Patient Packaging

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:

• Must be able to monitor injury or illness
  • Assess CSMs, Vital Signs, Mental Status, access O2, IV, IO if needed
• Protect patient from environment
  • Heat, Cold, Moisture, Wind
• Communication with patient must be maintained
• Secure patient from movement along linear and horizontal axis
• Protect patient from soft tissue injuries secondary to transport
• Pad patient in all directions to avoid movement with transport
• Create a sleek, compact package to avoid carries for hand transport and to avoid damage to helicopters and crew for air-evacuation.

 

Equipment:

Stretcher/Litter Types: 

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

 

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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.

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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.

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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. 

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.