Casualty lifting

The casualty lifting is the first step of the casualty movement. It is the procedure used to put the casualty on a stretcher.

The developped emergency services use lifting devices, such a scoop stretchers, that allow secured lifting withn minimal personnel. Other methods are explained, that can be used when such device is not available.

Mind that usually, only stabilised casualties are moved, so the lifting is usually never performed in emergency; emergency movements are sometimes performed to respect the Golden Hour. This depends on the organisation of the medical services and on the specific circumstances.

Maximum care must be taken to avoid to worsen an instable trauma. The rectitude of the head-neck-chest axis must be kept, to protect the spine, and the first responders must be stable (no movement of the feet) during the lift.

The first responders have to carry a heavy load (probably more than 20 kg for an adult casualty) in an incomfortable position. There is thus a risk of wound, especially of the lumbar back. To avoid an injury, thay must push with their legs (quadriceps), trying to keep their back straight.

Preparation of the stretcher

The stretcher must be unfolded, the hinges secured, and tested: a first responder presses the cloth with his knee at several point. When a vacuum mattress is used, it must be put on the stretcher, and the balls must be evenly distributed. A blanket is often used (hypothermia is a major risk for a casualty). The blanket must be wrapped around the casualty to avoid the heat leak from below (this is not necessary when the stretcher has a mattress, e.g. a vacuum mattress, or in case of an ambulance stretcher). For this purpose, the blanket is put before the lifting, and folded in a specific way:

1. the blanket is laid so the diagonal is along the axis of the stretcher;
2. the corners are put on the center of the stretcher;
3. the folded part are then rolled towards the stretcher;
4. the rolls are then put under the blanket, so they will not unroll spontaneously; the corners are sticking out so they can be pulled.

Vertical lift

The most secured way to put a casualty on a stretcher is to use a vertical lift with five first responders including the chief (the procedure is called pont amélioré in French, pont refers to a occiput, the other hand under the chin;

1. the first team member supports himself on the shoulder of another team member, and steps over the casualty; he/she puts his/hers hands under the shoulders;
2. the second team member supports himself on the shoulder of another team member, and steps over the casualty; he/she puts his/hers hands under the hip;
3. the third team member hold the ankles;
4. the fourth team member pushes the stretcher.

The feet of the team members must be enough spaced so the stretcher can slide inbetween. If the chief uses the occipital-chin grip, the knee that is up is the knee on the side of the hand under the neck: as this arm supports the heaviest weight, it can supports itself on the knee.

On the order of the chief, the casualty is lifted, the stretcher is pushed, and the casualty is put down on the stretcher. During this procedure, the chief remains kneeling (stable); the other team members lift pushing with their legs (arms stretched out, back kept straight). Then, the first and second team members pull back, supporting themselves on the shoulder of a still standing member.

Vertical lifting with five team members, the stretcher coming from the feet's side; the bottom illustration shows a view of the back of the casualty (from below), with the positions of the feet and of the hands of the first responders

With this method, the movement of the casualty is minimal, just vertical.

When there is no room at the feet of the casualty for the stretcher, it must then be placed on the side of the head. The chief must then kneel aside. If he uses the occipital-chin grip, the hand under the neck must be the closest to the casualty's feet; the same knee is up.

Vertical lifting with five team members, the stretcher coming from the head's side; the bottom illustration shows a view of the back of the casualty (from below), with the positions of the feet and of the hands of the first responders

With only four first responders, it is necessary to use a "simple" lift (pont simple in French): the chief plays the role of the first team member: he steps over the casualty and places one hand under the neck, the other hand under the back, between the shoulder blades. The stretcher can come from the feet or from the head. This method is not adapted in case of suspicion of a spine trauma.

Vertical lifting with four team members, or "simple lifting"; the bottom illustration shows a view of the back of the casualty (from below), with the positions of the feet and of the hands of the first responders

Translation lift

The translation lift, or "Dutch" lift, is used when it is not possible to push the stretcher: there no room for the stretcher and the feet or at the head of the casualty, or the stretcher cannot slide/roll on the ground, or there is not enough first responders available. In such a case, the stretcher is placed besides the causalty.

With four first responders (including the chief), the first and second team members step over the casualty and the stretcher, the foot is on the farthest pole of the stretcher. The chief holds the closest pole with his knee on the ground, and the third team member with his ankle. The positions of the hands are the same as for the vertical lift with five first responders.

On the order of the chief, the casualty is lifted and translated on the stretcher.

Casualty lifting using the translation lift with four first responders; the bottom picture is a view from below with the position of the hands and of the feet.

This method can be performed with only three first responders. In this case, the chief plays the role of the first team member; he blocks the pole with his ankle, and puts one hand under the neck, the other one under the back, between the shoulder blades. Only the team member at the hips steps over the stretcher.

Casualty lifting using the translation lift with three first responders; the bottom picture is a view from below with the position of the hands and of the feet.

Rolling methods

The rolling methods can only be used on casualty who do not have an instable trauma. They are interesting for heavy weighted casualties: the rolling does not require much effort, and the lifting itself is done in a more comfortable position (the back of the first responders is vertical). The rolling methods consist in rolling the casualty on his/her side; it is then possible:

• to put a long spine board against his/her back, then to roll back the casualty on his/her back;
• to slide a folded flexible stretcher (or a blanket); the causaulty is then rolled on the other side to un fold the flexible stretcher.

The casualty can then be lifted with the handles of the long spine board or fo the flexible stretcher (or holding the rolled sides of the blanket), and put on the stretcher.

Usually, the method is done with four first responders, including the chief:

1. the chief is kneeling at the head, in the axis of the casualty, and holds the head;
2. the first team member is kneeling besides the casualty, and holds the opposite shoulder and the opposite hip;
3. the second team member is kneeling at the feet, in the axis of the victime, and holds the ankles;
4. at the order of the chief, the casualty is rolled towards the first team member, and the fourth team member puts the board or the flexible stretcher in place.

Casualty lifting: rolling-and-lifting method with a long spine board

This method can also be performed by only two first responders: the chief plays the role of the first team member, and the only team member deals with the board or the flexible stretcher (neither the head nor the ankles are gripped). This is rather traumatic for the casualty, but can be used when there is non suspicion of trauma, either in emergency (e.g. to transport a cardiac arrest when advanced life support cannot be performed onsite), or when the first responders are lacking.

It is also possible to use a roll-and-lift method, or "spoon" lifting (relevage à la cuiller in French), with three people:

1. the first responders are placed on the same side of the casualty; the knee htat is closest to the head is lifted, the other one is on the ground;
2. the chief is at the head; he puts one arm under the neck and reach the opposite shoulder, the other arm under the back;
3. the first team member is besides the pelvis; he has one arm under the back, one arm under the back, the other one under the thighs;
4. the third team member supports the legs.

At the order of the chief, the casualty is lifted and put on the lifted knees of the first responders. Then, the casualty is flattened against the chests, and the first responders stand up. They move towards the stretcher; there, they put one knee on the ground (the closest to the casualty's feet), lay the casualty on his/her back, and move the casualty from their knees to the stretcher. For this last movement, additional first responders can be placed at the opposite side of the stretcher to help the landing.

Roll-and-lift method, or "spoon lifting", with three team members

The spoon lifting can also be used for emergency movements of a casualty when a spine trauma is suspected, e.g. the casualty is unconscious and is threatened by a fast rise of water level (flood).