Medical Emergencies

[cjmillsnun]

HSE wouldn't give a toss about First Aid delivery unless someone made a complaint about it.

Ultimately a lot of situations you cannot make worse..

Agreed.

 

[Elecman]

As a First Aid trainer I can assure anyone that as long as the first aid treatment given complied with that laid down in the joint First Aid manual then in this country no action can succeed.

The railways prior to Privatisation had a thriving first aid movement which BR fully supported to the extent of extra days and travel facilities to all qualified staff, and even supported the annual First Aid competitions run under the auspices of St John Ambulance. Sadly privatisation has destroyed all this as few of the railway companies now provide any support at all.

I have Overvthe years carried out many treatments to both passengers and staff both on trains/stations and offices.

 

[ComUtoR]

Surely the better option is to reduce speed and go to the next platform (in this case Elstree) where a) the driver can investigate more quickly, b) medical assistance can be more easily provided, and c) in the event of it being serious, passengers can detrain for other services. This is lower risk all round for the sick passenger, all other passengers, and the driver.

If this was a 319 then there is no override and the Driver cannot speak to the passengers :/ I assume it was different unit.

If I am going 100mph between Elstree and Radlet I very much doubt the train will stop in time when braked normally. Braking distance is an issue as well as concentration. The Emergency brake is quite severe. Assuming this is not a 319 and there was passenger communication then slowing the train is not the best option. When the passcom goes off there is a split second decision to override where possible. You gotta pick up the handset and have a conversation and make the decision to brake for the next station and be able to hit the station right.

With an override it may be better to accept the brake demand and after you come to a stand you would have had to conversation with the passenger and can then override to the next station. You still need to speak to the signaller and arrange assistance etc and that can be done at a stand and then overridden to the next station.

When the passcom goes off it comes at quite a shock. When I get a passcom I typically stick the brake in regardless as remaining in power is, well, ...

 

[SPADTrap]

As a trained first-aider myself, this excuse always annoys me.

No-one has ever being successfully sued for making a mistake whilst administering first aid in good faith - if someone is potentially dying, any first aid (even if insufficient) is better than none.

St John Ambulance also offer insurance to any of their trained first aiders so that they can use their skills without fear:

http://www.sja.org.uk/sja/training-...questions/associate-membership-insurance.aspx

IANAL, but isn't first aid at work covered by employer's liability insurance?

Also, I agree that drivers don't need first aid training (they are best utilised driving the tran safely and getting any casualty to a safe place), but guards could be trained?

Why would you need insurance but say a worry about being sued is an excuse?

 

[Bald Rick]

If this was a 319 then there is no override and the Driver cannot speak to the passengers :/ I assume it was different unit.

If I am going 100mph between Elstree and Radlet I very much doubt the train will stop in time when braked normally. Braking distance is an issue as well as concentration. The Emergency brake is quite severe. Assuming this is not a 319 and there was passenger communication then slowing the train is not the best option. When the passcom goes off there is a split second decision to override where possible. You gotta pick up the handset and have a conversation and make the decision to brake for the next station and be able to hit the station right.

With an override it may be better to accept the brake demand and after you come to a stand you would have had to conversation with the passenger and can then override to the next station. You still need to speak to the signaller and arrange assistance etc and that can be done at a stand and then overridden to the next station.

When the passcom goes off it comes at quite a shock. When I get a passcom I typically stick the brake in regardless as remaining in power is, well, ...

It was a 377 southbound, which can easily stop from 100 in under a mile. We were just south of Radlett when the brakes came on, and were at least a mile from Elstree when we stopped. There's not that much difference between full service and emergency brake on a 377. At least that's what the 377 fleet engineer tells me.

As it happens it was me calling the signaller to tell him what was happening, as the driver couldn't, being out of his cab for 20 minutes. Which is why it is my view that it would be better in similar circumstances to carry on to the next station, even if that perhaps means running at a lower speed to reduce the risk of an operational incident through distraction. (Which, incidentally, is what several other drivers have done in similar incidents).

I can't think of any circumstance of a trainborne sick passenger on a line with stations less than 10 minutes running time apart where it is better to stop out of a station.

 

[ComUtoR]

Thanks for the reply Bald Rick. I think the issue is that when the passcom goes off you have no idea what's on the end of it. Letting the unit and brakes do their job puts you in an advantageous position. As I highlighted with an override you get the best of both worlds. Stop, think, assess, risk. When the passcom goes off my first second thought is that a passenger wants the train to stop. My last concern is where the train is going to stop; especially if I can override it anyway. We are very much taught to bring the unit to a stand and when a safety system (passcom included) kicks the brakes in we shouldn't automatically override it. I would however overide it in a tunnel.

As to stopping a train from 100mph the problem is that we usually plan ahead and bring it down gently. If your going to put the brake in full service then you may as well leave it to the EM brake then make the judgement call to override and proceed into the next station. I don't want to be thinking about stopping and braking points when dealing with an emergency. As I said, I'm going to put it in brake through sheer instinct anyway.

I do wonder why the Signaler wasn't aware as the Driver should have contacted them before leaving the cab. I would also suggest that the Driver in normal circumstances wouldn't have been aware that someone was communicating with the Signaler. We are doing this blind in most circumstances.

Hindsight is a wonderful thing. As TDK stated there is only once instance where there is a hard and fast rule about where you cannot override the passcom and that has come from previous incidents.

I've had my share of passcoms and no two incidents are the same (there are some exceptions) My personal experience is that they occur just after departing a station or while at a stand. I did overhear a rather weird one and the train never skipped a beat. Not to make it part of the DOO debate but the Driver hit the override and the Guard dealt with the passenger.

 

[SPADTrap]

It was a 377 southbound, which can easily stop from 100 in under a mile. We were just south of Radlett when the brakes came on, and were at least a mile from Elstree when we stopped. There's not that much difference between full service and emergency brake on a 377. At least that's what the 377 fleet engineer tells me.

As it happens it was me calling the signaller to tell him what was happening, as the driver couldn't, being out of his cab for 20 minutes. Which is why it is my view that it would be better in similar circumstances to carry on to the next station, even if that perhaps means running at a lower speed to reduce the risk of an operational incident through distraction. (Which, incidentally, is what several other drivers have done in similar incidents).

I can't think of any circumstance of a trainborne sick passenger on a line with stations less than 10 minutes running time apart where it is better to stop out of a station.

There is a big difference between full service and emergency on the Electrostars I drive in regards to regen braking. Also getting the brakes off!

 

[sarahj]

I was a trained first aider when I joined the railway, but was told this was not needed. When you have a medical emergency it does help to stop at the correct station. I would never try to stop at Wivelsfield station, as its not very accessible, with steep steps etc, but would try and go onto Burgess Hill for easy access, or Haywards Heath which is staffed and closer to better help.

You do have to bite your lip sometimes. I've had paramedics on a train stopped at Redhill dealing with a collapsed punter, meanwhile another was stepping over him shouting at me about when we going to on the move. My reply was calm, but I so wanted to slap the guy. But you also see a good side. I've put the call out and suddenly your better staffed than some A&E's

You do end up making odd calls.: This is true:
me: I need an ambulance for a collapsed passenger. I'm on a train, but we will be at Redhill station soon.
A: Ok, blah blah, ok, oh can I have the address?
Me: Redhill station
A: I need an address
Me: I dont know sorry, try station rd.
A: No, thats not correct. I need a full address.
Me. I'm sorry, I dont know. this is a train thats moving, and will soon be at Redhill station. I dont know the address.

It did arrive, but aghhhhhh

 

[Lockwood]

I've had to deal with an incident on a platform as a passenger.
Platform staff were very happy to have a qualified person on scene - after the incident was dealt with, they told me that they were trained several years ago (10+?) and never given refresher training.

I'll also add to the "No one has been successfully sued/prosecuted for acting within their skillset" crowd. (Obviously doing something outside of skillset because "I saw it on Casualty" can land you in trouble)

 

[cjmillsnun]

Why would you need insurance but say a worry about being sued is an excuse?

You don't need insurance. St John provide it knowing that it'll never be claimed against. It's effectively a placebo.

 

[Lockwood]

Me. I'm sorry, I dont know. this is a train thats moving, and will soon be at Redhill station. I dont know the address.

It did arrive, but aghhhhhh

I've been there... Doing an event at a set of playing fields for a school, the other end of the city to where the school is.
One time, made 999 call. 6 minutes later, and after locating several incorrect locations and me giving more and more details of how to get there, the call taker has found me and is now able to take incident details. And sends a vehicle to the wrong playing fields.
Next time, made 999 call. Call taker was local so knew exactly where to send the truck. Then recognised me when he got to the "Are there any first aiders on scene already" bit of the script. Small world.

I would have said "If they could pass on the details to the crew with something like that, the crew would be likely to find Redhill Railway Station", but after failing to find pretty much every local landmark I've been given I wouldn't bank on that.

 

[magd1272]

I was a trained first aider when I joined the railway, but was told this was not needed. When you have a medical emergency it does help to stop at the correct station. I would never try to stop at Wivelsfield station, as its not very accessible, with steep steps etc, but would try and go onto Burgess Hill for easy access, or Haywards Heath which is staffed and closer to better help.

You do have to bite your lip sometimes. I've had paramedics on a train stopped at Redhill dealing with a collapsed punter, meanwhile another was stepping over him shouting at me about when we going to on the move. My reply was calm, but I so wanted to slap the guy. But you also see a good side. I've put the call out and suddenly your better staffed than some A&E's

You do end up making odd calls.: This is true:
me: I need an ambulance for a collapsed passenger. I'm on a train, but we will be at Redhill station soon.
A: Ok, blah blah, ok, oh can I have the address?
Me: Redhill station
A: I need an address
Me: I dont know sorry, try station rd.
A: No, thats not correct. I need a full address.
Me. I'm sorry, I dont know. this is a train thats moving, and will soon be at Redhill station. I dont know the address.

It did arrive, but aghhhhhh

I've had exactly this issue in central London. Was in a church when somebody collapsed. The 999 operator kept insisting they needed a full postcode, even though I'd given the name of the church, the road it was on, the side street immediately adjacent, and a partial postcode. Ditto when I called 999 about a fire in the park opposite my house. Gave the name of the park, my address and postcode, and said the fire was directly across the road, but that wasn't sufficient ("Is the fire at your postcode? Oh, so what postcode is the fire at?") Quite worrying, really.

 

[Lockwood]

You don't need insurance. St John provide it knowing that it'll never be claimed against. It's effectively a placebo.

It's also so that if someone tried to sue, there's something to help you.
I've seen the St John medicolegal guy in action - scary court room guy is scary.

 

[Chrisgr31]

SarahJ we had similar at Crowborough station. Friend of mi e passes out on platform as train pulls in. Guard calls ambulance, friend comes round, station staff have found duvet for him and my friend insists the train goes leaving him behind. Later discover friend is ok, but no breakfast etc, but it took an hour for the ambulance (well paramedic car) to arrive, and all they did was take him home and tell him to see a doctor later. But he did say the ambulance had had to stop to ask for directions to the station.

Next morning we are all waiting for the train, same guard and she says, ahh you're ok, I had a call from the ambulance wanting to know where the station was, she said I told them I didn't know, the train takes me there!

On the issue of pass ops I can understand why historically trains would stop immediately as passengers could open doors etc, but nowadays they can't, so wouldn't it be better for all of them to be overridden so that if the train is just leaving a station, it stops, but if it's left the station it continues to the next suitable place to stop?

 

[Bletchleyite]

I've had exactly this issue in central London. Was in a church when somebody collapsed. The 999 operator kept insisting they needed a full postcode, even though I'd given the name of the church, the road it was on, the side street immediately adjacent, and a partial postcode. Ditto when I called 999 about a fire in the park opposite my house. Gave the name of the park, my address and postcode, and said the fire was directly across the road, but that wasn't sufficient ("Is the fire at your postcode? Oh, so what postcode is the fire at?") Quite worrying, really.

Yes, that's concerning - people might die while time is wasted faffing around.
--- old post above --- --- new post below ---

On the issue of pass ops I can understand why historically trains would stop immediately as passengers could open doors etc, but nowadays they can't, so wouldn't it be better for all of them to be overridden so that if the train is just leaving a station, it stops, but if it's left the station it continues to the next suitable place to stop?

They can on any stock that has a passcom rather than an emergency brake.

 

[ralphchadkirk]

Later discover friend is ok, but no breakfast etc, but it took an hour for the ambulance (well paramedic car) to arrive, and all they did was take him home and tell him to see a doctor later. But he did say the ambulance had had to stop to ask for directions to the station.

What I presume happened was that after a full clinical examination the paramedic decided that a GP referral was more appropriate than an A&E admission, and kindly took your friend home?

Finding the correct location of the incident is the most important part of the call. Call takers therefore spend a fair proportion of the call ensuring that the location is correct. Unfortunately it doesn't help when someone's idea of a location is "you know, the park in the centre. By the lake". Call takers aren't local and only have OS and A-Z maps available. The Gazetteers are usually very accurate at matching locations, but they aren't perfect. If you call from a landline though, the address is passed through on the CLI and you should only be asked to confirm it. In much the same way as call takers can't use their local knowledge all the time to find calls, ambulance crews often aren't in the area they know, and are reliant on whatever mapping software the in-car computers and satellite navigation contain, and the map book version they carry. If a crew can't find a location then the first thing they do is try to ring back the caller, which doesn't help if they are a passer-by, saw something from a passing bus, or not actually with the patient.

 

[the sniper]

You do end up making odd calls.: This is true:
me: I need an ambulance for a collapsed passenger. I'm on a train, but we will be at Redhill station soon.
A: Ok, blah blah, ok, oh can I have the address?
Me: Redhill station
A: I need an address
Me: I dont know sorry, try station rd.
A: No, thats not correct. I need a full address.
Me. I'm sorry, I dont know. this is a train thats moving, and will soon be at Redhill station. I dont know the address.

It did arrive, but aghhhhhh

A fellow Guard had exactly the same thing up here trying to get the Police via 999. No railway station found, but the fire station and police station were in the 999 address system. Guard was asked if they were nearby... After buggering around for literally a few minutes, trying various options, the call handler eventually found the address for '[station name] Booking Office' in their system. :roll:

At least when you call BTP direct they can easily identify railway station locations, even if it does then take 25 minutes for them to get there.

 

[edwin_m]

Finding the correct location of the incident is the most important part of the call. Call takers therefore spend a fair proportion of the call ensuring that the location is correct. Unfortunately it doesn't help when someone's idea of a location is "you know, the park in the centre. By the lake". Call takers aren't local and only have OS and A-Z maps available. The Gazetteers are usually very accurate at matching locations, but they aren't perfect. If you call from a landline though, the address is passed through on the CLI and you should only be asked to confirm it. In much the same way as call takers can't use their local knowledge all the time to find calls, ambulance crews often aren't in the area they know, and are reliant on whatever mapping software the in-car computers and satellite navigation contain, and the map book version they carry. If a crew can't find a location then the first thing they do is try to ring back the caller, which doesn't help if they are a passer-by, saw something from a passing bus, or not actually with the patient.

Perhaps someone should give them access to, er, Google? Typing virtually any landmark into the search bar will bring up a map.

 

[Bald Rick]

But you also see a good side. I've put the call out and suddenly your better staffed than some A&E's

+1 to that.

I was on a train on the ECML when a colleague was taken ill. A steward made the call for medical assistance on the PA, and within 90 seconds there were 5 medically trained staff at his side.

The first to arrive was head of gynaecology for BUPA.

(Thankfully, one of the other four was an A&E doctor).

 

[Carntyne]

Are drivers able to call 999 via the GSMR?

I know that railway fixed lines when calling 999 go to the railway operator who should be helping with locations/access points.

 

[route:oxford]

Perhaps someone should give them access to, er, Google? Typing virtually any landmark into the search bar will bring up a map.

Not always helpful...

"Radley Railway Station" returns a map of Radlett railway station, however "Radley Station" returns the correct map.

If you ever want to look at a google map to see how far it is to walk from "Baker Street to Kings Cross", you'll find it is over 23 miles and will take around 7 hours.

 

[Llanigraham]

You don't need insurance. St John provide it knowing that it'll never be claimed against. It's effectively a placebo.

It also provides insurance cover for personal equipment and clothing, and personal injury, which is why some do take it out.

Although SJA do provide equipment a lot of members buy their own in excess of that provided. Whilst I was a member I had quite a bit of specialist stuff that I preferred to use to that provided, plus it stayed in my kit so could be safely used if needed when not "on duty".

 

[ralphchadkirk]

It also provides insurance cover for personal equipment and clothing, and personal injury, which is why some do take it out.

Although SJA do provide equipment a lot of members buy their own in excess of that provided. Whilst I was a member I had quite a bit of specialist stuff that I preferred to use to that provided

I'm not sure that's a good idea: there would be no quality control, no ability to recall faulty equipment, and no control of the competency of the person using specialist kit (plus, if something did happen, using unauthorised equipment would almost certainly invalidate the insurance!).

 

[mark-h]

Perhaps someone should give them access to, er, Google? Typing virtually any landmark into the search bar will bring up a map.

Staff at Police Scotland call centres did use Google maps because their own system was inadequate (point 8 on this BBC News article)


It would seem better that the signallers/control liaise with the emergency services, leaving the on-board staff to drive the train and deal with the incident. The control centres should have the required details of the station, including the address, access details and which platform the train is arriving at.

Station staff should also be informed so they can expect the arrival of the paramedics and ensure that they get to the ill customer as quickly as possible.

 

[neilb62]

Somewhat off topic, but do any trains carry a defibrillator? They seem to be everywhere nowadays, and are apparently fairly easy to use should the need arise.

VT 390's and 221's do.

 

[Llanigraham]

I'm not sure that's a good idea: there would be no quality control, no ability to recall faulty equipment, and no control of the competency of the person using specialist kit (plus, if something did happen, using unauthorised equipment would almost certainly invalidate the insurance!).

All personal equipment was subject to inspection, approval and had to be in date.

And I'm not sure what type of equipment you are thinking about, but in our Division it was typically Laerdal Facemasks, electronic blood pressure monitors, oxymeters, torches, equipment bags, multi-tools and such like. Not exactly very "specialised"

Because I also had qualifications in vehicle extraction and recovery I also used to carry a small amount of specialist equipment for that. I had to provide my certification for both the equipment and my usage of it, and that was provided by another (approved) body.

 

[Lockwood]

The love of CQC compliance means that the only personal equipment we are meant to use now is a steth. Everything else should be SJA owned and maintained in order to normalise the equipment pool and enhance accountability and stuff.

A member I knew was an AA patrol. He was explicitly told not to do any vehicle maintenance. Instead he was to follow policy and call for the AA. (yay)

 

[455driver]

As a trained first-aider myself, this excuse always annoys me.

No-one has ever being successfully sued for making a mistake whilst administering first aid in good faith - if someone is potentially dying, any first aid (even if insufficient) is better than none.

Maybe not successfully but quite a few have been taken to Court!

A position I would rather not be in so if* a first aid course was offered in work I would not be volunteering for it!

* not likely to be offered in my lifetime anyway!
--- old post above --- --- new post below ---

This is a false fear. While there is no formal good samaritan law in the UK, AIUI a First Aider acting within the remit of their training has never been successfully sued in a UK court.

Remove the highlighted word and your statement is very wrong because quite a few people have been sued!

Edit-
Out of the 7 medical emergencies I have had on my train 6 were because the patient hadn't had any breakfast or anything to eat or drink that day and they collapsed/fainted, only one was a genuine case which was dealt with by properly medically trained passengers on board the train.

 

[AnonymousUser1]

2. The nearest A&Es to New Cross are at Kings (Denmark Hill), St Thomas' (Waterloo) or Lewisham (Ladywell) i.e. in the middle of a big gap

which if any are PPCI units, HASUs or Trauma Units ? which sites have neuro etc etc etc

patients to the most appropriate unit not the closest ...
--- old post above --- --- new post below ---

The love of CQC compliance means that the only personal equipment we are meant to use now is a steth. Everything else should be SJA owned and maintained in order to normalise the equipment pool and enhance accountability and stuff.

A member I knew was an AA patrol. He was explicitly told not to do any vehicle maintenance. Instead he was to follow policy and call for the AA. (yay)

indeed

It's not just CQC compliance at play here though it;s also PUWER and corporate manslaughter.

also the aa man is not insured by the AA when woerking for SJA ...
--- old post above --- --- new post below ---

As a trained first-aider myself, this excuse always annoys me.

No-one has ever being successfully sued for making a mistake whilst administering first aid in good faith - if someone is potentially dying, any first aid (even if insufficient) is better than none.

St John Ambulance also offer insurance to any of their trained first aiders so that they can use their skills without fear:

http://www.sja.org.uk/sja/training-...questions/associate-membership-insurance.aspx

IANAL, but isn't first aid at work covered by employer's liability insurance?

Also, I agree that drivers don't need first aid training (they are best utilised driving the tran safely and getting any casualty to a safe place), but guards could be trained?

no bystander first aider has been sued ,

SJA associate member insurance does NOT apply in any workplace .

SJA operat ional member / staff insurance applies when working for SJA as a volunteer or paid staff OR If no other insurance applies.
--- old post above --- --- new post below ---

It also provides insurance cover for personal equipment and clothing, and personal injury, which is why some do take it out.

Although SJA do provide equipment a lot of members buy their own in excess of that provided. Whilst I was a member I had quite a bit of specialist stuff that I preferred to use to that provided, plus it stayed in my kit so could be safely used if needed when not "on duty".

no any more they don't -see other replies.
--- old post above --- --- new post below ---

VT 390's and 221's do.

which given the distances between stations etc on parts of the WCML probably isn;t a bad idea ...

 

[Llanigraham]

Maybe not successfully but quite a few have been taken to Court!

A position I would rather not be in so if* a first aid course was offered in work I would not be volunteering for it!

* not likely to be offered in my lifetime anyway!
--- old post above --- --- new post below ---


Remove the highlighted word and your statement is very wrong because quite a few people have been sued!

Edit-
Out of the 7 medical emergencies I have had on my train 6 were because the patient hadn't had any breakfast or anything to eat or drink that day and they collapsed/fainted, only one was a genuine case which was dealt with by properly medically trained passengers on board the train.

Sorry, but no case has reached Court. All have been thrown out before they got anywhere near it.