Medical incidents on board trains

[DelayRepay]

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

I agree you do not need training, and they are very easy to use.

However, without training, would you know that you do not need training? I realise that's a circular question, but if an emergency arose would an untrained passer by be confident enough to use the AED? I suspect not always. And if it was in a railway station, shop etc then I think the public would look to staff to manage the situation unless there happened to be a qualified passer by on scene.

A lot of first aid training is as much about giving you the confidence to act, knowing you're not going to make things worse for the patient. (I realise that in practice the ambulance call handler would give instructions if necessary).

When we did training at my work, there were lots of questions about whether you could accidentally shock the patient etc, so hopefully those who attended the training will be confident to use the machine if it's ever needed.

 

[61653 HTAFC]

To my utter shame - there was an old lady on Swansea bound Saturday train one morning , behaving erratically - I thought she had started very early on the gin or vodka.

Conducter came around and clocked it as a diabetic incident - he got her a glass of milk and and a well buttered scone and jam off the buffet , sat with her and conversed with her - she was recovered in a short time and was fine. Very apologetic - turned out to be a skimpy breakfast , stress in travelling to Padd etc etc.

He, of course . knew from his first aid training - and did an excellent and humane job. Excellent piece of work. I was humbled and learnt a lesson.

(different story on a similar train some while later , where an objectioanable drunk assaulted me and the conducter - drink related - but the excellent police response at Parkway dealt with that) ....

No shame in thinking she was drunk. As a person with type-1 diabetes I can absolutely concur that low blood sugar could easily be mistaken for drunkenness unless you know what to look for. Slowed reactions, slurred speech, unsteady, being both confused and short-fused... all symptoms of both too little sugar or too much alcohol in the system.

 

[stj]

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

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

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

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


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

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

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

Plenty of passer's by ignored him too.

My local stn has AEDs on every platform but its unstaffed.

 

[Trackman]

My local stn has AEDs on every platform but its unstaffed.

Northern are rolling out AED's to unstaffed stations.
Basically it has a keypad and the code can be obtained by calling the emergency services.
I think at major stations you don't a code, but break something or whatever.

I hope they are secure, I read a while back someone broke into one and ran off with it- I'm sure it was on the railways.

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

This is correct, I think the on-board electronics susses out the heart rhythm too, all very automated and well thought out.

 

[johnnychips]

Northern are rolling out AED's to unstaffed stations.
Basically it has a keypad and the code can be obtained by calling the emergency services.
I think at major stations you don't a code, but break something or whatever.

I hope they are secure, I read a while back someone broke into one and ran off with it- I'm sure it was on the railways.



This is correct, I think the on-board electronics susses out the heart rhythm too, all very automated and well thought out.

As somebody said, the defibrillator does give very clear instructions, but in an emergency it is sometimes hard to keep a clear head, especially if you are unfamiliar. I’m glad I’ve been trained.
One thing that I wasn’t clear on - and I wished I’d asked more about at the time - was that it wouldn’t work well on hairy chests, and the machine had a razor in the kit. I wonder how much time you should spend on this, and what is defined as hairy?
If you are not sure what to do, the main thing is to get help as soon as possible. The instructor said dialling 112 was better than 999 but I’m not sure why.
The only time I had to put it into practice was when a bus I was on, upstairs, knocked an old man, who ran into the road, over. Incredibly, another first aider was downstairs, and he had started the DR ABC checks. But I said ‘has anybody called 999?’ and nobody had.

 

[thejuggler]

112 is the worldwide emergency number and will connect from mobiles even if there is no signal on your network.

Last year we were chatting to an RNLI rep and she said to use 112, especially on coastal areas where mobile signal can be patchy as it is better at locating where the call is coming from.

When I called 999 at Christmas the call handler gave the coordinates of where I was calling from as it was from a mobile. Useful to locate a caller if its a fake call, but also good to locate where the incident is happening.

 

[D821]

The only time I had to put it into practice was when a bus I was on, upstairs, knocked an old man, who ran into the road, over. Incredibly, another first aider was downstairs, and he had started the DR ABC checks. But I said ‘has anybody called 999?’ and nobody had.

I did a fire safety course in work a couple of weeks back and the person running it gave several examples of well known incidents with loss of life where no one thought to phone the fire service: Summerland, Manchester Woolworths, Bradford stadium and King Cross. At
Bradford stadium the Fire service turned up as they had been watching the match on the TV and a local taxi driver phoned in the Summerland incident.

 

[Undiscovered]

As somebody said, the defibrillator does give very clear instructions, but in an emergency it is sometimes hard to keep a clear head, especially if you are unfamiliar. I’m glad I’ve been trained.
One thing that I wasn’t clear on - and I wished I’d asked more about at the time - was that it wouldn’t work well on hairy chests, and the machine had a razor in the kit. I wonder how much time you should spend on this, and what is defined as hairy?
If you are not sure what to do, the main thing is to get help as soon as possible. The instructor said dialling 112 was better than 999 but I’m not sure why.
The only time I had to put it into practice was when a bus I was on, upstairs, knocked an old man, who ran into the road, over. Incredibly, another first aider was downstairs, and he had started the DR ABC checks. But I said ‘has anybody called 999?’ and nobody had.

Hairy chests can interfere with the sticking of defib pads to the chest. Don't worry about it.
If the defib isn't attached properly, it won't go past the 'attach pads' stage (Lifepak AEDs used to make a tremendous screech if the pads were loose, the speaking is much better!). Either peel them back and try again, you'll probably give the pt a nice wax, and if that fails, rip them both off and plug in the spare set.

112 and 999 are the same. There used to be a myth about GPS etc, but they both work equally well.

Before I've ventured into any remotely suss situation on train, always a quick chat to drive and if I don't call you in 5 or open doors at next stop, find me!

 

[D821]

Last year we were chatting to an RNLI rep and she said to use 112, especially on coastal areas where mobile signal can be patchy as it is better at locating where the call is coming from.

I don't see how that would be the case - whether you called 999 or 112 the phone's location data would come from the network provider just the same, surely?

 

[jon0844]

I don't see how that would be the case - whether you called 999 or 112 the phone's location data would come from the network provider just the same, surely?

Your phone SIM has a list of numbers that trigger an emergency call. If you dial 999 or 112 it triggers a special call that has a higher priority than normal calls, as well as now sending your location automatically (either via text or a data packet).

I am not sure if you can edit the list yourself, but 112 was useful to remember as it works throughout the EU (and maybe elsewhere in Europe) so would be the number to use from a landline. I hope we don't do something stupid like get rid of 112 here because it is associated with the EU!

 

[D821]

Your phone SIM has a list of numbers that trigger an emergency call. If you dial 999 or 112 it triggers a special call that has a higher priority than normal calls, as well as now sending your location automatically (either via text or a data packet).

I am not sure if you can edit the list yourself, but 112 was useful to remember as it works throughout the EU (and maybe elsewhere in Europe) so would be the number to use from a landline. I hope we don't do something stupid like get rid of 112 here because it is associated with the EU!

I meant I didn't understand how dialing 112 or 999 would give different quality location data.

 

[jon0844]

I meant I didn't understand how dialing 112 or 999 would give different quality location data.

It's exactly the same. I guess the accuracy may come down to your handset though.

 

[Mcr Warrior]

I meant I didn't understand how dialing 112 or 999 would give different quality location data.

Don't 112 / 999 calls work on any available network?

 

[Dai Corner]

Don't 112 / 999 calls work on any available network?

Yes they do. Probably on French networks if you're on the Kent coast and sheltered from UK signals?

 

[Trackman]

It's exactly the same. I guess the accuracy may come down to your handset though.

I just thought it came down to the nearest cell site, is the phone sending GPS data too? (if it can)

 

[D821]

They can triangulate signals too, I believe

 

[Llanigraham]

112 is the worldwide emergency number and will connect from mobiles even if there is no signal on your network.

Last year we were chatting to an RNLI rep and she said to use 112, especially on coastal areas where mobile signal can be patchy as it is better at locating where the call is coming from.

When I called 999 at Christmas the call handler gave the coordinates of where I was calling from as it was from a mobile. Useful to locate a caller if its a fake call, but also good to locate where the incident is happening.

This comes up regularly and isn't true and that has been confirmed by the phone operators and other rescue organisations. 112 and 999 use EXACTLY the same system.

Don't 112 / 999 calls work on any available network?

Yes it does.

They can triangulate signals too, I believe

They can but it needs to be arranged and the accuracy depends on the number of masts it can use. In many rural areas with poor reception it can be very inaccurate if there are less than 3 masts available.
When you do ring 999/112 the call handler is notified what cell you are in, and that can be as small as one Hall at the NEC to many square miles in Mid Wales.

 

[Lloyds siding]

Worrying how many have fear about consequences, when the consequence of not doing anything can be dire.
I've been a first aider and they emphasise in training that you should talk to your patient. I can endorse this having had a medical incident myself: I was very nearly unconscious, not really sure where I was, couldn't see anything (blacked out), but I could still hear. I was reassured to hear a voice say 'I'm a consultant doctor, tell me what happened,how do you feel, is there any pain?' But shortly afterwards he said 'I'm actually a consultant in gynecology, so I'm now deferring to my colleague, who is a nurse and better able to deal with you'!
On another occasion I was sitting in a cafe, two women were dining at the table net to me when one started choking, her companion screamed 'Mum are you choking?' She nodded. I quickly introduced myself: 'Hi, I'm a trained first aider. Can you lean your mum forward a bit and giver some really hard bangs on the back. She's your mum and you'll know how hard you can hit her. If you aren't ready to do that I can do it. If that doesn't work I'm going to stand behind your mum and put my arms round the front below the rib cage and pull really hard to get the food out, but that is likely to hurt her, is that OK?' She said, 'Yes, anything!' Anyway she performed the back slaps well, and the food shot out.
Explaining what you are doing is reassuring to the victim, and helps avoid misunderstandings by companions and onlookers.

 

[jon0844]

I just thought it came down to the nearest cell site, is the phone sending GPS data too? (if it can)

Not all phones have GPS, so I think it will use assisted GPS too (which will be based on cell data) but I am quite certain the latest specs offer highly accurate location. Indeed, I think it's a legal requirement in some countries (starting with the USA).

 

[43066]

The myths your alluding to do get brought up in First Aid courses by the instructor, its to counter nonsense like yours.

Another rude response. As I’ve said above the fact of the matter is that a first aid course *does not* disapply civil or criminal law. If you (or a first aid course instructor) think it does then you fundamentally misunderstand the position. The only “nonsense” I’ve seen on this thread is your own ludicrous claims to give “guarantees” along these lines.

The risk of being prosecuted/sued/accused of inappropriate behaviour might be pretty remote, but *low* risk certainly doesn’t equal *no* risk.

But then you wouldn't be at one.

You’re quite right I wouldn’t be. Along with a very high % of the population, it’s simply not something I have any particular flair for, or interest in learning about. Giving first aid most certainly isn’t part of my job. If I wanted to do that I’d be a paramedic, not a train driver.

Yet I would certainly be annoyed should it was you I helped a child wouldn't have been given any considerations should they need help off you, I mean they might sue you.

This makes no sense and is impossible to follow.

I'd gladly go to court for helping someone out. What would the charge be ''Guilty of assault'' you stopped them bleeding to death by touching them?Should I put in a counter claim for my blood stained T-Shirt?

As is this.

As has been stated this is saferguarded under the legislation mentioned previously.

That legislation is not a cast iron guarantee, though, and it would have absolutely no impact against an allegation of improper behaviour.

If rail staff happen to have done first aid training under their own steam and wish to intervene then good luck to them. In my view it wouldn’t be right for this kind of training to be made compulsory for rail staff as that might then imply an obligation to directly assist in all situations, even where that person doesn’t feel comfortable doing so.

I’d certainly have no objection to it being made available on a strictly voluntary basis, but of course cost considerations will apply. People on here moan constantly about how high fares are and the money for this would have to come from somewhere.

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

I think most TOCs have similar now. Of course that policy has issues in practice as often a call to 999 will result in the operator instructing the caller not to move the patient until the emergency services have arrived and assessed the situation (unless that has changed?).

It’s a little difficult for a train guard (or whoever) to disregard this and again TOC control asking them to do so puts someone basically into an impossible position. In practice what often still seems to happen is an agreement to continue to the nearest suitable station and wait for the ambulance crew there.

I completely accept that the position becomes a lot more tricky with intense metro ops, LU etc. where you’ve then got to weigh up other risks created by people being stuck on trains in tunnels, possibly in hot and crowded conditions, with no access to help until trains start moving again.

 

[Runningaround]

Another rude response. As I’ve said above the fact of the matter is that a first aid course *does not* disapply civil or criminal law. If you (or a first aid course instructor) think it does then you fundamentally misunderstand the position. The only “nonsense” I’ve seen on this thread is your own ludicrous claims to give “guarantees” along these lines.

The risk of being prosecuted/sued/accused of inappropriate behaviour might be pretty remote, but *low* risk certainly doesn’t equal *no* risk.



You’re quite right I wouldn’t be. Along with a very high % of the population, it’s simply not something I have any particular flair for, or interest in learning about. Giving first aid most certainly isn’t part of my job. If I wanted to do that I’d be a paramedic, not a train driver.



This makes no sense and is impossible to follow.



As is this.



That legislation is not a cast iron guarantee, though, and it would have absolutely no impact against an allegation of improper behaviour.

If rail staff happen to have done first aid training under their own steam and wish to intervene then good luck to them. In my view it wouldn’t be right for this kind of training to be made compulsory for rail staff as that might then imply an obligation to directly assist in all situations, even where that person doesn’t feel comfortable doing so.

I’d certainly have no objection to it being made available on a strictly voluntary basis, but of course cost considerations will apply. People on here moan constantly about how high fares are and the money for this would have to come from somewhere.



I think most TOCs have similar now. Of course that policy has issues in practice as often a call to 999 will result in the operator instructing the caller not to move the patient until the emergency services have arrived and assessed the situation (unless that has changed?).

It’s a little difficult for a train guard (or whoever) to disregard this and again TOC control asking them to do so puts someone basically into an impossible position. In practice what often still seems to happen is an agreement to continue to the nearest suitable station and wait for the ambulance crew there.

I completely accept that the position becomes a lot more tricky with intense metro ops, LU etc. where you’ve then got to weigh up other risks created by people being stuck on trains in tunnels, possibly in hot and crowded conditions, with no access to help until trains start moving again.

You seriously go through all this nonsense while thinking ''I might do something but what if I am the first person to be sued''. Just think your equivalent might be the only one present when you or someone very close needs assistance. If it comes to a Coroners verdict will you be happy to see someone doing what you would walking on by or watching, doing nothing? Then will you be looking closely for the First Aiders actions thinking ''what can I earn out of this opportunity''?
You sound like the equivalent of a Youtuber filming an incident rather than helping out.

 

[43066]

You seriously go through all this nonsense while thinking ''I might do something but what if I am the first person to be sued''.

It isn’t just about being “sued”.

Again, rather than dismissing what someone has said as nonsense, you need to explain *why*. You’ve not actually addressed the points I’m making, perhaps that’s because you don’t understand them.

Just think your equivalent might be the only one present when you or someone very close needs assistance.

Well then that’s just tough luck!

If it comes to a Coroners verdict will you be happy to see someone doing what you would walking on by or watching, doing nothing?

Passers by are free to choose to assist or not, there is no general obligation on them to do so under U.K. law. Whether you, I or anyone else likes that is irrelevant.

Action short of first aid intervention such as calling the emergency services/following their directions/appealing for assistance from medically trained personnel also isn’t “doing nothing”.

Then will you be looking closely for the First Aiders actions thinking ''what can I earn out of this opportunity''?
You sound like the equivalent of a Youtuber filming an incident rather than helping out.

Again, clearly completely misunderstanding and misrepresenting what I’ve said. My views are clearly set out above and won’t be changing, so there’s little point in engaging with you further on the subject.

 

[nickswift99]

This comes up regularly and isn't true and that has been confirmed by the phone operators and other rescue organisations. 112 and 999 use EXACTLY the same system.


Yes it does.


They can but it needs to be arranged and the accuracy depends on the number of masts it can use. In many rural areas with poor reception it can be very inaccurate if there are less than 3 masts available.
When you do ring 999/112 the call handler is notified what cell you are in, and that can be as small as one Hall at the NEC to many square miles in Mid Wales.

That used to be the case but is no longer true. Advanced Mobile Location (AML) is used in the UK (see https://en.wikipedia.org/wiki/Advan...on (or AML,usually a Public Safety Answering).

Not all emergency service providers in the UK are able to consume this data currently, but many do.

 

[jon0844]

I did my first first aid training some 20 odd years ago and it's incredible that still today there are still people who think that someone might get sued, even though there have been no known cases, and seem to be helping keep that 'fear' going that might put others off wanting to help.

I mean, I guess if you went up to someone who was taken ill and started to jump up and down on them to get them to 'breathe God dammit' or started to rough them up out of frustration, then maybe you could become the first case.

Let's just stick to the facts; if someone says they don't want to step in and help, they're probably just too scared to. That's fine as there's no legal requirement here to help, and I have to say that I'm not confident either as I've never had to put first aid into practice (beyond dealing with some minor cuts and burns), but saying it's because of a fear of legal action is nonsense.

 

[Runningaround]

I did my first first aid training some 20 odd years ago and it's incredible that still today there are still people who think that someone might get sued, even though there have been no known cases, and seem to be helping keep that 'fear' going that might put others off wanting to help.

I mean, I guess if you went up to someone who was taken ill and started to jump up and down on them to get them to 'breathe God dammit' or started to rough them up out of frustration, then maybe you could become the first case.

Let's just stick to the facts; if someone says they don't want to step in and help, they're probably just too scared to. That's fine as there's no legal requirement here to help, and I have to say that I'm not confident either as I've never had to put first aid into practice (beyond dealing with some minor cuts and burns), but saying it's because of a fear of legal action is nonsense.

Helping someone needing it isn't going just as far as CPR although courses build confidence and any instructor will expel the getting sued myth. It can be simply being there and reassuring them, giving a sip of water, telling them you've phoned an ambulance. Standing doing nothing or worse walking off and leaving them is in my eyes negligence and if your doing this in fear of getting yourself into trouble cowardly

 

[Ken H]

Helping someone needing it isn't going just as far as CPR although courses build confidence and any instructor will expel the getting sued myth. It can be simply being there and reassuring them, giving a sip of water, telling them you've phoned an ambulance. Standing doing nothing or worse walking off and leaving them is in my eyes negligence and if your doing this in fear of getting yourself into trouble cowardly

page 1 of first aid. reassure the patent.

 

[Aaron1]

I boarded a great northern service yesterday for Kings Lynn at Cambridge, it turned out there was a medical incident unfolding on board and we eventually we had paramedics and the air ambulance in attendance, this train was cancelled at Cambridge and we was all put on the following train, when we got on the following train the patient was still on board with the paramedics and doctors, clearly serious but hopefully it had a favourable outcome

 

[Ediswan]

That used to be the case but is no longer true. Advanced Mobile Location (AML) is used in the UK (see https://en.wikipedia.org/wiki/Advanced_Mobile_Location#:~:text=Advanced Mobile Location (or AML,usually a Public Safety Answering).

Thanks for that. I thought I kept an eye open for such things, but had not spotted this one.

 

[dk1]

The ones that craze me are the bloody diabetics who don’t properly control their medication thus requiring urgent attention & messing the rest of the passengers, crew & NHS about unnecessarily in the process Grrrrr!!!

 

[Tim_UK]

One thing that I wasn’t clear on - and I wished I’d asked more about at the time - was that it wouldn’t work well on hairy chests, and the machine had a razor in the kit. I wonder how much time you should spend on this, and what is defined as hairy?

Only shave for a really hairy person. Thin hair is ok. It’s about whether the pad sticks on properly