First Aid - Stations

[Love life]

Hey,

Out of curiosity does anyone know if an employee of a TOC has to carry out first aid on Ill passengers, if they are not qualified to do so?

An example would be that a person has collapsed and needs help. You call 999 and they tell you to start first aid. Is that employee duty bound to start first aid?

Seems to be conflicting information from TOC's in general as to whether they would back you up if you did help.

 

[pdeaves]

if they are not qualified to do so?

I think that points you to the answer of your question. A person cannot do any job, first aid or otherwise, without some idea of what they are doing. Call it training or qualification or whatever you want, but you have to know what you are doing.

 

[Love life]

I think that points you to the answer of your question. A person cannot do any job, first aid or otherwise, without some idea of what they are doing. Call it training or qualification or whatever you want, but you have to know what you are doing.

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?

 

[800001]

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?

Qualified or not I would do exactly what 999 was telling me to do!

Save a life or sit back, I know exactly what 99% of people would do, and that is attempt to save life.

 

[zwk500]

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?

I think this is a question that would need to be asked of TOC management.
Somebody who knows the legal liability on this may be able to give a clearer answer

== Doublepost prevention - post automatically merged: 24 Jan 2023 ==

Qualified or not I would do exactly what 999 was telling me to do!

As would I, and if a toc tried to discipline me I'd contest it.

Save a life or sit back, I know exactly what 99% of people would do, and that is attempt to save life.

Quite a large amount of people in that situation freeze, as it happens. They don't make a conscious decision to ignore the person, they're just in a state of shock almost about what they've seen.
999 call handlers can have to work hard to persuade people to start giving first aid.

 

[Llanigraham]

I think that points you to the answer of your question. A person cannot do any job, first aid or otherwise, without some idea of what they are doing. Call it training or qualification or whatever you want, but you have to know what you are doing.

Not totally correct. For example, the Ambulance Service will instruct any callers on the 999 system to undertake basic aid, including the use of AED machines, and CPR, no matter what their qualifications are. I cannot see how that can be overruled by any employer.

 

[800001]

I think this is a question that would need to be asked of TOC management.
Somebody who knows the legal liability on this may be able to give a clearer answer

== Doublepost prevention - post automatically merged: 24 Jan 2023 ==


As would I, and if a toc tried to discipline me I'd contest it.

Quite a large amount of people in that situation freeze, as it happens. They don't make a conscious decision to ignore the person, they're just in a state of shock almost about what they've seen.
999 call handlers can have to work hard to persuade people to start giving first aid.

Oh I fully understand people freezing. I had a person who ultimately died in front of me, I had to do cpr and use Defibrillator until ambulance crews turned up, but for the first minute or so I froze as never had to deal with anything like that.

I followed ambulance service requests to the letter.

 

[AntoniC]

I have previously reponded to a tannoy request for a First Aider at Southport station , when I got to the casualty they were being looked after by a nurse.
I asked if they needed help and was told no so I went and caught my train.

 

[Mcr Warrior]

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?

 

[357]

From my own experiences, I never had any problems performing procedures that I was being talked through by 999, even when the person died.

The only time I had an issue was when a lady had fallen over, was fine, ambulance refused to attend, but was being dramatic and made a complaint that I hadn't administered first aid. My manager had a right go at me about it, even after being told that nobody on the station at that point was trained to give first aid. His solution was saying that I should have taken the first aid kit downstairs and then asked if anyone knows how to use it...

 

[jeremyjh]

There are no circumstances when you're going to find yourself in legal hot water for a good-faith attempt to follow instructions to give CPR, be they from 999 or from a defibrillator, or from the instructions on a first aid box. Fear of 'doing it wrong' is an impediment to people trying, but doing nothing is also doing it wrong. Even perfect CPR has a minority chance of success when conducted in real-life conditions outside of hospital.

You'd potentially have more to fear from inappropriate treatment for a more minor condition.

Even then, the provider of my workplace training provides liability insurance cover for the duration of the resulting certificate. They also mention that nobody has ever had to try to claim.

If you're on a station and someone is unconscious and not breathing, you definitely want the defibrillator if one is available. Apart from the increase in survival chance, it's a stressful situation and it's helpful to have something barking orders.

 

[pdeaves]

Not totally correct. For example, the Ambulance Service will instruct any callers on the 999 system to undertake basic aid, including the use of AED machines, and CPR, no matter what their qualifications are. I cannot see how that can be overruled by any employer.

OK; I answered on the basis of 'you're on your own' (literally 'do first aid' with no further input). Under instruction from someone who knows what they are doing (emergency services saying do this, now do that, tell me how the patient is responding, etc.) is, in my view, a very different matter.

 

[Love life]

Thanks for the comments

 

[Islineclear3_1]

I think the OP's question should be something like: Is any employee of an TOC required to undergo basic life support training or first aid as part of their role?

 

[43066]

There are no circumstances when you're going to find yourself in legal hot water for a good-faith attempt to follow instructions to give CPR, be they from 999 or from a defibrillator, or from the instructions on a first aid box. Fear of 'doing it wrong' is an impediment to people trying, but doing nothing is also doing it wrong. Even perfect CPR has a minority chance of success when conducted in real-life conditions outside of hospital.

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.

Fear of 'doing it wrong' is an impediment to people trying, but doing nothing is also doing it wrong.

But if you do nothing you don’t assume duty of care and there is no general duty to assist under UK law (such a duty can arise but only in specific situations such as parental responsibility for a child).

Even then, the provider of my workplace training provides liability insurance cover for the duration of the resulting certificate.

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.

== Doublepost prevention - post automatically merged: 24 Jan 2023 ==

I think the OP's question should be something like: Is any employee of an TOC required to undergo basic life support training or first aid as part of their role?

To which the answer is an emphatic “no”.

On a related note, some TOCs will instruct staff to move patients off trains to keep the service running. Personally I’d be extremely wary of following such an instruction, especially if it was contradicted by advice from a 999 operator.

 

[Llanigraham]

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.

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

But if you do nothing you don’t assume duty of care and there is no general duty to assist under UK law (such a duty can arise but only in specific situations such as parental responsibility for a child).

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.

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.

Not relevant.

To which the answer is an emphatic “no”.

Agreed.
However there are requirements for levels of trained personnell, depending on various things.

On a related note, some TOCs will instruct staff to move patients off trains to keep the service running. Personally I’d be extremely wary of following such an instruction, especially if it was contradicted by advice from a 999 operator.

Agreed.

 

[name_required]

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 a good faith attempt is low, but it’s quite wrong to suggest there are no circumstances in which liability could arise.

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.

 

[43066]

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.

Which merely confirms what I’ve said above: there is a theoretical risk of liability. Pretending otherwise helps nobody.

People have been sued in other common law jurisdictions such as the USA. The Resuscitation Council document you link to also confirms claims have been brought against rescuers in the UK, apparently none successfully (albeit one wonders how carefully they’ve checked)

 

[jeremyjh]

@43066 , you're right that I should have worded what I intended to convey more clearly. Legal action could be taken, but it's got pretty much as close to zero chance of success as is conceivable, provided that the circumstances merited, or appeared to merit, the attempt. Of course, that there's essentially no prospect of success significantly reduces the chance that anyone will try to sue you once they've taken advice.

There's loads of detail in this report from Resuscitation Council UK:

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

Their headline point 6: "The courts have always looked benevolently on those who have gone to the assistance of others."

From the executive summary: "The likelihood of causing harm by performing CPR or using an AED is very small indeed. Nevertheless, there has been some concern that should an attempt to resuscitate someone having a suspected SCA result in harm, a legal claim could be brought against the rescuer. To date, there has been no reported successful claim to this effect." ... "There are no statutory laws covering resuscitation but a potential liability could arise if a civil claim were brought by the victim, or their family, against someone on the grounds that intervention occurred without their consent and so constituted an assault and/or battery." ... "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. Added to that, an AED will only deliver shocks if it detects a pattern consistent with a cardiac arrest."

From further on in the report:

"Although there have been a few cases in the UK when a claim for damages has been brought against a member of the public or a first aider who has attempted resuscitation, there have been no reported cases in which someone has successfully sued anyone who came to help them in an emergency situation."

So, your concerns with what I originally said are both fair and don't really change how one ought to act in the circumstances. You can be sued but you're not going to be sued successfully if you act in good faith, and certainly not unless you've done something way outside the bounds of the procedure. So if you're following instructions from 999, or printed or recorded instructions, there's a slight chance of ending up in court but a truly negligible chance of any penalty. Certainly not something that ought to affect one's moral inclination to try to save the life of someone in peril.

The duty of care thing is interesting. Absent a medical qualification, the duty of care means that once you have intervened at all, you have to then do everything that you can. For the average member of the public, this is going to amount to fairly few rounds of CPR because it's a fairly physically demanding procedure. It's true that this does load some responsibility onto you. In normal circumstances, this is going to mean taking all practicable steps to get help and hand over to someone qualified.

@name_required 's post conveys my sentiment about this well. I'm trained and I have no qualms about helping someone, be it in the workplace (where I would be expected to respond) and in public. In practice, on my crowded London commute, there have always been people closer to the incident and/or better trained to handle, but nonetheless I carry a face shield to remove a further barrier to the instinct to act if required.

Bluntly, if someone has had a heart attack outside of a hospital setting they've got a single-digit chance of survival. Try CPR first, worry about lawyers later.

 

[43066]

@43066 , you're right that I should have worded what I intended to convey more clearly. Legal action could be taken, but it's got pretty much as close to zero chance of success as is conceivable, provided that the circumstances merited, or appeared to merit, the attempt. Of course, that there's essentially no prospect of success significantly reduces the chance that anyone will try to sue you once they've taken advice.

There's loads of detail in this report from Resuscitation Council UK:

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

Their headline point 6: "The courts have always looked benevolently on those who have gone to the assistance of others."

From the executive summary: "The likelihood of causing harm by performing CPR or using an AED is very small indeed. Nevertheless, there has been some concern that should an attempt to resuscitate someone having a suspected SCA result in harm, a legal claim could be brought against the rescuer. To date, there has been no reported successful claim to this effect." ... "There are no statutory laws covering resuscitation but a potential liability could arise if a civil claim were brought by the victim, or their family, against someone on the grounds that intervention occurred without their consent and so constituted an assault and/or battery." ... "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. Added to that, an AED will only deliver shocks if it detects a pattern consistent with a cardiac arrest."

From further on in the report:

"Although there have been a few cases in the UK when a claim for damages has been brought against a member of the public or a first aider who has attempted resuscitation, there have been no reported cases in which someone has successfully sued anyone who came to help them in an emergency situation."

So, your concerns with what I originally said are both fair and don't really change how one ought to act in the circumstances. You can be sued but you're not going to be sued successfully if you act in good faith, and certainly not unless you've done something way outside the bounds of the procedure. So if you're following instructions from 999, or printed or recorded instructions, there's a slight chance of ending up in court but a truly negligible chance of any penalty. Certainly not something that ought to affect one's moral inclination to try to save the life of someone in peril.

The duty of care thing is interesting. Absent a medical qualification, the duty of care means that once you have intervened at all, you have to then do everything that you can. For the average member of the public, this is going to amount to fairly few rounds of CPR because it's a fairly physically demanding procedure. It's true that this does load some responsibility onto you. In normal circumstances, this is going to mean taking all practicable steps to get help and hand over to someone qualified.

@name_required 's post conveys my sentiment about this well. I'm trained and I have no qualms about helping someone, be it in the workplace (where I would be expected to respond) and in public. In practice, on my crowded London commute, there have always been people closer to the incident and/or better trained to handle, but nonetheless I carry a face shield to remove a further barrier to the instinct to act if required.

Thanks for clarifying. I’m in agreement with all that (and apologies for being pedantic!) it’s just worth emphasising that low risk isn’t the same as no risk.

Bluntly, if someone has had a heart attack outside of a hospital setting they've got a single-digit chance of survival. Try CPR first, worry about lawyers later.

Absolutely.

== Doublepost prevention - post automatically merged: 24 Jan 2023 ==

London commute, there have always been people closer to the incident and/or better trained to handle, but nonetheless I carry a face shield to remove a further barrier to the instinct to act if required.

Out of interest, would you mind expanding on this? Is it psychologically easier to act if you can’t see the person’s face?

I’ve thankfully not (yet) been in the situation of having to help, so have no experience to draw from.

 

[Mcr Warrior]

@43066 I carry a face shield to remove a further barrier to the instinct to act if required.

Out of interest, would you mind expanding on this? Is it psychologically easier to act if you can’t see the person’s face?

No. They're primarily intended to reduce the risk of exposure to potentially contaminating bodily fluids emanating from the casualty, such as saliva, vomit, blood, etc., whilst performing basic mouth to mouth resuscitation. Helps avoid/reduce the 'yuk' factor.

 

[jeremyjh]

No. They're primarily intended to reduce the risk of exposure to potentially contaminating bodily fluids emanating from the casualty, such as saliva, vomit, blood, etc., whilst performing basic mouth to mouth resuscitation. Helps avoid/reduce the 'yuk' factor.

In the words of my trainer: "If you're doing it right, they are going to vomit." When asked to clarify, he said "every time".

In an unconscious casualty, every chance you're blowing some air stomachwards as well as into the lungs, and that's going to end chunkily.

He said this both to encourage us to carry a face mask and to emphasise the importance of the recovery position in the event that CPR has been performed successfully.

It's a small sheet of plastic that's folded flat into a wrapper. It has a basic valve mechanism folded/welded/cut into it. It lives in my wallet, so I'm always carrying it if I'm not at home. My work bag contains the next level up, which is a slightly thicker plastic sheet with a hard plastic valve. If I drove a car, I'd want the next level up again in my first aid kit, which slightly more resembles a hospital oxygen mask than a floppy plastic square.

These devices *reduce* the risk of an unpleasant time or infection from bodily fluids. They therefore hopefully *increase* the chances that someone will attempt CPR.

 

[D365]

In the words of my trainer: "If you're doing it right, they are going to vomit." When asked to clarify, he said "every time".

In an unconscious casualty, every chance you're blowing some air stomachwards as well as into the lungs, and that's going to end chunkily.

He said this both to encourage us to carry a face mask and to emphasise the importance of the recovery position in the event that CPR has been performed successfully.

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.

 

[Ediswan]

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.

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

 

[jeremyjh]

Courses I've done with SJA in the past have included the most basic level in the training pack. Being SJA, I'm super surprised they didn't try to sell you all of the different types. SJA trainers have always been super keen with groups I've been in to flog us the various kits.

Update: pictures and prices... https://www.sja.org.uk/first-aid-supplies/first-aid-supplies-and-consumables/masks-and-face-shields/

 

[Llanigraham]

Simple resus shield:


I carry a mask in my car, which can be conected into an oxygen system.

 

[Llanigraham]

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.

 

[43066]

No. They're primarily intended to reduce the risk of exposure to potentially contaminating bodily fluids emanating from the casualty, such as saliva, vomit, blood, etc., whilst performing basic mouth to mouth resuscitation. Helps avoid/reduce the 'yuk' factor.

In the words of my trainer: "If you're doing it right, they are going to vomit." When asked to clarify, he said "every time".

In an unconscious casualty, every chance you're blowing some air stomachwards as well as into the lungs, and that's going to end chunkily.

He said this both to encourage us to carry a face mask and to emphasise the importance of the recovery position in the event that CPR has been performed successfully.

It's a small sheet of plastic that's folded flat into a wrapper. It has a basic valve mechanism folded/welded/cut into it. It lives in my wallet, so I'm always carrying it if I'm not at home. My work bag contains the next level up, which is a slightly thicker plastic sheet with a hard plastic valve. If I drove a car, I'd want the next level up again in my first aid kit, which slightly more resembles a hospital oxygen mask than a floppy plastic square.

These devices *reduce* the risk of an unpleasant time or infection from bodily fluids. They therefore hopefully *increase* the chances that someone will attempt CPR.

Many thanks both!

 

[357]

There are no circumstances when you're going to find yourself in legal hot water for a good-faith attempt to follow instructions to give CPR, be they from 999 or from a defibrillator, or from the instructions on a first aid box

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

 

[jeremyjh]

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

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.