Medical incidents on board trains

[johntea]

Last night I departed my train and as I was walking away from the station heard a bit of a commotion around someone being ‘passed out’ but didn’t think anything much of it at the time (just thought it was a bit of Friday night drama as to someone who may have had a little too much to drink)

Looked on Railboard later on and it showed ‘delayed due to ambulance crew attending a situation’ and it eventually departed around half an hour late

It got me thinking are train crew trained in any form of first aid as depending on when and/or where such an incident occurs an ambulance could be quite a while away, or are they just expected to call 999?

Also if this was a longer distance service rather than a more local one I presume the driver would seek permission to be able to make a stop at an earlier station on route if possible rather than waiting until the next scheduled station?

 

[yorksrob]

Funnily enough, I was on a train with just such an incident last night. The staff seemed to be keeping things under control and keeping the patient comfortable until the ambulance arrived.

 

[johntea]

Funnily enough, I was on a train with just such an incident last night. The staff seemed to be keeping things under control and keeping the patient comfortable until the ambulance arrived.

Probably the exact one I'm on about! (23:02 Leeds - Sheffield)

 

[yorksrob]

Probably the exact one I'm on about! (23:02 Leeds - Sheffield)

Yes, that's the one !

Yes, can't fault the train staff. Kept things under control then got the train off when ready. Did a sterling job.

If assume that they must have basic first aid to put people in the recovery position etc.

 

[skyhigh]

Also if this was a longer distance service rather than a more local one I presume the driver would seek permission to be able to make a stop at an earlier station on route if possible rather than waiting until the next scheduled station

It depends really. Sometimes it's better to carry on to the next booked stop if it's in a bigger town/city and has an ambulance or hospital closer. If that's the case, it's generally better than stopping at an unstaffed station in the middle of nowhere.

 

[yorksrob]

Cass might seem like the wild West at times. But it's probably got the services needed !

 

[12guard4]

I've been at 2 TOCs and haven't been given any sort of first aid training. I don't think it really happens because if someone on a train is in a situation where they're desperate for medical assistance a few days on a first aid course probably won't be much help and more qualified assistance is required.

The drivers got to make a judgement if someone is in need of help urgently every situation will vary.

 

[TEW]

I don't know if any other TOCs have similar but SWR have a set process for dealing with ill passengers with a specific number for guards to call in control. They can then set up a 3 way call with the guard, controller and relevant ambulance control so the train can be stopped in the best location. They also have paramedics based at a few stations peak hours to speed up how situations are dealt with in the busiest parts of the network to avoid the lines being blocked for an extended period.

 

[2192]

At one time Southwesttrains paid for ambulances to be at Clapham Junction and two other stations during the morning rush hour so if help was needed the delay to trains was minimised. I don't know if that still applies. (News item in Modern Railways about five years ago.)

 

[John Webb]

Reading several auto-biographies of former railwaymen, it seems many were encouraged to volunteer for first-aid courses, those qualifying being given bonus free tickets each time they renewed their training, or with some other modest financial consideration.

I was a works first-aider from 1971 to around 1992. Over those 20 years the course material was greatly reduced; much of the bandaging of broken limbs etc. was dropped and more effort put into the 'airway-bleeding-circulation' basics, particularly chest compressions, and the need to summon help ASAP.

 

[Horizon22]

I don't know if any other TOCs have similar but SWR have a set process for dealing with ill passengers with a specific number for guards to call in control. They can then set up a 3 way call with the guard, controller and relevant ambulance control so the train can be stopped in the best location. They also have paramedics based at a few stations peak hours to speed up how situations are dealt with in the busiest parts of the network to avoid the lines being blocked for an extended period.

Yes it’s the “ambulance-to-train” procedure. It links Control into the initial call, then allows a 3-way process much like you describe. Works pretty well when the train crew follow the process as set out.

As for the OP’s question about where to deal with the issue, it will normally be the first staffed station or interchange (so we’ll say a small town at least) where help can be more readily provided. Although this isn’t always possible.

 

[Ken H]

Surprised TOC's dont encourage traincrew to get 1st aid cert. Staunching bleeding straight after an accident can be a life saver. Surprised its not a legal requirement TBH

 

[tonysk14]

I've been at 2 TOCs and haven't been given any sort of first aid training. I don't think it really happens because if someone on a train is in a situation where they're desperate for medical assistance a few days on a first aid course probably won't be much help and more qualified assistance is required.

The drivers got to make a judgement if someone is in need of help urgently every situation will vary.

I'm sorry but you are completly wrong on that. A few days on a first aid course may well keep a person alive until help arrives. Such as knowing how to do effective CPR or stopping heavy bleeding.

 

[Gloster]

Right up to the 1980s or 1990s the railway encouraged First Aid courses. Staff would attend the courses in their spare time, but for the actual exam (and refresher tests) they would, if necessary, be given paid leave to attend. As a reward they got, I think, an extra day’s leave each year that they maintained their competence; I am not sure about extra free tickets. BR usually provided the classroom (at Exeter it was an old hut at Central) and the necessary materials. The member of staff who taught the courses was a volunteer who would be given paid leave when necessary to organise the courses and reimbursed expenses. (All from the memory of someone who didn’t go near the classes due to his dislike of being in the vicinity of blood and passengers. And bloody passengers, well,...)

 

[Ashley Hill]

I am not sure about extra free tickets.

I think they were given two extra boxes on their Priv ticket. Plus there was also first aid competitions.

 

[Adam Williams]

I'm sorry but you are completly wrong on that. A few days on a first aid course may well keep a person alive until help arrives. Such as knowing how to do effective CPR or stopping heavy bleeding.

Yeah, completely agreed. The various TOCs appear to have dropped the ball here.

Hell, even when I worked in an office-based IT dept we had multiple staff in the building who had done the (more extensive) 3 day St John Ambulance first aid at work course - and it was very rare that the public visited that location, so it was mostly just for the benefit of the employees based there. The very nature of rail is that you're going to have the public to deal with - varied passenger ages with varied health conditions that you won't be forewarned about.

Given all the fuss about the risks of DOO, I'm really surprised to learn that guards seemingly aren't being routinely first-aid trained across the board.

 

[ChiefPlanner]

To my utter shame - there was an old lady on Swansea bound Saturday train one morning , behaving erratically - I thought she had started very early on the gin or vodka.

Conducter came around and clocked it as a diabetic incident - he got her a glass of milk and and a well buttered scone and jam off the buffet , sat with her and conversed with her - she was recovered in a short time and was fine. Very apologetic - turned out to be a skimpy breakfast , stress in travelling to Padd etc etc.

He, of course . knew from his first aid training - and did an excellent and humane job. Excellent piece of work. I was humbled and learnt a lesson.

(different story on a similar train some while later , where an objectioanable drunk assaulted me and the conducter - drink related - but the excellent police response at Parkway dealt with that) ....

 

[Ashley Hill]

Hell, even when I worked in an office-based IT dept we had multiple staff in the building who had done the 3 day St John Ambulance first aid at work course -

Plus of course there is maintaining that competency afterwards. Procedures often change and will a company like a TOC pay for all these courses.
Some TOCs encourage staff to download the first aid app onto their work phones.
By using the Ambulance to Train policy described above you will be advised by the ambulance service of anything you need to do. I’ve used it and it works very well.

 

[Elecman]

I think they were given two extra boxes on their Priv ticket. Plus there was also first aid competitions.

They we’re indeed and the First Aid competitions were always well represented and the ultimate railway team winning were entered into the St John Ambulance National Finals against the likes of the Coal /Electricity/ Gas / Steel industry teams

 

[DerekC]

I recall about fifteen years ago being on a train from Waterloo to Portsmouth when, at speed somewhere around Wimbledon, the conductor came on the PA and asked if there was a doctor on the train. A couple of minutes later he came back sounding distinctly shaky with "what we really need is a midwife". When we stopped at Woking the paramedics were waiting on the platform with trolley ready. The conductor updated us on the way to Guildford - he hadn't had to deliver the baby. He did sound quite relieved about it - not in SWT training, I guess!

 

[Bill57p9]

I recall about fifteen years ago being on a train from Waterloo to Portsmouth when, at speed somewhere around Wimbledon, the conductor came on the PA and asked if there was a doctor on the train. A couple of minutes later he came back sounding distinctly shaky with "what we really need is a midwife". When we stopped at Woking the paramedics were waiting on the platform with trolley ready. The conductor updated us on the way to Guildford - he hadn't had to deliver the baby. He did sound quite relieved about it - not in SWT training, I guess!

SWT didn't expect early arrivals

I was on a ScotRail service a couple of years ago where someone was taken ill. We were on a DCO service but with a conductor who dealt with the situation calmly, compassionately and efficiently but it did firm up my belief that having a member of staff who can to keep an eye on the passengers and keep them safe is probably a good idea.

 

[Tim_UK]

So for a bit of (non railway) background.

More technically the modern term is ‘pre hospital care’ rather than ‘first aid’.

Most work places (or their insurance companies) want some staff around who have done a 2 or 3 day ‘first aid at work’ course.

But increasingly organisations are asking for people qualified to FREC3 standard. It’s a proper accredited course, 5 days with scenarios and classroom. With written exams. Usually taught by senior paramedics or air ambulance crew on their day off. Most event medical teams are FREC3 as a minimum. If you ever get asked to do a 3 day ‘first aid course’ and you can find the extra £75 and 2 days and upgrade to do FREC3, you won’t regret it.

 

[High Dyke]

As an aside, the delay attribution code for an ill passenger is VD.

 

[Gloster]

As an aside, the delay attribution code for an ill passenger is VD.

I didn’t realise that it affected people that quickly.

 

[noddingdonkey]

I was on a Grand Central service which encountered a lengthy delay at Doncaster as a passenger boarded and gave a huge scream as she sat down. Turns out she had recently had surgery on her knee and sitting down had aggravated it.

Paramedics were called, I was surprised that passengers weren't moved out of the carriage concerned. They didn't have a wheelchair that would fit down the aisle so all they could do was give the patient enough gas and air and wait until she was able to be lifted out of the seat with the aid of a few passengers and hobble down to vestibule, supported by the paramedics, where a wheelchair was waiting.

 

[43066]

Yeah, completely agreed. The various TOCs appear to have dropped the ball here.

Hell, even when I worked in an office-based IT dept we had multiple staff in the building who had done the (more extensive) 3 day St John Ambulance first aid at work course - and it was very rare that the public visited that location, so it was mostly just for the benefit of the employees based there. The very nature of rail is that you're going to have the public to deal with - varied passenger ages with varied health conditions that you won't be forewarned about.

Given all the fuss about the risks of DOO, I'm really surprised to learn that guards seemingly aren't being routinely first-aid trained across the board.

There are good reasons why not. From the risks of something going wrong to the possibility of staff being accused of assault, you can imagine any number of unpleasant scenarios. Generally it’s always going to be best to get the emergency services to someone asap. DOO only makes that harder of course.

 

[dk1]

When we briefly did DOO work I asked if I could go on a days course for basic first aid that my TOC was offering at the time. The day before the course it got overruled by a senior manager as it was deemed that every driver would then want to go on one to get out of a days work.

That must be 15 years ago & I still have never had any training. Id be useless in many situations.

 

[Skymonster]

There are good reasons why not. From the risks of something being going wrong to the possibility of staff being accused of assault, you can imagine any number of unpleasant scenarios.

Totally agree… Because of these risks, in my workplace there is no way I’d go near getting involved these days especially when it involves interfacing with the public.

 

[Ken H]

When we briefly did DOO work I asked if I could go on a days course for basic first aid that my TOC was offering at the time. The day before the course it got overruled by a senior manager as it was deemed that every driver would then want to go on one to get out of a days work.

That must be 15 years ago & I still have never had any training. Id be useless in many situations.

Nothing to stop you doing it in your own time.

 

[43066]

When we briefly did DOO work I asked if I could go on a days course for basic first aid that my TOC was offering at the time. The day before the course it got overruled by a senior manager as it was deemed that every driver would then want to go on one to get out of a days work.

That must be 15 years ago & I still have never had any training. Id be useless in many situations.

Of all the (good) reasons for not offering the course, how typical of the railway to choose that one!