What is the best practice for rope handling during patient lowering?

• A. Let rope slide freely to speed lowering.
• B. Twist rope around your body.
• C. Use only one hand without brake.
• D. Maintain a controlled, ergonomic grip, avoid over-twisting, and keep the brake hand in the correct position.

Answer: (D)

When lowering a patient by rope, the key is controlling the descent with a stable, ergonomic grip and keeping hands in positions that allow immediate adjustment of speed. The best approach is to maintain a controlled, ergonomic grip, avoid over-twisting the rope, and keep the brake hand in the correct position so you can readily apply friction and slow or stop the descent as needed.

Having a controlled, ergonomic grip means your wrists stay neutral and your grip is firm but not jammed. The brake hand should be placed so you can quickly pull rope through the belay or descent device, usually near your body at about hip level, with the rope aligned to flow smoothly. The other hand guides the rope, helps manage its path, and prevents slack or tangles. This setup gives you precise, predictable control over the patient’s speed, reduces the risk of rope twists that can snag or injure you, and minimizes fatigue.

Letting rope slide freely eliminates your ability to modulate descent, which can cause a runaway lower and possible injury. Twisting the rope around your body increases entanglement and injury risk. Relying on one hand without braking capability removes essential control and can lead to an uncontrolled descent.