If you are the only one at the scene of an accident, and there are many casualties, it may be that the most you can do is to check that everyone’s airway is clear and put those who are unconscious into the recovery position. First aid should be given at the site of an accident: do not move a badly-injured or seriously-ill casualty unless his or her life is in immediate danger, or unless medical help is not on its way. In practice, this often means weighing up the risks and benefits to the casualty: someone who has been in a car accident, for example, may have a back or neck injury that could cause paralysis if he or she is moved; that risk may need to be weighed up against the danger of the car engine catching fire. If this seems likely (the exhaust pipe is hot, there is petrol leakage), then the injured person is better served by being dragged clear. There is a risk of paralysis, but at least the casualty will be alive.
A similar dilemma arises over putting unconscious casualties into the recovery position. Although the movement may make other injuries worse, it can be life-saving if there is a possibility that the casualty’s airway may become blocked by blood or vomited food and cause chooking.
If, because of a risk of fire or of a building collapsing, for example, you decide that the casualties do need to be moved, children and adults who are light enough should be picked up by placing one arm under their knees and the other around the top of their back. With heavier casualties, place your arms under the armpits and grab the bended forearm of the casualty and hold it horizontally against the chest. If a strong enough chair is available the casualty can be carried out in it, one person supporting the back while another holds it by the front legs. In exceptional circumstances you may need to im-provize a stretcher. An old door or other board will do; or two broom handles or other long poles can be pushed into the sleeves of several jackets, which are then buttoned up for increased strength. If possible, test the stretcher for strength before using it to transport the casualty. However, in most developed countries ambulances and other emergency services are well-equipped and usually arrive swiftly at the scene of an accident; the need for bystanders to splint and bandage a casualty before transporting him or her on a stretcher now seldom arises.
Always balance the speed with which a casualty needs to reach medical help against his or her comfort. A fractured limb is unlikely to be life-threatening (unless there is also severe bleeding that cannot be stopped), but it will be very painful. The casualty should not be subjected to rough handling and undue haste.