Wilderness Medicine, First Aid, and Outdoor Skills
Transportation of Casualties

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

Transportation of Casualties

B-8. Transportation of Casualties

a. Transportation of the sick and wounded is the responsibility of medical personnel who have been provided special training and equipment. Therefore, unless a good reason for you to transport a casualty arises, wait for some means of medical evacuation to be provided. When the situation is urgent and you are unable to obtain medical assistance or know that no medical evacuation facilities are available, you will have to transport the casualty. For this reason, you must know how to transport him without increasing the seriousness of his condition.

b. Transporting a casualty by litter (FM 8-35) is safer and more comfortable for him than by manual means; it is also easier for you. Manual transportation, however, may be the only feasible method because of the terrain or the combat situation; or it may be necessary to save a life. In these situations, the casualty should be transferred to a litter as soon as one can be made available or improvised.

B-9. Manual Carries (081-831-1040 and 081-831-1041)

Casualties carried by manual means must be carefully and correctly handled, otherwise their injuries may become more serious or possibly fatal. Situation permitting, evacuation or transport of a casualty should be organized and unhurried. Each movement should be performed as deliberately and gently as possible. Casualties should not be moved before the type and extent of injuries are evaluated and the required emergency medical treatment is given. The exception to this occurs when the situation dictates immediate movement for safety purposes (for example, it may be necessary to remove a casualty from a burning vehicle); that is, the situation dictates that the urgency of casualty movement outweighs the need to administer emergency medical treatment. Manual carries are tiring for the bearer(s) and involve the risk of increasing the severity of the casualty's injury. In some instances, however, they are essential to save the casualty's life. Although manual carries are accomplished by one or two bearers, the two-man carries are used whenever possible. They provide more comfort to the casualty, are less likely to aggravate his injuries, and are also less tiring for the bearers, thus enabling them to carry him farther. The distance a casualty can be carried depends on many factors, such as--

  • Strength and endurance of the bearer(s).

  • Weight of the casualty.

  • Nature of the casualty's injury.

  • Obstacles encountered during transport.

a. One-man Carries (081-831-1040).

    (1) Fireman's carry (081-831-1040). The fireman's carry (Figure B-1) is one of the easiest ways for one person to carry another. After an unconscious or disabled casualty has been properly positioned, he is raised from the ground. An alternate method for raising him from the ground is illustrated (Figure B-1 I). However, it should be used only when the bearer believes it to be safer for the casualty because of the location of his wounds. When the alternate method is used, take care to prevent the casualty's head from snapping back and causing a neck injury. The steps for raising a casualty from the ground for the fireman's carry are also used in other one-man carries.

    Figure B-1 Fireman carry.

    (2) Support carry (081-831-1040). In the support carry (Figure B-2), the casualty must be able to walk or at least hop on one leg, using the bearer as a crutch. This carry can be used to assist him as far as he is able to walk or hop.

    (3) Arms carry (081-831-1040). The arms carry is used when the casualty is unable to walk. This carry (Figure B-3) is useful when carrying a casualty for a short distance and when placing him on a litter.

    (4) Saddleback carry (081-831-1040). Only a conscious casualty can be transported by the saddleback carry (Figure B-4), because he must be able to hold onto the bearer's neck.

    (5) Pack-strap carry (081-831-1040). This carry is used when only a moderate distance will be traveled. In this carry (Figure B-5), the casualty's weight rests high on the bearer's back. To eliminate the possibility of injury to the casualty's arms, the bearer must hold the casualty's arms in a palms-down position.

    (6) Pistol-belt carry (081-831-1040). The pistol-belt carry (Figure B-6) is the best one-man carry when the distance to be traveled is long. The casualty is securely supported by a belt upon the shoulders of the bearer. The hands of both the bearer and the casualty are left free for carrying a weapon or equipment, climbing banks, or surmounting obstacles. With his hands free and the casualty secured in place, the bearer is also able to creep through shrubs and under low hanging branches.

    (7) Pistol-belt drag (081-831-1040). The pistol-belt drag (Figure B-7) and other drags are generally used for short distances. In this drag the casualty is on his back. The pistol-belt drag is useful in combat. The bearer and the casualty can remain closer to the ground in this drag than in any other.

Adjust/Extend Two Pistol Belts (Or Three, If Necessary) Or Similar Objects To Their Full Length And Join Them Together To Make One Loop. Roll The Casualty Onto His Back. Pass The Loop Over The Casualty's Head And Position It Across His Chest And Under His Armpits; Then Cross The Remaining Portion Of The Loop, Thus Forming A Figure Eight. Keep Tension On The Belts So They Do Not Become Unhooked. Lie On Your Side Facing The Casualty, Resting On Your Elbow. Slip The Loop Over Your Arm And Shoulder That Your Leaning On And Turn Away From The Casualty Onto Your Abdomen, Thus Enabling You To Drag The Casualty As You Crawl.

    (8) Neck drag (081-831-1040). The neck drag (Figure B-8) is useful in combat because the bearer can transport the casualty when he creeps behind a low wall or shrubbery, under a vehicle, or through a culvert. This drag is used only if the casualty does not have a broken/ fractured arm. In this drag the casualty is on his back. If the casualty is unconscious, protect his head from the ground.

    (9) Cradle drop drag (081-831-1040). The cradle drop drag (Figure B-9) is effective in moving a casualty up or down steps. In this drag the casualty is lying down.

b. Two-man Carries (081-831-1041).

    (1) Two-man support carry (081-831-1041). The two-man support carry (Figure B-10) can be used in transporting both conscious or unconscious casualties. If the casualty is taller than the bearers it may be necessary for the bearers to lift the casualty's legs and let them rest on their forearms.

    Figure B-10 Two-man Support Carry ( Illustration A and B)

    (2) Two-man arms carry (081-831-1041). The two-man arms carry (Figure B-11) is useful in carrying a casualty for a moderate distance. It is also useful for placing him on a litter. To lessen fatigue, the bearers should carry him high and as close to their chests as possible. In extreme emergencies when there is no time to obtain a board, this manual carry is the safest one for transporting a casualty with a back/neck injury. Use two additional bearers to keep his head and legs in alignment with his body.

    (3) Two-man fore-and-aft carry (081-831-1041). The fore-and-aft carry (Figure B-12) is a most useful two-man carry for transporting a casualty for a long distance. The taller of the two bearers should position himself at the casualty's head. By altering this carry so that both bearers face the casualty, it is also useful for placing him on a litter.

    (4) Two-hand seat carry (081-831-1041). The two-hand seat carry (Figure B-13) is used in carrying a casualty for a short distance and in placing him on a litter.

    (5) Four-hand seat carry (081-831-1041). Only a conscious casualty can be transported with the four-hand seat carry (Figure B-14) because he must help support himself by placing his arms around the bearers' shoulders. This carry is especially useful in transporting the casualty with a head or foot injury and is used when the distance to be traveled is moderate. It is also useful for placing a casualty on a litter.

B-10. Improvised Litters (B-17) (081-831-1041)

Two men can support or carry a casualty without equipment for only short distances. By using available materials to improvise equipment, the casualty can be transported greater distances by two or more rescuers.

a. There are times when a casualty may have to be moved and a standard litter is not available. The distance may be too great for manual carries or the casualty may have an injury, such as a fractured neck, back, hip, or thigh that would be aggravated by manual transportation. In these situations, litters can be improvised from certain materials at hand. Improvised litters are emergency measures and must be replaced by standard litters at the first opportunity to ensure the comfort and safety of the casualty.

b. Many different types of litters can be improvised, depending upon the materials available. Satisfactory litters can be made by securing poles inside such items as blankets, ponchos, shelter halves, tarpaulins, jackets, shirts, sacks, bags, and bed tickings (fabric covers of mattresses). Poles can be improvised from strong branches, tent supports, skis, and other like items. Most flat-surface objects of suitable size can also be used as litters. Such objects include boards, doors, window shutters, benches, ladders, cots, and poles tied together. If possible, these objects should be padded.

c. If no poles can be obtained, a large item such as a blanket can be rolled from both sides toward the center. The rolls then can be used to obtain a firm grip when carrying the casualty. If a poncho is used, make sure the hood is up and under the casualty and is not dragging on the ground.

d. The important thing to remember is that an improvised litter must be well constructed to avoid the risk of dropping or further injuring the casualty.

e. Improvised litters may be used when the distance may be too long (far) for manual carries or the casualty has an injury which may be aggravated by manual transportation.

f. Any of the appropriate carries may be used to place a casualty on a litter. These carries are:

  • The one-man arms carry (Figure B-3).

  • The two-man arms carry (Figure B-11).

  • The two-man fore-and-aft carry (Figure B-12).

  • The two-hand seat carry (Figure B-13).

  • The four-hand seat carry (Figure B-14).

    Unless there is an immediate life-threatening situation (such as fire, explosion), DO NOT move the casualty with a suspected back or neck injury. Seek medical personnel for
    guidance on how to transport.

g. Either two or four soldiers (head/foot) may be used to lift a litter. To lift the litter, follow the procedure below.

    (1) Raise the litter at the same time as the other carriers/bearers.

    (2) Keep the casualty as level as possible.


Use caution when transporting on a sloping incline/hill.

Back to Appendix B: Rescue and Transportation Procedures

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