Assess the situation to determine the best course of action based on the condition of the patient, the sea conditions and resources available. The IRB Driver needs to communicate back to the beach via radio or hand signals. This may include giving the ‘Assistance Required’ and/or ‘Powercraft wishes to return to shore’ signal and if appropriate immediately facilitate the return of the IRB to the shore. The IRB Driver should avoid going over any waves if possible but return to shore as safely and quickly as possible.
In the case of a conscious and cooperative patient, the patient should be instructed to sit in the centre of the IRB just in front of the driver’s foot strap and to hold the lifeline rope or passenger operator handle.
In the case of an unconscious or uncooperative patient the following steps should be taken:
- Subject to conditions, the patient should ideally be positioned on the floor of the IRB with the IRB Crewperson’s back against the spray dodger maintaining contact/grip. If it is deemed unsafe for the IRB Crewperson to maintain control of the patient on the floor, the IRB Crewperson should return to a normal crewing position with the patient positioned laying on the floor. This will ensure that in unfavourable conditions the IRB can still be properly manoeuvred and prevent the IRB Crewperson sustaining back injuries.
- The IRB Driver should radio ahead that the patient requires treatment so that the patrol members can be ready with the required equipment such as an AED and oxygen
- The IRB Driver returns the IRB to shore and hands the patient over to the patrol/other team members
- If necessary, commence CPR as soon as the patient has been removed from the IRB. The IRB may be left unattended to attend to the patient
- If the IRB is not returning immediately to shore, the IRB Driver or IRB Crewperson will need to make a decision-based risk vs gain assessment on how to manage the patient and whether to administer treatment before returning to shore
Lifting patient out of the IRB
After the patient is assessed and if removal from the IRB is required, the following technique is recommended -
- Where assistance is available from other members of the patrol the IRB should be secured to hold it steady in the water:
- The patient is positioned on their back on the floorboard to allow for the lift to commence
- The IRB Driver grasps the patient’s hands and pulls them forward so that the IRB Crewperson can get to their feet in a squatting position with the patient held against their chest and maintaining their airway
- The IRB Driver releases the patient’s hands, and the IRB Crewperson then locks their arms in close to the body. The IRB Driver grasps the patient’s legs above the knees and prepares to lift safely.
- On the command of the IRB Crewperson, together the IRB Driver and IRB Crewperson safely lift the patient onto the buoyancy tube keeping their backs neutral and using their legs to lift
- With the patient resting on the buoyancy tube, two other members of the patrol will come beside the IRB. One slides both arms under both of the patient’s armpits, making sure to support the patient at your elbow line (not with your wrists), then secure the patient’s arms against the chest to maintain the airway.
- The other member of patrol grasps the patient’s legs under the knees and thighs, carrying both legs to one side (usually on your hip) and then both simultaneously lift the patient off the buoyancy tube.
- Care should be taken not to straddle the IRB while lifting the patient
- On the command of the two patrol team members both carry the patient clear of the IRB and up the beach to a safe location above the high tide mark.
- Lower the patient at the same time to a supported sitting position (if conscious) or on their back (if unconscious) for patient assessment. Keep your back straight and vertical while lowering the patient.
- Assess the patient’s condition and treat as required.
- Where no assistance from other patrol members is available:
- The patient is positioned on their back on the floorboard to allow for the lift to commence
- The IRB Driver grasps the patient’s hands and pulls them forward so that the IRB Crewperson can get to their feet in a squatting position with the patient held against their chest and maintaining their airway
- The IRB Driver releases the patient’s hands, and the IRB Crewperson then locks their arms in close to the body. The IRB Driver grasps the patient’s legs above the knees and prepares to lift safely.
- On the command of the IRB Crewperson, together the IRB Driver and IRB Crewperson safely lift the patient onto the buoyancy tube keeping their backs neutral and using their legs to lift
- With the patient resting on the buoyancy tube, the IRB Driver exits the IRB with both feet when directed by the IRB Crewperson (as the IRB Crewperson has the best visibility of the incoming waves) the IRB Driver then grasps the patient’s hands and pulls them forward so that the IRB Crewperson exit the IRB with both feet
- When both are safely outside and standing beside the IRB the IRB Crewperson slides both arms under both of the patient’s armpits making sure to support the patient at your elbow line (not with your wrists), then secure the patient’s arms against the chest to maintain the airway.
- The IRB Driver grasps the patient’s legs under the knees and thighs, carrying both legs to one side (usually on your hip) and then both simultaneously lift the patient off the buoyancy tube.
- The IRB Driver and IRB Crewperson should take care not to straddle the IRB while lifting the patient.
- On the command of the IRB Crewperson, the IRB Driver and IRB Crewperson both carry the patient clear of the IRB and up the beach to a safe location above the high tide mark.
- Lower the patient at the same time to a supported sitting position (if conscious) or on their back (if unconscious) for patient assessment. Keep your back straight and vertical while lowering the patient.
- Assess the patient’s condition and treat as required.
For further details on carries, consult the PSAR Two-person carries and drags in Module 5
Where possible, the patient should be handed to members of the patrol for ongoing care, ensuring the IRB Crewperson and IRB Driver are free to manage the IRB and return to rescue duties as required. The patrol should be waiting at the water’s edge to receive the patient when the IRB returns to shore.