Moving a patient from one echelon of care to another requires mitigation of safety risks through the use of personal protective equipment (PPE). PPE is determined, in part, by the mode of transportation and terrain. PPE must be applied prior to transport. Land, sea, and air are possible transport environments via ruck, truck, boat, or ship, rotary or fixed wing platforms. Critical thought must be used when considering the appropriate protective equipment which may include but not limited to:

1. Hearing protection (single or double)
2. Eye protection (may or may not be ballistic grade)
3. Cranial protection (helmet or cranial)
4. Personal flotation device or life preserver unit
5. Hypothermia, commercial or standard warming (i.e. Hypothermia Prevention Management Kit (HPMK), wool blankets)
6. Securing straps to transport device.

Patient safety considerations also must be exercised when moving the patient to, from, and within the transportation platform. The patient must be properly secured to the litter or sled prior to movement. The securing devices must be reassessed after each movement to ensure all interventions are still in place. Consideration must also be given to have adequate numbers of personnel to move the patient from one echelon to another. A four-person litter team, directed by a medic, is the safest option when moving patients on a NATO litter. After the patient is transferred to a platform for transport, the final consideration is to ensure the litter or sled is secured to the conveyance. Though optimal, this final consideration may be omitted for the operational environment. If transporting via aircraft, work with air crew to determine the best patient position and securement method.