Sometimes both access to and transport after stabilizing a patient will require the use of ropes and technical rope systems. Historically, rope rescue probably began when the first person tied a rope around their waist and either climbed up to or was lowered down to someone in need. Rope rescue can be as simple as a walking belay, or as complicated as lowering and raising a patient and rescuer in vertical terrain (cliffs). The gear and techniques used are continually evolving, trending toward lighter, stronger and less prone to human error.

BASIC SAFETY CONSIDERATIONS

For those involved in technical rope rescue, safety is paramount. Personal protective equipment (PPE) must be worn by rescuers and patients. Life-safety gear must be inspected regularly, its use logged religiously and replaced when necessary. Although safety is the responsibility of everyone involved in a rescue operation, assigning one individual as a "safety officer" may be required. At a minimum, one set of "fresh eyes" must inspect the gear used, knots tied, or systems built before rescuers or patients enter a "danger zone."

PERSONAL AND TEAM GEAR

PPE includes but is not limited to helmets, eye protection, gloves and climbing harnesses. Many Search And Rescue (SAR) teams require rescuers to wear chest harnesses or industrial-grade harnesses. Patients should have PPE appropriate to the rescue. Personal gear may also include a personal anchor system (PAS), anchor materials, ascenders, descenders and assorted carabiners. Team gear will include litter, ropes, anchor materials, descent control devices, raising systems, edge protection, high directionals, and sometimes much more, including packs or bags to carry everything.

KNOTS, BENDS AND HITCHES

There are some basic knots, bends, and hitches used in SAR. They include:

• overhand

• double overhand (fisherman)

• figure eight (follow through, bend, on a bight)

• bowline

• sheet bend

• alpine butterfly

• water knot

• clove hitch

• munter (Italian) hitch

• prusik

PATIENT PACKAGING

Immobile patients are typically transported in litters designed for use in wilderness settings. In winter, toboggan-style or sliding litters are likely to be used. Titanium rescue litters are commonly used in other seasons.

When a patient is transported in a litter, they must have head and eye protection and be secured appropriately. A climbing harness should be put on the patient whenever possible. Some litters have purpose-built straps for securing the patient, other times improvised techniques will be used. Comfort and access to the patient for medical reasons must be considered. Padding and appropriate anatomical support should be used, and exposure to environmental conditions mitigated.

BELAYING

A belay in a rescue system may be slightly different from a belay commonly employed and understood by a rock or ice climber. When needed, a rope may be tied to a litter and held in hand as a backup as rescuers carry or wheel a patient down a trail. This is called a walking belay. As another belay technique, an anchored rescuer may pay out rope which is attached to a mobile patient's harness as the patient moves through steep or technical terrain. Belaying in rescue is usually indicated in lower angle or lower consequence terrain.

LOWERING/RAISING

When operating in vertical or near vertical terrain a lowering or raising system may be required to transport patients and rescuers.

A lowering or raising system consists of, at a minimum, the following components:

• appropriate anchors

• static ropes

• descent control devices

• raising or hauling systems

• edge protection

• high directionals

• a team of competent rescuers experienced in building and operating high-angle rope rescue systems