I am the one who stated in absolutist, dogmatic fashion that we should not use carabiners for patient or litter connections.
See my other thread on Cavechat / Cave Rescue about why I feel that there are times when such language is appropriate.
Let me see if I can adequately address the topic of this thread, about using carabiners for connections to patients or litters.
YES, the direct tie-in is a better connection mechanism than using a carabiner! So much so that I will defend stating that notion as a rule, and I'll deal with the rare exceptions to the rule as they happen in the field.
Let's address your points as you raised them:
[*]"...we're just stuck with repeatedly untying and retying these knots..." Yes, you are. Tying and untying knots is what riggers do. If it is too hard to untie a knot, and a few seconds of time will make the difference, use your knife and cut the rope. Risking a patient's life (or worse, a student's) in a situation of mis-using hardware is almost never justified, especially for the time savings difference in tying a knot versus wrangling a carabiner. I would like to see a formal study of how much time this actually saves, though my experience tells me that it can't be very much at all.
[*]"In cave rescue, we're clipping in and out of various complex and not-so-complex systems all the time." This is not true. I serve as a lead rigger on a very active rescue team, specializing in Cave and Cliff rescue, and the vast majority of our patient raises are simple, one-stage hauls--NOT complex, "clipping in and out" affairs. The situation where I would accept the risk of cross-loading or gate-loading a carabiner to save the additional time it takes to tie a knot is surely the very rare exception to my RULE about never allowing a situation where such a tool could become a life-threatening liability rather than a trustworthy technique. To use this argument as a defense of a technique which has--by photographic proof--failed and placed a human life in needless danger, seems frivolous to me.
[*]"...use carabiners for litter connections and have been doing so for decades." Let me reply with a similar argument: I have NOT trusted carabiners to catch a falling live load in circumstances where they might be cross-loaded for decades. I have personally witnessed, thousands of times, circumstances where falling onto a knot actually held a live load, where falling onto a carabiner might well have resulted in a fall. If you are defending this technique by saying that there are circumstances where it hasn't resulted in a failure yet, you are merely postponing a terrible accident that could be avoided. I maintain that your photograph is an example of a failure, while you seem to be saying that it illustrates that the patient has successfully "dodged the bullet" and that we should rig this way despite the carabiner clearly being in a failure mode. If so, sir, then we can end this discussion now with the understanding that you are an optimist, and I a pessimist, who have different expectations about what might happen based on what has happened.
[*]"...if the system ain't broke - why do we need to "fix" it?" The system IS broken. Your photograph illustrates that. You (in the NCRC 2010 curriculum) helped to teach the riggers who tied their patient into a litter with carabiners on a recent rescue training practice session where I was present. It was a single-pitch haul, with no mud and all the time in the world. The riggers used the tails of the main and belay lines to connect to the patient's harness with carabiners, and they used carabiners to connect the lines to the litter's head bridle. Had that bridle broken, or the main line failed, or the carabiner failed, then the load on the final connection points to the patient would have been by carabiner only, in a dynamic, uncontrollable situation where there was a distinct possibility of cross-loading, or gate-loading the carabiner. This was the time for the application of a rule about connections whose orientation cannot be predicted being made with knots, and not carabiners.
My proposed rule is this: "If you cannot be sure of the orientation of a carabiner when it will be loaded, don't use a carabiner! A knot is much better." The reason I recommend a knot is that a rigger will always have one at hand, an appropriate knot cannot be cross-loaded or gate-loaded, and its strength is very easy to judge. There are exceptions to this rule, such as rigging with a Maillion Rapide, but as that requires an item of hardware that is not always at hand, it is probably a less desirable alternative to a knot, at least in the context of introducing this rule to beginning riggers. I have also heard arguments such as "Use a stronger 'biner!" but the vast majority of carabiners are simply not meant to be used in a cross-loaded fashion and such use should not be taught. I challenge you to find a carabiner manufacturer that recommends the use of its 'biners in a cross-loaded orientation. My experience is that they all teach that carabiners should be loaded along their long axis, and more specifically along the spine. Even very strong carabiners, while they may state that they are strong enough to hold your calculated load even when cross-loaded, are being mis-used if you are using them in a way that may load them in anything other than along the long axis. There may be such tools on the market, but they exist as an exception to the rule.
I'll be happy to discuss this further, as I'm not one who merely stands behind a dogmatic position. Further, I'll do it here under my own name, and not a clever alias.
Clem