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When a member in your group sustains an injury on uneven or steep terrain, the first move is to perform a concise stabilization and triage assessment. Do not rush to relocate the patient before you address life-threatening issues such as uncontrolled bleeding, compromised airway, or suspected spinal injury. Assign a leader to consolidate information about the terrain, weather, and casualty status. Gather tools like a litter or improvised stretcher, ropes, slings, and stabilization devices, and confirm that at least one person can manage a contingency plan if a move becomes impractical. Clear, calm communication minimizes uncertainty and makes the plan executable. The initial assessment also guides whether assistive devices are needed during extraction.

The selection of a safe extraction method must reflect three core constraints: terrain, casualty condition, and available personnel. On rocky or forested slopes, carrying someone on a rigid litter might be impractical; using a two-belt drag or a seat-carry could be safer. If the casualty cannot bear weight, consider a short, controlled lower-and-retrieve technique with anchors and belay devices to control descent. For steeper sections, a team-based improvised sled with a tarp or rescue blanket can reduce strain. Before attempting any move, rehearse the sequence with everyone involved, assign responsibilities, and set a pace that matches the weakest link. Commit to stopping if any risk surge appears.

Training your group in common extraction patterns builds confidence and minimizes hesitation when real emergencies occur. Regular practice should include at least three scenarios: a simple slope slide, a shallow ravine crossing, and a rock-tattered ascent where footing is uncertain. Each drill must feature a dedicated scribe, a timekeeper, and a safety monitor who assesses weather changes and fatigue levels. Emphasize hands-on use of a litter, improvised drag devices, and securing knots that won’t loosen under load. After-action reviews should focus on how information was communicated, whether roles remained clear under stress, and how equipment performed in different light conditions or humidity. Continuous repetition increases efficiency without sacrificing safety.

When a casualty needs to traverse across uneven ground, securing the patient firmly to a stable carrying device is essential. If a rigid litter is unavailable, use a sturdy tarp or blanket as a makeshift carrier that can be strapped to a team member. The release of trapped air must be avoided if spinal injury is suspected, and the head, neck, and torso alignment must be preserved throughout the movement. Secure the casualty with multiple points of contact to prevent tipping, and use independent safety lines to manage any slip along the way. Maintain a steady cadence, keep communication concise, and adjust the team’s pace to the most fatigued member to sustain momentum and safety.

Before any lift, confirm the casualty’s comfort level and analgesia needs—if permitted by professional guidelines—and proceed with minor, continuous feedback during the move. In a high-angle scenario, a shoulder-sling harness can distribute load more evenly than a single grab, reducing spine and shoulder strain. If a unilateral injury is suspected, rotate carriers to protect the injured side and prevent compensatory movements that could aggravate pain. Hydration and energy management remain crucial; short, frequent pauses help prevent shock and overheating. Always maintain three points of contact on each carrier and verify that the ground below is stable before continuing. Posture discipline prevents secondary injuries.

Communication is the lifeline during extraction across difficult terrain. Establish a single, simple command sequence and use hand signals to complement spoken orders in windy environments. Assign a dedicated call-out person to announce progress, obstacles, or changes in terrain. Document changes such as slope angle, rockfall risk, or footing quality so the team can adjust the plan quickly. Encourage team members to vocalize concerns and observations, which helps protect against tunnel vision. If weather worsens, implement the contingency plan, which might involve delaying movement, selecting a safer route, or calling for external help. The goal remains to preserve life.

The two-person carry is a foundational technique that many outdoor operators rely on for short, stable sections. It requires one person to cradle the casualty’s upper torso and head, while the partner supports the legs and pelvis, distributing weight along the torso rather than the neck. This method works well on gentle slopes where footing is secure and there is no risk of rolling. Ensure the carrier’s arms stay locked, and the patient’s airway remains unobstructed. If the ground suddenly becomes unstable, switch to a side-by-side or seated carry that allows both rescuers to adjust their stance and maintain friction with the surface. Practice this with emphasis on smooth, synchronized movements.

For steeper or more technical terrain, a three-point or four-point carry becomes necessary. In this arrangement, the assisting rescuers anchor themselves at fixed points with improvised anchors, ropes, or trekking poles to stabilize the carrier’s path. The casualty’s knees can be aligned close to the chest to minimize leverage on the torso, reducing fatigue for the lifters. Use a feedback loop among team members to confirm that each step is deliberate rather than rushed. If the patient has back or neck concerns, avoid twisting and rotate the body as a unit to navigate obstacles. This technique demands coordination and trust among teammates.

A controlled descent along a steep patch requires a belay or friction-discipline system. One responder manages a rope or cordelette to regulate speed, while others monitor the patient’s alignment and breathing. The descent should be broken into short, manageable segments with rests as needed. Avoid sudden jolts or abrupt direction changes, which can aggravate injuries or cause panic. Keep a clear path and remove loose debris that could compromise footing. Protective gloves and knee pads reduce abrasions during slides. Rehearse the setup of anchors in advance, and verify that knots are tied correctly before applying load. The belay protocol should be known by every team member.

When the terrain allows a controlled slide or glide rather than a lift, this tactic can spare both patient and rescuers from excessive strain. A sliding method uses gravity to move the body gradually while a team member provides gentle steering with a rope or a tarp, ensuring the casualty remains aligned. The technique should be selected only after careful terrain assessment, ensuring that the slope angle and surface texture won’t accelerate beyond control. Maintain pace with the patient’s breathing; if distress increases, halt and reassess. Document the route and any adjustments so future rescues benefit from the learning.

After the move, deliver immediate post-rescue care, including spinal precautions if injury is suspected, tetanus status review, and pain management within medical guidelines. Transfer the casualty to a secure, comfortable location away from unstable ground, and monitor for signs of shock, hypothermia, or delayed symptoms. Debrief the team on what went well and what could be improved, including equipment performance, communication clarity, and tempo control. Capture a concise incident log with time stamps, terrain notes, and environmental conditions to inform training and future planning. The objective is to reduce repeat mistakes and increase readiness for subsequent challenges.

Finally, conduct a structured recovery plan for rescuers as well as the patient. Rescuers should restore equipment, rest, rehydrate, and re-evaluate footing and next steps. The patient’s rehabilitation timeline should be aligned with medical advice, gradually reintroducing movement and weight-bearing as approved. Schedule a follow-up training session that revisits each extraction technique, emphasizing the lessons learned from the recent operation. By turning experience into repeatable, ethical practice, your group becomes more resilient, confident, and capable of handling injuries without compromising anyone’s safety on challenging terrain.