Tactical Casualty Movement

9-1. MOVEMENT TO SAFETY UNDER FIRE

Moving a casualty to safety is an important aspect of providing care on the battlefield. One of the key concepts of tactical combat casualty care is preventing additional casualties. Casualty movement goes hand-in-hand with this principle. The development of a rescue plan for a casualty in the care under fire phase will usually precede any treatment that may be required. You must be in a situation in which you and the casualty are not under hostile fire before providing comprehensive care. If you are under enemy fire, and the tactical situation allows, attempt to control life threatening bleeding by applying a tourniquet. Then quickly move yourself and the casualty to a location where you can safely administer additional care. This may be behind cover, inside a building, or anywhere that you are not under effective enemy fire (see Lesson 2, Care Under Fire). Figure 9-1 shows a soldier moving a casualty to a safer location.

Maving a casualty to safety
Figure 9-1. Moving a casualty to safety.

a. The development of a casualty movement plan is complex and requires some problem solving. Evacuation scenarios can occur in all types of terrain and in all types of environments. The enemy situation will be the primary obstacle to be overcome. The plan must account for the tactical situation, mission requirements, and available troops and equipment. The following tactical combat casualty care principles must apply.

(1) Treat the casualty.
(2) Prevent additional casualties.
(3) Complete the mission.

b. Good medicine can be bad tactics. The combat lifesaver must know what to do and when to do it. A medically correct intervention performed at the wrong time in combat may lead to additional casualties.

(1) Casualties in an urban setting should generally be moved to the best tactical location as quickly as possible before treatment for their injuries is undertaken. Snipers are a significant threat in urban areas where there are numerous hiding locations that enable them to engage at relatively close range, thus increasing their accuracy.

(2) Open areas will often be under enemy observation. Improved casualty retrieval and area denial methods (to include smoke, diversions, custom-made or field-expedient casualty retrieval devices such a length of line with a snap link) can and should be used.

c. Finally, the following questions should be asked. Who is responsible for casualty retrieval? What training and equipment is needed, and how much emphasis is placed on this training? Which techniques are optimal given the mission and terrain?

9-2. MOVEMENT TECHNIQUES

a. The modern combatant carries personal protective equipment, weapons system, ammunition, survival gear, water, communications equipment, and miscellaneous other equipment. This gear significantly increases the weight of the average soldier, usually by 50 to 70 pounds. Because of this increased weight, casualty movement becomes a problem.

b. There are several different techniques we can utilize to move a casualty.
Some are given below.

(1) Individual movement techniques.
(2) Drags.
(3) Manual carries (one-person and two-person).
(4) Litter carries.

c. Historically, the primary casualty movement techniques utilize one-person and two-person carries. These techniques have proven to be difficult due to the increased weight of the average combatant. What is needed is a new philosophy on how to move casualties injured on the battlefield.

9-3. BASIC PHYSICS

When discussing movement of heavy objects (an unconscious casualty), think back to your high school physics class.

a. “Every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it.” The relationship between an object’s mass m, its acceleration a, and the applied force F is F = ma. Acceleration and force are vectors (as indicated by their symbols being displayed in italic font). In this law, the direction of the force vector is the same as the direction of the acceleration vector.

b. “For every action, there is an equal and opposite reaction.” So what does that actually mean? It means that a heavy object (a fully equipped injured soldier lying on the ground) is difficult to move easily. What is the best technique to accomplish this?

9-4. INDIVIDUAL MOVEMENT TECHNIQUES

Individual movement techniques are specific movements to move oneself to cover. Tactical training scenarios allow individuals to practice these movements prior to the onset of the mission. A wounded soldier should move to a safe location under his own power when medically and tactically appropriate.

a. Some individual movement techniques are listed below.

(1) Low crawl.
(2) High crawl.
(3) Rushes.
(4) Walking/running.

b. If the casualty is able to move on his own and perform self-aid, then a rescue attempt is not necessary. This greatly simplifies the matter. Some advantages are given below.

(1) Allows tactical leaders to keep uninjured or minimally injured soldiers engaged in the fight.
(2) Rescuers maintain weapon readiness.
(3) Allows medics and combat lifesavers to focus their attention on more seriously injured casualties.

9-5. DRAGS

Drags are techniques for moving a casualty for a short distance. When using a drag, the casualty maintains a lower profile during the movement. These techniques are generally easier to perform than trying to lift a heavy casualty and may allow the rescuer to employ his weapon system.

a. One-Person Drag.

This technique provides a lower profile for both the rescuer and the casualty. However, it is difficult to move a heavy casualty from the crouch position. Each movement is for a very limited distance and consumes high levels of energy from the rescuer. Figure 9-2 shows a soldier in a crouch position moving a casualty using a one-person drag.

b. Two-Person Drag.

This technique is much easier for the rescuers and moves much more quickly. It expends significantly less energy, but exposes the rescuers to a higher profile than does the crouch technique. The rescuers are better able to employ their weapons.

One-person drag (rescuer in crouch position.)Two Person Dragc. Disadvantages of Manual Drags.

Some disadvantages of drag techniques are given below.

(1) They are really only good for short distances.
(2) They still require significant strength to drag a fully combat loaded soldier any distance. The rescuer must overcome the laws of physics (friction, inertia, mass) to get move
ment started.
(3) Depending on technique, the rescuer may display a larger profile to the enemy. Bending over to grasp a casualty to drag him may displace the rescuer’s body armor and expose more of his torso to small arms fire and fragmentation wounds.
(4) There is no optimal place to grip the casualty to begin movement.

d. Drag Equipment. There are a number of new pieces of commercial equipment have been developed to assist in casualty recovery and movement. They are new concepts to the military and can greatly assist in casualty movement.

(1) Dragon Harness. The Dragon Harness is a harness that is worn under the individual’s body armor. It encircles the individual’s torso and lower extremities. It has two handles that are rolled and stored behind the casualty’s neck ready to be unrolled and grasped for rapid movement of the casualty.

Dragon Harness(1) Dragon Handle.

The Dragon Handle (figure 9-5) is a drag strap that can be attached to a down casualty either by a snap link worn on the soldier’s body armor or by being wrapped around the casualty’s armor or lower extremities to rapidly move the casualty to cover.

Dragon Handle(3) Rat strap.

The Rescue Assault Tether (rat strap) (figure 9-6) is a tether that can be rapidly attached to a casualty by means of a snap link and connected to the rescuers belt by a quick release buckle. This device has the advantage of leaving both the rescuer’s hands free to utilize his weapon while simultaneously dragging the casualty to safety.

Rescue Assault Tether (rat strap)e. Drag Litters.

Like drag straps, drag litters help facilitate casualty movement. There are a number of different devices available. Some are commercially designed and some are field expedient (like a poncho). The major advantage of these devices is the fact they greatly decrease the friction component of dragging a casualty over the ground. Some have straps that hold the casualty onto the device. Some examples of commercial drag litters available from different companies are given below. They are constructed of various materials from PVC to nylon. While these devices are too large to carry in the combat lifesaver aid bag, they can be carried in support vehicles to augment casualty movement.

(1) Soft Litter Individual Carry Kit (SLICK). See figure 9-7.

Slick drag litter(2) Black Hawk Fast Attack Litter. See figure 9-8.

Black Hawk Fast Attack Litter(2) Canadian Tactical And Operations Medical Solutions Litter (figure 9-9).

Canadian Tactical and Operations Medical Solutions Litter(4) Tactical extrication device.

(5) BattleLab rapid extrication device.

9-6. MANUAL CARRIES

Most manual carries are not easily executed because of the increased weight of the fully equipped soldier. However, there are some carries that can be executed to assist in rapidly moving an injured Soldier to cover. Caution should be exercised because of the high profile of the rescuer and the casualty.

a. Fireman’s Carry:

The fireman’s carry (figure 9-10) is the typical one-person carry practiced in training. However, in reality with a fully equipped casualty, it is nearly impossible to lift a soldier over your shoulder and move to cover easily. Note that the casualty in the figure is light (without armor and weapons) and the rescuer is larger than the casualty. The fireman’s carry is discouraged from being practiced and used.

Fireman's carryb. Hawes Carry:

The Hawes carry (figure 9-11) is more easily used to move a conscious casualty to cover. Grasp the injured soldier’s wrist with his arm over one shoulder and lean forward, raising him off the ground. When performed correctly, the rescuer can still employ his weapon. (The description of Hawes Carry below is found in Appendix B in the PDF manual that accompanies this course.)

Hawes Carry
Figure 9-11. Hawes Carry

SETTING UP HAWES CARRY

If the casualty is able (alert or verbal level of consciousness), he can assist you with preparing for the carry. However, if the casualty is unable to assist (unconscious or cannot follow instructions), you will have to move the casualty yourself in the correct position for the carry.

1. Position the casualty on his abdomen. If the casualty is lying on his back, roll him onto has abdomen using the procedures given below.

a. Kneel at the casualty’s uninjured side.

b. Place his arms above his head.

c. Cross the casualty’s ankle that is away from you over the ankle that is closest to you.

d. Place one of your hands near the casualty’s far shoulder, place your other hand at the casualty’s far hip or thigh, and securely grasp the casualty’s clothing.

e. Pull on the casualty, gently rolling the casualty on his uninjured side and then onto his abdomen.

Hawes Carry Setup A2. Raise the casualty to a standing position. The two methods used with the fireman’s carry can also be used with the Hawes carry.

a. Straddle the casualty, extend your hands under the casualty’s chest, and lock your fingers together.

b. Move backwards, lifting the casualty to his knees.

c. Continue to move backwards, lifting the casualty so that his legs straighten and his knees lock.

d. Walk forward, bringing the casualty to a standing position. Keep the casualty tilted slightly backward to prevent his knees from buckling.

e. Use one of your arms to maintain support of the casualty, use your free hand to grasp the casualty’s wrist and raise his arm.

f. Quickly pass your head and body under the casualty’s raised arm so that you will face the casualty, release the casualty’s arm, and support the casualty with both of your arms.

Hawes Carry Setup B3. Lift the casualty onto your back.

a. Once you have raised the casualty to a standing position and are facing the casualty, grasp the casualty’s wrist and raise his arm high above your head while continuing to support the casualty with your other arm. If you use your right hand to fire your weapon, grasp the casualty’s right wrist with your left hand. This will leave your right hand free to use your weapon.

b. Rotate your body so that your back is to the casualty’s chest. The casualty’s arm will be across your shoulder. In the example, the casualty’s right arm is across your right shoulder and is still being held by your left hand.

c. Lean forward, lifting the soldier off of his feet.

d. Adjust the casualty’s body as needed and move forward, carrying the casualty. When the carry is performed correctly, the rescuer can still employ his weapon.

Hawes Carry
Figure 9-11. Hawes Carry

c. Two-Person Supporting Carry. The two-person supporting carry (figure 9-12) is similar to the Hawes carry. Two rescuers grasp the casualty’s wrists over opposite shoulders, lean forward, and lift the casualty to move him. This carry is easier in that two rescuers are used instead of one.

Two person support carry
Fig. 9-12. Two person support carry.

d. Other Carries.

Other one-person and two-person carries may be appropriate for casualty movement, but their use must be based on the tactical situation and have been practiced for familiarity.

9-7. SUMMARY

Significant improvements in casualty care have been achieved over the past several years. One area that requires additional emphasis is tactical casualty movement. In most instances, the combat lifesaver is unable to provide care to an injured soldier on the battlefield until that soldier is moved out of harm’s way. Many of the techniques used in the past are no longer effective with the modern combatant. The soldier’s personal protective equipment and gear make the average soldier just too heavy to easily move out of danger, even for short distances. This section has identified several different methods of tactical casualty movement that may assist the combat lifesaver and his counterparts in being able to move injured soldiers to safety easier Than before. Tactical combat casualty care has significantly improved our ability to save lives in combat. Being able to treat casualties is primarily based on the tactical situation and movement of the injured soldier to cover is a paramount feature of providing this lifesaving care.

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