Stretchers

STRETCHERS, a device for carrying the sick and wounded in a lying position. Depending on whether transportation is carried out on foot or on pack animals, on sledges or on wheeled supports, a distinction is made between hand, pack, ski, wheeled, and other stretchers (Figures 1–5). At the same time, the primary and mandatory property of any stretchers is the possibility of carrying them by hand and ensuring rest for the patient. 2–4 people are needed to carry them, supporting the stretchers on their hands or shoulders, usually with the help of straps. Instead of human bearers for transport...

Figure 1. Ordinary stretchers. Figures 2 and 3. Two-wheel and single-wheel stretcher-carts. Figure 4. Folding stretchers. Figure 5. Stretcher-table.

over longer distances, pack animals are used, best of all mules or camels, with 1–2 stretchers installed or suspended on special saddles. In the mountains, along narrow paths with sharp turns, descents, and ascents, it is impossible for 2 bearers to walk with long, straight stretchers. Therefore, in alpine countries, practical experience has developed a whole series of chair-like mountain stretchers, the principle of which is that the bearer's head and back are loaded simultaneously, while the wounded person is on the stretcher in a semi-recumbent or sitting position. During the war in combat in a fortified sector with a multitude of deep, narrow trenches and a whole network of communication trenches branching at acute angles, conditions were created that also greatly complicated work with ordinary stretchers. Constructed during the imperialist war on the western front, special trench stretchers either resembled mountain models or represented various kinds of improvisations. Hammocks or short stretchers were made from overcoats and tent flaps, poles, bars, belts, and ropes. In general, the manufacture of homemade stretchers from available materials has been widely and variously practiced since ancient times in providing first aid in emergencies. A special variety of such improvised stretchers is the drag-sled (volokusha). In swampy forests, this is the simplest and sometimes the only possible means of transport. Two young trees are cut down, laid out parallel at a certain distance from each other, fastened in this position by struts, and covered with branches on top. The branches remaining on the underside spring when the victim placed on such a frame is dragged along the ground. With soft soil, the same purpose is served by mounting stretchers on runners. Loads that cannot be carried by hand in the alpine mountains are transported in winter and summer on special sledges, which are also easily adapted for the transport of the wounded. In flat areas in winter with an abundance of snow cover, the necessity of ski stretchers is indisputable. B. K. Leonardov distinguishes four categories of sledge-ski combinations with ordinary stretchers and singles out as a special group the conversion of walking skis into a means for transporting and carrying the wounded. The latter group includes the ski-stretchers of Tatarinov and Tsygankov: runners are fastened by two transverse extensions on which the stretcher canvas is installed with ski poles instead of poles. On ordinary passable roads, stretcher transport is significantly facilitated and accelerated by wheeled attachments to hand stretchers. The number of wheels ranges from 1 to 4. Accordingly, the device together with the stretchers has the appearance of a wheelbarrow, a two-wheeler, or a Chinese "rickshaw," a three- or four-wheeled cart. The last category of special stretchers not yet mentioned above is marine stretchers (see Marine Sanitary Service). Conditions in the mining industry bear some resemblance to the conditions of marine sanitary transport. For evacuating an injured person from mine drifts and bringing them to the surface ("bringing to the top"), stretcher-splints and stretcher-hammocks are also successfully used. Similar stretchers meet the technical conditions of loading, unloading, and transportation during the evacuation of the sick and wounded by aircraft better than others. The importance of stretchers as the main sanitary transport device stands out especially vividly during war. The desire to make military stretchers portable leads to the manufacture of folding or collapsible ones. The most convenient type of collapsible stretchers are those divisible into two identical halves, each of which can be used as a trench stretcher for carrying the wounded in a sitting position. Since transferring the wounded from one stretcher to another is usually painful and harmful to the wounded, the idea arose to create a standardized model of stretchers applicable for placement in any type of sanitary transport (cart, automobile, railway carriage, etc.). The need for a very large number of stretchers, adaptable not only to diverse external conditions but also to various therapeutic and prophylactic tasks, makes the question of a standard model even more acute. The International Committee of the Red Cross in Geneva at the 1925 conference decided to create a permanent technical commission for the standardization of sanitary supplies. First in line was the resolution of the stretcher issue. At present, an agreement has been reached regarding the dimensions and general properties of such unitary stretchers. In 1927, the commission established the following dimensions of stretchers mandatory for all states: maximum length of poles 230 cm; maximum width of stretchers (at the level of transverse struts) 59 cm; distance between the outer edges of the poles no more than 55 cm; maximum height together with the raised headrest 40 cm, without headrest 20 cm; distance along the length of the poles of the closest support points for installing or suspending stretchers 119 cm, length of the support belt in the head and foot parts of each pole 10 cm, length of the free ends of the pole on both sides 45.5 cm, maximum weight 12 kg. As for general properties, it is considered desirable that the stretchers, while retaining national characteristics, satisfy the following design requirements: 1) transverse divisibility of the stretchers into 2 strictly identical halves; 2) interchangeability of both halves of each pole and fastening them into a long pole with a simple and durable mechanism; 3) complete removability of each half-canvas; 4) absence of small parts, bolts, chains, etc.; 5) portability of each half of the stretcher on shoulder straps; 6) suitability of half-stretchers for work in trenches. Field stretchers of the 1927 model adopted for supply in the Red Army have wooden bars (poles) 221.5 cm long; metal crossbars 55 cm wide, folded on hinges towards the handles; low loop-shaped metal legs; a non-removable canvas nailed to the outer edges of the bars and protected from sagging downwards by 2 transverse strips. For greater strength during installation and suspension, the bars are sheathed with an iron sleeve in the central parts of the handles near the attachment of the canvas. The weight of the stretchers is about 9.5 kg, the height of the bed above ground level is 16 cm. The headrest is improvised, straps for bearers, belts for fixing unconscious wounded, and blankets for heat conservation are prepared separately as needed. American military-sanitary stretchers have a great similarity to the described stretchers. From a medical point of view, field stretchers must be a permanent sanitary-transport device up to the place of hospitalization, ensuring the wounded person rest without straining the muscles of the trunk or extremities and without restricting breathing and blood circulation, while at the same time protecting the patient from the sun, rain, and ground cold, and finally allowing carriage by hand and transport by wheeled and other means of transport without reloading.

D. O. Sinen. I. NASAL BLEEDINGS, see Epistaxis.