Doom and Bloom: Patient Transport in Austere Settings

The Altons at Doom and Bloom Medical have another good article up — this time on what you do when you need to transport a patient and there is no ambulance: Patient Transport in Austere Settings. The article discusses stabilization as well as many different field-expedient stretcher/transport options.

 What happens when you need transport and there’s no ambulance?

In normal times, your main goal upon encountering an injured or ill person is to transport them to a modern medical facility as soon as possible. In cases where there is a risk of spinal or neck trauma, you will read that the victim should not be moved until emergency personnel arrive.

That’s all well and good in situations when the ambulance is just a few minutes away, but what about when you’ve been knocked off the grid due to a disaster?

Even in normal times, there are circumstances where a victim must be moved despite the risk. These mostly involve common sense judgements, such as when there is an immediate danger from, say, a building on fire or in danger of collapse.

Probably a good idea to move the patient

When help is not on the way, however, you will have to decide whether your patient can or cannot be treated for their problem at their present location. If they cannot, you must consider how to move the victim safely.

Before deciding whether to transport, a patient must be stabilized as much as possible. This means assuring open airways, controlling bleeding, splinting orthopedic injuries, treating hypothermia, and more. If you are unable to do this with the materials at hand, consider having a group member get the supplies needed to make transport safer. If possible, gather a team to assist you before you move the victim. Knowing the amount of help available allows you to choose a method of evacuation that will cause the least trauma to both patient and medic.

MOVING THE VICTIM ONTO THE STRETCHER

Without stabilization, a neck injury can occur even if not part of the original trauma

When moving a trauma patient, you should be concerned about the possibility of a spinal injury, especially if there is:

• Head or neck trauma
• Altered mental status
• Pain in the head or neck
• Weakness, numbness, or paralysis in the extremities
• Loss of bladder control

A person with a possible spinal injury should be “logrolled” onto a stretcher as a unit without bending their neck or back if at all possible. A cervical collar and supportive blocks with straps can be used to secure the spine of at-risk patients. An unstable neck, especially in an unconscious victim, could easily be traumatized even if not involved in the original trauma. Keep the head in alignment with the spine during transport.

“logrolling” position

If you have several helpers, transporting the patient is easier but requires coordination. You, as medic, will serve as leader of the transport team. This entails making sure the patient is transferred to the stretcher safely, but also that all team members lift and move at the same time. Simple “Prepare to Lift”, “Lift”, and “March” commands should suffice to get everyone on the same page…

Click here to read the entire article at Doom and Bloom.