As Seen In: USA Today, Discovery Channel, US News & World Report

Caring for Casualties in Mountain Rescues

Mass Casualties

When there are mass casualties, an orderly rescue may involve further planning.

a. To manage a mass casualty rescue or evacuation, separate stages are taken.

  • FIRST STAGE: Remove personnel who are not trapped among debris or who can be easily evacuated.
  • SECOND STAGE: Remove personnel who may be trapped by debris, but whose extraction only requires the equipment on hand and little time.
  • THIRD STAGE: Remove the remaining personnel who are trapped in extremely difficult or time-consuming situations, such as moving large amounts of debris or cutting through a wall.
  • FOURTH STAGE: Remove dead personnel.
  • b. Evacuation of wounded personnel is based on the victim's condition and is prioritized as follows:

  • PRIORITY ONE: Personnel with life-threatening injuries that require immediate emergency care to survive; first aid and stabilization are accomplished before evacuation.
  • PRIORITY TWO: Personnel with injuries that require medical care but speed of evacuation is not essential.
  • PRIORITY THREE: Injured personnel who can evacuate themselves with minimal assistance.
  • PRIORITY FOUR: The logistics removal of dead personnel.
  • Special Training

    Before receiving training in basic mountain evacuation, litter teams should receive instruction in military mountaineering and basic first aid. Litter bearers and medics must know the use and care of rope as an item of equipment. The members of litter teams must be proficient in the techniques of belaying and choosing belay points. Proper support and protection must be given to victims and litter bearers when evacuating over steep, difficult terrain.

    Preparations for Evacuation

    Although the wounded soldier's life may have been saved by applying first aid, it can be lost through carelessness, rough handling, or inadequate protection from the elements. Therefore, before trying to move the wounded soldier, the type and extent of his injury must be evaluated. Dressings over wounds must be reinforced, and fractured bones must be properly immobilized and supported. Based upon the evaluation of the type and extent of the soldier's injury, the best method of manual transportation is selected.

    Manual Carries

    Personnel who are not seriously injured but cannot evacuate themselves may be assisted by fellow soldiers. Personnel who are injured and require prompt evacuation should not be forced to wait for mobile evacuation or special equipment.

    a. One-Man Carries. The basic carries taught in the Soldier's Manual of Common Tasks (fireman's carry, two-hand, four-hand, saddleback, piggyback, pistol belt, and poncho litter) are viable means of transporting injured personnel; however, the mountainous terrain lends itself to several other techniques. One-man carries include the sling-rope carry and the rope coil carry.

    (1) Sling-Rope Carry. The sling-rope carry (Figure 11-1) requires a 4.5-meter sling rope and two men—one as the bearer and the other as an assistant to help secure the casualty to the bearer's back. Conscious or unconscious casualties may be transported this way.

    (a) The bearer kneels on all fours.

    (b) The assistant places the casualty face down on the bearer's back ensuring the casualty's armpits are even with the bearer's shoulders.

    (c) The assistant then finds the middle of the sling rope and places it between the casualty's shoulders.

    (d) The assistant runs the ends of the sling rope under the casualty's armpits, crosses the ends, and runs the ends over the bearer's shoulders and back under the bearer's arms.

    (e) The assistant runs the ends of the rope between the casualty's legs, around the casualty's thighs, and back around to the front of the bearer. The rope is tied with a square knot with two overhand knots just above the bearer's belt buckle.

    (f) The rope must be tight. Padding, when available, should be placed where the rope passes over the bearer's shoulders and under the casualty's thighs.

    Figure 11-1. Sling-rope carry.

    Figure 11-1. Sling-rope carry.

    (2) Rope Coil Carry. The rope coil carry requires a bearer and a 36 1/2-meter coiled rope. It can be used to transport a conscious or unconscious victim.

    (a) Place the casualty on his back.

    (b) Separate the loops on one end of the coil, forming two almost equal groups.

    (c) Slide one group of loops over the casualty's left leg and the other group over the right leg. The wraps holding the coil should be in the casualty's crotch with the loops on the other end of the coil extending upward toward the armpits.

    (d) The bearer lies on his back between the casualty's legs and slides his arms through the loops. He then moves forward until the coil is extended.

    (e) Grasping the casualty's arm, the bearer rolls over (toward the casualty's uninjured side), pulling the casualty onto his back.

    (f) Holding the casualty's wrists, the bearer carefully stands, using his legs to lift up and keeping his back as straight as possible.

    (g) A sling rope around both the casualty and bearer, tied with a joining knot at chest level, aids in keeping an unconscious victim upright. This also prevents the coils from slipping off the carrier's chest.

    Note: The length of the coils on the rope coil and the height of the bearer must be considered. If the coils are too long and the bearer is shorter, the rope must be uncoiled and recoiled with smaller coils. If this is not done, the casualty will hang too low on the bearer's back and make it a cumbersome evacuation. A sling-rope harness can be used around the victim's back and bearer's chest, which frees the bearer's hands.

    b. Buddy Rappel. The carrier can also conduct a seat-hip rappel with a victim secured to his back. In this case, the rappeller faces the cliff and assumes a modified L-shape body position to compensate for the weight of the victim on his back. The victim is top-rope belayed from above, which provides the victim with a point of attachment to a secured rope. The methods for securing a victim to a rappeller's back are described below.

    (1) To secure the victim to the carrier's back with a rope, the carrier ties a standard rappel seat (brake hand of choice, depending on the injury) and rests his hands on his knees while the victim straddles his back.

    (2) A 4.2-meter sling rope is used. A 45-centimeter tail of the sling is placed on the victim's left hip. (This method describes the procedure for a seat-hip rappel with right-hand brake.)

    (3) The remaining long end of the sling rope is routed under the victim's buttocks, and passed over the victim's and carrier's right hip. The rope is run diagonally, from right to left, across the carrier's chest, over his left shoulder, and back under the victim's left armpit.

    (4) The rope is then run horizontally, from left to right, across the victim's back. The rope is passed under the victim's right armpit and over the carrier's right shoulder.

    (5) The rope is run diagonally, from right to left, across the carrier's chest and back across the carrier's and victim's left hip.

    (6) The two rope ends should now meet. The two ends are tied together with a square knot and overhand knots.

    (7) The knot is positioned on the victim's left hip. The carrier's shoulders may need to be padded to prevent cutting by the rope.

    (8) An alternate method is to use two pistol belts hooked together and draped over the carrier's shoulders. The victim straddles the carrier, and the belay man secures the loose ends of the pistol belts under the victim's buttocks. Slack in the pistol belt sling should be avoided, since the carrier is most comfortable when the victim rests high on his back (see FM 8-35).

    (9) A large rucksack can be slit on the sides near the bottom so that the victim can step into it. The victim is belayed from the top with the carrier conducting a standard rappel. The carrier wears the rucksack with the victim inside.

    (10) A casualty secured to a carrier, as described above, can be rappelled down a steep cliff using a seat-shoulder or seat-hip rappel. The casualty's and rappeller's shoulders should be padded where the sling rope and rappel lines cross if a seat-shoulder rappel is used. The buddy team should be belayed from above with a bowline tied around the victim's chest under his armpits. The belay rope must run over the rappeller's guide hand shoulder.

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