Transport of the injured victim

The decision to transport (i.e., evacuate) a victim is critical. Moving a patient can be incredibly complicated, arduous, and can increase the risks for a bad outcome for both the victim and rescuers. First and foremost is to consider the ability and rescue experience of the group. This is not medicine—it is logistics, including having the right people and equipment, knowing the terrain and how to navigate, and adhering to the following general advice about which persons require evacuation:

• Persons who are at risk of serious complications or death, and who do not improve or who deteriorate despite treatment.

• Persons for whom severe pain cannot be controlled.

• Persons with persistent severe abdominal pain.

• Persons with severe high-altitude illness.

• Persons with severe infections.

• Persons with severe chest pain.

• Persons with injury or illness beyond the comfort or skill of the group to manage.

Never move a victim unless you know where you are going. If you’re lost and caring for an injured victim (or yourself), prepare a shelter. Try to position yourself so that visual distress signals can be fashioned in an open field, in the snow, or near a visible riverbank. Keep the victim covered and warm. Assume that the victim is frightened and needs frequent reassurance. If they cannot walk, you must attend to their bodily functions. A urinal can be constructed from a wide-mouthed water bottle. Defecation is more complicated but can be assisted by cutting a hole in a blanket or sleeping pad placed over a small pit dug in the ground.

• Unless you are in danger, never leave a victim who is unconscious or confused.

• If possible, send someone for help and wait with the victim, rather than perform an exhausting and time-consuming solo extrication. If someone is to be sent for help, choose a strong traveler and provide them with a written request that details your situation (exact location, number of victims, injuries, need for supplies, specific evacuation method required). While you certainly don’t want to underestimate the seriousness of the situation, don’t request a helicopter evacuation for someone with a broken ankle who can easily be carried out in a litter. Anyone sent to obtain assistance should contact the closest law enforcement agency, which will seek the appropriate rescue agency.

• Conserve your strength. Don’t create additional victims with heroic attempts at communication or feats of strength and exertion.

• If a victim can walk on their own, or with some support, then this might be the best option.

Attempt to transport a victim only if waiting for a rescue party will be of greater risk than immediate movement, if there are sufficient helpers to carry the victim (as a general rule, it takes six to eight adults to carry one injured victim), and if the distance is reasonable (under 5 miles [8 km]). A victim who is carried on an improvised stretcher over difficult terrain usually gets a rough ride. Always test your carrying system on a noninjured person before you use it on the victim.

Lifting and moving techniques

Straight lift

If a person is seriously injured, profoundly weak, or unconscious, and there is concern for possible spinal injury, they should be lifted so that they remain motionless and with their spine in as straight an alignment as possible. This can be accomplished by five rescuers. The first kneels at the head, controls the victim’s head and neck, and calls out commands. The other four rescuers kneel at the victim’s sides, one at chest level and one at hip level on one side, and the others at lower back level and leg level on the opposite side ( Fig. 270 ). In this way, they can slide their hands under the victim in a staggered fashion to provide a continuous chain of support. If necessary, the rescuer closest to the legs can free a hand to position a pad, backboard, or litter underneath the victim. The rescuers should lift the victim straight up into the air, taking care not to injure their backs. Always lift with your legs, not your back.

The best way to carry and immobilize a person who might have an injured spine is to use a scoop stretcher, a vacuum mattress, or a backboard. A vacuum mattress is wrapped around the victim, and a pump is used to remove air inside the mattress making it stiffly take the shape of the victim. See vacuum mattress Fig. 271 . If there are enough rescuers, a straight lift can be used to move a victim onto a litter (see above).

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