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The ups and downs of being a public spirited citizen around public… - John C. Kirk

Oct. 7th, 2006

03:58 pm

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The ups and downs of being a public spirited citizen around public transport...

A few weeks ago I was coming home late, and wound up waiting at Waterloo Bridge for a while for a bus to turn up. There was an automated ticket machine bleeping (some kind of error), so I figured that I might as well phone the number they gave to report it. I was expecting an answerphone, but I actually spoke to a person (almost immediately) who took down the machine's ID number and said he'd send someone out. He asked whether I needed a refund (if I'd put money in and not received a ticket) but I told him I already had a travelcard, so he seemed pleasantly surprised and grateful that I'd made the effort to help them out - in return, that was a nice reaction that cheered me up for my journey.

Last week I was coming back late again, so I used a Cadbury's vending machine at a tube station to get a chocolate bar. Or at least I tried to, but it didn't work and the coin return slot was jammed up. Again, I phoned it in (this time I did leave a message at the answerphone) - it was only 60p, so not a huge amount, but I left my address anyway. I've now had a £1.50 voucher through the post, with a nice letter of thanks/apology, so that's all turned out well.

So, the people who run vending machines all seem to be doing a decent job. Sadly, the staff who handle medical emergencies aren't keeping on their toes quite as well.

On Thursday evening I'd just gone through the ticket barriers at East Croydon (on my way out) when I heard an announcement over the tannoy, asking for a doctor or nurse to go to platforms 1 and 2. I'm neither, but I do have first aid skills; in fact, I did my AED requal on Wednesday evening, which included my first assessment under the new resuscitation protocols. So, I figured it would be worth going along to see what was happening and offer my assistance - if there was already a doctor present then I could leave him/her to it, but if I was the only one around then I might be able to make myself useful. So, I went down there (one shared platform area between two tracks), where a train was just leaving platform 1. This was quite convenient, because it meant that the member of staff who'd waved it off was now free, so I approached him.

Me: "Excuse me."
Him: "Yes?"
Me: "I heard your announcement saying that you were looking for a doctor or a nurse?"
Him: "Um, hang on."

He didn't know anything about it, so he used his radio to call into control. He didn't get a reply, possibly because his radio wasn't working, so he then went into the little shed thing to use the bigger radio there. Still no reply, and the other 2-3 members of staff in there didn't seem to know anything about this either. While he was waiting, I clarified that I was just a first aider, not an actual doctor or nurse, and he nodded. When someone did reply to his radio call, he then said "I've got a nurse here"... Anyway, he wound up getting bounced around a few people, as each person he spoke to told him to call someone else.

By this point it was literally 5 minutes after the original announcment, so I was hoping that it wasn't, y'know, an actual emergency or anything like that! Anyway, he eventually got through to someone, and I heard them say "It's ok, I've got someone with medical skills here". That's a slightly vague description, which makes me wonder whether they were a first aider too. Anyway, the guy I was with then turned to me to relay this message, and he got about half way through the sentence "Ok, it looks like we don't need you, but thanks anyway", then he was interrupted by something in the shed. I wasn't particularly bothered about being thanked, but I thought it would be rude to walk off, so I hung around. After a minute or so, he was carrying on his conversation with the other person, so I did leave, and waved through the window at him to let him know. He then stuck his head back round the door to say "Ah, yes, thank you", which I acknowledged.

All in all, no harm done, so I guess there's a happy ending. However, to use the cliche, it's a hell of a way to run a railroad... Why didn't the staff on that platform know anything about this? I remember totherme talking about the tendency to ignore announcements while travelling (on the basis that they're mostly irrelevant), so maybe the same thing applies to people who hear them all day? The thing is, presumably some other member of staff had told the tannoy guy about the need for a doctor/nurse, but this message hadn't gone through the staff channel either. I don't blame the people I spoke to; I suspect that this is a management issue, either because they don't have a protocol for this type of situation or because the staff haven't been trained in how to follow it. I probably ought to report this to someone, but I fear that it would fall on deaf ears, based on past experience; it's been almost two years since I contacted London Transport about smoking on buses, and they've never replied. I think the best bet for next time is just to ignore the staff and walk the length of the platform myself, looking for the casualty, even though this seems like a sub-optimal solution.

Comments:

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From:totherme
Date:October 7th, 2006 04:16 pm (UTC)
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I guess it was probably a fairly minor thing that the staff are used to happening fairly regularly... How many times do you think someone faints on a platform or similar? I suspect that if something more urgent was going on, then it would also be unusual, so most of the staff would be more aware of it - since it would break their routine.

As for the most efficient way to make yourself known to the person that needs help, short of an implausibly technical solution the best I can think of is to walk the length of the platform while holding a billboard announcing your first aid skills. That way you can search for the victim, and anyone looking around for a first aider can recognise you - so you don't have to go through inefficient internal channels.

Of course, if you don't want to carry around a billboard, some sort of St Johns merch might work too :) My first thought was your uniform hat, but that just looks like a police cap, so it probably wouldn't work. Perhaps keeping a first aid kit with a big red cross on it in your bag might do?
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From:johnckirk
Date:October 7th, 2006 04:41 pm (UTC)
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I guess it was probably a fairly minor thing that the staff are used to happening fairly regularly...

I wouldn't have thought it was that common. Putting it another way, I assume that they have staff on duty with basic first aid training, so it should be unusual and/or urgent for them to require assistance from the public. (I'm guessing that the average member of station staff doesn't know all the details between doctors/nurses/paramedics/etc. in terms of their skill levels, so they didn't specifically need someone who could prescribe drugs or suchlike.)

Perhaps keeping a first aid kit with a big red cross on it in your bag might do?

I keep gloves and a pocket mask in my rucksack, sometimes with my SJA ID card. I could carry my tabard too (high-vis waistcoat thing), but I don't want to lug too much stuff around all the time :)
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From:sammoore
Date:October 7th, 2006 06:12 pm (UTC)
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I carry a few things almost all the time.

I have a small field hosptial in my car and I carry a comprehensive (right up to SAM splints) on most activities, whether with my friends or with a group for work.

This shows the small kit I made up to increase the odds of me saving the life of someone when weight/size matters. Mostly this is climbing or mountaineering but I have also used it for travelling. It is tiny (see the biro next to it), waterproof and could easily live in the bottom of a bag.

Sam
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From:johnckirk
Date:October 7th, 2006 06:25 pm (UTC)
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Interesting, thanks. I have been issued with a small "bum-bag" first aid kit by SJA, but it doesn't hold much, and I need to get it restocked. The main problem with things like gauze is that they have "use by" dates, so there's a trade-off in buying enough stuff to avoid running out without buying too much so that you'll have to throw some away. In my case, when I'm off-duty I'm normally in a well-populated area rather than somewhere remote, e.g. if I'm at a station then I assume that I could use their first aid kit to make a sling.

I bought a few things from St John Supplies recently, but they don't expire - pocket mask, penlight, tough cut scissors, and stethoscope. The stethoscope is for me to practice hearing a pulse with, so I won't be carrying that around with me (or at least not until I'm ambulance trained). My uniform shirts have a special pocket to hold pen lights (the chest pocket on the left hand side has a separate section about 1cm across), so I'll carry that with me on duty, but probably not the rest of the time. I'm not sure about the tough cuts, mainly because I might get awkward questions if they set off metal detectors and/or get classed as a weapon.
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From:sammoore
Date:October 7th, 2006 06:45 pm (UTC)
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I carry tough-cuts in my big kit. I have never had any problems and they have been very useful for all manner of things, not just first aid. (Have you tried cutting a penny in half?)

I can't see that carrying a pair of scissors of any sort will get you in trouble. Mind you, I routinely carry a 4inch knife as part of my river rescue kit and thats never caused me any problems.
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From:susannahf
Date:October 8th, 2006 09:21 am (UTC)
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The only first aid equipment I routinely carry (ie. every day in town) is a couple of pairs of gloves, and a little tin of plasters, which also houses my emergency medication. I have a mini-maglite on my keyring. I figure that I'm unlikely to need more than this in an urban situation, where an ambulance or full first aid kit should be less than 8 minutes away, plus all of the individual items are useful in their own right (most of the gloves get used for putting chains back on bikes). If I have my usual rucksack with me, I also have alcohol hand gel.

If I'm going somewhere a bit more isolated, or I'm doing something where I might reasonably expect to encounter injuries (eg. an interdepartmental football match), I'll take my little kit, which also has wipes, a variety of dressings, bandages and tape, more plasters/gloves, another mini-mag, a pair of scissors, face mask, space blanket and alcohol hand gel. I'm currently putting together a bigger kit in a small rucksack which will also house things like a steth, ice packs, and a HSE-kit volume of bandages, since I'm doing quite a bit of volunteer work with a local charity, and they often ask me to act as a first aider, so I'd like to have more volume for that.

If I was going walking/climbing, I might want yet another balance of things. It's all to do with the likely risks and availability of help.
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From:shuripentu
Date:October 8th, 2006 01:57 pm (UTC)
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Gauze has use-by dates? That's weird; I can't see gauze going off.

In any case, if you have any expired items that you can't use for professional first aid stuff (I can see SJA might get upset if their members were using first aid equipment that wasn't certified totally safe), I'm always happy to make use of them.
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From:johnckirk
Date:October 8th, 2006 02:03 pm (UTC)
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Actually, I'm not 100% sure about gauze, but dressings and so on do have these dates unless they're really ancient; every so often we'll dedicate a class night to going through all our first aid kits and removing the things that have gone past their expiry dates. Anyway, I'll keep you in mind if there's anything that's about to get binned.
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From:sammoore
Date:October 8th, 2006 08:15 pm (UTC)
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My 'personal' first aid kits are stocked with the items that have gone out of date from my 'work' kit. When the dressing I have fails to save someones life because it is 1 month past its useby date I will change this system :-)


Sam
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From:susannahf
Date:October 8th, 2006 10:01 pm (UTC)
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sterile gauze does, because they can't guarantee it's sterile after a certain time. But like sammoore says, it's unlikely to kill someone (unless it's obviously mouldy, which I have seen before now on dressings that are over 20 years old and have been kept in a cardboard box in a damp shed).
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From:susannahf
Date:October 8th, 2006 09:02 am (UTC)
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I've had exactly the same experience at east croydon - was shunted round 2 of the 3 platforms before they realised the casualty was at the gates (I'd been going down the underpass), by which time a doctor had turned up. But, yes, I was appalled at their lack of organisation.

Plus, they really ought to have their own first aiders (not just morally, but legally), and they don't seem to...
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From:sammoore
Date:October 8th, 2006 10:23 am (UTC)
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As an outdoor instructor, it is required that I have a valid first aid certificate in order to work.

This I expect and understand. What amazes me is that teachers are not required to have any first aid training at all. At the school I used to work at, it was more likely that you would bump into a pupil with a first aid qualification than a member of staff.

If we can't have it in the national curriculum, can we at least have it in the PGCE?

Sam
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From:johnckirk
Date:October 8th, 2006 10:48 am (UTC)
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For a school, I assume that someone has to be qualified, e.g. a matron/nurse? However, I still think that it would be a good idea for all teachers to do the 1-day "appointed person" course, even if they don't do the full 4-day FAW course. (Or whatever the new equivalents are going to be.)
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From:susannahf
Date:October 8th, 2006 11:32 am (UTC)
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Yes, someone does have to be. It's usually a receptionist
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From:sammoore
Date:October 8th, 2006 11:48 am (UTC)
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Or a lab technician in the science departments. My belief is this isn't just related to schools but to all workplaces.

Sam
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From:johnckirk
Date:October 8th, 2006 02:10 pm (UTC)
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There are HSE guidelines that cover workplaces, although there aren't any fixed rules - the idea is that you do a risk assessment (based on factors like the number of employees and the nature of the business) and then work out what you need based on that. For instance, at my last job we only needed one appointed person, so two of us went on the training course for that (in case one of us was on holiday).

There's some more info about this on the HSE website, e.g.
http://www.hse.gov.uk/firstaid/faqs.htm
http://www.hse.gov.uk/pubns/indg214.pdf

One interesting aspect is that technically an appointed person doesn't need to have any first aid skills; they are just responsible for making sure that the first aid kit is up to date (nothing past its expiry date) and taking charge in an emergency (e.g. by calling an ambulance). In practice, the one day course that various organisations offer (e.g. SJA, Red Cross) will include things like CPR, but there's no assessment to get the certificate. I heard about one trainer who issued the certificate to his dog, on the basis that it had satisfied the attendance requirements...
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From:susannahf
Date:October 8th, 2006 10:04 pm (UTC)
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No, there aren't fixed rules, but I think a station with the throughput of East Croydon (and all the associated dangers of big lumps o' steel travelling at many mph) would find it hard to argue that they only need an appointed person. Unfortunately, these things don't get checked until someone gets hurt/killed to a certain level (a reportable incident), when the HSE come in and smash heads together.

I guess this is almost a reason not to respond to a call like that, but I'm not sure I could live with my conscience knowing that I'd abandoned someone I could have helped.
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From:johnckirk
Date:October 11th, 2006 12:20 am (UTC)
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Yes, I know what you mean. I think there's a parallel with the last ambulance strike, when SJA filled in for them; that arguably reduces the incentive to treat the paid ambulance crews properly, but I'd feel bad about letting other people get caught in the crossfire.

In the case of East Croydon, I was thinking about using that argument if I asked them about their arrangements and they were uncooperative; basically, "if you want me to help you out then you should answer my question". The snag is that it's the person who's collapsed who really needs my help, rather than the current manager in charge.

Anyway, I think I will write a (paper) letter to the station, and ask them about this. If they don't come back with a sensible reply in a month or so, maybe I can then contact the HSE directly, and ask them to investigate.
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From:totherme
Date:October 8th, 2006 04:02 pm (UTC)
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johnckirk said:

I wouldn't have thought it was that common. Putting it another way, I assume that they have staff on duty with basic first aid training


susannahf said:

Plus, they really ought to have their own first aiders (not just morally, but legally), and they don't seem to...


...yeah, I was under the impression that they didn't have first aiders of their own too. And it sucks. And it means that they have to call for a helpful passenger every time someone twists their ankle, which means that the regular staff start to tune out the first aid announcements, which in turn is why none of them could help either of you find where the patient was. I hope that if something genuinely serious were to happen, they'd have a different way of asking for help, which would make the regulars take notice, and point the way a bit more efficiently. Possibly that's just me being a bit optimistic though... ;)

(Hm - long sentences. Possibly a sign that the orginisational incompetence bugs me... ^_^)
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