a. SML - You will be tested later in the course by written and performance evaluations on this period of instruction.

b. SMO - You will be evaluated by an oral exam and a performance exam on T- 11.

TRANSITION: Are there any questions over the purpose, learning objectives, how the class will be taught, or how you will be evaluated? Any disabled Marine requiring Casevac must be treated with basic first aid, along with considerations in conducting the actual evacuation properly.


1. (5 Min) GENERAL CONSIDERATIONS The general considerations are a set of guidelines that can be used no matter how serious the casualty is. They are remembered by a simple acronym, A PASS NGG.

a. Apply Essential First Aid. (i.e. splints, pressure bandage, etc.)

b. Protect the Patient from the Elements. Provide the casualty with proper insulation from the ground. Ensure that he is warm and dry. If there are any natural hazards (i.e. rock fall, lighting, etc.) either move the casualty as quickly as possible or ensure that he is well protected.

c. Avoid Unnecessary Handling of Patient.

d. Select Easiest Route. Send scouts ahead if possible, to break trails.

e. Set Up Relay Points and Warming Station. If the route is long and arduous, set up relay points and warming stations with minimum amount of medical personnel at warming stations to:

(1) Permit emergency treatment. Treat for shock, hemorrhage, or other conditions that may arise.

(2) Reevaluate the patient constantly. If patient develops increased signs of shock or other symptoms during the evacuation, he may be retained at an emergency station until stable.

f. Normal Litter Teams Must Be Augmented in Arduous Terrain.

g. Gi ve Litter Teams Specific Goals. This litter teams job is extremely tiring, both physically and mentally. The litter teams must be given realistic goals to work towards.

h. Gear. Ensure all of the patient's gear is kept with him throughout the evacuation.

TRANSITION: Now that we have covered the considerations, are there any questions? The basic carries that are taught in the EST manual (fireman's carry, two-hand, four-hand, and the poncho litters) are still viable of transporting an injured man; however, we need to know a few more that can aid us during a medevac.

2. (10 Min) EXPEDIENT LITTERS. There are five types of expedient litters that we will talk about. They are the sling rope carry, rope coil carry, pole carry, the alpine basket and the poncho litter.

a. Sling Rope Carry. The sling rope carry requires two men and a 15-foot sling rope. One as the bearer, and an assistant to help in securing the casualty to the bearer. Conscious or unconscious casualties my be transported in this manner:

(1) Bearer kneels on all fours and the assistant places casualty face down on bearer's back ensuring the casualty's armpits are even with the bearer's shoulders.

(2) He then finds the middle of the sling rope and places it between the casualty's shoulders and the ends of the sling rope are run under the casualties armpits, crossed and over the bearer's shoulders and under his arms.

(3) Then the ropes are run between the casualty's legs, around his thighs, and tied with a square knot with two overhands just above the bearer's belt buckle.

(4) Ensure the rope is tight. Padding, when available, should be placed where the rope passes over the bearer's shoulders and under the casualties thighs. SLING ROPE CARRY

b. The Rope Coil Carry. This requires a bearer and a , rope coil. It can be used to carry a conscious or unconscious casualty.

(1) Position the casualty on his back.

(2) Separate the loops of the mountain coil into two approximately equal groups.

(3) Slip / of the coil over the casualty's left leg and / over his right leg so that the wraps holding the coil are in the casualty's crotch, the loops extending upward the armpits.

(4) The bearer lies on his back between the casualty's leg and slips his arms the loops. He then moves forward until the coil is extended. When using the rope coil the bearer ties the coil to himself vice slipping his arms through the loops.

(6) Holding the casualty's wrists, the bearer carefully stands, using his legs to lift up and keeping his back as straight as possible.

NOTE: The length of the coils on the rope coil and the height of the bearer are to be considered. If the coils are too long and the bearer happens to be a shorter person, it will require the coils to be uncoiled and shortened. If this is not done, then the casualty will hang too low on the bearer's back and make it a very cumbersome evacuation. A sling rope harness can be used around the victim's back and the bearer's chest, which will free the bearer's hands.

c. Pole Carry. The pole carry method is a field expedient method and should be considered as a last resort only, when narrow ledges must be traversed; vegetation limits the bearers to a narrow trail. This method is difficult for the bearers and uncomfortable for the casualty. Two bearers, four sling ropes and a 12 foot pole - 3 inches in diameter, are required for this carry.

(1) The casualty is placed on his back in a sleeping bag or wrapped in a poncho or blanket, then placed on an insulated pad.

(2) One sling rope is placed under the casualty below the armpits and tied with a square knot across the casualty's chest.

(3) The second sling rope is tied in the same manner at the casualty's waist.

(4) The third sling rope is placed at the casualty's legs below the knee.

(5) The fourth sling rope is tied around the ankles.

(6) The pole is placed along the casualty's length and secured using square knots with two overhands with the ends of the sling ropes. The square knots should be so tight that the overhands are tied onto themselves

(7) The casualty should hang below the pole, as close to the pole as possible, to prevent swinging during movement.

(8) The casualty's head may be supported using a triangular bandage or a cartridge belt passed around the pole.

(9) For additional support and of movement, two additional bearers may be required, as well as a mountain coil.

(a) Mountain coil is split into two equal coils.

(b) Place knot of mountain coil under casualty's lower back.

(c) Additional bearers slip into each half of the hasty coil one on each side of casualty, aiding in support and movement of the casualty.

d. Alpine Basket. To belay the alpine basket, the pre-rigs are attached to the bights formed coming through the loops.

(1) If barrow boy is to be used, the procedure previously discussed will be adhered to.

(2) If barrow boy is not used, then a tag line from the bottom must be implemented to keep the casualty away from the cliff face on the decent.

(3) Construction of the Alpine Basket:

(a) Start by making the same amount of bights as in the rope litter, but start from one end and tie a figure-of-eight loop to run the first bight through.

(b) Place padding i.e., isopor mat, on top of the bights and then lay the casualty on the padding and bights.

(c) Start at the casualty's feet and pull the first bight up around the casualty's ankles and through the figure-of-eight loop tied into the starting end of the rope.

Rope Basket Litter Evacuation

(d) Go to the opposite side of the casualty and pull up the second bight and pull it through the loop formed by the bight that was pulled through the figure-of-eight.

(e) Continue until you get to the casualty's armpits, bring the second to the last bight up over the casualty's shoulder and into the bight and then bring the last bight up over the casualty's other shoulder and into the last bight formed.

(f) Secure the last bight with a round turn and two half hitches leaving a big enough bight to tie a figure eight at the end.


e. Poncho Litter. A poncho, poncho liner, bivy bag or similar piece of material may be used. In addition you will need six individuals with sling ropes.

Lay poncho litter flat on the ground.

(2) Select six rocks about the size of a golf ball. Place one rock in each of the corners and one in the middle on each side in the middle of the litter. The rocks are placed on the under side of the poncho or like material. If a bivy bag is used the casualty should be zipped inside the bivy bag. The rocks should then be arranged in the same manner only on the inside below the zipper.

(3) Tie the sling rope together with an overhand knot. Take the middle of the rope and secure it around the rock with a clove hitch.

(4) An isomat may be laid on the poncho to help make the litter firmer.

(5) The casualty is then placed in the litter. The sling ropes are adjusted by feeding the pigtails of the over hand knot through itself to adjust for length. The loop is then put over the inboard shoulder of the carriers. Insure that the casualty is carried level.

TRANSITION: Are there any questions over the expedient litters? For casualties with more serious injuries, or causalities that may occur in moderate to vertical terrain a more ridged litter may need to be employed.

3. (10 Min) LITTERS. There are two kinds of litters that are used for casualty evacuations in moderate to vertical terrain. The SKED litter and the Stokes litter. Each has a variation of procedures for securing a casualty and rigging the litters for either raising or lowering. Let's first look at the SKED litter.

a. SKED Litter. The SKED litter is constructed of thin foam padding, straps and grommets.

(1) Securing a Casualty to the SKED

(a) First unroll the litter. The litter must be re-rolled the opposite way to allow the litter to lay flat. Then lay the litter next to the casualty.

(b) If the casualty has any possibility of a spinal injury the Oregon Spine Splint must be used. Secure the splint to the casualty by use of the color-coded buckles. Experienced medical personal are recommended if spinal immobilization is necessary.

(c) Once the casualty is on the SKED use the four body straps to secure the casualty to the litter. Unless injuries prevent, the casualty's arms should be at his sides to prevent further injuries to himself or the rescuers.

(d) Once the casualty is secured with the body straps the feet straps must be secured. The feet straps are secured last to ensure the casualty is in the proper position on the SKED. The feet can be positioned in three ways. The first position is feet together with the straps running on the outside of the feet. The second position is feet apart with the straps running on the inside of the feet. The last position is the feet stacked. This is the most uncomfortable position and not recommended for casualties with possible spinal cord injuries. This position is formed by placing the heel of one foot on top of the toes of the other. This position will only be used for a casualty in confined spaces. Once the feet are positioned the feet straps must be secured. Start by bending the feet end of the SKED to form a plat form for the feet. Then loop the feet straps through the second grommets on each side.

(e) The last thing to do is to form the head end to protect the casualty's head. If possible the casualty should wear a helmet. Form the head end tying the pull strap up and secure it to the first body straps.

(2) Casevacing a Casualty. There are many ways to move a casualty once in the SKED. However the medevac team must keep the general considerations in mind. The two methods that we will talk about next are the simplest and require the least amount of additional rigging

(a) The first way is to drag the casualty by the drag strap located at the head end of the SKED. You can also use the SKED's carrying bag as a harness in conjunction with the pull strap and towing harness. If additional people are required, cordage can be added to the pull strap or the front carrying handles.

(b) The second way is to carry the casualty using the carrying handles. By using the set of four removable webbing the litter team can be augmented. To do this each pieces of webbing is tied to make an endless loop. Then pass a bight of the loop through one of the grommets to create additional handles.

(3) Rigging the SKED for Vertical Terrain and Helicopter Lift. In this type of terrain special requirements must be taken to raise or lower a casualty in the SKED.

(a) Rigging the SKED for a Vertical Employment. A vertical raise or lower is used when moving a casualty on steep earth to avoid any further injury to the casualty. On vertical terrain the vertical raise or lower can be used if the terrain is not uniformed or there is a chance of rock fall. Ensure that the casualty's head is always above his feet.

1 Identify the 30-foot piece of cordage that comes with the SKED. Then tie a figure eight in the middle of the rope. If the rope is worn or missing, the same process can be done with two sling ropes.

2. Next pass each end of the rope through the grommets at the head of the SKED. Leaving approximately 1-2 feet of rope between the stretcher and the knot.

3. Continue to feed each end through the grommets and the carrying handles towards the foot end of the SKED. Pass the ends of the rope through the last grommets at the foot end and secure the two ends with a square knot without over hands.

4. Bring the pigtails up and over the casualty's feet and pass the ends through the a carrying handles towards the middle of the casualty. Then tie a square knot b with two over hands.

(4) Rigging the SKED for a Horizontal Employment. A horizontal raise or lower is preferred on uniformed vertical terrain. The horizontal employment allows the rescuer to assist the casualty on either a raise or lower. It also allows the rescuer the ability to monitor the casualty's condition and can easily treat the casualty if the need arises.

(a) Identify the two 4 inch nylon straps. They should be two lengths; one four inches shorter than the other. The shorter strap should be marked HEAD STRAPS.

(b) Insert one end of the head strap into a slot near the head of the litter. Then wrap the rest of the straps under the SKED and pass the other end through the opposing slot. Do the same at the foot end of the SKED with the other strap. Ensure that the strap runs smoothly under the SKED.

(c) Connect the strap ends with the large locking carabiner that comes with the SKED. If the carabiner is worn or missing, opposing stubai 85 locking carabiners will suffice.

b. Stokes Litter. The stokes litter is a litter that is constructed of metal tubing with a plastic covering. The litter is formed in a rectangular basket shape with mesh attached to the frame. Using the stokes for an evacuation (as with any evacuation) it should be padded for the casualty.

(1) Securing the casualty to the stokes litter. In the event that the "seat belts" are missing from the stokes litter, sling ropes can be used to the lash the casualty. The steps involved are:

(a) Tie two sling ropes together using square knots and two overhands.

(b) Tie a stirrup hitch around ankles and feet, feed the two pigtails through the right angles of the stokes. Do not cross the ropes at the ankles.

(c) Lace the sling rope towards the casualty's head by passing the rope through the right angles (not over the top of the rails of the stokes).

(d) Secure the ends of the sling ropes by tying a clove hitch with two half hitches on the thick vertical bar located by the victim's shoulder.

TRANSITION: Know that we have talked about the two different litters, let us now discuss how to attach a belay line to the litter.

6. (5 Min) YOSEMITE PRE-RIG. The title of this method, pre-rig implies the meaning ready to use, but in this case the rig must be constructed. Its purpose is for attaching a belay line to a litter and to make the litter easily adjusted. This is the one method that is used to secure a litter to a belay line.

a. Construction. This method normally requires four sling ropes. The steps are: (1) Using one sling rope, tie a figure-of-eight loop with one tail.

(1) Take the remaining tail and run it through the window of the stokes litter or in the stirrups of the collapsible litter.

(2) Tie a kragur knot onto the same sling rope.

(3) Repeat steps (1), (2), and (3) with the three remaining sling ropes.

(4) Suspend the litter to ensure that the comers are balanced.

TRANSITION: Now, let's cover the ways to make descents and the belaying methods.

7. (10 Min) ASCENTS OR DESCENT OVER STEEP TO MODERATE SLOPES. When the litter team is ascending or descending a slope they must consider the potential for further injury to the casualty or to themselves. If the risk of injury is high a belay line may be used to prevent injury to the casualty and the rescuers.

a. Preparing Casualty for Ascents or Decent over Steep to Moderate Terrain. This procedure will be depending on several things. Initially, site selection should contain the following features.

(1) Suitable anchor points.

(2) Clearance for casualty along the route

(3) Loading and unloading points.

b. Additional considerations.

(1) The casualty will always be rigged for vertical employment when on steep to moderate terrain.

(2) The smoothest possible route must be selected.

(3) Ensure that the casualty's head is above his feet.

c. Rescuers positions. There are two methods that can be used for the rescuers for moving a casualty in steep to moderate terrain.

(1) Two to four men will position themselves on each side of the litter. They can then carry the litter by the carrying handles. In steep terrain a second belay line may be used to assist the rescuers. We will discuses the belay line later in the chapter.

(2) The Caterpillar method will require as many personnel as possible. The personnel will split in half and position themselves on each side of the litter forming a tunnel. As the litter is raised or lowered each member will hand the litter to the next member in the tunnel. As the litter passes each person in the tunnel he will peel off and assume the lead either at the top or bottom of the tunnel. This will continue until the litter reaches its desired destination.

d. Belay Line. For belaying of a casualty, one rope will be used and from the top using one of two methods depending on the application.

(1) Body Belay. This method should only be used over moderate terrain. The belay man will establish a sitting position behind a suitable anchor (i.e., rock, tree, etc.) and pass the standing end of the rope behind his back. The running end of the rope will feed out from the belay man's right side. A figure of eight loop is tied to the end of the running end of the rope. It is then attached to the litter's figure eight loop with a locking carabiner. The belay man will then remove all of the slack between himself and the litter. The standing end of the rope should be stacked on the belay man's left side and run through his left side. As the casualty is lowered, the belay man will feed the rope from behind his back allowing it to run through his right hand. If the belay man needs to stop the casualty, he will clench the rope in his left hand, and bring the rope to the center of his chest.

(2) Direct Belay. This method is the safest for either raising or lowering a casualty in either moderate to steep terrain.

(a) To Lower a Casualty. First a swami wrap will be tied around a suitable anchor point. Two locking carabiners will be clipped into all of the wraps of the swami wraps, gates up. A figure of eight loop is tied into the end of the static rope and attached to the litter with a locking carabiner. After all the slack has been taken up between the litter and the anchor, the rope must be tied through an appropriate belay device. The belay device is attached to the anchor through one of the two locking carabiners on the anchor. A safety (French) prussic will be tied to the running end of the rope and clipped into the second locking carabiner on the anchor. While the casualty is being lowered, one person will control the rope running through the belay device. The safety prussic will be controlled by a second person. Should the primary belay man lose control, the person operating the safety prussic simply lets go and the prussic will bind onto the rope, stopping the casualty.

(b) To Raise a Casualty. The anchors will be established in the same manner as discussed in lowering the casualty with one minor change. The one change is that instead of running the rope through a belay device, the rope will only run through a locking carabiner. The load will be raised by the use of a mule team. The mule must consist of as many people as possible. The mule team will raise the load in as straight a line from the anchor as possible. If the space does not permit a ninety-degree angle away from the anchor is also an option. The mule team will walk backward until the last man reaches his limit of advance. Once he reaches that limit he will peel off the end and return to the front of the mule team. This process is continued until the casualty reaches the top. If the load becomes unmanageable, the safety prussic will be allowed to bind on the rope while the mule team repositions themselves. If the person operating the safety prussic can not see the casualty a Point NCO will be in charge of communicating with the mule team.

(c) To Belay the Rescuers. If the route is too steep or the footing is poor the rescuers may need some assistance either on the raising or lowering of a casualty. If this is the case a separate belay line will be established for the rescuers. The anchor and the belay line are established in the same manner. The same anchor can be used if it is suitable for the load. The rescuers will then tie either around the chest bowlines or swami wraps. A figure eight loop will be tied into the end of the static rope and connected to the bottom rescuer with a locking carabiner. The other rescuers will connect themselves to the same rope with middle of the line prussic. They will be connected in this manner so that they can adjust their position to the casualty.

8. (7 Min) BARROW BOY. A barrow boy is no more than an assistant to the litter on vertical to near vertical cliff faces. The barrow boy can be used for either the Stokes or the SKED litters. For this situation the Stokes litter should only be used in the horizontal position. However the SKED can be employed in either the horizontal or the vertical positions.

NOTE: For safety purpose at MWTC, two ropes will be utilized. a. Rigging the Barrow Boy.

(1) First the rescuer must ensure that a suitable anchor has been established, a proper belay has been constructed, and that a safety prussic has been constructed.

(2) Then the rescuer must ensure that if an A-frame is used that it has been constructed and anchored properly.

(3) Next the rescuer will tie a rappel seat on. ( a sit harness can also be used ) Then he will ensure that an around the body bowline is tied onto the casualty. A figure eight will be tied on to the end to act as the casualty's safety.

(4) Then after running the running end of the rope though the carabiners or pulley of the A-frame he will tie a figure eight loop at the end of the static rope. He will then attach the figure eight loop to his hard point with a locking carabiner. Then he will tie a middle of the line prussic above the figure eight and attach it to the same locking carabiner in his hard point. This is called the adjustment prussic. It is used to adjust the position of the Barrow Boy in relation to the litter. Next he will take six to eight feet of slack from the end of the line figure eight and tie a directional figure of eight with direction of pull down. (Note: the prussic should be between the end of the line figure of eight and the directional figure of eight.) The directional figure of eight is the attaching point for the litter and the casualty's safety.

(5) Once the rescuer and the litter are secured, the belay man must take all the slack out of the system. The rescuers will the maneuver the litter through the apex of the Aframe with the help of the point NCO.

(6) Once onto the cliff face the rescuer will then position him self with his adjustment prussic so that he can be of most assistance to the litter on the raise or lower. The rescuer will pull the litter out away from the cliff face so that the casualty rides smoothly up or down the cliff face.

(7) The Point NCO will be in charge of the belay men or the mule team. He will also communicate with the rescuer about the rate of speed, if the rescuer need to be stopped along the route, and when he reaches the top or bottom of the cliff.

9. (5 Min) TANDEM LOWERING. The tandem lowering system can be used for the walking wounded, POW's, or more serious casualties when situation would not permit using the barrow boy.

NOTE: For safety purposes at MWTC, two ropes will be utilized.

a. The assistant to the casualty should first tie a rappel seat on himself and then assist the casualty with his.

b. The assistant will take two belay lines and tie a end of the line figure 8 loop, and clip this into his rappel seat.

c. A directional figure 8 will be tied approximately 12 inches up the rope from the figure 8 loop (with the loop pointed down) and this will be clipped to the casualty's rappel seat.

d. If needed, adjustment prussic cords should be tied above the casualty's directional figure 8. These adjustment cords should be attached in the same manner as the first man down a rappel.

e. The casualty and the assistant will lower as one, with the assistant helping on the way down the cliff.

10. (3 Min) OTHER CONSIDERATIONS. All of the techniques we have discussed for the evacuation of a casualty from top to bottom can also be used on a suspension traverse or rope bridge, with a slight variation in the belay line. Two belay lines may be used for rope bridges and the suspension traverse, if they are available. No matter what type of litter is used, the individuals involved in the evacuation must ensure that the head is always uphill or not lower than the feet.

TRANSITION: What we have just covered are other considerations for Casevac, are there any questions.

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