Transporting an unconscious victim with a chest injury: algorithm of actions and critical errors

Chest injuries are one of the most dangerous injuries that require not only competent first aid, but also proper transportation of the victim. If a person is unconscious, the risks are aggravated: improper movement can lead to displacement of bone fragments, damage to the lungs or heart, and internal bleeding. Statistics from the Ministry of Emergency Situations show that up to 30% fatalities with such injuries, it occurs precisely because of errors at the evacuation stage - even before arriving at the hospital.

This article is not about abstract recommendations, but about concrete actionsthat will save lives. We will look at: how to assess the condition of the victim before transportation, what body positions are acceptable, what available means can be used for immobilization, and why It is strictly prohibited to turn a person over on their stomach if there is a suspicion of pneumothorax.. The material has been prepared taking into account the latest protocols European Resuscitation Council (ERC) 2023 and adapted for conditions of road accidents or domestic incidents.

1. Initial assessment of condition: what to do before transportation

Before you think about moving, you need to stabilize vital signs. An unconscious victim with a chest injury may die before your eyes from hypoxia or blood loss - and your task is not to aggravate this.

Follow the checklist:

• 🩺 Check your breathing: bring your ear to the victim’s mouth, watch the movement of the chest. If there is no breathing, start CPR (CPR) according to the 30:2 scheme (30 compressions, 2 breaths). If there is a sternum injury, do compressions softer than usualso as not to displace the fragments.
• 🩸 Assess bleeding: If there is an open wound to the chest (for example, from a knife or broken glass), close it immediately occlusive dressing (sealed material - polyethylene, foil). This will prevent pneumothorax.
• 💓 Check your pulse: on the carotid artery. If the pulse is thready (barely noticeable) or absent, this is a sign of shock. Raise the victim's legs 30 cm (if there is no spinal fracture!).
• 🦴 Examine the chest: asymmetry, paradoxical breathing (when one side “retracts” when inhaling), crepitus (crunching of fragments) - signals for the most careful transportation.

If the victim is in agonal state (wheezing, convulsions, bluish skin), transportation is postponed until breathing and cardiac activity are stabilized. In this case, call an ambulance and follow the dispatcher's instructions over the phone.

2. Optimal positions for transportation: what to choose

The choice of position depends on type of injury and the presence of associated injuries. There is no universal solution - what will save you in case of a bruised lung will kill you in case of a ruptured aorta. Below is a table with recommendations:

Type of injury	Recommended position	What not to do	Additional measures
Closed rib fracture without pneumothorax	Half-sitting (30–45°), with a bolster under the knees	Lay horizontally, bend the torso	Fixing the chest with a bandage or towel
Open pneumothorax	On the injured side (if there was consciousness and the victim was breathing)	Turn over on stomach, sit upright	Sealed bandage, control breathing every 2 minutes
Suspicion of aortic or cardiac rupture	Horizontally on the back, on a hard surface	Raise your head, bend your legs	The fastest possible delivery to the hospital (risk of death - 90% in the first hours)
Displaced sternum injury	On the back with a cushion under the shoulder blades (head thrown back)	Press on the sternum, turn to the side	Artificial ventilation through a mask

If the type of injury cannot be determined (for example, the victim was found without witnesses to the incident), use universal position:

1. Lay on your back on hard surface (shield, door, board).
2. Place a cushion of clothing under your knees (angle 15–20°).
3. Turn your head to the side (prevention of asphyxia with vomit).
4. Secure the body with belts or ropes in the chest and hips (so that it does not move when carried).

3. Carrying technique: how to lift and move

Basic rule: minimize chest movement. Even a slight displacement of rib fragments can puncture a lung or damage blood vessels. Below are step-by-step instructions for 2-3 rescuers:

If there is only one rescuer, use "drag" technique:

1. Kneel at the victim's head.
2. Place your hands under your armpits and grab your chest behind (without squeezing!).
3. Roll your body onto your side, then onto your back.
4. Move like a crab, dragging the victim by the armpits. At the same time, his head should lie on your hips.

Critical error - carrying "in your arms like a child". This leads to:

• 🔴 Compression of the diaphragm (aggravates respiratory failure).
• 🔴 Displacement of rib fragments inward.
• 🔴 Bend of the spine (risk of paralysis due to associated injuries).

What to do if the victim is large (weight 100+ kg)?

In this case use "sliding" method: Place thick material (tarpaulin, blanket) under the body and pull at the corners. Alternative - shovel stretcher (if you have it in your car's first aid kit). Never try to pull by the legs or arms - this is guaranteed to injure the cervical spine.

4. Immobilization of the chest: what and how to fix it

The purpose of immobilization is limit the mobility of the ribs and sternum during transportation. Ideally use vacuum mattress or "vest" type corset, but in the field, improvised means are suitable:

Fixation methods:

• 🧣 Scarf/towel: fold into a wide tourniquet, wrap around the chest as the victim exhales. Secure with a knot on the healthy side.
• 👕 T-shirt/shirt: cut along the seam, tie the sleeves behind the back (like a backpack), pull it over the chest.
• 📦 Cardboard/plastic: for open wounds, apply a flat object (folder, book) to the chest and bandage it.

Important: don't overtighten! The pressure should limit movement but not interfere with breathing. Check whether your palm fits between the clamp and the body. If the victim is choking or turning blue, loosen the bandage.

5. Transportation in a car: how to position the victim

If evacuation occurs by personal transport (for example, after an accident in a remote area), follow the rules:

Prohibited:

• 🚗 Place the victim in a seat (even in a semi-lying state).
• 🚗 Transport in the trunk without fixation (when braking, the body will “fly” forward).
• 🚗 Use seat belts in the standard way (they will compress the chest).

Allowed options:

1. In the back seat: lay the victim down head to the door, feet to the center of the cabin. Place a folded blanket under your knees. Tie your body with straps criss-cross (one belt across the chest, the second through the hips).
2. In the trunk of the station wagon: free up space, lay on your back on hard covering (board, skis). Secure with ropes to the luggage brackets.

Movement speed - no more 60 km/h. Avoid sharp turns and potholes. If the victim is in critical condition, turn on alarm and move along the side of the road (according to traffic rules, clause 2.7).

6. Mistakes that kill: what you should never do under any circumstances

Some actions that seem logical actually hasten the death of the victim. Here top 5 deadly mistakes:

⚠️ Attention! If the victim is unconscious breathes, but he has paradoxical breathing (one side of the chest “falls in” when inhaling) is a sign valvular pneumothorax. It is strictly forbidden to turn him on his stomach or sit him down: this will lead to complete collapse of the lung.

• 🚫 Give water or medicine. In case of sternum injury, the risk of asphyxia from vomit is higher than the benefit of pain relief.
• 🚫 Bend your torso. Even a slight forward bend can displace rib fragments towards the heart.
• 🚫 Use a soft stretcher. Sagging your body increases pain and the risk of internal injury.
• 🚫 Leave alone. An unconscious victim can suffocate from a sunken tongue in 2–3 minutes.
• 🚫 Transport in an upright position. This increases the load on the diaphragm and reduces the volume of inspiration.

Special case - chest trauma in children. Their ribs are more elastic, but their internal organs are more vulnerable. Never secure your chest with a bandage (risk of respiratory arrest!). Use vacuum mattress or carry it in your arms with back support.

7. Actions after delivery to the hospital: what to tell the doctors

The speed of diagnosis depends on how you convey information to doctors. Prepare 5 key data:

1. Mechanism of injury: “fell from 3 meters”, “hit the steering wheel during an accident”, “knife wound to the left side of the chest”.
2. Consciousness: “unconscious since the injury” or “lost consciousness after 10 minutes.”
3. Breathing: “independent, wheezing in the right lung” or “artificial ventilation from the moment of assistance.”
4. Immobilization: “the chest is fixed with a towel”, “the pneumothorax is covered with a film.”
5. Dynamics: “the condition worsened on the way - the lips turned blue” or “stable, pulse 80.”

If the victim is in serious condition, ask the doctor to immediately do:

• 🩻 Chest X-ray (to detect pneumothorax, hemothorax).
• 🩺 Ultrasound of the heart (rule out tamponade).
• 💉 Blood gas analysis (determine oxygen level).

⚠️ Attention! If you suspect spinal injury (fall from a height, hit in the back), report it up to before the doctors begin to move the victim. Improper shifting can lead to paralysis!

FAQ: Frequently asked questions about transportation for chest trauma

Is it possible to transport an unconscious victim in a sitting position if he is large and difficult to carry?

No! A sitting position with a chest injury leads to decrease in lung volume by 30–40%, which aggravates respiratory failure. For large casualties, use sliding technique (see section 3) or wait for rescuers with special equipment.

What to do if the victim begins to choke during transportation?

Stop immediately and follow these steps:

1. Check the airway (tilt your head back, remove foreign bodies).
2. If there is no breathing, start CPR (30 compressions, 2 breaths).
3. If breathing is possible, but difficult, loosen the hold on the chest, raise your head 10–15°.
4. If there are signs of pneumothorax (wheezing, chest asymmetry), immediately apply occlusive dressing.

Once stabilized, continue transport to side position (if there are no contraindications).

How to transport a victim with a chest injury and suspected spinal fracture?

This extremely dangerous combination. Proceed like this:

• Use rigid stretcher or an improvised shield (door, board).
• Fix all the torso (chest, pelvis, legs) with belts or ropes.
• Transport strictly horizontalwithout bending your neck or back.
• If there is no stretcher, roll the body onto its side as a single “block” (3-4 people).

Important: don't turn your head to check your breathing, listen to it at your mouth without changing the position of your neck.

Can a vacuum mattress be used on an open chest wound?

Yes, but with reservations:

• Close the wound first sealed bandage (film, foil).
• Make sure that the dressing will not move when evacuated.
• Do not create excess pressure in the mattress - this may increase bleeding.

Vacuum mattress preferred when transporting over long distances (more than 30 minutes), as it reliably fixes the chest and spine.

What to do if the victim regains consciousness during transportation?

Don't let him move! Explain that:

• Any movement can aggravate the injury.
• You will get him to the hospital as quickly as possible.
• If he is in pain, offer clench your fist and breathe through your nose (this distracts and reduces panic).

If the victim insists on changing position (for example, sitting down), don't resist forcefully — help you take a comfortable position, but fix your chest and watch your breathing.