Transcript Slide 1

ROPE SYSTEMS
PATIENT PACKAGING
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 basket
Tarp
Patient harness
Patient PPE
Litter shield
Head protection
Eye protection
Padding/pads
Blanket for warmth
Medical supplies as needed;
Backboard
Cervical 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.
SAFETY
Patient(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, splinting
Prepare the litter to receive the patient
Load the patient
Lash the patient into the litter securely
--Internal lashing (utilize only the amount needed for the type of rescue)
--External lashing
INTERNAL LASHING
2. Secure torso
webbing with
round turn and 2
half-hitches on
either side.
NOTE: webbing
is tied off to an
upright stay, not
the railing.
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.
EXTERNAL LASHING
3. Finish with a
round turn
and 2 halfhitches on one
end, then pull
slack back
through entire
black
webbing.
Finish other
end in same
manner.
NOTE: External
lashing is
required when
performing high
angle rescue.
2. Weave webbing
around upright
stays, not over
the railing.
1. Start with
middle of black
webbing here.
LOW ANGLE RESCUE
LOW ANGLE RESCUE
During this session we’ll discuss the various degrees or classifications of Low Angle Rescue,
and Patient extrication.
OBJECTIVES
Identify, 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 initiate
first aid/triage
-- Load the patient into the litter
Talk 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 discomfort
or harm
-- Establish a rapport
Plan and flag the best extrication/evacuation route while the patient is being packaged
-- Best route on medical & terrain considerations, and resources available
Start 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 considerations
require something different
Only 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.
PATIENT 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 the
hillside.
-- Hillside has stable footing and attendants can safely carry the litter and patient up the
hill 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 up
the hillside past minor obstacles. (Attendants should not be hooked to the litter, if you
lose 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 exposed
to death or injury. If litter is dropped to the ground and haul line is unattended the litter
will 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 at
risk.
-- If the decision is made to in any way shape or form attach attendants to the liter or
system, 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 or
slope angle, revise your system to a steep angle rescue system using a main line and
a belay line with three litter attendants.
-- Also consider upgrading to a steep angle system using a mainline and a belay if slope
angle, poor footing or potential for death or injury dictate.
CARRY OUT
The 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 line
2 locking steel carabiners
Litter with patient lashing
Red or yellow webbing for every tender to construct webbing loop
RESOURCES 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 belay
Low angle, moderate to high risk terrain, poor footing =
-- 3-6 personnel - if the angle and quality of the slope or terrain dictates use of a main line
to 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 (if
needed).
SAFETY
The 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.
Belay 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
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.
In 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.
STEEP ANGLE RESCUE
SAFETY 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.
Third attendant primary
and secondary
attachment points
One of front
attendants
primary and
secondary
attachment points
End of other
long tail to
patient
Other front
attendant
primary and
secondary
attachment points
Clove hitch around litter
rail constructed from
portion of bowlines long
tail
Interlocking long tail
bowlines to connect the
main line and belay line
to the litter bridle
Interlocking long tail
bowlines to connect the
main line and belay line to
the litter bridle