7. IRB Rescues

General Approach

Patient pick up is a primary role for IRB personnel and can be a safe, fast and effective way to effect a rescue. However, rushing a patient pick up is a factor in a number of IRB rollovers. It is important to note that just because someone is conscious, they may not necessarily be able to assist in the rescue due to injury, fatigue or other factors. There are a number of patient pick up options that the IRB Driver and IRB Crewperson should consider based on their ability and prevailing conditions. When selecting the most appropriate patient pick up the IRB crew should consider variables such as the size and condition of the patient, the size and physical ability of the IRB Crewperson, the location and number of patients, the conditions and the experience of the crew.

The following pick up options are recommended for use of an IRB crew when performing a rescue. They include:

• Conscious or Assisted Rescue
• Unconscious or Unassisted Rescue
• Bounce Method
• Tube Rescue
• Mass Rescue
• Multiple Patient Rescue
  

*NOTE: The above are the recommended techniques to perform an IRB rescue, however there will be many factors that can affect the rescue. The ultimate aim is to get the patient in the IRB the safest way possible to minimise delay and not cause injury/harm to the IRB crew or patient. This may mean that a patient pick up is performed that doesn’t strictly conform to one of the described techniques provided.

During a patient pick up it is recommended to follow these four key components:

1. Approach – approach the patient at a 2 o’clock angle relative to the waves
2. Contact – the initial contact with the patient on the port (drivers) side
3. Hold – the patient is being pulled to the IRB and supported or held as required
4. Pick up – the final step involving getting the patient into the IRB

Approach	Contact	Hold	Pickup

The general approach to the patient is the same:

• First approach is important. It needs to be without hesitation and with an appropriate level of urgency with both IRB Driver and IRB Crewperson in a good position
• The IRB Crewperson should keep visual contact and provide a directional signal to the IRB Driver at all times
• Approach the patient as soon as practical with the IRB at a 2 o’clock angle relative to the waves with the patient on the port (drivers) side

*NOTE: Starting at 12 o’clock or earlier makes the turn too tight to lift the patient into the IRB potentially causing the patient to be dragged towards the beach or causing the IRB Driver to correct back to starboard.

• First contact by the IRB should be at idle at the bow port (drivers) side
• The IRB Crewperson is to position themselves over the spray dodger, holding the top of the bow rope in their right hand above the first or second knot. Their left foot should stay within the foot-strap, their left knee is against the port (driver’s) side buoyancy tube. If necessary, their right foot can be straight out behind their body as a counterweight.
• Grab and hold the patient securely in front of the bow lifting handle
• If required, push through the next wave and maintain a 2 o’clock direction
• Pick up the patient as soon as practical but use the necessary time to bring the patient safely onboard

*NOTE: The position gripped by the IRB Crewperson on the bow rope will depend on the Crewpersons size and reach. The gripping of the bow rope with the right-hand serves as an anchor point for the hold and lift into the IRB.

The next steps in the technique vary depending on what type of pick up is being effected:

Conscious or Assisted Rescue

Best suited when rescuing a conscious patient who is able to assist in getting themselves into the IRB.

• Approach the patient at a 2 o’clock angle. The IRB Crewperson communicates with the patient to raise their left arm.
• The IRB Crewperson uses their left hand to reach forward over the spray dodger making contact with the patient, preferably by grabbing the patient’s left forearm to form a wrist to wrist grip before pulling them in next to the IRB.
• The IRB Driver should maintain a good line and extend their left arm out as a back stop for a possible IRB Crewperson contact miss. They can assist the IRB Crewperson by leaning out to lower the port (drivers) side buoyancy tube and moving back to the transom to allow legroom for the patient.
• The IRB Crewperson should maintain hold of the patients arm and move into a crouched position, staying high and using their knees on the buoyancy tube to generate lift.
• When safe to do so, the IRB Driver commences an anticlockwise turn around the patient.
• Using this turn as a pivot point, the IRB Crewperson holds the patients arm and swings them into the IRB to perform the pick up as the buoyancy tube lowers. If the turn is too tight there won’t be enough time for the patient to get in. Care should be taken not to release the patient until the IRB has stabilised.
• After the pick up, the patient is to assume a seated position either adjacent to the IRB Crewperson or IRB Driver and holding onto the passenger handle or lifeline.

*NOTE: If the patient moves towards the IRB Driver, the pick up becomes more difficult. It is important to keep the patient at the front of the IRB to maintain the IRB’s maneouverability and the sea anchor effect of the patient at the bow. The forward hold and lowered port (drivers) side buoyancy tube are critical in performing a clean, fast pick up.

!If the pick up is unsuccessful you will need to decide what the next course of action should be. Where it is safe to do so, maintain contact with the patient and re-attempt a pick up (if necessary after the next wave passes). If you are unable to safely maintain contact with the patient, give the person the rescue tube so that you can attempt a re-approach. As a last resort release the patient and, advise them that you’ll repeat the approach. Repeat the approach while maintaining visual contact with the patient. There are a number of factors that will affect this decision making process such as the condition of the patient (how fatigued or panicked are they), the size of the patient and the surf conditions. The safety of the crew should always be your number one priority.

Unconscious or Unassisted Rescue

Best suited for rescuing smaller unconscious patients or conscious patients who are unable to assist in getting themselves into the IRB.

• Approach the patient at a 2 o’clock angle.
• First contact is the IRB Crewperson using their left hand reach forward and grab the patients arm to pull them to the IRB, in front of the bow lifting handle.
• The IRB Crewperson should remain low with their chest over the buoyancy tube and hold the patient as close to the bow as possible.
• The IRB Driver should maintain a 2 o’clock angle and extend their left arm out as a back stop for a possible IRB Crewperson contact miss. By leaning out this also lowers the port (drivers) side buoyancy tube, extending the reach of the IRB Crewperson.
• To prepare for the pick up the IRB Crewperson may need to turn the patient and hold them with the patients back against the IRB, positioned between the bow and centre lifting handles. The IRB Crewperson should be positioned with both their arms under the patient’s armpits, at the elbow line of the IRB Crewperson.
• Once the IRB Crewperson has a good hold of the patient and the IRB Driver decides that it is safe to perform the patient pick up, the IRB Crewperson should move into a crouched position with both knees against the buoyancy tube (not on the floor).
• The IRB Driver accelerates slightly causing the patient’s legs to raise within reach of the IRB Driver, this will assist to counteract the drag to the port (drivers) side caused by the patient’s dead weight.
• The IRB Driver will then commence a wide anti-clockwise turn to pick up the patient as they turn back towards the beach.
• Using this turn as a pivot point, the IRB Crewperson lifts the patient into the IRB. The IRB Driver’s primary responsibility is to maintain the turn but they may assist by lifting the legs if necessary.
• The patient is placed in the middle of the IRB or in a seated position between the IRB crewpersons legs who is seated on the floor, with their back resting on the spray dodger.

*NOTE: The safety and limitations of the IRB Crewperson must be considered before performing this rescue. Some people will find this pick up difficult, especially if the patient is larger than the IRB Crewperson.

!If the pick up is unsuccessful and it is safe to do so, maintain contact with the patient against the buoyancy tube and revert to the bounce method. It is not recommended to lose contact with an unconscious patient unless the safety of the crew will be compromised. Alternatively, the IRB Crewperson may also be advised to enter the water with a tube and their PFD still on, to maintain contact with the patient. The IRB Driver will return to shore to pick up another IRB Crewperson, who can assist with the rescue.

Bounce Method

Best suited for rescuing larger or more difficult patients. It is also more suited for all rescues performed by a smaller IRB Crewperson. The Bounce method may be used if an alternative rescue method has been unsuccessful.

In the case of the IRB Crewperson requiring more assistance to retrieve a patient, the following steps will apply:

• Approach the patient at a 2 o’clock angle.
• The IRB Crewperson uses their left hand to reach forward and make contact with the patient’s forearm pulling them in next to the IRB. Ideally the patient needs to be manoeuvred to face the IRB.
• The IRB Driver places the motor in neutral
• The IRB Crewperson holds the left arm and the IRB Driver holds the right arm of the patient, then both the IRB Driver and IRB Crewperson grip the patient’s wrist and upper arm.
• On the IRB Driver’s command, they both bounce the patient down into the water up to their armpits, trying to avoid submerging their mouth under water. A large patient may need to be bounced up to three times to create momentum to get them into the IRB.
• The pick up is performed as the patient starts to rise out of the water, both IRB Driver and IRB Crewperson lift the patient to a lying position on their stomach across the buoyancy tube at the waist, with their face down into the IRB.
• Once the patient is on the buoyancy tube, the Driver returns to the motor.
• The IRB Crewperson pulls the patient into the IRB and positions them appropriately for their condition (see Patient Management for more information).

!As an alternative option if a patient is facing away from the IRB and the IRB Driver and Crewperson determines that there is insufficient time to turn the patient, the crew may use the bounce method with the patient facing away from the IRB. Noting this is not the preferred method due to an increased risk of injury to the patient, and the increased height that the patient is required to be lifted from the water to enable the patient buttocks to be positioned onto the buoyancy tube before moving them into the IRB.

Tube Rescue

Best suited for rescuing patients close to rocks or locations where it is difficult for an IRB to operate.

The IRB Driver may decide that due to nearby rocks or broken surf, it is unsafe to perform a patient pick-up and may direct the IRB Crewperson leave the IRB and use the rescue tube to swim to the patient.

• The IRB Driver will drop the IRB Crewperson as close as possible to any patient.
• The IRB Crewperson keeps their PFD on, entering the water feet first on the driver’s side, ensuring they signal all clear/ ok after safely exiting the IRB.
• The IRB Crewperson will then need to swim with a rescue tube to reach the patient.
• The IRB Crewperson secures the patient in the rescue tube and returns to the IRB which will be idling in a safe position nearby.
• The IRB Driver puts the motor in neutral and takes hold of the patient.
• The IRB Crewperson re-boards the IRB and both conduct an assisted lift into the IRB.
• The IRB Crewperson is to repeat the process for multiple patients.
  

Mass Rescue

A mass rescue situation is where there is more than one patient that requires rescuing.

On approaching the patients, keep an appropriate distance to enable the prioritising of patients who are needing assistance.

Prioritising Patients
When multiple patients require rescue, the IRB crew should prioritise rescuing the patients who are most likely to drown first, and consider strategies such as distributing floatation aids, using the IRB as a floatation device, and encouragement to swimmers who are less unwell. The general order of priority for rescue and being bought into the IRB is: 

1. Unconscious patients (drowned patients)
2. Conscious patients struggling to stay above water (imminent drowning)
3. All other patients
   

Depending on the number of patients and their condition the IRB crew will need to decide whether to use the mass rescue method, or the multiple patient rescue method (explained below).

Initially, attempt only to pick up patients in distress and provide alternative flotation device such as a rescue tube to others where possible. The IRB will need to return to shore, transfer the patient(s) and then return to the water as quickly as possible and repeat until all patients are rescued.

To turn the IRB around quickly, the following approach can be used:

• The IRB Driver returns to shore with the patient(s), ensuring they radio and/or signal to the patrol for assistance
• The IRB Driver places the motor in neutral or kills the motor
• The IRB Crewperson exits the IRB while holding the operator handle and pivots the IRB around to face back to sea
• The IRB Driver advises the patient to exit the IRB on the port (driver) side, handing them over to a waiting patrol member
• The IRB Crewperson holds the IRB in position facing into the incoming waves
• The IRB Driver re-starts the motor if required, then instructs the IRB Crewperson when to enter the IRB before heading back out to sea

!As an alternative option in some situations, it may be more appropriate to leave the IRB Crewperson and a rescue tube with the patients and return to the beach to collect another Crewperson. This is not the preferred method, however in all rescues the IRB crew will need to make a decision on the best method to manage patients. This should be based on the assessment and prioritisation of the patients. Each scenario will have pros and cons that need to be taken into consideration when making a decision on the most appropriate way to manage the rescue.

Multiple Patient Rescue

Where the number of people holding onto the IRB prevents it from being manoeuvred safely in or out of the surf, the best procedure to follow is to place the motor in neutral or kills the motor and radio or signal that assistance is required. Depending on the condition of the patients they may be brought into the IRB or instructed to hold onto the lifelines from outside the IRB. If necessary, at the instruction of the IRB Driver, the IRB Crewperson may be instructed to jump overboard feet first (keeping their PFD on) and act as a sea anchor to help stabilise the IRB to help stop the IRB from rolling over as waves pass, until further assistance arrives.

It is important to not overload an IRB as it will affect its buoyancy and make it harder to manoeuvre in surf conditions. This will impact the ability of the IRB to run away from a set of waves and puts all passengers on board at risk. Always consider the safety of everyone on board and operate within your limits.

It is important in any mass rescue situation to utilise all other available resources to assist with the rescue. This could be other personnel and craft on your patrol, or other nearby resources.

*NOTE: IRBs are not permitted to exceed the maximum weight limit for the vessel. This is an average of five (5) people per vessel, however always refer to the manufacturer’s guidelines or your local SOPs for clarification.

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