Passenger Taking Ill. Procedures?

[bAzTNM]

Hi there. I'm noticing this a lot in the disruption area of the Scotrail site a lot recently (Normally very early trains). What are the procedures? Say, somebody collapses with a heart attack, does the train stop where it is and an ambulance comes in? Thanks a lot!

 

[wintonian]

Hi there. I'm noticing this a lot in the in the disruption area of the Scotrail site a lot recently (Normally very early trains). What are the procedures? Say, somebody collapses with a heart attack, does the train stop where it is and an ambulance comes in? Thanks a lot!

Should think it would stop at the next station a bit dangerous especially down here with 3rd rail otherwise.

 

[Kingston Flyer]

I'm sure I remember this happening on a train I was on a few years ago.

From what I remember the train manager arranged for an ambulance to meet the train at the next station, and did his best to look after the ill passenger until then.

 

[Matt Taylor]

We stop at the next suitable station, in other words it is unlikely we would stop somewhere that has not decent road access or no step free access.

 

[Michael.Y]

I'm sure I remember this happening on a train I was on a few years ago.

From what I remember the train manager arranged for an ambulance to meet the train at the next station, and did his best to look after the ill passenger until then.

This is pretty much what occurred on an ATW I was working recently as well.

 

[driver9000]

For this kind of eventuality Northern has recently fixed labels with the stations post code onto the running in board (both ends on single lines) to help giving emergency services the location of the station where help is required. Emergency services require the post code as they use satnav equipment so I'm told.

 

[Minilad]

Only had this once. Was on the way to Bournemouth. Guard contacted me and explained what was happening. I made an NRN call and arranged for medical assistance at the next station.

 

[syorksdeano]

They continue to the next station while the guard either tries to reassure the casualty or perform First Aid.

I knew someone that died a few years ago on the Skipton to Leeds train of heart attack

 

[Schnellzug]

If it's mainly "very early trains", would it be stereotyping to speculate that what it means is "passenger on way home after night out taken hung over"?

 

[michael769]

I have over the years seen a couple of folks pass out probably as an emotional overreaction to a combination of excessive heat and crowding - I'm guessing that such incidents are more common than heart attacks, and need to be checked out by an ambulance crew just in case.

 

[Anvil1984]

Yep usually first thing though is quick announcement.... If there is a medically trained person on board....... You'd be surprised how many times there is one there to help

 

[ralphchadkirk]

Yep usually first thing though is quick announcement.... If there is a medically trained person on board....... You'd be surprised how many times there is one there to help

In most cases there's very little even someone medically trained can do without any equipment.

 

[ANorthernGuard]

For this kind of eventuality Northern has recently fixed labels with the stations post code onto the running in board (both ends on single lines) to help giving emergency services the location of the station where help is required. Emergency services require the post code as they use satnav equipment so I'm told.

Such a simple idea that they have implemented, a big thumbs up to my employer for that, so simple but so effective

 

[PTF62]

it is unlikely we would stop somewhere that has not decent road access or no step free access.

Well that is exactly what happend on a train I was on earlier this year.

The FCC train I was on had just gone through Sandy, when the train came to a very fast stop. At that location, there is nothing but fields, and too add to the problem, we were on the fast line.

The driver announced that a passenger had been taken ill, and asked if there were any medical people on the train who could help to go to carriage x.

After about 20 minutes or so (with a couple more requests for any medical people), we set off again, and the driver announced that the train would still call at St Neots, before carrying on to Huntingdon where an ambulance would be waiting (presumably because St Neots only has access to the platforms via stairs, and at Huntingdon the hospital is only a stones throw from the station).

It did seem a bit odd to stop somewhere where it would have been very hard to get access to the train, and although the decision that was eventually taken was the sensible one, it did seem to take a long time to get there. I would have assumed that the train companies would have had a standard set of procedures - passenger taken ill between x & y, do z, between a & b, do c, etc.

 

[Anvil1984]

In most cases there's very little even someone medically trained can do without any equipment.

True but they are a lot better trained to deal with the scenario and are more likely to know where the nearest hospital is than myself or the person at control, Ive had 2 instances and had staff nurses on the train and they were both excellent.

 

[DaveNewcastle]

True but they are a lot better trained to deal with the scenario and . . . .

all very true, I'm sure.

But, sadly, much of the practice and policy in such incidents will be governed by a Company's risk-aversion.
If their insurance doesn't include medical intervention, advice, movement etc. then the instructions to staff will be to do nothing which could lead to a counter-claim (if things go badly for the striken passenger). A claim which is likely to suceed even if staff had been pro-active and helpful. From the records, there are many times more of such claims from people injured but whom survived, than from those injured and and died and whose Executors are acting for those whose life was lost.

The maddening outcome of all this is that all employers are likrly to have a Policy in place which instructs all staff NOT to intervene and NOT to offer assistance (even if the individual has appropriate training). This unfortunate outcome if not confined to the Rail industry.

 

[ralphchadkirk]

Off duty medical staff will, in most cases, step in if asked to do so - if NHS ambulance staff then they are covered automatically (and sometimes get paid!). Refusal to help could see you in front of the HPC/NMC/GMC.

My comment about there not being much to do is true. You can't really do anything unless they are either bleeding or in cardiac arrest. Yes you're better trained - but there's no use being a world-class cardio-thoraic surgeon if you haven't got any equipment. You might as well be Joe Bloggs from St. John Ambulance.

 

[Mike C]

Well that is exactly what happend on a train I was on earlier this year.

The FCC train I was on had just gone through Sandy, when the train came to a very fast stop. At that location, there is nothing but fields, and too add to the problem, we were on the fast line.

The driver announced that a passenger had been taken ill, and asked if there were any medical people on the train who could help to go to carriage x.

After about 20 minutes or so (with a couple more requests for any medical people), we set off again, and the driver announced that the train would still call at St Neots, before carrying on to Huntingdon where an ambulance would be waiting (presumably because St Neots only has access to the platforms via stairs, and at Huntingdon the hospital is only a stones throw from the station).

It did seem a bit odd to stop somewhere where it would have been very hard to get access to the train, and although the decision that was eventually taken was the sensible one, it did seem to take a long time to get there. I would have assumed that the train companies would have had a standard set of procedures - passenger taken ill between x & y, do z, between a & b, do c, etc.

Yes, this would be as much to do with the proximity of Hinchingbrooke hospital to Huntingdon station as anything - also, bear in mind the main hospital in the area IS Hinchingbrooke, so if the person was picked up by ambulance at St Neots, they would simply have been transferred to Hinchingbrooke anyway.

I was on a train that made an unscheduled (and lengthy) stop at Stevenage not so long ago. The only call was "if there are any doctors or medical professionals on board, can you make yourself known to a member of staff please".

 

[ralphchadkirk]

bear in mind the main hospital in the area IS Hinchingbrooke, so if the person was picked up by ambulance at St Neots, they would simply have been transferred to Hinchingbrooke anyway.

Not necessarily.

 

[transportphoto]

Off duty medical staff will, in most cases, step in if asked to do so - in most cases (certainly if they are NHS) then they are automatically covered. If not, they generally do so anyway. I am not aware of any claim being made against an off-duty healthcare professional for stepping in when asked.

My comment about there not being much to do is true. You can't really do anything unless they are either bleeding or in cardiac arrest. Yes you're better trained - but there's no use being a world-class cardio-thoraic surgeon if you haven't got any equipment. You might as well be Joe Bloggs from St. John Ambulance.

All St John Ambulance personnel are also covered, I would step in should the situation arise however I would stand back (to more of an assistance role) should there be a higher qualified HCP be onboard

To be entitled to the insurance we have to fill in a Patient Report Form, detailing the problem and personal details etc... this is stored securely in our county head quarters (in-accordance with the Data Protection act) and we, as a the person who signed the form, have access to it as we need it.

 

[Mike C]

Not necessarily.

I have it on good authority (My wife who works locally for the NHS!) that this would be the case.

 

[ralphchadkirk]

I have it on good authority (My wife who works locally for the NHS!) that this would be the case.

Ambo staff will take a clinical decision about what hospital to go to. It's not always the nearest one. For example, people needed PPCI or coronary care would probably be taken to Papworth.


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[Mike C]

Ambo staff will take a clinical decision about what hospital to go to. It's not always the nearest one. For example, people needed PPCI or coronary care would probably be taken to Papworth.

OK - I'll put her online and you can argue with her!

 

[ralphchadkirk]

OK - I'll put her online and you can argue with her!

Not arguing at all. In most cases the local hospital is the best hospital. In other cases it isn't.

I was being a bit simplistic when saying coronary care = Papworth - the decision is being based on a large number of factors. Sometimes you want someone in hospital and quickly, other times you want to get someone direct to the specialist care they need.


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[tsr]

Such a simple idea that they have implemented, a big thumbs up to my employer for that, so simple but so effective

It's also worth noting that if you have to call emergency services that the number 112 is far better than 999. It will permit automatic triangulation (location) of the phone being used. This choice of number has, to the best of my knowledge, directly led to successful rescue attempts.

 

[O L Leigh]

Coming up in a heap in the middle of nowhere is usually what happens when someone pulls a PASSCOM on an older train. It just slams the brakes on, which is why many older trains now have notices saying that, for medical emergencies, it's best to wait until the train is in a station before pulling a PASSCOM.

If that does happen there is no immediate emergency response. The E brake application will be investigated, but even if it is a pulled PASSCOM this won't be immediately obvious to the traincrew. The box will need to be notified and then the traincrew can go back into the train to find out what has occurred. All this takes time, especially as the train can't be moved until the PASSCOM has been reset. You can easily waste 10 minutes this way, though it often works out to be much much more.

Calling for trained medical staff doesn't always mean that the patient will get treatment any sooner, but they are at least better trained than traincrew in being able to assess whether or not it is an emergency situation (i.e. immediately or imminently life-threatening) and in gathering the important information that needs to be relayed to the emergency services.

O L Leigh

 

[PTF62]

Yes, this would be as much to do with the proximity of Hinchingbrooke hospital to Huntingdon station as anything - also, bear in mind the main hospital in the area IS Hinchingbrooke, so if the person was picked up by ambulance at St Neots, they would simply have been transferred to Hinchingbrooke anyway.

Yes, as I mentioned, I thought that was the most sensible decision. I was just a bit puzzled why it took 20 minutes to work out that it was.

As I mentioned before, I would have thought that the rail companies would have already considered this, and have designated procedures (i.e. If passenger taken ill before Welwyn Garden City, stop at Welwyn Garden City, after WGC stop at Stevenage, etc), rather than try and work out what to do when you have an ill passenger to deal with.

 

[stut]

Also bear in mind that there are motorcycle paramedics in these areas. There's quite a gap between the Lister, Bedford South Wing, Addenbrookes and Hinchingbrooke, so quite often you'll get a lone paramedic turning up to treat what they can (usually within a couple of minutes) before getting full assistance - and his could have happened at St Neots if it had been worthwhile.

From experience, there are preferred hospitals, but it all comes down to conditions at the time - load in A&E, traffic problems, etc. St Neots is in reasonable reach of 3-4 large hospitals.