Why the over-the-shoulder rescue carry can put both rescuer and victim at greater risk

Which rescue carry is riskier than it looks? A quick look at the numbers behind a simple lift

In a rescue, every move has to count. You’re balancing speed, safety, and the stubborn reality that people don’t always cooperate—especially when they’re hurt or unconscious. So when a scenario asks you to pick a method for getting someone to safety, the choice isn’t just about speed. It’s about where the risk lives and how your body and the patient move together. Here’s a practical way to think through one common question you might encounter in the DoD Driver/Operator Aerial context: which carry can actually increase the risk of injury for both rescuer and victim?

The bottom line: over the shoulder carry is the tricky one here.

Why the over-the-shoulder carry can backfire

Let me explain the mechanics. In an over-the-shoulder carry, the rescuer supports the person across their shoulder and upper back. The weight isn’t just in the arms—it sits higher up, pressed against the neck and shoulder girdle. That position forces the rescuer to lock in a precise posture for long periods. If the victim is heavy, limp, or unable to help, the rescuer bears a big load with a relatively narrow base of support. The result? A higher chance of muscle strain in the back and shoulders, plus a lot of torque on the spine if you’re not perfectly aligned.

Balance is another enemy here. When you’re carrying someone across your shoulders, your center of gravity shifts forward and upward. Any wobble—on uneven ground, around a corner, or on a slope—can become a tipping risk. A stumble isn’t just a personal stumble; it’s a potential drop that could injure both people. And if the victim is unconscious or requires immobilization, the lack of active participation only makes the situation more fragile. The rescue becomes a one-person power move, and that’s where the danger creeps in.

In the field—whether you’re in a damaged vehicle, a tight cabin, or a rooftop perch—the over-the-shoulder approach amplifies these issues. It’s easy to underestimate how much strain builds up in the rescuer’s back, neck, and shoulders when you’re trying to keep the weight close and the posture correct while moving through obstacles. That combination—high load, awkward leverage, limited help from the victim—creates a recipe for both immediate injury and longer-term musculoskeletal pain.

A quick tour of the safer alternatives

If you’re trying to ensure you and the patient stay safe, it helps to know how the other carries work and why they’re favored in many scenarios. Here’s a practical contrast.

Two-person carry: shared load, shared responsibility

This method distributes weight between two rescuers. It’s excellent for stability and balance because each person contributes to lifting, carrying, and guiding the patient. The shared load means you’re less likely to lose balance and you can maneuver through tight spaces with more control. It does require good coordination and clear communication. The benefit is straightforward: fewer opportunities for a single point of failure, and less strain on any one back or shoulder.

Firefighter carry: speed with a secure grip

The firefighter carry, also known as the fore-and-aft carry, keeps the victim's torso close to the rescuer’s chest and uses a firm grip around the body. This approach tends to be quicker and can be more ergonomic than an over-the-shoulder lift, especially when you’re moving through debris or narrow passages. It also frees up one arm to steady doors or manage obstacles. The trade-off? It can be awkward if the patient is tall or if you’re working alone; you’ll still want a partner if the scene allows it.

Spinal carry: immobilization done right

When there’s a potential spinal injury, immobilization is non-negotiable. The spinal carry typically involves a rigid litter or spine board with straps that secure the patient in alignment, minimizing movement of the neck and spine. The goal is to protect neurological function while you move the patient to safety. It’s a different mindset—more about immobilization and coordination—than pure speed. But when done well, it’s one of the safest options for a patient with possible spinal trauma.

Real-world nuance: what this means in aerial and field environments

DoD driver/operator scenarios aren’t about a tidy gym floor. They’re about unpredictable environments: uneven surfaces, wind, confined cockpits, and sometimes the need to move a person from a danger zone to a safer area without compromising vehicle stability or mission readiness. In these settings, the choice of carry matters for both immediate safety and long-term outcomes.

So, when would you reach for each option?

• If you’re working with a partner and have a clear line of sight, a two-person carry often makes the most sense. It’s balanced, safer for the back, and easier to control over obstacles or stairs.

• If you’re dealing with a straight line of travel and the patient is conscious and cooperative, the firefighter carry can offer speed and control while keeping the patient’s torso secured close to you.

• If there’s a suspected spinal injury or the patient must be immobilized immediately for transport, the spinal carry or a board-assisted transfer is the prudent choice. Immobilization comes first, even if it means slower movement.

• The over-the-shoulder carry, while elegant in some classic rescue drills, tends to be best left for situations where other methods aren’t viable or when the operator has specialized training and strong back support. In most field conditions, its risks can outweigh the benefits.

Practical tips you can take to the field

• Prioritize teamwork. If you have a partner, talk through the plan before you lift. Confirm who will take the lead, where the weight will be distributed, and how you’ll navigate obstacles.

• Use the right equipment. A spine board, a Stokes basket, or a rigid litter can drastically improve safety. When you can, have the patient stabilized before lifting, and secure them properly during the move.

• Keep the load close to your body. Regardless of the carry, keeping the weight close reduces strain and improves balance. Stand with your feet shoulder-width apart, bend at the hips, and keep your core engaged.

• Communicate constantly. A simple “one, two, three” or a quick tap on the shoulder to pause to adjust grip can prevent slips and missteps. Your cadence matters as much as your grip.

• Train for the edge cases. Real rescues aren’t neat. Practice in varied environments—stairs, uneven ground, confined spaces—to build a sense for which carry works best where.

• Slow down when needed. It’s tempting to rush, but rushing increases the chance of a misstep. If the ground looks unstable, pause, regroup, and secure your position before moving again.

• Always assess the patient first. If you suspect a spinal injury or other serious trauma, immobilize before you lift. The right move at the right moment can save a life and protect a spine.

A practical mental model you can carry forward

Think of carries like different gears on a vehicle. Each gear serves a purpose, and you shift based on the terrain and the payload. The over-the-shoulder carry is a specialized gear that’s powerful in the right situation but risky if you push it where it doesn’t fit. The safer options—two-person, firefighter, and spinal—are your all-purpose gears for most field conditions. The key is knowing when to switch gears, and how to use each one without straining your own body.

In the end, safety isn’t only about following a rulebook. It’s about reading the scene, protecting both people, and moving with deliberate control. The DoD Driver/Operator Aerial context emphasizes not just mechanical skill but also the judgment to choose the option that minimizes risk. The over-the-shoulder carry may have its place, but it’s the system of teamwork, stabilization, and immobilization that often keeps rescuers and victims safer in adverse conditions.

A quick takeaway you can remember

• Over-the-shoulder carry can increase injury risk for rescuer and victim due to load placement, balance challenges, and potential for muscle strain.

• Two-person, firefighter, and spinal carries are designed to share load, stabilize the patient, and reduce risk.

• Always assess the situation, use proper equipment, and communicate clearly with your team.

• Practice across varied environments so you’re not surprised when the terrain changes.

As you move through the rigors of aerial operations, keep this mindset: safety first, then speed, then stability. The right carry isn’t just a move—it’s a decision that protects you and the person you’re helping. And in high-stakes missions, that decision matters more than any single technique. If you’re curious to see more real-world scenarios or want to compare carries side by side, look for field guides that pair practical demonstrations with the equipment you’re likely to encounter—spine boards, litters, and the sturdy, dependable gear that keeps both rescuers and victims out of harm’s way.