Specific stretchers enhance rapid extraction by tactical medical support teams in mass casualty incidents

Abstract

ObjectiveIn mass casualty incidents where the threat is on-going, victim evacuation remains a challenge: fast extraction while respecting spinal immobilisation and haemorrhage control. Different devices can be used but their suitability has not been compared. MethodsWe conducted a simulation study comparing eight extraction devices with a randomisation of the order of testing. Five teams, consisting of four officers, evacuated a single victim in five steps: device’s deployment, loading the victim, carrying the victim along a corridor, negotiating a corner passage and a descent by staircase. Primary outcome was the emergency extraction time, from deployment to the first obstacle. Secondary outcomes included ease of transport and victim’s stability, rated from 1 (worst) to 10 (best). ResultsOne hundred and sixty simulations were carried out. The median emergency extraction time was 16.7 [IQR: 11.6–24.9] seconds. The three speediest devices were the “firefighters’ worn”, “snogg” and “flexible tarp”, taking 9.7 [8.1–11.0], 11.7 [10.9–15.4] and 12.2 [11.2–17.9] seconds respectively (p < 0.0001). Regarding the ease of transport, the three best-evaluated devices were the “firefighters’ worn”, “strap” and “flexible tarp” with 10 [9–10], 9 [8–9] and 8 [8–9] respectively (p < 0.0001). Considering stability reported by simulated victims, the three best-evaluated devices were the “inflated stretcher”, “flexible tarp” and “firefighters’ worn” with 8.0 [7.8–9.0], 8.0[7.0–8.0] and 6.5 [6.0–7.0] respectively. ConclusionDevices were not equivalent in terms of extraction time and suitability criteria. For rapid extraction of victims from danger zones, the “firefighter’s worn” and “flexible tarp”, as very simple stretchers, seem to be the most appropriate devices.