opposite side of first blanket

Dress with three blankets

(1) Place first blanket on litter lengthwise so that one edge is even with litter pole farthest from you

(2) The upper end of blanket is even with head of canvas

(3) Fold blanket back upon itself once, so that the folded edge is along litter pole near you and outer edge of blanket overhangs the other pole

(4) Place second blanket lengthwise over first one as described above, except start with opposite litter pole so that the blanket overhang is on opposite side of first blanket

(5) After casualty is placed on litter, fold third blanket once lengthwise and place it over casualty with one end under chin

(6) Fold overhanging edges of first two blankets over third blanket and secure them in place with safety pins, if available, or securing straps

Use of patient securing straps

Used after casualty is placed on dressed litter and covered

Used to hold casualty is position

Number of straps and body parts over which they should be placed depend upon type of terrain over which casualty is carried

(1) If two straps are necessary

(a) Put one strap across chest and one across legs just below the knees

(b) Extend straps under litter and buckle against litter pole

(2) If terrain is rough

(a) Apply two additional straps

(b) One placed across waist and other across thighs

(3) If casualty is carried either up or down steep slopes

(a) Use two additional straps

(b) Secure each thigh to litter separately

(d) Take remaining strap and secure opposite thigh in same manner

Identify the general rules for litter bearers

General rules for litter bearers

(1) In moving a casualty, the litter bearers must make every movement deliberately and as gently as possible. The command STEADY should be used to prevent undue haste.

(2) The rear bearers should watch the movements of the front bearers and time their movements accordingly to ensure a smooth and steady action

(3) The litter must be kept as level as possible at all times, particulary when crossing obstacles, such as ditches

(4) Normally, the casualty should be carried on the litter feet first, expect when going uphill or upstairs; his head should then be forward. If casualty has a fracture of a lower extremity, he should be carried uphill or upstairs feet first and downhill or downstairs head first to prevent the weight of body from pressing upon injured part.

(e) When casualty is loaded on litter, his individual equipment is carried by two of the bearers or placed on litter

NOTE: For balance and support when lowering a litter, each bearer places free hand

on other knee which remains in an upright position.

Use Spine Boards and the Kendricks Extrication Device (KED)

NOTE: Spine boards and the KED aid in rescuing and immobilizing casualties with known or suspected spinal fractures. Spine boards can be prefabricated from plywood or any suitable material.