Limb Injuries (4): Improvised Transport and Recommended Equipment

In the previous article, we discussed how to provisionally stabilize an injured limb in outdoor conditions. This article continues with the topic of improvised transport—situations where waiting for rescue is not an option and the injured must be moved using only available resources. Improvised transport requires careful assessment of both the situation and your capabilities. It is not the preferred option, but in remote or rugged terrain, it may become necessary. Here, we’ll explore when to consider moving the injured, how to do so as gently as possible, and what tools or improvisations can help.

When and Why to Move an Injured Person

Improvised transport should always be a last resort, justified by real necessity. Proper and gentle movement of an injured person is both physically and mentally demanding. It requires experience, teamwork, and the right equipment—things that are often lacking in non-professional, outdoor scenarios.

It’s important to consider that you might lose access to gear you’ll need later during the transport. In addition to the physical and emotional stress, rescuers face the risk of exhaustion or injury themselves.

Before deciding to transport the injured, carefully evaluate whether it might be safer to remain on site and provide basic care. Consider whether you can call for help—something that can be very limited in remote areas. Assess the severity of the injury, terrain difficulty, current weather, your physical and mental capacity, and above all, the risk that improper transport could worsen the injured person’s condition.

A mountain rescue operation in exposed terrain. Rescuers are securing and preparing the injured person for stretcher transport under challenging alpine conditions. Coordination, speed, and thermal protection are critical.

Risks of Improper Transport

Improvised transport in rugged terrain always carries risks—not just for the injured, but also for their helpers. Even well-meaning attempts to move or support the injured person can cause complications or worsen existing injuries.

❌ Potential risks include:

• Worsening the limb injury – Poor fixation or mishandling can cause further damage to tissues, nerves, or blood vessels.
  

• Spinal injury – If a spinal injury is unrecognized or unsupported, it may lead to permanent spinal cord damage.
  

• Loss of consciousness or shock – Movement may exacerbate internal bleeding or pain, worsening the overall condition.
  

• Hypothermia or overheating – Prolonged transport without protection from cold or heat significantly increases complications.
  

• Rescuer exhaustion – Physical and mental fatigue can result in coordination loss, injuries, or complete mission failure.
  

• Loss of critical equipment – Challenging terrain can lead to damage or loss of supplies essential for ongoing care.
  

Alternatives to Improvised Transport

🟩 Call for Help

If there is any way to contact emergency services, this is always the safest option. Use all available resources:

• Mobile phone – Use your country's emergency number (e.g., 112 in Europe, 911 in the US and Canada, 000 in Australia).
  
• Emergency apps – If available in your region, use dedicated rescue apps (e.g., Záchranka in Central Europe).
  
• Satellite communication –Devices like Garmin InReach, SPOT, or Zoleo allow you to send SOS messages from remote areas without cellular signal.
  
• Two-way radios / walkie-talkies – Useful for communication within your group or, in some regions, with local rescue services or park rangers.
  

🟨 Stay in Place and Provide Basic Care

If the injured person is not in immediate danger, it’s often safer to stay on-site. Provide fixation, warmth, hydration, and psychological support. This is often better than risking a dangerous evacuation.

🟧 Send a Group for Help

If communication is impossible from the incident site, you may need to send part of your group for help—ideally in pairs, while at least one person remains with the injured. This decision should be made carefully based on the terrain and situation.

First aid in the mountains. Rescuers respond to an injured person in difficult-to-access terrain, where they use specialized equipment – including a rescue kit, helmets, and ropes. Emphasis is placed on stabilizing the condition and ensuring team safety.

Key Principles for Improvised Transport in the Field

✅ Only transport when it is clearly safer for the injured person than remaining in place—such as when their condition could deteriorate with further delay.

✅ Before beginning transport, prepare thoroughly:

• Assess the situation and choose the best transport method based on the injury, terrain, and available materials.
• Treat the injury and carefully immobilize the limb with a makeshift splint.
  
• Ensure thermal comfort—protect the injured from cold, wind, or overheating.
  
• Plan your route—it should be as straight, short, and safe as possible.
  

✅ Transport should be as gentle as possible:

• Minimize jolts, shocks, and limb movement.
  
• Continuously monitor the injured person—consciousness, circulation in fingers, pain, thermal comfort.
  
• Take regular, short breaks.
  

✅ Involve multiple people: One carries, another stabilizes the person, and a third monitors their condition and communicates. If you’re a small group, take turns based on strength.

Methods of Improvised Transport

Without Equipment

🟠 Assisted Walking

For minor injuries like sprains or fatigue: two helpers support the injured on either side, their arms over the rescuers' shoulders.

🟠 Rautek Maneuver

Used mainly to quickly evacuate someone from danger (e.g., a collapse zone). The injured is seated; the rescuer wraps their arms under the person's armpits, grabs the forearms or wrists, and drags them backward.

👉 A second rescuer can support or carry the legs to ease handling and reduce risk of further injury.

The Rautek maneuver is used for rapid evacuation of an unconscious person from a danger zone. The rescuer grips the casualty from behind under the arms and drags them to a safer location. Suitable for short-distance moves in critical situations.

🟠 Fireman’s Carry

The rescuer hoists the injured person over both shoulders—torso on one, legs on the other. This requires strength and proper technique.

🟠 Two-Person “Chair” Carry

Two rescuers form a “chair” with their arms (or arms and backs), and the injured person sits on it. One supports the back, the other the legs.

The four-handed seat carry is a simple method of improvised transport performed by two rescuers. By interlocking wrists and palms, they form a stable seat for the injured person to sit on. Suitable when the person is fully conscious and able to cooperate.

With Equipment

🔵 Using a Backpack

A sturdy hiking backpack (with a rigid frame and hip belt) can serve as a transport aid.
The injured person leans against the pack; the rescuer secures them using straps, scarves, or clothing strips—typically across the chest and thighs. The "package" is then carried like a normal backpack.

🔵 Using Rope or Rolled Emergency Blankets

If you lack a stretcher, you can improvise sling straps from rope, flat loops, or tightly rolled foil blankets.
Pass one set under the armpits and another under the thighs or knees, forming a simple seated harness. Two rescuers carry the person suspended between them using these straps.

🔵 Two Backpacks and Four Trekking Poles

This method creates a makeshift “seat” using two solid backpacks and four trekking poles.

Steps:

1. Place the two backpacks side-by-side on the ground, with their backs facing up. Shoulder and hip straps stay unused.

2. Insert four trekking poles horizontally underneath the back panels—two in front, two in back—forming a rigid seat.

3. The injured carefully sits on the structure, legs hanging down, maintaining balance and communication.

4. Two rescuers wear the packs simultaneously and lift the seated person together.

🔵 Improvised Stretcher

If the injured person is completely immobile, and no carrying or supporting method is viable, you can build an improvised stretcher from available gear.
This allows safer and more stable movement but requires at least two bearers and a strong enough structure.

Gear in Your Backpack That Helps with Transport

Summary: When and How to Transport an Injured Person in the Field

Improvised transport is always a last resort—but in some situations, it may be the only option. If the person’s condition risks deteriorating or remaining in place is too dangerous, a careful evacuation might be the best chance for survival.

Before deciding to move the injured:

• Assess the risks—for both the injured and the rest of the group.
• Choose a suitable transport method and prepare the necessary gear.
• Thoroughly treat the injury—especially immobilize the limb and ensure thermal comfort.
• Plan your route and schedule, including potential rest points and carrier rotations.

👉 Remember: Even improvised transport can be safe—when preceded by proper planning and sound judgment. If professional help can be summoned, always make that your first option.