Discussion of moving people taken ill on trains

Deafdoggie · 20 Jul 2018

Mod note: split from https://www.railforums.co.uk/threads/suicidal-male-on-stockport-viaduct-19-jul-18.167305/

xc170 said:
Mental illness/depression/whatever - he's still caused mass disruption for thousands of people and wasted the valuable time of the emergency services.

This could have been resolved in an hour if we hadn't become so soft.

Yeah, we are just too soft, making people better. If I had a heart attack on a train at, say, Longport station, and they didn't move the train, it is a two track section of the West Coast Mainline, I wouldn't want to cause delays to thousands of people, but i would still rather that than the train carried on with me left to die on board. If that means we have gone soft, so be it.

Illness is illness, mental or physical

RailUK Forums

Mojo · 20 Jul 2018

Deafdoggie said:
Yeah, we are just too soft, making people better. If I had a heart attack on a train at, say, Longport station, and they didn't move the train, it is a two track section of the West Coast Mainline, I wouldn't want to cause delays to thousands of people, but i would still rather that than the train carried on with me left to die on board.

Not quite the same thing, if someone is having a heart attack onboard a train then they should be removed onto the platform or a convenient location where they can be afforded 360degree access for efficient chest compressions to take place; this is what medical responders request and is expected. Of course at an unstaffed station removing such a person would still not mean the train moving and there are other considerations such as spinal injury or the fact that the person is too large to move with the resources available.

ComUtoR · 20 Jul 2018

Mojo said:
If someone is having a heart attack onboard a train then they should be removed onto the platform or a convenient location where they can be afforded 360degree access for efficient chest compressions to take place; this is what medical responders request and is expected.

Could you point me in the direction of said advice please. I have had someone have a 'heart attack' on my train and in no way was I advised to move the patient. I cannot find any advice that states they should be moved. I would very much like to see anything that would help me assist a passenger if it arose again.

Mojo · 20 Jul 2018

ComUtoR said:
Could you point me in the direction of said advice please. I have had someone have a 'heart attack' on my train and in no way was I advised to move the patient. I cannot find any advice that states they should be moved. I would very much like to see anything that would help me assist a passenger if it arose again.

Hopefully you can read the attached, it’s a screenshot as the file is a pdf and I can’t upload that from my iPhone. I can upload from a desktop Ifneedbe. I’ve also sent you a PM

Advised by whom? In my and my colleagues experience many “helpful bystanders” or so called medical professionals are not experienced in dealing with incidents out in the field but only usually work in the confines of a hospital etc.

ComUtoR · 20 Jul 2018

Mojo said:
Hopefully you can read the attached

My personal thanks. I am indebted to you.

Loop & Link · 20 Jul 2018

Mojo said:
Hopefully you can read the attached, it’s a screenshot as the file is a pdf and I can’t upload that from my iPhone. I can upload from a desktop Ifneedbe. I’ve also sent you a PM

Advised by whom? In my and my colleagues experience many “helpful bystanders” or so called medical professionals are not experienced in dealing with incidents out in the field but only usually work in the confines of a hospital etc.

ComUtoR said:
My personal thanks. I am indebted to you.

Hmmm, if you are advised by the ambulance service, when phoning 999, to not move an ill passenger, you don’t move them, simple as that.

Unfortunately, the stock response when phoning 999, seems to be not to move the person, therefore stopping the job.

jamesst · 20 Jul 2018

Loop & Link said:
Hmmm, if you are advised by the ambulance service, when phoning 999, to not move an ill passenger, you don’t move them, simple as that.

Unfortunately, the stock response when phoning 999, seems to be not to move the person, therefore stopping the job.

If someone falls ill on my train only paramedics/ ambulance staff remove that person regardless of what any passenger on board says, regardless of what control say.
Removing Ill passengers from the train without a medical assessment leaves me wide open to complaints/potential disciplinary action if something goes wrong and frankly isn't a route I have any intention of going down.

158756 · 20 Jul 2018

Mojo said:
Hopefully you can read the attached, it’s a screenshot as the file is a pdf and I can’t upload that from my iPhone. I can upload from a desktop Ifneedbe. I’ve also sent you a PM

Advised by whom? In my and my colleagues experience many “helpful bystanders” or so called medical professionals are not experienced in dealing with incidents out in the field but only usually work in the confines of a hospital etc.

That may be the policy of the London Ambulance Service, who's staff are trained for such things, but it is not usually advised that the untrained public attempt to move a patient unless in a dangerous position. Railway staff would have to consider what their training and TOC policies enables and permits them to do to avoid any unintended consequences.

Bromley boy · 21 Jul 2018

ComUtoR said:
Could you point me in the direction of said advice please. I have had someone have a 'heart attack' on my train and in no way was I advised to move the patient. I cannot find any advice that states they should be moved. I would very much like to see anything that would help me assist a passenger if it arose again.

Mojo said:
Advised by whom? In my and my colleagues experience many “helpful bystanders” or so called medical professionals are not experienced in dealing with incidents out in the field but only usually work in the confines of a hospital etc.

Thing is you don’t know what’s wrong with them (unless there happens to be someone medically trained on board). Is it worth getting involved with decisions like this, in case you unwittingly make the situation worse?

jamesst said:
If someone falls ill on my train only paramedics/ ambulance staff remove that person regardless of what any passenger on board says, regardless of what control say.
Removing Ill passengers from the train without a medical assessment leaves me wide open to complaints/potential disciplinary action if something goes wrong and frankly isn't a route I have any intention of going down.

Quite. I’m exactly the same.

158756 said:
Railway staff would have to consider what their training and TOC policies enables and permits them to do to avoid any unintended consequences.

Nothing in my case (and I suspect all cases), other than to contact the signaller to arrange for an ambulance and hope the alarm is pulled at a sensible place!

Mojo · 21 Jul 2018

Bromley boy said:
Thing is you don’t know what’s wrong with them (unless there happens to be someone medically trained on board). Is it worth getting involved with decisions like this, in case you unwittingly make the situation worse?

Advice from my company is that you are expected to remove the person from the train, unless they are suffering from a spinal injury, or are in the active stages of a seizure. These are the only medical reasons not to move someone from a train; the former being extremely unlikely and the latter only typically being a few minutes.

I appreciate however that not all railway operators are willing to be as sensible, so you should abide by your company’s advice in this matter. There was a leaked Thameslink briefing a few weeks ago which also reiterated the advice to move an ill person, so it is not just mine.

IanXC · 22 Jul 2018

Mojo said:
I appreciate however that not all railway operators are willing to be as sensible, so you should abide by your company’s advice in this matter. There was a leaked Thameslink briefing a few weeks ago which also reiterated the advice to move an ill person, so it is not just mine.

I don't think its a matter of being sensible or otherwise.

The circumstances of these kind of incidents are rather different outside of London and as such it seems to me that the risks stack up in different ways. For instance, I really struggle to imagine a situation outside of the South East where, within 90 minutes you could have 30 trains stood with 20,000 passengers onboard! Whereas clearly in London that can and would happen. The risk of secondary incidents, I would therefore suggest is very significantly less than in the London case, and as such the balance of risks is different, and hence the optimum choice is different.

Where things really could be improved are cases where passengers are taken ill in more remote or rural locations, where the attending Ambulance is having to travel some distance to meet the train - in most cases patient and Ambulance would meet quicker if the train proceeded to the next major station. Thus resulting in the patient receiving medical attention sooner, *and* the level of disruption being reduced.

PHILIPE · 22 Jul 2018

There was a case in the evening peak just before Platform 8 came into use at Cardiff Central when a person was taken ill on a northbound Cardiff Valley train on Platform 6 and the Ambulance service had said that the person was not to be moved until a paramedic had arrived and assessed the person. However, that didn't stop passengers on the train shouting for the person to be laid across a seat on the platform so that the train could go on it's way and they could get home. I mention Platform 8 because it has provided more flexibility to work round delayed trains.

AM9 · 22 Jul 2018

PHILIPE said:
There was a case in the evening peak just before Platform 8 came into use at Cardiff Central when a person was taken ill on a northbound Cardiff Valley train on Platform 6 and the Ambulance service had said that the person was not to be moved until a paramedic had arrived and assessed the person. However, that didn't stop passengers on the train shouting for the person to be laid across a seat on the platform so that the train could go on it's way and they could get home. I mention Platform 8 because it has provided more flexibility to work round delayed trains.

The rants of people inconvenienced by a medical emergrncy are irrelevant at the time of the event. If they are interfering with those dealing with the patient they should be restrained/removed from the vicinity of the scene. If persist, they should be subject to public order or assault charges as appropriate.

furnessvale · 22 Jul 2018

Deafdoggie said:
Mod note: split from https://www.railforums.co.uk/threads/suicidal-male-on-stockport-viaduct-19-jul-18.167305/

Yeah, we are just too soft, making people better. If I had a heart attack on a train at, say, Longport station, and they didn't move the train, it is a two track section of the West Coast Mainline, I wouldn't want to cause delays to thousands of people, but i would still rather that than the train carried on with me left to die on board. If that means we have gone soft, so be it.

Illness is illness, mental or physical

IMO much better that the train continues to the next major station say Stoke where the emergency services will be ready and waiting having been already warned. Why stop in the middle of nowhere, although I appreciate that the stated example of Longport is not really "the middle of nowhere".

LowLevel · 22 Jul 2018

Far too often train crew panic and just stop the train at the next stop rather than the sensible one for access to medical help.

Where I work there's no expectation that guards will start dragging unconscious people off on to platforms unless the ambulance crew request help as many stations are unmanned anyway.

What is being pushed is advice from the ambulance service themselves to take the train to a predetermined list of stations they can get to more easily (sometimes you'll park up for up to an hour before they find you otherwise) with the crew being supported by control if they judge that the situation for example warrants running the train express to get to the appropriate location faster for help to arrive.

Doctors and nurses travelling on board can be very helpful depending on the emergency but it's important for the crew not to feel pressurised into parking trains up at random because they will often say that they need help at the next stop.

The best way I find to explain to people is that if I'm on a train and someone is seriously ill, if I was to park up at say Whittlesea an ambulance has got to get out there, the line has to be blocked in the mean time and it could cause other problems.

Continuing to Peterborough takes less than 10 minutes and will greatly reduce the amount of time it takes for an ambulance to arrive and increase immeasurably to facilities available.

theageofthetra · 22 Jul 2018

I personally think that traincrew should be given advice on which stations on their signed routes are best located for a medical evacuation- near an A & E dept, step free access etc.

LowLevel · 22 Jul 2018

theageofthetra said:
I personally think that traincrew should be given advice on which stations on their signed routes are best located for a medical evacuation- near an A & E dept, step free access etc.

They are. Whether they panic about being sued or allow themselves to be pressurised out of following them is another matter.

AM9 · 22 Jul 2018

LowLevel said:
... but it's important for the crew not to feel pressurised into parking trains up at random because they will often say that they need help at the next stop. ...

It's even morre important that the crew aren't pressured by impatient passengers or selfish management to minimise their inconvenience unless the emergency services have expressly said that the train should proceed to a more convenient place. It might not be operationally convenient,if others are delayed, but the health (indeed survival chances) of somebody taken ill must not be compromised merely because it might make other people late. On the roads, the police have no hesitation about stopping traffic in the interests of patients, (even if they were the cause of their own injuries) so why shouldn't rail passengers be expected to make the same compromises?

al78 · 22 Jul 2018

If someone is undergoing cardiac arrest you need to apply first aid immediately. The speed of response can mean the difference between life and death. Never mind if it causes a delay to some people, this is a human life hanging in the balance.

http://www.sja.org.uk/sja/first-aid-advice/heart/cardiac-arrest.aspx

It is ironic that there is worry of delaying people on other trains by stopping the train. Not many people seemed to be worried about leaving people on trains for up to 18 hours in freezing conditions in the snow back in the winter. :rolleyes:

Loop & Link · 22 Jul 2018

Procedure I have dealt with and deal with is the following:

Traincrew report ill passenger on the train, ascertain the condition of the casualty, ask station staff to assist (if available) and see if they can be moved off the train into the care of the station staff. Train gets on the move. Easy.

However, as I’ve mentioned when you phone 999, the advice no matter what usually, is not to move the casualty from the train, this mean you know the job is stopped now until an ambulance arrives.

Problem is this seems to be the advice no matter what, so it could be something that isn’t serious, but as soon as you are told “Don’t move the casualty” you don’t simple as that, no going forward to another station or moving them to the platform. And I know, I would never, or expect traincrew to deviate from this advice.

LowLevel · 22 Jul 2018

AM9 said:
It's even morre important that the crew aren't pressured by impatient passengers or selfish management to minimise their inconvenience unless the emergency services have expressly said that the train should proceed to a more convenient place. It might not be operationally convenient,if others are delayed, but the health (indeed survival chances) of somebody taken ill must not be compromised merely because it might make other people late. On the roads, the police have no hesitation about stopping traffic in the interests of patients, (even if they were the cause of their own injuries) so why shouldn't rail passengers be expected to make the same compromises?

This is the advice provided by the ambulance service. Parking your train up against their advice increases risk to the patient as often the train will proceed to the ambulance rendezvous far more quickly than an ambulance will make it's to a more remote location.

If I'm due to call at Chinley is it better to try and drag an ambulance out there (remote location, step access only etc) or is it better to go to Hazel Grove, Stockport or Marple.

The knee-jerk reaction of train crew is that it's just the management seeking to avoid delay.

As a train guard who has been involved in working groups on this issue I can tell you that the advice is produced by the ambulance service in conjunction with the train operator. This is in my opinion not publicised enough to the crews who follow it.

Thus it is always the emergency services who have said the train should proceed wherever humanly possible.

What *should* happen is that the member of staff requesting the ambulance, whether it be a driver, guard, signaller, control or whoever should tell the call handler which station the train is proceeding to for help (if that means running express so be it) and not muddy the water by telling them where the train is now as the handler will simply react to that otherwise.

We've had incidents where patients have been put at risk by the crew stopping at remote stations which have taken significant amounts of time to reach by road. Particularly when the station is unsuitable for factors not necessarily immediately obvious to the train crew.

For example take Hykeham station. The platforms are adjacent to an AHB-X crossing. If you stand at it for more than a few minutes the crossing thinks you're making a wrong direction movement and closes to road traffic and won't reopen again until the train has passed or someone from Network Rail comes out to reset it. Thus advice is to proceed directly to Newark or Lincoln. There was an incident where a patient was put at risk due to the advice not being heeded and the crossing coming down, gridlocking the area and preventing the ambulance getting through.

nottsnurse · 22 Jul 2018

Mojo said:
Advice from my company is that you are expected to remove the person from the train, unless they are suffering from a spinal injury, or are in the active stages of a seizure.

I feel that you should dig a bit deeper into this and ask for clarification.

The priority is the welfare of the individual, not getting the train moving. Even in the advice you posted earlier it states that moving the patient should only be done "if practicable" and that the first priority is (effective) continuous CPR.

Having performed CPR 'in the wild' on numerous occassions considerations about moving the patient are very much down the line. Without access to a Lucus Device (these are not always available) maintaining effective chest compressions whilst moving a patient is nigh on impossible. 'Going through the motions' and providing ineffective compressions just to move a patient off of a train would be a very unprofessional action to take and I doubt any trained responder would consider such action.

There is also the not insignificant matter of being able to perform a top to toe assessment to be able to rule out C-spine injury before moving them. The first priority is obviously to perform effective CPR, only after ROSC has been achieved or the equipment is in place to transfer a patient onto a scoop with Lucus should moving them even be considered, and then only after taking precautions regarding spine movement. Even just falling within a patients' own height could cause spinal injury, especially if they were to strike something in the tight confines of a train which caused abnormal flexion. Just dragging a person out onto a platform could cause permanent damage that could have been prevented if a more measured approach were to have been taken.

Service punctuality always comes second to responding to an unwell patient in a measured and thought through manner.

AnonymousUser1 · 22 Jul 2018

LowLevel said:
Far too often train crew panic and just stop the train at the next stop rather than the sensible one for access to medical help.

Where I work there's no expectation that guards will start dragging unconscious people off on to platforms unless the ambulance crew request help as many stations are unmanned anyway.

What is being pushed is advice from the ambulance service themselves to take the train to a predetermined list of stations they can get to more easily (sometimes you'll park up for up to an hour before they find you otherwise) with the crew being supported by control if they judge that the situation for example warrants running the train express to get to the appropriate location faster for help to arrive.

Doctors and nurses travelling on board can be very helpful depending on the emergency but it's important for the crew not to feel pressurised into parking trains up at random because they will often say that they need help at the next stop.

The best way I find to explain to people is that if I'm on a train and someone is seriously ill, if I was to park up at say Whittlesea an ambulance has got to get out there, the line has to be blocked in the mean time and it could cause other problems.

Continuing to Peterborough takes less than 10 minutes and will greatly reduce the amount of time it takes for an ambulance to arrive and increase immeasurably to facilities available.

I agree with all the above ... also by continuing to a slightly larger station , you can have the crew ready to to meet the train as it pulls in rather than the train sat at a station ...

there is also logistics to consider ...

I used to live in West Yorkshire and i have in the past been ambulance crew for a large voluntary Organisation as well as having a substantive HCP role in NHS hospitals ... for those who know stations in West Yorks - i'd rather the train continue to Castleford than stop at Normanton ... as at castleford you can pull an ambulance to within a few yards of the platform and ther;es no bridges etc to deal with , where Normaton would mean driving down into the car park, blocking it up completely and then shifting trolley stretcher and kit up over and back down the bridge...

slightly different if someone was taken ill on a train between Lincoln and Newark ( Castle or NNG it doesn't matter) as stopping at Hykeham, Swinderby or Collingham is not a great deal different accessibility wise that stopping at Castle - which is also unstaffed from a platform staff point of view and if you were going to NNG one of the intermediate stations might be better than platform 3 at NNG as you wouldn't need to cross the bridge ...

LowLevel · 22 Jul 2018

mph1977 said:
slightly different if someone was taken ill on a train between Lincoln and Newark ( Castle or NNG it doesn't matter) as stopping at Hykeham, Swinderby or Collingham is not a great deal different accessibility wise that stopping at Castle - which is also unstaffed from a platform staff point of view and if you were going to NNG one of the intermediate stations might be better than platform 3 at NNG as you wouldn't need to cross the bridge ...

All 3 intermediate stations are on the no-no list on the Newark Lincoln line for different reasons - whether technical (Hykeham) or comparative remoteness (Swinderby and Collingham). Standing instructions are to proceed to Newark or Lincoln. We had a train stopped for over an hour at Collingham waiting for an ambulance - the ambulance service in the post incident review pointed out that had the train continued to Lincoln it would have been there in less than 20 minutes during which time the ambulance could also have been heading for the station and then on to Lincoln hospital.

It isn't always down to the physical layout of the stations involved but also the local road network and proximity to ambulance stations or hospitals.

The other thing to consider is the likelihood of serious harm or death - I believe most ambulances are called due to incidences of fitting which are disturbing for the crew having to deal with them but often nothing unusual to the patient themselves - our one recent death on board was a chap who had a heart attack having run for his train and was pretty much gone before anyone could do anything (the train hadn't even left it's origin, emergency services were present immediately as it was a major terminal etc).

AnonymousUser1 · 22 Jul 2018

presumably the difficultues at hykeham relate to be unable ot clear the crossing ?

location of ambulance stations is irrelevant when it comes to DMAs as other than handover times and the longer break in a shift in some services it is rare in man services for ambulances to make it back to station ... ( not carrying food in the cab is a red herring )

LowLevel · 22 Jul 2018

mph1977 said:
presumably the difficultues at hykeham relate to be unable ot clear the crossing ?

location of ambulance stations is irrelevant when it comes to DMAs as other than handover times and the longer break in a shift in some services it is rare in man services for ambulances to make it back to station ... ( not carrying food in the cab is a red herring )

Pretty much. It's a suburban station like any other but it has an inconveniently positioned automatic level crossing on a busy road which will close if a train stands at the station for too long. Stopping there out of course is consequently highly undesirable.

AnonymousUser1 · 22 Jul 2018

jamesst said:
If someone falls ill on my train only paramedics/ ambulance staff remove that person regardless of what any passenger on board says, regardless of what control say.
Removing Ill passengers from the train without a medical assessment leaves me wide open to complaints/potential disciplinary action if something goes wrong and frankly isn't a route I have any intention of going down.

Care to cite the legislation that states that ?

love to see the basis other than Union scaremongering for any complaint or civil action where a member of railways staff permits or assists an individual who is feeling unwell from leaving the train to take a seat on the platform ...

especially was 'ambulate before carrying' is standard part of all health sector moving and handling of people training

Hadders · 22 Jul 2018

I’ve been on trains when almost identical medical situations have occurred, both handled differently.

The first one was a Stevenage-Kings Cross non-stop train operated by GTR. Passcom is activated around Potters Bar, driver comes on the tannoy and says the train will stop at Hadley Wood and wait for an ambulance to attend to the passenger. Delay of around 30 mins, most of which was waiting for the ambulance to arrive from what I could see.

The second one was also on a non-stop GTR service from Stevenage to Kings Cross. Passcom activated between Hatfield and Potters Bar. Driver comes on the tannoy and says he’s aware that a passenger has been taken I’ll, has radioed ahead requesting the attendance of paramedics at Kings Cross and will continue as this will be the quickest way of getting help to the passenger. Zero delay, paramedics waiting on the platform as the train arrived at Kings Cross.

I think the second incident was far better for everyone concerned rather than the first.

Mojo · 22 Jul 2018

nottsnurse said:
I feel that you should dig a bit deeper into this and ask for clarification.

What further clarification do you suggest? I feel the training, advice and documentation on the matter is pretty clear.

Mag_seven · 22 Jul 2018

Hadders said:
I’ve been on trains when almost identical medical situations have occurred, both handled differently.

The first one was a Stevenage-Kings Cross non-stop train operated by GTR. Passcom is activated around Potters Bar, driver comes on the tannoy and says the train will stop at Hadley Wood and wait for an ambulance to attend to the passenger. Delay of around 30 mins, most of which was waiting for the ambulance to arrive from what I could see.

The second one was also on a non-stop GTR service from Stevenage to Kings Cross. Passcom activated between Hatfield and Potters Bar. Driver comes on the tannoy and says he’s aware that a passenger has been taken I’ll, has radioed ahead requesting the attendance of paramedics at Kings Cross and will continue as this will be the quickest way of getting help to the passenger. Zero delay, paramedics waiting on the platform as the train arrived at Kings Cross.

I think the second incident was far better for everyone concerned rather than the first.

i.e. realising that in most cases a train can get to an ambulance quicker than an ambulance can get to a train if the train is allowed to proceed to a more "accessible" location.

Discussion of moving people taken ill on trains

Established Member

RailUK Forums

Forum Staff

Established Member

Forum Staff

Attachments

Established Member

Member

Member

Established Member

Established Member

Forum Staff

Emeritus Moderator

Veteran Member

Veteran Member

Established Member

Established Member

On Moderation

Established Member

Veteran Member

Established Member

Member

Established Member

Member

Member

Established Member

Member

Established Member

Member

Veteran Member

Forum Staff

Forum Staff