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Congratulations! You have successfully located, accessed,
treated, stabilized and packaged your patient in a basket style
litter for evacuation by rope or helicopter short haul. The litter
takes on a vertical, sideways, face down, or spinning orientation
during transport. Will the manufacturer supplied restraint straps
that came with your litter keep your patient secure in the litter?
Your patient may be in for a nasty surprise if you think so.
Basket Litters
Traditionally, these have been the most common litter design.
The original basket litter (designed in 1895 by Charles Stokes)
became so popular that many rescuers incorrectly refer to all
basket litters as "Stokes litters". The classic basket
litter has a tubular metal frame with chicken wire used to form
the basket. Modern day basket litters can have a frame constructed
from tubular aluminum, mild steel, or stainless steel with a
chicken wire or high density polyethylene plastic basket. (See
attached photos)
There are many different methods for securing patients into
a basket litter. Some work very well while others may lead to
tragic results. Your patient has to remain secure in the litter
in any of five different positions; horizontal, on their side,
feet down, head down, or face down. The easiest position to achieve,
and the one that gives the best ride for the patient, is when
the litter is horizontal with the patient in a supine position.
(See attached photo) In theory, no restraint straps are required
as the basket and litter frame keep the patient from falling
downward to the ground. To keep the patient from sitting up we
commonly use the restraint straps supplied by the litter manufacturer
and they work very well to secure the patient in this situation.
In any other position, the method used to secure the patient
from falling from the litter becomes of critical importance to
the patient. If the patient has an airway problem or if we suspect
they may vomit, we frequently orient the litter on its side during
transport for airway management. Another commonly used orientation
is vertical with the feet pointing down. (See attached photos)
The two remaining positions, vertical with the head down and
horizontal with the face down, are a good indication that something
has gone seriously wrong with your rescue operation.
Manufacturer Supplied Restraint Straps
The two most common litter restraint straps supplied by manufacturers
are made of nylon with a seat belt style buckle or a pass through
style buckle. Both types can fail under the stresses of rope
rescue. (See attached photos) The seat belt style has a potential
to release under load when it receives a blow to the back of
the buckle. Try this experiment for yourself. Tension the seat
belt on both ends and strike the back of the buckle with a plastic
VHS video tape storage case. Not much force can be applied with
this "lethal" instrument. If your seat belt buckle
released, as is common, what happens when the litter suddenly
changes orientation and the patient falls against it? In case
you were wondering; yes, your automobile seat belt may have the
same results in a side impact crash. The pass through buckle
also has a potential problem. These are very secure buckles until
force is applied to the middle of the back of the buckle. The
hinge pin acts as a pivot point to release the gripping teeth
and the strap either loosens or comes completely apart.
Lashing Technique
One very effective lashing technique involves the use of three
25 foot lengths of rope or tubular webbing.
The center of the first section is placed at the patient's
waist near the navel. The two ends are placed between the legs,
then passed under the knees to the outside. There is a natural
hollow space under the knees that allows this with minimal patient
movement. The webbing is worked gently up under the thighs to
the groin, being sure to check for any possible entrapment. The
end of each strap passes through the loop of webbing at the waist
from the bottom up. From there, the ends are taken toward the
head end of the litter and secured with a clove hitch and safety
knot. (See attached drawing and photos) This modified seat harness
will keep the patient secure in a feet down orientation while
keeping pressure off an injury to the back or lower extremities.
A loop of rope or webbing placed around the patient's feet, is
a commonly taught restraint method that can aggravate any back
or leg injuries. The center of the second section of rope or
webbing is placed on the patient's chest in about the same location
you would place your hands to perform CPR. The ends go under
the arms and above the head. The webbing ends are gently passed
under the patient's neck (another place where a natural hollow
occurs) to form an "X" behind the back. The ends of
the webbing are then brought up and over the shoulders to the
chest where a round turn is placed on the center of the webbing
loop. The ends of the webbing then are taken toward the foot
end of the litter and secured with a clove hitch and safety knot.
(See attached drawing and photos)
This modified chest harness keeps the patient from falling
from the litter in a head down orientation. If a neck injury
is suspected, do not cross the webbing behind the neck before
bringing it up and over the shoulders to the chest. The center
of the third section of webbing is used in a diamond lashing
technique beginning near the knee area. The webbing is crisscrossed
back and forth across the patient and secured near the shoulders
with a clove hitch and safety knot. (See attached drawing and
photos) This technique is easy to learn and teach and is very
reliable for keeping the patient secure in the litter in any
position. We strongly recommend that whatever method you have
used in the past for securing your patient in basket litters,
don't accept on blind faith that it works in all situations.
Be questioning, experiment and always keep an open frame of mind
to find the best method for your team before trusting someone
else's life to it.
Michael Dunn is the President of Emergency
Response Training, Inc., a Baton Rouge, LA. based fire/rescue
training and consulting firm. He has been a member of the IADRS
since 1980 and is a PSSI and Dive Rescue I Trainer. |
