Medical incidents on board trains

[Fyldeboy]

Many many years ago, I went on a First Aid at Work training course as part of my management training for (IIRC) Rail Goutmet. On the final day, a few of the course attendees were gathered at Paddington Station awaiting various trains home from London when a customer has an epileptic fit pretty much in front of us! Embarrassed to say, I was not the first with a folded up coat under the passengers head, but those that had the confidence to use their newly trained skills could well have saved serious injury to that person.

 

[Runningaround]

Now you have got that off your chest, read the last sentence of #46.

If someone has fallen ill and caught and broken their neck on their way to the floor and you helpfully drag them back to their seat paralysing them for life, rest assured you will be sued.

OTOH if someone is lying with no pulse the situation is different because whatever you do you're (probably) not making it worse. But do you know how to check for a pulse, do you know how to elicit a response from someone just messing about, do you know how to put someone in the recovery position?

Personally I think that basic life saving should be taught to everyone regardless of whether they ever use it... (having said that my first aid training and involvement is decades ago now so what do I know)

Thats where First Aid training helps you and them. You don't drag or move someone unless it's absolutely necessary eg a train coming that'll have worse consequences. Still I'd rather be attempting to help rather than ignore the situation or leave them incase I got sued.

 

[the sniper]

To my mind there is unlikely to be a problem if the person is clearly sick or injured, either then in the presence of witnesses or later. The difficulty is if they are not, they might be drunk, for example, and there are no other witnesses able to back you up. Other witnesses, if there are any, may only have seen half the story and could even give an embroidered version of it. We know that people will often stick to seriously damaging (to others) lies out of a wish not to be seen to have made a mistake.

You are on a train and the only other passenger in your coach is a young woman who suddenly gasps, falls to the floor and lies still. You go to help, realise that she is drunk, but stay to help her get up again. As you are helping her she suddenly loses it and starts screaming at you and calls you a pervert, etc. This attracts passengers from the next coach and she gabbles out an accusation of molestation. What happens next?

You don't assist, someone walks in to the carriage. They notice a women on the floor and some lone shifty looking bloke nearby pretending he's unaware... What happens next?

Clearly it's entirely sensible to get other people involved in the unusual event you're entirely alone under these circumstances if you can, if only to witness what's going on or get a second opinion on what you're observing. But you could still then use basic first aid skills, if needs be.

 

[Runningaround]

Under German law, failure to respond to a medical emergency is punishable by a fine or up to a year in jail. People are required at least to alert emergency services, if they lack first aid skills.

In September 2017, four citizens in Essen were fined after walking past an unconscious 83 year old male found in the lobby of a bank and failing to alert the emergency services. Believed to be homeless, the four individuals dismissed the mans plight, who later died in hospital. They were separately fined between €2,400 and €3,600 each

First Aid & The Law Part 3: The Rest of The World — REAL First Aid

In the previous articles we looked at some of the legal instruments which protect individuals who attempt to help others. In this article we look at some of the differences in the legal situation in other countries.

www.realfirstaid.co.uk

Compare this to the case of Jamel Dunn who, on 9th July 2017, drowned in Florida. Dunn was filed as a missing person on 12th July and his body was found on 14th July. Mr Dunn was filmed drowning by five teenagers who witnessed the event and did nothing to help, including failing to inform the emergency services. In the video, one of them is heard saying "Ain't no one gonna rescue you." Under US law there is no duty to rescue so the five teenagers had no charges brought against them

 

[noddingdonkey]

You won't get sued for attempting to save a life.

I think you missed out the word "successfully" - some misguided pillock might take the matter as far as court but your defence of administering first aid would be a strong one

 

[Runningaround]

I think you missed out the word "successfully" - some misguided pillock might take the matter as far as court but your defence of administering first aid would be a strong one

The what if's that never happen mentioned here are what the teacher pulls out in a first aid course as myths.
What would be the verdict? Guilty of trying to stop them dying. If I extinguished someone on fire will I get sued for destroying there favourite Blouse.
I've got a feeling some on here would seriously consider reporting a passenger if their ticket got lost rather than help them in distress.

 

[michael74]

Here is my tuppence worth. Every train should have an AED on board and every office space should have access to one, every member of staff public facing or otherwise should attend a Basic Life Support course as a part of their CPD, involving instructions on what to do if you find someone unconscious, (call for help/summon 999, actually tell if they are ill or just having a snooze after a double BigMac and Caramel Frappe) how to operate an AED and how to prform CPR (if you feel able to) it's 2 hours and at the end if the day you do nothing more than ring 999 and put someone into the recovery position that could just be enough to save someone's life. Yes the whole do we move the injured biker and risk further injury or watch them drown in their own blood is a regular question on BLS course.

 

[Horizon22]

I've dealt with serious incidents on-board trains at stations (and unable to be moved) and am not first aid trained. One was a broken leg (the most serious issue I've seen) We were eventually able to get a first aider to scene but not immediately. Crew and other station staff were instrumental in trying to provide comfort and do the best possible, and I think most people's personal judgment is fairly sound here; be very careful, reassure the passengers as best as possible, call out for medical personnel / 1st aiders and follow their instructions when they arrive / on the phone.

Train crew should probably be offered a 1st Aid / basic life support course and at major stations those of Supervisor above should also have the same. It need not be mandatory, but I think offering it will be helpful. Ultimately though, you will need to await the trained paramedics who, in an real emergency, will be there surprisingly quickly (even in these long ambulance waiting times). This is especially true if BTP & Control are advised.

I also think these arguments about being sued are something of a red herring. Also the law backs this up for "good samaritans" (wikipedia extract below).

In the common law of England and Wales there is no criminal liability for failing to act in the event of another person being in danger; however, there are exceptions to this rule. In instances where there has been an assumption of responsibility by the bystander, a dangerous situation was created by them, or there is a contractual or statutory duty to act, criminal liability would be imposed on the bystander for their failure to take action.

The courts are reluctant to penalize people attempting rescue. The Social Action, Responsibility and Heroism Act 2015 helps protect 'good Samaritans' when considering a claim of negligence or a breach of duty.

 

[BayPaul]

I'm seriously shocked that first aid training isn't mandatory for all train crew. It could absolutely save lives, and reduce the possibility of being sued for doing something wrong. The idea that someone could 'talk you through' CPR on the phone, as someone suggested is laughable. For what it's worth, every crew member on a ship has a 2.5 day 1st aid training course, revalidated every 5 years, which seems like a reasonable system.

 

[12guard4]

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.

Another incident I known to have happened is after a train member has tried to provide First aid on a passenger who ultimately died, the family tried to put blame on staff member. Horrible society we live in where people who try to help may get a come back from it.

 

[yorkie]

If someone has fallen ill and caught and broken their neck on their way to the floor and you helpfully drag them back to their seat paralysing them for life, rest assured you will be sued.

If someone has been on an emergency first aid course they would know not to do that.

OTOH if someone is lying with no pulse the situation is different because whatever you do you're (probably) not making it worse. But do you know how to check for a pulse, do you know how to elicit a response from someone just messing about, do you know how to put someone in the recovery position?

If someone has been on an emergency first aid course they would know what the recovery position is and how to put someone in that position (they may have difficulty recalling it, especially in the heat of the moment, if they are not used to enacting their training, but if there are multiple such people present they could work together to fill in any blanks)

Personally I think that basic life saving should be taught to everyone regardless of whether they ever use it...

It is in some countries.

Another incident I known to have happened is after a train member has tried to provide First aid on a passenger who ultimately died, the family tried to put blame on staff member. Horrible society we live in where people who try to help may get a come back from it.

They presumably did not succeed.

I had a family try to blame me for not doing enough to help someone who was being attacked, even though I did everything correctly as I was trained to do, and if anything went beyond. It's not quite the same thing, but it's a similar principle, but such people will not succeed and should never be a reason not to act in the manner you believe is right.

This sort of "question" comes up on every First Aid Course I have done and is totally incorrect, even for an untrained person.
As long as the person has used common sense and has acted reasonably they cannot and will not be taken to Court. That has been tested and advice gained by ALL the major First Aid suppliers in the UK. As has been stated this is saferguarded under the legislation mentioned previously.

Having been on an emergency first aid course myself, I endorse this post.

 

[ic31420]

A few weeks ago I was on the last train ex Blackpool on a Thursday night.

My god it was like the end of civilization! Stepping over drunks and ended up pushing one lad back onto a seat.. another looked like he was about to expire with positional asphyxia.

The conductor came alone periodically and shouted at them to find what stop they needed and resorted to writing the station on ticket. Blanks and sticking them in the reservation holders to save having to ask. Presumably he'd roll them out onto the platform.

Personally I'd have dumped them all off at blackrod with the lights off.


Mid covid lockdown 1. I came across a chap who collapsed outside a station he had no cardiac output and CPR was started.

Staff at the station just stood watching as I dispatched passers by to call ambulance and go to supermarkets for defibs etc. The station defib was located trapped behind some heras fencing. Eventually I persuaded the ticketline guard to help drag the fence out of the way and deployed the defib. Left with the ambo as I got my train but didn't look good.

Now the station staff didn't get involved, but its a personal choice especially given the unravelling covid situation and certainly not for me to criticize. They're variously station staff not medical staff.

Plenty of passer's by ignored him too.

 

[james60059]

Seeing some replies that "you may get sued" if you help.

Surely to God though, No solicitor or even judge would even consider having them sort of charges laid against you where you are trying to help?. If so they should be blooming well struck off.

 

[DelayRepay]

If I was in a supermarket or a restaurant and had a heart attack would I expect the staff to be trained in first aid and take responsibility for assisting me? Of course not. It would hardly be fair to expect them to. The railway is no different. The best thing for staff to do is alert the emergency services and/or ask if there’s anyone on board who is medically trained and knows what they’re doing.

The first proper first aid course I went on was when I worked for a supermarket. And during my time there I dealt with plenty of minor issues like small cuts. I also dealt with a couple of life changing incidents. Thankfully we were never waiting long for help as the shopping centre we were part of had their own paramedic.

When I left that job, I kept my skills up to date and I have used them several times since. Including once on a train when I assisted a BTP officer providing CPR to another passenger. I do not know what happened to him, but I do know that between us we kept going until we got to the next station where paramedics were waiting. That is as much as you can do.

I must admit I was quite surprised to read the posts above that train staff don't have even basic first aid training.

 

[ic31420]

Seeing some replies that "you may get sued" if you help.

Surely to God though, No solicitor or even judge would even consider having them sort of charges laid against you where you are trying to help?. If so they should be blooming well struck off.

If you do the decent multi day first aid courses they will explain why that as long as you act reasonably with the best interests of the patient in mind you will never be sued. Even if you make things worse. I have dragged people out of cars who have been immobilised in lane 3 much to the alarm of bystanders. One one occasion shortly before another car hit the car. Fortunately the people involved suffering bumps and bruises and mainly shock. Its a judgement call.

*Whatever you do never sit a casualty in your car. After the adrenaline subsidies and they feel the knocks and strains and whiplash you'll have the FRS cutting the roof off your car to get them out. Keep them out of vehicles, of the worst happens and they want to put them on a spinal board it's much much easier in the open.

If as someone said before you just come along pick someone up and lob them in a seat, making no assesment then you have assaulted them plain and simple, the existing condition is of little relevance.

 

[DelayRepay]

Seeing some replies that "you may get sued" if you help.

Surely to God though, No solicitor or even judge would even consider having them sort of charges laid against you where you are trying to help?. If so they should be blooming well struck off.

I have (perhaps misguided) faith in our justice system. If it came to it, I do not think a judge would convict someone who was trying to save another person's life.

My first aid course fee includes personal liability insurance cover if someone does try to sue me. So long as I follow the training, and don't do anything stupid, I will be ok I think.

 

[Gloster]

In case anybody is in any doubt I would always help, and if someone is ill there is little doubt about your intentions, even if unsuccessful. However, situations could arise where the ill person isn’t ill, or not seriously so, and your attempts to help are interpreted as attempted theft/assault/molestation/child abduction/etc. It is not unknown for people to jump to the wrong conclusion and then stick to their story, or even embroider it, rather than admit they made a mistake.

 

[dk1]

Under BR you would get an additional lieu day each year for being a designated first aider.

 

[DelayRepay]

In case anybody is in any doubt I would always help, and if someone is ill there is little doubt about your intentions, even if unsuccessful. However, situations could arise where the ill person isn’t ill, or not seriously so, and your attempts to help are interpreted as attempted theft/assault/molestation/child abduction/etc. It is not unknown for people to jump to the wrong conclusion and then stick to their story, or even embroider it, rather than admit they made a mistake.

I think in that situation, calling 999 before doing anything else would be sensible. If you were going to molest someone, you wouldn't call 999 before doing so. It would demonstrate that you intentions were good.

 

[Pseudonym]

I am an Emergency Medicine consultant and have found some of the responses on here either terrifying, funny (we do a lot of very black humour) or occasionally sensible (thanks for those).
Few points....
1. In our department (full of emergency medicine docs and nurses) we have to have a nominated number of first aiders! These are mostly health care assistants - hugely valuable but the least qualified members of the team, who will immediately ask someone else what to do - quite rightly, given where we work. I am astounded that the same rules that apply in offices, shops, airports (as I understand) and hospitals re: first aiders don't apparently apply on the railways. There should be first aiders on the railway.
2. As there are automated defibrillators on most, if not all, major stations and others too I wonder if railway staff would really wait for a passenger to get on and attach/use it should someone collapse? Surely basic training is given to station staff??
3. You will never be convicted in a British court if you are an untrained bystander trying to save a life. Clearly if that involved obviously inappropriate behaviour that would be different. If I tried to intervene however after an evening in the pub and made a cock up - then that would be different - as I would be deemed to have the knowledge to know when it was appropriate to intervene and when not to.
4. Sometimes you have to do something even if it seems unwise in other circumstances (someone earlier mentioned a neck injury and paralysis). Extreme example - drag someone off the track with a potential neck injury or let them be sliced up by an approaching train. Possible bad things vs certain death???
5. You are more likely to be criticised by a judge or coroner for doing nothing rather than trying your best to do something.

Happy Easter (I can now enjoy a few glasses of red having worked all weekend)

 

[DelayRepay]

Under BR you would get an additional lieu day each year for being a designated first aider.

In my supermarket job I got an extra 20p an hour! Although this was in the early 2000s when 20p was worth a bit more than it is now.

 

[thejuggler]

I've done numerous first aid and CPR/AED courses over the years, both for work and sports first aid.

Never used it at work, have used it in sport plenty of times. Cuts, broken bones, concussion.

However last Christmas Day some neighbours decided to have a domestic which resulted in a fight in the street. It ended with what could have been a one punch manslaughter. One guy hit another in the face, he fell back and missed a kerb edge by inches, but hit the street, he was out cold with a head injury.

First job was an ambulance call, then sort him out. His wife was hysterical so she was removed from scene. He had fallen on his side in recovery position, but when he gained conciousness tried to roll over and get up. I managed to get him back laid down and found blankets. By then the police and ambulance arrived.

He survived, but the irony is both him and his wife are paramedics, but she was in no fit state to even call an ambulance, never mind provide first aid.

However this isn't surprising as my first aid coach once told me of someone during a training session giving CPR by pressing the stomach, he was a consultant surgeon!

 

[DelayRepay]

2. As there are automated defibrillators on most, if not all, major stations and others too I wonder if railway staff would really wait for a passenger to get on and attach/use it should someone collapse? Surely basic training is given to station staff??

This is an interesting point. We have an AED in our workplace. It's in the reception and, as well as the first aiders, the reception and security staff have been trained to use it. In my rural village we have an AED attached to the local pub (paid for by community donations) and there are regular sessions where anyone can go and learn how to use it. I am very surprised if railway stations are equipped with AEDs but nobody there knows how to use it.

 

[Ashley Hill]

Regarding liability/concerns of getting sued for assault/battery: this is the exact reason the Social Action, Responsibility and Heroism Bill was passed - to try and protect good samaritans

There has been much talk of liability and getting sued here but I think the above has been overlooked. It’s not a get out of jail card but if your intentions were genuine then you have nothing to worry about. Equally as long as you did seek help as you couldn’t deal with the situation yourself you still need not worry as you’ve still done the right thing.
At the end of the day if you don’t feel confident then get help.

 

[Ediswan]

This is an interesting point. We have an AED in our workplace. It's in the reception and, as well as the first aiders, the reception and security staff have been trained to use it. In my rural village we have an AED attached to the local pub (paid for by community donations) and there are regular sessions where anyone can go and learn how to use it. I am very surprised if railway stations are equipped with AEDs but nobody there knows how to use it.

Do you need to be trained to use the type of AED that you might find on a wall in a public place ? My understanding is that they come with 'no training required' instructions and will not shock unless the device detects the appropriate cardiac activity. No doubt training would help with confidence and significantly speed up the process.

 

[ic31420]

5. You are more likely to be criticised by a judge or coroner for doing nothing rather than trying your best to do something.

Happy Easter (I can now enjoy a few glasses of red having worked all weekend)

Exactly, I'd rather stand in a civil court and explain to the court why I did Something, than stand in the coroner's and explain to the family (for they can address you) why I didn't do something.

This is an interesting point. We have an AED in our workplace. It's in the reception and, as well as the first aiders, the reception and security staff have been trained to use it. In my rural village we have an AED attached to the local pub (paid for by community donations) and there are regular sessions where anyone can go and learn how to use it. I am very surprised if railway stations are equipped with AEDs but nobody there knows how to use it.

The whole point of an AED is that you don't need to know how to use one. I've used them where they won't shock (there are only a couple of shockable "rhythms" anyway and I think they're rarer. They won't shock an unsuitable patients, be that because they've good a good normal output, asystole (nothing) or other unsuitable scenario.

I was actually suprised when the AED delivered multiple shocks in the case I outlined earlier.

Another great bit of kit is a Lucas cpr machine, but I doubt they'll be made available like AEDs .

 

[muz379]

Contrary to what some say in this thread I think guards/other on board and some station staff should have first aid training.

Shops and Restaurants are bound to have first aiders for their own staff and I've witnessed staff in these places administering first aid to the public in the past . If anything as a member of staff in uniform you are going to be expected to intervene in an emergency . I think it'd end up looking poor on the company if you didn't.

When I've been faced with an emergency like that on board a train in the past I first always look to see if there is someone else trained in first aid who can directly assist the person so I can focus on what I'm trained for which is operational railway stuff- contacting control , the driver , arranging an RV point for emergency services etc . If not I'd fully expect to have to assist the person directly myself after letting control know and ringing an ambulance.

Yes a degree of common sense is necessary , if you are a male guard it probably isn't wise to go manhandling a female passenger without a witness or cctv coverage . And there'll always be situations when you cannot do much because someone's situation is so serious . But if you can be of assistance in some situations then that's surely a good thing .

Out of course stopping . Again it's always best to run by control but if I knew there wasn't enough time and I needed to act I'd make the decision with my driver and field any consequences later . I've never known anybody get in trouble for out of course stopping for an emergency. The main two being police to train for a fight and to meet an ambulance for an unwell passenger .

 

[Mojo]

Some of the very good posts in this thread seem to have been missed out in amongst the discussion. Even under basic Civil law, it is very unlikely the requirements for you to face successful civil action ("be sued"). The Social Action, Responsibility and Heroism Act 2015, often colloquially referred to as the "Good Samaritan Act," as firstly pointed out in the post above by @Horizon22, reduces this even further.

With regard to First Aid training; I think many people here are over-egging the benefits of this, or are perhaps unduly concerned at the lack of railway staff having this. There is no one such "First Aid training" course or qualification; this could be anything from the level 2 qualification which is probably the most common, often called "Emergency First Aid At Work" and is usually a halfday or one day course, or "First Aid At Work" which is level 3 and two or three days. There are also other courses out there such as fire warden training, sports first aid, mental health first aid, AED training and many more. And that's even before you take into account refresher courses.

Do you need to be trained to use the type of AED that you might find on a wall in a public place ? My understanding is that they come with 'no training required' instructions and will not shock unless the device detects the appropriate cardiac activity. No doubt training would help with confidence and significantly speed up the process.

I think your final sentence hits the nail on the head. I often see people in my role that during an incident seem to be suffering from adrenalin or something else that makes them incapable of carrying out fairly simple tasks or following instructions. Whilst an AED is very easy to use, and indeed contains both written and spoken automatic instructions, people in the "excitement" (probably a bad word to use) of a situation in which it's required, I can very easily imagine someone struggle to work it out themselves.

Back to the original question posed, railway staff will follow the instructions and policy of their employer. My company's policy is that a customer should always be removed from the train when ill, the exceptions being:
1. If you suspect a spinal injury, with the knowledge that this is extremely unlikely on a train
2. If the person is too large, or volatile to move, without possibly causing injury to yourself
3. If the person is in an active stage of a seizure

I often find the biggest barrier to implementing this procedure is people (not railway staff but other travellers) who have done some kind of first aid course where the advice is not to move someone, or to put someone in the recovery position. This might be fine in an office or restaurant, but isn't particularly good advice on a train. I've never had such a problem with a paramedic or trauma doctor, who understand the risks of working in a railway environment.

Such guidance is supported by the ambulance service - https://www.whatdotheyknow.com/requ...erations 18March2013.pdf?cookie_passthrough=1

 

[DerekC]

Do you need to be trained to use the type of AED that you might find on a wall in a public place ? My understanding is that they come with 'no training required' instructions and will not shock unless the device detects the appropriate cardiac activity. No doubt training would help with confidence and significantly speed up the process.

Our village AED sits by the door of the village hall, of which I am a Trustee. Yes, it its supposed to work on a "no training required" basis, but certainly I feel a lot more confident about using it with the knowledge acquired in the training course - and in fact it's time I had a refresher. It has been used three times so far, once successfully and the other two occasions not.

Oddly the only emergency when I worried about being sued, or my actions misunderstood, was not a medical one. I was standing by the doors on a Bakerloo line train one evening when a woman arrived just as the train was about to depart, pushed her little girl (about three) onto the train and then turned round to attend to her suitcase. The doors closed just at the wrong moment and off went the train leaving little girl and me staring at each other. Oddly she didn't make a sound. I definitely didn't want to be accused of abduction so I caught the eye of the nearest adult female and suggested we get off at the next station with little girl, see if mum arrived on the next train and if not, report to the nearest member of staff. Mum did arrive (in floods of tears) and was reunited with daughter - so happiness all round. But it was a bit scary for a few moments!

 

[Llanigraham]

Do you need to be trained to use the type of AED that you might find on a wall in a public place ? My understanding is that they come with 'no training required' instructions and will not shock unless the device detects the appropriate cardiac activity. No doubt training would help with confidence and significantly speed up the process.

No you don't need training. All of those in public areas now are foolproof, include full instructions, often in sound and by diagrams, and actually will not work if the patient isn't in a suitable state, or if the pads are put on incorectly. I have taught 10 year olds how to use one, and there are instances of children of that age using them successfully, as well as numerous untrained members of the public doing the same.