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Baroness Masham of Ilton: My name is added to Amendments Nos. 113 and 115, which I strongly support. For years, I have felt that first aid should be taught in our schools as part of the curriculum, but this would be a help. It would target a group of people who really need to be able to help each other when they may be stuck in a car. There was a multiple crash on the M1 not long ago when helicopters had to take people off. When someone is stuck in a car bleeding to death and they do not know what to do and how to put pressure on to stop the bleeding they can die in a few minutes.

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The British Red Cross and St John Ambulance are willing to work closely with the Government to get something workable off the ground. We would not be the first country to have first aid in the driving test. Slovakia and various other European countries have it. They have far more stringent safety guards in their driving—we have grown slack—and triangles are put out in accidents. All cars have to have triangles, even in France. We are lagging behind. First aid saves lives: that should be the message.

If one thinks back to the horrific recent bombings, anyone who was first-aid trained could see how a first aider would be able to help and they would not be frightened. The public were magnificent in the way that they helped each other. They would be able to help each other more in such horrible situations if they had basic first-aid training. I implore the Government to take the issue seriously and to be helpful.

Earl Attlee: I have tabled Amendment No. 114 in this group. These are extremely important amendments. I am grateful to my noble friend Lord Hanningfield for moving his amendment and to other noble Lords who have spoken. I agree with most of what my noble friend has said, but I have a slightly different approach. All noble Lords agree that we have an opportunity for improvement. We know that the Minister is probably not keen on introducing a major first-aid test into the driving test. The Driving Standards Agency—the DSA—should be employing driving examiners, not first-aid examiners.

However, we could require either a first-aid certificate or evidence of first-aid training. Another difficulty with the approach is that youngsters taking their driving test have enough on their plates at that point in their lives. In addition, they will do only the bare minimum of study and then forget what they have learnt. We have a life-skill problem, which I hope that many of us will pursue, particularly when we debate education and health matters.
 
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After Second Reading, mindful of the Minister's anxieties about new tests, I sought a high-quality briefing on the matter and I was lucky enough to be briefed by a senior emergency medicine consultant. I circulated a report of my meeting to many Members who were present at the start of the Committee. Aside from the general discussion on first aid, he was at pains to emphasise that the casualty would die in four minutes, as my noble friend Lord Hanningfield pointed out, if three key life-saving actions were not taken immediately: procure an airwave; immobilise the neck; and detect and control external bleeding.

A casualty is very lucky if he has a competent first aider attend him in the first few minutes, but that is all it takes to die if the immediate action drill is not carried out. However, he would be unlucky if he did not have a competent first aider in seven or eight minutes. The logic is as follows: the casualty will die in about four minutes if his airway remains blocked. Therefore, if the casualty is unconscious, the head needs to be carefully brought back and the jaw pushed forward: that opens the airway. If the casualty is speaking or trying to do so, there is not a breathing problem or an airway problem. The neck must be kept immobilised because the spine could be severely damaged: if one does not know, play it safe. The casualty should not be moved from the vehicle unnecessarily. Lastly, there needs to be a check for bleeding. The casualty can bleed to death in a few minutes from external wounds, but normally it can be stopped simply by applying pressure using anything, not just a sterile dressing. The casualty might be bleeding internally, but additional external bleeding will reduce the chances of survival.

If we did decide to introduce some element of testing, what should be done—especially if we want the DSA to employ driving instructors, not first aid testers? It is very simple. All that is needed is for the candidate to demonstrate at the test centre attempting to communicate with the casualty—"Hello mate. How are you doing?"—procuring an airway by carefully tilting the head back and pushing the jaw forward if necessary, and immobilising the neck and holding it still until more skilled help arrives. The candidate should then state the need to the examiner to search for bleeding and demonstrate applying pressure to the wound to stop the bleeding. It is as simple as that. Those are the three things that must be carried out immediately, in the first four minutes.

There are a number of obvious advantages to this approach. It is a drill involving almost no diagnosis and no specialist skills are required to train or test it. Young drivers would find it easy to explain among themselves how easy the drill is, which means that they will not forget it. There is also a hidden advantage. Passing the driving test is not easy and a certain amount of bottle is required. If the examiner is able to tell the candidate that he has passed part of the test, it is bound to help the candidate's confidence.

The Minister could increase the number of first aid questions in the theory test, but the problem with such an approach is that unless a full-blown first aid course underpins the candidate's knowledge, he or she will
 
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quickly forget. At Second Reading the Minister mentioned the difficulty of candidates who are squeamish. While the drill I have described will cover most cases, it might be sensible to provide for some exemptions with a doctor's certificate. It would be far better to dispense with all the theory questions and go for a very quick practical assessment that tests only the ability to procure an airway, immobilise the neck, and detect and control bleeding. It would mean about 30 seconds' worth of practical testing with a dummy.

Finally, I should like to remind the Committee that this is not my interpretation of first aid requirements at road traffic accidents; it is derived from a briefing by a senior emergency medicine consultant.

Baroness Gardner of Parkes: This is an interesting series of amendments, but I have grave reservations about them. The point made by my noble friend Lord Attlee is sound: that it is not possible to incorporate full first aid training into a driving licence requirement. That is the practical point. The three main areas set out by the consultant are splendid, except that it is not nearly as easy as it sounds to immobilise the neck while opening the airway because it involves two slightly conflicting actions. I speak as someone who has given many thousands of anaesthetics.

However, the biggest problem with the whole issue is the question of liability and litigation. Some 20 years ago a friend's life was saved after a road traffic accident by a doctor who was jogging past the scene. He vanished immediately and has never been traced. We were told clearly that his reason for leaving was because he could have been sued if the patient had not been satisfied with how well she had been treated, even though he definitely saved her life. I know that to be the medical view. While I take the point that a lay person with only basic training cannot be expected to do more than the basic minimum, and in that way the proposal is good, we need to change our law in other respects. We should adopt the French system whereby an obligation is placed upon citizens to be the Good Samaritan, but they are not held liable if whatever is done to aid the injured person is intended to help them. Here, however, there is a great reluctance to help anyone for fear that they will not be 100 per cent pleased with the outcome. It is an interesting issue and should certainly be considered.

In serious cases—someone mentioned the recent terrible bomb incidents or train crashes—any degree of first aid knowledge is extremely valuable. However, if this is something that everyone has to acquire in order to pass their driving test, I am not sure that a good enough standard will be achieved. The points made by the noble Earl, Lord Attlee, could well be incorporated in the Highway Code or in advice to people. Then it would be up to people to do their best. I do not think that this Act could cover the change to a Good Samaritan system whereby you were obliged to help people and if you did not do so you were at fault. That change would be needed before these measures could really work properly.

Baroness Gibson of Market Rasen: I rise as one of those who mentioned at Second Reading the views of
 
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the Red Cross and its support for legislation of this kind. The Red Cross and St John Ambulance have been working hard for the Government to hear their voices on this issue. I recognised at Second Reading that there were some practicalities in relation to the kind of first aid training that would be given—the noble Baroness has just outlined some of them. However, I believe that the amendment of the noble Earl, Lord Attlee, has overcome many of them because it calls for,

not extensive knowledge of first aid. I hope that, with the help of the Red Cross and St John Ambulance, the Government will come up with some support for these amendments. I hope that my noble friend will give us a favourable response.


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