FM 8-35 
WAR DEPARTMENT 
MEDICAL FIELD MANUAL 
TRANSPORTATION OF 
THE SICK AND WOUNDED 
February 21, 1941 FM 8-35 
MEDICAL FIELD MANUAL 
TRANSPORTATION OF 
THE SICK AND WOUNDED 
Prepared under the direction of 
The Surgeon General 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1941 
sale by the Superintendent of Documents, Washington, D. C. - Price 25 cents Washington, February 21, 1941. 
WAR DEPARTMENT, 
FM &-35, Medical Field Manual, Transportation of the Sick 
and Wounded, is published for the information and guidance 
of all concerned. 
[A. G. 062.11 (10-30-40.)] 
order of the Secretary of War: 
G. C. MARSHALL, 
Official : 
Chief of Staff, 
E. S. ADAMS, 
Major General, 
Distribution : 
The Adjutant General. 
B (2); R (2), 8 (10); Bn 8 (5); C 8 (10). TABLE OF CONTENTS 
Chapter 1. General . 
Chapter 2. Manual Transport for Sick and 
Wounded. 
Section I. General 
11. Instruction in manual transport 
Chapter 3. Litter Transportation of the Sick and 
Wounded. 
Section I. General 
11. Instruction in the use of the 
litter 
Chapter 4. Adjuncts to the Litter in the Trans- 
portation of the Sock and Wounded. 
Section I. General 
11. Instruction in the use of the 
wheeled litter carrier : 
Chapter 5. Ambulance Transportation of the 
Sick and Wounded. 
Section I. General ; 
11. Instruction in ambulance loading 
and unloading I 
Chapter 6. Air Transportation of the Sick and 
Wounded , , ■ 
Chapter 7. Rail Transportation of the Sick and 
Wounded ■ 
Chapter 8. Water Transportation of the Sick and 
Wounded 
Index 
Paragraphs Page 
I—s 
6-8 
9-12 
13-17 
18-24 
25-28 
29-31 
32-36 
37-41 
42—48 
49-54 
55-60 
1 
2 
27 
36 
45 
93 
110 
113 
131 
137 
147 
161 
169 FM 8-35 
MEDICAL FIELD MANUAL 
TRANSPORTATION OF THE SICK AND WOUNDED 
(This manual supersedes TR 405-50, October 7, 1924; TR 405-60, 
May 10, 1927; TR 405-80, October 7, 1924; and TR 405-90, March 
29, 1926.) 
CHAPTER 1 
GENERAL 
■ 1. Purpose of Manual.—The purpose of this manual is to 
describe methods and means by which patients may be 
transported in the field. 
■ 2. Scope of Manual.—This manual includes a brief descrip- 
tion of all common methods of transporting patients by land, 
sea, and air; means of transport, ranging from the hand litter 
to the hospital ship; and methods of instructing personnel in 
the employment of such methods and means. 
■ 3. Relation of Transportation to Medical Task.—One of 
the chief responsibilities of the medical service is the evacu- 
ation of sick and wounded. Prompt and orderly evacuation of 
casualties from forward areas, in a manner calculated least 
to interfere with other military requirements, allows combat 
units to preserve their mobility and promotes the morale of the 
remaining effectives (FM 8-10). Evacuation must be con- 
tinuous ; it must be carried out with all speed possible without 
endangering life or limb and, in modern warfare, under many 
serious handicaps. Evacuation includes the collection of cas- 
ualties on the battlefield and their subsequent movement 
through every medical installation from aid station to gen- 
eral hospital. The transport involved in this movement must 
be designed to meet the particular conditions existing in 
various stages of the journey. 
■ 4. Principles of Evacuation.—See FM 8-10. 
■ 5. Responsibility for Evacuation.—See FM 8-10. 
1 CHAPTER 2 
MANUAL TRANSPORT FOR SICK AND WOUNDED 
Paragraphs 
Section I. General 6-8 
11. Instruction in manual transport 9-12 
Section I 
GENERAL 
■ 6. General.—Not infrequently situations arise demanding 
the movement of patients without litters or other equipment. 
Such situations may require that the patient be lifted and car- 
ried by hand, by one or more bearers. In the selection of a 
method for such movement, two factors must be considered: 
a. Nature of disability and the care necessary to preclude 
complications likely to arise as a result of movement, 
b. Element of fatigue of bearer which indicates that the 
method be least awkward and tiring, especially when the carry 
involves any appreciable distance. 
■ 7. Movement by One Bearer.—a. Supporting carry.—When 
patients are conscious and the character of their disabilities 
permits, they may be assisted in walking. This assistance is 
designated the “supporting carry,” The procedure is as 
follows: 
(1) The bearer turns the patient on his face (fig. 1) and 
steps astride the patient’s body, facing his head (fig. 2). 
(2) The bearer places his hands under the patient’s armpits 
and raises him to his knees (fig. 3). 
(3) The bearer clasps the patient around his waist and 
raises him to his feet (fig. 4). 
(4) The bearer seizes the patient’s left wrist with his left 
hand and draws the patient’s left arm around the bearer’s 
neck (fig. 5). The patient’s body now rests against the right 
side of the bearer’s body, the latter’s arm being placed around 
the patient’s waist for support (fig. 6). 
(5) The patient walks, assisted by the bearer. 
2 TRANSPORTATION OF SICK AND WOUNDED 
7 
b. Arms carry.—This method is applicable to an unconscious 
as well as to a conscious patient. The procedure is as follows: 
(1) The patient is brought to upright position by the first 
three steps described in the supporting carry (a above). 
(2) The bearer turns slightly toward his right (left), brings 
his right arm upward to a supporting position about the 
patient’s back, and passes his left (right) arm under the 
patient’s thighs (fig. 7). 
(3) The bearer lifts the patient into a carrying position. 
The patient should be carried high to lessen fatigue (fig. 8). 
Figure 1.—Supporting carry, first step. 
c. Saddle-hack, carry.—This method cannot be employed 
except with the cooperation of the patient. The procedure is 
as follows: 
(1) The patient is brought to upright position by the first 
three steps described in the supporting carry (a above). 
(2) The bearer maintains a pull on the patient’s arm (fig. 9) 
and steps in front of the patient. Then, with his back to him, 
bearer stoops and raises the patient upon his back (fig. 10). 
The patient having encircled the bearer’s neck with his arms, 
the bearer grasps the patient’s thighs (fig. 11). 
3 7 
MEDICAL FIELD MANUAL 
Figure 2.—Supporting carry, second step. 
4 TRANSPORTATION OF SICK AND WOUNDED 
7 
Figure 3.—Supporting carry, third step. 
5 7 
MEDICAL FIELD MANUAL 
Figure 4.—Supporting carry, fourth step. 
6 TRANSPORTATION OF SICK AND WOUNDED 
7 
Figure s.—Supporting carry, fifth step 
7 7 
MEDICAL FIELD MANUAL 
Figure 6.—Supporting carry. 
8 TRANSPORTATION OF SICK AND WOUNDED 
7 
Figure 7.—Arms carry, fourth step. 
9 7 
MEDICAL FIELD MANUAL 
Figure 8.—Arms carry. 
10 TRANSPORTATION OF SICK AND WOUNDED 
7 
Figure 9.-Saddle-back carry, fourth step. 
11 7 
MEDICAL FIELD MANUAL 
Figure 10.—Saddle-back carry, fifth step. 
12 TRANSPORTATION OF SICK AND WOUNDED 
7 
Figure 11.—Saddle-back carry, sixth step. 
13 7 
MEDICAL FIELD MANUAL 
Figure 12.—Saddle-back carry. 
14 TRANSPORTATION OF SICK AND WOUNDED 
7-8 
(3) The bearer resumes upright position, at the same time 
lifting the patient, bringing him well up on his back. The 
patient continues to secure himself by grasping the bearer’s 
neck (fig. 12). 
d. Fireman’s carry.—This is the method of preference in 
the movement of an unconscious patient. The procedure is 
as follows: 
(1) The patient is brought to upright position by the first 
three steps described in the supporting carry (a above). 
(2) The bearer passes around to face the patient’s left, 
grasps the patient’s right wrist with his left hand, and pulls 
upward (fig. 13). 
(3) The bearer stoops (fig. 14), passes his right arm between 
the patient’s legs, and then draws the patient over his left 
shoulder (fig. 15). 
(4) The bearer passes the patient’s right wrist to his own 
right hand (fig. 16), reaches backward with his left hand 
and grasps the patient’s left wrist, and draws the patient’s 
left arm forward and around the bearer’s body (fig. 17). 
(5) The bearer then resumes upright position (fig. 18). 
■ 8. Movement by Two Bearers.—a. Supporting carry.—By 
this method, two bearers, one on each side, assist a conscious 
patient in walking. The procedure is similar to that described 
in paragraph 7a (see fig. 6). 
b. Arms carry.—This method is applicable to patients, 
conscious or unconscious, requiring movement for a limited 
distance, or when being loaded on some mechanical carrier. 
The procedure is as follows: 
(1) With the patient lying on his back, the bearers kneel 
on one knee, on the same side of the patient, and place their 
arms beneath the patient as follows: 
(a) One bearer places an arm beneath the patient’s 
shoulders, the partially bent elbow supporting the head and 
neck, the other arm beneath the patient’s back at about the 
lower rib margins. 
(b) The other bearer places his arms beneath the patient’s 
hips and knees, respectively (fig. 19). 
(2) Bearers lift patient to their knees (fig. 20). 
15 8 
MEDICAL FIELD MANUAL 
Figure 13.—Fireman’s carry, fourth step. 
16 TRANSPORTATION OF SICK AND WOUNDED 
8 
Figure 14.—Fireman’s carry, fifth step. 
17 8 
MEDICAL FIELD MANUAL 
Figure 15.—Fireman's carry, sixth step. 
18 TRANSPORTATION OF SICK AND WOUNDED 
8 
Figure 16.—Fireman’s carry, seventh step. 
19 8 
MEDICAL FIELD MANUAL 
Figure 17.—Fireman’s carry, eighth step. 
20 TRANSPORTATION OF SICK AND WOUNDED 
8 
Figure 18.—Fireman’s carry. 
21 8 
MEDICAL FIELD MANUAL 
Figure 19.—Arms carry, beginning (2 bearers). 
Figure 20.—Arms carry, second step (2 bearers). 
22 TRANSPORTATION OF SICK AND WOUNDED 
8 
Figure 21.—Arms carry (2 bearers). 
23 8 
MEDICAL FIELD MANUAL 
(3) Bearers rise simultaneously, lifting the patient in 
horizontal position, his weight being carried well up (fig. 21). 
c. Saddle-back carry.—This method, employed by two 
bearers, is applicable to the unconscious as well as the con- 
scious patient. It requires no effort on the part of the patient 
but is not applicable to patients with severe injuries of the 
extremities. The procedure is as follows; 
(1) With the patient on his back, the front bearer spreads 
the patient’s lower extremities, steps between them facing 
the patient’s feet, kneels, and grasps the patient’s thighs with 
his arms (fig. 22). 
Figure 22.—Saddle-back carry, beginning (2 bearers). 
(2) At the same time, the rear bearer kneels at the patient’s 
head facing the patient, thrusts his arms beneath the patient’s 
shoulders, brings his forearms inside the patient’s arms, up- 
ward and across the patient’s chest (fig. 23). 
(3) Bearers rise simultaneously, lifting the patient into a 
semirecumbent position (fig. 24). 
d. Packsaddle carry.—This method is applicable only to a 
conscious patient. The procedure is as follows; 
24 TRANSPORTATION OF SICK AND WOUNDED 
8 
Figure 23.—Saddle-back carry, actions rear bearer. 
Figure 24.—Saddle-back carry, completed (2 bearers). 
25 8 
MEDICAL FIELD MANUAL 
Figure 25.—Packsaddle carry, first step. 
26 TRANSPORTATION OF SICK AND WOUNDED 
8-9 
(1) The bearers face each other, each grasping his left 
wrist with his own right hand (figs. 25 and 26), 
(2) A seat is then made by interlacing the four hands, each 
bearer grasping the other’s right wrist with his own free left 
hand (figs. 27 and 28). 
Figure 26.—Packsaddle carry (close-up). 
(3) On this improvised seat the patient sits, supporting 
himself by placing an arm around the neck of each bearer 
(figs, 29 and 30). 
Section IT 
INSTRUCTION IN MANUAL TRANSPORT 
■ 9. General—a. Purpose.—The purpose of this section is 
to provide guides for instruction in the manual transport of 
patients, thus insuring uniformity in the application of proper 
procedures and the saving of valuable training time. It is 
in no sense a drill, and the commands are for instruction 
purposes only. 
b. Formation for instruction.—(l) For instruction in the 
handling of a patient by one bearer, the unit will be formed 
27 9 
MEDICAL FIELD MANUAL 
Figure 27.—Packsaddle, completed. 
28 TRANSPORTATION OF SICK AND WOUNDED 
9-10 
in two ranks, facing each other. After each rank has counted 
off, men with the same number form teams, the two ranks 
alternating in the role of patient and bearer. 
(2) For instruction in 2-bearer transport, formation will 
be in single rank, the unit then being divided into groups of 
threes. The individual members of each group will be alter- 
nated in the roles of No. 1 bearer, No. 2 bearer, and patient. 
The No. 1 bearer will be in charge of each group. 
Figure 28.—Packsaddle, completed (close-up). 
c. Demonstration.—The speed and value of this instruction 
will be enhanced by utilization of the applicatory system, that 
is, demonstration followed by practice. 
d. Commands.—The following types of commands are 
utilized in instruction: preparatory commands and commands 
of execution. The former are distinguished by appearing in 
small capitals, the latter in large capitals. 
■ 10. To Carry Patient by One Bearer (see par. 7).—ln- 
struction is carried out by means of a single set of commands 
varied to meet the requirements of each method of handling 
the patient. 
29 10 
MEDICAL FIELD MANUAL 
Figure 29.—Placing patient on packsaddle. 
30 TRANSPORTATION OF SICK AND WOUNDED 
10 
Figure 30.—Carrying patient on packsaddle. 
31 10 
MEDICAL FIELD MANUAL 
Figure 31.—One bearer, right (left) side, POST. 
32 TRANSPORTATION OF SICK AND WOUNDED 
10-11 
a. To place hearer in position.—The patient being prone, 
to place the bearer in position, the commands are: 1. right 
(left) side, 2. POST. The preparatory command will vary 
with the patient’s disability. If there be no choice, the 
command will be left side, thus enabling the bearer to work 
from his right. At the command POST, the bearer moves by 
the nearest route and takes an erect position by the patient’s 
right (left) hip, facing the patient (fig. 31). 
b. To lift patient.—The bearer being in position, to lift 
the patient to the carry, the commands are: 1. by supporting 
carry (or other type carry desired), 2. lift, 3. PATIENT. 
At the first command, the bearer stands fast. A short pause 
after this command enables the bearer to mentally review 
the actions he will take. At the second command, the bearer 
proceeds to bring the patient to an erect position (see par. 
7a). At the command patient, the bearer lifts the patient 
to the position indicated by the first command. 
■ 11. To Carry Patient by Two Bearers (see par. B).—a. 
To place hearers in positicm.—As in the case of the single 
bearer carry, to place bearers in position, the same commands, 
varied to meet the desired method of carry, are prescribed. 
These commands are as follows: 
(1) Supporting carry.—To place bearers in position for the 
supporting carry, the commands are: 1. both sides, 2. POSTS. 
At the command posts, bearers proceed by the most direct 
route to the patient and take erect positions facing the 
patient, No. 1 opposite the right, and No. 2 opposite the 
patient’s left hip (fig. 32). 
(2) Arms carry.—To place bearers in position for the arms 
carry, the commands are: 1, right (left) side, 2. POSTS. At 
the command posts, bearers take position on the right (left) 
side of the patient, No. 1 opposite and facing the patient’s hip, 
No. 2, the patient’s shoulder (fig. 33). 
(3) Saddle-hack carry.—To place bearers in position for 
the saddle-back carry, the commands are: 1. head and feet, 
2. POSTS. At the command posts, bearers take position as 
follows: No. 1 between the patient’s legs, No. 2 at the patient’s 
head, both facing the patient’s feet (fig. 34). 
33 11 
MEDICAL FIELD MANUAL 
Figure 32.—Two bearers, both sides, POSTS. 
Figure 33.—Two bearers, right (left) side, POSTS. 
34 TRANSPORTATION OF SICK AND WOUNDED 
11-12 
b. To lift patient.—The bearers being in position, to lift 
patient, the commands are: 1. by saddle-pack carry, (or other 
type carry desired), 2. lift, 3. PATIENT. At the second com- 
mand, bearers place themselves and the patient in the neces- 
sary position for lifting. At the command patient, bearers 
lift patient to the position designated in the first command. 
Figure 34.—Two bearers, head and feet, POSTS. 
■ 12. To Lower Patient.—Whether one or two bearers are 
being utilized, to lower patient, the commands are : 1. lower, 
2. PATIENT. At the command patient, patient is carefully 
lowered to a prone position by a reversal of the steps by which 
he was originally lifted, when the bearer or bearers resume 
posts assumed prior to lifting the patient. 
35 CHAPTER 3 
LITTER TRANSPORTATION OF THE SICK AND 
WOUNDED 
Section I. General 13-17 
11. Instruction in the use of the litter 18-24 
Paragraphs 
Section I 
GENERAL 
■ 13. General.—a. Litter, definition.—A litter is a stretcher, 
carried by two or more bearers, for the movement of sick 
and wounded. 
b. Classification of cases.—(l) Ambulant.—All sick and 
wounded patients who are able to walk from the place where 
they become casualties to the medical installation designed 
for their treatment, without aggravating their condition, are 
classified as ambulant or ambulatory cases. 
(2) Litter.—All patients who are unable to walk either with 
or without assistance, or whose condition might be aggravated 
by walking, are classified as litter cases. All litter cases, 
regardless of whether they occur in posts, camps, or on the 
battlefield, will require more or less movement on a litter, 
or on a substitute therefor. The distance of movement by 
litter and the terrain over which movement will be accom- 
plished will vary with the situation. 
c. Requisites of military litter.—For satisfactory employ- 
ment in the military service, a litter must possess the follow- 
ing requirements: 
(1) Size.—The size of the litter must be sufficient to 
accommodate individuals whose height and weight are within 
the maximum limits as prescribed by the War Department, 
without undue discomfort. 
(2) Weight.—The weight should be as light as possible 
without sacrificing necessary strength and durability. 
(3) Durability.—The durability should be commensurate 
with the rough usage entailed in prolonged field operations. 
36 TRANSPORTATION OF SICK AND WOUNDED 
13-14 
(4) Type.—lt should be collapsible in at least one axis to 
facilitate handling, storage, and movement to the point of 
employment. 
(5) Standardization.—All litters should possess the same 
dimensions when open. This allows a patient to pass through 
the various echelons of medical service, entailing movement 
on several types of carrier, without being removed from 
the litter upon which he initiates his journey. The benefits 
thus derived are twofold: first, loss of valuable time is pre- 
cluded; and second, danger to the patient incident to chang- 
ing litters is obviated. This standardization is highly de- 
sirable not only throughout the military service but also 
between the military and naval services to facilitate evacua- 
tion during joint operations. (See FM 8-25.) 
■ 14. Litters Employed by the Medical Department.—a. 
Litter, canvas, aluminum pole (fig. 35).—The standard Medi- 
cal Department nonfolding litter is the aluminum pole type, 
so-called to distinguish it from the former standard wooden 
pole litter, many of which are still in service and will continue 
to be employed until they reach a state of unserviceability. 
Both the aluminum and the wooden pole litters are further 
designated nonfolding to distinguish them from the folding 
litter, although actually they are capable of being folded in 
one axis with consequent approximation of the poles. The 
aluminum pole litter consists of a canvas bed, 6 feet long and 
22% inches wide, supported by two aluminum alloy poles 
which are inserted into heavily-stitched casings on either 
side of the canvas. The poles are tubular, 1.54 inches in 
diameter and 77 inches long, and equipped at either end with 
knurled wooden handles which project 6% inches beyond the 
pole ends. Each pole is supported (when the litter is 
grounded) by two feet or stirrups, 3% inches wide and 5% 
inches high, bolted firmly to the pole, 18% inches from the 
outer end of the handle. These bolts perform the dual role 
of securing the stirrup and preventing the canvas from slip- 
ping on the pole. Conversely, removal of the stirrup bolts 
allows replacement of worn canvas. Straight, single-jointed 
spreader bars extending crosswise between adjacent stirrups 
hold the canvas taut. The litter weighs approximately 15 
37 14 
MEDICAL FIELD MANUAL 
pounds and, when collapsed, occupies a comparatively small 
space. All parts of the litter are of aluminum alloy except 
the canvas bed, wooden handles, and cadmium-plated steel 
stirrup bolts. There are no slings attached to the aluminum 
pole litter. Two web litter-carrying straps are included in 
the individual equipment of the Medical Department soldier. 
These straps are attached by snaps to the forward and rear 
rings on the suspender, the length adjusted by means of sliding 
loops, and the handles of the litter inserted into the slings 
Figure 35.—Aluminum pole litter (open). 
thus formed. The aluminum pole litter possesses the follow- 
ing distinct advantages over earlier types; considerably less 
weight and greater durability. 
b. Litter, canvas, wooden pole (fig. 36).—The wooden pole 
litter consists of a canvas bed 6 feet long and 22 inches wide, 
made fast to two wooden poles 7% feet long, and made taut 
by two jointed spreader bars. The stirrups, 4 inches high and 
1% inches wide, are similar to those of the aluminum pole 
litter. On the left front and right rear handles, a half-round 
iron ring is fixed inches from the end, and between this 
and the canvas plays the movable ring of the litter sling. 
38 TRANSPORTATION OF SICK AND WOUNDED 
14 
One pair of slings is permanently attached to the litter. The 
slings are of khaki-colored webbing, 21/z inches wide, with a 
leather-lined loop or bight at each end, and each sling is 
equipped with a metal slide to regulate the length. One loop 
of the sling passes through a metal swivel, itself attached to 
the movable ring of the handle. The weight of this litter 
is approximately 22 pounds. 
Figure 36.—Wooden pole litter (open). 
c. Litter, canvas, folding (fig. 37).—The standard folding 
litter is similar to the aluminum pole litter, except that it not 
only collapses in its long axis but also folds at the center, a 
characteristic made possible by a socket-type joint near the 
middle of each pole. The weight of this litter is approximately 
15V2 pounds. Originally designed to permit carrying with 
the top load on a pack saddle, it also lends itself to storage 
in airplane and other compartments of limited dimensions. 
d. Litter, metal, airplane (figs. 38 and 39).—The metal 
basket, modified Stokes, litter is no longer a standard item, 
although it is still used to a limited extent by the attached 
medical personnel with the Air Corps. It is approximately 
7 feet long, 23 inches wide, 8 inches deep, and weighs about 
39 14-15 
MEDICAL FIELD MANUAL 
20 pounds. The litter consists of a rigid frame of steel tubing, 
to which wire mesh netting is attached to form a bed. The 
lower half is divided to form two compartments conforming, 
in general, to the lower extremities of the patient. Its chief 
advantage lies in the security of the patient when the litter 
is tilted. The Navy uses this general type of litter, especially 
for loading patients from small boats to large hospital ships 
or transports. For mass evacuation by air, employment of 
the standard litter is deemed preferable. (See ch. 6.) 
Figure 37.—Folding litter (closed). 
■ 15. Improvisation of Litters.—ln the absence of actual 
litters, satisfactory substitutes may be improvised, the product 
varying with the material at hand and the ingenuity of the 
individual or individuals concerned. The following improvisa- 
tions are suggested, not only for their own merit but also 
as models on which to base other satisfactory substitutes. 
a. Improvised rifle litter.—(l) With rifles and overcoat.— 
The barrel of a rifle is inserted through each sleeve of an 
overcoat turned inside out and buttoned, sleeves inside, 
buttons down, collar toward the rifle butts. The front bearer 
rolls the tail of the overcoat tightly around the barrels 
40 TRANSPORTATION OF SICK AND WOUNDED 
15 
Figure 38.—Modified Stokes litter (empty). 
41 15 
MEDICAL FIELD MANUAL 
Figure 39.—Modified Stokes litter, with patient. 
42 TRANSPORTATION OF SICK AND WOUNDED 
15 
and takes his grasp over them; the rear bearer holds by the 
butts, trigger guards up. 
(2) With rifles and blanket.—A blanket being folded once 
from side to side, a rifle is laid transversely upon it across 
its center so that the butt and muzzle project beyond the 
edges; one end of the blanket is folded upon the other and a 
second rifle laid upon the new center in the same manner as 
before. The free ends of the blanket are now folded upon 
the end containing the first rifle so as to project a couple of 
inches beyond the first rifle. This is carried in a manner 
similar to that described in (1) above. 
(3) With rifles and blouses.—Two or three blouses may be 
utilized in the same manner as, and in lieu of, the overcoat 
described in (1) above. 
b. Imvrovised vole litters.—(l) With voles and blanket (fig. 
40).—A most satisfactory litter may be improvised by utilizing 
a blanket and two poles approximately 7 feet in length. The 
blanket is spread lengthwise on the ground. One pole is 
laid across the center of the blanket which is then folded 
over it. The second pole is placed across the center of the 
new fold and the blanket is folded over the second pole as 
over the first. Another method of utilizing the same means 
consists of rolling one-half of the blanket into a cylinder 
which is placed alongside the back of the patient who has 
been carefully turned on his side; the patient is then turned 
over upon the blanket and the cylinder unrolled on the other 
side. The poles are then laid down on the outer edges of 
the blanket and rolled tightly toward the patient, each a like 
number of times, until the side of the patient has been 
reached. 
(2) With voles and blouses or overcoats (fig. 41.)— Two 
poles and two overcoats, or three blouses, may be utilized in 
the following manner: sleeves reversed, coats buttoned, and 
poles passed through the sleeves in such manner as to place 
the buttons of the garments beneath the litter bed. The posi- 
tion of the collars, that is, front or back, is immaterial. 
(3) With voles and shelter half.—The shelter half may be 
utilized in the same manner as described for the blanket in 
(1) above. 
43 15 
MEDICAL FIELD MANUAL 
Figure 40.—Improvised litter, poles and blanket. 
Figure 41.—Improvised litter, poles and overcoat. 
44 TRANSPORTATION OF SICK AND WOUNDED 
15-19 
(4) With miscellaneous items.—With poles as a basis, 
various other items may be utilized in the improvisation of 
litters, for example, cloth sacks or bags, bedticks, matting, 
rugs, carpets, woven rope or rawhide strips, and other similar 
items. 
c. Utilization of litter-shaved objects.—Many common 
items, such as properly padded camp cots, doors, benches, 
and ladders, may be utilized as improvised litters. 
d. Doyan.—The Filipino doyan (pronounced doo-yan) con- 
sists of a hammock swung on two long bamboo poles, the latter 
resting on the outer shoulders of four bearers. 
■ 16. Employment of Litter Bearers of Medical Detach- 
ments.—See FM 8-10. 
■ 17. Employment of Litter Bearers of Collecting Units.— 
See PM 8-10. 
Section II 
INSTRUCTION IN THE USE OF THE LITTER 
■ 18. General.—a. Purpose.—The purpose of this section is 
to provide guides for instructing personnel in methods of 
handling litters and litter cases. Their general use will se- 
cure uniformity in the proper methods of performing a highly 
important function of medical service, and, at the same time, 
save valuable training time. 
b. Scope.—This section includes proper methods of han- 
dling, opening, closing, and strapping litter; loading, carry- 
ing, and unloading of patients; and the actions of bearers 
upon encountering unusual situations, such as obstacles, stairs, 
and unusual injuries. 
c. Commands.—Although not to be considered a precision 
drill, certain commands should be utilized to facilitate instruc- 
tion. The use of these commands in actual operations is not 
contemplated. 
■ 19. Litter Squad.—a. Composition.—A litter squad (fig. 42), 
both for purposes of instruction and for actual field employ- 
ment, ordinarily will consist of four bearers. Fewer are un- 
able to withstand the fatigue of long and frequent carries, 
except when aided by a wheeled litter carrier or similar device. 
45 19-20 
MEDICAL FIELD MANUAL 
b. Designation of hearers.—During instruction, each bearer 
will be given a numerical designation. Members of a litter 
squad, being in line, are numbered consecutively from right 
to left. No. 1 is the squad leader; in his absence, No. 4 com- 
mands; if both Nos. 1 and 4 are absent, No. 3 becomes the 
squad leader. 
c. Duties in reduced squads.—Nos. 3 and 2 being absent, 
their duties are assumed by Nos. 1 and 4, respectively. No. 1 
Figure 42.—Litter squad. 
being absent, No. 4 assumes his duties. In his absence, the 
duties of No. 4 do not require replacement. 
d. Instruction in reduced squads.—Under exceptional cir- 
cumstances, when 2-bearer squads are being instructed, the 
instruction will be as for Nos. 2 and 3 of the 4-bearer squad. 
■ 20. Litter, Strapped and Closed.—a. Litter, strapped.—The 
aluminum pole litter is said to be strapped (fig. 43) when it is 
folded, the canvas doubled smoothly, and secured by the cross 
straps. The wooden pole litter is said to be strapped (fig. 44) 
when it is folded, the canvas doubled smoothly on top, the 
slings placed thereon parallel to each other, and all secured 
by the cross straps. 
46 TRANSPORTATION OF SICK AND WOUNDED 
20 
Figure 43.—Aluminum pole litter, strapped. 
Figure 44.—Wooden pole litter, strapped. 
47 20-21 
MEDICAL FIELD MANUAL 
h. Litter, closed.—The aluminum pole litter is said to be 
closed (fig. 45) when it is folded but unstrapped. The wooden 
pole litter is closed (fig. 46) when it is folded but unstrapped, 
the loop of the front sling upon the left handle and the loop 
of the rear sling upon the right handle, the bight of each sling 
embracing the opposite handle. 
■ 21. Instruction with Unloaded Litters.—a. Formation for 
instruction.—Being in its normal formation, to form and aline 
the unit (detachment, platoon, or company) in a single rank 
Figure 45.—Aluminum pole litter, closed. 
for instruction in the litter, appropriate commands from FM 
22-5 will be employed. Similarly, following completion of the 
instruction, to return the unit to its normal formation, appro- 
priate infantry drill commands will be employed. 
b. Formation of litter squads.—The unit being in single rank 
facing the front, to form litter squads, the commands are: 1. 
count, 2. FOURS. At the command fours, all except the right 
file execute eyes right, and, beginning with the right file, 
count one, two, three, four, one, etc.; each man turns his head 
and eyes to the front as he counts. 
48 TRANSPORTATION OF SICK AND WOUNDED 
21 
c. Designation of squads.—Litter squads being formed, to 
designate squads by number, the commands are: 1. count, 2. 
LITTER SQUADS. At the command litter squads. No. 1 of 
each squad except the right squad, executes eyes right, and, 
beginning on the right, counts, in consecutive order, one, 
two, three, etc., until all have counted. Each No. 1 turns his 
head and eyes to the front as he counts. 
d. Procurement of litters.—Being in proper formation (fig. 
47) and litters being available in the immediate vicinity, for 
Figure 46.—Wooden pole litter, closed. 
each litter squad to procure one litter, the commands are: 
1. procure, 2. LITTER. At the command litter, all Nos. 3 
step one pace to the rear (fig. 48), execute right (left) 
face, as required by the location of the litters, and imme- 
diately proceed in column of files by the nearest route to 
the (closed or strapped) litters. Each takes one litter, 
placing it on the right shoulder (see / below), and all promptly 
return in reverse order to the rear of the line (fig. 49), turn, 
and step into the line in unison (fig. 50), litters at the vertical. 
Upon arriving in position, Nos. 3 taring litters to the shoulder 
49 21 
MEDICAL FIELD MANUAL 
Figure 47.—Formation for instruction in the litter. 
Figure 48.—procure, LITTER, first step. 
50 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 49.—Nos. 3 halted in rear of line. 
Figure 50.—Nos. 3 in line, litters vertical. 
51 21 
MEDICAL FIELD MANUAL 
(fig. 51) . This march should be supervised by a noncommis- 
sioned officer. It can be executed in double time. 
e. Return of litters.—lnstruction having been completed, to 
return litters to place of procurement, the commands are; 
1. return, 2. LITTER. This movement is executed in the 
same manner as procure, litter, except that the litters are 
carried from, instead of toward, the unit. 
f. Litter at the shoulder (fig. 52).—1n the position “at the 
shoulder,” the litter is held at a 45° angle, canvas down, upon 
Figure 51.—procure, LITTER, completed. 
the right shoulder, the right hand grasping the lower right- 
stirrup; the left hand is dropped to the side. In all motions 
from the shoulder or to the shoulder, the litter should be 
brought to vertical position (fig. 53) against the right shoul- 
der, canvas to the rear, right hand grasping right lower stir- 
rup, left forearm horizontal, and left hand steadying the litter 
against the shoulder. The vertical position should be taken 
automatically by the bearer when resuming his place in line 
(see d above) and in any formation or movement in which 
there may be danger of the handles of the litter striking 
52 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 52.—Litter at the shoulder. 
53 21 
MEDICAL FIELD MANUAL 
Figure 53.—Litter at the vertical. 
54 TRANSPORTATION OF SICK AND WOUNDED 
21 
neighboring men, after which “at the shoulder” is resumed 
without command. 
g. To order litter (fig. 54).—Being at the shoulder, to order 
litter, the commands are: 1. order, 2. LITTER. At the com- 
mand litter, the litter is brought to vertical position, the 
lower handles then dropped to the ground outside the right 
foot, canvas to the rear, right arm extended naturally, right 
hand grasping the poles, and left hand dropped to the side. 
h. To shoulder litter.—(l) From the order.—Being at the 
order, to shoulder litter, the commands are: 1. shoulder, 
2. LITTER. At the command litter, the litter is lifted 
with the left hand (fig. 55) to the vertical position (fig. 53), 
then raised until the left wrist is level with the chin, when 
it is laid, canvas down, upon the shoulder as described in 
/ above (fig. 52). 
(2) From the carry.—Being at the carry (see i below), 
to shoulder litter, at the command litter. No. 3 advances 
to his former position in line, at the same time bringing 
the litter to vertical, and then to shoulder position. In this 
he is aided by No. 2 who lifts his end of the litter to the 
vertical as he steps backward into his former position in 
line. Nos. 1 and 4 stand fast. 
i. To carry litter.—(l) Being in line.—Being in line, litters 
at the shoulder, to carry litter the commands are: 1, carry, 
2. LITTER. At the command utter, each No. 3 brings his 
litter to the vertical position, steps backward two paces 
(fig. 56), drops the upper handles forward and downward 
until the litter is in horizontal position, canvas up, and 
grasps the outside handle with his right hand; meanwhile, 
No. 2 steps directly to the front until he is opposite the 
front handles, when he grasps the outside handle with his 
left hand (fig. 57); Nos. 1 and 4 stand fast (fig. 58); guides, 
if any, aline on Nos. 1 and 4. 
(2) Being at the ground.—Being at the ground, to carry 
litter, at the same command, Nos. 3 and 2, using their right 
and left hands, respectively, stoop, grasp the outside handles 
(fig. 59), and raise the litter from the ground to the carry. 
(3) Designation of litter ends.—That portion of the litter 
normally supported by No. 2 is the foot or front; that by 
No. 3, the head. With the exception of a few special move- 
55 21 
MEDICAL FIELD MANUAL 
Figure 54.—Litter at the order. 
56 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 55.—shoulder, LITTER, first step. 
57 21 
MEDICAL FIELD MANUAL 
Figure 56.—carry, LITTER from shoulder, first step. 
Figure 57.—carry, LITTER from shoulder, second step. 
58 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 58.—carry, LITTER, completed. 
Figure 59.—carry, LITTER from ground, first step. 
59 21 
MEDICAL FIELD MANUAL 
ments, such as carrying patients up and down stairs, the 
same designation of loaded and unloaded litters apply. 
Furthermore, the feet of the patient normally correspond 
to the foot of the litter. 
(4) Unloaded litter in marching.—ln marching, the litter 
is usually at the carry, but when space permits or squads 
are working independently, it may be at the shoulder. 
j. To ground litter (fig. 60).—Being at the carry, to ground 
litter, the commands are: 1, ground, 2. LITTER. At the com- 
Fxgure 60.—Litter at the ground. 
mand litter. Nos. 3 and 2 stoop and lower litter to the ground, 
canvas up, release the handles, and resume erect position, 
facing front. , 
k. To change hearers.—(l) Being at the carry.—Being at 
the carry, in marching, to change bearers, the commands 
are; 1. change bearers, 2. MARCH. At the command march. 
Nos. 1 and 4 step to the right rear and left front of the litter, 
respectively, and grasp the handles relinquished by Nos. 2 
and 3, who step to right and left center, respectively. 
60 TRANSPORTATION OF SICK AND WOUNDED 
21 
(2) Being at the ground, closed.—Being at the ground, 
closed, to execute change bearers, bearers move as at the 
carry, but Nos. 1 and 4 do not grasp the handles. 
(3) Being at the ground, open.—The litter being at the 
ground, open, to execute the same command, Nos. 1 and 4 
assume the rear and front posts, respectively, while Nos. 2 
and 3 assume right and left posts, respectively, thus all de- 
scribing part of a circle in a clockwise direction around the 
litter. 
I. To open litter.—Being at the carry, litter strapped, to 
open litter, the commands are; 1. open, 2. LITTER. At the 
command litter, all bearers face the litter (fig. 61); No. 4 
supports the litter at the center, canvas up (fig. 62); Nos. 2 
and 3 unfasten straps, button straps to their respective 
studs if it be a litter so equipped, and grasp the left handles 
with their left hands, leaving the litter suspended longitudi- 
nally, canvas to the right (fig. 63); Nos. 2 and 3, assisted by 
Nos. 1 and 4, extend the braces (fig. 64) and, supporting the 
litter horizontally, canvas up, lower it to the ground, when all 
resume their positions at litter posts. If the litter is closed, 
but not strapped, so much of this directive as relates to the 
unfastening of the straps does not apply. If the litter is 
equipped with slings, Nos. 2 and 3 slip the free loop of their 
respective sling upon the ring handle, the bight embracing 
the opposite handle. 
m. To secure slings.—(Applicable to litter with slings at- 
tached.) Unsecured slings tend to drag the ground, catch on 
small obstacles, and, at times, actually interfere with loading 
ambulances and similar operations. This may be avoided by 
securing slings. To secure slings, the litter being lowered, 
the commands are: 1. secure, 2. SLINGS. At the command 
slings. Nos. 2 and 3 slip the loop end of the sling over the 
ring handle (fig. 65). Each drops the double end over the 
free handle and brings it up around the handle, slipping the 
the double end through the sling (fig. 66) and over the end 
of the handle (fig. 67). 
n. To close litter.—Being open, to close litter, the com- 
mands are: 1. close, 2. LITTER. At the command litter, 
Nos. 2 and 3 step outside the right front and left rear 
handles, respectively, and face inward; they stoop and, with 
61 21 
MEDICAL FIELD MANUAL 
Figure 61.—open, LITTER, first step. 
62 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 62.—open, LITTER, second step. 
63 21 
MEDICAL FIELD MANUAL 
Figure 63—open, LITTER, third step. 
64 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 64.—open, LITTER, fourth step. 
65 21 
MEDICAL FIELD MANUAL 
Figure 65.—secure, SLINGS, first step. 
Figure 66.—secure, SLINGS, second step. 
66 TRANSPORTATION OF SICK AND WOUNDED 
21 
their right hands, raise the litter by the left handles: they 
then fold the braces and, bringing the lower pole against the 
upper, support the litter at the carry. 
o. To strap litter.—The litter being closed, to strap litter, 
the commands are: 1. strap, 2. LITTER. At the command 
litter, all face the litter; No. 4 supports the litter at the 
center (fig. 68); Nos. 2 and 3, assisted by No. 1, fold canvas 
by doubling it smoothly on top of the poles (fig. 69), release 
free loops of slings if litter have slings attached, place them 
Figure 67.—secure, SLINGS, completed. 
on the canvas, buckles out, and secure all by the cross straps 
at each end, passing them through the loops of the slings 
(fig. 70) if any, when all take their posts at the carry. In 
the field, the litter should be carried strapped or closed, and 
opened only upon reaching the patient. The litter being 
open, may be closed and strapped at the command strap, 
LITTER, in which case the procedures outlined are both 
executed in rotation, at the one command (see also n above). 
p. To bring litter squad into line.—During litter instruc- 
tion, it may be desired to move the squad, without litter, to 
67 21 
MEDICAL FIELD MANUAL 
Figure 68.—strap, LITTER, first step. 
68 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 69.—strap, LITTER, second step. 
69 21 
MEDICAL FIELD MANUAL 
another point. Bearers being at posts with litter at the 
ground, to bring the squad into line, the commands are: 
1, form, 2. RANK. At the command rank. No, 2 advances 
one pace and remaining bearers move forward and aline 
themselves on him, in regular order (fig. 71). 
q. To resume litter posts.—Normal bearer posts, with the 
litter at the ground, may be recovered at any time by the 
commands: 1. litter, 2, POSTS. At the command posts, 
all members of the squad move by the nearest route and 
resume posts as shown in figure 60. 
Figure 70.—strap, LITTLE, third step. 
r. To lift open litter, loaded or unloaded.—(l) Aluminum 
pole litter.—Being at the ground with bearers at litter posts, 
to lift the aluminum pole litter utilizing the litter-carrying 
straps, the commands are: 1. prepare to lift, 2. LIFT. At 
the first command, Nos. 2 and 3 remove their litter-carrying 
straps from their pouches, attach them to their suspenders, 
then stoop and grasp handles firmly. Meanwhile, Nos. 1 
and 4 face litter, stoop and grasp adjacent pole (fig. 72). At 
the command lift. Nos. 2 and 3 arise slowly, assisted in lift- 
ing by Nos. 1 and 4, following which Nos. 1 and 4 adjust the 
70 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 71.—Squad at form, RANK. 
Figure 72.—Squad at prepare to lift, with, straps. 
71 21 
MEDICAL FIELD MANUAL 
litter-carrying straps of Nos. 2 and 3, respectively, then 
resume their posts (fig. 73). The litter may be lifted with- 
out litter-carrying straps by prefixing without litter-car- 
rying straps to the command. 
(2) Wooden vole litter.—Being at the ground with bearers 
at litter posts, to lift the open wooden pole litter, at the com- 
mand prepare to lift. Nos. 2 and 3 stoop, slip the slings off 
the handles and place them over their shoulders; they then 
replace the free loop upon its handle and firmly grasp the 
Figure 73.—Litter lifted, with straps. 
handles of the litter. At the same time, Nos. 1 and 4 face 
litter, stoop, and grasp the adjacent pole (fig. 74). At the 
command lift, all lift the litter, arising slowly until erect. 
No. 4 then advances to the side of No. 2 and No. 1 steps back- 
ward obliquely to the side of No. 3, adjusts slings, lengthen- 
ing or shortening as necessary to level litter, then resume 
their posts (fig. 75). The litter may be lifted without slings 
by prefixing without slings to the command. 
s. To march forward.—Being at the lift, to march forward, 
the commands are: 1. forward, 2. MARCH. At the com- 
mand march. No. 2 steps off with the left foot, No. 3 with the 
72 TRANSPORTATION OF SICK AND WOUNDED 
21 
Figure 74.—Squad at prepare to lift, with slings. 
Figure 75.—Litter lifted, with slings. 
73 21-22 
MEDICAL FIELD MANUAL 
right, both taking short, sliding steps of about 20 inches, to 
avoid jolting and to secure uniform motion of the litter. 
Nos. 1 and 4 step off with the left foot, employing the normal 
pace at a cadence to conform with the progress of Nos. 2 and 
3. 
t. To lower litter.—Being at the lift, to lower litter, the 
commands are: 1. lower, 2. LITTER. At the command 
litter. Nos. 2 and 3 slowly lower litter to the ground, dis- 
engage litter-carrying straps from litter handles, and resume 
erect position. Or, if employing litter with slings, Nos. 2 
and 3, after lowering litter, seize the free loop and bight of 
their respective slings from their shoulders, place loops upon 
ring handles, the bights embracing opposite handles, then 
resume erect position. The open litter should be lifted and 
lowered slowly without jerks, both ends simultaneously, the 
rear bearer moving in accord wtih the front bearer so as to 
maintain a horizontal canvas. The open litter, unloaded, 
for purposes of instruction should be handled as a loaded 
litter and as soon as the men are familiar with the handling 
of the unloaded litter, instruction should be with the loaded 
litter. 
■ 22. Instruction With Loaded Litters.—a. General.—(l) 
Patients for purposes of instruction.—For purposes of instruc- 
tion with loaded litters, certain men are designated “patients.” 
To make the instruction more realistic and to instruct in the 
handling of different types of injuries, patients should wear 
bandages and splints to simulate actual disabilities. In early 
periods of instruction, these patients will be placed on the 
ground at suitable intervals near the line of litters, first with 
the heads and later with the feet toward the line. As the 
instruction progresses, the positions may be varied and, lastly, 
dispersed or concealed in such positions as they would occupy 
on the battlefield. When patients are loaded on litters, their 
arms and accouterment are carried by Nos. 1 and 4 or placed 
on the litter. 
(2) Arrangement for instruction.—Several squads may be 
instructed by the same individual at the same time, or each 
squad may be instructed separately by an instructor or by the 
squad leader (No. 1). In the latter case, squad leaders assume 
charge at a directive by the instructor or the unit commander. TRANSPORTATION OF SICK AND WOUNDED 
22 
At the signal for assembly, the squads form in line, lower lit- 
ters, and come to rest, when the patients if still on the litters 
are divested of dressings and splints, and resume their posts. 
Further movements are performed as directed by the 
instructor. 
(3) General rules for moving patients.—(a) In moving 
the patient, either with or without the litter, every move- 
ment should be made deliberately and as gently as pos- 
sible, care being taken not to jar the injured part. The 
command steady will be used to prevent undue haste and 
other irregularities. 
(5) The rear bearer should watch the movements of the 
front bearer and time his own with them, so as to insure ease 
and steadiness of action. 
(c) As a rule, the patient should be carried on the litter feet 
foremost, taut in going uphill or upstairs his head should be in 
front. 
id) In case of fracture of the lower extremities, he is car- 
ried uphill or upstairs feet foremost and downhill head fore- 
most, to prevent the weight of the body pressing upon the 
injured part. 
(e) In passing obstacles and ditches, the litter must be kept 
level at all times. 
b. To load and unload litter.—(l) Position for lifting pa- 
tient.—The patient having been located, the general nature 
of his wounds having been determined, and the litter being 
open and available, to place bearers in proper position to lift 
patient, the commands are: 1. right (left) side, 2. POSTS. 
At the command posts, bearers take position as follows: No. 
2 at the right (left) ankle; No. 3 at the right (left) shoulder; 
Nos. 1 and 4 at the right and left hips, respectively, all facing 
the patient (fig. 76). 
(2) To lift patient and place litter in position.—The bear- 
ers being at posts, to lift patient preparatory to placing him 
on the litter, the commands are: 1. lift, 2. PATIENT. At 
the preparatory command lift, all bearers kneel on knees 
nearest the patient’s feet; No. 2 passes both forearms under 
the patient’s legs, carefully supporting the fracture, if there 
is one; Nos. 1 and 4 place their arms under the small of the 
back and the thighs, not locking hands; No. 3 passes one 
75 22 
MEDICAL FIELD MANUAL 
Figure 76.—Squad at right side, POSTS. 
76 TRANSPORTATION OF SICK AND WOUNDED 
22 
hand under the patient’s neck to the farther armpit, with 
the other supporting the nearest shoulder (fig. 77). At the 
command patient, all lift together, slowly and carefully, and 
place the patient upon the knees of the three bearers on the 
same side (fig. 78). As soon as he is firmly supported there, 
the bearer on the opposite side (No. 1 or 4) relinquishes his 
hold, passes quickly by the nearest route to the litter which 
he takes up by the middle, one pole in each hand, and, re- 
turning rapidly, places it under the patient and against the 
ankles of the other three bearers (fig. 79). 
Figure 77.—Squad at lift. 
(3) To lower patient on litter.—The patient being on the 
knees of three bearers, and the litter being in proper position 
to receive the patient, to lower patient on litter, the com- 
mands are: 1. lower, 2. PATIENT. At the command lower, 
the free bearer (No. 1 or 4) resumes his former kneeling po- 
sition opposite the other three bearers and prepares to as- 
sist in lowering the patient. At the command patient, the 
patient is lowered gently upon the litter, made as comfort- 
able as possible, then without further orders all bearers rise 
and resume their positions at litter posts. 22 
MEDICAL FIELD MANUAL 
Figure 78.—First step after command patient. 
Figure 79.—Litter being placed beneath patient. 
78 TRANSPORTATION OF SICK AND WOUNDED 
22 
Figure 80.—Loading litter with three bearers. 
Figure 81.—Lowering patient on litter. 
79 22 
MEDICAL FIELD MANUAL 
Figure 82.—Two bearers at right side, POSTS. 
80 TRANSPORTATION OF SICK AND WOUNDED 
22 
(4) To unload litter.—The patient being on the litter, to 
unload litter, the same commands are given and the actions 
of the bearers are the same, with the following exception; 
after the patient has been lifted to the knees of the three 
bearers, the free bearer removes the litter from beneath the 
patient instead of placing it under him. 
c. To load and unload litter with three bearers.—ln the 
absence of one man from the litter squad, No. 3 or 2 is replaced 
by No. 4 or 1, respectively, while Nos. 1 and 4 replace each 
Figure 83.—Actions of two bearers at lift. 
other. With three bearers, the litter is placed as usual and, 
at the prescribed commands, the bearers take their proper 
positions. The patient, having been lifted by the three bear- 
ers, is supported on the knees of the two on one side, while the 
third (No. lor 4) places the litter in position (fig. 80). In like 
manner, the patient is lowered on the litter (fig. 81). To un- 
load the litter, the maneuvers are reversed. 
d. To load litter with two bearers.—(l) With bearers on 
the same side.—At the command right (left) side, posts. 
Nos. 2 and 3 take positions at patient’s right (left) thigh and 
81 22 
MEDICAL FIELD MANUAL 
Figure 84.—Two bearers at command patient. 
Figure 85.—Two bearers placing patient on litter. 
82 TRANSPORTATION OF SICK AND WOUNDED 
22 
shoulder, respectively (fig. 82), At the command lift, bear- 
ers kneel on knees nearest the patient’s feet; No. 2 passes 
his arms beneath the patient’s hips and knees; No. 3 passes 
his arms beneath the patient’s shoulders and small of his 
back (fig. 83). At the command patient, they lift together, 
raising the patient upon their knees, then, readjusting their 
holds, rise to their feet and carry patient to the side of the 
litter. At the command lower, patient, the bearers kneel and 
place the patient on their knees (fig. 84), stoop forward and 
place him on the litter (fig. 85), then rise and assume the posi- 
tion of litter posts without command. To unload, posts are 
taken in the same way, at the same commands. 
(2) With bearers on opposite sides.—ln case the patient is 
conscious and able to cooperate in the movement, a method 
whereby the bearers take positions on opposite sides of the 
patient may be employed. To carry out this movement, the 
commands are: 1. both sides, 2. POSTS. At the command 
posts. Nos. 2 and 3 take positions at the patient’s right and 
left hips, respectively, facing the patient (fig. 86). At the 
command lift, bearers kneel on the knees nearest the pa- 
tient’s feet, raise him to a sitting position, and pass their 
arms around his back and under his thighs, locking hands. 
The patient, if able, clasps his arms around the bearers’ 
necks (fig. 87). At the command patient, they lift the 
patient, both rising together, and carry him to the center of 
the litter (fig. 88). At the command lower, patient, they 
stoop and lower the patient upon the litter in a sitting posi- 
tion, and the patient releases his hold on the bearers’ necks 
(fig. 89). No. 3 then passes his left hand across the front 
of the patient’s chest to the opposite armpit and grasps the 
patient. No. 2 releases his hold at the right side of the pa- 
tient, steps astride the patient’s lower extremities, and grasps 
the patient’s right and left thighs just above the knees with 
his left and right hands, respectively. Both bearers then 
turn and lower the patient upon the litter, head toward No. 3, 
when both bearers take the position of litter posts without 
command. Unloading is performed, in reverse order, at the 
same commands. 
83 22 
MEDICAL FIELD MANUAL 
Figure 86.—Two bearers at both sides, POSTS. 
84 TRANSPORTATION OF SICK AND WOUNDED 
22 
e. To load and unload hack cases.—To avoid aggravating 
the condition of patients with actual or suspected back in- 
juries, the following procedure will be followed: 
(1) To place patient face down.—The patient being in the 
prone position on his back, a blanket rolled or folded length- 
wise to two-thirds its normal width is placed alongside the 
patient, the roll or fold in close proximity to his body (fig. 90). 
At the command roll. No. 2 kneels at the patient’s feet, firmly 
grasping the patient’s ankles; No. 3 kneels at the patient’s 
head, hands grasping the patient’s chin and occiput (back of 
Figure 87.—Two bearers ready to lift patient. 
head). No. 1 kneels by the side of the patient, opposite the 
blanket, while No. 4 places an open litter in close proximity, 
and prepares to assist No. 1. At the command patient. Nos. 
2 and 3 exert moderate traction, while Nos. 1 and 4 gently 
roll the patient over on the blanket, face down, arms extended 
over his head, forearms supporting his head (figs. 91 and 92), 
(2) To place on litter.—At the command lift. No. 2 grasps 
the lower end of the blanket, No. 3 the left half of the upper 
end and the upper half of the left side, and No. 1 grasps 
the right half of the upper end and the upper half of the 
85 22 
MEDICAL FIELD MANUAL 
Figure 88.—Two bearers ready to lower patient. 
86 transportation of sick and wounded 
22 
Figure 89.—Bearers depositing patient on litter. 
Figure 90.—Rolled blanket alongside back case. 
87 22 
MEDICAL FIELD MANUAL 
Figure 91.—Back case being rolled onto blanket. 
Figure 92.—Back case face down on blanket. 
88 TRANSPORTATION OF SICK AND WOUNDED 
22 
Figure 93—Back case being placed on litter. 
Figure 94.—Loaded litter carried by four bearers. 
89 22-23 
MEDICAL FIELD MANUAL 
right side. At the command patient. Nos. 1, 2, and 3 lift pa- 
tient on the blanket, while No. 4 places the open litter beneath 
the patient (fig. 93). At the command lower, patient. Nos. 
1, 2, and 3, assisted by No. 4, lower the patient gently down 
on the litter. 
(3) To unload from litter.—To unload the patient from the 
litter, the same maneuvers, at the same commands, are 
executed in reverse order. 
f. To carry loaded litter by jour bearers.—lf it is desired 
that the four bearers carry the loaded litter, while marching, 
the commands are: 1. by four, 2. carry, 3. LITTER. At the 
command litter. No. 1 steps backward to the right rear, No. 
4 forward to the left front, and each grasps the handle 
nearest him, relinquished by Nos. 2 and 3, respectively, who, 
retaining their grasp on the other handles, move to the out- 
side (fig. 94). Normal positions are resumed by the com- 
mand litter, posts. 
■ 23. To Pass Obstacles.—a. General.—Obstacles include 
fences, walls, cuts, ditches, running streams, or other natural 
or artificial impediments. Obstacles should be avoided when 
feasible, otherwise they must be surmounted. Orders for 
surmounting separate obstacles are neither necessary nor 
feasible. Hence, flexibility in the execution of orders con- 
cerning obstacles must be maintained, common sense dictat- 
ing details of action most suited to the situation with which 
the bearers may be confronted. 
b. To pass minor obstacles.—For crossing wide, shallow 
streams, rough or cultivated ground, or similar obstacles, the 
command is obstacle. At this command, Nos. 1 and 4 close 
in, grasp the centers of the adjacent poles, and give support 
until the obstacle has been surmounted (fig. 95), then they 
resume their posts without command. 
c. To pass major obstacles.—To pass over fences, ditches, 
and similar obstacles, when Nos. 2 and 3 must entirely re- 
lease the litter to cross such obstacle, the orders are: 1. ob- 
stacle, 2. MARCH. At the preparatory command obstacle, 
Nos. 1 and 4 move as outlined in subparagraph b. At the 
command march, No. 2 relinquishes his grasp on the front 
handles, removes the slings from his shoulders and places 
them on the litter (or disengages the litter-carrying straps). 
90 TRANSPORTATION OF SICK AND WOUNDED 
23 
and crosses the obstacle (fig. 96). The litter being advanced 
by the other three bearers, No. 2 grasps the front handles 
and, after further aiding in advancing the litter, assists 
No. 3 in steadying it while Nos. 1 and 4 cross the obstacle 
(fig. 97). The litter is then lifted over and across the ob- 
stacle by Nos. 1, 2, and 4, while No. 3 crosses and resumes 
his grasp on the rear handles. Nos. 1 and 4, after assisting 
Nos. 2 and 3 in adjusting slings, if any, resume their posts 
without command. 
Figure 95.—Carrying litter over minor obstacles. 
d. To surmount obstacles over 5 feet high.—The squad be- 
ing in position of by four, carry, litter, to surmount an 
obstacle over 5 feet high, the commands are: 1. raise, 2. LIT- 
TER. At the command litter, the litter is raised carefully to 
the level of the obstacle and advanced until the front feet of 
the litter have cleared, or become well anchored on, the 
obstacle (fig. 98); Nos. 2 and 4 then clear the obstacle, assist 
in advancing the litter to the rear feet, then steady it while 
Nos. 1 and 3 clear the obstacle and resume their grasp on the 
rear handles. Upon clearing, the litter is lowered to its 
former level without command. 
91 23 
MEDICAL FIELD MANUAL 
Figure 96.—Crossing low obstacle, first step. 
Figure 97.—Crossing low obstacle, second step. TRANSPORTATION OF SICK AND WOUNDED 
23 
Figure 98.—Surmounting obstacle over 5 feet. 
93 24 
MEDICAL FIELD MANUAL 
■ 24. To Carry Loaded Litter Up and Downstairs.—a. Up- 
stairs carry.—Normally, a loaded litter is carried upstairs head 
first (see par. 22a). The litter is marched to the foot of the 
stairs in the usual manner, wheeled about, and halted (fig. 
99). To negotiate the stairs, the commands are: 1. prepare 
for stairs, 2. MARCH. At the comand prepare for stairs. 
Nos. 1 and 4 face inward, advance to the center of the litter, 
and support it by grasping a pole with both hands; Nos. 2 
and 3 slip free loops of slings off handles (or disengage litter- 
carrying straps), face about and again grasp the handles (fig. 
Figure 99.—Upstairs carry, first step. 
100); No. 4 then steps to the handle nearest him, at the foot 
of the litter, which he grasps firmly with both hands (fig. 101) 
while No. 2 grasps the opposite handle. At the command 
march, the litter is carried upward by Nos. 2, 3, and 4 (fig. 
102), the rear bearers being responsible for maintaining the 
level of the litter. No. 1 falls out, accompanies the litter, and 
renders assistance as required. When only three bearers are 
present, the litter must be lowered before the first command. 
After the stairs have been negotiated, normal positions are 
resumed by the command litter, posts. Or, if only three 
94 TRANSPORTATION OF SICK AND WOUNDED 
24 
Figure 100.—Upstairs carry, second step. 
Figure 101.—Upstairs carry, third step. 
95 24 
MEDICAL FIELD MANUAL 
Figure 102.—Upstairs carry, fourth step. 
Figure 103.—Downstairs carry. 
96 TRANSPORTATION OF SICK AND WOUNDED 
24 
bearers be present, the litter must be lowered before resuming 
normal positions. 
h. Downstairs carry.—Normally, a loaded litter is carried 
downstairs feet first (see par. 22a). The loaded litter is car- 
ried to the head of the stairs in the usual manner and 
halted. At the command prepare for stairs. No. 4 advances 
to the left front handle, which he grasps firmly with both 
hands, while No. 2 grasps the opposite handle (fig. 103). At 
the command march, the litter is carried downward, Nos. 2 
and 4 keeping the litter as nearly level as possible, No. 3, 
aided by No. 1, carefully observing the patient to insure no 
untoward incident during the descent. Upon reaching the 
foot of the stairs, normal positions are resumed by the com- 
mand LITTER, POSTS. 
c. With fractures of the lower extremity.—When the pa- 
tient being transported has a fracture of the lower extremity, 
or if for any reason it be desired to carry the patient up- 
stairs feet first, or downstairs head first, the bearers are 
reversed, in the former case No. 2 becoming the front 
bearer, in the latter, No. 3. 
97 ADJUNCTS TO THE LITTER IN THE TRANSPORTATION 
OF THE SICK AND WOUNDED 
CHAPTER 4 
Section I. General 25-28 
U. Instruction in the use of the wheeled litter 
carrier 29-31 
Paragraphs 
Section I 
GENERAL 
■ 25. General.—The manual carrying of a loaded litter is 
one of the most grueling tasks performed by the personnel 
of the Medical Department. In prolonged actions, the criti- 
cal point in the chain of evacuation within the division lies 
between the casualty on the field and the most forward am- 
bulance. Therefore, every effort is made to minimize the 
task of litter bearers. Front line medical installations, in- 
cluding advanced ambulance loading posts, are placed as far 
forward as the situation and terrain will permit, and any 
mechanical device which will aid the litter bearers and ac- 
celerate the tempo of evacuation is employed whenever fea- 
sible. Among such mechanical aids is the carrier, field, 
commonly known as the wheeled litter carrier. (Pig. 104 
shows World War, improvised, animal-drawn wheeled litter 
carriers.) 
■ 26. Wheeled Litter Carrier (figs. 105 and 106).—a. De- 
scription.—The standard wheeled litter carrier is a collapsible, 
2-wheeled cart, capable of transporting one loaded litter. Its 
weight is 59 pounds and its measurements are as follows: 
open—width 32V2 inches, height over all 31 inches, length 28 
inches; folded— 9by2B by 61V2 inches. Folded, it occupies 
approximately 10 cubic feet of space. Wheels are bicycle type 
with wire spokes, equipped with pneumatic tires size 26 by 2. 
It is equipped wtih two full elliptical springs upon which the 
litter is supported by a pair of angle brackets, held in position 
by a pair of screw brackets. The carrier, open, is kept in 
98 TRANSPORTATION OF SICK AND WOUNDED 
26 
Figure 104.—World War improvised animal-drawn wheeled Utter carriers. 
99 26 
MEDICAL FIELD MANUAL 
Figure 105.—Carrier, wheeled litter, collapsed. 
Figure 106.—Carrier, wheeled litter, open. 
100 TRANSPORTATION OF SICK AND WOUNDED 
26 
upright position by a hinged, tubular, metal, inverted V- 
shaped support stand which, when not in use, folds centrally 
from its lateral attachment to the axle rod, to be held in place 
by a spring latch. The preceding model (figs. 107 and 
108), of which there are many in service and in depot storage, 
is similar in many respects. Its measurements approximate 
those of the standard carrier, but the wheels are wooden 
spoke, solid rubber tired, buggy type, and its Weight is 
approximately 72 pounds. 
b. Advantages of standard wheeled litter carrier.—(l) Col- 
lapsibility.—The shape plus the space requirements, assumed 
by the carrier when collapsed, facilitates its transportation 
to and from the place of actual employment, either as part 
of a top load or attached to the rear of an ambulance or 
truck by means of appropriate hooks. 
(2) Weight.—There is a distinct reduction in weight over 
previous models. 
(3) Economy of personnel.—Over suitable terrain, the 
litter squad employing the carrier may be reduced to two 
men, and the smaller squad still perform the same task with 
increased rapidity and less fatigue. 
(4) Employment in mud and sand.—In consequence of the 
wide pneumatic tire, employment of the carrier in mud and 
sand becomes reasonably feasible. 
(5) Increased comfort for passenger.—The pneumatic 
tires and elliptical springs increase the comfort of the patient 
being transported and, at the same time, decrease the tend- 
ency of the movement to cause or aggravate the condition 
of shock. 
(6) Safety factors.—(a) Balance.—The vehicle is well bal- 
anced and the center of gravity is so located as to minimize 
the likelihood of over-turning. 
(b) Litter lock.—The loaded litter is securely locked to the 
carrier during movement, thus precluding inadvertent or 
premature unloading. This also enables bearers to lift litter 
and carrier over minor obstacles without dismounting the 
litter. 
(c) Support stand.—Safety during loading and unloading 
is insured by the stabilizing effect of the support stand. 
101 26 
MEDICAL FIELD MANUAL 
Figure 107.—Carrier, wheeled litter (old type) collapsed. 
Figure 108.—Carrier, wheeled litter (old type) open. 
102 TRANSPORTATION OF SICK AND WOUNDED 
27-28 
® 27. Employment of Wheeled Litter Carrier in the 
Field.—See FM 8-10. 
■ 28. Substitutes for Wheeled Litter Carrier.—a. Gen- 
eral.—Frequently, situations arise wherein the following con- 
ditions obtain: the evacuation of sick or wounded mandatory; 
wheeled litter carrier either not available or use not feasible; 
ambulance either not available or its employment precluded; 
evacuation by bearers either too fatiguing, too time-consum- 
ing, or even impossible. Such situations demand ingenuity. 
There are as many solutions to such problems as there are 
individuals who may be called upon to solve them. As guides 
for action in such adverse situations, several substitutes for 
the wheeled litter carrier are described. These substitutes 
are not standard items of supply, nor is their standardization 
contemplated. 
b. Cacolet.—(l) Definition.—A cacolet is a packsaddle fitted 
with a frame capable of supporting one or two litters or fold- 
ing chairs. Its employment by the military, for transporta- 
tion of sick and wounded, dates to the Crimean War, when 
it was utilized by the French Army. 
(2) Types.—Numerous types have been developed and used 
with varying degrees of success. The following are examples 
possessing merit: 
(a) Carlisle cacolet (figs. 109 and 110).—This cacolet, de- 
veloped by the Medical Department Equipment Laboratory, 
Carlisle Barracks, Pa., consists of a folding metal frame fitted 
to a Phillips packsaddle, and, when open, will support two 
loaded litters, one on each side, the litters firmly secured 
to the frame by setscrew clamps. 
(b) Panama jungle cacolet (fig. Ill).—Devised by the med- 
ical service for the purpose of evacuating sick and wounded 
from the jungle, this type consists of a metal frame similar 
to the modified Stokes litter in appearance, over which metal 
bows have been securely fastened. In this, the patient rests 
on a waterproof kapok pad. The whole device is firmly 
bolted to a Phillips packsaddle, protection to the patient on 
the trail thus being rendered from all directions. The weight 
of the entire apparatus is 57 pounds and the apparatus, 
loaded, may be floated across unfordable streams. 
103 28 
MEDICAL FIELD MANUAL 
Figure 109.—Cacolet, Carlisle, front view. 
Figure 110.—Cacolet, Carlisle, side view. 
104 TRANSPORTATION OF SICK AND WOUNDED 
28 
Figure 111.—Sketch of Panama jungle cacolet. 
105 28 
MEDICAL FIELD MANUAL 
Figure 112.—Cacolet, Ist Cavalry Division, front view. 
106 TRANSPORTATION OF SICK AND WOUNDED 
28 
(c) Ist Cavalry Division cacolet (figs. 112 and 113).—This 
device, originating in the medical service of the Ist Cavalry 
Division and field tested by that organization, consists of a 
tubular metal frame, fitted to the Phillips packsaddle, and 
bent to conform to the animal’s dorsal contour. A canvas 
bed is stretched tightly within the frame, giving it an appear- 
ance similar to the Bradford frame. It is equipped with four 
metal braces which are inserted into corresponding keepers 
on the packsaddle. It is light, well balanced, and fairly 
comfortable. 
Figure 113.—Cacolet, Ist Cavalry Division, side view. 
(d) Hamilton chair cacolet (fig. 114).—The Hamilton 
chair is applicable to the evacuation of conscious or semi- 
conscious patients, especially from mountainous terrain. It 
consists of a regulation riding saddle equipped with four 
sockets, two each front and back, into which, when desired, 
four metal uprights are placed. The front uprights are joined 
at their upper ends by a transverse bar, and the whole sur- 
rounded by a wide web belt which threads through slots in 
the uprights. The patient cannot fall, may relax against 
the webbing, and increases his security, when fully con- 
107 28 
MEDICAL FIELD MANUAL 
scious, by grasping or leaning against the transverse bar. 
When not in use, the superstructure occupies relatively little 
space on the top load of the medical pack. 
Figure 114.—Sketch, of Hamilton chair cacolet. 
c. Travois, or travail.—(l) Definition.—The travois is a 
contrivance for transportation of sick and wounded, consist- 
ing of two long poles lashed at one end to each side of a 
horse or similar animal, the other ends trailing the ground. 
Hurdles are lashed across these poles to receive the load. 
108 TRANSPORTATION OF SICK AND WOUNDED 
28 
(2) Improvisation of a travois (fig. 115).—A travois may be 
improvised by cutting poles about 16 feet long and 2 inches 
in diameter at the small end. These poles are laid parallel 
to each other, large ends to the front and feet apart, the 
small ends 3 feet apart with one of the latter projecting some 
Figure 115/—Sketch of one-horse travois. 
8 or 10 inches beyond the other to impart a rocking rather 
than a jolting motion to the load. The poles are connected 
by a crossbar about 6 feet from the front ends and another 
about 6 feet back of the first, each notched at the ends and 
securely lashed to appropriate notches in the long poles. Be- 
Figure 116.—Sketch of 2-horse travois. 
tween the crosspieces, the litter bed, 6 feet long, is filled in 
with canvas, blanket, or similar material, securely fastened 
to the poles and crossbars. In lieu of canvas or blanket, 
rope, a lariat, or rawhide strips may be stretched obliquely 
from pole to pole, in many turns, crossing each other to 
form the basis for a light mattress or improvised bed. A 28-30 
MEDICAL FIELD MANUAL 
litter or cot may be fastened between the poles for the same 
purpose. The front ends of the poles are securely fastened 
to the saddle of the animal, and joined around the animal’s 
chest by means of a breast strap. On the march, bearers 
should be ready to lift the rear end of the travois when 
passing obstacles, streams, or when going up hill. 
(3) Turn-horse travois (fig. 116).—A further development 
of the original travois is in current use by the British medi- 
cal service. The rear ends of the poles, instead of being al- 
lowed to drag, are lashed to the saddle of a second horse, 
following the first in tandem. 
Section II 
INSTRUCTION IN THE USE OF THE WHEELED 
LITTER CARRIER 
■ 29. General.—a. Purpose.—The purpose of this section is 
to furnish a guide for instruction in the use of the wheeled 
litter carrier and thereby standardize and accelerate such 
training. 
b. Scope.—lt includes instruction in opening, closing, load- 
ing, and unloading of the carrier. 
c. Objectives.—The objectives of this instruction will be a 
thorough knowledge of the mechanism of, and a high degree 
of proficiency in the employment of, the carrier. 
d. Commands.—Any commands used are for the purposes 
of instruction and their employment in the field is not con- 
templated. 
e. Formation for instruction.—For purposes of instruction 
in the use of the wheeled litter carrier, groups of three are 
preferable, men within the group alternating in the role of 
patient. The two members of the group acting as bearers 
are designated Nos. 1 and 2, No. 1 being in charge. 
■ 30. To Open and Close Carrier.—a. To open carrier.— 
The carrier being on the ground, folded, to open, the com- 
mands are: 1. open, 2. CARRIER. At the command carrier, 
the following steps of procedure are executed: 
(1) Both bearers proceed by the most direct route to the 
folded carrier and take positions, one on each side adjacent 
110 TRANSPORTATION OF SICK AND WOUNDED 
30 
the wheels, No. 1 on the side to which the support stand is 
attached (fig. 117). 
(2) Bearers stoop, grasp the litter pole racks (fig. 118) and, 
in unison, lift them until the wheels are in upright position 
(fig. 119). 
(3) Maintaining the upright position of his respective 
wheel with his left hand, each bearer, with his right, pushes 
lock into position and secures it by tightening the setscrew 
(fig. 120). 
Figure 117.—Bearers in position to open carrier. 
(4) No. 1 unlatches the support stand and brings it down 
to the vertical (fig. 121). 
(5) Both bearers loosen the screw brackets and swing them 
laterally, leaving the litter pole racks open to receive the 
litter, then they resume their positions at the wheels, facing 
the carrier (fig. 122). 
b. To close carrier.—The carrier being open and unloaded, 
to close carrier, the commands are: 1. close, 2. CARRIER. At 
the command carrier, bearers move directly to positions at 
wheels, if not already there, and proceed to perform in re- 
verse order, the same steps as required to open it (a above). 30 
MEDICAL FIELD MANUAL 
Figure 118.—Opening carrier, first step. 
Figure 119.—Opening carrier, second step. 
112 TRANSPORTATION OF SICK AND WOUNDED 
30 
Figure 120.—Opening carrier, third step. 
Figure 121.—Opening carrier, fourth step. 
113 30 
MEDICAL FIELD MANUAL 
Figure 122.—Opening of carrier completed. 
Figure 123.—Bearers at facing patient, litter, POSTS. 
114 TRANSPORTATION OF SICK AND WOUNDED 
30-31 
Screw clamps are moved centrally and tightened; No. 1 lifts 
the support stand and latches it; both unfasten wheel locks, 
and, in unison, allow wheels to fold at the axle joints. When 
the carrier has been completely closed, bearers resume up- 
right position. 
■ 31. To Load and Unload Carrier.—a. Posts at loaded 
litter.—The carrier being open and conveniently located, to 
place bearers in position to proceed with the loading, the 
commands are: 1, facing patient, 2. litter, 3. POSTS. At the 
command posts, bearers move by the most direct route and 
take positions between the handles of the litter, Nos. 1 and 2 
facing the patient’s head and feet, respectively (fig. 123). 
b. To load carrier.—The litter being loaded, the bearers at 
posts, and the command prepare to lift, LIFT, having been 
given and executed, to load carrier the commands are: 
1. load, 2. CARRIER. At the command carrier, the procedure 
is as follows: 
(1) Bearers carry the litter and place it on the carrier, the 
poles lying firmly in the racks and the litter well balanced 
on the carrier (fig. 124). 
(2) No. 1 remains in position and steadies the litter while 
No. 2 locks poles into racks by adjusting and tightening the 
screw brackets (fig. 125). 
(3) No. 2 folds and latches the support stand (fig. 126) and 
resumes his position at the patient’s feet, facing front 
(fig. 127). 
c. To unload carrier.—The carrier being loaded and the 
bearers being in position for movement, to unload carrier, the 
commands are: 1. unload, 2. CARRIER. At the command 
carrier. No. 1 stands fast and steadies the litter while No. 2 
loosens the screw brackets, moves them laterally, unlatches 
and lowers the support stand, and resumes his post, facing the 
patient’s feet. Without further command, bearers lift lit- 
ter, move it clear of the carrier, and perform further actions 
at the command of the instructor or No. 1 bearer. 
115 31 
MEDICAL FIELD MANUAL 
Figure 124.—Placing loaded litter on carrier. 
Figure 125.—No. 2 locking poles to racks. 
116 TRANSPORTATION OF SICK AND WOUNDED 
31 
Figure 126.—N0. 2 latching support stand. 
Figure 127.—Carrier loaded, bearers ready to move out. 
117 CHAPTER 5 
AMBULANCE TRANSPORTATION OF THE 
SICK AND WOUNDED 
Paragraphs 
Section I. General 32-36 
11. Instruction in ambulance loading and unloading. 37-41 
Section I 
GENERAL 
■ 32. General.—a. Definition.—An ambulance is a wheeled 
vehicle designed and employed for the conveyance of sick and 
wounded. 
b. Ambulances employed by Medical Department.—(l) 
Motor.—Figure 128 shows an ambulance station in France, 
1918, with World War motor ambulances. 
(a) Metropolitan ambulance (figs. 129 and 130).—The large 
metropolitan ambulance, designed for and equipped with 
large, single, basket-type, wheeled litter, is used at general 
hospitals in the zone of the interior and at the larger Air 
Corps posts. 
Ib) Ambulance, field (figs. 131 and 132).—The field am- 
bulance, motor, used at the majority of posts and stations 
and in the field is a 2-wheel drive, panel body vehicle 
with a patient capacity of four litter, or eight sitting, or 
various combinations of litter and sitting cases. It is satis- 
factory as a road ambulance but its value is limited for 
cross-country employment. 
(c) Ambulance, field, cross country (figs. 133 and 134). 
For front line and cross country use, the 4-wheel drive, Mj-ton 
motor ambulance is the preferred vehicle. (See par. 33 for 
detailed description.) 
(2) Animal-drawn.—(a) Ambulance, 4-animal (figs. 135 
and 136).—The 4-animal ambulance, model of 1909, is avail- 
able for employment in situations requiring an animal-drawn 
vehicle but not demanding any considerable speed. This am- 
bulance is satisfactory for employment with foot troops on 
the march. 
118 TRANSPORTATION OF SICK AND WOUNDED 
32 
Figure 128.—An ambulance station of the 42d Division, Rolampont, February 10, 1918 
119 32 
MEDICAL FIELD MANUAL 
Figure 129.—Metropolitan ambulance, exterior view. 
Figure 130.—Metropolitan ambulance, interior view. 
120 TRANSPORTATION OF SICK AND WOUNDED 
32 
Figure 131.—Ambulance, field, motor (exterior). 
Figure 132.—Ambulance, field, motor (interior). 
121 32-33 
MEDICAL FIELD MANUAL 
(b) Ambulance, 2-animal (figs. 137 and 138).—The new 
2-animal ambulance is an excellent cross country vehicle and 
possesses the ability to match the speed of horse cavalry. 
(See par. 34 for detailed description.) 
■ 33. Ambulance, Motor, Field.—a. General.—(l) 
Status.—Two distinct types of field ambulance are now being 
employed (see par. 32). The new cross country field ambu- 
lances are allocated to field units, such as armored, cavalry 
Figure 133.—Ambulance, field, motor, cross country (exterior view). 
and infantry divisions. The former field ambulance will con- 
tinue to be used wherever necessary and feasible. In time, if 
experience proves the lighter cross country vehicle capable 
of universal use, it may supplant the field ambulance 
entirely. 
(2) Definitions.—(a) Panel body.—The term “panel body” 
used in connection with an ambulance implies that the light, 
commercial type, delivery truck body has been utilized with- 
out structural change. 
122 TRANSPORTATION OF SICK AND WOUNDED 
33 
Figure 134.—Ambulance, field, motor, cross country 
(interior view). 
Figure 135.—Ambulance, animal-drawn (old type), exterior. 
123 33 
MEDICAL FIELD MANUAL 
Figure 136.—Ambulance, animal-drawn (old type), interior. 
124 TRANSPORTATION OF SICK AND WOUNDED 
33 
Figure 137.—Ambulance, animal-drawn, (new type) exterior. 
Figure 138.—Ambulance, animal-drawn, (new type) interior. 
125 33 
MEDICAL FIELD MANUAL 
Figure 139.—Insert, ambulance, Carlisle. 
126 TRANSPORTATION OF SICK AND WOUNDED 
33 
(b) Carlisle ambulance insert (fig. 139).—The Carlisle am- 
bulance insert is a light frame equipped with two folding 
seats and brackets and hangers for supporting loaded litters. 
This insert converts the panel body truck into a field ambu- 
lance. As implied by the designation, it was developed at the 
Medical Department Experimental Laboratory, Carlisle Bar- 
racks, Pa. 
(3) Ambulance, field, requirements of.—(a) Capacity.— 
Vehicle should be capable of transporting seven sitting or 
four litter cases with their impediments, a maximum load of 
approximately 1,500 pounds. 
(b) Speed.—The ability to travel 50 miles per hour on 
suitable roads is desirable. 
(c) Cruising radius.—Fuel capacity should be sufficient to 
carry the vehicle at least 200 miles. 
id) Ability to cross rough terrain.—A reasonable ability to 
overcome such obstacles as steep inclines, shallow ditches, 
cultivated ground, loose boulders, muddy or swamp ground, 
sand, or snow is mandatory. 
(e) Ease in driving.—Ease in driving will result in economy 
of personnel in a sustained action. 
(/) Riding comfort.—The vehicle, to best serve not only the 
patient’s comfort but also his general condition, should pos- 
sess pneumatic tires, a satisfactory type spring, and facilities 
for heating, lighting, and ventilating the interior. 
(g) Safety factors.—The safety of operating and passenger 
personnel should be considered in the selection of such equip- 
ment as brakes, lights, horns, shatter-proof glass, and 
similar items. 
b. Cross country motor field ambulance (fig. 133).—The 
new cross country ambulance more nearly meets the ideal 
requirements than does any other similar vehicle developed 
thus far. 
(1) Description.—Any measurements given are maximum 
or minimum specifications and are subject to slight variations 
by the manufacturer. 
ia) Chassis. 
1. General.—1/2-ton, truck type, 123-inch wheel base, 
4-wheel drive, 47 V 2 inches between wheel housings. 
2. Wheels.—Four, 16-inch, steel construction. 
127 33 
MEDICAL FIELD MANUAL 
3. Tires.—7.so, pneumatic, low pressure, all weather, 
non-skid. 
4. Engine.—6-cylinder. 
5. Brakes.—4-wheel, hydraulic. 
6. Shock absorbers.—Double action. 
7. Gas tank.•—Capacity 25 gallons. 
(b) Body. 
1. General.—Panel, steel, insulated; height of floor 
from ground, 32 inches maximum loaded; height 
(over all), 86% inches (approximate). 
2. Patient compartment. Inside measurement, 98 
inches long, 60 inches wide, 53% inches high. 
3. Bear door.—Measurements, 56 inches wide, 46 inches 
high. 
4. Seats for personnel.—Two, single, separate; one for 
chauffeur, non-folding, leather covered, capable 
of being displaced forward 13 inches when load- 
ing: one for ambulance orderly, folding. 
5. Glass.—Safety plate, shatter-proof. 
6. Seats and litter supports (see fig. 134).—Lateral, 
longitudinal, folding seats for sitting patients, 
padded with sponge rubber, duck covered; lat- 
eral brackets and centrally suspended slings for 
supporting upper tier of litters; lower tier of lit- 
ters fixed by lateral straps near floor. It will be 
noted that, in this ambulance, the insert has been 
eliminated and seats, brackets, and supports are 
all bolted firmly to the body. 
7. Ventilation.—Double system, front and rear, pri- 
mary and auxiliary, positive exhaust. 
8. Heater.—Type capable of heating interior to 70° P., 
outside temperature being 0° F. 
(2) Capabilities.—(a) Speed.—Governed at 50 miles per 
hour. 
(b) Cruising range.—Estimated 250 miles. 
(c) Patient capacity.—Four litter, seven sitting, or two 
litter and four sitting cases. 
c. Personnel.—Two men, a chauffeur and an ambulance 
orderly, are assigned to each motor ambulance. The former 
Is responsible for the vehicle at all times. He makes minor 
128 TRANSPORTATION OF SICK AND WOUNDED 
33-34 
repairs and is responsible for reporting major defects to his 
section leader or, if the latter is not available, to the unit 
transportation sergeant or mechanic. The ambulance or- 
derly acts as assistant driver, prepares the ambulance for 
loading and unloading, prepares it for departure after load- 
ing and unloading, and renders necessary first-aid and care 
to patients being transported. 
■ 34. Ambulance, Animal-Drawn.—a. Status.—To a consid- 
erable extent, the cross country motor field ambulance has 
supplanted the animal-drawn ambulance. However, situa- 
tions will arise wherein the latter will be employed. The new 
type ambulance is preferable to the old model 1909, but 
many of the latter are still in service and in depot storage, 
and will be utilized until they reach a stage of unservice- 
ability. 
b. Ambulance, animal-drawn, requirements.—To be of 
practical value, the animal-drawn ambulance should meet 
the following general requirements: 
(1) Weight.—The weight should be such as to permit its 
being drawn by two animals at the average speed of horse 
cavalry. 
(2) Height.—A low vehicle decreases the tendency to over- 
turn on rough terrain and the target presented by its 
silhouette. 
(3) Cross country employment.—The general construction 
of the vehicle and its equipment should be sufficiently durable 
to permit prolonged usage over rough terrain. 
(4) Comfort and safety.—Such equipment as tires, brakes, 
springs, and lights should be of such character as to reason- 
ably insure the comfort and safety of patients and operating 
personnel. 
(5) Trailer employment.—Vehicle should be capable of 
conversion to trailer for use with light motor vehicles. 
c. Ambulance, animal-draim, new type.—(l) General.— 
The new type animal-drawn ambulance was designed at the 
Medical Department Equipment Laboratory, Carlisle Bar- 
racks, Pa., and has had field testing over a period of several 
years. Its capabilities approach the ideal requirements of 
an animal-drawn ambulance. 
129 34-35 
MEDICAL FIELD MANUAL 
(2) Description (fig. 137).—(a) General.—The weight of 
the vehicle is approximately 1,000 pounds, and height over 
all, 80 inches. Even in the field, but two animals are needed 
for propulsion. 
(b) Chassis.—The frame is metal with automotive type 
front axle and transverse, semielliptic springs, front and rear. 
The wheels are five in number (one spare), automotive type, 
of metal construction, and equipped with low pressure pneu- 
matic tires, size 7.50 by 16. The brakes are front wheel, in- 
ternal expanding, mechanical type, operated by pressure on 
a foot pedal located centrally in front of the driver’s seat. 
(c) Body.—The body bed is of wood, reinforced with strap 
iron. The frame of the superstructure is of wood and tubular 
duraluminum, the cover being of waterproof, olive-drab can- 
vas. The inside measurements are length, 90 inches: width, 
47j/2 inches; and height, 57 inches. A central, wooden, longi- 
tudinal seat may be elevated or lowered. In its normal posi- 
tion, lowered, it will accommodate five sitting cases, and when 
raised becomes the central support for the upper tier of lit- 
ters. Lateral support for the upper tier is furnished by two 
longitudinal troughs, attached to the frame on each side, in 
which the litter stirrups slide during loading and unloading. 
The lower litters rest on the floor where their exact fit pre- 
cludes the necessity for other means of fixation. The body 
is designed to accommodate a maximum load of four litter 
or five sitting cases. However, with two litter cases, three 
sitting cases may be transported although they will be un- 
comfortable for the reason that half the seat will be occupied 
by the upper litter. Immediately in front of the body, a 
transverse seat, accommodating two men, rests on the jockey 
box, the latter being sufficiently large to hold necessary tools 
and the personal equipment of operating personnel. 
d. Personnel.—The animal-drawn ambulance requires two 
men, a driver who is responsible for the vehicle and animals, 
and an attendant who acts as assistant driver, assists in load- 
ing and unloading, and renders necessary care to the patients 
en route. 
■ 35. Employment of Ambulances in the Field.—See FM 
8-10. 
130 TRANSPORTATION OF SICK AND WOUNDED 
36-37 
■ 36. Training of Ambulance Personnel.—a. Motor ambu- 
lance.—See FM 25-10, Motor Transport. 
b. Animal-drawn ambulance.—See FM 25-5, Animal Trans- 
port. 
Section II 
INSTRUCTION IN AMBULANCE LOADING AND 
UNLOADING 
■ 37. General.—a. Purpose.—The purpose of this section is 
to furnish guides for training enlisted personnel in proper 
methods of loading and unloading the ambulance. 
b. Demonstration.—Utilization of demonstration will en- 
hance the efficacy of this instruction. 
c. Commands.—Any commands used are for purposes of 
instruction, and their use in the field is not contemplated. 
These commands are limited in number and cover the general 
acts performed in loading and unloading the ambulance. 
Details of the actual performance of these acts will vary 
slightly, depending on the number of bearers, presence or 
absence of ambulance orderly or assistant driver, and type 
ambulance employed. 
d. General rules.—(l) Berths and order of loading.—The 
four longitudinal spaces formed within an ambulance, when 
loaded litters are in place, are known as berths and are 
designated right (left) upper (lower). Four litter cases 
are loaded in the following order: right upper, left upper, 
right lower, and left lower. When loading two litter and one 
or more sitting cases, the right berths are utilized for the 
loaded litters, the order being right upper; and right lower. 
When loading two litter and no sitting cases, the lower berths 
are utilized, the order being right lower; and left lower. 
(2) Order of unloading.—Berths are unloaded in reverse 
order to that by which they are loaded. 
(3) Patients with splints.—Patients with cumbersome 
splints will be loaded in lower berths, when the situation 
permits. 
(4) Position of patient in ambulance.—Unless otherwise 
indicated, litter cases will be loaded head first. Prior to load- 
ing, litter will be grounded three paces to the rear of, and 
with the patient’s head toward, the ambulance. 
131 37-39 
MEDICAL FIELD MANUAL 
e. Preparation for instruction.—(l) Ambulances.—The 
number of ambulances to be utilized will depend on the size 
of the unit to be instructed and the availability of ambu- 
lances. Each ambulance should have its full complement 
of personnel, that is, driver or chauffeur, and assistant 
driver or ambulance orderly. 
(2) Formation.—Unit to be instructed will be formed in 
litter squads and two squads will be detailed to each ambu- 
lance, if available. Personnel will alternate, by litter squads, 
in the role of bearers and patients. 
Figure 140.—Litter squad at ambulance, POSTS. 
■ 38. Ambulance Posts.—The squad being in the vicinity of 
the ambulance, to assemble prior to loading or unloading, 
the commands are; 1. ambulance, 2. POSTS. At the com- 
mand posts, the members of the squad move rapidly by the 
shortest practicable route to the ambulance, ahd aline them- 
selves in numerical sequence from left to right, one pace in 
rear of the vehicle (fig. 140). This is the invariable position 
of the squad at ambulance, POSTS. 
■ 39. Ambulance Loading.—The squad being at ambulance, 
posts and the ambulance being prepared to receive patient 
132 TRANSPORTATION OF SICK AND WOUNDED 
39 
(fig. 141), to load ambulance, the commands are: 1. right 
(LEFT) UPPER (LOWER) BERTH, PREPARE TO LOAD, 2. LOAD. The 
procedure is as follows: 
a. At the first command, bearers take position as follows: 
No. 2, at foot of litter facing patient, stoops and grasps 
handles; Nos. 1 and 3, one on each side of litter facing pa- 
tient’s shoulders, grasp the right and left poles, respectively 
(fig. 142). 
b. At the command load, the litter is lifted by Nos. 1, 2, and 
3 and advanced into the berth designated in the preparatory 
command (fig. 143). 
Figure 141.—Ambulance ready to receive patients. 
c. At the same command, the ambulance orderly or assist- 
ant driver, from the front of the ambulance, assists in ad- 
vancing the litter within the ambulance, and secures front 
handles in brackets, straps, hooks, or other device present. 
d. The rear handles are secured by Nos. 1 and 3 (fig. 144). 
e. No. 4, in the meantime, renders aid as indicated or, in 
the absence of the ambulance orderly, performs the orderly’s 
normal duties. 
/. Following the loading, preparation of the ambulance for 
departure, such as lowering curtains and closing doors or 
133 39 
MEDICAL FIELD MANUAL 
Figure 142.—Loading ambulance, first step. 
Figure 143.—Loading ambulance, second step. 
134 TRANSPORTATION OF SICK AND WOUNDED 
39 
Figure 144.—Rear handles being secured. 
Figure 145.—Ambulance loaded, being prepared to move. 
135 39-41 
MEDICAL FIELD MANUAL 
tail gate, is accomplished by the ambulance orderly or, in his 
absence, by No. 4 (fig. 145). 
g. When loading has been completed, squad resumes posi- 
tion at ambulance, posts without command. 
■ 40. To Unload Ambulance.—The squad being at ambu- 
lance posts, and the ambulance being prepared for unload- 
ing, to unload ambulance, the commands are: 1. RIGHT (LEFT) 
UPPER (LOWER) BERTH, PREPARE TO UNLOAD, 2. UNLOAD. The 
procedure is as follows: 
a. At the first command, Nos. 1, 2, and 3 step forward and 
arrange themselves numerically, from right to left, at the 
foot of the litter; and the ambulance orderly (or No. 4 in 
his absence) takes position within the ambulance, at the head 
of the litter. 
b. At the command unload. No. 2 grasps the projecting 
handles and draws out the litter, assisted by Nos. 1 and 3, 
who, facing inward, support the poles. 
c. An upper berth being unloaded, Nos. 1 and 3 free the 
rear, the ambulance orderly the front, handles, then all three 
lower the litter to the floor and the squad proceeds as in 
unloading a lower berth. 
d. When clear of the ambulance, the litter, carefully sup- 
ported in horizontal position, is grounded three paces in 
rear of the vehicle. Members of the squad resume their 
positions at litter posts without command. 
■ 41. Loading and Unloading by Limited Personnel.—Situ- 
ations will arise wherein loading and unloading of ambu- 
lances must be performed by less than the normal comple- 
ment of personnel. The absence of No. 4 bearer entails no 
substitution. In the absence of No. 4 and the ambulance 
orderly or assistant driver, the chauffeur or driver will per- 
form their duties. In the absence of Nos. 3 and 4, the am- 
bulance orderly will substitute for No. 3, and the chauffeur, 
or driver, will assist from the front. In the absence of Nos. 
3, 4, and the ambulance orderly, the ambulance will be pre- 
pared by No. 1, after which the litter will be placed in lower 
berth by Nos. 1 and 2. An upper berth being loaded. Nos. 1 
and 2 will perform the duties of Nos. 1 and 3, the chauffeur 
or driver assisting from the front. Unloading is performed 
in like manner but in reverse order. 
136 CHAPTER 6 
AIR TRANSPORTATION OF THE SICK AND WOUNDED 
■ 42. General.—a. Increased difficulty of evacuation.—Mo- 
torization, mechanization, and aviation have increased the 
tempo of modern warfare. Concepts of distances have shrunk 
and, frequently, lines of communication are long and insecure. 
For evacuation to keep apace, every available means must be 
employed. Evacuation by air will be utilized whenever 
feasible. 
b. Present status of evacuation by air.—The value and prac- 
ticability of evacuating certain types of cases by air during 
times of peace have been demonstrated fully in our Army. 
Recently, certain powers have demonstrated its value in time 
of war, under favorable conditions. The most important fac- 
tor in the successful employment of such means is air 
superiority. 
c. Results of evacuation by air.—Actual application of the 
airplane to the medical task of evacuation accomplishes the 
following: 
(1) With a maximum degree of rapidity and comfort and a 
minimum degree of deleterious effect, certain types of seriously 
injured patients are transported from combat zone to general 
hospital, either in the communications zone or zone of the 
interior, where early definitive treatment can be instituted. 
(2) The psychological effect upon the remaining effectives 
results in a marked elevation of the morale of the entire 
fighting force. 
■ 43. Advantages of Evacuation by Air.—a. Speed.—The at- 
tainable speed of air transport will decrease evacuation time 
and reduce the number of fatalities incident to transportation, 
providing that, under medical supervision, cases for evacua- 
tion are properly selected prior to, and properly cared for 
during, the actual movement. 
b. Comfort of patients.—ln general, no other mode of trans- 
port approaches the degree of comfort offered the patient by 
the airplane. The discomfort, and actual danger involved in 
137 43-44: 
MEDICAL FIELD MANUAL 
certain types of cases, may be circumvented by low-altitude 
flying and the administration of oxygen en route. 
c. Safety.—The airplane, if air superiority is maintained, 
represents the safest means of transport and, if cases for 
movement be selected properly, the safest method of trans- 
portation. Safety guaranteed by agreement between nations 
will be of questionable value. 
d. Morale.—Successful evacuation by air will increase the 
morale of combat troops. 
e. Treatment en route.—In aircraft designed or converted 
for transportation of casualties, considerable treatment can 
be administered en route. Examples: application and read- 
justment of splints: administration of stimulants, sedatives, 
sera, and other medication; arrest of hemorrhage; treatment 
of shock; and most important of all, administration of 
oxygen. 
Note.—All aircraft intended for purposes of evacuation will be 
equipped with apparatus for the administration of oxygen. 
f. Medical supplies.—Aircraft utilized for evacuation may 
be employed, in their forward movement, for delivery of 
emergency medical supplies to medical units functioning in 
the combat zone. 
g. Redistribution of the medical task.—lnstitution of evac- 
uation by air within the combat zone will transfer the heavier 
treatment load from mobile installations of the combat zone 
to fixed installations of the communications zone or zone of 
the interior. 
■ 44. Areas of Employment.—a. Theater of operations.— 
Within the theater of operations, two echelons of evacuation by 
airplane ambulance are contemplated: 
(1) Within the combat zone.—Small landing fields will be 
located as near division clearing stations as possible. (The 
location of potential fields will be considered by clearing 
elements in the establishment of their installations.) Prom 
these fields, selected cases (par. 45) from clearing stations 
will be evacuated by light ambulance transport or shuttle 
planes to larger fields in the rear portion of the army area. 
(2) From combat to communications zone.—At landing 
fields in the army area will be collected the cases brought by 
138 TRANSPORTATION OF SICK AND WOUNDED 
44-45 
plane from more forward areas, plus selected cases from 
evacuation hospitals, from which collection centers they will 
be transported by heavy ambulance transport airplanes to 
general hospitals in the communications zone or, in some 
situations, to those in the zone of the interior. 
b. Zone of the interior.—(l) From theater of operations.— 
If the theater of operations and zone of the interior are 
contiguous, or separated by a small body of water, large 
ambulance airplanes may evacuate sick and wounded from 
either the combat or communications zone of the theater 
directly to the zone of the interior. In this event, incoming 
ambulance airplanes may proceed to one conveniently located 
central field or to one of several fields located in the vicinity 
of general hospitals. 
(2) Within zone of the interior.—ln the event that casual- 
ties from the theater of operations are brought to large 
reception centers by airplane or other means of transport, 
ambulance airplanes may then be utilized for distribution of 
such cases to various general hospitals within the zone of the 
interior. Furthermore, casualties occurring within the zone 
of the interior itself, either because of the peculiar nature of 
the case or the isolated character of its geographical loca- 
tion, may be evacuated by airplane ambulance to civilian or 
military medical centers. 
■ 45. Type Patient for Evacuation by Air.—a. General.—All 
cases do not respond favorably to air transportation, hence 
proper selection of cases by medical personnel is the foremost 
consideration in the application of the airplane to the task 
of evacuation. Care must also be taken to avoid evacuating 
cases to either the communications zone or zone of the in- 
terior, which normally would not be moved farther to the 
rear than the evacuation hospital. 
b. Cases adapted to air transportation.—Evacuation by air 
is intended primarily for seriously sick and wounded cases. 
The following types of cases are examples of those especially 
adapted to such means of transport; severe facial wounds; 
brain injuries; eye injuries; shattering wounds of the spinal 
column, pelvis, or extremities; severe wounds of the chest or 
abdomen providing such cases are recent, have not been 
operated upon, and have not suffered severe hemorrhage; 
139 45-46 
MEDICAL FIELD MANUAL 
and such medical cases as severe dysentery, typhoid, and 
similar conditions. 
c. Contra-indications to evacuation by air.—For physiologi- 
cal reasons, presence of the following conditions should con- 
tra-indicate evacuation by air: severe shock; recent major 
operative procedure; severe anemia due to hemorrhage; cases 
of, or complicated by, pneumonia; cases complicated by re- 
stricted breathing capacity as a result of hemothorax, pneu- 
mothorax, pulmonary hemorrhage, or marked elevation of the 
diaphragm due to severe intra-abdominal pressure, gaseous 
or otherwise. 
d. Evacuation by air in emergencies.—Air transport being 
available and evacuation by air being feasible, all cases, 
regardless of type, will be evacuated by such means if by so 
doing the abandonment of patients or their capture by the 
enemy will be averted. 
■ 46. Airplane Ambulances.—a. Types.—Depending upon 
their two principal missions, the following general types of 
aircraft will be employed as airplane ambulances; 
(1) A light transport airplane capable of transporting, be- 
sides the operating personnel, 2 to 4 litter cases and 1 medical 
officer or enlisted attendant. 
(2) A heavy transport airplane (see fig. 146, exterior view, 
Douglas C-39 ambulance airplane) capable of carrying, be- 
sides the operating personnel, from 9 to 16 litter cases, a 
medical officer, and an enlisted attendant (fig. 147, interior 
view, same airplane showing nine modified Stokes litters 
ready to receive patients). The former will be utilized in 
the combat zone as a shuttle airplane to transport cases from 
loading points in the vicinity of clearing stations to loading 
centers in the army area. The latter, or heavy airplane, will 
evacuate cases from the rear of the combat zone to the com- 
munications zone, or to the zone of the interior, as the situ- 
ation permits. Large airplanes may be employed to evacuate 
cases from installations of the communications zone to the 
zone of the interior. 
b. Requirements.—The general type, number of engines, 
structural specifications, safety appliances, and flying in- 
struments of airplane ambulances come within the purview 
of the Air Corps. However, from the point of view of the 
140 TRANSPORTATION OF SICK AND WOUNDED 
46 
Figure 146.—Douglas G-39, exterior. 46 
MEDICAL FIELD MANUAL 
Figure 147.—Douglas C-39, interior. 
142 TRANSPORTATION OF SICK AND WOUNDED 
46-47 
arm or service charged with care and treatment of patients 
being transported, the following requirements are consid- 
ered desirable: 
(1) For all airplane ambulances.—(a) Cabins.—Regard- 
less of size, cabins should be equipped with heating and ven- 
tilating systems, doors of sufficient size to permit free entry 
of a loaded litter, and racks or supports for the accommoda- 
tion of standard Medical Department litters (see par. 13). 
Utilization of a standard litter precludes unnecessary move- 
ment of the patient incident to his evacuation. 
(£>) Radio.—For liaison with ground personnel at loading 
and unloading points, inclusion of the radio in the equip- 
ment of airplane ambulances is considered of vital necessity. 
(c) Medical equipment.—All airplane ambulances will be 
equipped with apparatus for the administration of oxygen 
and those items of medical supply (litters, blankets, and 
splints) necessary to accomplish the usual property exchange. 
Other medical equipment may be added as indicated. 
(2) For shuttle or light transport airplane.—Those ambu- 
lance airplanes plying within the combat zone should accom- 
modate, in addition to the operating personnel, from 2 to 4 
litter cases and 1 medical officer or enlisted attendant. Gaso- 
line for more than 100 miles will seldom be required. 
(3) For heavy transport plane.—Those airplanes furnish- 
ing the second echelon of airplane ambulance evacuation 
service should accommodate from 9 to 16 litter cases and 2 
medical attendants (1 officer and 1 enlisted) in addition to 
the operating personnel. Gasoline for more than 500 miles 
will seldom be required. 
c. Sources.—Aircraft for airplane ambulance use may be 
obtained direct from manufacturers or by conversion of 
commercial or military transport planes. The latter will 
require but minor structural changes. (Fig. 148 shows the 
interior of a standard commercial passenger airplane con- 
verted for the accommodation of 12 litter cases. Note that 
litters are firmly attached to floor and litter racks and that 
patients are securely strapped to the litters.) 
■ 47. Units for Evacuation by Air.—a. Air Corps.—(l) Des- 
ignation.—Air Corps units, for the purpose of transporting 
143 47 
MEDICAL FIELD MANUAL 
Figure 148.—Interior of commercial plane, converted (looking 
forward). 
144 TRANSPORTATION OF SICK AND WOUNDED 
47 
sick and wounded, are designated Air Corps airplane ambu- 
lance groups, the number of such groups to coincide with the 
number of field armies. 
(2) Organization.—The Airplane ambulance group is or- 
ganized as follows; 
(a) A headquarters and headquarters squadron similar to 
the corresponding unit of the transport group (see T/01-352) 
but with three light ambulance transports substituted for 
the three combat planes. 
(b) Two squadrons of 12 heavy ambulance transports each, 
similar to the squadron, transport (see T/O 1-355). 
(c) One squadron of 18 light ambulance transports. 
(3) Personnel.—The airplane ambulance group is an Air 
Corps unit and all personnel, other than medical (b below), 
will be furnished by the Air Corps. 
(4) Employment.—Typically, the squadron of light trans- 
ports will operate a shuttle system of evacuation between the 
division and army areas of the combat zone, the two squad- 
rons of heavy transports between the army area of the combat 
zone and the communications zone or zone of the interior. 
b. Medical Department.—(l) Designation.—The medical 
unit, known as the medical battalion, airplane ambulance, 
is organized to function with the Air Corps airplane ambu- 
lance group. 
(2) Organization.—The medical battalion, airplane ambu- 
lance, is organized as follows: 
(a) A headquarters and headquarters detachment, corre- 
sponding to the headquarters and headquarters squadron of 
the group. 
(b) Two medical companies, airplane ambulance (heavy 
transport). 
(c) One medical company, airplane ambulance (light 
transport). 
(3) Personnel.—Personnel for the medical battalion, air- 
plane ambulance, will be furnished by the Medical Depart- 
ment from personnel attached to the Air Corps for duty. 
The unit will contain sufficient personnel for its own adminis- 
tration (except that messing will be with Air Corps or army 
units), the medical care of the companion Air Corps unit, 
and the care of patients during their actual transportation 
145 47-48 
MEDICAL FIELD MANUAL 
(one medical officer and one enlisted attendant per heavy 
transport and one medical officer or an enlisted attendant 
per light transport). 
■ 48. Control of Airplane Ambulance Units.—Air Corps Air- 
plane ambulance groups and their companion medical bat- 
talions, airplane ambulance, are under control of GHQ and 
will be attached to field armies as need for their employment 
arises. While so attached, they will be under control of the 
army commander. The chief surgeon of the field force and 
the army surgeon will make recommendations to the force 
and army commander, respectively, for their actual employ- 
ment. The responsibility for ambulance transports will rest 
with the Air Corps at all times; that for care and treat- 
ment of patients transported, with the Medical Department. 
146 CHAPTER 7 
RAIL TRANSPORTATION OP THE SICK AND WOUNDED 
■ 49. General.—a. When employed.—Railway transportation 
for the sick and wounded will be utilized whenever feasible, 
unless other available means be preferable. 
b. Where employed.—Normally, the extreme limits of rail 
evacuation are a railhead in the army area and a general 
hospital in the zone of the interior. Within these limits, 
other means such as airplanes and ships, may be employed as 
adjuncts to the rail transport. Under exceptional circum- 
stances, wherein the military situation has become stabilized 
and railways have been constructed for the supply of troops 
in forward areas of the combat zone, evacuation of divisions 
may be feasible by rail transportation. 
c. Means of transport.—For evacuation of army and rear- 
ward installations, hospital trains will be utilized. For evacu- 
ation of division areas, any available rail transport will be 
utilized. 
■ 50. Hospital Trains.—a. Status.—Hospital trains are mo- 
bile agencies of the Medical Department by means of which 
evacuation of sick and wounded is accomplished. The Med- 
ical Department is charged with furnishing personnel and 
medical equipment for such trains, and with their general 
administration. As railway units, they are operated and 
maintained mechanically under direction of the Corps of 
Engineers in the theater of operations. 
b. Classification.—(1) Type hospital train.—See paragraph 
53. 
(2) Improvised hospital train.—See paragraph 51. 
■ 51. Improvised Hospital Train.—a. Composition.—The 
composition of improvised hospital trains will depend on the 
number and type of patients to be transported, and rolling 
stock available. Cars suitable for employment are— 
(1) Standard Pullman sleepers.—Standard Pullman sleep- 
ers are capable of transporting from 24 to 36 litter cases, in- 
clude compartments for quartering duty nurses, and require 
147 51 
MEDICAL FIELD MANUAL 
no structural changes prior to employment. Integral berths 
may be utilized or hospital beds may be installed. 
(2)' Tourist sleepers*—Tourist sleepers may be utilized 
without structural changes. Their patient capacity is 
greater than that of standard sleepers, but they lack the 
comfort and privacy afforded by the latter. Hospital beds 
may be installed (fig. 149). 
(3) Standard chair cars.—Standard chair cars may be 
utilized without structural change for the transportation of 
sitting cases. Their conversion for the accommodation of 
litter cases may be accomplished by removing the chairs and 
installing 2- or 3-tiered beds, such as the Glennan bunk (fig. 
150). The Glennan bunk is 2-tiered and consists of a metal 
frame arranged for bolting to the floor and wall, which sup- 
ports a mattress and springs of a hospital bed fitted with side 
hinges and straps. Figure 151 shows interior of car utilizing 
Glennan bunks. The upper tier may be used for a patient, 
or folded against the wall as a back rest for patients sitting 
on the lower tier. 
(4) Standard baggage cars.—One standard baggage car 
for each improvised hospital train is desirable for the pur- 
pose of transporting the impedimenta of patients, the bag- 
gage of duty personnel, and surplus medical and other sup- 
plies. In the absence of more suitable cars, they may be 
converted for transportation of patients (see (3) above). 
(5) Hospital unit car.—Each improvised train should in- 
clude one hospital unit car (see par. 52). 
b. Capacity.—The patient capacity will vary with the limi- 
tations imposed upon train length by the character of the 
road bed and the motive power. For economical operation, 
trains having a minimum capacity of 300 patients are 
desirable. 
c. Personnel.—No definite allotment of Medical Depart- 
ment personnel for improvised hospital trains is possible. 
Sufficient officers and enlisted men will be furnished to insure 
proper care of the patients en route. The utilization of 
nurses on such trains is contemplated. 
d. Where employed.—lmprovised hospital trains will be 
employed routinely in the zone of the interior and in the 
theater of operations, whenever feasible, thus leaving the 
148 TRANSPORTATION OF SICK AND WOUNDED 
51 
Figure 149.—Interior of standard car showing beds installed. 
149 51 
MEDICAL FIELD MANUAL 
Figure 150,—Converted chair car with patients on tiered hunks. 
150 TRANSPORTATION OF SICK AND WOUNDED 
51 
Figure 151.—Glennan bunks installed in standard car. 
151 51-53 
MEDICAL FIELD MANUAL 
type hospital trains free for employment in those areas pre- 
cluding the utilization of standard rolling stock. 
■ 52. Hospital Unit Car.—The hospital unit car is a standard 
Pullman car, the interior of which has been altered according 
to plans and specifications approved by the Medical Depart- 
ment to provide— 
a. Cooking facilities for approximately 500 individuals (pa- 
tients and duty personnel). 
b. A small combination dressing and emergency operating 
room. 
c. An office for the administration of the train. 
d. Quarters for officers. 
■ 53. Type Hospital Train.—a. Orientation.—The term “hos- 
pital train,” unqualified, is applied to a train composed of a 
variable number of cars, the superstructures of which have 
been altered and equipped to serve some particular purpose 
incident to the movement of sick and wounded by rail. The 
exact number and type of cars will depend upon the mission, 
time and distance involved, where the train will operate, 
condition of track and roadbed, and type of engine to which 
attached. The term “type hospital train” is applied to a 
train composed of 16 ward, 1 kitchen, 1 dressing and operat- 
ing, 1 utilities, and 3 personnel cars—a total of 22 cars, all 
of the 20-ton boxcar type. This train is self-sustaining for a 
considerable period of time (at least 3 days); is capable of 
traversing hurriedly constructed and poorly ballasted track; 
and can be drawn by the 30-ton, internal combustion loco- 
motive operated by the Corps of Engineers. To permit stand- 
ardization of supplies and personnel, the type train will be 
utilized whenever practicable, but may be altered to meet 
existing situations. 
b. Requirements.—(l) General.—(a) Composition.—The 
composition should be such as to include facilities for the 
transporting, feeding, and rendering of proper care and treat- 
ment en route, to sick and wounded patients. 
(b) Patient capacity.—There are too many influencing fac- 
tors to permit the establishment of definite and inflexible 
figures for the patient capacity of hospital trains. Based upon 
the mission, type patient, limit as to number of cars, ward 
152 TRANSPORTATION OF SICK AND WOUNDED 
53 
car capacity, train facilities, and time and distance involved, 
the capacity of each train must be determined in such a 
manner as to insure economical operation. If the time in- 
volved is more than 24 hours, all patients must be regarded 
as litter cases. As a guiding principle, while the means need 
not exceed the task, ordinarily the patient capacity should be 
the maximum permitted by physical factors. For patient 
capacity of type train, see e below. 
(c) Flexibility.—Economical operation of hospital trains 
requires flexibility and this is gained by the development of 
special purpose cars covering the more important general 
facilities. Such cars can be added or eliminated to meet the 
requirements of the particular mission. 
(2) Special requirements.—(a) Accessibility.—All ward 
cars should possess side doors to permit free entry of loaded 
litters and end doors to permit the movement of litter cases 
between cars with train in motion. Fig. 152 shows side door 
loading of ward car during World War. 
(b) Beds.—All cars destined to carry patients should be 
equipped with beds or bunks capable of conversion to accom- 
modate either sitting or litter cases. Their arrangement 
should facilitate loading and the rendering of care and treat- 
ment to patients. 
(c) Supplies.—There should be available space for storage 
of sufficient general and medical supplies for at least a 3-day 
period. Drinking water and emergency medical supplies 
should be available in all cars. 
(d) Heating.—The heating system should be such as to 
insure the proper warmth of patients regardless of the pres- 
ence, absence, or type of engine attached. 
(e) Lighting.—The lighting system should be independent 
of the locomotive or, if dependence be placed in the locomo- 
tive, an auxiliary system should be available. 
(/) Sanitary arrangements.—All cars should be capable of 
being thoroughly cleaned and fumigated when necessary. 
Adequate ventilating, toilet, and bathing facilities should be 
installed. 
(g) Personnel.—Because of possible delay due to the mili- 
tary situation or damage to track or bridges, Medical Depart- 
ment personnel should be sufficient to render proper care and 
153 53 
MEDICAL FIELD MANUAL 
Figure 152.—Loading a hospital train. 
154 TRANSPORTATION OF SICK AND WOUNDED 
53 
treatment for a maximum patient load for a minimum of 
three days. 
(h) Miscellaneous.—Cars should be equipped with safety 
devices to prevent accident or undue exposure of patients 
incident to movement between cars. 
c. Description of type hospital train.—Figure 153 shows the 
exterior of a World War hospital train. 
(1) Composition.—See a above. All cars have the under- 
carriage of the light, 20-ton boxcar, the superstructure altered 
to meet a special purpose. The weight of each loaded car is 
limited to 30 tons. 
(2) Description of special purpose cars.—(a) Ward car.— 
Figure 154 shows the interior of a World War ward car. The 
ward car contains six tiered bunks of the Glennan, or similar 
type, arranged longitudinally, three on each side. Depending 
upon the type bunk and the time element, the patient capacity 
varies. If the bunks are 2-tiered and the trip of less than 
24 hours duration, the maximum capacity is 12 litter cases 
or 6 litter and 24 sitting cases. If the bunks are 2-tiered 
and the trip of more than 24 hours duration, the maximum 
capacity is 12 cases, regardless of type. If the bunks are 3- 
tiered and the trip of less than 24 hours duration, the maxi- 
mum capacity is 12 litter and 6 sitting cases (use of the upper 
tier for litter cases is not contemplated), or 30 sitting cases. 
If the bunks are 3-tiered and the trip of over 24 hours dura- 
tion, the maximum capacity is 18 cases, regardless of type. 
Obviously, if the trip is of short duration, other combinations 
to meet existing situations are possible. Ward cars will have 
side and end doors of sufficient width to permit ingress and 
egress of loaded litters. Toilets and tanks for drinking water 
will be installed in each car. Heat and light will be furnished 
from central installations in the utilities car (see (e) below). 
(b) Personnel car.—Cars designed for duty personnel are 
of two types: For enlisted men—containing five 3-tier bunks, 
a toilet, a shower bath, and three storage lockers beneath each 
set of bunks; and for officers and noncommissioned officers— 
containing three compartments, one for an office, one for 
officers, and one for noncommissioned offiers. The office 
contains a built-in table, seats, and a filing case. The com- 
155 53 
MEDICAL FIELD MANUAL 
Figure 153.—Exterior of a hospital train. 
156 TRANSPORTATION OF SICK AND WOUNDED 
53 
partments for personnel contain two double-decked bunks, 
shower bath, toilet and lavatory, and storage lockers. 
(c) Dressing and operating car.—Figures 155 and 156 are 
interior views of a World War dressing and operating car. 
This car contains a portable dressing and operating table, a 
double-decked bed for seriously ill patients, a dispensary table 
with closets and sink, toilet and lavatory, a floor sink, and 
necessary medical equipment, including a small sterilizer, 
Figure 154.—Interior of a ward car, hospital train. 
water boiler, instrument cabinet and table, and a small 
anesthesia apparatus. Other equipment and storage lockers 
will be installed as indicated. 
(d) Kitchen car.—Figure 157 shows the interior of a World 
War kitchen car. This car will contain a range, coffee urn, 
steam table, refrigerator, water heater, dishwasher, cooking 
utensils, dishes, and storage lockers and closets for linen, 
silverware, dishes, nonperishable food, fuel, and other supplies. 
157 53 
MEDICAL FIELD MANUAL 
(e) Utilities car.—This car will contain central lighting 
and heating units, facilities for storing fuel, and several 
shower baths for the use of assigned enlisted personnel. 
d. Personnel for type hospital train.—ln general, personnel 
for the type hospital train will be as follows: 3 or 4 medical 
officers: 4 noncommissioned officers (Ist sergeant, mess, sup- 
ply, and operating and dressing car); approximately 30 pri- 
vates or privates first-class (cooks, clerk, pharmacist, orderlies, 
and medical and surgical technicians). A medical detachment 
Figure 155.—Interior of dressing room, hospital train. 
of this size can furnish proper care for the average patient 
load (see e below) and can be accommodated in three person- 
nel cars (one of the officers and noncommissioned officers type, 
and two of the enlisted type). Employment of nurses in the 
type hospital train is not contemplated. 
e. Patient capacity.—Depending upon the factors discussed 
in c(2) above, the patient capacity of a type train containing 
16 ward cars will vary from 192 litter cases to 480 sitting 
cases, with the maximum actual load seldom reaching 300 
158 TRANSPORTATION OF SICK AND WOUNDED 
53 
Figure 156.—Interior of operating room, hospital train. 
159 53-54 
MEDICAL FIELD MANUAL 
patients. On the basis of World War 3:4 ratio, the average 
load will be approximately 268 patients, 116 litter and 152 
sitting cases. * Personnel and service facilities are inadequate 
for more than 400 patients. 
/. Arrangement of cars.—A suggested arrangement of the 
various cars in the type hospital train follows: two enlisted 
personnel cars; eight ward cards; utilities car; kitchen car, 
Figure 157.—Interior of kitchen car, hospital train. 
dressing and operating car; nine ward cars; officer and non- 
commissioned officer personnel car. In loading, the more se- 
rious cases should be placed near the center of the train, with 
surgical cases adjacent the dressing and operating car. Such 
an arrangement of cars and patients will facilitate the care 
and treatment of patients en route. 
■ 54. Employment and Control in Theater of Operations.— 
See PM 8-20. 
160 CHAPTER 8 
WATER TRANSPORTATION OP THE SICK AND 
WOUNDED 
■ 55. General.—a. Orientation.—For transportation of the 
sick and wounded by water, any floating conveyance, depend- 
ing upon its availability and feasibility, may be employed. 
b. Application to military service.—Although seemingly a 
naval problem, nevertheless situations will arise wherein evac- 
uation of the sick and wounded must be accomplished over 
bodies of water of varying size, without aid of the naval serv- 
ice. Under such conditions, a knowledge, though limited, of 
water transport, by the personnel of the Medical Department, 
becomes exceedingly important. 
■ 56. Water Transportation, When Employed.—a. Oversea 
operations.—Evacuation of the sick and wounded by means 
of water transport is mandatory if a military force is operat- 
ing in a theater separated from the zone of the interior by a 
large body of water. Under these circumstances, one of two 
situations may obtain, separately, or one as an outgrowth of 
the other. These are— 
(1) Joint Army and Navy oversea operation.—See FM 8-25. 
(2) Separate Army oversea operation. 
b. River crossings.—In the event of a river crossing and 
the establishment of a bridgehead, evacuation of casualties by 
small boats will be necessary pending sufficient development 
of the situation to permit bridge construction. 
c. Airplane crashes.—Airplane crashes occurring over water 
demand rescue by boat in the absence of amphibian aircraft. 
d. Waterways within theater of operations.—Rivers, lakes, 
canals, or other bodies of water within the theater of opera- 
tions, especially if they tend to be more or less perpendicular 
to the front, may become if suitable craft is available an 
important link in the chain of evacuation. 
■ 57. Classification of Water Transport.—a. By type ves- 
sel.—(1) Ships.—(a) Fleet hospital ship (fig. 158).—A fleet 
161 57 
MEDICAL FIELD MANUAL 
Figure 158.—Fleet hospital ship. 
162 TRANSPORTATION OF SICK AND WOUNDED 
57 
hospital ship, a naval institution, is a vessel designed and 
built to accompany the fleet and provide hospital facilities. 
It requires special construction and corresponds to a military 
general hospital in equipment and functions. 
(b) Hospital ship.—Hospital ships are large vessels 
equipped to treat the sick and wounded. Usually such ves- 
sels are of the commercial type, passenger, cargo, or a com- 
bination of both, converted and equipped for this particular 
mission. If converted by and commissioned in the Navy, 
they become adjuncts of the fleet hospital ship or serve as 
hospitals for advanced naval bases. If converted and 
equipped by humanitarian societies such as the Red Cross, 
they may be placed at the disposal of the Army or Navy. 
(c) Hospital transport.—A hospital transport is usually a 
converted commercial vessel, designed and equipped for 
evacuation of appropriate cases from the theater of opera- 
tions to the zone of the interior, and controlled by either 
the Army or Navy. 
(d) Ambulance ships.—Obsolete naval vessels, usually de- 
stroyers, may be equipped and employed as ambulances 
to transport patients from combatant naval vessels, or from 
evacuation hospitals on shore, to hospital ships. 
(2) Boats.—(a) Ambulance boats.—Ambulance boats are 
motor-propelled craft of varying size and design controlled 
by the Navy and intended solely for the purpose of evacuating 
patients from shore or combatant ship to hospital ship. 
(b) Motor launches.—Figure 159 shows motor launch with 
patient, approaching hospital ship. Naval motor launches 
of the Class A (50-foot) and B (40-foot) types may be used 
for beach evacuation during a landing operation. (See 
FM 8-25.) 
(c) Air Corps rescue boats.—The Air Corps of both the 
Army and Navy possess small, high speed motorboats, known 
as “crash boats”, and maintained in constant readiness for 
rescue work in the event of forced landings or crashes of air- 
craft in water. The Army rescue boat is 72 feet long and has 
a 16-foot beam, two 600-horsepower gasoline motors, and a 
cruising speed of 30 miles per hour. Besides a crew of four, 
it carries a complete radio installation, medical supplies and 
163 57 
MEDICAL FIELD MANUAL 
Figure 159.—Motor launch approaching hospital ship, TRANSPORTATION OF SICK AND WOUNDED 
57-58 
equipment, facilities for fighting fire, and the necessary 
gear for towing disabled planes. 
(d) Assault boats.—The assault boat, an item of engineer 
equipment, is employed in the initial phase of river crossings 
and similar operations for ferrying combat troops. These 
boats on their return trips may be utilized for the evacuation 
of casualties, pending bridge construction. (See FM 5-5). 
(e) Miscellaneous.—ln an emergency, any available craft 
such as canoes, rowboats, outboard motorboats, and towboats 
will be employed. 
(3) Lighters.—Lighters, or barges, of varying sizes and 
types may be employed in the evacuation of casualties from 
shore to ship, or from combat to communications zone, 
utilizing inland waterways. 
b. Naval classification of hospital ships.—See FM 8-25. 
c. Classification based on immunity to attack.—(l) Vessels 
immune to attack.—Under provisions of the Hague Conven- 
tion of October 18, 1907, any vessel regardless of size if in- 
tended only for the care or transportation, or both, of the 
sick, wounded, or shipwrecked may become immune to attack 
by a belligerent by conforming to certain requirements, in- 
cluding the following: 
(a) The painting will be distinctive, and in conformity 
with current international agreement. 
(e) The vessel will be announced to the enemy prior to 
its employment. 
Ib) The Red Cross flag will be flown. 
(d) It will be manned and staffed by noncombatant per- 
sonnel. 
(e) It will not be employed for any military or unneutral 
purpose such as the transportation of armed forces, military 
supplies, or military communications. 
(2) Vessels liable to attack.—Any vessel, even though it is 
intended primarily for the transportation or care of the sick 
and wounded, which at) any time performs a military mission, 
is liable to enemy attack. For example, a hospital transport, 
carrying troops or supplies, other than medical, to a theater 
and returning with casualties, is not immune to attack. 
■ 58. Selection of Vessels for Hospital Transports.— 
Within the limits of availability, commercial vessels for con- 
165 58-59 
MEDICAL FIELD MANUAL 
version and employment as hospital transports should be 
selected with the following points receiving careful consider- 
ation : 
a. Type.—Because of the relative adequacy of messing, 
fresh water, laundry, latrine, and other important facilities, 
types of vessel, in order of preference, are passenger, com- 
bination passenger and cargo, and cargo. 
b. Means of propulsion.—Unless the availability of fuel is a 
pertinent factor, engines utilizing oil rather than coal are 
preferable. The type engine and the number of propellers 
should be investigated with a view to reducing noise and vi- 
bration to a minimum. Fuel storage space must be commen- 
surate with the desired cruising radius. 
c. Size.—Unless the duty to be performed and the distance 
to be traversed dictate otherwise, a vessel of about 10,000 tons, 
capable of transporting from 350 to 500 patients after con- 
version, is preferable. Larger vessels have difficulty in enter- 
ing small harbors and estuaries; supplying their fuel and 
water becomes more difficult; and, with less than a full load 
of patients, employment will be uneconomical. 
d. Speed.—lf not immune to enemy attack, a hospital trans- 
port should be capable of equaling the speed of the train or 
convoy accompanying it. If immune, the speed should be 
commensurate with the distance to be traversed. Other fac- 
tors being normal, a cruising speed of 15 knots with a few 
knots reserve is most satisfactory. Greater speed increases 
vibration and decreases the cruising radius. 
e. Steadiness.—The comfort of patients is influenced to a 
marked degree by the steadiness of the vessel and this factor, 
which varies even in similar craft, should be determined prior 
to selection. 
/. Odors and infestation.—Due to the difficulty of complete 
eradication, vessels which have been carrying odoriferous 
cargoes or which have been infested recently with insects or 
vermin should be avoided. 
■ 59. Conversion of Selected Vessels.—Details in the con- 
version of commercial vessels into hospital transports will 
vary with the type selected, the distance to be traversed, 
and the type patients to be transported. General guides for 
consideration incident to such conversion are as follows: 
166 TRANSPORTATION OF SICK AND WOUNDED 
59-60 
a. Wards.—Wards having a patient capacity of approxi- 
mately 50 patients will allow economical employment of per- 
sonnel. Dining rooms and salons become excellent wards. 
With the exception of a few for selected cases, cabins should 
be converted into wards by the removal of partitions as in- 
dicated. Doors should be altered to permit free entry of 
wheeled litters. Wards for bed patients should be located, 
preferably, amidships and on decks above the main deck; those 
for ambulant patients may be on or below the main deck. 
b. Airspace.—The amount of airspace must be adequate but 
the exact amount will depend upon the location of the ward, 
number of portholes, and efficacy of the ventilating system, 
if any. 
c. Facilities, offices, and quarters.—Service facilities, such as 
laundry, bakery, and galleys, should be located aft; quarters 
for duty personnel, forward. Professional facilities, such as 
X-ray, physio-therapy, and dental clinics, should be located 
amidships or forward and may be below the main deck. 
d. Toilets.—Lavatories should be located proximal to the 
wards they are to serve, and should contain sufficient fixtures 
to accommodate 5 percent of the patients at one time. 
e. Diet kitchens.—A diet kitchen, with facilities for heating 
and rapid serving of patients’ meals, should be adjacent each 
large ward. 
/. Lights.—Primary and auxiliary lighting systems should 
be installed, with special fixtures for indirect floor lighting. 
■ 60. Responsibility. Responsibility for the command 
aboard a hospital transport (or ship) will vary with the sit- 
uation and status of the vessel. 
a. Joint Army and Navy oversea operation.—See FM 8-25. 
b. Vessel under Army control.—Hospital transports under 
Army control will be commanded and operated by personnel, 
civilian and otherwise, of the Quartermaster Corps. Patients 
and medical personnel will be commanded by a medical 
officer. 
c. Vessels immune to attack.—Command responsibilities 
aboard a vessel having immunity under the provisions of the 
Hague Convention, especially those manned and equipped 
by benevolent societies, may be complicated. The operating 
personnel may be civilian or merchant marine, and the med- 
167 60 
MEDICAL FIELD MANUAL 
ical personnel, civilian, Army or Navy Medical Department. 
In any case where there is question as to who will be re- 
sponsible for the safety and navigation of the vessel and who 
will command the crew, medical personnel, and patients, the 
rules in (1) and (2) below should be followed; 
(1) The fields of responsibility for each individual con- 
cerned should be set forth in writing by the proper authority, 
prior to sailing. 
(2) Those concerned must employ the utmost tact and 
give the fullest mutual cooperation at all times. 
168 INDEX 
Air Corps: 
Airplane ambulance group 47 
Control 48 
Employment 47 
Organization 47 
Personnel 47 
Rescue boats 57 
Units for evacuation 47 
Control 48 
Designation 47 
Employment 47 
Organization 47 
Personnel; 
Operating 47 
Medical 47 
Air evacuation: 
Advantages 43 
Airplane ambulance 46 
Areas of employment 44 
Status of, present 42 
Superiority, air, as factor 42 
Type patient 45 
Units 47 
Air Corps 47 
Control 48 
Medical Department 47 
Airplane. (See also Air Corps.) 
Ambulance 46 
Areas of employment 44 
Requirements 46 
Sources 46 
Types) 46 
Units 47 
Commercial, conversion 46 
Crashes: 
Evacuation of, by boat 56 
Rescue, by boats 57 
Transportation of the sick and wounded 42-48 
Ambulance: 
Airplane 46 
Animal-drawn 32 
Four-animal 32 
Requirements 34 
Status 34 
Two-animal, description 32-34 
Boats 57 
Definition 32 
Employment, in field 35 
Insert, Carlisle 33 
Instruction in loading and unloading 37-41 
Preparation 37 
Purpose 37 
Paragraphs 
Page 
143 
146 
143 
143 
143 
161 
143 
146 
143 
143 
143 
143 
143 
137 
140 
138 
137 
137 
139 
143 
143 
146 
143 
140 
138 
140 
140 
140 
143 
140 
161 
161 
137 
140 
118 
118 
129 
129 
118 
161 
118 
130 
122 
131 
131 
131 
169 INDEX 
Ambulance—Continued. 
Loading, general rules 37 
Metropolitan 32 
Motor, field 32 
Requirements 33 
Status 33 
Motor, field, cross country 32 
Capabilities 33 
Description 33 
Panel body 33 
Personnel: 
Animal-drawn ambulance 34 
Motor ambulance 33 
Training 36 
Posts 38 
Ships 57 
Transportation of the sick and wounded 32-41 
Arms carry: 
Instruction 10-11 
Procedure: 
One bearer 7 
Two bearers 8 
Assault boat 57 
Barges, transportation of sick and wounded 57 
Battalion, medical, airplane ambulance 47 
Company, medical 47 
Headquarters detachment 47 
Organization 47 
Status 47 
Bearer: 
Actions in instruction: 
Ambulance loading 38—41 
Litter 19>-24 
Wheeled litter carrier 30-31 
Designation 19 
Employment of litter bearers 16-17 
Movement of patient; 
One bearer 7 
Two bearers 8 
Number in litter squad 19 
Transportation of the sick and wounded 6-12 
Boats: 
Ambulance 57 
Assault 57 
Launches, motor 57 
Rescue, Air Corps 57 
Transportation of the sick and wounded 57 
Cacolet; 
Definition 28 
Transportation of the sick and wounded 28 
Types 28 
Carlisle 28 
First Cavalry Division 28 
Hamilton chair 28 
Panama Jungle 28 
Paragraphs 
Page 
131 
118 
118 
122 
122 
118 
122 
122 
122 
129 
122 
131 
132 
161 
118 
29 
2 
15 
161 
161 
143 
143 
143 
143 
143 
132 
45 
110 
45 
45 
2 
15 
45 
2 
161 
161 
161 
161 
161 
103 
103 
103 
103 
103 
103 
103 
170 INDEX 
Car (see also Hospital trains); 
Standard: 
Baggage 51 
Chair 51 
Carrier, wheeled litter (field) : 
Advantages 26 
Description 26 
Employment of, in field 27 
Instruction in use 29^31 
Formation 29 
Loading and unloading 31 
Objectives 29 
Opening and closing 30 
Purpose 29 
Purpose 25 
Substitutes: 
Cacolet 28 
Travels 28 
Transportation of the sick and wounded 25-31 
Cases (patient) : 
Aboard air transport: 
Comfort 4.3 
Treatment 43 
Ambulance loading 37 
Ambulant 13 
Back, loading and unloading 22 
Capacity: 
Trains, hospital: 
Improvised 51 
Type 53 
Transport, hospital 58 
Care in handling 22 
Classification 13 
Litter 13 
Position of, in ambulance 37 
Type for evacuation by air 45 
With splints, in ambulance loading 37 
Corps of Engineers, operation: 
Hospital trains 50 
Standard boxcar 53 
Thirty-ton locomotive 53 
Evacuation: 
Means. See Transport. 
Principles 4 
Responsibility 5 
Scope 3 
Fireman’s carry; 
Instruction 10 
Procedure 7 
Fleet hospital ship 57 
Group, airplane ambulance. See Air Corps. 
Hague Convention: 
Immunity, basis of classification 57 
Responsibility aboard immune vessels 60 
Paragraphs 
Page 
147 
147 
98 
98 
103 
110 
110 
115 
110 
110 
110 
98 
103 
103 
98 
137 
137 
131 
36 
74 
147 
152 
165 
74 
36 
36 
131 
139 
131 
147 
152 
152 
1 
1 
1 
29 
2 
161 
161 
167 
171 INDEX 
Hospital ship: 
Definition 57 
Fleet 57 
Naval classification 57 
Hospital trains: 
Classification 50 
Employment and control 54 
Improvised 51 
Capacity 51 
Car, hospital unit 52 
Cars, standard: 
Baggage 51 
Chair 51 
Composition 51 
Personnel 51 
Sleepers; 
Pullman, standard 51 
Tourist 51 
Where employed 51 
Status 50 
Transportation of the sick and wounded 49-54 
Type 53 
Arrangement of cars 53 
Capacity, patient 53 
Composition 53 
Definition 53 
Description 53 
Personnel 53 
Requirements 53 
Unit car 52 
Hospital transport: 
Conversion of selected vessels 59 
Air space 59 
Diet kitchens 59 
Facilities, officers and quarters 59 
Lights 59 
Toilets 59 
Wards 59 
Definition 57 
Immunity to attack 57 
Responsibility aboard 60 
Selection of vessels 58 
Means of propulsion 58 
Odors and infestation 58 
Size 58 
Speed 58 
Steadiness 58 
Type 58 
Immunity to attack, vessels 57, 60 
Instruction: 
Ambulance loading and unloading 37-41 
Manual transport 9-12 
Use of litter 18-24 
Use of wheeled litter carrier 29-31 
Launch, motor 57 
Lighters, transportation of sick and wounded 57 
Paragraphs 
161 
161 
161 
147 
160 
147 
147 
152 
147 
117 
147 
147 
147 
147 
147 
147 
147 
152 
152 
152 
152 
152 
152 
152 
152 
152 
166 
166 
166 
166 
166 
166 
166 
161 
161 
167 
165 
165 
165 
165 
165 
165 
165 
161, 167 
131 
27 
45 
110 
161 
161 
Page 
172 INDEX 
Litter: 
Bearers, employment 16-17 
Canvas: 
Aluminum pole 14 
Folding 14 
Wooden pole 14 
Cases 13 
Definition 13 
Improvised 15 
Dayan 15 
Poles and blanket 15 
Poles and blouses or overcoats 15 
* Poles and shelter half 15 
Rifles and blanket 15 
Rifles and blouses 15 
Rifles and overcoat 15 
Instruction in the use 18-24 
Commands 18 
Formation 21 
Metal, airplane 14 
Requisites 13 
Squad 19 
Standardization 13 
Transportation of the sick and wounded 13-24 
Litter squad: 
Ambulance loading and unloading: 
Formation 37 
Instruction 39-41 
Composition 19 
Designation 21 
Designation of bearers 19 
Duties of bearers in reduced squads 19 
Formation 21 
Instruction 19-24 
Position, at ambulance posts 38 
To bring into line 21 
Manual transport for sick and wounded: 
Arms carry; 
One bearer 7 
Two bearers 8 
Fireman’s carry 7 
Instruction 9-12 
Commands 9 
Formation 9 
Purpose 9 
Methods , 7-8 
Pack-saddle carry 8 
Saddleback carry: 
One bearer 7 
Two bearers 8 
Supporting carry: 
One bearer 7 
Two bearers 8 
Transportation of the sick and wounded 6-12 
When required 6 
Paragraphs 
Page 
45 
37 
37 
37 
36 
36 
4C 
40 
40 
40 
40 
40 
40 
40 
45 
45 
48 
37 
36 
45 
36 
36 
131 
132 
45 
48 
45 
45 
48 
45 
132 
48 
2 
15 
2 
27 
27 
27 
27 
2 
15 
2 
15 
2 
15 
2 
2 
173 INDEX 
Oversea operations: 
Joint Army and Navy 56 
Responsibility 60 
Separate Army 56 
Pack-saddle carry: 
Instruction 11 
Procedure 8 
Personnel: 
Airplane Ambulance Group 47 
Ambulance: 
Animal-drawn. 34 
Motor 33 
Hospital trains: 
Improvised 51 
Type 53 
Medical Battalion, Ambulance Group 47 
Quartermaster Corps, operation of hospital trans- 
port 60 
Rail transportation of the sick and wounded 49-54 
Employed: 
When 49 
Where 49 
Employment and control 54 
Hospital trains: 
Classification 50 
Improvised 51 
Status 50 
Type 53 
Hospital Unit oar 52 
Means of transport 49 
Rescue boats, Air Corps 57 
Responsibility: 
Aboard hospital ships 60 
Air evacuation units 48 
Evacuation 5 
Hospital trains 50 
Of ambulance: 
Assistant driver 34 
Chauffeur 33 
Driver 34 
Orderly 33 
River crossings: 
Employment of assault boats 57 
Evacuation of casualties 56 
Saddleback carry: 
Instruction 10-11 
Procedure: 
One bearer 7 
Two bearers 8 
Ships: 
Ambulance 57 
Fleet hospital 57 
Hospital 57 
Paragraphs 
Page 
161 
167 
161 
33 
15 
143 
129 
122 
147 
152 
143 
167 
147 
147 
147 
160 
147 
147 
147 
152 
152 
147 
161 
167 
146 
1 
147 
129 
122 
129 
122 
161 
161 
29 
2 
15 
161 
161 
161 
174 INDEX 
Ships—Continued. 
Hospital transport 57 
Conversion of selected vessels 59 
Responsibility aboard 60 
Selection of vessels 58 
Transportation of the sick and wounded 57-60 
Sleeper: 
Pullman, standard 51 
Tourist 51 
Supporting carry: 
Instruction 10-11 
Procedure: 
One bearer 7 
Two bearers 8 
Train, hospital, transportation of sick and 
wounded , 49-54 
Transport: 
Airplane 42-48 
Ambulance 32-41 
Gacolet 28 
Carrier, wheeled litter 25-31 
Choice 3 
Litter 13-24 
Manual 6-12 
Train 49-54 
Travois 28 
Water 55-80 
Transportation of the sick and wounded: 
Air 42-48 
Ambulance 32^41 
Bearer 6-12 
Carrier, wheeled litter 25-31 
Rail 49-54 
Water 55-60 
Relation to medical task 3 
Travois 28 
Improvisation 28 
Transportation of sick and wounded 28 
Two-horse 28 
Water transportation of the sick and wounded 55-60 
Classification of transport 57 
Conversion of selected vessels 59 
Military application 55 
Responsibility 60 
Selection of vessels 58 
When employed 56 
Paragraphs 
Page 
161 
166 
167 
165 
161 
147 
147 
29 
2 
15 
147 
137 
118 
103 
98 
1 
36 
2 
147 
103 
161 
137 
118 
2 
98 
147 
161 
1 
103 
103 
103 
103 
161 
161 
166 
161 
167 
165 
161 
175 PM 8-35 
c i 
MEDICAL FIELD MANUAL 
TRANSPORTATION OF THE SICK AND WOUNDED 
Changes ] 
No. 1 J 
WAR DEPARTMENT, 
Washington, 8 June 1943. 
FM 8-35, 21 February 1941, is changed as follows : 
■ 13. General.—a. Litter, definition.—A litter is a rectangular 
framework across whch is placed canvas or other material 
and is used to transport sick, wounded, or dead persons. 
[A. G. 300.7 (6-2-43).] (C 1, 8 June 1943.) 
order of the Secretary of War ; 
G. C. MARSHALL, 
Chief of Staff. 
Ob'Ficial : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
U. S. GOVERNMENT PRINTING OFFICE: 1943 EM 8-35 
C 2 
MEBTCAlLI'‘PITErED MANUAL 
TRANSPORTATION OF THE SICK AND WOUNDED 
Changes 
No. 2 
WAR DEPARTMENT, 
Washington 25, D. C., 4 November 1943. 
FM 8-35, 21 February 1941, is changed as follows: 
9 25.1 (Added). Litter Securing Strap.—a. Litter securing 
straps are available in the ratio of four per litter. The strap 
consists of a length of 2-inch webbing with buckle and two 
metal hooks, one at each end. The purpose of the securing 
strap is to hold litter patients in position on the litter, thus 
facilitating movement and obviating danger of the patient 
falling from the litter. The litter securing strap is so designed 
as to fit all standard Army litters. The straps are used in 
numbers according to circumstances. When movement is over 
relatively level areas, two securing straps will generally be 
sufficient; one across the patient’s chest and one across his 
legs below the knees. In securing the straps, one end is fastened 
by the metal hook to the litter pole; the strap is then carried 
across the patient’s body and fixed to the far litter pole by 
the hook on the other end of the strap. When the litter is to 
be moved over rough terrain or the proposed movement is of 
such a nature that there is particular danger of a patient 
Slipping from the litter, all four securing straps are used. The 
four straps may be applied one across the chest, one across the 
waist, one across the thighs, and one across the legs below the 
knees. However, when considerable movement of the litter in 
a vertical direction is contemplated, the following method of 
application is employed: two straps are applied across the chest 
and legs as before and the other two as follows: one is clasped 
to the litter pole, carried over the thigh of one leg, passed 
between the legs and under the other leg to the far pole. The 
other strap is applied in the reverse manner; that is, clasped 
to the far pole, carried over the thigh of the far leg, under 
the near leg, and finally attached to the near pole. (See fig. 
103.1.) 
b. Whenever litter securing straps are used, care must be 
taken that the strap is so placed as not to interfere with what- 
ever wounds may be present. If tbe patient suffers a broken 
leg which has been splinted, straps are passed over only the 
uninjured leg, since the litter bar will serve to hold the splinted 
leg in position. MEDICAL FIELD MANUAL 
Figure 103. i. 
2 TRANSPORTATION OF THE SICK AND WOUNDED 
Figure 103.1—Continued. 
3 MEDICAL FIELD MANUAL 
Figure 103.1—Continued. 
[A. G. 300.7 (22 Oct 43).] (C 2, 4 Nov 43.) 
By order of the Secketary of War : 
G. C. MARSHALL, 
Chief of Staff. 
Official : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
4 
u. S. GOVERNMENT PRINTING OFFICE: 1943 EM 8-35 
C 3 
MEDICAL FIELD MANUAL 
TRANSPORTATION OF THE SICK AND WOUNDED 
Changes] 
No. 3 J 
WAR DEPARTMENT, 
Washington 25, D. C., 13 April 1944. 
FM 8-35, 21 February 1941, is changed as follows: 
CHAPTER 9 (Added) 
CONVERSION OF COMMON MILITARY VEHICLES TO 
PATIENT CARRIERS 
■ 61. General.—a. Many common military vehicles can be con- 
verted into patient carriers with little or no structural change. 
Often in combat areas ambulances will be unavailable, too few 
in number, or incapable of evacuating certain regions due to 
the tactical situation or difficulties arising from the terrain. 
In such cases it becomes necessary to utilize whatever vehicles 
are available to transport the wounded. Methods of using 
several of the more common military vehicles to carry casualties 
are described in this chapter. 
h. Most of these vehicles are not inclosed. In order to insure 
that the casualty does not bounce off the litter in transit, he 
should always be bound to the litter prior to loading on the 
vehicle. Straps to be used for this purpose and known as 
“Litter Securing Straps” are an item of issue. (See C 2, 4 
Nov. 43.) 
o. To insure that the litters themselves will not bounce off 
the vehicles, it is necessary that they be lashed securely to the 
sides of the various trucks after being loaded. For this purpose 
lengths of rope, litter straps, or any other convenient materials 
may be used. 
d. In general, litters will be loaded as follows: when litters 
are lengthwise to the truck, patients’ heads will be toward the 
front. When litters are loaded crosswise to the truck, patients’ 
heads will be alternately right and left to minimize discom- 
fort to adjacent patients in cases of nausea and vomiting. MEDICAL FIELD MAX PAT 
■ 62. Conversion of Selected Vehicle's to Patient Carriers'.— 
a. The truck.—The %*ton truck (Jeep qr Peep), anffi 
trailer are standard equipment of medical battalion sections 
and many other units of the Army. They will be available 
almost always and are easily adapted to carrying casualties. 
(1) Two litter patients can be carried on the truck 
without alteration in the vehicle (other than removal of spare 
tire) or the use of additional equipment (fig. 160). 
Figure IGo.—The %-ton truck loaded with two litter patients. 
One litter is placed across the back of the truck, handles of 
the litter resting on the truck sides. The second litter is placed 
lengthwise on the right side of the truck. The rear handles 
of the second litter rest on the side of the first litter, and the 
front stirrups fit in the groove below the windshield. 
(2) A disadvantage to the method of transportation de- 
scribed in (1) above results from the necessity of placing the 
first litter crosswise to the truck. When the route of evacua- 
tion is along narrow roads or trails, there is danger of the 
litter handles catching on projecting trees and hushes. This 
danger can be obviated by construction of an improvised frame 
2 TRANSPORTATION OF THE SICK AND WOUNDED 
to permit carrying of two litter casualties lengthwise on the 
rear of the truck. Such a frame can be made by binding 
together four poles, saplings, or boards in the shape roughly 
of a two-rung ladder (fig. 161). The frame is lashed to the 
bows and side handles of the jeep with ropes or straps, and 
the litters loaded with patients’ heads toward the front. The 
front of the litters rest on the front cross piece of the frame, 
and the back of the litters on the bows of the truck (fig. 162). 
Figure 161.—Improvised frame for t4-ton truck. 
(3) A more permanent frame may be made from salvaged 
2 by 4’s or similar material (fig. 163). An advantage of this 
type of frame is that it can be folded up and stored when not 
in use. When mounted on the truck, the crosspiece of the 
frame is placed in position just behind the backs of the front 
seats. The side pieces of the frame extend to the rear and 
slightly inward over the corners of the truck. These pieces 
support the truck bows which are slid to the rear where they 
fit into a notch and are lashed to the side pieces. When the 
litters are loaded onto the truck, they are supported in front 
by the crosspiece of the frame, and in the rear by the truck 
bows (fig. 164). 
(4) The 14-ton cargo trailer may be readily adapted to the 
transportation of litter casualties (fig. 165). Two litters are 
placed lengthwise on the trailer, with the litter stirrups fitting 
inside and thus preventing the litters from falling off. The 
3 MEDICAL FIELD MANUAL 
Figure 162.—Tw0 litters loaded on improvised frame. 
Figure 163.—Plan of permanent frame for 14-ton truck. 
4 TRANSPORTATION OF THE SICK AND WOUNDED 
Figdre 164.—Tw0 litters loaded onto permanent frame. 
Figure 165.—%-ton cargo trailer loaded with two litters. 
5 MEDICAL FIELD MANUAL 
litter handles are bound to the small hooks on the sideboards 
of the trailer. 
(5) By attaching the loaded %-ton cargo trailer to the %-ton 
truck, four litter casualties may be transported. The method 
of litter loading described in (1) above must ordinarily be used 
to load the %-ton truck, as use of either the improvised or 
permanent frames on the rear of the truck would make it im- 
possible to attach the trailer. 
(6) If it is thought desirable, a frame for two litters on the 
front of the truck may he constructed, thus making it possible 
to attach the trailer and transport four patients in a position 
lengthwise to the truck (fig. 166, drawing). The frame is 
BLOCKS "A", ’e", "C" PREVENT MOTION OF THE RACK TO FRONT OR REAR. 
Figure 166.—Plan of hood frame for (4-ton truck. 
placed on the hood of the truck and the litters loaded length- 
wise. The rear handles of the litter extend over the dashboard 
with the outer handles lashed to eyebolts on the dashboard 
directly below. Patients’ heads are toward the truck body to 
minimize the danger of accidents during transport (tig. 167). 
1). The %-ton truck and iy2-ton 6x6 truck.— (1) The %-ton 
truck (weapons carrier) is a common vehicle both in the in- 
fantry and in medical units. It is easily adapted for use as a 
patient carrier. Two litters are placed lengthwise and head 
foremost in the bottom of the %-ton truck, their protruding 
ends supported by the tail gate. The protruding ends are 
6 TRANSPORTATION OF THE SICK AND WOUNWKD 
Figure 167.—Hood frame loaded with two litters. 
bound with ropes to prevent the litters from sliding out. If 
the roof bows of the truck are off, a second layer of three lit- 
ters is placed side by side crosswise, resting on the slats and 
lashed in place. If the roof bows of the truck are in position, 
the second layer of litters is placed crosswise so that the litter 
handles rest on the bow braces. The handles of the center 
litter straddle the center bow. The litters of the top layer are 
secured by lashing their handles to the bow braces (fig. 168). 
Tims a total of five litter casualties can be transported. 
(2) The 1%-ton 6x6 truck is loaded similarly; that is, two 
litters lengthwise along the floor and a second layer crosswise 
over the bow braces. Because of the additional length of the 
truck body, however, five litters can be accomodated on the 
second layer, making a total of seven in the truck. 
c. The 4 x 4 truck.—The 1%-ton 4x4 truck, a common 
vehicle in many organizations, is also easily adapted as a 
patient carrier. This truck can accomodate three layers of 
litters. The bottom layer consists of two litters placed length- 
wise on the floor. The middle layer of four litters is placed 
crosswise resting on the seats of the truck, and the top layer 
crosswise on the bow braces. The truck is loaded from front to 
rear, top layer first, then middle layer, top layer, and middle 
7 MEDICAL FIELD MANUAL 
Figure 168. %-ton truck loaded with five litters. 
Figure 160.—1 %-ton 4x4 truck loaded with ten litters. 
8 TRANSPORTATION OF THE SICK AND WOUNDED 
layer in alternation until the two upper layers are filled. Then 
the 2 litters on the floor are slid in from the rear. The tail 
gate is raised and fastened, and the litters of the two upper lay- 
ers secured to the seats and bow braces by straps (fig. 1G0). 
Thus the capacity of the truck is ten litters. 
d. The 21/-2-ton truck.—The 2%-ton truck, another vehicle of 
wide general use, is loaded similarly to the 1%-tou truck but has 
a greater capacity. The upper, middle, and bottom layers are 
again placed on the bow braces, on the seats, and on the floor, 
respectively. The floor of the truck will accommodate six litters 
in two rows of three litters each loaded lengthwise to the truck 
in the following manner: the two side litters are placed on the 
floor first and then slid sideways until they are under the seats. 
Then the center litter is placed between the two. The back three 
litters protrude from the floor of the truck and are supported by 
the tail gate which cannot be closed. The entire truck is loaded 
from front to rear in any convenient order, care being taken not 
to obstruct placing of one litter by premature loading of another. 
Finally the litters are hound securely to the bow braces and 
the tail gate raised slightly above the horizontal to prevent 
slipping. The truck when fully loaded permits transportation 
of eighteen litter patients (fig. 170). 
Figure 170.—2%-ton truck loaded with eighteen litters. 
9 MEDICAL FIELD MANUAL 
Figure 171.—Half-track loaded with four litter patients plus medical 
personnel. 
e. The half-track.— (1) The half-track is a common vehicle 
in the armored force and is used as an ambulance for armored 
force medical detachments. When so employed, it will con- 
veniently accommodate four litter patients, plus four slightly 
wounded patients or medical attendants (fig. 171). The lit- 
ters are loaded in layers of two litters each lengthwise to the 
vehicle body. Certain structural changes (fig. 172) in the 
10 TRANSPORTATION OF THE SICK AND WOUNDED 
vehicle are required to support the litters as follows. U-shaped 
brackets are mounted on the gun pedestal to support the inner 
front handles of the four litters. Rings are suspended from 
chains fastened to the vehicle backplates and sideplates to 
support the inner rear handles of the four litters, as well as the 
outer front handles of the two top litters. The outer rear 
handles of the two top litters are supported on brackets welded 
to the rear plates. The outer front handles of the two bottom 
litters rest on the vehicle seats. 
(2) An alternative method of loading the half-track may be 
Figure 172.—Half-track converted for patient carrier. 
11 MEDICAL FIELD MANUAL 
employed when it is not considered desirable or feasible to 
make structural changes in the vehicle itself (fig. 173). Five 
litters are mounted across the top of the half-track, then an 
additional litter is slid lengthwise into the vehicle on the floor. 
A disadvantage of this method results from the difficulty of 
lashing the five top litters in place. However, this can be 
accomplished if sufficient rope or other suitable material is 
available. 
Figure 173.—Loading half-track (alternative method). 
(3) In cases of emergency, nine litter patients can be trans- 
ported in the half-track by combining the two methods de- 
scribed above. The required structural changes must first be 
made, after which four litters are loaded into the vehicles. 
Then five additional litters are loaded crosswise on the top of 
the half-track. 
f. The 2y2-ton amphibian truck.— (1) The 2%-ton amphib- 
ian truck (DUKW) can be adapted as a patient carrier. The 
12 TRANSPORTATION OF THE SICK AND WOUNDED 
■vehicle will usually be available only to troops engaged in or 
contemplating amphibious operations. It is most useful in 
transferring casualties from shore landing parties to ships 
nearby. The same truck that brings supplies to the shore may 
carry wounded men hack to the ship. The truck may be loaded 
at the unit aid station, then driven down to the shore and out 
to the ship, or it may be loaded at the water’s edge (fig. 174). 
Figuke 174.—Loading the 2%-ton amphibian truck. 
(2) To convert the 2%-ton amphibian truck to a patient 
carrier the bows are first loosened and slid forward where 
they are bound in place against the front bow. Five litters 
can then be placed on the bottom of the truck, two crosswise 
in front and three lengthwise in the rear. In order to rest 
litters on the sides of the truck and thus make a second layer, 
it is necessary to construct a rail along each side of the truck 
just outside and above the side. This rail is held in place by a 
special bracket which clips on the side of the truck. When lit- 
ters are placed across the sides of the truck, their handles 
abut against the rail, preventing the litters from sliding off. 
Six litters can be loaded side by side across the top. The 
13 MEDICAL FIELD MANUAL 
capacity of the truck fully loaded is eleven litter casualties, 
five on the bottom and six on top. All litters must be tied 
securely in place so that they will not slide around or be dis- 
placed by rocking of the truck in rough water. 
[A. G. 300.7 (18 Feb 44).] 
order of the Secretary of War : 
G. C. MARSHALL, 
Chief of Staff. 
Official : 
J. A. ULIO, 
Major General, 
The Adjutant General. 
U. S. GOVERNMENT PRINTING OFFICE: 1944 
14 FM 8-35 
C 4 
MEDICAL FIELD MANUAL 
TRANSPORTATION OF THE SICK AND WOUNDED 
Changes ] 
No. 4 
WAR DEPARTMENT. 
Washington 25, D. C., 17 August 1944. 
FM 8-35, 21 February 1941, is changed as follows: 
■ 7. Movement By One Bearer. 
e. (Added) Pistol belt carry.— (1) This carry is easily learned, 
can be accomplished with items of equipment which will always 
be present with or on the soldier, and will permit the ordinary 
soldier to transport a casualty with a considerable degree of 
comfort for long distances over all types of terrain. Although 
this one man carry is commonly known as the “pistol belt carry” 
it can be accomplished with one rifle sling and one pistol belt; 
two triangular bandages; two litter straps, or any other equip- 
ment that will make a loop of 2% to 3 feet in diameter. 
(2) After treating the wounds, or splinting the fracture of 
the injured man in the appropriate manner, link together two 
pistol belts or other equipment to form a continuous belt under 
his thighs and hips so that a loop extends from each side. (See 
fig. 18.1.) Then lie between the wounded man’s extended legs, 
thrusting your arms through the belt loops. (See fig. 18.2.) 
(8) Grasp or support the wounded part with free hand, then, 
rolling toward the uninjured side, turn over to the prone posi- 
tion, carrying the wounded man onto your back. Make necessary 
adjustments of slings before proceeding. (See fig. 18.3.) 
(4) Then rise to kneeling position. The continuous belt will 
hold casualty firmly in position. (See fig. 18.4.) 
(5) Place one hand on your knee for support, then rise to 
upright position. The patient is now supported on your shoul- 
ders and held in position by the continuous belt, and will ride 
comfortably whether conscious or not. (See fig. 18.5.) 
(6) You are now ready to move with your hands and arms 
unencumbered by the necessity of supporting the patient. You 
can use your hands to assist you in climbing steep banks or in 
surmounting all types of obstacles. (See fig. 18.6.) MEDICAL HELD MANUAL 
Figure 18.1. 
2 
ADO 331 D TRANSPORTATION OF THE SICK AND WOUNDED 
Figure 18.2. 
AGO 331 D 
3 MEDICAL MELD MANUAL 
Figure 18.3. 
4 
AGO 331 D TRANSPORTATION OF THE SICK AND WOUNDED 
Figukk 18.1. 
AGO 331 D 
5 MEDICAL FIELD MANUAL 
Figure 18.5. 
AGO 331 D TRANSPORTATION OF THE SICK AND WOUNDED 
Figure 15.6. 
AGO 3311) MEDICAL FIELD MANUAL 
(7) A strong man can carry another for quite some distant 
in this manner without undue fatigue. In certain cases rh 
carry may be substituted for litter bearers in rough or mom' 
tainous terrain, and can easily be used as a method for carryiu 
medical equipment. 
[A. G. 300.7 (26 May 44).] 
order of the Secretary of War : 
G. C. MARSHALL, 
Chief of tStaff. 
Official : 
J. A. ULIO. 
Major General, 
The Adjutant General. 
Distribution : 
As prescribed in paragraph 9a, FM 21-6; B (2) ; R (2 
except R8 (10) ; Bn 8. 19 (5). 18 (2) ; C 8 (10). 
For explanation of symbols, see FM 21-6. 
8 
AGO .331 
U. S. GOVERNMENT PRINTING OFFICE: 1944