Content excerpts from Rigging Lab Academy's Confined Space Rescue Demonstrations
Sked Stretcher Spinal Packaging for Vertical & Horizontal Use
In this unit, we’ll be going over the NFPA Confined Space Rescue job performance requirements for spinal packaging both vertically and horizontally. We’ll begin by going over vertical rigging.
As you can see in the next video demonstration, our patient is strapped down to a spine board with some spider straps and a hard collar. The specific spinal procedures and precautions you would use are up to the authority having jurisdiction (AHJ) in your area as they determine what products and procedures need to be used, when, and how much spinal precaution to apply depending upon the circumstances.
Alright, now back to our patient. Notice that we have the head secured with tape and a hard collar. We recommend that anytime you’re doing confined space rescue that you have a method of securing both the head and the hands. We want to be able to fully control the patient and don’t want them to be able to reach out or move their head and then contact any hazards that might be in a confined space.
We also have the patient wearing a Class II harness as this allows us to attach a secondary means of connection directly to the patient. We have some minimal padding between the patient and the spine board as well. Typically, when using a spine board we would apply more padding. However, when operating in a confined space environment it’s often difficult to provide a good, robust level of padding on the spine board due to space and time constraints. For this reason, we’re just using some minimal closed cell foam.
Our patient also is wearing a helmet and eye protection. We recommend a helmet for the patient when packaging in a Sked stretcher because the roll that forms at the top of the stretcher has a tendency of hitting the top of the patients head. You also want to protect the patient’s head and the eyes because they won’t be able to do so once they’re secured in the device with their arms and hands strapped down.
When putting the patient into a Sked stretcher, the first thing we have to do is give ourselves a little bit of room to work. You can do this by moving the patient out of the way.
When you remove the Sked stretcher from the bag, you’ll notice that it’s made of a really thick, durable plastic material that has a lot of memory to it. To remove some of that memory so that it actually lays out flat for us, we’ll do what’s called a reverse roll where we unroll the stretcher, turn it over, and roll it backwards. This does take a bit of effort! Notice in the video how much the stretcher wants to roll back up on itself. Ideally, this is something you would do outside of the confined space and then pass the Sked stretcher into the space to the rescuers that are inside the space already laid out flat.
Next, we need to make sure which end is the head of the stretcher (the labeled end.) Before you place the patient on the stretcher, you want to make sure that all of your straps are free and clear and aren’t going to be caught underneath the stretcher or the backboard.
When placing your patient in a Sked stretcher, you need to make sure the shoulders of the patient are close to the double grommets located near the head end of the stretcher. Shoulders should be inline with the grommets and centered on the Sked itself. This allows the upper straps to be on the upper chest (nipple line).
Then the next step is to secure the four cross straps that go across the body. This can all be done by a single rescuer but it’s most efficiently done with a two rescuer team. At this point in time, you just need to secure these straps loosely because you’ll be adding a lifting bridle next and we don’t want the cross straps to interfere with our lifting bridal rigging.
The Sked stretcher, being of a plastic material, is pretty pliable and it slides over surfaces really well. As it rolls up around the patient it does offer some rigidity. The spine board itself gives it a lot more rigidity and also protects not just for spinal precaution but also for comfort; if we needed to slide the stretcher across gravel, bolts, or sharp edges, we don’t want the patient to feel that and the spine board protects them.
Once we’ve got the first four cross straps done up, we’ll add the vertical lifting bridle. One of the primary reasons for using a Sked stretcher is that it has a much smaller diameter than a basket stretcher, which requires at least a minimum of a 2-foot opening.
In order to get the Sked stretcher through minimal openings like that, we use the vertical lifting bridle. Provided by the manufacturer, it’s a 10-meter length of 9-millimeter rope with a figure eight on a bight tied in the middle (a double loop figure 8 on a bight as well as double butterfly’s are also used in some training videos by SKEDCO and others).
To do this, you’ll start by feeding the ends of the lifting bridle through the two grommets from the outside to the inside at the head end of the stretcher, pull all the rope through, and then make sure you have the figure eight knot centered.
Then as you go down the outside of the stretcher — going from the outside to the inside — you’ll pass the lifting bridle through the grommets, at the shoulder, and then through the handles. Then again from the outside to the inside through the next grommet at the waist level. Some videos from providers show this rigging as inside to outside on the grommets.
Next, you’ll attach the vertical lifting bridle to the spine board with a Munter hitch. The way you tie the Munter hitch is kind of unique. To start, take a large bite of rope and pass it around underneath the spine board, coming up through one of the slots in the spine board.
Pull out a large bite that’s up above the edge of the Sked stretcher that you’’ll be able to access after you’ve tightened it up. Then take the running end of the rope, pass it through the bite (don’t pull it tight at this point).
Then take the running end of the rope and finish the bridle through the stretcher handles again and then through the grommet at the foot end of the stretcher (the top one, from outside to inside). Leave the ends of the bridle for now — you can finish those off after you’ve tightened everything up. Then tighten the four cross straps.
This is when you can place the patient’s hands down along the sides of their body. Assess your patient to see if they’re wearing a watch or some other type jewelry on their wrists. If they are, remove it. The stretcher is very tight and conforms to the person and something as small as a wristwatch could become quite painful for a patient suspended any length of time.
After tightening up the four cross straps you’ll then tighten up the vertical lifting bridle itself. Again, ensure that the figure eight knot is centered between the two grommets. Then pull down on either side of the stretcher equally, getting all the slack out of the lifting bridle.
When you get down to your Munter hitch that’s securing the spine board, grasp the bite of rope that was left out loose, pull all the slack out, pull the bridle tight, and then grab the running end of the rope and pull the slack out of the Munter hitch itself. Not only is your spine board encapsulated within the Sked stretcher, but it’s also now actually tied into the vertical lifting bridle itself.
Finish the vertical lifting bridle off with a square bend. The square bend, being an inherently loose knot, requires overhand safeties on either side of it. You’ll also want to tuck in the ends of the bridle to make sure they don’t catch on anything during transport. Once that’s done, make sure all the ends of your straps are tucked inside the stretcher.
Secure the foot end of the stretcher by taking the foot straps, wrapping them around the lowermost cross strap, and securing them. SKEDCO has Cobra buckles into the last grommets on their video. Your SKED may or may not have Cobra buckles depending on when it was purchased. You don’t want to secure it too tightly because when you lift a patient in a Sked stretcher vertically, they’re going to slide down; they’re strapped to a plastic spine board and inside that plastic Sked stretcher, it’s going to slip. The Sked stretcher forms a wedge or cone shape and as the patient slips down in that stretcher, they become even more tightly secured within the stretcher. So, when you fasten up the foot straps you need to leave some room for that sliding of the patient to occur.
Now your patient is packaged in the Sked stretcher and is ready for vertical lift. The figure eight knot at the head end forms the connection to the master attachment point of your rigging system and the Class II harness, or the waist connection, provides the patient’s secondary point of contact.
Now let’s discuss the horizontal rigging of the Sked stretcher. A patient hung vertically or suspended vertically in a Sked stretcher is going to be fairly uncomfortable after a short period of time. It’s not the most comfortable experience and it’s not necessarily the best for patient care, but it’s what we use to remove a patient from a confined space, through constricted openings, etc. Whenever possible, you’ll want to place the patient horizontally. If you still have some transportation to do by rope system, whether it’s raising or lowering, but you no longer require the patient to be vertical to get through the space or the space openings, repackage the stretcher so it can be transported in a horizontal manner.
The manufacturer provides some lifting straps for this purpose. There are two lifting straps and a tri-link for creating the horizontal lifting bridle. SKEDCO provides a steel locking carabiner, however, many teams have changed this to a tri-link to prevent cross loading. The two lifting straps are very similar except that one is longer than the other. The short one will be marked head-end and goes to the head end of the stretcher. That’s what keeps the patient in a slightly head up angle.
We don’t have to remove the patient or undo anything in order to convert from a vertical rigging to a horizontal rigging. All that’s needed is for one rescuer to lift up the stretcher while the other rescuer slides the straps underneath.
Make sure that you have an equal amount of strap on either side. Once you have equal length straps, feed the ends of the straps through the diagonal slots on the side of the stretcher. Feed the strap from the outside to the inside through the diagonal slot and then route the strap up towards the middle of the package. Make sure that you aren’t pinching any of the cross straps or the vertical rigging bridle and that you route the straps so that they aren’t compromising one of the other systems or the stretcher.
Once you have the straps in place, take your tri-link and capture all four straps. From a rigging perspective, the best way to do this is to capture one of the foot-end straps first and then both of the head-end straps and then finally the second-foot end strap. This creates a neat package in a tri-link.
Now, again, the manufacturer provides one tri-link for this purpose. Some agencies may use two tri-links (one for the head strap and one for the foot end strap) or even individual carabiners in all four straps depending upon their preference and what their AHJ requires. This is the manufacturer’s supplied and recommended way of preparing the patient for horizontal rigging.
The tri-link forms the attachment point for the stretcher on the horizontal configuration to the rope rigging master attachment point and a secondary connection to the patient again to his class two harness.
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Peace on your Days
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