.

Transport of Injured Person

Transporting a victim involves taking the victim to medical facility. This can be done by
stretchers, ambulance or by your own transport vehicle to some safer place where first aid and
medical help can be provided. It is crucial that the method is proper and movement is swift.

Methods of Transportation of a Victim

When a victim is to be transported, you must pick the best possible method to transfer.

There are many methods. The different methods are:-

1) STRETCHERS

Stretcher is most widely used device to transport/move victim who requires medical attention. It
is very comfortable as well as safe method. So let us learn about stretchers in detail. Stretchers
are of many types and they are carried by two or more persons. These are:

 Simple stretchers are the earliest type usually made of canvas put between two poles or
tube like frames. They are lightweight, portable and easy to handle.
 Folding stretcher, similar in design to the simple stretcher, and can be folded or
collapsed into a more compact smaller form for easier handling or storage.
 Scoop Stretcher is used for lifting victim with spinal cord injury or where stability is
important, for instance from the ground onto an ambulance. In this, one or both ends of
the stretcher are detached, the halves placed under the victim from either side and tied
back together
 Basket Stretcher or Rescue Basket, is designed to be used where there are obstacles to
movement or other hazard e.g., in confined spaces, on slopes. The person is strapped
into the basket and so it is very useful in search and rescue operations.
 Spinal Board Stretcher is a hard and flat plastic stretcher used to transfer the causality
with spinal injury, since spine needs to be kept straight. A head stabilizer is also included
to keep the head straight and stabilized.
 Sheet Stretcher is made of soft sheet or mattress of synthetic material. They are very
light weight and usually carried by more than two persons.
 Improvised Stretcher is made from available supplies when actual stretcher is not
available in emergency since unavailability of actual stretcher must not stop or delay the
rescue/movement of the casuality. A good first aid provider must know how to make
best use of available resources. Any possible thing available e.g. plank, door, cot, bed
sheet etc. can be used to move the victim.

Carrying a Stretcher: Carrying a casuality on stretcher needs a lot of coordination among

stretcher bearers (people carrying the stretcher). There can be 2 or 3 or 4 stretcher bearers.
Time is very important so movements must be swift with an eye on the vital signs, response
and well being of the causality. The stretcher should be carried in such a way that feet side
of victim should come first while transporting.
2) Ambulance:

It is a vehicle which is usually called to pick up the victim, provide further care and transport the
victim to the hospital. Road ambulance is the most widely used and least expensive mode of
transportation. It is easily available. It can provide emergency medical services to preserve life
during transport from site of emergency to the health care facility. It has various necessary
equipments and supplies to resuscitate and maintain the victim on the way to the hospital. It
provides basic life support and also advanced life support with equipments and medicines for
treating critical illness or emergencies. Ambulances are usually vans but many other vehicles like
cars, motorcycle, helicopter, boat, ship, bus and train can also act as ambulances depending
upon the area and situation. The Ambulance has the presence of First Aid responders,Paramedic
Staff, Emergency Care Nurses and other volunteers trained in extensive First Aid to act during
emergency.

Ambulance can be of various types like Government, Private, Charity, and Volunteer and so on
depending on the service providers. Many Centralized Ambulances like CATS (Centralized
Ambulance Trauma Services) have been launched by Government of India for transporting the
victims in trauma emergency anywhere and at anytime.

Air transport is undertaken by air ambulance. Helicopter, jets and cargo planes are few types of
aircrafts used for air ambulance. The air ambulance is designed to meet the needs of critically
wounded or critically ill victims who are in an area where land vehicle cannot reach easily.
Helicopters can take 5 to 6 minutes to takeoff and can easily reach the spot of emergency and
then fly back to the desired hospital within a short period of time. Chopper aircrafts can easily
reach the remotest of the places. Air ambulance can be used for the treatment of a victim who
has been severely injured or is critically ill. It is primarily used in emergency situation where
transport of the client by road ambulance is not safe or timely or not possible. Each air
ambulance has specialized medical equipments/medicines that can handle any emergency that
may arise.

3) Own transport:

One’s own car, scooter can become an important means for transporting the victim from the site
of emergency to the hospital or Health Care Facility. The modes of transport are chosen as per
the condition of the victim and requirement of the situation.

Safety and Precautions

At the place of occurrence of emergency one of the major tasks for first aid provider is to
transfer the casualty to medical facility or to safer place. A proper assessment of the casualty is
required for choosing the best transport method.

This assessment makes the transfer more comfortable and swift for the casualty.

• Assess and keep watch on CAB i.e. Circulation, Airway and Breathing of the victim.

• Assess the type of injury e.g. for transporting a spinal injury casualty a flat hard stretcher or
similar improvisation is the only option.
• Look for any recurrent bleeding or any other problem during transportation.

• Assess the danger to the casualty and to you before starting.

• Maintain scene safety so that transportation is not problematic.

Do’s and Don’ts during transportation

Do’s

• Strap the victim properly before moving the stretcher to avoid fall or unnecessary
jerks/movement.

• Keep all of your belongings as well as of the casuality away before transportation.

• Keep the stretcher at a proper level and keep it as stable as possible.

• Movement must be coordinated among the stretcher bearers.

• Keep an eye at the victim’s face for discomfort or respiratory or circulatory problems.

• In case of going upstairs via transportation or loading onto the ambulance victim’s head should
come first. But when carrying always carry with feet side first and head at back.

• Take utmost care that casuality is comfortable and movement should be such that it does not
deteriorate the victim's condition.

• Take care of safety of yourself as well as others around.

Don’ts

• Don’t overdo; do for what you are sure of.

• If it is life threatening, then don’t proceed until expert medical help arrives.

• Avoid unnecessary body movement of victim during transportation.

Thus, transportation of the victim is one of the important task in reviving a victim, so that you
are able to carry the victim to the place where he/she receives first aid and healthcare. You can
be in any situation and in any surroundings with many or limited supplies/helpers and you may
have to attempt transportation. So, you must keep in mind the safety and precautions and
methods for transportation of the victim because correct way of transportation and an early
transportation can reduce complications that may develop overtime in the victim.

6. Wound and Bleeding

 A wound is an injury in which the skin or another surrounding surface is torn, pierced, cut or
otherwise broken. Wounds can be external or internal in the body. Each type of wound carries
specific risks associated with the surrounding tissue damage and infection.

Different types of wounds are:-

Abrasions These wounds appear often when experiencing a sliding fall (e.g. of a bike). The
wounds often contain embedded foreign particles which may result in infections. Abrasions do
not bleed much, but are usually very painful Incisions Incised wounds are caused by sharp
instruments such as a knife, razor, etc. The blood vessels show a straight cut and bleeding may
be profuse.

 Contusions(bruises) Contused wounds are caused by blows, byblunt instruments or by

punching. The capillaries are ruptured by the punch and blood leaks into the tissues.
 Lacerations Lacerated wounds are caused by crushing, ripping forces by machinery, or
clawing of animals resulting in tears or lacerations. The edges are mostly irregular in
shape.
 Puncture wounds Puncture wounds are caused by stabs or sharp instruments like knifes,
daggers or nails. These wounds typically have a smaller opening, but may reach deep
into the tissue. These may not be very painful.

 Amputations Amputation is the removal of a limb by trauma. Re-attachment of

amputated limbs, fingers or toes might be possible if the injured and the amputated
part(s) arrive at the hospital as soon as possible.

Wounds can cause two great dangers:

 Bleeding, and
 Infection

Bleeding

Bleeding is the immediate complication of a wound and must be treated immediately.

Infection

Germs are tiny, not visible to the human eye, organisms that can cause diseases. Germs are bacteria,
viruses, fungi and protozoa. An infection is caused by germs getting into the body through the
broken skin. The germs multiply in the wound and make it ‘infected’, also called as ‘septic’.

First aid for bleeding

Bleeding is the loss of blood escaping from the circulatory system. It arises due to either traumatic
injury, underlying medical condition, or a combination and can occur internally, where blood leaks
from blood vessels inside the body, or externally, either through a natural opening such as the
mouth, nose, ear, urethra, vagina or anus, or through a break in the skin.

External bleeding is generally described in terms of the origin of the blood flow by vessel type. The
basic categories of external bleeding are:

– Arterial bleeding: As the name suggests, blood flow originating in an artery. With this type of
bleeding, the blood is typically bright red to yellowish in colour, due to the high degree of
oxygenation. Blood typically exits the wound in spurts, rather than in a steady flow. The amount of
blood loss can be copious, and can occur very rapidly.

– Venous bleeding: This blood is flowing from a damaged vein. As a result, it will be blackish in
colour (due to the lack of oxygen being transported) and will flow in a steady manner. Caution is still
indicated; while the blood loss may not be arterial, it can still be quite substantial, and can occur
with surprising speed without intervention.

– Capillary bleeding: Capillary bleeding usually occurs in superficial wounds, such as abrasions. The
colour of the blood may vary somewhat (distal portion of circulation with oxygenated and
unoxygenated blood mixing), and will generally ooze in small amounts, as opposed to flowing or
spurting.

Internal Bleeding is one of the most serious consequences of trauma. It may occur after any
significant physical injury. There are two main types of trauma, and either may cause internal
bleeding:

– Blunt trauma - This kind of trauma happens when a body part collides with something else, usually
at high speed. Blood vessels inside the body are torn or crushed either by shear forces or a blunt
object. Examples are car accidents, physical assaults, and most falls.

– Penetrating trauma - This happens when a foreign object penetrates the body, tearing a hole in
one or more blood vessels. Examples are gunshot wounds, stabbings, or falling onto a sharp object.

Almost any organ or blood vessel can be damaged by trauma and cause internal bleeding. The most
serious sources of internal bleeding due to trauma are:

• Head trauma with internal bleeding (intracranial hemorrhage)

• Bleeding around the lungs (hemothorax)

• Bleeding around the heart (hemopericardium and cardiac tamponade)

• Tears in the large blood vessels near the center of the body (aorta, superior and inferior vena cava,
and their major branches)

• Damage caused by trauma to the abdomen such as liver or spleen lacerations or perforation of
other soft organs

Symptoms of Bleeding are:-

• Blood coming from an open wound

• Bruising

• Shock, which may cause any of the following symptoms:

– Confusion or decreasing alertness

– Clammy skin

– Dizziness or light-headedness after an injury

– Low blood pressure

– Paleness (pallor)

– Rapid pulse, increased heart rate

– Shortness of breath

– Weakness

If the injured has internal bleeding, the aforementioned symptoms are joined by the following

symptoms :

• Abdominal pain and swelling

• Chest pain

• External bleeding through a natural opening

– Blood in the stool (appears black, maroon, or bright red)

– Blood in the urine (appears red, pink, or tea-colored)

– Blood in the vomit (looks bright red, or brown like coffee-grounds)

– Vaginal bleeding (heavier than usual or after menopause)

Any of these signs of internal bleeding after a trauma should be treated as a medical emergency. The
injured person needs to be evaluated in a hospital emergency room.

The following measures need to be taken in giving first aid to a victim of a external bleeding :

1. Wash your hands to avoid infection and put on gloves

2. Lay on the injured person down and cover the person to prevent loss of body heat.

– If possible, position the person's head slightly lower than the trunk or elevate

the legs and elevate the site of bleeding

3. While wearing gloves, remove any obvious dirt or debris from the wound.

– Don't remove any large or more deeply embedded objects.

– Your principal concern is to stop the bleeding.

4. Apply pressure directly on the wound until the bleeding stops

– Use a sterile bandage or clean cloth and hold continuous pressure for at least 20 minutes without
looking to see if the bleeding has stopped.

– Maintain pressure by binding the wound tigh adhesive tape.

– Use your hands if nothing else is available.

– If the bleeding continues and seeps through the gauze or other material you are holding on the
wound, don't remove it. Instead, add more of it

5. Squeeze a main artery if necessary

– If the bleeding doesn't stop with direct pressure, apply pressure to the artery delivering blood to
the area. Use a sterile bandage or clean cloth and hold continuous pressure for at least 20 minutes
without looking to see if the bleeding has stopped. Maintain pressure by binding the wound tightly
with a bandage or clean cloth and Use your hands if nothing else is available. If the bleeding
continues and seeps through the gauze or other material you are holding on the wound, don't
remove it. Instead, add more absorbent material on top. If the bleeding doesn't stop with direct
pressure, apply pressure to the artery delivering blood to the area.

8. Bones and Joints & Unconsciousness

A fracture is a break/bend or crack in a bone. Generally, a considerable force is needed to break a
bone, unless it is diseased or old. The bones that are still growing are supple and may split, bend, or
crack.

 A strain is overstretching of a muscle or a tendon

 A dislocation is separation of the head of a bone at a joint (this can have an associated
fracture)
 A sprain is tearing of a ligament at the joint
 Injuries to bones and soft tissue can happen from kicks, punches, road accidents, falling from
a height, sports injuries, and playground injuries

Types of Fracture:-
  Closed Fracture The skin above the fracture is intact, although the bone ends may have
damaged nearby tissues and blood vessels.
 Open Fracture The skin above the fracture is not intact. There is bleeding. The bone is
exposed to the outside air at the surface; dirt, dust and germs can enter the wound. There is
a high risk of infection.

First Aid:-

1. Fractures often occur in major accidents. Therefore, it is necessary to treat other potential injuries
also. The first aider must decide which injury is more urgent. Providing CPR when the victim does not
breathe, or treating a severe bleeding is more urgent and should be handled on priority.

2. There may be more than one fracture in the same person or even in the same limb.

3. Try not to move the broken or dislocated limb unnecessarily. Try not to move the casualty until
the injured part has been secured. If you need to move the victim, be careful when moving or
turning him. It is better to ask assistance by bystanders.

4. Reassure the casualty.

5. Advice the person to keep calm.

6. Arrange appropriate transport to the nearest healthcare facility.

7. Continuously observe the casualty.

8. Do not give the casualty anything to eat or drink.