Chapter 1 — Manual Evacuation Methods

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. Refer to Field Manual (FM) 4-25.11 for additional information on handling and moving casualties.

Casualty Handling

1-1. Casualties evacuated by manual means must be carefully handled. Rough or improper handling may cause further injury to the casualty. The movement effort should be organized and performed methodically. Each movement made in lifting or moving a casualty should be performed as deliberately and as gently as possible. Taking the tactical situation into consideration, 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 enhanced first aid [CLS]) or tactical combat casualty care (combat medic or ambulance crew) is administered

CAUTION The exception to this occurs when the situation dictates immediate movement for safety reasons. For example, if a casualty is inside, on or near a burning vehicle, or exposed to enemy fire, it may be necessary to first move him to a safe location away from the hazard. This situation dictates that the urgency of casualty movement outweighs the need to administer first aid or tactical combat casualty care.

 

1-2. Every effort should be made to adequately treat and/or dress injuries to prevent loss of life, limb, or eyesight prior to moving the casualty. Except in extreme emergencies, the type and extent of injuries must be evaluated before any movement of the casualty is attempted.

Measures are taken, as needed, to:

• Stop life-threatening bleeding.
• Open the airway and restore breathing and heartbeat.
• Prevent or control shock.
• Protect the wound from further contamination.

1-3. When a fracture is evident or suspected, the injured part must be immobilized. Every precaution must be taken to prevent the broken ends of the bone from cutting through muscle, blood vessels, nerves, and skin. 1-4. 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 

1-5. In manual evacuation, individuals performing the evacuation are referred to as bearers. Improper handling of a casualty can result in injury to the bearers, as well as to the casualty. To minimize disabling injuries (muscle strain, sprains, or other injuries) that could hamper the evacuation effort, the following rules should be followed: 

• Use the body’s natural system of levers when lifting and moving a casualty.  Know your physical capabilities and limitations.
• Maintain solid footing when lifting and transporting a casualty.
• Use the leg muscles (not the back muscles) when lifting or lowering a casualty. Use the shoulder and leg muscles (not the back muscles) when carrying or standing with a casualty.
• Keep the back straight; use arms and shoulders when pulling a casualty. 
• Work in unison with other bearers, using deliberate, gradual movements. 
• Slide or roll, rather than lift, heavy objects that must be moved.
• Rest frequently, or whenever possible, while transporting a casualty.
• Carry your weapon so that it does not harm the casualty but can be put into operation quickly.

1-6. Normally, a casualty’s individual weapon is not moved with him through the evacuation chain. Prior to moving the casualty from the point of injury, the bearer should make every effort to secure the injured Soldier’s weapon and sensitive items (if any). Every attempt should be made for the Soldier’s unit to secure the weapon and sensitive items prior to evacuation. In those circumstances where this is not possible, weapons and sensitive items will travel to the first MTF where they will be secured and held until the Soldier’s parent unit can claim them. Individual equipment, to include protective clothing and mask, remains with the casualty and is evacuated with him.

Casualty Positioning

1-7. The first step in any manual carry is to position the casualty to be lifted. If he is conscious, he should be told how he is to be positioned and transported. This helps to lessen his fear of movement and to gain his cooperation. It may be necessary to roll the casualty onto his abdomen, or his back, depending upon the position in which he is lying and the particular carry to be used. This can be accomplished by performing the following:

• Roll a casualty onto his abdomen, kneel at the casualty’s uninjured side and perform the following:
• Place his arms above his head; cross his ankle which is farther from you over the one that is closer to you.
• Place one of your hands on the shoulder which is farthest from you; place your other hand in the area of his hip or thigh.
• Roll him gently toward you onto his abdomen (Figure 1-1).
• Roll a casualty onto his back, follow the same procedure described in above, except gently roll the casualty onto his back, rather than onto his abdomen.
  
  

Figure 1-1. Positioning the casualty on his abdomen 

Manual Carries

1-8. Manual carries are tiring for the bearers and involve the risk of increasing the severity of the casualty’s injuries. In some instances, however, they are essential to save the casualty’s life. When a litter is not available or when the terrain or the tactical situation makes other forms of casualty transport 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—

• Strength and endurance of the bearers.
• Weight of the casualty.
• Nature of the injuries.
• Obstacles encountered during transport.

1-9. Carries can be used to move both a conscious and an unconscious casualty by one or two bearers. Carries, when performed correctly (paragraphs 1-10 through 1-21), provide the casualty more protection from further injury than drags (paragraphs 1-22 through 1-25) and are used to move a casualty a greater distance (from 50 to 300 meters depending on the carry).

One-Man Carries

Fireman’s Carry

1-10. The fireman’s carry (Figure 1-2) is one of the easiest ways for one individual to carry another. After an unconscious or disabled casualty has been properly positioned, they are raised from the ground, then supported and placed in the carrying position. When possible, the bearer should transport the casualty so that the bearer’s dominant (firing) hand is free. This can be accomplished by performing the following:

After rolling the casualty onto his abdomen, straddle him. Extend your hands under his chest and lock them together.

• Lift the patient to his knees as you move backward.
• Continue to move backward, thus straightening the casualty’s legs and locking his knees.
• Walk forward, bringing the casualty to a standing position; tilt him slightly backward to prevent his knees from buckling.
• As you maintain constant support of the casualty with one arm, free your other arm and quickly grasp his wrist, and raise his arm high. Instantly pass your head under his raised arm, releasing it as you pass under it. 
• Move swiftly to face the casualty and secure your arms around his waist. Immediately place your foot between his feet and spread them apart (approximately 6 to 8 inches).
•  Grasp the casualty’s wrist and raise his arm high over your head. 
• Bend down and pull the casualty’s arm over and down on your shoulder, bringing his body across your shoulders. At the same time, pass your arm between his legs.
• Grasp the casualty’s wrist with one hand and place your other hand on your knee for support.
• Rise with the casualty positioned correctly. Your free hand may be used to grasp your weapon

Figure 1-2. Fireman’s carry

 1-11. The alternate method of the fireman’s carry for raising a casualty from the ground is illustrated in Figure 1-3; however, it should be used only when the bearer believes it to be safer for the casualty because of the location of his wounds. When the alternate method is used, care must be taken to prevent the casualty’s head from snapping back and causing a neck injury. The steps for raising a casualty from the ground for the fireman’s carry are also used in other one-man carries. 

 

Supporting Carry

1-12. In the supporting carry (Figure 1-4), 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. To use this technique—

• Raise the casualty from the ground to a standing position by using the process described above for getting him positioned for the fireman’s carry.
• Grasp the casualty’s wrist and draw his arm around your neck.
• Place your arm around his wrist. The casualty is now able to walk or hop, using you as a support.

Figure 1-4. Supporting carry

Arms Carry

1-13. The arms carry (Figure 1-5) is useful in carrying a casualty for a short distance (up to 50 meters) and for placing a casualty on a litter. This carry requires greater upper body strength than other carries and can cause the carrier to quickly become fatigued. To use this technique—

• Raise or lift the casualty from the ground to a standing position, as in the preparation for the fireman’s carry.
• Place one arm under the casualty’s knees and your other arm around his back.
• Lift the casualty.
• Carry the casualty high to lessen fatigue

Saddleback Carry

1-14. Only a conscious casualty can be transported by the saddleback carry (Figure 1-6) because he must be able to hold onto the bearer’s neck. To use this technique—

• Raise the casualty to an upright position, as in the preparation for the fireman’s carry.
• Support the casualty by placing an arm around his waist. Move to the casualty’s side. Have the casualty put his arm around your neck and move in front of him with your back to him.
• Have the casualty encircle his arms around your neck.
• Stoop, raise him on your back, and clasp your hands together beneath his thighs, if possible.
• Carry the casualty high to lessen fatigue.

Figure 1-6. Saddleback carry

Pack-Strap Carry

1-15. In the pack-strap carry (Figure 1-7) 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. To use this technique—

• Lift the casualty from the ground to a standing position, as in the preparation for the fireman’s carry.
• Support the casualty with your arms around him and grasp one of his wrists and pull it closer to you.
• Place his arm over your head and across your shoulders.
• Move in front of him; while still supporting his weight against your back—
• Grasp his other wrist and place this arm over your shoulder.
• Bend forward and raise or hoist the casualty as high on your back as possible so that his weight is resting on your back.

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.

Figure 1-7. Pack-strap carry

TWO-MAN CARRIES

1-16. Two-man carries should be used whenever possible. Two-man carries 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. 

Two-Man Supporting Carry

1-17. The two-man supporting carry (Figure 1-8) 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. The bearers—

• Help the casualty to his feet and support him with their arms around his waist.
• Grasp the casualty’s wrists and draw his arms around their necks.

Figure 1-8. Two-man supporting carry

 

Two-Man Arms Carry

1-18. The two-man arms carry (Figure 1-9) 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. The bearers—

• Kneel at one side of the casualty and place their arms beneath the casualty’s back, waist, hips, and knees.
• Lift the casualty while rising to their knees.
• Turn the casualty toward their chests, while rising to a standing position.
• Carry the casualty high to lessen fatigue.

Figure 1-9. Two-man arms carry

Two-Man Fore-and-Aft Carry 1-19. The two-man fore-and-aft carry (Figure 1-10) is a useful two-man carry for transporting the casualty over a long distance (over 300 meters). The taller of the two bearers should position himself at the casualty’s head. By altering this carry so that both bearers face the casualty, it is useful for placing a casualty on a litter. To use this technique—

• One bearer spreads the casualty’s legs and kneels between them with his back to the casualty. He positions his hands behind the casualty’s knees. The other bearer kneels at the casualty’s head, slides his hands under the arms, across the chest, and locks his hands together.
• The two bearers rise together, lifting the casualty.

Figure 1-10. Two-man fore-and-aft carry

Four-Hand Seat Carry

1-20. Only a conscious casualty can be transported with the four-hand seat carry (Figure 1-11) since they must help support him 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). It is also useful in placing a casualty on a litter. To use this technique—

• Each bearer grasps one of his wrists and one of the other bearer’s wrists, thus forming a packsaddle.
• The two bearers lower themselves sufficiently for the casualty to sit on the packsaddle; then, they have the casualty place his arms around their shoulders for support. The bearers then rise to an upright position.

Figure 1-11. Four-hand seat carry

Two-Hand Seat Carry

1-21. The two-hand seat carry (Figure 1-12) is used when carrying a casualty for a short distance (up to 50 meters) and in placing a casualty on a litter. With the casualty lying on his back, a bearer kneels on each side of the casualty at his hips. Each bearer passes his arms under the casualty’s thighs and back and grasps the other bearer’s wrists. The bearers rise lifting the casualty.

Figure 1-12. Two-hand seat carry

 

Drags

1-22. Drags are used to move a casualty when the situation dictates that an expedient removal from dangerous situations or hostile environments is required. Drags allow the bearer and the casualty to stay low and use cover and concealment to move out of hazardous areas when the use of upright manual carries or litters would put the bearers and casualty in greater danger. Drags are generally used for short distances of up to 50 meters. 

CAUTION Rough or improper handling may cause further injury to the casualty.

 

Personnel Drag

1-23. A conscious or unconscious casualty can be readily grasped by their equipment (clothing, equipment harness, or body armor drag strap) and dragged to an area of safety where they can be treated and further evacuated by other means. This drag can be accomplished by one or two bearers and provides one of the fastest means to move a casualty. As with most drags it provides a minimum amount of protection for the casualty’s injuries and is only used to move the casualty out of imminent danger. The bearer or bearers grasp the casualty by his equipment and pull him backwards to safety. Another variation for moving a conscious casualty is to have the casualty assist by grasping the bearer’s hands or forearms over his shoulders; the bearer also grasps the casualty by his hands or forearms and pulls the casualty backwards to safety (Figure 1-13).

Neck Drag

1-24. The neck drag (Figure 1-14) is useful in combat because the bearer can transport the casualty as he creeps behind concealment or under obstacles. The neck drag cannot be used if the casualty has a broken arm. To use this technique perform the following:

Note. If the casualty is conscious, he may clasp his hands together around the bearer’s neck

Neck Drag

1-24. The neck drag (Figure 1-14) is useful in combat because the bearer can transport the casualty as he creeps behind concealment or under obstacles. The neck drag cannot be used if the casualty has a broken arm. To use this technique perform the following:

Note. If the casualty is conscious, he may clasp his hands together around the bearer’s neck

• Tie the casualty’s hands together at the wrists.
• Straddle the casualty in a kneeling face-to-face position.
• Loop the casualty’s tied hands over and around your neck.
• Crawl forward dragging the casualty with you.

Note. If the casualty is unconscious, his head must be protected from the ground.

Figure 1-14. Neck drag

Cradle-Drop Drag

1-25. The cradle-drop drag (Figure 1-15) is effective in moving a casualty up or down stairs, steps, or to maintain a low profile. To use this technique perform the following:

• Kneel at the casualty’s head (with him lying on his back). Slide your hands, with palms up, under the casualty’s shoulders and get a firm hold under his armpits.
• Rise (partially), supporting the casualty’s head on one of your forearms. (You may bring your elbows together and let the casualty’s head rest on both of your forearms.)
• Rise and drag the casualty backward. (The casualty is in a semisitting position.)
• Back down the steps, supporting the casualty’s head and body and letting his hips and legs drop from step to step. 

Note. If the casualty needs to be moved up steps, you should back up the steps, using the same procedure.

Figure 1-15. Cradle-drop drag


References These are the sources quoted or paraphrased in this publication. ARMY PUBLICATIONS 
Army publications are available at: https://armypubs.us.army.mil/.
ATP 3-90.90, Army Tactical Standard Operating Procedures, 1 November 2011. ATTP 3-06.11 (FM 3-06.11), Combined Arms Operations in Urban Terrain, 10 June 2011.
FM 3-04.113 (FM 1-113), Utility and Cargo Helicopter Operations, 7 December 2007.
FM 3-05.213 (FM 31-27), Special Forces Use of Pack Animals, 16 June 2004. FM 3-21.38, Pathfinder Operations, 25 April 2006.
FM 3-97.6 (FM 90-6), Mountain Operations, 28 November 2000. FM 4-02.2, Medical Evacuation, 8 May 2007.
FM 90-5, Jungle Operations, 16 August 1982. TC 3-97.61, Military Mountaineering, 26 July 2012.
Technical Bulletin, Medical 505, Altitude Acclimatization and Illness Management, 30 September 2010.
Technical Bulletin, Medical 508, Prevention and Management of Cold-Weather Injuries, 1 April 2005.
ARMY FORMS
DA forms are available on the APD web site (www.apd.army.mil).
DA Form 2028, Recommended Changes to Publications and Blank Forms.
DA Form 7656, Tactical Combat Casualty Care (TCCC) Card.
DEPARTMENT OF DEFENSE FORMS
Department of Defense forms are available at: http://www.dtic.mil/whs/directives/infomgt/forms/index.htm.
DD Form 1380, U.S. Field Medical Card.
JOINT PUBLICATIONS
Joint publications are available at: http://www.dtic.mil/doctrine/new_pubs/jointpub.htm.
JP 4-02, Health Service Support, 26 July 2012.
MULTISERVICE PUBLICATIONS
These publications are available at: https://armypubs.us.army.mil/.
ATTP 3-97.11/MCRP 3-35.1D (FM 31-70 and FM 31-71), Cold Region Operations, 28 January 2011.
FM 4-25.11 (FM 21-11)/NTRP 4-02.1.1/AFMAN 44-163(I)/MCRP 3-02G, First Aid, 23 December 2002. FM 90-3/FMFM 7-27, Desert Operations, 24 August 1993.
NATO STANAGs
These documents are available online at: https://nsa.nato.int (password required).
STANAG 2040. Stretchers, Bearing Brackets and Attachment Supports, Edition 6, 6 October 2004.
STANAG 3204. Aeromedical Evacuation, Edition 7, 1 March 2007.


This publication is available at Army Knowledge Online (https://armypubs.us.army.mil/doctrine/index.html).
*ATP 4-25.13

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