91PATIENT PACKAGING SAFETY Objectives: To identify, describe and define the advantages and disadvantages of each type of litter.To demonstrate securing patient to a littler properly.Equipment needed:Litter basketTarpPatient harnessPatient PPELitter shieldHead protectionEye protectionPadding/padsBlanket for warmthMedical supplies as needed;BackboardCervical collar, etc.2- yellow webbing (internal lashing)1- black webbing (external lashing, if needed)Medical and environmental considerations and the type of litters available dictate patient packaging. Careful packaging protects the patient while allowing access to monitor vitals. The patient should not move or shift in the litter during transport.SAFETYPatient(s) must be internally lashed to protect them from ejection out of the ends of the litter. They must also be externally lashed to prevent them from movement within the litter.All carabiners should have gates opening down and toward the “inside” of the litter basket. Ensure carabiners are properly loaded and will not torque or side load.Never tie patient lashing around top rail of the litter: Always weave webbing between uprights of the stokes or to internal areas of plastic stretchers.STEPS TO PATIENT PACKAGING:Stabilize the patient before loading;--Head/eye/face protection--Sit harness (for steep& high angle, maybe considered during medium)--C-collar, backboard, bandaging, splintingPrepare the litter to receive the patientLoad the patientLash the patient into the litter securely--Internal lashing (utilize only the amount needed for the type of rescue)--External lashing
92INTERNAL LASHINGNOTE: webbing is tied off to an upright stay, not the railing.2. Secure torso webbing with round turn and 2 half-hitches on either side.1. Connect yellow webbing to harness with an interlocked girth hitch.3. Secure legs in same manner as torso. Ensure leg webbing is pulled taut against torso webbing. This may or may not be needed in low load angle environment.
93EXTERNAL LASHINGNOTE: External lashing is required when performing high angle rescue.3. Finish with a round turn and 2 half-hitches on one end, then pull slack back through entire black webbing. Finish other end in same manner.2. Weave webbing around upright stays, not over the railing.1. Start with middle of black webbing here.
95LOW ANGLE RESCUEDuring this session we’ll discuss the various degrees or classifications of Low Angle Rescue, and Patient extrication.OBJECTIVESIdentify, describe & define when and how to perform a Low Angle vs. a Steep Angle rescue.The goal of the low angle evacuation is to keep the patient moving and get them out as safely and comfortably as possible. In order to achieve this goal follow these steps:Locate and stabilize the patient-- The first responder may have to rappel down to the patient to recon the area and initiatefirst aid/triage-- Load the patient into the litterTalk to the patient, whether they are conscious or not-- Make the as comfortable as possible-- The patient is afraid and uncomfortable, being lashed to a litter completely helpless,exposed to the weather, relying on other hands not to cause them any further discomfortor harm-- Establish a rapportPlan and flag the best extrication/evacuation route while the patient is being packaged-- Best route on medical & terrain considerations, and resources availableStart the carry-out and keep the patient moving-- Arrange litter handlers by height-- Keep the patient’s head level or higher than the feet unless medical considerationsrequire something differentOnly one attendant calls signals.Rotate attendants, if appropriate, to avoid rest stops and prevent rescuer fatigue.Have handlers use webbing loops as “across-the-shoulders” straps to distribute the weight of the patient and facilitate ease of the carryout.Tag obstacles along the route for quick belays before you need them, keeping ahead of the patient.If not actually handling the litter, rescuers should be out in front where they are needed most.
96PATIENT EXTRICATION / EVACUATION Keep your systems as simple as possible! In reality, most backcountry evacuations are low angle, not high angle rescues. This involves moving the patient in a litter over low angle rugged terrain. The number of ropes, the rigging used depends on the slope and terrain characteristics.When evaluating the conditions, and you come to the point when you need to make the decision weather to use a mainline and a belay, or just a main line, or just a belay, ask yourself this question, “What are the consequences if you have a failure in a single rope system?” Let’s call this “The consequence based decision process”In General Low Angle Rescue Considerations:Use of belay line only:-- If the slope is of a low enough angle where it allows rescuers to carry the load up thehillside.-- Hillside has stable footing and attendants can safely carry the litter and patient up thehill without the use of a mechanical advantage system.-- Consequences of failure of the single rope system are not exposing rescuers and patient to potential death or injury.Use of a 2:1 mechanical advantage system, by itself, is allowed in low angle rescue situations when:-- You only need a slight bit of mechanical advantage to assist the litter and patient upthe hillside past minor obstacles. (Attendants should not be hooked to the litter, if youlose your footing while handling the litter, let go of the litter).-- Once again, if the single rope system fails, rescuers and patient will not be exposedto death or injury. If litter is dropped to the ground and haul line is unattended the litterwill not slide or fall down the hillside.Use of both a main line and a belay line:-- When consequences of a failure of a single rope system place rescuers and patient atrisk.-- If the decision is made to in any way shape or form attach attendants to the liter orsystem, a mainline and a belay line should be used.Other important considerations for low angle rescue:-- If you need more than a 2:1 mechanical advantage system to overcome weight orslope angle, revise your system to a steep angle rescue system using a main line anda belay line with three litter attendants.-- Also consider upgrading to a steep angle system using a mainline and a belay if slopeangle, poor footing or potential for death or injury dictate.
97CARRY OUTThe carry out should be performed when lashing is complete and webbing loops are established for each rescuer/handler. And most important, everyone should know what the “Action Plan” is.EQUIPMENT NEEDED FOR THE CARRY OUT:½” static rope for belay line2 locking steel carabinersLitter with patient lashingRed or yellow webbing for every tender to construct webbing loopRESOURCES NEEDED:The angle and terrain stability will determine number of attendants.Low angle, low hazard terrain with stable footing =-- 6 personnel, not tied to litter or main line.-- Rope = 0-1-- Rigging = tandem Prusik belayLow angle, moderate to high risk terrain, poor footing =personnel - if the angle and quality of the slope or terrain dictates use of a main lineto haul up the load, only 3 rescuers will be used. For information on steep angle rescue,reference the next section in this manual.-- Ropes = 1 or 2-- Rigging = tandem Prusik belay, main line lower (if needed) and main line raise (ifneeded).SAFETYThe overall safety tip we can offer is that you always consider the environment you are working in, such as, terrain, angle and weather conditions. Also consider the resources you have available, call for help when in doubt. In making a good scene size up, most of these concerns will be answered.The first step to safety is to ensure that everyone is on the same page. Is this a Rescue? Body Recovery? Who’s in charge? And what is the over all “Plan of Action?” What are the hazards we face? These are some of the questions that should be answered in your briefing.
98Belay line attachment is with Long Tail Bowline with tail going to patient Webbing bridle needs to go around rail for strength...DO NOT rely on plastic alone
99Note the single yellow webbing attachment on the harness Note the single yellow webbing attachment on the harness. Considering this is a low angle setting, the only risk to the patient is whether or not they will slide out the foot end of the litter.
100In low angle rescue, the burden of carrying the patient falls upon the rescuers. The single line shown is a belay line to prevent the load from sliding down the slope.
102SAFETY CONSIDERATIONS 2 rope system - main line and belay (rope dependent).3 attendants shall be used. 2 attendants are tied into the main line and belay via Purcell Prusik and a secondary Prusik. The strongest of the 3 attendants shall be located at the foot of the litter and tied into the system with a Prusik wrapped around the foot of the litter and hard tied using the long tail of the belay line.The patient should be lashed to the litter and also tied into the main line.The 2 side attendants’ weight must hang from the Purcell Prusik, not from the main/belay line.One person calls the commands.
103Third attendant primary and secondary attachment points One of front attendantsprimary and secondaryattachment pointsEnd of other long tail to patientOther front attendantprimary and secondaryattachment pointsInterlocking long tail bowlines to connect themain line and belay lineto the litter bridleClove hitch around litter rail constructed from portion of bowlines long tail
104Interlocking long tail bowlines to connect the main line and belay line to the litter bridle