The head-neck-chest axis must be kept straight to protect the spine, and the first responders must keep the patient's body stable (no movement of the feet) during the lift.
The first responders have to carry a heavy load (probably more than 20 kg for an adult casualty) in an uncomfortable position.
The stretcher must be unfolded, and the hinges secured and tested: a first responder presses the cloth with their knee at several points.
The most secured way to put a casualty on a stretcher is to use a vertical lift with five first responders including the chief (the procedure is called pont amélioré in French, pont refers to a gantry, amélioré means "enhanced").
The casualty is lifted by four first responders: The feet of the team members must be enough spaced so the stretcher can slide in between.
Another method consists in placing the team members at both sides of the casualty and holding the cloths.
During this procedure, the chief remains kneeling (stable); the other team members lift pushing with their legs (arms stretched out, back kept straight).
A team member lifts a part of the body (head, then shoulders, then hips), and the other one slide the board.
The strap can be put with two method: Then, one extremity of the strap goes on a shoulder of the team member and under their opposite armpit (it crosses the back), and is tied to the other or held together by the team member; a hand is also put under the neck to support the head.
The chief holds the closest pole with their knee on the ground, and the third team member with their ankle.
Once the both extremities of the pole are blocked, the other team members can step over the casualty (one by one, holding the others' shoulder to avoid falling) without any risk of rocking for the stretcher.
In this case, the chief plays the role of the first team member; blocking the pole with their ankle, and putting one hand under the neck, the other one under the back, between the shoulder blades.
They are especially helpful for heavy weighted casualties: the rolling does not require much effort, and the lifting itself is done in a more comfortable position (the back of the first responders is vertical).
This is rather traumatic for the casualty, but can be used when there is non suspicion of trauma, either in emergency (e.g. to transport a cardiac arrest when advanced life support cannot be performed on site), or when the first responders are lacking.
For this last movement, additional first responders can be placed at the opposite side of the stretcher to help the landing.
The team member can then support the hole weight of the top of the casualty's body while keeping a vertical back.
In this case, the casualty must be transported lying; a long spine board is put against their back to support it while they are laid down.