Although the types of extractions you may encounter will vary based on your unit mission and the vehicles you use or locations you encounter, a couple of principles have universal application and can apply to most extraction situations.

The first principle is safety. The worst outcome would be to have additional casualties during an extraction attempt, and almost all extraction scenarios have some compromised safety; whether that is from fires at the removal site, vehicle rollovers that are unstable, condemned buildings that are structurally compromised, or some other scene issues.

The second principle is that the concept of MARCH still applies, and the treatment priorities do not change because the casualty is in a position that is difficult to access. If lifesaving treatments like limb tourniquet application can be done before extraction, they should be completed and monitored throughout the extraction process. If the casualty is in a position where access to provide those treatments can’t be accomplished, then they need to be moved as quickly as is safely possible. To that end, if a cervical spine injury might be suspected, the delay to immobilize the spine may lead to a bad outcome and shouldn’t be prioritized over accessing the casualty to perform other lifesaving interventions.

The third principle is that is it important to spend time training, before deployments and during deployments, on how to extract and remove casualties from the unit assets and tactical environments that you are most likely to encounter while performing your unit mission. The unit medical team may organize these, but as a combat lifesaver it is also your responsibility to ensure the unit is properly trained to help support you if an extraction is needed.