First Aid - Stations

[D365]

They have been around for many years. I bought one around 2006. Unusually for first aid items, no expiry date.

Indeed - "single use only" is the only form of expiration that I can see.

 

[Robert Ambler]

Is there any requirement/expectation for there to be a certain minimum number of First Aid trained staff at manned stations / principal manned stations, onboard trains, or elsewhere on the railway, such as might apply to rail track maintenance staff, given the public facing nature of much of the railway, or the relative remoteness of where other rail operations take place?

I think the answer to that is yes. The Health and Safety at Work Act and other legislation lays down requirements for all workplaces and other locations regarding the minimum numbers of staff trained in basic first aid. Risk assessments will also dictate minimum numbers of staff with first aid training and equipment provided based on the assessed risk.

 

[357]

TBH, I can sort of see the reluctance to do minor stuff that might deplete a first aid kit intended for workers. But if it's serious and I was trained and I was at my workplace, I'd have more fear of management upset if I didn't act. And in the case of CPR being called for, I'm not sure offending my managers or not would be high up on my list of concerns.

If it was serious the 999 operator tells you exactly what to do.

 

[D365]

TBH, I can sort of see the reluctance to do minor stuff that might deplete a first aid kit intended for workers. But if it's serious and I was trained and I was at my workplace, I'd have more fear of management upset if I didn't act. And in the case of CPR being called for, I'm not sure offending my managers or not would be high up on my list of concerns.

I think the answer to that is yes. The Health and Safety at Work Act and other legislation lays down requirements for all workplaces and other locations regarding the minimum numbers of staff trained in basic first aid. Risk assessments will also dictate minimum numbers of staff with first aid training and equipment provided based on the assessed risk.

As I understand it, there is also a level of responsibility in keeping consumables topped up (i.e. staff responsible for checking and replenishing the kits).

 

[Horizon22]

Is there any requirement/expectation for there to be a certain minimum number of First Aid trained staff at manned stations / principal manned stations, onboard trains, or elsewhere on the railway, such as might apply to rail track maintenance staff, given the public facing nature of much of the railway, or the relative remoteness of where other rail operations take place?

I think the intention is for every Network Rail station, the duty manager or supervisor should have first aid training so there should be 24/7 coverage, but it’s never absolute in reality (training lapsed, new starters, sickness etc.)

 

[Glasgowbusguy]

I understand that quote raised. But there's 999 that tell you want to do in an emergency for first aid. My point being that if you were to follow 999s advice would you still get in trouble with the TOC if you were not qualified to do so? See my grey area?

You can not be punished or harmed by following the advice and guidance of a 999 operator , the question is do you feel comfortable doing first aid on the person.

Do you have correct equipment for first aid at your disposal i.e. AED (which frankly a toddler can use)

 

[DelayRepay]

I think the intention is for every Network Rail station, the duty manager or supervisor should have first aid training so there should be 24/7 coverage, but it’s never absolute in reality (training lapsed, new starters, sickness etc.)

I once offered first aid to someone at a medium sized station. There was a staffed ticket office, a manned gate line and a dispatcher, but apparently nobody trained in first aid. They did let me use their first aid box though. They also insisted on calling an ambulance even though it was a minor injury and the patient did not want an ambulance, and in my opinion didn't need one.

At every company I've worked for the fear was getting in hot water with management rather than the law, and that's what resulted in first aid being refused in all situations where the instructions weren't coming directly from a 999 operator

I think that depends on the nature of the injury. If it's a minor injury I can understand someone who's not trained or confident not wanting to get involved. Although if it is a minor injury then people shouldn't be calling 999 either.

If someone is in a life threatening situation then nobody will stop me trying to help them to the best of my ability. Whilst there are theoretical risks, I would rather defend my attempts to save someone's life in court than live with the knowledge that I might have been able to help them but didn't.

 

[Boilinthebag]

Have to admit that this is the first time I've come across a resuscitation mask - I'm surprised that this wasn't mentioned on my SJA (St John Ambulance) first aid course last year. We practiced on a dummy and talked about legal liability, but only a brief mention of oral expulsion.

This is probably because post covid SJA (and most first aid trainers I believe have not been teaching rescue breaths alongside CPR post covid. I believe this recently changed so pocket masks etc. will be mentioned again on courses.

 

[D365]

This is probably because post covid SJA (and most first aid trainers I believe have not been teaching rescue breaths alongside CPR post covid. I believe this recently changed so pocket masks etc. will be mentioned again on courses.

We were taught how to do rescue breaths, with the proviso that it would not be mandatory. Perhaps will be worth me signing up to a refresher this year.

 

[MargaretNoodle]

This is probably because post covid SJA (and most first aid trainers I believe have not been teaching rescue breaths alongside CPR post covid. I believe this recently changed so pocket masks etc. will be mentioned again on courses.

I'm an SJA member and yes that's correct, rescue breaths are back as of January! It being down to personal choice of the rescuer as to whether to do them of not.

 

[Sebastian O]

From a legal perspective, the First Aid at Work (FAW) regs require risk assessments in place and flowing from that, appropriate FAW training in place for the purposes of providing first aid to employees only. Some companies may choose to extend that towards customers in a customer facing environment, although the same considerations apply such as assault where first aid is forced upon someone, but one could argue this may occur when a staff member doesn’t want first aid.

Duty of care doesn’t exist when attempting CPR, therefore a negligence claim would fail. The only time I’d argue this would possibly be questioned is in a coroners court, where you, as an FAW trained member of staff, refused to render aid without good reason.

 

[43066]

Not according to the likes of The British Resusitation Council, St John, or the British Heart Foundation!

Those organisations don’t make the law. They also don’t say there’s no possibility of liability. The poster I quoted has now clarified his comments.

I suggest you read the full Health & Safety legislation. Whilst there is no "duty to assist" in UK Law we still all have a duty of care to all others.

Which bit of “health and safety legislation” do you think means we all owe a duty of care to all others? Can you cite it?

Not relevant.

It’s absolutely relevant. If there wasn’t a small/theoretical risk there would be nothing to insure against!

In any case the point has been clarified so I don’t think there’s much point discussing it further.

== Doublepost prevention - post automatically merged: 25 Jan 2023 ==

Duty of care doesn’t exist when attempting CPR, therefore a negligence claim would fail.

Also completely wrong! It’s easy to assume a duty of care and if you start administering CPR to someone you will certainly have done so.

 

[LowLevel]

Certainly on board moving trains whilst not a first aider myself (though in a previous life I had to do a basic life saving course) I've always taken it as written that if someone is taken seriously ill then I'll do whatever is necessary, preferably under the direction of someone more qualified by phone or in person.

At it's most disgusting this involved lifting a man of 60 who had drunken himself into unconsciousness in a toilet and then plastered himself in vomit, nearly choking to death in the process out and on to the floor. Luckily I am a fairly large person who enjoys weight training but it was still a struggle and most helpful when an off duty nurse and paramedic came to assist me in handling him further.

 

[Adam Williams]

Even if there's not a requirement for staff to undertake first aid or stock items at smaller stations, I've had success with getting basic treatment for a minor injury when I asked politely at the gateline (I somehow cut myself quite deeply [in relative terms!] on a CCST ticket at Leamington and it was fairly cold, so it bled an annoying amount - I wasn't carrying any plasters).

There's another reason to support E-Tickets on all flows, if you ever needed one..

 

[357]

At it's most disgusting this involved lifting a man of 60 who had drunken himself into unconsciousness in a toilet and then plastered himself in vomit, nearly choking to death in the process out and on to the floor.

In my case a similar type of man also had a heart attack. Unfortunately our CPR was hopeless and CCTV revealed he had been going up and down the line for over two hours.

It's very easy for people to post here what they would like to think they'd do in a situation, the same way we had people in another thread saying how they'd apply brakes, hit the red button on the GSMR and dive out the cab door to tell passengers to move back and sit down prior to collision...

Having been involved in hundreds of medical emergencies over the years, I'll stand by my statement that I'm not first aid trained and won't administer any assistance, unless a 999 operator is giving instructions.

If it's not serious enough for me to call 999, it's not serious enough to need urgent medical attention!

The only exception to this rule of mine was when a pregnant woman was having contractions during the ambulance shortages a few years ago. I ended up taking the station wheelchair and ordering an Uber myself to go with her to hospital. MTR, despite many promises, never did reimburse me. But sometimes, you find yourself in a situation when you know what the right thing to do is.

 

[Runningaround]

The Resuscitation Council UK (the body that sets standards for CPR training) says this about liability:

"Anyone who attempts resuscitation would only be legally liable if it could be shown that the intervention had left a person in a worse position than they would have been in had no action been taken. In the case of a cardiac arrest, this would be virtually impossible, since without intervention death is inevitable." (Cardiopulmonary resuscitation, automated defibrillators and the law)

Sadly, the myth that people who help those in cardiac arrest might get sued for doing so is very prevalent – one in three people say they would not help because they fear being sued. This is despite no one ever being successfully held civilly or criminally liable for making a good-faith attempt at CPR.

Please don't discourage people from doing CPR because they might get sued or arrested – it simply isn't true.

One of the first things they go over in a First Aid course is the myths on being sued when attempting to help someone needing it.
''Nobody's ever been sued for helping to save a life''.
You still get plenty believing it though, even shop workers when assisting someone who tripped over and was stuck on the floor, they left them there and waited for the Ambulance which today can mean hours. At least one member of staff is required to be First Aid trained the shop even has a Defibrillator on its wall, yet they done nothing over phoning 999 and keeping customers away. The myths prevail over even those who attend the courses, which tells me they weren't taking any notice on the course and probably learnt nothing and used it as an excuse for an afternoon off work.

 

[Runningaround]

At every company I've worked for the fear was getting in hot water with management rather than the law, and that's what resulted in first aid being refused in all situations where the instructions weren't coming directly from a 999 operator

Which is the fault of management believing myths over reality.

 

[Runningaround]

I think the intention is for every Network Rail station, the duty manager or supervisor should have first aid training so there should be 24/7 coverage, but it’s never absolute in reality (training lapsed, new starters, sickness etc.)

Some places just have a First Aider to tick a box, whether the First Aider took any notice on the course or not is another thing.

 

[LowLevel]

In my case a similar type of man also had a heart attack. Unfortunately our CPR was hopeless and CCTV revealed he had been going up and down the line for over two hours.

It's very easy for people to post here what they would like to think they'd do in a situation, the same way we had people in another thread saying how they'd apply brakes, hit the red button on the GSMR and dive out the cab door to tell passengers to move back and sit down prior to collision...

Having been involved in hundreds of medical emergencies over the years, I'll stand by my statement that I'm not first aid trained and won't administer any assistance, unless a 999 operator is giving instructions.

If it's not serious enough for me to call 999, it's not serious enough to need urgent medical attention!

The only exception to this rule of mine was when a pregnant woman was having contractions during the ambulance shortages a few years ago. I ended up taking the station wheelchair and ordering an Uber myself to go with her to hospital. MTR, despite many promises, never did reimburse me. But sometimes, you find yourself in a situation when you know what the right thing to do is.

I've had a burst appendix, a nicked artery in an ulcerated leg, a brain aneurysm in a hospital absconder, a spinal tumour causing paralysis, a hat full of seizures, a woman who fell on a bottle outside and had blood pouring out of her and so on and so forth - I am to say the least a bit of a magnet for problems.

The point I agree with was these were all what I would call serious and requiring some intervention to manage, generally guided by a 999 operator, either physically helping or behaviourally by taking charge and providing reassurance.

For "minor" issues I'll hand out the first aid box if need be but I'm not getting involved with treating cuts and washing out eyes.

 

[mpthomson]

I understand that quote raised. But there's 999 that tell you want to do in an emergency for first aid. My point being that if you were to follow 999s advice would you still get in trouble with the TOC if you were not qualified to do so? See my grey area?

No, and no one ever has. 999 operators give clear and simple instructions, and they really are clear and simple, on how to carry out CPR and all a member of staff is doing is to follow those instructions. The instructions are specifically designed and worded (they're read off a script) so that someone with no knowledge of first aid or CPR can carry them out. They will also tell health profesionals what to do in similar scenarios, as everyone reacts to a situation, especially if it's never happened to them before.

This isn’t correct. By undertaking CPR you assume a duty of care to the patient you are treating and if you stuff it up badly enough you could be both civilly and criminally liable. The risk of liability from a good faith attempt at helping is low, but it’s quite wrong to suggest there are no circumstances in which liability could arise.


The fact the insurance is available shows that there are circumstances where civil liability can arise. Note this wouldn’t have any bearing on potential criminal liability.

Sorry, this is completely wrong. It's actually specifically legislated against in law as long as someone acts in good faith, it's covered in the Social Action, Responsibility and Heroism Act 2015.

Those organisations don’t make the law. They also don’t say there’s no possibility of liability. The poster I quoted has now clarified his comments.




It’s absolutely relevant. If there wasn’t a small/theoretical risk there would be nothing to insure against!

In any case the point has been clarified so I don’t think there’s much point discussing it further.

== Doublepost prevention - post automatically merged: 25 Jan 2023 ==



Also completely wrong! It’s easy to assume a duty of care and if you start administering CPR to someone you will certainly have done so.

None of this is correct, please refer to the legislation linked to above. If you act in good faith (ie try your best) there is zero chance of you being sued, and it has never happened in this country even prior to this legislation. There is no assumption of duty of care unless you are a healthcare professional and registered as such, so a doctor, nurse, paramedic etc. Even then if registered as long as you act in good faith then there will be no outcome, either civilly, criminally or in terms of registration.

For lay people, the Resus Council (the UK Govt organisation that decides how resus is best carried out, and that includes informing/advising govt regarding the law. All other reputable organisations eg St Johns, the NHS, the military, BHF either teach to this guidance or promote it) legal guidance is here and it's specifically aimed at those with minimal or no training; https://www.resus.org.uk/sites/default/files/2020-05/CPR AEDs and the law (5).pdf , and this makes it very clear that the only chance someone has of making a claim is if the CPR attempt leaves a person in a worse state than if no attempt was made. As no CPR in cardiac arrests or respiratory arrest inevitably leads to death then the chances of this bar being reached are fundamentally zero.

This is probably because post covid SJA (and most first aid trainers I believe have not been teaching rescue breaths alongside CPR post covid. I believe this recently changed so pocket masks etc. will be mentioned again on courses.

Rescue breaths shouldn't have been taught as a mandatory component of CPR since 2018 or so when the Resus Council changed the guidance. It has nothing to do with Covid, it's more to do with people's general squeamishness and to encourage them to do something, even if it's not quite as good as rescue breaths and chest compressions together. They're still not being taught nagain ow (I oversee hundreds of First Aid and CPR courses a year for my staff, both for the military and in my civilian job). Resus Council guidance has not changed with respect to rescue breaths and any reputable First Aid trainer should be training to that guidance if it's for non-healthcare professionals..

== Doublepost prevention - post automatically merged: 25 Jan 2023 ==

As I understand it, there is also a level of responsibility in keeping consumables topped up (i.e. staff responsible for checking and replenishing the kits).

There is and it's also a requirement for an employer to have a First Aid policy that's up to date and reviewed, stating what provision should be made including the proportion or number of staff that should have training.

 

[43066]

Sorry, this is completely wrong. It's actually specifically legislated against in law as long as someone acts in good faith, it's covered in the Social Action, Responsibility and Heroism Act 2015.

You’ve either not read it or not understood it. That act clarifies that courts should have regard to the circumstances when considering whether a duty of care has been breached in rescue situations, but certainly doesn’t remove the underlying duty of care.

None of this is correct, please refer to the legislation linked to above. If you act in good faith (ie try your best) there is zero chance of you being sued, and it has never happened in this country even prior to this legislation. There is no assumption of duty of care unless you are a healthcare professional and registered as such, so a doctor, nurse, paramedic etc. Even then as long as you act in good faith then there will be no outcome, either civilly, criminally or in terms of registration.

Please cite the provisions of that act which you think mean that a non medically qualified first aider doesn’t assume a duty of care.

I’ll wait.

 

[Sebastian O]

You’ve either not read it or not understood it. That act clarifies that courts should have regard to the circumstances when considering whether a duty of care has been breached in rescue situations, but certainly doesn’t remove the underlying duty of care.



Please cite the provisions of that act which you think mean that a non medically qualified first aider doesn’t assume a duty of care.

I’ll wait.

You said it therefore the burden of proof is on you to clarify why there’s a duty of care!

 

[philthetube]

The only time you would be prosecuted is if you did something totally stupid, such as open heart surgery when you have not been trained in it.

 

[jon81uk]

To add, on several of the training courses (Motorsport) I have been on we also teach mouth to nose resus, as it reduces the regurg problem a little and can sometimes be easier to get a good seal.

On my work first aid training we were told if unable or unwilling to give mouth breaths, just don't do the month-to-mouth and concentrate on the chest compression. If its a cardiac arrest they will have a few minutes of oxygen in the body anyway, so good quality compressions are far more important than breaths.

 

[mpthomson]

You’ve either not read it or not understood it. That act clarifies that courts should have regard to the circumstances when considering whether a duty of care has been breached in rescue situations, but certainly doesn’t remove the underlying duty of care.



Please cite the provisions of that act which you think mean that a non medically qualified first aider doesn’t assume a duty of care.

I’ll wait.

I understand it perfectly, thank you. I deal with this regularly on a professional basis. No-one has assumed a duty of care by providing first aid, unless you are a healthcare professional or on duty first aider, as we have different standards as laid down in our Codes of Conduct or policy/guidelines. Read the Resus Council legal guide as that's the 'Bible' for this, it's clearly stated in there. Current legislation is based on their advice and recommendation as they are the UK subject matter experts. Bear in mind that EFAW courses now are extremely basic for most workplaces, often not much beyond CPR/AED plus use of oxygen and very basic airway management and what to do to try to stop catastrophic haemorrhage, desling with seizures and diabetic hypos and hypers, and most are done in a day for appropriate workplace cover.

These are the legal definitions of those who may have a duty of care (I've noted that you've moved the goalposts to include first aiders, but even then it's not that simple). It's also worth noting that duty of care simply means 'to do something', ie you have to act. The bottom one is relevant in this instance as it may cover nominated First Aiders;

A doctor or nurse responsible for the health and wellbeing of a patient under their professional care,

Ambulance staff dispatched to attend a particular incident,

A trained responder or first aider in a workplace setting because they have willingly taken on this role as part of their employment. This will have involved training to an approved standard in a specified list of competencies.

The bottom line is that if you're a member of untrained staff or the general public (even if they have received FA training elsewhere and may act as a first aider elsewhere) then you don't hold a duty of care to give CPR or any first aid or whilst giving it if you decide to in a public place like a station or even your own home. In any case the only possibility of liability for anyone is where the end result is worse than no first aid attention. We're specifically discussing CPR for this example and there are no circumstances where that would apply as death is inevitable without intervention. You would also not be liable if someone has a DNACPR in situ that you were not aware of and you DID attempt resus.

 

[43066]

I understand it perfectly, thank you. I deal with this regularly on a professional basis.

I find that worrying because, with all due respect, it’s evident you don’t. The legislation you cited above does not do what you appeared to claim (I note you haven’t been able to cite a section supporting your earlier assertion).

No-one has assumed a duty of care by providing first aid, unless you are a healthcare professional or on duty first aider, as we have different standards as laid down in our Codes of Conduct or policy/guidelines.

Yes by stepping in to assist you do assume a duty of care. This is a fairly basic and well established legal principle. If I attempt CPR on someone (say because I mistakenly believe they need it when they don’t) and end up smothering them to death, you’re seriously suggesting I will be able to say “I have no first aid training” and therefore will be able to avoid any potential liability?

It’s beyond the scope of the thread to discuss in detail but (if you’ve got a spare few hours!) look up Donoghue and Stevenson and go from there if you want to read around the tortious concepts of negligence, duty of care etc. and when it can arise. Acting negligently can also give rise to potential criminal liability if you do enough damage (albeit less likely).

Read the Resus Council legal guide as that's the 'Bible' for this, it's clearly stated in there. Current legislation is based on their advice and recommendation as they are the UK subject matter experts. Bear in mind that EFAW courses now are extremely basic for most workplaces, often not much beyond CPR/AED plus use of oxygen and very basic airway management and what to do to try to stop catastrophic haemorrhage, desling with seizures and diabetic hypos and hypers, and most are done in a day for appropriate workplace cover.

I have read it. It’s a somewhat badly worded summary of the position I have already set out. Nothing in there contradicts what I have stated above.

The Resus guide provides:

https://www.resus.org.uk/sites/default/files/2020-05/CPR%20AEDs%20and%20the%20law%20%285%29.pdf

If someone could show that a rescuer owed them a duty of care and that, as a result of the rescuer’s intervention, they had been left in a worse position than if there had been no intervention, the claimant would still have to show the court that the standard of care employed had been negligent. They would also have to show that this negligent care was the reason for them being in
a worse state of health than they would have been otherwise.

And crucially (my emphasis):

Naturally, the standard of care expected would vary according to level of training. For instance, a member of the general public with no training wouldn’t be judged by the same standards as
a trained responder, and a trained responder wouldn’t be judged by the same standards as a healthcare professional. Rest assured, the court would make a judgment appropriate to the level of expertise of the defendant.

Therefore the guidance quite correctly (and in direct contradiction to what you’ve said above!) contemplates that a duty of care will be owed by an untrained member of the public who steps in to assist, albeit that they will be assessed against a lower standard than a medical professional. At no point does the guidance state that no duty of care will be owed by someone choosing to assist, simply because they lack medical training.

It's also worth noting that duty of care simply means 'to do something', ie you have to act.

Incorrect. There is generally no duty of rescue or compulsion to act under UK law. However if you attempt to administer resuscitation/first aid/whatever you assume a duty of care.

This is actually the whole reason why the so called “good Samaritans” act you cited above was introduced - it is intended to make people feel less afraid to assist by clarifying that where people act in extremis the courts will have regard to this when considering whether they have breached their duty. That is absolutely not the same as saying “you have no duty of care unless you’re medically trained” and you are quite incorrect to suggest otherwise.

You can accept that or not - it’s no skin off my nose - but if you make factually and legally incorrect statements you should expect to be challenged.

The bottom line is that if you're a member of untrained staff or the general public (even if they have received FA training elsewhere and may act as a first aider elsewhere) then you don't hold a duty of care to give CPR or any first aid or whilst giving it if you decide to in a public place like a station or even your own home.

You are confusing concepts (to be fair the Resus guide itself doesn’t spell this out particularly clearly). I agree there is no general duty to act in the first place, however if you do decide to act you assume a duty of care which you can breach if you have found to act negligently.

In any case the only possibility of liability for anyone is where the end result is worse than no first aid attention.

So now you’re agreeing there is a duty of care after all!

there are no circumstances where that would apply as death is inevitable without intervention. You would also not be liable if someone has a DNACPR in situ that you were not aware of and you DID attempt resus.

The point is you might mistakenly believe this and then be found to have been wrong. Making absolute statements like you have made above is unsafe, albeit I do agree the risks are so low they they could almost be described as theoretical!

== Doublepost prevention - post automatically merged: 25 Jan 2023 ==

The only time you would be prosecuted is if you did something totally stupid, such as open heart surgery when you have not been trained in it.

For the record I’m also not disagreeing with this at all.

Criminal liability really is vanishingly unlikely. Tortious liability is more likely (perhaps I should say less unlikely), but still a negligible risk, however “I’m not trained in first aid/CPR” is not going to be a defence to either if you decide attempt it and botch it up badly enough.

Nothing in the “good Samaritans” act or the Resus guide changes that basic position.