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Delay waiting for ambulance
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Definitely continued throughout the pandemic and I'm pretty sure it's still going now.
Falcon1200
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I in turn disagree. Never in my 30 year Control career did I or my colleagues receive a PPM-related bonus, and in any case the expense of managing an incident is not Control's concern. We are not on site at any incident and can only be guided by those who are.
DelayRepay
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I think it would also depend on the view of any off duty medical professional who happened to be present.
If there was a possibility that someone might need CPR, I would want to get them off the train and onto the platform where there's more space. I think it would be very difficult to perform CPR in a standard class carriage with 3+2 seating.
My experience of 20+ years as a workplace first aider, in shops and offices, tells me that the majority of injured/ill people can safely move under their own steam, with assistance if necessary. Injuries where movement poses a danger are rare, and I don't think it would be any different for 'typical' injuries and medical episodes occurring on trains. Obviously where movement increases the risk to the patient then they should stay where they are until professional help arrives.
From my experience it is very much a 'well you need to move the to the platform so we can restart moving trains. You are blocking the line". Certainly how control at my TOC deals with such situations, have reported them several times for putting such pressure on a guard in an awful situation.
Recently we have had a new process where we are now no longer allowed to call 999 without having control on a 3-way call! Train crew no longer allowed to make decisions regardless of the emergency
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And I very much feel that my control try and force crew to remove passengers from trains, many colleagues have reported similar conversations. I'm not saying all controls or all TOCs do this, but my TOC definitely does! I even got repremanded for daring to call 999 before control for an unconscious and unresponsive passenger despite me getting the driver to call Signaller and control.
Needless to say the conversation with my manager lasted about 20 seconds and a complaint lodged against the controller.
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Having a 3 way call with control for contacting emergency service control rooms is/should be standard practice now.
There are several reasons for it.
First is that the traincrew are not in possession of all the facts regarding the best location both clinically and operationally for their train to be met. If you call 999 from a train you'll be connected to an operator and they'll send you an ambulance to whichever location you tell them. There will be no consideration of whether continuing a bit further on a train, relatively speaking, will get a better faster response with resource availability - if you can carry on for 10 minutes at 90 mph and get an ambulance in 15 total, rather than parking up at the edge of another response area and waiting 45 total why wouldn't you? The control can help by deciding to knock out stops if need be to get you to the agreed rendezvous more quickly.
When the control takes those calls they patch you in to an ambulance control room supervisor who is specifically trained to help make those decisions with regards to the railway.
There are also other factors in play - not blocking up the railway when carrying on for 5 minutes to the next stop with better access to boot *is* an important consideration.
There are also operational considerations a guard may not be aware of. A classic example I know is a guard was told to stop at the next stop and wait for an ambulance during a medical emergency by a nurse on board. The control disagreed and asked them to run express to their terminus in a city 6 minutes away from their current location. The guard refused to move their train as it was on a main road and they considered it a good location with step free access.
Shortly afterwards as a consequence of the train being stood, the automatic half barrier crossing immediately behind their train was put into fail mode because it didn't move and closed across the road, requiring a MOM to attend. It caused significant traffic congestion in the area heavily delaying the attendance of the ambulance and putting the sick passenger at significant further risk.
I'm not a manager - I'm an experienced train guard who was asked to attend the steering group on introducing this 3 way policy at my TOC some years ago having dealt with a few medical emergencies and it was quite striking actually how much better it was having everyone who could contribute to the process able to do so on the call, rather than leaving it to the guard who doesn't necessarily possess all the relevant information and is in the most stressful position.
That's a fair point, I would say that knowledge of where hospitals/ambulances are in relation to stations is something I've had covered in route knowledge at both depots I've been at. I'm not saying that control shouldn't be involved, they absolutely should but calling them prior to 999 I just won't do. I can have the driver next to me on the phone to control. This is only in absolute emergency situation obviously, if it's non life threatening then it's a call to control and they deal with it.
swt_passenger
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Thanks for the update, of course it’s something you’re not usually aware of as a passenger.
Gloster
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This has prompted me to think: how do they recruit controllers nowadays? In my days a lot of the operational desks were manned by former signalmen made redundant by the power-box schemes of the sixties and seventies. They generally trusted the judgement of the staff on the ground and merely kept them informed or told them things they couldn’t know. The safety of the train and the passenger was paramount. And of course we didn’t have mobiles, so messages had to be passed through various people.
I had one where somebody had collapsed and the cord had been pulled, before the train came through to my box. A quick discussion led to the train being sent to the next station and met by an ambulance, which then hared back past my box to the major hospital. But it was still probably quicker to use a station than try to unload near my box. I don’t think we told control until after we had decided what to do and the train was on its way to the next station: the ambulance had already been called. I heard later that the chap spent quite a while in the local hospital and it was the railway that had to start the process of contacting his family.
I had one where somebody had collapsed and the cord had been pulled, before the train came through to my box. A quick discussion led to the train being sent to the next station and met by an ambulance, which then hared back past my box to the major hospital. But it was still probably quicker to use a station than try to unload near my box. I don’t think we told control until after we had decided what to do and the train was on its way to the next station: the ambulance had already been called. I heard later that the chap spent quite a while in the local hospital and it was the railway that had to start the process of contacting his family.
357
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Not the case on the Elizabeth line. Managers have threatened staff with disciplinary action in the past if they didn't move a passenger off a train, despite the 999 operator saying not to move them (back injury).
MTR even put a net at each station at one point, to roll a passenger onto and then use other passengers and staff to lift them onto the platform!
I've never known staff intentionally keep someone on a train when they didn't need to, but at the same time I'm a driver on a DOO route with mostly unmanned stations - I wouldn't feel comfortable to move a passenger to the platform and then leave them behind hoping the ambulance arrives soon.
185143
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Well I've just used more obscenities across a public house than was necessary at this time of an afternoon.
Personally speaking, especially if a 999 call handler has said not to move a patient, fire all the disciplinary action at me you like, I'd like to think 999 calls are recorded and I'd have the Union behind me if I fully adhere to the 999 call handlers instructions. I'd do so in every circumstance, and frankly eff the train service, preservation of life comes first.
357
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Indeed
That manager didn't last too long with the company in the grand scheme of things, for obvious reasons.
You're right it is. Most TOCs have "Ambulance to Train" policies or similar. One complication is services that run DOO, but overall it is about getting an appointed, safety-critical person (usually) on the ground as the liaison. As you say you need both the pecture of what is occuring on the ground, but the wider awareness of geography and the impact that control can provide. Ultimately, as frustrating as it is to control staff, if the 999 call handler or paramedic says the patient can't be moved, that's the end of it.
But some gentle challenging can be helpful; I've come across times where they've said they can't be moved and actually the passenger is actually drunk and/or disordely and can be safely moved away at no risk. Or miraculously recovers and can be helped off. What appears critical can sometimes change after the initial assessment has been made. It's where clear communications is vital.
On intensive metro services with no diversionary route, prolonged periods can cause their own issues with services delayed in the rear and the risk of egresses or other medical episodes (e.g. panic attacks).
In London (and no doubt other big cities) Police Medics are often utilised too. I know BTP have these, though very inner-city centric, and they're trained to Ambulance Technician standard (or there about) so will be able to make certain clinical decisions to extricate someone from a train if there's concern of staff moving them. It's when you're outside London etc that things get thinner on the ground, naturally.
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Indeed, people seldom collapse in a classroom environment
From experience, people in cardiac arrest usually end up where it's most difficult to perform affective CPR. The best place of course (obviously not arresting in the first place would be best really, however....) would be on an empty station platform, in front of a defibrillator.
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Llanigraham
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Indeed, people seldom collapse in a classroom environment
From experience, people in cardiac arrest usually end up where it's most difficult to perform affective CPR. The best place of course (obviously not arresting in the first place would be best really, however....) would be on an empty station platform, in front of a defibrillator.
And I am very pleased to see that many stations in Wales are now so equipped!
It’s becoming the norm at a lot of stations to have defibrillators installed. GTR have them at ALL of their stations apparently. SWR were always reluctant because they didn’t like the responsibility of having to replace the pads every 5 years or so (or after use). GWR are quite good with them too.
DelayRepay
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Do the TOCs train their staff to use the defibs? In theory, you don't need training but in practice it is important to have confidence if you're ever going to use one in an emergency.
357
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I was never even given a first aid course on stations.
We were told the first aid kits were for staff accidents.
I've used a defib under instructions from a 999 call handler, when you open the lid there are loud audible instructions and it's very easy, however unfortunately it didn't help the poor guy in my situation.
dk1
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Perhaps they train some platform staff but as traincrew I wouldn’t have a clue. Id personally struggle putting a plaster on somebody.
DelayRepay
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That's really what the training needs to cover - the fact that the machine will tell you what to do, and using it cannot make things any worse. As I said, training is more to give confidence, than the actual mechanics of how to use the machine.
That is interesting; I helped someone who fell down steps outside a motorway service station. I sent someone inside to ask for a first aid kit so I could deal with bleeding, and they were told they were for staff use only, but they could not locate a first aider. By the time they found someone, I had dealt with the problem using equipment from someone's car.
I have no first aid training whatsoever as a train guard.
However, I can access the first aid box and give it to someone if needed, I make it my business to remember where I've seen defibs around my network and if it's really that critical I know the basic principles of trying to stop blood coming out of someone, the recovery position or CPR from an emergency life saving course taken years ago when I did zero hours work for the NHS.
I wouldn't stand and watch someone die if it came to it in any case - if you're going to work in a job with safety responsibilities you have to have confidence in your own actions I think. Taking initial steps and knowing when to pass to someone more qualified is important, and how to efficiently summon that help.
However, I can access the first aid box and give it to someone if needed, I make it my business to remember where I've seen defibs around my network and if it's really that critical I know the basic principles of trying to stop blood coming out of someone, the recovery position or CPR from an emergency life saving course taken years ago when I did zero hours work for the NHS.
I wouldn't stand and watch someone die if it came to it in any case - if you're going to work in a job with safety responsibilities you have to have confidence in your own actions I think. Taking initial steps and knowing when to pass to someone more qualified is important, and how to efficiently summon that help.
DelayRepay
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That might be all it takes. When my dad collapsed, it was a passer by who started CPR based on what they remembered from a years old course and instructions from a 999 call handler. He was very lucky that a fast response paramedic car was near by, but they said that it was the actions of the passer by, not the paramedic, that saved his life.
Situations where someone can't be moved off a train for medical reasons before an ambulance arrives are incredibly rare in comparison to the total number of incidents. Generally people can make their own way or be assisted. What you do with them after they're off is likely to be a bigger problem, especially as someone said above if it's DOO + unstaffed station.
One example I recall was with a spinal injury. Pretty much impossible to get one onboard a train but it turned out the person had been in hospital with one and self discharged. They were also large enough that it took a specialist crew in addition to the original ambulance. Luckily in that case we were able to get the train into sidings to await the ambulance.
A few people in this thread making the assumption that stopping near an ambulance station/hospital is a good thing to get a quicker response. It's very rare an ambulance will be sitting waiting to be called out, crew generally go from job to job. So for that reason it's better to have an overall view of where resources are before allocating the ambulance and deciding what to do with the train.
The chance of further medical emergencies on trains trapped behind the incident is decidedly non trivial and something I've had happen a number of times even after quite short delays. That's something people dealing with the original incident don't see as it's someone else's problem.
As a controller I'll ask questions and offer options to those on site when there's an incident, but ultimately I have to trust their judgment as I'm not there.
One example I recall was with a spinal injury. Pretty much impossible to get one onboard a train but it turned out the person had been in hospital with one and self discharged. They were also large enough that it took a specialist crew in addition to the original ambulance. Luckily in that case we were able to get the train into sidings to await the ambulance.
A few people in this thread making the assumption that stopping near an ambulance station/hospital is a good thing to get a quicker response. It's very rare an ambulance will be sitting waiting to be called out, crew generally go from job to job. So for that reason it's better to have an overall view of where resources are before allocating the ambulance and deciding what to do with the train.
The chance of further medical emergencies on trains trapped behind the incident is decidedly non trivial and something I've had happen a number of times even after quite short delays. That's something people dealing with the original incident don't see as it's someone else's problem.
As a controller I'll ask questions and offer options to those on site when there's an incident, but ultimately I have to trust their judgment as I'm not there.
alxndr
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Unfortunately doesn't surprise me. My partner was sent to A&E after a tooth extraction went wrong and was still bleeding several hours later. It was only semi-controlled by biting hard on a non-adhesive swab, but this became completely sodden and ineffective while they were waiting, so were left just having to spit or swallow the blood. A&E wouldn't even consider giving them another bit of gauze until they'd been triaged, leading to the bizarre scenario of me having to empty my car's first aid kit in the carpark of an A&E looking for something suitable.
Individuals often want to help and go above and beyond to do so, but once they feel they're representing a company or organisation they seem to start to worry about getting in trouble/being held liable.
I think it is usually a misunderstanding lead as you say by fear of getting into trouble, generally 100% misplaced.
I did once get into a pickle as a result of helping someone, but not in the way you'd imagine. I found a man who'd possibly nicked an artery standing in a pool of blood on a platform and having experienced it before (his foot was ulcerated) he asked me for the first aid box so he could see if he could stop the bleeding, otherwise he would ask me to call an ambulance.
This seemed reasonable, so using my training I broke into the emergency cupboard with my t key, as I'd been trained. Unfortunately, with sugar glass for some reason in short supply the break glass covers had been replaced with plate glass, which promptly shattered and sliced my fingers to ribbons, leaving me bleeding everywhere too. Still got the scars! I'd have loved to have met whichever clown decided plate glass would do.
If the defib is installed by the Ambulance Service, they often train staff to use them. I know the service I volunteer with (I’m a community first responder) will give free lessons to staff on how to use them when we install them. The issue always remains with the TOCs being prepared to take ownership really.
At my previous TOC I even offered to brief staff on how to use a defib but wasn’t allowed (long story but because it’s not an official first aid course delivered in an official capacity, they were worried about being sued).
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Is unfortunate that people are still really reluctant to use a defib or administer CPR, even taking away the mouth to mouth aspect (this was removed from most ads from the likes of BHF because it was putting people off). Of course another issue is if it’s a female that requires CPR, members of the public (males mainly) don’t want to start cutting bras off. Understandably. Even that now isn’t an issue with defibs. It’s better to do something than nothing at all. And let’s face it, it’s not going to get any worse for the patient if you if you do CPR, but not doing it, they will die. There’s no two ways about it. Nobody has ever been sued for injuries caused by CPR as far as I’m aware (you usually break a few ribs).
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DelayRepay
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That's a real shame. We have a community funded defib in our village and our local first responder runs regular sessions to show people how it works. As I said before, the real benefit is giving people confidence to use it, knowing that they cannot make the situation any worse.
DelayRepay
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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.
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