Delay waiting for ambulance

[Stigy]

All of our defibs are automatic ones. They are specially designed for use by anyone without training. They have pictograms and an audible walkthrough as you use it.

Indeed, but sadly that doesn’t always mean people will be willing to use it. It’s not even the fact that it won’t shock a heart that’s beating normally, as many people don’t like the nature of CPR in general as it’s outside most peoples’ comfort zone and all dignity for the patient initially goes out of the window.

I’m a firm believer that basic life support should be taught from primary school age as part of the curriculum. That or from year 7 at least.

 

[357]

I know, so are the ones I have been shown. But the point is 'training' tells you that you can use it without training, if that makes sense?

Someone may be reluctant to even fetch the defib if they don't realise it can be used by anyone. The training only needs to explain that the machine tells you what to do, and you cannot make anyone's situation worse by using it.

Agree

When I was stations we had no training at all, and there wasn't even a sign saying they can be used by anyone.

I and a colleague learnt how to use them by using them on ourselves when we were bored during an engineering possession !

 

[pitdiver]

s an ex LUL station supervisor the occasion would arise where someone had been taken ill on a train. So on the one hand you would have the Line Controller hassling you to try and keep the trains moving and on the other your first aid training saying "Don't move the Patient". The first aid training always won. Any delay to the service wasn't critical on the north end of the Met but problematical on the Charing Cross branch on the Northern Line

 

[dcbwhaley]

1E25 in platform north of Edinburgh a few weeks ago for over 3 hours awaiting an ambulance as person couldn’t be moved, category 1 priority call, but still over 3 hours, another catergory 1 at edinburgh Waverley with customer on board for nearly 2 hours awaiting ambulance an unable to be moved off train.

I have multiple other examples of trains stopped for hours awaiting ambulances.

Perhaps the ToCs should operate their own ambulances to avoid those delays

 

[43066]

Perhaps the ToCs should operate their own ambulances to avoid those delays

In addition to the large fleets of replacement buses that many on here believe are on permenant standby around the network, you mean?

 

[Mojo]

s an ex LUL station supervisor the occasion would arise where someone had been taken ill on a train. So on the one hand you would have the Line Controller hassling you to try and keep the trains moving and on the other your first aid training saying "Don't move the Patient". The first aid training always won. Any delay to the service wasn't critical on the north end of the Met but problematical on the Charing Cross branch on the Northern Line

I don’t know how long ago you left, but training for the last ten years has always been to move the person, unless they are in an active seizure, with a spinal injury, or are too large or difficult to move without risking yourself injury.

 

[pitdiver]

I don’t know how long ago you left, but training for the last ten years has always been to move the person, unless they are in an active seizure, with a spinal injury, or are too large or difficult to move without risking yourself injury.

i left in 99 obviously things change.I was referring to the time when the patient . was having a seizure. But sadly the atmosphere even in those days was if you got it wrong you were on your own.

 

[43066]

I don’t know how long ago you left, but training for the last ten years has always been to move the person, unless they are in an active seizure, with a spinal injury, or are too large or difficult to move without risking yourself injury.

Personally I wouldn’t feel qualified to make that decision, so I’d be letting someone else move the person if they wished to. Especially if moving them went against the advice of a 999 operator as (is my understanding) it generally would.

But sadly the atmosphere even in those days was if you got it wrong you were on your own

It hasn’t changed in that respect.

 

[Horizon22]

Perhaps the ToCs should operate their own ambulances to avoid those delays

In addition to the staff bank, taxi, bus and hotel businesses they should apparently be running too?

 

[Mojo]

Personally I wouldn’t feel qualified to make that decision, so I’d be letting someone else move the person if they wished to. Especially if moving them went against the advice of a 999 operator as (is my understanding) it generally would.

LU staff don’t call the ambulance directly, all calls are made via the Control Centre. I posted a link earlier from London ambulance service’s own documentation, this is a misnomer not to move someone and is not their advice.

== Doublepost prevention - post automatically merged: 22 Sep 2022 ==

It hasn’t changed in that respect.

Again, this is not correct any more, in training it is made quite clear that the law is on your side (Social Action, Responsibility and Heroism Act 2015 and if any civil action was brought it would be against the company not the individual anyway). With medical advice not only explaining when a person should not be moved but also explaining in most cases better treatment can be provided off the train.

In anything it would be up to the staff member in this instance to explain why they did not act, and even more so if it made the situation worse!

 

[Stigy]

It hasn’t changed in that respect.

Sadly people still believe this to be the case even when administering CPR. It’s completely untrue that you could be sued if a person survives a cardiac arrest and they suffer injuries as a result (which they generally do). It’s similar, though dramatic in terms of road traffic collisions. For example, if someone is in cardiac arrest following a crash, obviously the best thing to do is get them out of the vehicle or remove crash helmets in order to administer CPR. If you don’t they’ll die. There’s no two ways about it. The WILL die (and to be fair, probably will if it’s traumatic and there’s no advanced life support available). If you remove them and they have a broken back, they may be paralysed for the rest of their lives. Or die. The priority is the here and now. Similar on a train I guess, if it’s that serious (fell over and hit head, and subsequently suffers an arrest).

 

[43066]

LU staff don’t call the ambulance directly, all calls are made via the Control Centre. I posted a link earlier from London ambulance service’s own documentation, this is a misnomer not to move someone and is not their advice.

What would the 999 operator advise? I’d suggest it would depend on the circumstances. If the 999 operator advised not moving the patient would the controller accept that or ask that they be moved anyway?

Unfortunately my experience of the railway is that people who are tasked with getting things moving again tend to say anything to achieve that objective, whether strictly true or not, hence I’d want to check with “the horse’s mouth” before following any such instruction.

I accept it’s more difficult on LU due to lack of phone signal but if I were the member of staff concerned I’d be inclined to call 999 and follow their instructions to the letter. It’s difficult to imagine disciplinary action being brought for failure to follow control’s instructions if those were indeed contradicted by the 999 operator.

Again, this is not correct any more, in training it is made quite clear that the law is on your side (Social Action, Responsibility and Heroism Act 2015 and if any civil action was brought it would be against the company not the individual anyway). With medical advice not only explaining when a person should not be moved but also explaining in most cases better treatment can be provided off the train.

In anything it would be up to the staff member in this instance to explain why they did not act, and even more so if it made the situation worse!

The law absolutely remains that you can be both criminally and civilly liable for intervening in these situations. Anyone stating that isn’t the case is either being deliberately misleading or doesn’t understand the law.

That particular act is still relatively untested, and it’s clear that it does not alter the basic legal position. It remains something of a grey area decided on a case by case basis.

Sadly people still believe this to be the case even when administering CPR. It’s completely untrue that you could be sued if a person survives a cardiac arrest and they suffer injuries as a result (which they generally do). It’s similar, though dramatic in terms of road traffic collisions. For example, if someone is in cardiac arrest following a crash, obviously the best thing to do is get them out of the vehicle or remove crash helmets in order to administer CPR. If you don’t they’ll die. There’s no two ways about it. The WILL die (and to be fair, probably will if it’s traumatic and there’s no advanced life support available). If you remove them and they have a broken back, they may be paralysed for the rest of their lives. Or die. The priority is the here and now. Similar on a train I guess, if it’s that serious (fell over and hit head, and subsequently suffers an arrest).

As above, there is a theoretical possibility of both criminal and civil liability for intervening. Remember in this situation we aren’t talking about an act intended to benefit the person injured, but moving them to get trains running again because that suits a TOC.

There’s no way TOC staff who aren’t even first aid trained should be expected to make decisions of this magnitude. Personally I would not feel comfortable intervening, even less comfortable moving an injured person off a train, possibly against medical advice, because it suits TOC control!

 

[Stigy]

What would the 999 operator advise? I’d suggest it would depend on the circumstances. If the 999 operator advised not moving the patient would the controller accept that or ask that they be moved anyway?

Unfortunately my experience of the railway is that people who are tasked with getting things moving again tend to say anything to achieve that objective, whether strictly true or not, hence I’d want to check with “the horse’s mouth” before following any such instruction.

I accept it’s more difficult on LU due to lack of phone signal but if I were the member of staff concerned I’d be inclined to call 999 and follow their instructions to the letter. It’s difficult to imagine disciplinary action being brought for failure to follow control’s instructions if those were indeed contradicted by the 999 operator.



The law absolutely remains that you can be both criminally and civilly liable for intervening in there situations. Anyone stating that isn’t the case is either being deliberately misleading or doesn’t understand the law.

That particular bill is still relatively untested, and it’s clear that it does not alter the basic legal position. It remains something of a grey area decided on a case by case basis.


As above, there is a theoretical possibility of both criminal and civil liability for intervening. Remember in this situation we aren’t talking about an act intended to benefit the person injured, but moving them to get trains running again because that suits a TOC.

There’s no way TOC staff who aren’t even first aid trained should be expected to make decisions of this magnitude. Personally I would not feel comfortable intervening, even less comfortable moving an injured person off a train, possibly against medical advice, because it suits TOC control!

I’m talking about extremes here Admittedly, but if it’s because of basic life support, you’re protected under law. I’d rather move someone I knew would die if I didn’t and take the minor risk that they may have underlying injuries, than not move someone and watch them die.

All that in mind, an ambulance control operator/duty paramedic would never advise against moving a patient if it was clear they would die, even if in an ideal world they’d not want them to be moved.

 

[GordonT]

In addition to the large fleets of replacement buses that many on here believe are on permenant standby around the network, you mean?

Together with their drivers who are hanging on hooks in the back shop.

 

[43066]

I’m talking about extremes here Admittedly, but if it’s because of basic life support, you’re protected under law. I’d rather move someone I knew would die if I didn’t and take the minor risk that they may have underlying injuries, than not move someone and watch them die.

All that in mind, an ambulance control operator/duty paramedic would never advise against moving a patient if it was clear they would die, even if in an ideal world they’d not want them to be moved.

In the dragging someone out of a burning building necessity scenario, absolutely.

The problem would come where some hapless station staff member is badgered by control into moving someone off a train to keep things moving, who ends up paralysed as a result. Obviously it’s also a fairly unlikely scenario, but it’s putting staff into a very difficult position.

Better to leave it to the professionals!

 

[357]

Having called an ambulance many times until I left stations a few years ago, the advice I always got was to only move them if they were in immediate danger. This was because if they could get off the train easily we had already done this before calling the ambulance.

 

[noddingdonkey]

If the advice is not to move the patient but an ambulance can't attend for a significant period of time, that wouldn't preclude moving the train (with them on board) to another location where the train wouldn't be blocking the line completely and possibly where passengers can get connecting services?

 

[Stigy]

If the advice is not to move the patient but an ambulance can't attend for a significant period of time, that wouldn't preclude moving the train (with them on board) to another location where the train wouldn't be blocking the line completely and possibly where passengers can get connecting services?

Indeed. That’s what the ambulance to train policy usually sets out anyway, although they usually stipulate that the train should be met at a station it’s easiest to get an ambulance to in the the first place, with a means of “working around” any delayed train.