Evacuating the Injured: Stretchers and Transportation

Introduction: Why Evacuation Skills Save Lives

In survival and disaster scenarios, knowing how to evacuate an injured teammate is one of the most vital—and most underestimated—skills. Even if first aid has been successfully provided, a victim may still die if not transported safely to shelter or medical assistance. Improper evacuation techniques can worsen spinal injuries, cause internal bleeding, or exhaust rescuers before reaching safety.

The goal of evacuation is not only to move the injured person but to preserve their condition, minimize pain, and maintain group energy efficiency. Every survival group should train in basic transport methods and improvised stretcher construction to ensure readiness for emergencies.

Fundamentals: Principles of Casualty Evacuation

Evacuation involves moving a casualty from an unsafe area to a safer location while preventing further injury. In survival environments, this may require navigating through difficult terrain with limited equipment and personnel.

Primary Objectives of Evacuation:

1. Preserve life – Maintain vital signs throughout transportation.

2. Prevent deterioration – Avoid aggravating wounds or fractures.

3. Ensure safety – Protect both casualty and rescuers from environmental hazards.

4. Optimize efficiency – Use methods that conserve group strength and time.

Types of Evacuation Methods

Method	Description	Use Case
Self-evacuation (assisted walking)	The injured person moves with help.	For minor injuries.
One-person carry	Solo rescuer supports or carries victim.	Light casualties or short distances.
Two-person carry	Two rescuers share weight.	Medium to heavy casualties, moderate terrain.
Stretcher transport	Victim fully supported.	For serious injuries or long distances.
Drag method	Victim pulled using fabric or stretcher substitute.	When time is critical or terrain uneven.

Step-by-Step: How to Prepare for and Perform an Evacuation

Step 1: Assess the Situation and Injury Severity
Before moving anyone, determine whether evacuation is safe and necessary.

• Check for spinal, neck, or leg fractures—movement can cause paralysis.

• Evaluate environment (fire, flood, rockfall) and available manpower.

• Prioritize casualties based on triage principles (life-threatening first).

Step 2: Stabilize the Casualty Before Movement

• Control bleeding, immobilize fractures, and cover wounds.

• Treat for shock (keep warm, calm, and reassured).

• Record time and condition before movement begins.

Step 3: Choose the Evacuation Method

Situation	Recommended Method
Minor leg injury	Assisted walk with shoulder support
Arm injury	Rescuer supports opposite side
Unconscious but breathing	Recovery position + stretcher transport
Spinal injury suspected	Hard stretcher or board evacuation only
Dangerous environment	Drag method (improvised or blanket drag)

Improvised Carrying Techniques (One- and Two-Person)

One-Person Techniques:

1. Fireman’s Carry – Rescuer lifts casualty over shoulders; efficient but risky with back injuries.

2. Pack-Strap Carry – Victim’s arms over rescuer’s shoulders; suitable for moderate loads.

3. Piggyback Carry – For conscious casualties who can hold on.

Two-Person Techniques:

1. Two-Handed Seat Carry – Rescuers face each other, arms interlocked, casualty sits on the “seat.”

2. Four-Handed Seat Carry – Similar, but casualty holds rescuers’ shoulders for balance.

3. Fore-and-Aft Carry – One rescuer behind (under arms), another in front (under knees).

4. Chair Carry – Using an actual chair or improvised seat for short-distance transport indoors.

Improvised Stretchers: Construction and Usage

In the field, professional stretchers are rarely available. Knowing how to construct sturdy substitutes is crucial.

Basic Improvised Stretcher Designs:

Type	Materials	Instructions
Pole and Blanket Stretcher	2 sturdy poles + blanket/jacket	Lay blanket flat, place poles 1/3 from edges, fold edges over poles.
Rope or Vine Net Stretcher	Rope/vines + branches	Weave a grid pattern between two poles, tie firmly.
Jacket Stretcher	2 poles + 2 jackets	Slide poles through sleeves; zip up jackets to create a bed.
Tarp or Tent Fly Stretcher	Tarp + poles/sticks	Roll poles inside tarp edges; tie ends to prevent slipping.
Backpack Stretcher	Two backpacks linked	Secure shoulder straps together; victim lies on top or is secured inside.

Stretcher Transport Technique

• Ensure at least two, preferably four carriers.

• Keep stretcher level and avoid jerky movements.

• Swap carriers regularly to prevent fatigue.

• Communicate before changing pace or terrain (“Ready, move,” “Stop,” “Down”).

• Maintain head elevation slightly higher than feet unless shock is present.

Drag and Slide Methods (for Emergencies)

When time or resources do not allow for proper stretcher use, dragging can save lives in critical moments.

Method	Description	Best Used For
Blanket Drag	Roll casualty onto blanket and pull by head end.	Smooth ground, short distances.
Clothing Drag	Pull by back of shirt or shoulders.	Indoors or firm terrain.
Arm Drag	Grip wrists and pull backward.	Confined spaces.
Rucksack Drag	Strap victim into backpack and pull.	Uphill or narrow paths.
Rope Harness Drag	Secure rope around chest and under arms.	Slopes or wet areas.

Terrain-Specific Evacuation Considerations

1. Mountainous Terrain – Keep casualty’s head uphill; avoid sudden shifts.

2. Forested Area – Clear path of obstacles; use logs or poles as rollers.

3. Snow/Ice Terrain – Use sled, tarp, or skis as sliding base.

4. Desert – Move during cooler hours; protect from sun exposure.

5. Urban Disaster Zones – Avoid unstable structures; use ladders or boards as supports.

Communication and Coordination During Evacuation

Evacuation requires discipline and coordination. Establish commands for movements:

• “Lift!” – All rescuers raise stretcher simultaneously.

• “Move!” – Begin synchronized walking.

• “Lower!” – Set stretcher down gently.

Keep a designated leader responsible for pace and route selection. The rear carrier usually monitors the casualty’s condition, reporting any distress immediately.

Table: Energy and Safety Management for Rescuers

Factor	Recommendation
Carrying Duration	Switch carriers every 5–10 minutes.
Hydration	Drink water regularly to avoid heat exhaustion.
Load Distribution	Alternate front/rear positions among rescuers.
Communication	Use brief, standardized phrases.
Rest Intervals	Every 15–20 minutes during long transport.

Evacuation Planning in Team Scenarios

1. Route Selection – Choose shortest, safest, most level path possible.

2. Waypoint Planning – Identify rest zones or cover points along the route.

3. Load Preparation – Secure equipment before lifting; avoid dangling items.

4. Casualty Comfort – Maintain verbal reassurance and cover against cold.

5. Evacuation Logs – Record time, vitals, and distance for later medical reference.

Case Example: Wilderness Rescue, Alaska 2018
A mountaineering team successfully evacuated an injured climber 3 km across rocky terrain using an improvised tarp stretcher reinforced with branches. They rotated carriers every 10 minutes, maintained communication, and reached the extraction site without secondary injuries. Their success emphasized planning, teamwork, and proper pacing over brute strength.

FAQ: Evacuating the Injured in Survival Situations

1. When should evacuation be avoided?
   When movement risks spinal or neck injury without proper immobilization.

2. How do I know if someone can walk?
   If they can bear weight on both legs and communicate clearly.

3. What if the casualty refuses evacuation?
   Respect their autonomy unless unconscious or in immediate danger.

4. Can a single person carry an adult?
   Only short distances—risk to both rescuer and victim increases rapidly.

5. How can we protect the victim during rain or snow?
   Use a tarp, poncho, or tent material to keep dry and warm.

6. What’s the best way to lift safely?
   Bend knees, keep back straight, and coordinate with partner.

7. How should the head be positioned on a stretcher?
   Slightly elevated unless spinal or head injury is suspected.

8. Is dragging safe for unconscious people?
   Yes, if airway is maintained and surface is smooth.

9. How do you move someone through narrow passages?
   Use a head-first drag with padded protection for arms and shoulders.

10. What if terrain is too steep?
    Use rope belay and anchor points; move gradually in segments.

11. Should you ever tie a casualty to the stretcher?
    Yes, with soft bindings to prevent slipping, especially on slopes.

12. How to cross water with an injured teammate?
    Use flotation (logs, backpacks, or air mattresses); avoid fast currents.

13. Can injuries worsen during evacuation?
    Yes—hence the need for stabilization before movement.

14. How can morale be maintained during evacuation?
    Constant reassurance, clear progress updates, and rotation of roles.

15. What if multiple people are injured?
    Apply triage: evacuate those with highest survival chance first.

16. How to transport in the dark?
    Use headlamps or glow sticks; move slowly and communicate frequently.

17. What’s the ideal stretcher weight capacity?
    At least 120–150 kg for adult transport safety.

18. What’s the most common mistake in evacuation?
    Rushing movement before proper stabilization of injuries.

19. How can fatigue be minimized?
    Rotate carriers often and plan hydration breaks.

20. Can improvised stretchers match real ones in effectiveness?
    Yes—when built correctly and used with coordination.

Note

This article provides general educational information about emergency evacuation and field transport of injured persons. It is not a substitute for certified wilderness rescue or emergency medical training. Readers are strongly advised to complete accredited first aid and evacuation courses (e.g., Wilderness First Responder, Mountain Rescue Certification) before attempting real-life applications. Improper evacuation techniques may cause permanent injury or death.