Treatment stabilizes a patient where they lie. Evacuation gets them to definitive care. Between those two points sits one of the hardest jobs in wilderness medicine: moving a hurt person across rough country. Whether you are carrying a patient a few hundred yards to a landing zone or hours down a trail in a full ground evacuation, the principles are the same. Protect the patient, protect your team, and keep moving with purpose.
Deciding Whether to Move the Patient at All
The first question is not how to move the patient, but whether you should. Movement always costs something: pain, risk of worsening injuries, heat loss, and rescuer energy. Move a patient when staying put is worse, for example when the landing zone cannot come to them, when weather is closing in, when the terrain where they lie is unsafe, or when ground evacuation is the plan and every hour of daylight matters. If a helicopter is coming and can reach a suitable site near the patient, a short, careful move to that site is usually better than asking a crew to land somewhere marginal. We covered how to pick that site in our article on selecting a helicopter landing zone.
Package Before You Carry
A patient is not ready to move until they are packaged. Packaging means three things:
- Immobilize what needs immobilizing. Splint fractures before the first step. If spinal motion restriction is indicated, the patient goes on a rigid device or in a vacuum mattress, not slung over a shoulder.
- Insulate. A litter carry can run for hours, and a patient lying still against the ground or a metal frame loses heat fast. Get insulation under them, wrap them well, and protect them from wind and precipitation before you lift.
- Secure. The patient must stay in the litter through tilts, slips, and hand-offs. Strap them at the chest, hips, and legs, snug but not so tight you restrict breathing or circulation. Recheck straps after the first few minutes of movement, because they always settle.
Commercial litters like the Stokes basket or a flexible wrap-style stretcher earn their place here. In their absence, rescuers have improvised litters from poles and jackets, webbing, tarps, and rope for generations. Improvised litters work, but build and test them with a rescuer's weight before the patient ever goes in.
Carrying Across Country
A loaded litter is heavier than it looks, and rough terrain multiplies that weight. Plan on a minimum of six carriers per litter team, with fresh rescuers rotating in. Four carriers is a short-distance answer, not a cross-country one.
- Move on command. One person calls every lift, lower, and turn. "Ready, lift" keeps eight hands working as one and keeps the litter level.
- Keep it level-ish. On slopes, carriers on the downhill side lift high and the uphill side drops low. A tilted litter exhausts the patient and terrifies them.
- Rotate early and often. Swap carriers before they are tired, not after. Tired carriers stumble, and a dropped litter can undo all your treatment in one second.
- Set a sustainable pace. Short, steady intervals with planned rest stops beat a heroic first mile followed by a spent team.
Route selection matters more than raw distance. A route that is twenty percent longer but avoids scree, deadfall, and a stream crossing is the shorter route in the ways that count. Scout ahead when you have the personnel. Keep the team hydrated and fed, because a depleted rescuer becomes the second patient.
Short Moves: Improvised Carries
Not every move needs a litter. For short distances, such as dragging a patient out of a rockfall zone or shifting them to a nearby LZ, simple carries are faster:
- Blanket or tarp drag for short moves over relatively smooth ground, pulling from the head end.
- One- and two-person carries such as the pack-strap carry, piggyback, or two-handed seat, for conscious patients who can tolerate them.
- Webbing seats and improvised harnesses for patients who can hold on and help a little.
Match the carry to the patient's injuries. Anyone with a suspected spinal, pelvic, or significant lower-extremity injury gets a litter or rigid support, even for a short move.
Monitor the Patient While You Move
Evacuation is not a pause in patient care. Build reassessment into your rest stops: airway, breathing, circulation, vital signs if you are taking them, splint and strap checks, and a look at skin where the patient contacts the litter. Talk to your patient. A patient who knows what is happening tolerates the ride far better, and their answers are your cheapest monitor.
Getting to the Aircraft
If the carry ends at a landing zone, timing and discipline close the deal. Have the patient fully packaged and strapped before the helicopter is on final approach. Secure every piece of loose gear well away from the LZ, because rotor wash will find anything you forgot. Keep the patient covered against the downwash, and wait for the flight crew to signal you forward. Nobody approaches the aircraft on their own initiative, and nobody goes near the tail. The last hundred yards of an evacuation is where impatience hurts people.
Train the Carry, Not Just the Care
Patient movement is a team skill, and it shows. Teams that drill litter handling, rotations, and commands move patients smoothly. Teams that improvise it on the day learn that lesson the hard way, usually with a patient watching. Our Wilderness First Aid courses put litters in your hands and patients in them, across real terrain, so the first time you carry someone out is not your first time carrying someone. Come train the whole problem with us.
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