Moving an injured person is one of the highest-risk moments in field trauma management. Done wrong, it converts a survivable injury into a fatal one — a spinal fracture becomes a cord transection, a controlled bleed reopens, a shock patient deteriorates from the exertion. Done right, it gets someone who cannot save themselves to a location where they can receive care.
This post covers when to move and when not to, spinal precautions in improvised settings, carry techniques for one and two rescuers, and how to build a functional improvised stretcher from materials available in most environments.
WHEN TO MOVE — AND WHEN NOT TO
The general rule in trauma: do not move a patient unless the hazard they are in is greater than the risk of movement. A patient in a burning building or flood water must be moved immediately. A patient with a possible spinal injury on flat ground should not be moved until spinal precautions are in place and enough people are available to execute a safe move.
Move immediately (scene is unsafe):
- Active fire, smoke, or toxic fumes
- Rising water or flood
- Structural collapse risk
- Active violence threat
- Exposure to extreme cold or heat that will kill before spinal concerns can be addressed
Do not move until stabilized:
- Suspected spinal injury without immediate life threat
- Active arterial hemorrhage not yet controlled
- Suspected femur fracture (stabilize with traction before transport)
- Suspected pelvic fracture (stabilize with a pelvic binder or improvised wrap before transport)
SPINAL PRECAUTIONS IN THE FIELD
Assume spinal injury in any patient with:
- Mechanism suggesting spinal loading (fall from height, vehicle collision, diving injury, direct blow to the head or neck)
- Neck or back pain after trauma
- Any neurological symptoms — numbness, tingling, weakness in limbs, incontinence
- Altered mental status (cannot reliably report symptoms)
Improvised cervical collar: Roll a towel, shirt, or blanket to approximately 3-4 inches in diameter and fold it around the neck, secured loosely enough that it does not compress the airway. The goal is limiting flexion and extension, not immobilizing completely. Commercial cervical collars are far more effective — stock one if you can.
Neutral spine position: The head should be in a neutral position — eyes looking straight ahead, not flexed forward or extended back. If the patient is found in a position that is not neutral, do not force correction if resistance or pain is encountered. Immobilize in the position found.
Log roll: The technique for moving a patient while maintaining spinal alignment. Requires a minimum of three people ideally — one managing the head and directing, two managing the body. The person at the head calls the movement. On command: the patient is rolled as a single unit, maintaining head-spine alignment throughout, onto the side, then onto the backboard or stretcher. One person managing the head and one managing the body is possible but less controlled.
CARRY TECHNIQUES — NO STRETCHER
Blanket drag (solo, ground level): Lay the patient on a blanket, tarp, or coat. Grip the material at the head end and drag along the ground. Maintains the patient in a roughly flat position. Suitable for short distances on smooth or semi-smooth surfaces. Not suitable for suspected spinal injury if a better option exists.
Shirt drag (solo, emergency): Grip the patient’s shirt or jacket at the shoulders and drag backward. Fast and requires only one person. Provides some head and neck support through the shirt if gripped correctly at the collar.
Two-person carry (conscious patient, no spinal concern): One person at the shoulders, one at the knees. Lift together, carry. Simple and effective for short distances with a cooperative patient.
Firefighter’s carry (solo, short distance): The patient is placed over the rescuer’s shoulders across the back of the neck, one arm and one leg hanging on each side. Distributes weight across the shoulders. Extremely difficult to execute with an unconscious patient of similar or larger body mass than the rescuer. Not suitable for suspected spinal injury.
Seat carry (two rescuers, conscious patient): Two rescuers face each other behind the patient. Each rescuer passes one arm behind the patient’s back and under the opposite arm (supporting the torso), and both rescuers clasp their free hands together under the patient’s thighs to support the legs. Patient sits on the clasped hands. Comfortable for the patient, manageable for short distances.
IMPROVISED STRETCHER BUILDS
CLOTHING STRETCHER (2 jackets, 2 poles)
Most practical improvised stretcher in a field environment.
Materials: 2 sturdy long poles or branches (6-8 feet, 2 inches or more in diameter), 2 jackets or shirts.
Construction:
- Button or zip each jacket fully
- Thread one pole through the sleeve of both jackets — in through one sleeve, out through the other
- Thread the second pole through the other two sleeves in the same manner
- The jackets form the sleeping surface, poles provide the rigid frame
The jacket buttons/zipper prevent the garments from sliding. This stretcher holds significantly more weight than most people expect. Test it before loading a patient by having someone sit on it.
BLANKET STRETCHER (blanket, 2 poles)
Materials: A blanket or tarp at least 5 feet wide, 2 sturdy poles 6-8 feet long.
Construction:
- Lay the blanket flat
- Lay one pole at one-third of the blanket’s width from one edge
- Fold that one-third of the blanket back over the pole
- Lay the second pole against the folded edge
- Fold the remaining two-thirds of the blanket back over the second pole
When the patient’s weight is placed on the stretcher, the folded blanket layers lock against themselves and prevent unfolding. This is the military field-expedient stretcher method. It is more stable than it looks.
DOOR OR FLAT BOARD STRETCHER
A solid-core interior door, a section of plywood, a tabletop, or any flat rigid surface serves as a stretcher for patients requiring full spinal support. Heavy, awkward to maneuver through doorways, but provides the most stable platform available for spinal injury. Tie or strap the patient to the surface to prevent rolling during transport.
COTS AND TARPS (with attachment points)
A camping cot disassembled to its frame and fabric provides a ready-made stretcher. A tarp with reinforced grommets at the corners can be gripped at the grommets by multiple carriers. A hammock works on the same principle.
LOADING A PATIENT ONTO A STRETCHER
For non-spinal injury patients: Position the stretcher alongside the patient. Two or more people lift together — one at shoulders, one at hips, one at legs — and lower onto the stretcher. Coordinate lifts so the patient moves as a unit.
For suspected spinal injury: Log roll the patient onto the stretcher. Requires coordination and enough personnel to maintain spinal alignment throughout. The person managing the head directs all movement and calls each step.
Secure the patient to the stretcher before transport — a strap across the chest and across the thighs at minimum. An unsecured patient on a tilted or uneven stretcher will shift, which can reinjure, panic, or fall.
CARRYING THE STRETCHER
Minimum two carriers for a stretcher. Four is better for any distance over 50 meters. Carriers should communicate continuously — obstacles, terrain changes, direction changes. The person at the head end should be walking backward, which limits speed and requires attention.
For longer distances, establish a carry relay: set the stretcher down, rotate carriers, resume. A loaded stretcher carried by two people for more than 50-100 meters exhausts most adults. Plan for rotation.
WHAT TO STOCK
- Commercial cervical collar — $15-30, worth having
- Folding or rolled-up litter (Recon Medical, various manufacturers) — $30-60, packs small, rated for significant weight
- Triangular bandages (for securing patient to improvised stretcher)
- Thick-walled walking poles or trekking poles that can double as stretcher poles
Cross-reference: Fractures — Field Stabilization | Shock — Recognition & Response | Tourniquet