RESCUE AND EVACUATION - Medicine for Mountaineering and Other Wilderness Activities - page 83

andcervicalcollarsifneeded.Thepersonmustbekeptwarm,eventhoughimmobile,while
allowing for reassessment of injuries with the least possible interruption of transport. The
individual must be protected from hazards of transport, including falling objects or tree
branches, secured to the litter (except for some forms of water transport), and in technical
terrain belayed independently of the litter. A vacuum mattress is easily secured to most lit-
ters, and most commercial litters come with tie-in straps.
For the rucksack litter, an improvised litter constructed with three or four rucksacks se-
cured end to end, the hip belts serve as tie-in straps. The person's head can usually be se-
cured by placing the hip belt of the pack at the end for which the hip belt is not part of the
assemblyaroundtheforehead.Caremustbetakennottosecureahipbelttootightlyaround
the chest, which would restrict breathing. Depending on the specific injuries, some adjust-
ments may be necessary to avoid placing pressure on injured areas. Slings, short lengths
of rope, and tape can all be used to improvise systems for immobilizing individuals and
injured areas so they do not slide in the litter and sustain further injury.
Rucksack stretchers containing clothing provide some padding. If backboards or com-
mercial litters are used, the person should be placed in (or on) a sleeping bag, preferably
with sleeping pads underneath the sleeping bag for padding. The vacuum mattress is the
only ideal way to prevent pressure sores, however.
A person who is vomiting or likely to vomit ideally should be transported on one
side—the “recovery position”—to protect against aspiration. However, no good method to
secure a person in that position has been developed. Elevating injured parts, as advocated
by some writers, is usually not feasible, although injured areas should be protected from
excessive pressure. Most individuals are transported in the supine position. They must be
tightly secured in the litter and monitored so that if they vomit the entire unit—litter and
occupant—can be turned on its side and the airway protected. If pelvic or leg injuries are
not present, padding placed under the knees greatly increases comfort in the supine posi-
tion.
Individualswhoneedevacuationareusuallyplacedinasleepingbagforwarmth.Inany
case their bodies should be covered for protection against falling or windblown objects,
especially for helicopter evacuations. The face and head should be covered for the same
reason, although goggles reduce claustrophobia. In steep terrain, the person should wear a
climbing helmet. The arms should be restrained in the litter for ease of packaging and in-
jury avoidance.
If the litter could be upended, the person should be prevented from sliding downward
either head first or feet first. Because vacuum mattresses conform to the body, they do not
allow the person to shift, either lengthwise or from side to side. Commercial litters some-
times have leg dividers, which help, although they do not allow fractured legs to be splin-
ted by lashing the legs together. Padding under the knees also reduces the tendency for the