BASKET LITTER BASICS
It often has been observed that the most effective and efficient rescue tools are simple in design and have few or no moving parts. Such a tool is the often-underutilized rescue basket, also referred to as a stokes litter. Since many fire departments are becoming more involved with EMS (often at a first-responder level), awareness of patient-care techniques and safety procedures in rescue operations has been growing. It is common for the fire department to be responsible for removing accident victims and rescuing people from hazardous environments. The basket litter, when properly used to its full potential, ensures that the victim is delivered to EMS personnel without compounding any existing injuries.
Generally, a basket litter is used to move a victim from a danger zone to an area of safety. Some of the situations in which a basket litter would be used are confined space rescues, removing victims from an elevated area (such as a rooftop), trench rescue, structural collapse, and incidents requiring patient immobilization. When used in conjunction with properly designed accessories, it also can be used for water rescue or moving a patient over traverses (such as between buildings). It can be pulled over the snow or used with a shield to protect the patient from falling debris. High-angle rescue teams have used basket litters for many years with a great degree of success. Many of the techniques and equipment these highly skilled teams use can benefit the fire service.
The two basic types of basket litters used in the fire service are the familiar steel-framed wire basket and the newer polyethylene basket built around a metal frame. The following design criteria must be considered for baskets used by the fire service:
- The basket must be of sufficient size to comfortably accommodate the victim, allowing for blankets, backboards, and so on. Most baskets are between 80 and 85 inches long and from 22 to 24 inches wide. Narrower and shorter baskets are available for special applications.
- It must be of minimal weight without sacrificing strength. Most baskets weigh between 27 and 31 pounds. The weight can become an important factor if the basket has to be carried a considerable distance.
- It must be rigid enough to withstand the external forces encountered when it is handled with a patient in it; otherwise, it could fail under such stress. Some kinds of flexible baskets now available, used by mountain rescue groups, can be used successfully for lifting.
- It must be suitable for lifting in both vertical and horizontal positions. It must be properly fitted with grommets to accommodate rope or carabiners, since lifting puts a great deal of stress on the basket and can cause sudden failure.
- The basket must be able to accept patient-immobilization devices such as backboards, MAST units, and orthopedic stretchers. Some models of basket litters are equipped with leg dividers that prohibit the use of such items.
- Perhaps the most important design feature of the basket litter is that it have the capacity to safely protect the patient within. The basket must hold the patient securely within its confines while offering protection from any objects that might strike or fall on the victim. Patient movement within the basket after the patient has been properly secured must be minimal.
BASKET LITTER USES
The use of the basket litter by no means is confined to the fire service. Wilderness and mountain rescue groups have developed many of the techniques and much of the equipment used with basket litters. The basket litter was used extensively during World War II, when it became necessary to remove victims from bombed and collapsed structures in an expedient and safe manner. The many varied uses of the basket litter are limited only by the imagination and skill of the rescuers.
Following are some of the rescue evolutions in which a basket litter can be used effectively:
- When a victim has to be removed from the upper level of a structure or raised from an open pit or ravine, lifting or lowering the basket litter with ropes often is the only available means of removing the victim. Of course, the preferred method is to package the victim in the basket litter and carry him/her to a safe area, but this may not be possible because of a steep incline or obstructions. In circumstances when the basket litter must be raised or lowered by hand using ropes, an aerial ladder, or ground ladders, remember to secure tag lines to the ends of the basket whenever it is lifted, to minimize movement and guide it away from any obstructions (see sidebar).
- The basket litter is useful when rescuing and carrying a victim out from a remote area. Basket litters are designed to be carried by six rescuers, three per side. However, if conditions dictate, this procedure can be modified. If a steep grade must be negotiated, use a belay line. A useful accessory in this case would be a wheel that attaches to the bottom of the basket litter, allowing it to be guided over the terrain. Be careful, however, because its use can result in a jarring and uneven ride for the patient.
- Should it become necessary to move the victim up or down a steep grade such as a hillside or stairwell, secure the victim in the basket litter and slide or drag the entire unit. Most basket litters have runners on the bottom to facilitate such movements, but be careful to ensure that the basket does not become damaged.
- With the help of flotation devices, you can use basket litters to remove victims from the water. The flotation devices attach to the outer rails of the basket and provide about 50 pounds of buoyancy to maintain the patient at the water line.
- Since the weight of a loaded rescue basket is distributed over a large surface, the basket can be beneficial in ice rescues. Although many specialized units are made specifically for ice rescues —such as ice-type “sleds” or other devices—the basket litter can be very effective when such sleds are not available.
Lifting the victim. When lifting a rescue litter with rope, make sure the rope and/or harness assembly will support the weight and stress imposed by lifting. Some basket litters are rated at a 2,500-pound capacity (before using a basket litter, always check the manufacturer’s load rating), indicating that the equipment’s designers have anticipated a significant amount of stress.
Any rope used for lifting in a rescue situation should be manufactured and maintained in accordance with the latest edition of NFPA 1983, Fire Service Life Safety Hope, Harness, and Hardware (1990). The rope should have a working load of 600 pounds; anything less will not have a sufficient safety factor for the anticipated loads.
Most rescue litters have four lifting grommets at which points the lifting bridle or rope can be attached. The lifting harness usually is equipped with carabiners that fasten directly to these grommets. The lifting harness usually is constructed of webbing or cable. On some lifting harnesses, the lengths of the legs are adjustable; this can be an important feature should the situation require the basket to be kept slightly tilted or the basket to be leveled to compensate for an unevenly balanced load. The lifting harness usually is equipped with a large ring for attaching the lifting line. Depending on whether the basket litter will be lifted in a vertical or horizontal position, either two or four of the lifting grommets will be used. If a lifting harness is not available, you can use a lifeline to tie a four-point rescue hitch through the grommets of the basket litter. If you do this, make sure that the rope does not wear against the basket.
Securing the patient. Enough cannot be said about the importance of properly securing the patient in the basket litter. Since the object of a rescue is to successfully extricate the victim from a hazardous environment, protect the victim while moving the basket litter. A patient not properly secured in the basket can suffer additional injuries.
Some styles of basket litters are equipped with a foam pad for patient comfort. It is a good practice to wrap a blanket around the patient, with the arms inside the blanket, before placing the victim in the basket litter. The blanket serves as a cushion and also can assist in lifting the patient in the basket. Secure the patient’s arms to prevent them from moving, voluntary or otherwise, and to overcome the patient’s tendency to grab the outer rails of the basket whenever it strikes an object or moves unexpectantly. If the patient fits loosely in the basket, generously pad the void areas to prevent movement. If the basket is to be lifted by mechanical means or in a vertical direction, secure the victim against any downward movement within the basket. Most basket litters have an adjustable footrest that can be removed easily if it is not needed.
If the patient is immobilized to a backboard or other device and placed in the basket litter, secure the victim to the backboard before placing him/ her in the basket. Secure equipment accompanying the patient, such as oxygen cylinders or IV setups, from any movement.
The preferred method of securing the patient in the basket litter is to use webbing and quick-release buckles; in the absence of webbing, YOU can use rope. Place sufficient padding over the areas of the patient that contact the securing straps; doing this distributes stress. If you use rope, criss-cross it over the patient. Secure separately from the patient appliances such as an oxygen bottle. Do not attach the straps or rope around the outside rail or through the carrying handles; doing this can cause the rope to chafe or get in the way when lifting the basket.
CARE AND MAINTENANCE
As with almost any rescue tool, preventive maintenance and cleanliness can greatly extend the reliability and service life of the basket litter. The baskets are subject to a great deal of physical stress when being lifted; they also can be damaged if improperly stored. At the rescue scene, they are subject to contamination from various body fluids, petroleum products, and other substances.
If used under adverse conditions, the metal frames of the basket litters can break at the welds or other weak points. Inspect the baskets regularly at all of the joints and connections for dents, corrosion, tight connections, and solid welds. The finish on the all-metal baskets should be kept freshly painted to help inhibit corrosion, but inspect the basket prior to painting to ensure that you are not covering up any defects. Never repaint the polyethylene baskets, as the paint may damage the shell.
Mild soap and water will remove most contaminants from the basket litters. Consult the manufacturer for advice on how to remove tar or stains. Clean all strapping and buckles.
Inspect the runners on the bottom of the basket for any cracks or splinters. Whenever the basket is dragged along a hard surface, the runners are prone to wear or damage. If the basket is lifted with a harness, check the grommets where the carabiners attach for tightness or sharp edges.
The most important aspect of using the basket litter in operations is that rescuers become proficient in its use before using it at the rescue scene. Also, never exceed the manufacturer’s load recommendations; check them before using the basket. When purchasing a basket litter, consult the manufacturer about which basket and accessories are best suited to your needs.