CLMRG STRETCHER PROCEDURES
REVISION D 8/97

*See notes on printing this thing at the end; this version is made to look good on-line but it doesn't print well.

INTRODUCTION: These are the recommendations for stretcher operations from the CLMRG Stretcher Procedures committee. This document will be updated as necessary and should be considered as the official CLMRG methods and procedures for rescues involving victims in stretchers, i.e. this is the way CLMRG will conduct stretcher rescue. This version supersedes all previous editions.

WARNING - - Even when properly performed, loss of life or injuries may result to you or the persons you are working with. The China Lake Mountain Rescue Group and/or authors accept no responsibility for loss, damage, injury, or death resulting from information contained in, or omitted from, this chapter. We wrote this for our CLMRG members for training purposes ONLY.

The comments in this document are referenced to the enclosed figures. Refer to the figures to fully understand the comments.

1. VICTIM TIE-IN
Figure 1, Stretcher tie-in
Figure 1 illustrates the proper method for securing the victim in the stretcher. Girth hitches must be tied at each end of the 1 in. wide tie-in webbing and as necessary to accommodate injuries. The top rail of the stretcher must not be used for the Girth hitches.


There are three tie-ins: The first tie-in should have the first wrap go around the chest and under the subject's arm for more secure torso tie-in and a less restrictive feel around the arms. Lower arms should be left unrestrained initially and tied with the Velcro wrist restraint strap as the last thing.
The second tie-in is around the lower part of the upper body. The third tie-in is for the hips, legs and feet. Start the tie-in at the hips and use one half of the 20 ft 1 in. webbing for one side and the other half for the other side. Use the two ends of the webbing for the stirrups. These foot stirrups must be tied with a girth hitch immediately on both sides of each stirrup. The preferred method is the crossed stirrup shown in figure 1. A slip knot must NOT be used because it can tighten around the foot causing loss of circulation or other such complication. Do not use a foot stirrup if there is an injury to that foot or leg.

Pads should be used as needed to protect and secure the victim. Adaptations to the tie-in may be dictated by special first aid considerations.

2. STRETCHER RIGGING
Figure 2, Stretcher Rigging
Figure 2 illustrates the ropes and slings used for rigging the stretcher for a horizontal lowering. The stretcher and belay ropes are 11 mm low-stretch ropes, 200 ft in length. The rigging ropes are 11 mm dynamic ropes unless otherwise indicated. The recommended safety tie off method for the figure eight and bowline knots on the rigging ropes is the pass back method shown in Figure 1a. Safety tie-off Either the pass back method or the 1/2 grapevine safety is okay in other situations. Figure 2 has not been updated with this tie off method. The following points should be noted when assembling the rigging:


a. For the equalization yokes we use two 20 ft, 11 mm dynamic ropes. The double bowline on a coil is used for equalization. The large auto-lock carabiners in the accessory bag are used to connect the yokes to the stretcher. A figure eight on a bight with safety is used for the tie in to the belay and stretcher ropes. One yoke should be shorter and should be used for the head to achieve a slightly head up position. Prerigged equalization yokes are in the stretcher accessory bag.
b. The attachment loops for the stretcher and belay ropes are tied as figure eight follow through. The height of the rigging from the top rail of the stretcher to the stretcher rope tie-in should be approximately 2 ft.
c. The attendant and victim tie-in uses a single 20 ft, 11 mm dynamic rope. The central figure eight on a bight should be very short and should be tied so that approximately 6 ft remain for the victim tie-in. The longer section is used for the attendant tie-in.
d. One of the adjusting Prusiks is clipped to the attendant's harness to adjust his vertical position with respect to the stretcher. The other is fitted with a foot loop to release tension on the first Prusik so that it can be adjusted.
e. Small end down is the preferred orientation for the large auto-locking carabiners clipped into the stretcher. Gates are always in.
f. The stretcher tilt line should be attached to a reinforced cross support for strength and so that the line will not abrade.

3. LOAD DISTRIBUTING ANCHOR (LDA)
a. We will use a LDA, a three point anchor system for the stretcher and belay anchor. The angle between adjacent legs of the three-point system should be less than or equal to 30·. The length of the outer legs must be 12-15 in. (figure 3)
Figure 3, LDA.
b. The LDA uses 5 locking carabiners from the rescue rack. Doubled non-locking carabiners with opposite and opposed gates is an alternate method in lieu of a locking carabiner. Locking gates should be on the side away from the rock, if possible.
c. The LDA rope should be a 20 ft long, 11 mm dynamic rope.

Load Distributing Anchor

4. "Z" SYSTEM FOR RAISING
a. Separate locking carabiners must be used to attach the pulley and the Rescucender to the main anchor (figure 4)
Figure 4, Z System for raising.
b. A load releasing hitch should be used. See the description under "Load Releasing Hitch (LRH)" in paragraph 9.

5. MAIN SYSTEM FOR LOWERING
a. Figure 3 shows the 3-point anchor system.
b. A load releasing hitch is essential.

6. BELAY METHOD (RAISING/LOWERING)
The belay rope must never be used without back-up for shifting the load during a working operation.
The belay method is with Tandem Prusik knots and pulley. We use two 8 mm Prusiks, (tied with a double Fisherman's knot) of different length (53 in. and 65 in.). Three wraps are used around the belay rope. Make sure the knots are tied neatly with the knots' bridges on the same side. Clip the two Prusiks and the Prusik Minding Pulley (PMP) into a pear-shaped locking carabiner in the following order: Long Prusik first, then the shorter Prusik and then the pulley. This locking carabiner is then clipped into the belay LDA in series with the load releasing hitch. When properly positioned, the Prusik knots will be about 4 in. apart. The belayer must be experienced in using the Prusik belay and must be very attentive to keep the knots taut but free running using the tips of the fingers with the thumbs pushing on the knot's bridge. The rope should be flaked so it will enter the Tandem Prusik System smoothly from the side without twisting.
When belaying a raising, the Tandem Prusik may be tended by the Prusik Minding Pulley as the belay rope is pulled through it. For passing a knot safely, two sets of Prusik slings must be available.
A load releasing hitch is required in case the Prusik knots lock up. After using the load releasing hitch always retie it, so it will be ready for its next application.
Tandem Prusik knot


7. EDGE ATTENDANT TIE-IN
Edge Attendant Tie-in
Any persons acting as an edge attendant to assist with the stretcher must be tied into an adjustable length personal anchor. See the illustration below for the recommended 2-point LDA method. A good solid single point anchor may be used if a two-point system is not feasible.

8. STRETCHER ACCESSORIES
a. 2 low stretch 200 ft, 11 mm ropes for the stretcher lowering and raising and for belaying.

b. The accessory bag attached to each stretcher will contain the following items:
-2 Rescucenders
-2 Pulleys
-2 prerigged yokes
-1 Mini Prusik minding pulley
-2 Sets of 8 mm Prusik slings
-1 approx. 6 ft long, 8 mm Prusik sling
-4 Large Pear Shaped Auto-Locking carabiners for Stokes Stretcher or 4 Extra Large Auto-Locking carabiners for Thompson Stretcher
-1 Brake bar rack
-2 48" slings for tilt line
-1 Wrist restraint
-1 Helmet restraint
-1 Fully adjustable Seat Harness
-1 Pair goggles
-1 Pair of Pliers
-1 Stretcher nut wrench and 1 Allen and 1 crescent wrench for the wheel. Not required for the Thompson stretcher.

c. We will have two hardware bags. Each will contain the following items:
-1 Set of cams (7-8)
-1 Set of stoppers (9)
-15 Locking carabiners or 30 normal carabiners
-4 Large locking carabiners
-1 Cordelette
-12 24 in. Slings
-4 48 in. Slings
-1 Load Releasing Hitch with carabiners
-1 Gear Sling

d. Other items which will be packed with the stretcher include:
-1 victim pad,
-1 helmet with Velcro attachment,
-3 20 ft long, 1 in. orange slings for victim tie-in to the stretcher
-5 20 ft long, 11 mm dynamic ropes:
-1 for victim/attendant tie-in to the load and belay ropes
-2 for LDAs
-2 for edge attendant tie-in
-1 snow cover
-several fire hose rope protectors

9. LOAD RELEASING HITCH (LRH)
Larson Load Releasing Hitch: Use 20 foot 8 mm accessory cord, two pear shaped locking carabiners and one standard locking carabiner. Tying this knot is easier with two people because the carabiners must be held in the proper position. Tie the ends
of the cord with a figure eight. Put one pear shaped carabiner at the middle of the cord; tie a Münter hitch with the doubled cord on the other pear shaped carabiner at least one foot away from the mid-point carabiner. Pull the mid-point carabiner toward the Münter hitch until it nearly touches; then reverse direction and pull the mid-point carabiner away from the Münter hitch until it is separated by about six inches. Make several wraps around the doubled cord between the Münter hitch and the mid-point carabiner until there is just enough space left to push a bight of rope through between the doubled cord just in front of the mid-point carabiner. Start with this bight and chain the extra double cord up to the figure eight, then lock off the chain. Use the third carabiner to clip from between the double cord (just in front of the figure eight) and onto the mid-point carabiner.

To release the LRH and extend it for use: Unclip the third carabiner from the mid-point carabiner and unlock the chain. Before undoing the chain clip the third carabiner between the double cord (just in front of the figure eight) and completely around the double cord just in front of the mid-point carabiner. When this last carabiner is properly placed the LRH cannot come completely apart. The chain can then be undone and the wraps removed until the LRH begins to extend.

Load Releasing hitch

10. PASSING KNOTS
a. In the belay rope for a raising: (the belay is not holding the load) Place a second set of tandem Prusik slings approximately one foot below (downhill) the knot and clip them to the Load Releasing Hitch (LRH) with a separate sling and locking carabiners (independent of the original belay). Remove the Prusik Minding Pulley (PMP) and place it with the second set of tandem Prusik slings below the knot. Remove the original tandem Prusik slings.


b. In the belay rope for a lowering: (the belay is not holding the load) Let the knot get close to the PMP. Place a second set of tandem Prusik slings on the uphill side of the knot and clip into the LRH. Remove the original set and the PMP. The PMP can then be placed with the second set of Tandem Prusik slings. This leaves about a foot of slack in the belay line until the stretcher is lowered a little to remove the slack.

c. In the stretcher rope for a raising (using a 3:1 Z system):
The Rescucender which is moved to take a new bight can simply be placed on the other side of the knot. The load is then pulled up until the knot is close to the Rescucender that is holding the load. Place a Prusik (8 mm cord, triple wrapped) on the load side of the knot down at least 2 ft below the knot and clip it into the LDA. Set the Prusik to hold the load with minimum movement when the load is transferred from the Rescucender. To transfer the load, the Z system must be pulled just enough to allow the top Rescucender to be released. After the Prusik takes the load the Rescucender and top pulley can be moved down past the knot by extending the connection to the LRH about two feet. With this accomplished, the Z system can be pulled again to allow the removal of the Prusik that was placed to hold the load during transfer.

d. In the stretcher rope for a lowering: (extra Rescucenders normally used for raising are available) Let the knot get to about one foot before the brake bar device (don 't let the knot get locked up in the brake bar). Attach a Rescucender down the rope below the brake bar device and clip the Rescucender with a sling and locking carabiner to the LRH. Allow the Rescucender to take the load, then move the brake bar device to the other side of the knot and clip it into the LDA (not the LRH). Release the LRH until the brake bar again takes the load and then remove the Rescucender.

11. ROPE COILING METHOD
a. The rope coiling method, known as the Butterfly coil, will be the standard coil for all dynamic rescue ropes. See figure 5
Butterfly Coil.

b. All low stretch rescue ropes will be stuffed into their bags. They should not be coiled. One end of the rope must be tied with a figure eight into the bag.

12. REVIEW/UPDATE PROCEDURES
a. The Stretcher Procedures Committee membership will include current Technical members, Operation Leaders, and the Training Committee Chairperson. There will be no official chairman of this committee. Rather, coordination responsibility for each meeting will be by appointment from the President of CLMRG.
b. Any Procedures Committee member can call for an update or review meeting when they feel it is needed. Periodic reviews will not automatically be conducted. Expeditious revision of the "official position" shall be done after any such meeting which results in a significant update/change.
c. Dissemination of updates will be by multiple methods. Methods will include handouts and demonstrations, when appropriate, at meetings and stretcher hut nights. Updates will be posted with the most recent and dated procedures.

Revision D was prepared by Werner Hueber, Tom Roseman and Al Green. It was reviewed by the Operation Leaders and Technical Members.

8/97


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