1. CONFIRM OPERATIONAL NEED AND ASSESS THE PATIENT: Verify that a confined space, stairwell obstruction, or bariatric lift condition makes the carry sheet the appropriate extrication tool. Assess the patient and confirm there is no suspected spinal, pelvic, or long bone instability before proceeding without a rigid backboard.

2. IMMOBILIZE FIRST IF TRAUMA IS SUSPECTED: If mechanism of injury indicates potential spinal trauma, fully immobilize the patient on a rigid long spine board or equivalent device before any contact with the carry sheet. The carry sheet will then be used to move the complete patient-and-board package, not the patient alone.

3. COMMUNICATE THE PLAN: Brief your team on lift positions, path of travel, and obstacle points before initiating movement. Communicate the plan clearly to the patient as well to reduce uncontrolled movement and maintain cooperation.

4. POSITION THE CARRY SHEET: Lay the carry sheet flat alongside the patient. Perform a coordinated log roll, moving the patient onto their side away from the sheet. Position the sheet against the patient's back, bunched or folded lengthwise, then roll the patient back onto the sheet and confirm the patient is centered with the head, torso, and legs fully supported.

5. ASSIGN LIFT POSITIONS: Position operators evenly on both sides of the sheet. For bariatric patients, a minimum of 4 rescuers is required and 6 is optimal. The team leader positions at the head or feet to maintain clear observation of the path of travel.

6. ACQUIRE GRIP AND EXECUTE THE LIFT: All operators take a firm, supinated (palms up) grip on the reinforced perimeter handles. The team leader issues the preparatory command and execution count: "Team, prepare to lift to waist height on my count, one, two, LIFT." All operators lift simultaneously and smoothly, driving from the legs and maintaining a straight back.

7. NAVIGATE TO THE TRANSFER POINT: The team leader provides continuous verbal direction throughout movement to navigate obstacles, stairwell landings, and transitions. Operators must maintain active control of the sheet at all times, particularly during stairwell descents and on uneven terrain, as the device has no integrated patient straps.

8. TRANSFER TO THE GURNEY: Position the loaded carry sheet directly over the primary gurney or transport device. On the team leader's command, lower the patient in a controlled, unified manner. Once the patient is confirmed secure on the gurney, remove the carry sheet by reversing the log roll procedure.

9. INSPECT AND DECONTAMINATE AFTER USE: Conduct a full inspection of the nylon body for new punctures, cuts, or abrasions. If any handle stitching or load-bearing surface is compromised, remove the device from service immediately. If bodily fluid exposure occurred, decontaminate using an approved, non-bleach, intermediate-level disinfectant compatible with nylon, follow manufacturer contact time instructions, rinse if required, and ensure the device is completely dry before storage.