EMERGENY HANDLING OF CASUALTIES

The prime purpose of all rescue work is to get the injured people out of
danger and to medical help as quickly as possible. When the number of casualties
outnumbers the immediate help available the aim becomes one of trying to
ensure the best use of time to effectively help the most people. This decision-
making process is called “triage.” In triage, those responding to the incident are
called upon to examine all casualties quickly and rank them according to the level
of need for both first aid and transportation to medical help. In any rescue or
multiple casualty situation, confusion may be evident. It is essential that
individuals charged with helping injured people be able to remain calm and act
quickly but carefully, always attentive to potential hazards to either themselves
or other people in the area.

Try to establish quickly how many casualties are involved in the incident.
Go to the nearest casualty, provided it is safe, and check for responsiveness. If
the person does not answer you or respond to your attempts to wake him, check
to see if he is breathing. Your aim is to keep the casualty alive until medical help
arrives. Do not waste time dealing with minor injuries until all casualties have
been found and stabilized. If the person is not breathing, try to find someone
nearby who is able to do artificial respiration until help gets there. If the casualty
is bleeding severely, apply a pressure bandage before moving to the next
casualty. Remember, time is valuable. Give first aid for life- threatening
conditions quickly and go to the next casualty.

HOW TO ASSES SITUATIONS?

 NON-RISKY SITUATION
 Package casualties wherever possible
 Evacuate casualties with stretchers
 Ensure comfort or minimize the suffering of the casualties
 EMERGENCY OR RISKY SITUATION
 No stretchers or time to construct improvised stretchers
 The casualty must be removed quickly due to potential dangers.
 Do not attempt to rescue if your own life is in danger.

FACTORS AFFECTING THE METHODS USED

 Type and severity of the injuries

 Casualty’s status
 Conscious
 Unconscious
 Weight of the casualty
  Availability of rescuers
 Distance and route

Classification of Casualties

All casualties who require treatment can be broadly classified under three main headings:

(a) Walking Injured;

(b) Slightly Injured Casualties; and
(c) Seriously Injured Casualties.

Walking Injured - the term is self explanatory but the following are examples of some types of
casualties who should not be allowed to walk:

(a) if there is a marked degree of shock;

(b) if there is the slightest risk of internal injuries;
(c) casualties who have bled or are bleeding from an artery, even a small wound; and
(d) casualties who have head wounds even though they may appear to be slight.

Slightly Injured Casualties - are those whose injuries require that they must be evacuated for
further treatment, but the nature of the injury does not necessitate the use of a stretcher
allowing evacuation to be affected by other means. Two examples of slightly injured casualties
are:

(a) cases of serious shock; and

(b) casualties with an injury to a lower limb unless it is only a slight flesh wound.

Seriously Injured Casualties - are those who will require hospital treatment. A few examples of
seriously injured casualties are:

(a) all cases of internal haemorrhage; open wounds of the chest; shattered limbs; grossly
lacerated and crushed limbs; wounds of the stomach; open complicated fractures: fractures of
the skull, spine, pelvis and thigh; injuries involving the eye; injuries involving the lower jaw and
control of the tongue;

(b) cases of external hemorrhage and multiple or extensive burns;

(c) cases in which further shock is likely to develop, as with persons trapped for long periods
under debris or exposed to cold and wet; in fact, all but those with trivial injuries or who are
merely shaken, frightened or faint, not forgetting that very small external wounds may well be
associated with damage beneath the surface; and
(d) all diabetic patients who may be injured or who are suddenly taken ill.

NOTE: It should be noted that serious injuries will not always provide highly visible symptoms
or signs, and that careful casualty checks must be carried out.

There are several pointers that must be carried out during transfer. These are necessary to
ensure the safety of the victim and to avoid complications.

 The casualty’s airway should stay open.

 If there is bleeding, it should be controlled.
 The casualty must maintain an accurate position.
 There should be regular monitoring of the condition of the casualty.
 The supporting bandages and dressing should stay in place and remain effectively
applied.
 The chosen transfer method is secure, comfortable and prompt as the situation allows.
 The body of the patient is transferred as one unit.
 The head side of the casualty must be carried by taller first aiders.
 First Aiders must observe ergonomics in the carrying and transferring of the casualty.

METHODS IN HANDLING CASUALTIES

Single Rescuer Human Crutch

For this method to work, the casualty must be conscious and capable of giving the rescuer
some assistance. Illustration below clearly indicates how the single rescuer human crutch is
effected. Note the position of the rescuer's hands, one holding the casualty's wrist and the
other taking a firm grip of the clothes at the waist on the far side of the body. The injured side
of the casualty should be closest to the rescuer.

Pick-a-Back

This is an effective method when conducted correctly. When the casualty has been loaded (he
must be conscious) care should be taken to ensure that he is supported well up on the rescuer's
hips and his body literally draped across the rescuers back (a). Notice in Figure b, where the
casualty is incorrectly positioned, that the rescuer is off balance and likely to fall.

One Person Pack-Strap Carry

This method is better for longer distances to lift a victim safely.

 Place both the victim's arms over your shoulders.

 Cross the victim's arms, grasping the victim's opposite wrist.
 Pull the arms close to your chest.
 Squat slightly and drive your hips into the victim while bending slightly at the waist.
 Balance the load on your hips and support the victim with your legs.

Firefighter's Crawl

This is an invaluable method where a casualty has to be removed from a burning building.
As you can see in Figure below, both rescuer and casualty have their heads low down where the
clearest and coolest air is to be found if the building is on fire. It can also be appreciated that
the entire weight of the casualty does not have to be supported by the rescuer.

The hands should be crossed over and tied with a bandage or similar. The firefighter's crawl
method can be varied according to personal preference. An alternative method is for the
rescuer to place an arm, shoulder and head through the casualty's arms.

Tied-Hands Crawl

The tied-hands crawl may be used to drag an unconscious casualty for a short
distance. It is particularly useful when you must crawl underneath a low structure,
but it is the least desirable because the casualty's head is not supported.

Use a triangular bandage, a torn shirt, etc to tie the casualty's hands together and
place them around your neck. This way you can move a person much heavier than
yourself.

One Person Arm Carry

Single rescuer to lift a victim safely by arm carries. Rescuer holding the victim around
the victim’s back and under the knees.

Fire Man Carry

This technique is for carrying a victim longer distances. It is very difficult to get the
person up to this position from the ground. Getting the victim into position requires
a very strong rescuer or an assistant.
 The victim is carried over one shoulder.
 The rescuer's arm, on the side that the victim is being carried, is wrapped
across the victim's legs and grasps the victim's opposite arm.

Ankle Pull

The ankle pull is the fastest method for moving a victim a short distance over a
smooth surface. This is not a preferred method of patient movement.

• Grasp the victim by either ankles or pant cuffs.

• Pull with your legs, not your back.
• Keep your back as straight as possible.
• Try to keep the pull as straight and in-line as possible.
• Keep aware that the head is unsupported and may bounce over bumps and
surface imperfections.
Shoulder Pull

The shoulder pull is preferred to the ankle pull. It supports the head of the victim.
The negative is that it requires the rescuer to bend over at the waist while pulling.

• Grasp the victim by the clothing under the shoulders.

• Keep your arms on both sides of the head of Support the head.
• Try to keep the pull as straight and in-line as possible.

Two Rescuer Human Crutch

The arms of the rescuers cross over on the casualty's back and grasp the clothing on the
opposite sides of his body.
Two Handed Seat

This technique is for carrying a victim to the longer distances and can support an
unconscious victim.
 Pick up the victim by having both rescuers squat down on either side of
the victim.
 Reach under the victim's shoulders and under their knees.
 Grasp the other rescuer's wrists.o From the squat, with good lifting
technique, stand.
 Walk in the direction that the victim is facing.

Three handed seat

This method gives the casualty good support and is reasonably comfortable for the
rescuers. It has the added advantage that the two rescuer team has a spare hand
for steadying.
• One rescuer grasps his left wrist with his right hand and the second rescuer
places his hand and wrist. This forms a seat.
• If the casualty is capable of standing for a short period he can be loaded by
placing the seat under his buttocks, but if not, the rescuers' hands must be
placed under the casualty's knees first and then joined up. Four Handed Seat
 Four Handed Seat

This technique is for carrying conscious and alert victims to moderate

distances. The victim must be able to stand unsupported and hold
themselves upright during transport.

• Position the hands as indicted in the graphic.

• Lower the seat and allow the victim to sit.
• Lower the seat using your legs, not your back.
• When the victim is in place, stand using your legs, keeping your back
straight.

The Fore and Aft Method

This is perhaps the most suitable way in which two rescuers can handle an unconscious
casualty.

• The casualty is prepared in the same way as for the removal down stairs method ie, the
wrists are tied together.
• The first rescuer stoops at the rear of the casualty. Reaching under the casualty's arms,
the first rescuer grips the casualty's wrists.
• The second rescuer stoops between the casualty's legs grasping them underneath the
knees. The standard lift orders are given and the casualty is lifted to the carrying
position (a). Should the casualty have a leg injury, the effects of this can be minimized by
the front rescuer crossing the casualty's legs over, then carrying them to one side as in
Figure b.
• The advantage of this method is that the rescuer supporting the casualty's feet has a
free hand with which to open doors, clear debris, etc.
• It is again stressed that the foregoing one and two rescuer techniques are generally
confined to emergencies where removal from the scene is the first priority.
 •

Three Person Carry

This technique is for lifting a patient into a bed or stretcher, or for transporting to short
distances
 Each person kneels on the knee nearest the victim's feet.
 On the command of the person at the head, the rescuers lift the victim up and rest the
victim on their knees.

Initial Triage or Tagging

Triage pertains to the sorting of patients in priority categories for care and
transport. The category is based on how severe the injuries are and if they are
considered medical emergencies. Patient tags are as follows:

 Priority 1 (RED tag): life-threatening conditions; considered the worst

(requires immediate transfer)
 Priority 2 (YELLOW tag): can wait for up to an hour
 Priority 3 (GREEN tag): wounded but can walk
 Priority 4 (BLACK tag): dead