Manual Evacuation



As a medic, you will be expected to extricate and remove a casualty from the immediate area.  It is essential that appropriate removal techniques be used to prevent additional injury.


Overview of Manual Evacuation

Manual evacuation is the process of transporting casualties by manual carries

It is accomplished without the aid of a litter or other forms of transport

It is intended to end at the point where a more sophisticated means of evacuation becomes available.  For example, manual evacuation ends when a litter, vehicle, or other form of conveyance is available


Steps in Casualty Handling

Casualty Handling:

(1)        Casualties evacuated by manual means must be carefully handled.

(2)        Rough or improper handling may cause further injury to the casualty.

(3)        The evacuation effort should be organized and performed methodically.

(4)        Each movement made in lifting or moving casualties should be performed as deliberately and as gently as possible.

(5)        Casualties should not be moved before the type and extent of their injuries are evaluated and the required first aid (self-aid, buddy aid, or combat lifesaver) or Emergency Medical Treatment (combat medic or ambulance crew) is administered.


NOTE:  The exception to this occurs when the situation dictates immediate movement for safety reasons. For example, if a casualty is on the ground near a burning vehicle, it may be necessary to move him a safe distance away from the vehicle.  This situation dictates that the urgency of casualty movement outweighs the need to administer first aid or EMT. Even when immediate movement of casualties is required, they should be moved only far enough to be out of danger.


Steps taken prior to moving the casualty:

(1)        Many lifesaving and life-preserving measures are carried out before evacuating injured or wounded soldiers

(2)        Except in extreme emergencies, the type and extent of injuries must be evaluated before any movement of the casualty is attempted

(3)        Measures are taken, as needed, to:

(a)        Open the airway and restore breathing and heartbeat

(b)        Stop bleeding prevent or control shock

(c)        Protect the wound from further contamination

(4)        When a fracture is evident or suspected, the injured part must be immobilized

(a)        Every precaution must be taken to prevent broken ends of bone from cutting through muscle, blood vessels, nerves, and skin

(b)        When a casualty has a serious wound, the dressing over the wound should be reinforced to provide additional protection during manual evacuation


General Rules for Bearers

General Rules for Bearers:

(1)        In manual evacuation, individuals performing the evacuation are referred to as bearers

(2)        Improper handling of a casualty can result in injury to the bearers as well as to the casualty

(3)        To minimize disabling injuries (muscle strain, sprains, or other injuries) that could hamper the evacuation effort


The following rules should be followed:

(1)        Use the body's natural system of levers when lifting and moving a casualty. Know your physical capabilities and limitations

(2)        Maintain solid footing when lifting and transporting a casualty

(3)        Use the leg muscles (not the back muscles) when lifting or lowering a casualty

(4)        Use the shoulder and leg muscles (not the back muscles) when carrying or standing with a casualty

(5)        Keep the back straight; use arms and shoulders when pulling a casualty

(6)        Work in unison with other bearers, using deliberate, gradual movements. .Slide or roll, rather than lift, heavy objects that must be moved

(7)        Rest frequently, or whenever possible, while transporting a casualty


NOTE:    Normally, a casualty's individual weapon is not moved through the evacuation chain with him. Weapons are turned in at the first available MTF (BAS or division clearing station) to be returned to the parent unit through supply channels. Individual equipment, to include protective clothing and mask, remains with the casualty and is evacuated with him.


Manual Carries

Manual Carries

(1)        Manual carriers are tiring for the bearers and involve the risk of increasing the severity of the casualty's injuries.

(2)        In some instances, however, they are essential to save the casualty's life.

(3)        When a litter is not available or when the terrain or the tactical situation makes other forms of casualty transportation impractical, a manual carry may be the only means to          transport a casualty to where a combat medic can treat him.


The distance a casualty can be transported by a manual carry depends upon many factors, such as:

(1)        Strength and endurance of the bearers

(2)        Weight of the casualty

(3)        Nature of the injuries

(4)        Obstacles encountered during transport

(5)        Terrain and weather


Position the Casualty

Casualty Positioning

(1)        The first step in any manual carry is to position the casualty to be lifted.

(2)        If conscious, the casualty should be told how s/he is to be positioned and transported.

(3)        This helps to lessen the casualty's fear of movement and to gain cooperation.

(4)        It may be necessary to roll the casualty onto their abdomen, or back, depending upon the position in which s/he is lying and the particular carry to be used.

(a)       To roll a casualty onto their abdomen

(i)         Kneel at the casualty's uninjured side

(ii)        Place his arms above his head; cross his ankle which is farther from you over the one that is closer to you

(iii)       Place one of your hands on the shoulder which is farther from you; place your other hand in the area of his hip or thigh

(iv)       Roll the casualty gently toward you onto their abdomen

(b)        To roll a casualty onto their back, follow the same procedure described in (a) above, except gently roll the casualty onto his back, rather than onto their abdomen


Categories of Manual Carries

Categories of Manual Carries

(1)        One-Man Carries. These carries should be used when only one bearer is available to transport the casualty

(a)        The fireman's carry, is one of the easiest ways for one individual to carry another

(b)        Fireman's carry 2, The alternate method of the fireman's carry should be used only when the bearer believes it to be safer for the casualty because of the location of his wounds

(c)        The arms carry, is useful in carrying a casualty for a short distance (up to 50 meters) and for placing a casualty on a litter

(d)        Supporting carry, The casualty must be able to walk, or at least hop, on one leg, using the bearer as a crutch. This carry can be used to transport a casualty as far as he is able to walk or hop

(e)        Saddleback carry, Only a conscious casualty can be transported by the saddleback carry because he must be able to hold onto the bearer's neck

(f)         Pack-strap carry , the casualty's weight rests high on your back. This makes it easier for you to carry the casualty a moderate distance (50 to 300 meters). To eliminate the possibility of injury to the casualty's arms, you must hold the casualty's arms in a palms-down position.


NOTE:  Once the casualty is positioned on the bearer's back, the bearer remains as erect as possible to prevent straining or injuring his back.


(g)        Pistol-belt carry, is the best one-man carry for a long distance (over 300 meters).  The casualty is securely supported upon your shoulders by a belt. Both your hands and the casualty's (if conscious) are free for carrying a weapon or equipment, or for climbing obstacles. With your hands free and the casualty secured in place, you are also able to creep through shrubs and under low- hanging branches


NOTE:  If pistol belts are not available for use, other items such as rifle slings, two cravat bandages, two litter straps, or any other suitable material which will not cut or bind the casualty may be used.


(h)        The pistol-belt drag, as well as other drags,  is generally used for short distances (up to 50 meters). This drag is useful in combat, since both the bearer and the casualty can remain closer to the ground than in other drags.

(i)         The neck drag, is useful in combat because the bearer can transport the casualty as he creeps behind a low wall or shrubbery, under a vehicle, or through a culvert. If the casualty is unconscious, his head must be protected from the ground. The neck drag cannot be used if the casualty has a broken arm.


NOTE:  If the casualty is conscious, he may clasp his hands together around your neck.  If the casualty is unconscious, protect his head from the ground.


(j)         The cradle-drop drag is effective in moving a casualty up or down steps.


NOTE:  If the casualty needs to be moved up the steps, you should back up the steps, using the same procedure. Cradle-drop drag. The load-bearing equipment (LBE) carry using the bearer's LBE can be used with a conscious casualty.


(2)        Two-Man Carries. These carries should be used whenever possible. They provide more comfort for the casualty, are less likely to aggravate injuries, and are less tiring for the bearers. Five different two-man carries can be used.      

(a)        The Two-man supporting carry can be used in transporting both conscious and unconscious casualties. If the casualty is taller than the bearers, it may be necessary for the bearers to lift the casualty's legs and let them rest on their forearms.

(b)        The two-man arm's carry, is useful in carrying a casualty for a moderate distance (50 to 300 meters) and placing him on a litter. To lessen fatigue, the bearers should carry the casualty high and as close to their chests as possible, In extreme emergencies when there is not time to obtain a spine board, this carry is the safest one for transporting a casualty with a back injury, if possible, two additional bearers should be used to keep the casualty's head and legs in alignment with his body.

(c)        The two-man fore-and-aft carry, is a useful two-man carry for transporting the casualty over a long distance (over 300 meters).

(d)        Four hand seat carry, only a conscious casualty can be transported with the four-hand seat carry since he must help support himself by placing his arms around the bearers' shoulders. This carry is especially useful in transporting a casualty with a head or foot injury for a moderate distance (50 to 300 meters).

(e)   The two-hand seat carry is used when carrying a casualty for a short distance (up to 50 meters) and in placing a casualty on a litter.


Special Manual Evacuation Techniques

Special Manual Evacuation Techniques, The use of special techniques are required to remove injured soldiers from tanks, other armored vehicles, motor vehicles, or from other limited-access positions.


CAUTION:  Parking next to a battle damaged tank can draw antitank fire to the ambulance. If there is the potential for enemy fire, approach from the opposite side of the vehicle, using all available cover and concelement. Ambulance teams should park the vehicle behind protective terrain and dismount with the necessary equipment to provide emergency medical treatment to include stabilization of the head and spine, when required.


Observing the vehicle for fire

(1)        Exercise extreme caution when approaching a burning vehicle

(2)        Use fire suppression equipment and any protective measures available

(3)        In some cases,           attempting to save the crew of a burning vehicle may only result in the injury or death of the rescuer. This must be a rescuer's decision based on the specific       circumstances.


The procedures for extracting a casualty include

(1)        Gaining access to the casualty

(2)        Administering lifesaving measures

(3)        Freeing the casualty from the vehicle or other limited-access positions

(4)        Preparing the casualty for removal

(5)               Transporting the casualty from the site


Evacuating a casualty from a tank

(1)        Steps in Casualty Evacuation

(a)        Observe the vehicle for fire

(b)        Stabilize head and neck if possible

(c)        Extract the casualty from the vehicle

(d)        Check and treat the casualty

(e)        Evacuate the casualty

(2)        Vehicle Exit Procedures

(a)        The M1  is equipped with three exits. Some of these exits are used to evacuate specific crew members while others are used to evacuate any of the crew.

(b)        The exits are:

(i)         Commander's hatch

(ii)        Loader's hatch

(iii)       Driver's hatch

(3)        Removing a wounded soldier from the interior of a tank is difficult and requires speed (as there is the potential that a damaged tank may explode or the tank may be more easily            acquired/targeted by the enemy)

(4)        Whenever possible, crew members should be used to extract casualties from tanks because of their experience with these vehicles

(5)               Removing casualties from a tank requires 3 crew members/soldiers


Steps taken by medical personnel prior to the casualty being extricated


NOTE: Rescuers should always attempt to stabilize the injured soldier's head and neck prior to moving him.


(1)        If a head and or spine injury are suspected-

(a)        Medical personnel will stabilize the neck as much as possible prior to attempting to extract the casualty

(b)        The neck should be stabilized using a cervical collar, Kendricks Extrication Device (KED)

(c)        Manual stabilization (using forearms of the rescuer, as appropriate when no equipment is available)

(2)        Depending upon the tactical situation, these procedures may be abbreviated if the vehicle and its crew are in imminent danger


NOTE:  Rescuers should always attempt to stabilize the injured soldier's head and neck prior to moving him.



In battlefield, extrication of casualties is often a challenging task.  In this lesson, we have identified steps, procedures, and rules associated with manual evacuation.  As a medic, it essential that you have an understanding of manual evacuation in order to prevent injury to yourself and further injury to your soldier of care.