Lesson 3: Moving someone who can't walk

Television teaches the fireman's carry. Reality teaches the rescue blanket, and the gap between the two is the subject of this lesson. Here is the problem honestly stated. A conscious adult who can partly help you is one situation. An unconscious or uncooperative adult of ordinary weight, on a floor, in a doorway, at the bottom of stairs, is a completely different one, and it defeats a single rescuer almost regardless of fitness. Dead weight does not have handles, does not stay in a shape, and cannot be lifted from a crouch through a turn in a stairwell. So this lesson covers the one piece of equipment that changes the arithmetic, one carry that works with two rescuers, and, most importantly, the cases where the correct action is to leave the person exactly where they are and wait.

Two skills and one principle. The first skill is planning an extraction path from every floor of your home before you need one, which is a fifteen-minute walk around that almost nobody has done. The second is knowing the single piece of equipment most households lack and would benefit most from, which we will come to. The principle is the one that outranks both: knowing when not to move somebody, and being willing to act on that when every instinct is telling you to get them out of there. Moving a person with a spinal injury, an unstable pelvis, or uncontrolled bleeding can cause harm that the original event had not yet caused. The default in this lesson is stabilise and wait, and moving is the exception you justify.

A rescue blanket is a reinforced sheet with eight to ten sewn-in handles around the perimeter, and it is the highest-value item in this lesson because it converts an impossible task into a manageable one. The physics is straightforward. Without it, lifting an adult means gripping limbs and clothing, which distributes the load badly, hurts the patient, and gives you nothing to hold in a stairwell. With it, two to four people each take a handle, the load spreads across the group, everybody can stand upright and use their legs, and the patient stays in one shape while you move. In practice, four people can take a two-hundred-pound adult from a basement to a driveway in a couple of minutes, and the same four without a blanket may not manage it at all. It folds to about the size of a jacket, costs less than most of the electronics in your house, and lives in the home base layer.

The two-person seat carry works for a conscious patient who cannot walk but can hold on, which is a common enough case to be worth knowing: a twisted ankle on a trail, someone faint but responsive, an older relative who cannot manage a step. Four steps. The two rescuers face each other on either side of the patient. Each grips their own wrist and the other rescuer's wrist beneath the patient's thighs, so you form a seat rather than a sling. Lift together on a spoken count, keeping your backs straight and driving with your legs, with the patient sitting on your linked arms and one arm over each of your shoulders. Then walk on three, in step, with one of you calling the pace and watching for obstacles. Two cautions. This needs a patient who can hold on, so it is not for anybody unconscious or confused. And it needs a route wide enough for three people abreast, which rules out most staircases.

Now the cases where moving somebody makes things worse, and these override everything else in the lesson. Suspected spinal injury: any significant fall, a vehicle collision, a diving injury, or a patient reporting numbness, tingling, or weakness. Moving them can turn a spinal cord injury into a worse one. Keep the head and neck still, tell them to stay put, and wait. Suspected pelvic fracture, usually after a fall from height or a vehicle impact, where the pelvis is a ring around large blood vessels and moving them can convert a stable fracture into serious internal bleeding. And uncontrolled bleeding, where the answer is to stop the bleeding where they lie and then reassess, because moving first costs blood. One exception covers all three. If staying put will kill them faster than moving them, because of fire, water, traffic, or a collapsing structure, then move them. Outside that, stabilise, monitor, and wait for people with the equipment.

Recap. First, tour every floor of your home and ask a specific question at each one: how would an unconscious adult leave this floor? Look at the stairs, the doorway widths, the turns, and where you would have to set them down. Do it this week, because the answer sometimes changes where somebody sleeps. Second, a rescue blanket with handles is the single highest-value purchase in this lesson, and it is the one that turns a task requiring strength into a task requiring people. Third, and above both: spinal injury, pelvic fracture, or active bleeding means stabilise and wait, unless staying put is more dangerous than moving. That last sentence is the one to remember when it is your own family on the floor and every instinct says pick them up.