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Stretcher

A stretcher, also known as a gurney, , or , is a consisting of a frame—often made from poles, metal, or composite materials—with a fabric or padded covering designed to support and transport patients in a . It is primarily used to move individuals who are sick, injured, or deceased, ensuring safe and stable conveyance by emergency responders, healthcare providers, or , in compliance with standards such as the European EN 1865 series for equipment. Stretchers have evolved from simple frames documented as early as the to modern designs incorporating wheels, adjustable features, and safety mechanisms. They are classified into various types, including wheeled, portable, and specialized variants for specific terrains or injuries, to suit diverse medical and emergency applications.

Overview

Definition and Purpose

A stretcher is a lightweight, portable apparatus designed to immobilize and transport injured, ill, or deceased individuals while minimizing the risk of additional harm, typically allowing the patient to lie in a supine position. It functions as a medical device for carrying patients who require care from one location to another, often serving as a cart or frame in ambulance operations. The primary purposes of a stretcher include stabilizing injuries to prevent further damage during movement, enabling safe in challenging environments such as confined spaces or rough terrain, and supporting integration with (EMS), military , and search-and-rescue operations. The term "stretcher" originates from around 1420, deriving from the verb "stretch" and initially referring to a frame or device for extending fabrics, later extending to supports for carrying extended bodies like those of the injured. Unlike specialized devices such as backboards, which provide rigid spinal and are commonly used during , or basic litters, which are simple non-wheeled frames for manual carrying, stretchers emphasize versatility as carriers adaptable to wheeled or portable configurations.

Primary Uses

In (EMS), stretchers serve as essential tools for transporting patients during ambulance operations, facilitating safe movement from incident scenes to medical facilities. They enable paramedics to secure and immobilize injured individuals, supporting vital interventions en route to hospitals. Additionally, stretchers are integral to inter-hospital transfers, where patients requiring specialized care are moved between facilities while maintaining stability. In scenarios, such as mass casualty events from natural calamities or accidents, stretchers allow for efficient and evacuation of multiple victims to temporary treatment areas or ambulances. Within military contexts, stretchers are primarily employed for battlefield evacuation, enabling rapid extraction of wounded personnel from combat zones to aid stations or evacuation vehicles. They support casualty collection at forward operating points, where medics stabilize soldiers before transport via ground or air assets. Durable designs like the Stokes wire-basket stretcher have been used historically and continue to aid in rugged terrains, minimizing exposure to ongoing threats during movement. Search-and-rescue () operations rely on specialized for evacuating individuals from challenging environments, including areas where hikers or climbers sustain injuries. In incidents, such as building failures, facilitate the removal of trapped through fields to safety. For rescues involving floods or accidents, adaptable ensure secure transport from aquatic hazards to shore-based medical support. In forensic and mortuary settings, are used to deceased bodies from scenes of death to examination facilities, preserving integrity during movement. They aid in processes by allowing controlled handling that prevents or disturbance of remains. Mortuary-specific support the dignified transfer of cadavers within hospitals, funeral homes, or morgues for autopsies and . Beyond applications, the term "stretcher" also refers to wooden frames used to tension for in art conservation, and in , it denotes bricks laid lengthwise in walls for bonding.

History

Early Origins

The use of simple litters for transporting the injured dates back to ancient civilizations, including and , where pole-and-cloth or hide-based designs facilitated the movement of wounded soldiers from battlefields to care. In practice, wounded legionaries were often carried on such litters by comrades or (soldiers exempt from regular duties), with capsarii providing initial and bandaging to stabilize during evacuation. These rudimentary devices prioritized portability and basic support, reflecting the era's limited infrastructure amid frequent conflicts. By the late medieval period in , more structured stretchers emerged, with the earliest documented references appearing around 1380 in illuminated manuscripts depicting or wooden frames for carrying wounded knights and soldiers. These designs, often constructed from available natural materials like woven branches over rigid poles, allowed for across rough during sieges and skirmishes, marking an evolution from litters to purpose-built aids. Such illustrations highlight the growing recognition of organized in feudal warfare. The 19th century saw significant innovations driven by large-scale conflicts and other needs, including the illustration of in 1865, as shown in medical treatises on the transport of sick and wounded troops. This portable variant, featuring hinged wooden components and a seat-like configuration, enabled easier maneuverability in confined spaces or over uneven ground, reducing strain on bearers while accommodating seated or semi-upright patients. Earlier in the century, mountain rescue operations adapted rudimentary stretchers for extracting injured climbers from rugged terrain. Warfare profoundly shaped these early designs, with canvas coverings introduced to shield against rain and debris, enhancing patient protection during prolonged field transports. By the late 1800s, organizations such as the Red Cross and Association introduced standardized, more durable designs, with key contributions from figures like Henri Dunant, who advocated for organized medical transport.

Modern Developments

The standardization of stretchers accelerated during , when military needs prompted the adoption of uniform designs such as the Furley stretcher, which was adapted with wheel attachments for easier transport in field conditions. By , metal frames became prevalent, with the U.S. Army introducing aluminum and steel litters like the 9935000 straight aluminum model (15 pounds) and the 9937600 steel variant for cost-effective production, ensuring compatibility across evacuation echelons. Wheeled prototypes emerged during these conflicts, including spoke-wheel carriers used by British forces in WWI and the Duff stretcher's detachable wheels patented in 1944 for Allied use. In the United States, the term "gurney" gained popularity in healthcare settings during , referring to wheeled that facilitated patient movement within s, building on earlier four-swivel-wheel designs pioneered around 1910. Post-1950s innovations introduced hydraulic mechanisms for height adjustment and smoother operation in environments, with systems becoming standard in by the 1960s to reduce caregiver strain during transfers. Adjustable features, such as folding frames and backrests, further evolved in models like the MacInnes Mk series from 1961 onward, enhancing versatility for urban and expeditionary use. The 21st-century spurred adaptations in stretcher design, including coatings applied to high-touch surfaces like rails to mitigate viral transmission, as demonstrated in trials showing significant bacterial reduction after 24 hours. These coatings, often quaternary ammonium-based, were integrated into materials for rapid antiviral efficacy without compromising functionality. Regulatory influences, particularly the U.S. Food and Drug Administration's 1976 Medical Device Amendments, classified stretchers as Class I devices under general controls, enforcing registration, labeling, and safety standards that shaped post-1970s manufacturing for durability and infection control.

Design and Components

Structural Elements

The structural elements of a stretcher form its foundational framework, ensuring , portability, and safe transport across various medical scenarios. The is typically constructed using rigid poles or lightweight aluminum alloys, which provide the necessary strength to support patient weight while minimizing overall mass for ease of handling. Common designs include X-frame or H-frame configurations, where the X-frame enhances during loading and unloading by distributing forces evenly across the structure. Foldable mechanisms, often incorporating hinged joints or collapsible segments, allow the frame to compact for storage and transport without compromising integrity when deployed. Patient support systems are integral to the stretcher's core, designed to immobilize and cushion the individual during movement. Traditional constructions utilize durable stretched between the frame poles, offering a flexible yet supportive surface that conforms to the body while allowing for quick assembly and disassembly. Modern variants incorporate coverings over padding, such as high-density , to enhance comfort, reduce pressure points, and facilitate easy cleaning in clinical environments. These materials ensure by preventing lateral shifting, with layers providing ergonomic contouring for prolonged support without causing discomfort. Mobility aids are embedded within the structural design to facilitate secure handling by medical personnel. Ergonomic handles, positioned at the head and foot ends, enable multiple operators to grip and lift the stretcher evenly, often reinforced with padded grips to accommodate gloved hands. Restraint straps, typically adjustable or similar , secure the patient to the support surface, integrating with quick-release buckles to prevent movement during transit. Locking mechanisms, such as twin safety locks or central braking systems, stabilize the frame and any attached components, ensuring no unintended shifting occurs during carry or wheeled operation. Ergonomic considerations in stretcher construction prioritize handler safety and efficiency, with weight distribution optimized through balanced frame geometry to minimize strain on the back and arms. Empty weights generally range from 15 to 50 kg, depending on materials and features, allowing teams of two to four rescuers to maneuver without excessive fatigue. This range supports rapid deployment in emergencies while adhering to principles that reduce musculoskeletal injury risks for operators.

Materials and Accessories

Stretchers have historically been constructed using traditional materials such as for the poles or and for the patient bed, providing a simple yet sturdy design for basic patient . has also been employed in early rigid frames to enhance durability and support, particularly in and applications where robustness was essential. In the , manufacturers shifted toward lightweight composites to improve portability without compromising strength, incorporating materials like carbon fiber for frames and ripstop nylon for the covering to achieve weights under 20 kg in many models. These innovations reduce the physical burden on rescuers during extended operations, with carbon fiber offering high strength-to-weight ratios suitable for foldable designs. Common accessories enhance stretcher functionality by accommodating medical needs, including IV poles for fluid administration, oxygen tank holders for respiratory support, restraint straps to secure patients, and head devices to prevent spinal movement. These attachments are typically modular, allowing customization based on the scenario, such as mounting oxygen holders at the head or foot end. During the around 2020-2023, innovations included disposable covers to minimize cross-contamination and fabrics treated with silver ions to inhibit bacterial and viral growth on surfaces. Silver-ion treatments, embedded in textiles, provide ongoing protection, addressing heightened control demands in healthcare settings. As of 2025, recent developments incorporate smart sensors for patient monitoring and advanced powered systems compliant with updated standards like EN 1865-2:2024. Durability standards for stretchers, such as the EN 1865 series and , emphasize load capacities of at least 250-300 kg to accommodate diverse patient sizes, including bariatric cases, while weather-resistant coatings on frames and fabrics ensure reliability in outdoor environments by preventing rust and moisture damage. These features maintain structural integrity across various conditions, from urban hospitals to field rescues.

Classification

Basic Stretchers

Basic stretchers consist of rigid or semi-rigid frames without wheels, designed primarily for manual transport of patients in a supine position, often utilizing pole-based litters that facilitate carrying by two or four personnel via integrated handles. These devices provide a stable, flat horizontal surface to support the patient, with lightweight construction to enable portability while maintaining structural integrity under load. Typical dimensions for standardized models, such as those compliant with NATO specifications, include a length of 2,290 mm and width of 584 mm, ensuring compatibility across medical and military operations. Prominent examples include scoop stretchers, which are specialized for extracting patients with suspected spinal injuries by splitting into two halves that slide under the body, minimizing movement and eliminating the need for log-rolling maneuvers. These adjustable, lightweight devices effectively limit motion in destabilized cases, performing comparably or better than traditional transfer techniques. Another key example is the litter, a standard military design under STANAG 2040 that features a rigid frame with skid-proof, flame-retardant fabric for secure patient during evacuation. The primary advantages of basic stretchers lie in their high portability, allowing effective use in off-road or confined environments where wheeled alternatives cannot navigate, such as rugged terrain or tight spaces during or operations. Their compact and lightweight build—often under 10 —facilitates rapid deployment by small teams without reliance on vehicles. However, a notable disadvantage is their labor-intensive nature, as carrying requires multiple operators and can lead to physical strain or injury risks for personnel, particularly over extended distances. Key features of basic stretchers include quick-release straps for rapid patient securing and release, typically provided as tension belts or restraint systems to ensure safety without complicating extrication. Many incorporate folding mechanisms, such as quad-fold designs in NATO-compliant models, for compact storage and easy transport when not in use.

Flexible Stretchers

Flexible stretchers are constructed primarily from durable fabric or materials, incorporating minimal rigid elements such as slats or frames to allow significant bending and flexibility. This design enables rescuers to maneuver patients through narrow passages, around obstacles, or along uneven surfaces where rigid alternatives would be impractical. The fabric components, often vinyl-coated for and resistance, provide a yet robust structure that prioritizes adaptability over structural rigidity. A prominent example is the Reeves Sleeve stretcher, developed in the early 1960s by the Reeves Company for rapid packaging and . Its sleeve-like , made from heavy-duty with integrated straps, allows it to slide easily under a while conforming to contours for secure horizontal or vertical transport. Another key example is the basket stretcher, such as the Stokes basket, which features a or wire tub-shaped supported by a minimal , facilitating secure in challenging environments like water rescues or rugged terrain extractions. Central to their functionality are features like full-body enclosures that enhance security by distributing weight evenly and minimizing risks, alongside built-in restraints and multiple carry handles for team handling. The flexible material composition also permits quick deployment and sliding beneath in awkward positions, reducing the need for patient repositioning. These typically support weight capacities exceeding 300 kg, accommodating a wide range of adult during demanding operations. In practice, flexible stretchers excel in urban search-and-rescue scenarios, where they navigate debris-filled buildings or collapsed structures, and in extractions, such as industrial tanks or underground voids, enabling safe evacuation without compromising patient stability. Their portability and conformance to irregular spaces make them indispensable for scenarios involving multiple rescuers coordinating in limited areas.

Wheeled Stretchers

Wheeled stretchers, also known as gurneys in , are mobile transport devices featuring a four-wheel base designed for efficient movement within medical facilities. These stretchers typically include hydraulic height adjustment mechanisms to facilitate transfers between different levels, such as from to , with adjustment ranges often spanning 21 to 34 inches. Locking brakes on the wheels ensure during stationary use, preventing unintended movement, while retractable side rails provide patient security and ease of access for caregivers. The term "gurney" is synonymous with wheeled stretchers in U.S. hospitals and originated as slang derived from J. Theodore Gurney's 1883 for a wheeled horse-drawn , gaining widespread use in contexts by . Modern iterations include powered variants equipped with electric controls for height, tilt, and propulsion, which emerged prominently after to enhance in high-volume environments. These electric systems allow for battery-operated adjustments, reducing manual effort compared to traditional hydraulic pedals. A key advantage of wheeled stretchers is their ability to minimize physical strain on healthcare providers; for instance, powered models like Ferno's Power X1 cot can reduce spinal forces by up to 50% during loading and unloading, thanks to electro-hydraulic lifts supporting loads up to 700 pounds unassisted. This design promotes safer handling in busy settings, with features like enhanced maneuverability and stability outperforming manual alternatives in speed and control. Wheeled stretchers are engineered for seamless into healthcare , including with standard elevators and ramps to enable smooth navigation across multi-level facilities without requiring specialized modifications. Their configurations, often including swivel casters, support passage through doorways as narrow as 32 inches and inclines up to 5 degrees on ramps.

Specialized Stretchers

Specialized stretchers are designed for extreme or highly specific scenarios, such as rugged terrains, high-risk patient profiles, or constrained environments, where standard models would be inadequate. These devices incorporate targeted modifications to ensure , , and with operational demands, often prioritizing portability, load-bearing , or integration with auxiliary equipment. The Stokes basket, a rigid wire or metal-framed stretcher, is widely used in operations for vertical extractions, such as from cliffs, buildings, or confined spaces. Its open-frame design allows secure lashing of patients with harnesses and permits hoisting via ropes or aerial devices, supporting both horizontal and vertical orientations during evacuation. Originally derived from applications, modern variants like the Ferno Titan feature a one-inch top rail for improved handling and compatibility with lifts..pdf) For bariatric patients, hover stretchers employ air cushion technology to facilitate low-friction transfers, particularly useful in () for individuals exceeding typical weight limits. Developed in the early by companies like HoverTech International, these systems inflate to create a thin air layer beneath the patient, enabling smooth movement from floors to stretchers without excessive manual lifting; the Evacuation EMS HoverJack, for instance, supports up to 1200 pounds (544 kg) and aids in home extractions. Neonatal adaptations, conversely, integrate enclosed incubators to maintain precise thermal and humidity control during transport of vulnerable infants, with devices like the Ferno iNX securing monitors, pumps, and oxygen systems to standard stretcher frames for ground or air evacuation. Bariatric models often feature reinforced steel or aluminum frames capable of supporting over 500 kg, such as the Gendron Heavy Duty Stretcher rated at 1000 pounds (454 kg) evenly distributed. Military applications include track-mounted tailored for armored personnel carriers (APCs), which secure casualties within the vehicle's interior during evacuations over rough terrain. In vehicles like the British , these setups accommodate up to four stretchers on adjustable mounts, ensuring stability amid tracked mobility and ballistic protection. Forensic variants combine body bags with rigid supports to preserve evidence integrity during body recovery, such as the Reeves Model 106, which uses seven removable slats between vinyl layers for structural reinforcement while sealing fluids and contaminants. As of 2025, focus on drone-compatible lightweight stretchers for remote evacuations, leveraging carbon fiber composites to reduce weight below 10 kg while maintaining 120 kg patient support. Innovations like the remote-controlled mechanical stretcher and the 911 Rescue Drone integrate with unmanned aerial systems for or extractions, enabling rapid deployment without ground access.

Applications and Safety

Operational Contexts

In emergency medical services (EMS), operational protocols begin with rapid patient assessment to determine the need for spinal immobilization, evaluating factors such as Glasgow Coma Scale score below 15, intoxication, midline spinal tenderness, focal neurologic deficits, or anatomic deformities. For suspected spinal injuries, the log-roll technique is employed to minimize movement, involving a coordinated team of four or five personnel: one stabilizes the head in neutral position, two or three support the body, and the fourth slides a long spine board underneath on command, with the patient's arms crossed over the chest to facilitate rolling. Once positioned, the patient is secured to the stretcher using crisscrossing straps over the torso, pelvis, and upper legs, followed by head immobilization with rolled towels or commercial blocks taped across the forehead, ensuring stability during ambulance transit to prevent further injury. Military protocols integrate stretcher deployment with triage systems like the (START) method to prioritize casualties based on respiratory effort, , and mental status during operations. In (CASEVAC), basic stretchers are used for immediate extraction from the point of injury, with teams of litter bearers transporting patients to a helicopter while maintaining alignment to avoid exacerbating wounds. For helicopter sling loads, basic stretchers are rigged with cargo nets or Stokes baskets attached to the aircraft's external hook, allowing rapid hoist extraction in denied landing areas, though this requires precise ground coordination to ensure the load remains level and secure during ascent. In disaster response, stretcher operations emphasize coordination among EMS, fire, and hazmat teams for mass casualties, using incident command systems to designate collection points where patients are triaged and moved via relays of handlers to avoid bottlenecks. Following the 2020 pandemics, protocols incorporate decontamination steps, such as wiping stretchers with hospital-grade disinfectants like 0.1% sodium hypochlorite after each use or isolating contaminated units for ultraviolet treatment, to mitigate infectious risks during surge events. Teams prioritize immediate (red) and delayed (yellow) patients for stretcher transport, integrating with mutual aid networks to distribute loads across multiple ambulances or temporary treatment sites. Key challenges in stretcher operations include navigating uneven terrain, such as in or , where wheeled or basic may require manual carrying by teams, increasing and risk of handler slips that could jostle the patient. Multi-handler coordination demands clear verbal commands and pre-rehearsed maneuvers to synchronize movements, as misaligned lifts can cause secondary injuries like muscle strains to providers or shifts in patient positioning leading to complications. In high-stress scenarios, communication breakdowns among handlers exacerbate these issues, underscoring the need for standardized and role assignments to maintain safety.

Standards and Training

International standards for wheeled stretchers emphasize safety, performance, and compatibility in patient transport, with the European Norm EN 1865 specifying minimum requirements for design, dimensions, and testing of stretchers used in ambulances, including load-bearing capacity and stability under dynamic conditions. In the United States, the (FDA) classifies wheeled stretchers as Class II (special controls) medical devices under 21 CFR 880.6910, subjecting them to general controls such as good manufacturing practices but exempting most from premarket notification due to low risk. While no stretcher-specific antimicrobial updates occurred in 2023, FDA guidance on applies broadly to devices with such features, requiring manufacturers to assess risks in labeling and design to mitigate transmission. U.S. regulations further integrate stretcher safety within (EMS) vehicles through NFPA 1917, the Standard for Automotive Ambulances, which mandates dynamic crash testing for compartments, including stretcher securement systems, to ensure occupant protection during collisions; this standard, first published in 2013, built on post-2010 research highlighting ambulance crash risks and requires compliance for new vehicles. The standard incorporates SAE J3027 protocols for cot mounting and floor fixtures, simulating frontal impacts at 20-30 to verify stretcher integrity and restraint effectiveness. Training for safe stretcher use is embedded in certification programs from the National Registry of Emergency Medical Technicians (NREMT), where candidates complete at least 120-150 hours of initial education, including practical modules on lifting, moving, and equipment handling to prevent injuries during transport. under the NREMT National Continued Competency Program requires 40 hours biennially, with portions dedicated to operational skills like stretcher deployment and maintenance checks, often delivered through 4-8 hour focused sessions or integrated into broader courses. These programs stress techniques such as power lifts and team coordination to minimize musculoskeletal strain. With proper training and adherence to standards, stretcher failure rates in remain low, at approximately 0.018 incidents per 1,000 transports in large urban systems, primarily involving minor malfunctions without patient harm. As of 2024, OSHA's proposed Emergency Response Standard requires agencies to implement hazard assessments and training to address overexertion risks, among others, with general provisions for protective equipment. A 2025 review of powered patient-handling equipment confirms these tools lower ergonomic demands, improving safety in stretcher operations.