Terry O’Connor, MD

Generally speaking, patient packaging is the process of securing a patient for transport.  The technique is dependent on environment, available resources, type of rescue and number of rescuers as well as extraction plan. 

Below is a brief review, but if you’d like to learn more: join us for for some hands-on practice during one of our courses

Principles of Patient Packaging:



Stretcher/Litter Types: 

Fashioning improvised litter from skiis

Completely Improvised: Least desirable for rescue.  Principles of improvisation: should be padded well without pressure points, safe and secure for rescuers and patient, adjustable, sleek/non-bulky, protect patient from the environment.  Not recommended for a patient with a suspected spinal cord injury




Stokes litter with vacuum splint backboard
Sked device packaging with NPS SAR

Basket-Style Stretchers:  Include: Stokes, Ferno, Cascade, Scoop, others.  Often stainless steel or aluminum, may be rated for rope rescue, need to know this ahead of time.  Often collapsible, in half, for transport.  Often used with rescue teams.  Unrealistic for lightweight backcountry travel. May have additional equipment/accessories including skis, wheels, toboggan, harnesses systems, plastic shield for patient.

Back board and head blocks in cascade sled

Backboard:  Utilized for evacuation of patients with suspected spinal injuries.  Should be limited to only these situations and only for transport.  Risk of increasing pain and decubitus ulcers with extended duration of time on a backboard.  Should be well padded.  C-spine should be secured, ideally with a commercial c-collar, otherwise, an improvised c-collar.  Head blocks should be utilized.  Patients immobilized on their back should never be left alone.

Performing rescue lower with a rescue bubble tarp device

Other Stretchers:  several types of lightweight, mobile stretchers exist on the market, including nylon litters, the Sked Rescue Stretcher, the Brooks-Range Mountaineering Rescue sled, the Rescue Bubble, and others.  Advantages include being light-weight and collapsible and patients can often be slid over snowy or icy terrain.  Disadvantages include comfort, lack of rigidity, limitation on other terrain. 

Loading patient onto vacuum splint device

Vacuum Devices: utilize a hand or foot pump to extract the air from a bean-bag type mattress.  Advantages include: rigidity, warmth, patient comfort.  May be used for patients with suspected spinal injuries.  Disadvantages include losing integrity when the device is damaged.