LESSON 16
TRANSPORT A CASUALTY
(TASK 081-831-1046)
TASK:
Identify the appropriate one-man carry and/or how to perform the carry.
CONDITIONS:
Given multiple-choice examination items pertaining to evacuation.
STANDARD:
Score 70 or more points on a 100-point comprehensive examination.
REFERENCES:
STP
21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM
21-11, First Aid for Soldiers.
NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.
After evaluating the casualty's illness or injury and administering first aid, you may need to decide the most effective means of transporting a casualty. Casualties moved by manual carries must be carefully and correctly handled; otherwise, moving the casualty could result in additional injury. Manual carries are often used to transport casualties in tactical situations. Your choice of which type of carry to use depends upon the seriousness of the illness or injury, the weight of the casualty, the strength of the carrier (s)), and the distance to be traveled. Using a two-man carry benefits the casualty and the bearers by spreading the load. Improvised litters are the preferred method when the distance may be too far for manual carries or the casualty has an injury that may be aggravated by manual transportation. These litters are for emergency measures and must be replaced by a standard litter at the first opportunity.
16-2. CHOOSE THE APPROPRIATE METHOD TO MOVE A CASUALTY ON THE BATTLEFIELD
If you need to move (evacuate) a casualty to an aid station or collection point, you must decide which evacuation method is appropriate. The following are general rules. (The rules are listed in order of most likely to be used to less likely to be used in a frontline combat situation.)
| CAUTION: Do not transport a casualty with a suspected fracture of the neck or back unless a life-threatening hazard is in the immediate area. Wait until medical personnel arrive. |
If no other help is available, use an appropriate one-man carry to move the casualty.
If a litter cannot be used (no time, no materials) and another person is available to help carry the casualty, use an appropriate two-man manual carry to move the casualty.
If a standard litter is not available and if the time, materials, and litter bearers are available, construct and use an improvised litter. A door, ladder, cot, bench, chair, or similar objects can be used as an improvised litter.
If the casualty is to be moved, use a standard litter if one can be obtained and two or more litter bearers (including yourself, if applicable) are available. A litter allows a casualty to be moved a greater distance than do manual carries. Also, a casualty is less likely to aggravate existing injuries or to suffer additional injuries if a litter is used.
If possible, use a vehicle to transport the casualty.
16-3. CHOOSE AN APPROPRIATE ONE-MAN CARRY
Manual carries are tiring to the bearer. Choose an appropriate carry based upon the casualty's condition, the nature of the casualty's injury, the military situation, the distance to be covered, the weight of the casualty, your strength and endurance, and obstacles that will be encountered.
The fireman's carry is usually used to quickly move an unconscious or disabled casualty for a moderate or long distance. This carry leaves one of the bearer's arms free to carry a rifle, move around obstacles, and so forth.
The support carry is used only with a conscious casualty who can walk or at least hop on one leg. The carry can be used for a long distance until the casualty tires.
The arms carry is generally used to move a conscious or unconscious casualty for a short distance.
The saddleback carry is only used for a conscious casualty who can put his arm (s)) around your neck. It is generally used to carry a casualty for a moderate or long distance.
The pack-strap carry is generally used to carry a conscious or unconscious casualty for a moderate distance. This carry is not used if the casualty has a broken arm.
The pistol-belt carry is generally used to carry a conscious or unconscious casualty for a long distance. It is the preferred carry if you must use your rifle, climb banks, or move over obstacles since the carry leaves both of your hands free.
The pistol-belt drag is generally used to move a conscious or unconscious casualty for a short distance. This carry is primarily used when the rescuer must keep very close to the ground, such as during combat.
The neck drag is generally used to move a conscious or unconscious casualty for a short distance. This carry allows the rescuer to stay close to the ground, but not as close as the pistol-belt drag. The carry can be used when moving behind a low wall, under a vehicle, or through a culvert. The neck drag is not used if the casualty has a broken arm.
The cradle drop drag is generally used to move a conscious or unconscious casualty up or down steps or to quickly move a casualty from a life-threatening situation (fire, etc.).
Some one-man carries require the casualty to be lying on his abdomen (prone position); other carries/drags require him to be lying on his back (supine position). To turn the casualty either to the prone or supine position, follow these steps.
Kneel at the casualty's uninjured side.
FIGURE 16-1. TURNING A CASUALTY ONTO HIS ABDOMEN
| WARNING | |
| If you are in a chemical environment, squat--do not kneel on the ground. | |
Place the casualty's arms above his head.
Cross his far ankle over the near one.
Grasp the casualty's clothing at his far shoulder and hip.
Gently pull so that the casualty rolls toward you. Continue until the casualty is on his abdomen or back.
Place the casualty's arms at his sides and straighten his legs.
16-5. RAISE A CASUALTY TO A STANDING POSITION
Regular method.
Position the casualty in a prone position.
Straddle the casualty, slip your hands under his chest, and lock your hands together.
Lift the casualty and begin walking backwards until he is on his knees.
Continue walking backwards until his legs are straight and his knees are locked.
Walk forward and bring the casualty to a standing position. Keep the casualty tilted slightly backwards so his knees will remain locked. If his knees do not remain locked, walk backward until they lock and then move forward until the casualty is in the standing position.
Grasp one of the casualty's wrists and raise his arm. Use your other arm to hold the casualty erect.
FIGURE 16-2. RAISING A CASUALTY TO HIS FEET (REGULAR METHOD)
Move under the casualty's arm to his front, replace his arm, and hold the casualty around his waist.
Place your foot between the casualty's feet and spread them so that his feet are about six to eight inches apart.
Alternate method
Position the casualty in a prone position.
Kneel on one knee at the casualty's head.
Put your hands under his armpits, down his sides, and across his back.
Rise, lifting the casualty to his knees.
| CAUTION: Keep the casualty's head from snapping back and injuring his neck. |
Lower your arms, secure a hold on the casualty, and raise him to a standing position with his knees locked.
Put your arms around the casualty's waist and tilt his body slightly backward to keep his knees from buckling.
Place your foot between his feet and spread them so that they are about six to eight inches apart.
FIGURE 16-3. RAISING A CASUALTY TO HIS FEET (ALTERNATE METHOD)
16-6. PERFORM THE FIREMAN'S CARRY
Raise the casualty to a standing position.
Grasp the casualty's wrist and lift his arm over his head while continuing to support the casualty with your other arm.
| CAUTION: If the casualty has an injured arm, grasp the wrist of the uninjured arm. |
Bend at the waist and kneel, pulling the casualty over your shoulder. At the same time, slip your arm from his waist, pass the arm between the casualty's legs, and grasp behind the casualty's knee.
FIGURE 16-4. PERFORMING THE FIREMAN'S CARRY
Move the hand grasping the casualty's wrist to the hand at the casualty's knee.
Grasp the casualty's wrist with the hand at the casualty's knee, freeing your other hand.
Place your free hand on your knee and slowly rise to a standing position. Use the hand on your knee to help you rise without straining your back.
Adjust the casualty's body so his weight is distributed comfortably.
Move forward, carrying the casualty.
16-7. PERFORM THE SUPPORT CARRY
FIGURE 16-5. SUPPORT CARRY
Position the casualty in a sitting position.
Bend down at the casualty's side so that you are facing in the same direction as the casualty.
| CAUTION: If the casualty has an injured leg, position yourself so that the injured leg is next to you. |
Bring the casualty's near arm over your shoulder and grasp his wrist with your hand that is away from the casualty.
Put your near arm around the casualty's waist.
Stand up, helping the casualty to rise to a standing position also.
Assist the casualty to walk or hop on one leg. Adjust your walking motion as needed to help the casualty maintain his balance.
Raise the casualty to a standing position.
Slide one of your arms under the casualty's arm, behind his back, and under his other arm.
Move to the casualty's side, bend down, and place your other arm behind the casualty's knees.
Lift the casualty from the ground and stand erect.
Carry the casualty high on your chest to lessen fatigue.
FIGURE 16-6. ARMS CARRY
16-9. PERFORM THE SADDLEBACK CARRY
FIGURE 16-7. SADDLEBACK CARRY
Raise the casualty to a standing position. (Since the casualty is conscious, he may be able to rise with assistance.)
Grasp the casualty's wrist and lift his arm over his head while continuing to support the casualty with your other arm.
Turn so that your back is to his front and bring his arm over your shoulder. Support the casualty's waist with your other arm, if needed.
Have the casualty put his other arm around your neck. If possible, he should grasp one of his wrists with his other hand.
Stoop and move your arms back and around the outside of the casualty's thighs.
Bring your hands inside of his thighs to your sides, lifting the casualty's thighs.
Stand up and clasp your hands together in front of you.
Adjust the casualty's weight to make the weight distribution more comfortable and walk forward.
16-10. PERFORM THE PACK-STRAP CARRY
FIGURE 16-8. PERFORMING THE PACK-STRAP CARRY
Raise the casualty to a standing position.
Grasp one of the casualty's wrists and lift his arm above his head while continuing to support the casualty's waist with your other arm.
Turn and bring the casualty's raised arm over your shoulder as you turn so that your back is to the casualty's front. Bend your knees somewhat so that your shoulder fits under his arm.
Release his waist, grasp his other wrist, and bring that arm over your other shoulder.
Bend forward and hoist the casualty as high on your back as possible so that his weight is resting on your back.
Walk forward, keeping bent so that the casualty's weight is balanced on your back and his feet are not dragging.
16-11. PERFORM THE PISTOL-BELT CARRY
Form the sling by joining two fully-extended pistol belts together to form one large loop. If pistol belts are not available, use any material which will not break and which will not cut or bind the casualty (one rifle strap, two cravat bandages, etc.) to make the sling.
Position the casualty on his back.
Slip the sling under the casualty so that top part of the loop is under his lower back, the bottom part of the loop is under his thighs, the belt buckles are centered behind the casualty, and a loop end extends from each side.
Move the casualty's legs apart and lie between them on your back.
Thrust your arms through the loop ends. Adjust the sling so that the loop ends fit over your shoulders.
Grasp the casualty's wrist and his trouser leg on his injured side.
Roll toward the casualty's uninjured side and onto your abdomen. (Both you and the casualty are now in a prone position.)
Release the casualty's wrist and leg and push yourself up until you are on your knees.
Rise to a kneeling position and place your hands on your knees for support.
Rise to your feet. Lean forward to balance the casualty's weight.
FIGURE 16-9. PERFORMING THE PISTOL-BELT CARRY
Adjust the casualty's weight to a more comfortable position, if needed, and walk forward. Your hands are free to carry a rifle or other objects, climb obstacles, etc.
16-12. PERFORM THE PISTOL-BELT DRAG
Extend two pistol belts to their full length and join them together to make one large loop. Other materials, such as a rifle sling or two cravats, can be used if pistol belts are not available. In some cases, three pistol belts may be needed.
Position the casualty on his back.
Slip one end of the loop across the casualty's chest, under his armpits, and under his shoulders.
Twist the remainder of the loop to form a figure 8. Adjust the loops so that the buckles cross in the center of the figure 8.
Lie on your side facing the casualty. You should be lying in the same direction as the casualty. Support yourself on your elbow.
Slip the arm on which you are resting through the top loop of the figure 8 and bring the loop over your shoulder.
Turn onto your abdomen. The sling is now across your chest and the loop is on the shoulder away from the casualty. This far shoulder will support his weight. Having the sling under your chest will help to keep the casualty from slipping out of the loop.
Crawl, dragging the casualty with you.
FIGURE 16-10. PERFORMING THE PISTOL-BELT DRAG
Tie the casualty's hands together with material that will not cut his wrists, such as the casualty's field dressing or a cravat. Do not tie the materials tight enough to interfere with blood circulation. If the casualty is conscious, have him interlock his fingers.
Face the casualty's head and straddle his hips on your knees.
Loop the casualty's arms around your neck.
FIGURE 16-11. NECK DRAG
Crawl forward on your hands and knees, dragging the casualty beneath you.
| CAUTION: If the casualty is unconscious, keep his head from dragging on the ground. |
16-14. PERFORM THE CRADLE DROP DRAG
Position the casualty on his back.
Kneel at the casualty's head.
Slide your hands (palms up) under his shoulders and grasp the clothing under his armpits.
Partially rise so that the casualty is pulled to a semi sitting position. Support his head on one of your arms. If possible, bring your elbows together and use both forearms to support the head.
Rise to a stooped position and drag the soldier backward.
| CAUTION: If you are going down steps, walk down them carefully going backward. Support the soldier's head and shoulders, letting his hips and legs drop from step to step. |
FIGURE 16-12. PERFORMING THE CRADLE DROP DRAG
16-15. MOVE A CASUALTY USING THE TWO-MAN FORE-AND-AFT CARRY
Sometimes, a litter is not available and cannot be improvised. In such cases, manual carries may be used to evacuate the injured soldier. A two-man manual carry is usually preferred over a one-man manual carry. The two-man fore-and-aft carry can be used to move a conscious or unconscious casualty. It is not as tiring as other carries; therefore, it is usually the preferred two-man carry for moving a casualty for a long distance.
FIGURE 16-13. TWO-MAN FORE-AND-AFT CARRY
Position the casualty on his back with his arms by his sides.
The taller of the two bearers kneels at the casualty's head and faces toward the casualty's feet. He then slides his hands under the casualty's arms and across the casualty's chest. Then he locks his hands together over the casualty's chest.
The second bearer spreads the casualty's legs and kneels between the casualty's legs with his back to the casualty's head. He then reaches down and places his hands under the casualty's knees.
Both bearers rise together and lift the casualty.
Bearers walk forward with the casualty.
Modified Two-Man Fore-and-Aft Carry (for placing casualty on litter).
Bearer #1 kneels behind the casualty's head and slips his arms under the casualty's arms.
Bearer #2 spreads the casualty's legs apart and squats or kneels between the casualty's legs while facing Bearer #1.
Both bearers rise in unison upon the leader's command.
Bearers move the casualty over the litter.
Bearers lower the casualty onto the litter in unison upon the leader's command.
FIGURE 16-14. LIFTING A CASUALTY USING THE MODIFIED
TWO-MAN FORE-AND-AFT CARRY
16-16. MOVE A CASUALTY USING THE TWO-MAN SUPPORT CARRY
The two-man support carry can be used to transport either a conscious or an unconscious casualty. It is especially useful if the casualty is conscious and needs assistance walking.
FIGURE 16-15. TWO-MAN SUPPORT CARRY
Bearers kneel on each side of the casualty and face so that the casualty will also be facing the same direction.
Each bearer takes the casualty's nearest arm, brings it around his neck, and grasps the casualty's wrist in his outside hand.
Each bearer puts his other arm (the arm that is nearest the casualty) around the casualty's waist.
Both bearers rise in unison, lifting the casualty. If the casualty is conscious, he can help the bearers lift his weight and may be able to walk with assistance. The arms around the casualty's waist should support most of the weight.
| CAUTION: If the casualty is unconscious, the bearers should not release the casualty's wrists. |
Bearers walk forward with the casualty.
If the casualty is taller than the bearers, the bearers can remove their arms from around the casualty's waist and use them to lift and support the casualty's thighs. This will keep to the casualty's feet from dragging.
16-17. MOVE A CASUALTY USING THE TWO-MAN ARMS CARRY
The two-man arms carry can be used to move a conscious or unconscious casualty for a moderate distance.
FIGURE 16-16. LIFTING A CASUALTY USING THE TWO-MAN ARMS CARRY
Position the casualty on his back and place his arms above his head.
Both bearers position themselves on the same side of the casualty--one at the casualty's chest and one at his thighs.
Both bearers kneel on one knee.
The bearer at the casualty's chest slips one arm beneath the shoulders and the other arm beneath his waist.
The bearer at the casualty's thighs slips one arm beneath the casualty's hips and the other arm beneath his knees.
Both bearers shift their weight backward in unison and lift the casualty to knee level, keeping the casualty as level as possible.
Both bearers bring the casualty's front close to their chests.
Both bearers rise to their feet in unison.
Bearers move forward carrying the casualty high on their chest. (This lessens fatigue while transporting the casualty.)
| CAUTION: More than two bearers may be required if the casualty is heavy or if the casualty's head or legs need additional support. If a casualty with a back or neck injury has to be moved by manual carry, a four-man arms carry is used. A third bearer supports the casualty's head and a fourth supports his legs. The casualty's body is kept as level as possible and all movements are done in unison to keep the casualty's body in alignment. |
Modified Two-Man Arms Carry (for placing casualty on litter).
Two litter bearers position themselves on the same side of the casualty (opposite side from litter) and kneel on one knee.
Bearer #1 slips his arms under the casualty's back and waist.
Bearer #2 slips his hands under the casualty's hips and knees.
Both bearers lift in unison upon command from the leader.
Bearers move the casualty over the litter or have another bearer push the litter under the casualty.
Bearers lower the casualty onto the litter in unison upon the leader's command.
FIGURE 16-17. LIFTING A CASUALTY USING THE MODIFIED
TWO-MAN ARMS CARRY
16-18. MOVE A CASUALTY USING THE TWO-HAND SEAT CARRY
The two-hand seat carry can be used to move a conscious or unconscious casualty for a short distance.
FIGURE 16-18. TWO-HAND SEAT CARRY
Position the casualty on his back.
Bearers position themselves on opposite sides of the casualty's hips and kneel.
Each bearer passes one arm under the casualty's back and the other arm under the casualty's thigh.
Bearers grasp each other's wrists securely.
Both bearers rise in unison, lifting the casualty.
Bearers move forward, carrying the casualty.
16-19. MOVE A CASUALTY USING THE FOUR-HAND SEAT CARRY
FIGURE 16-19. FOUR-HAND SEAT CARRY
Both bearers position themselves behind the casualty.
Bearers face each other. Each bearer grasps his own left wrist with his right hand, and grasps the other bearer's right wrist with his left hand. This forms the seat for the casualty.
Casualty stands on his own or another soldier helps the casualty to a standing position.
Both bearers lower their bodies so that the seat is about even with the casualty's knees.
Casualty sits on the bearers' forearms and places his arms around the bearers' shoulders for balance and support.
Bearers stand erect in unison, lifting the casualty.
Bearers move forward.
16-20. MAKE AN IMPROVISED POLE AND PONCHO LITTER
An improvised litter can be made using two tent poles and a poncho. Variations of this litter include using straight tree limbs or other rigid objects for the poles. When the casualty is placed on the litter, his weight will hold the litter together.
FIGURE 16-20. CONSTRUCTING AN IMPROVISED POLE AND PONCHO LITTER
Open the poncho and lay it flat on the ground.
Lay two poles lengthwise across the poncho so that the poncho is divided into thirds.
Reach in and pull the hood toward you and lay it flat on the poncho. Make sure that the draw strings are not hanging out of the hole.
Fold one outer third of the poncho over the pole.
Fold the other outer third of the poncho over its pole.
16-21. MAKE AN IMPROVISED POLE AND JACKET LITTER
An improvised litter can be made using two tent poles and two or three field jackets. Tree limbs or other straight, rigid objects can be used instead of the poles. Heavy shirts or other jackets can be used instead of field jackets.
FIGURE 16-21. POLE AND JACKET IMPROVISED LITTER
Close (zip or button) the jackets (or other garments).
Pass the poles through the sleeves.
16-22. MAKE AN IMPROVISED POLE AND SACK LITTER
An improvised litter can be made using two tent poles or similar rigid objects and two empty heavy-fabric sacks such as potato sacks.
FIGURE 16-22. POLE AND SACK IMPROVISED LITTER
Cut holes in the two corners of the closed end of each sack.
Place the sacks lengthwise so that the open ends of the sacks are facing each other.
Slide the poles or limbs through the holes.
Overlap the open ends of the sacks about three inches to provide extra strength in the middle of the litter.
16-23. MAKE AN IMPROVISED BLANKET LITTER
FIGURE 16-23. BLANKET LITTER
16-24. EVACUATE A CASUALTY BY LITTER
Care must be used when placing the casualty on the litter in order to avoid causing additional injury to the casualty. A modified two-man arms carry or modified two-man fore-and-aft carry is usually used to place the casualty onto the litter. Normally, four soldiers are used to transport the litter. The litter team, however, can be composed of more or fewer members based upon the military situation and the distance and terrain to be covered.
General Rules
Explain the Procedure to the Casualty. If the casualty is conscious, tell him what you are going to do. The explanation will help to calm his fears and will help you to get his cooperation.
Walk Around the Casualty. Walk around the casualty rather than stepping over him. If you step over the casualty, he may flinch or tighten his muscles and aggravate his injuries. In addition, mud or other debris may fall from your boots into his eyes or wounds.
Perform Necessary Measures Before Transporting. Make sure the casualty is breathing properly, open wounds have been dressed and bandaged, and fractures have been splinted before transporting the casualty.
Have One Person in Charge. One person must give the instructions to the remainder of the team so actions will be performed in unison.
Position Litter
Position the casualty on his back with his arms at his sides. Place the litter (standard or improvised) near and parallel to the casualty.
FIGURE 16-24. LITTER PLACED PARALLEL TO CASUALTY
Place Casualty On the Litter
Modified Two-Man Fore-and-Aft Carry (see paragraph 16-15).
Modified Two-Man Arms Carry (see paragraph 16-17).
Lift Litter
If there are four litter bearers, each bearer positions himself at one of the handles, faces so that the casualty will be carried feet first, and kneels on one knee (the knee nearest the litter). The leader of the litter team should position himself at the handle nearest the casualty's right shoulder and direct the other bearers. This position allows the leader to monitor the casualty during the evacuation.
Upon command of the leader, the four litter bearers lift the litter in unison and move the casualty to the aid station or collection point.
(NOTE: Additional information concerning evacuation by litter can be found in Field Manual 8-10-6, Medical Evacuation In A Theater Of Operations Tactics, Techniques, And Procedures.)
FIGURE 16-25. LIFTING A LITTER