In every technical rescue class I teach, I pose the same question to the class…Outside of actually getting to the call, what is the single most important operation you're going to perform? Generally it gets pretty quiet in the classroom while everyone racks his or her mind trying to figure it out. The Answer: Patient Packaging.
You can be the best driver in the department getting your crew there safely and in a timely manner. You could be the best rigger, or trench boss, or shoring-operation leader. However, if you go through all the hard work of rigging a rope operation, shoring a trench or building etc., but then skimp on your patient packaging (or improperly package a patient) you're not performing the duties you were called there to do. There's a simple rule I like to adhere to and teach in my classes. "Do it once…do it right." Your total operation was a waste of time if in the end you further injure or kill your patient because of improper packaging.
In this article, we'll look at several methods you can use to successfully and properly package a patient. To be successful, all it takes is a little practice.
I guess you can say the first rule in patient packaging is realizing and identifying the victim's injuries. Do a quick scan of the patient. Look, listen and feel, and if the patient is conscious, simply ask them what happen and what hurts. I want to quickly point out that when dealing with a conscious patient, your ability to calm them can go a long way. Excitement and panic in patients can cause a host of problems, such as hyperventilation, rapid heart rate (which will increase bleeding if there are lacerations) and combativeness. By playing the role of rescuer/psychologist, you can relax your patient and, in turn, help stabilize their injuries and overall increase the safety in your operation.
One rule I like to follow is no matter how bad the injury or situation it's always going to be all right. It's our job to worry, not the patient's. Now don't get me wrong, they're going to worry, but could you imagine if you (the rescuer) were panicking and yelling? Your patient's fear and anxiety would really skyrocket. So, just remember never lead on to the severity of a situation. Just make the rescue happen and make the patient will think it's a walk in the park.
Equipment Choices
Now, let's look at a few different means of packaging a patient. Before choosing your equipment, you need to look at a few things.
- Patient Access
- Patient's Injuries
- Decide whether this is going to be a vertical or horizontal evacuation
- Decide what will be the simplest and quickest
Proper choice of the equipment being used to package the patient is paramount. The last thing you want to do is make a snap decision and in the end find out that you can't make egress from the location with the patient due to the equipment you used. Take a minute and do a solid scene size-up. One minute now can save you 30 minutes in the end. Before we look at some equipment choices and rigging methods, I want to point out that in all the demonstrations you'll see, the patient will be packaged in a manner that is universal between a vertical and horizontal operation. My reasoning behind that is if you have a patient that is packaged for a horizontal evacuation, and during the operation the patient is forced into a vertical position (whether that be because of a system problem or just a positioning issue) any injuries that were stable horizontally may not be stable vertically. That goes for the patient as well.
Before we look at packaging devices, I want to go over securing a patient to the backboard, something you'll see a few times in this article. Anytime you package a patient, you should be using a backboard (unless the device is equipped with a rigid back designed to act as a backboard) as well as maintaining spinal immobilization. We're not doctors and we didn't see the accident, so it's in our best interest to play it safe and smart.
The method I like to use is called a hasty harness. The hasty harness is simply a Class-3 harness created from a piece of 1-inch webbing. By utilizing this technique, we will keep the patient in contact with the backboard and we can utilize this webbing as a belay connection. It's important to note that the webbing is terminated at the top of the backboard with a clove hitch on each side. We do this because should there be a belay catch, we want to terminate most of that force at or on the backboard, not the patient. If we didn't terminate the webbing with clove hitches, you could use your imagination as to where the force would go and the pain and discomfort your patient would experience.
SKEDS
The first piece of equipment we'll look at is the SKED. The SKED is, to say the least, one of the most used pieces of equipment in confined-space rescue. This is because of your ability to package a patient in a tight, narrow profile. SKED claims you can pass a patient through a very narrow hole when packaged correctly, and I've seen it done. The SKED can package and evacuate a patient both vertically and horizontally. The horizontal lift slings are rated at 9,000-pounds tensile strength. The 3/8-inch rope used for vertical lifting has a tensile strength rating of 5,800 pounds. It's lightweight (weighing in at 19 pounds when packed away) and is self-contained in its carrying bag. This is a nice feature because it allows the rescuer to transport it with them as they make their way to the patient. It's tough, durable and very user friendly…all features we expect in our equipment. (See Figures 1, 2, and 3 for examples of a patient secured to a backboard and a patient packaged in a SKED.)
Stokes Basket
Now let's move on to the stokes basket, probably the most popular means of packaging a patient. The stokes basket is a very versatile piece of equipment in the ways of rigging. If you were to pick up 10 different rope rescue books, you would probably learn 10 different ways to rig a stokes basket.
As I said in the beginning of the article, I always like to package my patient in a universal vertical/horizontal system. Those features that will keep your patient stable (meaning minimal or no movement should the stokes be forced to go from a horizontal to a vertical position) generally are found in two places: at the waist, such as a Swiss seat-webbing harness connected to the rails of the stokes about shoulder height by rescue cord or webbing; Or at the feet, by wrapping the feet during patient lashing, securing them together (I like to use a square knot) then securing either side of the webbing to the stokes via a clove hitch. This will lock the patient's feet and, in turn, body in that position in the event the stokes was forced into a vertical position. One other little feature of importance I'd like to point out is as you lash the stokes, you want to keep the webbing wraps on the inside of the stokes and off the rails. Webbing wrapped over the rails is just asking to be damaged rubbing against a building or other obstacles in your rescue. (See Figures 4 and 5 for examples of a patient packaged in a stokes basket.)
Rite Rescue System
Let's wrap things up by looking at the Rite Rescue System (RRS), a newcomer in the world of patient-packaging equipment. The RRS does a nice job of providing a fast, secure way of packaging your patient. Just like other systems we looked at, attention to patient injuries must be addressed and acted on accordingly. The RRS resembles the SKED, however it's internal harness system and deployment differentiate it. The RRS was originally designed for firefighter removal or Rapid Intervention Team (RIT) applications. If a firefighter was trapped in a building, for whatever that reason may be, the RRS makes removal of an injured or unconscious firefighter relatively fast and easy. As time went on and more people got their hands on the RSS, the technical rescue applications came to light.
The RRS allows you to evacuate a patient both vertically and horizontally. It also has a model that comes equipped with an eternal bladder that inflates with the help of a small carbon dioxie cartridge. The RRS can then carry up to a 300-pound load. For spinal immobilization, a short backboard can be used and the hasty harness method we discussed earlier can be applied. The patient gets secured in the RRS via three straps that, when applied, create a Class-3 harness. (See figures 6, 7 and 8 for examples of this system in use.)
I can't express enough the importance of proper patient packaging and care. You've put a lot of effort into accessing the patient and rigging for the operation, don't lose it all because of poor packaging methods or techniques. Persistence for perfection is always a nice model to follow and perfection is achieved through persistence in your training.
Now you've seen three different choices of packaging equipment, as well as a method of securing a patient to a backboard. I hope you have also taken away from this is that proper technique, situation size-up and good patient care are a must, because that's what will either make you or break you out in the field.
I'll end this article with a great quote I read. I often use it in training programs because I think it embodies a mentality a lot of students bring with them to classes, that being the fear of making mistakes in front of their peers. If we're honest with ourselves, I think we all experience this sometimes.
"The person that does not make mistakes is unlikely to do anything" - Paul Arden
I admit I'm a sucker for a good motivational quote. I hope you can use this one for your own students...or yourself.
Stay Safe, Stay Progressive
