Emergency handling of casualties

The prime purpose of all rescue work is to get the injured people out of danger and to medical help as quickly as possible. When the number of casualties outnumbers the immediate help available, the aim becomes one of trying to ensure the best use of time to effectively help the most people. This decision-making process is called "triage." In triage, those responding to the incident are called upon to examine all casualties quickly and rank them according to the level of need for both first aid and transportation to medical help.
In any rescue or multiple casualty situation, confusion may be evident. It is essential that individuals charged with helping injured people be able to remain calm and act quickly but carefully, always attentive to potential hazards to either themselves or other people in the area.

In any situation where you suspect a possible head or spinal injury, if the life of the casualty is not under immediate threat, seek the help of specialists. If it is essential to move the casualty, and your life is not in danger, maintain normal anatomical alignment (nose, belly button, inside of ankles). If the person is not in this position, get the help of qualified personnel.

Try to establish quickly how many casualties are involved in the incident. Go to the nearest casualty, provided it is safe, and check for responsiveness. If the person does not answer you or respond to your attempts to wake them, check to see if the person is breathing. Your aim is to keep the casualty alive until medical help arrives. Do not waste time dealing with minor injuries until all casualties have been found and stabilized.
If the person is not breathing, try to find someone nearby who is able to do artificial respiration until help gets there. If the casualty is bleeding severely, apply a pressure bandage before moving to the next casualty. Remember, time is valuable. Give first aid for life-threatening conditions quickly and go to the next casualty.

One-rescuer methods

Never move the casualty any further than needed. Scan the escape routes to determine the best method and route to carry the casualty. If you're alone and must move the casualty quickly, try one of the following rescue carries.

Human crutch
This method is only for casualties who can help themselves. It is an easy way to move the less seriously injured.
Drag carry
This carry is used to drag a casualty who is either lying on their back or in a sitting position. Ease your hands under the casualty's shoulders and grasp the clothing on each side, supporting the head between your forearms. Drag the casualty backward only as far as necessary for his/her safety. But be careful, make sure not to choke the casualties when pulling on their clothing.

Blanket drag

An alternate method to the drag carry where the rescuer can use a blanket to support and pull the casualty.

Pick-a-back

Simply lift the casualty from a standing or sitting position onto your back. Don't try it if the casualty is unconscious or has arm injuries.
Removal Downstairs

Don't try this if you suspect head or spinal injuries or broken limbs. Use a mattress or rug under the person if one is available.

Firefighter's crawl

Use a triangular bandage, a torn shirt, etc to tie the casualty's hands together and place them around your neck. This way you can move a person much heavier than yourself.

Two-rescuer methods

If there are two of you to do the carrying, try one of these emergency methods:
Chair lift
The chair carry can be used for a conscious or unconscious casualty but not for suspected head/spinal injuries. For protection, secure the casualty's hands across his or her chest and, if the casualty is unconscious, secure the person to the chair.

Two-hand seat carry

This is another way to carry a conscious casualty who can neither walk nor support the upper body. Make a hook with your fingers by folding them towards your palm and grab onto your partner's "hook". If you don't have any gloves, use a piece of cloth to protect your hand from the other person's nails. This is yet another good reason to wear gloves!

Four-hand seat carry

This is also a good carry for a conscious casualty who can use hands and arms for support.

Multi-rescuer methods

If there are more than two of you to do the job, there are a number of different methods that can be used to carry casualties.
Blanket lift
Don't use this lift if head/spinal injuries are suspected.

1. Roll the blanket or rug lengthwise for half its width. Position bearers at the head and feet to keep the head, neck and body in line.
2. Kneel at the casualty's shoulder and position a bearer at the waist to help logroll the casualty onto the uninjured side. Turn the casualty as a unit so that his/her body is not twisted during the logroll.
3. Roll the casualty back over the blanket roll to lay face up on the blanket. Unroll the blanket and then roll the edges of the blanket to each side of the casualty. Get ready to lift the casualty – have bearers grip the rolls at the head and shoulders, and at the hips and legs.
4. Keep the blanket tight as the casualty is lifted and placed on the stretcher.

Three-person lift and carry

This is an excellent way of lifting a badly hurt person without complicating most injuries. The casualty can be carried forward, sideways or lowered onto a stretcher.

Improvised stretchers

If a commercially prepared stretcher is not available, you can improvise one by using a tabletop, door, two rigid poles and a blanket or clothing. Don't use non-rigid stretchers for casualties with suspected head or spinal injuries.

Blanket and poles stretcher

1. Place the blanket flat on the ground and place a pole one-third of the way from the end. Fold the one-third length of the blanket over the pole.
2. Place the second pole parallel to the first so that it is on the doubled part of the blanket, about 15 cm (6 in) from the doubled edge.
3. Fold the remaining blanket over the two poles. The casualty's weight on the blanket holds the folds in place.

Stretchers from found materials

Doors, short ladders, sheets of galvanized metal, etc can all be used to improvise stretchers. Keep an eye out for suitable materials.
Make sure the stretcher and casualty will clear passageways and that the stretcher is strong enough to hold the casualty.
NOTE: Test an improvised stretcher with someone equal to or heavier than the casualty to ensure that it will hold. Check the clearance of an improvised stretcher to ensure that it will pass through hallways, doors and stairways without harm to the casualty.

Blanketing stretchers

One blanket can be used to wrap the casualty for warmth and provide easy access to the casualty's wounds.
Place a blanket diagonally on the length of the stretcher. Fold the overhanging edges and tuck them on both sides of the stretcher bed to keep them off the ground.
After the casualty has been placed on the stretcher, bring the bottom corner (1 in the figure) over the feet and tuck between the ankles. The corner at the head (2) is brought around the head and neck towards the chest. Cover the casualty with the two other sides (3 and 4).

Lashing casualty to stretcher

Whenever casualties have to be carried over uneven ground or debris, they should be lashed to the stretcher using clove hitches. A clove hitch on the stretcher handle starts the lashing. This is followed by a series of half hitches positioned around the casualty at mid-chest, at the hip, where the legs join the torso and just below the knee.

Carrying stretchers

A stretcher should be carried by at least four people, normally facing the direction of travel, with the casualty's feet first. They should carry head first if going uphill or upstairs and when loading into an ambulance or onto a bed. Remind rescuers that someone should keep watching the casualty while they are transporting.
Uneven ground and obstacles
When crossing uneven ground, a stretcher should be carried by four people and kept as level as possible. The rescuers must adjust the height of the stretcher to compensate for dips and rises in the terrain (Figure 1).
If the ground is unstable, the stretcher should be passed along a row of six to eight people rather than have bearers move over the rubble – especially when set down – since the lashing could tighten around the casualty.
If going through a doorway, the front bearers should move to the middle
of the stretcher and let the front part protrude through the door. One rescuer at a time moves through the doorway, then re-grasps the stretcher.
Avoid crossing a wall or high obstacle, even if it means a longer carry. Where a wall must be crossed, follow these steps:

1. Lift the stretcher so that the front handles are supported by the wall. The people in the rear hold the stretcher level while the front person crosses the wall.
2. All bearers lift together and move the stretcher forward until the rear handles rest on the wall.The people in the rear then cross the wall.

Extrication from a sitting position

Sometimes in earthquakes or blasts, casualties are found sitting in their vehicles. When there is an immediate danger and you are alone and must move a seated casualty from a vehicle, proceed as follows:

1. Disentangle the person's feet from the wreckage and bring the feet foward to exit. Ease your forearm under the person's armpit on the exit side, extending your hand to support the chin.
2. Ease the person's head gently backward to rest on your shoulder while keeping the neck as rigid as possible.
3. Ease your other forearm under the armpit on the opposite side and hold the wrist of the casualty's arm which is nearest the exit.
4. Establish a firm footing and swing around with the casualty, keeping as much rigidity in the neck as possible. Drag the casualty from the vehicle to a safe distance with as little twisting as possible.

Any casualty who has been injured may experience increased distress and pain as a result of rescue efforts. Remember, never move the casualty any further than necessary to wait safely for additional help. Do only what is necessary to ensure the casualty's safety and to preserve life. Continue to reassure the conscious casualty and, where available, have someone stay with him/her until help arrives.