Discussion of moving people taken ill on trains

edwin_m · 22 Jul 2018

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

What you describe in this and your other posts seem like excellent advice. Not least because if staff are given a clear list of where to stop and not to stop, then the "getting sued" factor kicks in and they are more likely to follow it than to give in to pressure from others. Concerned passengers ought to be able to understand that the train is proceeding (express if necessary) to a station where assistance can be given more quickly.

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nottsnurse · 22 Jul 2018

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

So you're confident in your ability to perform a c-spine clearance in order to rule out such an injury?

Out of interest how does your employer suggest removing someone from your train?

theironroad · 22 Jul 2018

Mojo said:
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.

The advice you attached from LAS is guidance to their crews, not train crews. It's one thing to move a patient in cardiac arrest when a medical clinician seems it ok , I'd suggest that's not the decision of a driver, guard, control manager or 99.9% of railway employees who are not medically qualified to make that call.

Ianigsy · 22 Jul 2018

Interesting responses. A couple of years ago I was on a bus between two locations in West Yorkshire when a disembarking passenger informed the driver that somebody on the upper deck had passed out - having seen the individual boarding, almost certainly due to consumption of alcohol and/or illicit substances. The bus company's response was to summon an ambulance and order the driver to wait where he was - in open country about 8 miles from Leeds and about another 2 from its terminus in the next town, which happens to have a hospital.

The next bus on the route came 20 minutes later so the remaining passengers went forward on that, the ambulance not having fought its way through Leeds peak traffic in the time available. I did wonder at the time, particularly given that the poorly passenger was accompanied by several friends, whether it wouldn't have been better for all concerned for the bus to proceed non stop to its terminus and meet the ambulance there, rather than attempting the transfer in the dark on a busy single lane A-road.

Bromley boy · 22 Jul 2018

mph1977 said:
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

This is nonsense I’m afraid.

Once you start moving someone or interfering with them in any way you will take on a duty of care to that individual.

Following TOC advice and moving a patient against the advice of a 999 operator could open up quite a can of worms.

Caparo Industries plc v Dickman is a leading case on duty of care in English tort law.

Bromley boy · 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. 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 imagine you are a TM/customer facing? Certainly as a driver I’m not aware of any such advice (even though I will usually be the sole member of staff on board, so could find myself in this situation).

I would be very wary indeed of following TOC advice without recourse to 999 (or a medically qualified passenger).

nottsnurse said:
So you're confident in your ability to perform a c-spine clearance in order to rule out such an injury?

Out of interest how does your employer suggest removing someone from your train?

Personally, as someone not medically qualified, I would be calling 999 and following the advice of the operator before moving anyone.

Mojo · 22 Jul 2018

nottsnurse said:
So you're confident in your ability to perform a c-spine clearance in order to rule out such an injury?

I'm confident in my ability to assess; knowing that the person walked on the train themselves and also knowing that such a possibility is extremely unlikely. In 99%+ of cases you can ask them, because they are alert.

nottsnurse said:
Out of interest how does your employer suggest removing someone from your train?

Either by asking them to walk off; getting someone else to help you walk them off, or by using a carry sheet.

theironroad said:
The advice you attached from LAS is guidance to their crews, not train crews. It's one thing to move a patient in cardiac arrest when a medical clinician seems it ok , I'd suggest that's not the decision of a driver, guard, control manager or 99.9% of railway employees who are not medically qualified to make that call.

Okay then, here is advice that has been published under Freedom of Information Act which advises staff of LU to remove the person in almost all instances. As I said above, you should of course comply with your company's instructions; however there is no medical reason not to remove someone in the overwhelming majority of situations; assuming the place you are moving them to is suitable which again is likely to be an issue on a number of Mainline stations.

Bromley boy said:
Caparo Industries plc v Dickman is a leading case on duty of care in English tort law.

Since then, the Social Action, Responsibility and Heroism Act 2015 has come into force which affects liability in a manner similar to "Good Samaritan" legislation in parts of the USA.

eMeS · 22 Jul 2018

Ianigsy said:
Interesting responses. A couple of years ago I was on a bus between two locations in West Yorkshire when a disembarking passenger informed the driver that somebody on the upper deck had passed out - having seen the individual boarding, almost certainly due to consumption of alcohol and/or illicit substances. The bus company's response ...

Epilepsy and related illnesses can also be dealt with in an uncaring fashion, but complying with "the Rules" of the establishment.
My brother suffered severe epilepsy throughout his life, and his attacks whilst inconvenient, were not generally life threatening. We, the immediate family, knew what to do. But when one occurred during a family visit to a garden centre, the staff followed procedure, and called an ambulance - we were not consulted. We eventually caught up with him waiting in A&E, and after a long wait he was seen by a junior doctor. This was the first time that the doctor had seen such a case, and he didn't know what to do, but at least I got his agreement to discharge my now shivering brother, so that we could take him home and put dry clothes on him - he'd "fallen in the water" at the garden centre. A few hours later, my brother now in dry clothes, and warm again, was as good as normal - i.e. not very good at all, but that's serious epilepsy in practice. Time lost due to staff at garden centre following their rules - around three to four hours.
Unfortunately, despite my experience as an H&S professional in industry, I can't offer anything better than "rules"... Perhaps if I'd been wearing a stethoscope at the garden centre, I might have been allowed to get my brother home into dry clothes several hours earlier.

Bromley boy · 22 Jul 2018

Mojo said:
Since then, the Social Action, Responsibility and Heroism Act 2015 has come into force which affects liability in a manner similar to "Good Samaritan" legislation in parts of the USA.

It adds a veneer to the existing duty of care law, but isn’t a get out of jail free card (its also been much criticised and is largely untested).

We are clearly talking about extreme cases here but if you had an unconscious passenger, the 999 operator advised you to keep them still and TOC control asked you to move them you would be in an invidious position.

If they are “walking wounded” and happy to detrain themselves, this will clearly not be an issue.

Personally I think TOCs should be advising staff to follow medical advice in all cases since we are clearly not medically trained and, in my view, should not be put into the position of having to chose between conflicting advice.

AnonymousUser1 · 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.

nearness to A+E is irrelevant as if a patient is sufficiently unwell to require an ambulance they will be transported to the APPROPRIATE recieving unit not the closest.

access however is a good call - much rather take someone off at Castleford than Normanton or P2 or 3 at Kirkgate for instance ...

AnonymousUser1 · 22 Jul 2018

nottsnurse said:
So you're confident in your ability to perform a c-spine clearance in order to rule out such an injury?

Out of interest how does your employer suggest removing someone from your train?

you are aware of the 2016 AACE / JRCALC guideline update aren't you ? the one that further legitmised 'self extrication' and 'banned' transport on extrication boards ...

bramling · 22 Jul 2018

AM9 said:
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.

All well and good, but unless BTP happen to be present, this is all irrelevant.

Mugby · 22 Jul 2018

A couple of weeks ago, I was at Norwich station and heard an announcement by GA which went something like this: (may not be exact wording)

" If you (or someone) are taken ill on one of our trains, please don't pull the emergency switch. allow the train to continue to the next or nearest station where medical help can be obtained "

It was new to me, I've never heard such an announcement before, may have been due to the very hot weather of late!

theironroad · 22 Jul 2018

Mugby said:
A couple of weeks ago, I was at Norwich station and heard an announcement by GA which went something like this: (may not be exact wording)

" If you (or someone) are taken ill on one of our trains, please don't pull the emergency switch. allow the train to continue to the next or nearest station where medical help can be obtained "

It was new to me, I've never heard such an announcement before, may have been due to the very hot weather of late!

It's becoming quite a common announcement and one that does actually make sense.

Pulling an emergency on many trains that still run on the mainline, creates and automatic brake application and will bring the train to a stand , possibly in the middle of nowhere. It can then take time to reset the alarm as either the driver or guard has to do so at the position it was operated. All this time wasted isnt going to help the emergency. In those situations, it is best to wait until a station. In the meantime someone should locate on board staff so a plan can be created for getting help.

Newer stock allows the driver to override the brake application and then decide where to stop in conjunction with the signaller and guard .

faltskog36abba · 22 Jul 2018

My stepfather has suffered from mental illness since his teens, He took ill whilst on holiday in Blackpool. What we didn't know is that he had stopped taking his medication, Which made him unable to walk/speak/physically function. We had to put him in mums wheelchair whilst mum got a taxi to the station, We then informed the guard on our train of the situation, The guard arranged for an ambulance to meet the train in Victoria. On arrival in Manchester the ambulance crew was aboard the train checking the patient for ten minutes before he was carried off, This happened ten years ago and the Blackpool train had a 35 minute layover. If this train had arrived at Piccadilly it would of caused delays for over ten minutes.

AM9 · 22 Jul 2018

bramling said:
All well and good, but unless BTP happen to be present, this is all irrelevant.

Not really. If the driver refuses to accede to their unreasonable 'demands', (bear in mind, he/they is/are the only one who can enable the train to proceed) and then alerts BTP, by the time the train does move, suitable action could then be taken. A couple of publicised instances of prosecution would then act as a warning to would-be other bullies.

nottsnurse · 22 Jul 2018

mph1977 said:
...the one that further legitmised 'self extrication'...

If someone is able to 'self extract' then the question you quoted would be pretty moot.

...and 'banned' transport on extrication boards ...

It recommends assessing the appropriateness of using extraction boards, something that crews should already have been doing. In cases of potential c-spine injury the most appropriate method of transport (until a spinal clearance can be performed by a competent person) is still collared, blocked and boarded.

AnonymousUser1 · 22 Jul 2018

nottsnurse said:
It recommends assessing the appropriateness of using extraction boards, something that crews should already have been doing. In cases of potential c-spine injury the most appropriate method of transport (until a spinal clearance can be performed by a competent person) is still collared, blocked and boarded.

it is not. hence the AACE / JRCALC update.

leaving people on Long Extrication boards is harmful , number need to harm through inappropriate or excessive immobilisation is far far smaller ( i.e. harm much more likely) than the Number needed to treat for a highly unstable Spinal injury .

Warwick · 22 Jul 2018

Mugby said:
A couple of weeks ago, I was at Norwich station and heard an announcement by GA which went something like this: (may not be exact wording)

" If you (or someone) are taken ill on one of our trains, please don't pull the emergency switch. allow the train to continue to the next or nearest station where medical help can be obtained "

It was new to me, I've never heard such an announcement before, may have been due to the very hot weather of late!

I believe that this is mentioned on posters in trains on the LUL.

noddingdonkey · 23 Jul 2018

I was on a Grand Central service about 18 months ago, which got held up in Doncaster due to a medical issue. A passenger boarded, sat down and in doing so started screaming. It transpired that she had recently had an operation on her knee and had managed to damage it while sitting down.

The ambulance service attended, and had some real difficulty in getting her out of the seat, not helped because they didn't have a wheelchair narrow enough for the gangway of a 180. All they could do was give her gas and air until the pain was sufficiently numbed for them to be able to carry her out of the train. The train was not particularly busy, I was surprised they didn't clear that carriage while the matter was dealt with.

Unlucky for GC to have picked up over an hour of delay minutes and the delay repay claims.

theironroad · 23 Jul 2018

noddingdonkey said:
I was on a Grand Central service about 18 months ago, which got held up in Doncaster due to a medical issue. A passenger boarded, sat down and in doing so started screaming. It transpired that she had recently had an operation on her knee and had managed to damage it while sitting down.

The ambulance service attended, and had some real difficulty in getting her out of the seat, not helped because they didn't have a wheelchair narrow enough for the gangway of a 180. All they could do was give her gas and air until the pain was sufficiently numbed for them to be able to carry her out of the train. The train was not particularly busy, I was surprised they didn't clear that carriage while the matter was dealt with.

Unlucky for GC to have picked up over an hour of delay minutes and the delay repay claims.

Thought you were going to say that she sat down on a new Thameslink train and the wooden seat hurt her

Discussion of moving people taken ill on trains

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