Stokes Litter Lower on a Steep Rail Embankment
At 02:10 a 52-year-old hiker fell about 18 m down a 38-degree vegetated slope and is 45 m below the trail in a ravine. He is conscious but has an unstable pelvis and an open forearm fracture. The slope is loose shale with small trees. A four-person team arrives with 150 m of 11 mm low-stretch rope, webbing, steel carabiners, a brake rack, edge protection, and a stokes litter. A healthy 25 cm oak is 8 m back from the edge; the edge is rounded exposed rock. The patient weighs 95 kg; litter and gear add 15 kg. One paramedic and three technicians are on scene, and no additional resources are available for 90 minutes. Light rain is falling, the temperature is 7°C, and a helicopter is unavailable because of weather. The trail is narrow and the only access is from above.
1. What lowering system and anchor arrangement would you build, and what safety factors drive the choice? Address mainline, belay, and anchor independence.
Read the worked answer
Choose a two-rope lower, not a raise. The fall line is 45 m and gravity assists, while a raise would need a larger mechanical advantage and more rescuers than the four on scene. The suspended load is 95 kg patient plus 15 kg litter and gear, about 110 kg or 1.1 kN static; with a litter attendant, plan for roughly 190 kg or 1.9 kN. An 11 mm low-stretch rope with a minimum breaking strength near 30 kN still gives a static safety factor above 10, but the system must not be shock-loaded and every component must be rated.
Rig the mainline through a brake rack on an anchor that is independent of the belay. The 25 cm oak is strong enough, but do not attach both systems to one sling. Use two separate basket slings, each with its own carabiner, and equalize only within each system. Use enough brake-rack bars for a 110-190 kg load. Belay with tandem prusiks or a rescue belay device on a separate line and anchor, tended by a dedicated belay operator. A 150 m rope leaves adequate tail for a 45 m lower, but tie a stopper knot and keep the tail controlled.
2. The edge is rounded rock and the litter will contact the slope. What edge and litter-attendant plan do you use?
Read the worked answer
Place an edge attendant on a personal tether, out of the fall line. That person manages the rope at the edge, checks the pad, and communicates; they do not also operate the brake rack. Secure the edge protection so the rope cannot flip it off, using an edge roller if available or a double layer of fire hose or webbing tied off. Keep mainline and belay over separate protected points. Inspect the pad every time the rope moves and replace it if the rock cuts through.
Rig the litter with a four-point bridle and secure the patient with a pelvic binder and splinted forearm. Use one litter attendant because the slope is steep and the patient has an unstable pelvis; an attendant can control rotation better than a tag line, and no one is positioned below to tend a tag line. The attendant needs their own attachment to the litter and a separate safety line if the system permits. Keep the patient supine and minimize tilt; if slope angle forces a tilt, keep the head slightly uphill and pad pressure points. The attendant monitors airway, binder, and splint during the lower.
3. Halfway down, the patient becomes combative and the litter starts to spin. What are your immediate actions and what is the rescue priority?
Read the worked answer
Stop the lower and hold both mainline and belay. A spinning litter can twist the bridle, unseat the patient, and shock-load the system. The belay operator holds; the edge attendant communicates; the litter attendant stabilizes the patient and controls rotation at the bridle. Do not improvise a tag line from the patient's body or from a rescuer's harness.
Reassess the cause: pain, hypoxia, head injury, hypothermia, or fear. The paramedic directs care from the edge. Do not sedate a patient in a spinning litter unless the paramedic is with the patient and the litter is stable; airway control would be worse. If the patient is trying to unbuckle, soft restraints per protocol may be needed.
The priority is to reach the nearest stable bench or flatter spot rather than continue another 20 m. If rotation cannot be controlled, a changeover to a raise is a high-risk evolution; do it only if the litter or airway is failing. Otherwise continue the lower at a slower rate with the attendant controlling the bridle.