Reader Aira is working on a development progress about bystander reactions and the various ways in which bystanders react in distress or emergency situations. If you have relevant experiences you’d like to share with her, you can email her at: aira [dot] planting [at] northonetv [dot] com.
Aira’s request has lead to some discussion about typical bystander reactions. From my experience, the typical bystander reaction is this:
1) Ring 999, even though you can see at least four people doing the same. If you happen to be passing on a bus or car, and have no idea where you are, do this anyway, and under no circumstances get off the bus to help, as this may make you late for an important engagement, such as a church service.
2) Swear repeatedly at call taker for asking you stupid questions like “what’s happened?” and “where are you?” Hang up phone. If call taker is impertinent enough to ring you back again, switch phone off.
3) Refuse to follow first aid instructions such as controlling bleeding and doing CPR - those are the ambulance service’s job! Put patient in recovery position, even though he is fully conscious and has broken arm.
4) Switch phone back on and ring ambulance service to berate them for not being there yet. You rang two whole minutes ago! Become stunned at incompetence of call taker when you tell him you’re ringing about “the accident outside Tesco’s” and he does not realise which of the 200 calls taken in the last hour you mean instantly. Hang up again.
5) Give patient cup of tea and cigarette. Stand back as patient starts to vomit.
6) Flag down police patrol car. Tell police you called for an ambulance half an hour ago but none has arrived. Police ring ambulance control who have no record of the call, but have been trying to contact a person who rang back “an accident outside Tesco’s” five minutes ago, but whose mobile phone seems to be malfunctioning and repeatedly dropping the call.
7) Ambulance arrives. Yell at ambulance crew for taking too long. Tell them how to do their job, as you read in Metro lately that all ambulances are staffed by technicians who have no training.
Go home and tell everyone how dreadful the ambulance service and how the patient would never survived without your intervention. Sell story to local newspaper. Be acclaimed as local hero.
February 5th, 2007 at 3:59 pm
Sounds about right - but you missed out the bit where they ring the service back - hang up the phone asking you to call them back so you do the good thing and call them back (making a metnal note to tell them that 999 is free!) so you ring them back just to have them yell down the phone about how s*** the nhs is - how they can’t believe they pay taxes to “be treated like s***…” and so on and so on until they stop for breath and you calmly ask - do you need an ambulance - to which you receive more abuse during which they tell you that they called for an ambulance half an hour ago - you ask them the address and it turns out they rang about 3 minutes ago - bystanders have no sense of time - which i can understand if someone they care about is poorly/injured - but this guy was more bothered about his shoes which were covered on vomit?!
February 5th, 2007 at 7:02 pm
My pet hates are the bystanders who are soooooo concerned about the collapsed person/unconscious drunk/no fixed abode person having a nice sleep that they call 999 but don’t go over and see if they actually are really ill and in fact don’t actually wait around till the ambulance turns up - they just call 999 and then b****r off.
My favourite ever bystander was the one who had put a spoon in the mouth of someone who’d just had a funny turn and been rather sick, ‘to prevent them swallowing their tongue’. The patient was sitting up and fully conscious (and looking a bit cheesed off at having cutlery shoved down their throat no doubt) . This person then repeatedly refused to remove the spoon when I asked them to, and in fact looked at me as if removal of the spoon would result in instant death, although I only wanted to put an oxygen mask on, honest.
February 5th, 2007 at 8:33 pm
From my experiences (patient side), ambulances being summoned aren’t the usual result when I collapse or faint, although it has happened a couple of times.
It’s water.
People who aren’t ignoring me completely, always offer me a drink of water.
Sometimes they offer other sorts of help as well, but the water is a constant.
I have no idea why.
February 6th, 2007 at 12:08 am
I like the ones who wave you down as you approach the scene of a multi vehicle pile up big enough to be seen on Google Earth!
February 6th, 2007 at 1:06 am
Kingmagic,
You beat me to it!
Great pile of smoking wreckage infront of you, you are just picking the place where you are going to park, and there’s some nutter pointing at the said pile of wreckage just incase you missed it.
Add to that, getting abuse or the side of your vehicle punched/kicked because your siren has interrupted some prats mobile phone conversation as he staggers home in the middle of the road.
Video recording incidents, particularly if the helicopter is involved… what’s that all about? Does the arrival of the Parrot mean that patients confidentiality/dignity is no longer valued?
SD
February 6th, 2007 at 3:18 am
SD, that’s always something I’ve ever understood - they’ll be a major accident or something and then on the news they always seem to have someones amateur video footage to show. Why is the person standing there filming instead of helping/getting out of the way? Although it satisfies the curiosity of viewers at home, you’ve got to admit, it’s a bit warped.
As for bystander experiences, I don’t have many. One time I had to call an ambulance for a man lying in the road with his head against the curb. I was useless because I couldn’t find a road sign to tell the call taker the name of the road. Still, the ambulance arrived promptly, and in the mean time a man had stopped (well, he had no choice, my car was blocking the road) and got a blanket out of his car for the patient.
Another time a lad that I knew was sitting on the ground at a busy bus terminal, and he’d been sick everywhere and was looking very ill and drowsy. No one stopped to help him, they just walked past or stared. I presume that they presumed he was drunk, (even though it was early in the day and he was obviously too young to have been drinking in a pub) but actually he suffers from migraine. I didn’t have a mobile phone then, so I rushed to a phone box to call his Dad. Poor kid. It must be awful to be so ill and people just walk past you staring.
February 6th, 2007 at 5:17 am
Thanks Mark!
That really made me laugh, it’s spot on.
Especially the recovery position. I’ve had so many bystanders proclaim “I’m a qualified first aider” then either roll the spine injury person into the recovery position, or spend so long explaining they’re qualified they forget to start CPR.
February 6th, 2007 at 11:19 am
Thanks Mark. And, dullahan_999, you’re spot on!
I was at a training session last night, and we had a newbie turn up. They proclaimed, “Yes, I’m already FAW-qualified”, so we gave her the usual, “OK, can you please show us how you’d deal with the following scene.” The scenario was simply another lady unconscious on the floor.
I’ll tell you what, the member in question’s treatment was good. She did everything right, except it took her about 15 minutes of arguing with herself before she decided what to do and how to do it…
Oh, and when we got to the end of it, I asked her, “OK, what are you going to do now?” She was like, “Nothing.”
“Nothing?”, I queried. “Not even ring for an Ambulance?”
“Oh, I didn’t think of that.”
As you might have guessed, she won’t be going out with St John anytime soon!…
Thanks again Mark,
Regards
Nick
http://nickhough.blogspot.com
February 6th, 2007 at 12:06 pm
Mr Mans Wife,
It goes beyond that, I have come across people who look for this sort of event to film, I understand from colleagues in other areas that it’s not just round here.
We don’t see so much of it since we moved from passing virtually 100% of our information over the radio to using the data terminals and mobiles. Some bloke would turn up on the motorway and take pics of patients, wreckage and bodies from the other side of the road with a long lens, he’d often be there before some of the emergency vehicles.
I don’t know if he was a freelance photographer, I don’t really care either, his actions defined his morals and he was almost certainly illegally monitoring radio traffic.
SD
February 6th, 2007 at 12:36 pm
WC’s or waving c***s always make me laugh.
The thing I find most interesting though is when people get the hump when you turn up at a suspended or an RTC and they say “I think his handss bleeding”. I dont mean to be rude and ignore them but it’s not really my main concern.
The other day, while I’m here, I was at an RTC where someone had helped a young bloke out of his over-turned car into his nice new sab. C and T spine pain. Had to try very hard to avoid having the lid removed from this bystanders car. Dont think he would of liked us for that one.
February 6th, 2007 at 4:35 pm
Hello Mark,
Thanks for the post. I am very interested to see that you mention the fact that 4 other people are calling. Are multiple calls a nuisance? How do you deal with this? Are they as much of a problem as malicious calls? As a complete lay person, I always try to go by the adage that it is better to have everyone call in an incident rather than assume everyone else has done it. Apart from the fact that it ties up staff at CAC, I assume that sometimes it must be useful - not all eye witnesses are as reliable as each other, and some may be more willing to help (e.g administer CPR at the instruction of the CAC). I can remember that there was also a public service broadcast thing on this subject some years ago.
As I say, I am curious about this from the other side of the fence. I have had cause to call the fire brigade on a couple of occasions, and remember being told by a friend on one of those occasions that some one else will have made the call. At the time, I thought that was a risk that I was not prepared to take. However, I did stay and be as helpful as I could, so hopefully avoided several of the mistakes that you mention in your post (although I did not attempt to put out either fire!). What are your thoughts on this please?
February 6th, 2007 at 4:47 pm
I once had a bystander at a motorcycle RTC tell me that I was not allowed to remove the motorcyclists helmet and that I should wait for the professionals. I wouldn’t have minded this sensible adivce but I had just got out of a big yellow ambulance with blue lights flashing and wearing an RTA jacket. If I was not allowed to remove the helmet then who is?
February 6th, 2007 at 4:48 pm
I wouldn’t lump multiple calls in with malicious calls at all, but they can cause problems. For instance, when there was a large accident in Islington, we had 50+ calls which jammed the phone lines for 5 minutes, which is long enough to make the difference between life and death for someone else waiting to get through. It’s fair enough to call when you are not sure if someone else has phoned, but it’s often the case that people ring in mention that they can see someone else calling, and it would be far better if they asked that person “are you calling 999?” rather than calling themselves straight away. We also get people calling in who have no idea what has happened or where it has happened, giving details so far from the truth that we end up sending a second ambulance on a wild goose chase.
It’s always best that the person making the call gets as close to the patient/scene of the accident as is safe, then they will be able to give us the correct details and will know if anyone else is currently making the call. Anyone thinking of calling 999 should shout “has anyone called 999?” before doing so. I reckon that would seriously cut down the number of duplicates.
February 6th, 2007 at 7:06 pm
Another bystander I had the misfortune to meet (most are good people with good intentions by the way) was the woman who kept barging past me to do a chest examination on a female cyclist who ahd crashed into a concrete lampost.
The casualty was alert, had not been unco, was breathing fine, no chest pains on inspiration, main complaint being pain in her hips.
Three times this woman pushed by me whilst I was talking to the casualty and kept touching her saying “I,m a first aider with ** ***** so I know what I,m doing!”
I had to forcefully point out that I was a Paramedic with a big ambulance parked nearby and that if she carried on I would call the police and have her arrested for assault. She eventually got the message and buggered off!
February 6th, 2007 at 7:32 pm
Where does “bystander” and “helper” collide? I know in America people are afraid to assist in any incident for fear of being sued. Are we there yet in the UK? As I said in previous posts (not on this thread) I’m totally up to date with FA but get scared in helping people. I’d quite happily do it for a mate, but strangers…I don’t know. Prefer to leave it to the professionals.
February 6th, 2007 at 9:02 pm
Simon Gray…
There are a few legal definitions dotted about, but if I remember correctly, if you are acting with good intentions AND within the limit of your own abilities then your pretty safe in a court. Following basic first aid principles and not getting carried away shouldn’t get you sued.
Plus, to quote the EMD big book of quotes. Good doctors get sued, bad doctors get sued, nice doctors don’t. People aren’t likely to sue if they know your trying to help them and be kind.
February 6th, 2007 at 10:21 pm
dullahan_999…
Thanks for that reply, it’s just I was recently told by St John, that as a volunteer never to attempt CPR in case it goes horribly wrong. Pfft, I suppose graphic designers should just hide behind computers…
February 6th, 2007 at 10:36 pm
Just to add to the comments before on duplicate calls. There was an incident where two people inside a house both calling for a 3mom who had arrested called at the same time from the same room, myself and another call taker sitting behind me recieved the calls.
We were all pretty amazed that they must have been looking at eachother if not at least hearing eachother, (i could hear both ends of the other call)!
It shows how when your in a panic your not always aware of your surroundings, good ol’ tunnel vision sets in!
My favourites are when people are driving the opp side of the m’way and report a car accident and they are sure someones trapped, however someone has broken down and a nice passerby has arrived to assist them. And then, im sure to their amazement, they get the assistance of a FRU, Ambulance, Fire and Highway Patrol too!
February 6th, 2007 at 11:03 pm
Myself and my crew mate recently attended a ?suspended call at a local old people’s home. En route to the job, dispatch advised that CPR was not ongoing on the patient because it was “not the policy of the care home to do so”!!! Arriving on scene, we were met by 3 supposedly qualified NURSES, all of whom were just sitting watching this poor lady clearly in need of a little help on the floor. The lady was 60 and was visiting a relative in the home.
I am currently teaching my kids the importance of not putting Mummy & Daddy in a care home if they want to see any of my last will & testament!
February 6th, 2007 at 11:35 pm
Got to love care homes…
February 6th, 2007 at 11:50 pm
Simon Gray…I cant believe St. Johns told you not to attempt CPR!
Please everyone out there….any CPR is better than no CPR!
Its all to do with the Chain of Survival…Early Access=dial 999/Early CPR=buys time/Early Defibrillation=restart the heart/Early ACLS=drug therapy etc. to stabilise.
Nothing galls me more than turning up at a cardiac arrest and the patient has been down for many minutes without any ventilations/compressions.
It makes our job harder if not impossible.
Whoever at St. Johns told you not to attempt CPR must have been caught out on a job and is now bitter.
Care home policies are written by pseudo lawyers who have no idea. Bystanders are covered by the Good Samaritans Act so long as there intentions are good.
February 7th, 2007 at 5:26 am
You would be surprised at the number of multipul calls we get to the same address by 2 people at the same time, often they are standing beside each other. The other night we got a call to a collapse on the footpath. The first caller was being instructed on how to perform CPR while we were on the way. The caller stated that there was a doctor on scene. To our amazement, instead of helping the patient, the doctor was on their cell phone to another call taker.
February 7th, 2007 at 6:07 am
This is just slightly off topic but thought you’d be interested in this.Hope this link works ok. It’s about Metro Nashville Police/Fire/EMS Emergency Communications Center calltakers being slammed by the public for asking to many questions prior to dispatching medics. I’ll make no comment as to whether l agree or not but in the calls that News Channel 5 highlighted,2 of the call takers were disciplined
lhttp://www.newschannel5.com/Global/story.asp?S=6033742
February 7th, 2007 at 6:08 am
Oops..screwed up the link,here it is again
http://www.newschannel5.com/Global/story.asp?S=6033742
February 7th, 2007 at 8:17 am
It’s quite right that (in the US, in any case) Good Sam laws will protect you from any but gross negligence if you act within the scope of your training (and don’t take anything for it). However, that sure doesn’t stop someone from suing you. I just makes a really good defense.
February 7th, 2007 at 10:28 am
Alan, that link is really peculiar. Unless it works differently in America (which I doubt), call takers do not dispatch ambulances at all. They tap in all the information given, which is then viewed by the dispatch team who send the ambulance. The call taker stays on the phone throughout giving advice. Think I’ll drop Channel 5 a line!
February 7th, 2007 at 6:28 pm
I would like to say that as a student nurse I have been unfortunate enough to have 3 serious car accidents, and 2 heart attacks happen in my vicinity, where I have been able to give adequate treatment, and call 999 and know where I am.
What annoys me though…..
There is a local drunk, who is also epileptic, sometimes this chap is sober for 3weeks, and will bring flowers to the wards and various other gifts, and other times he’s a p*ssed as a skunk, and is trying to punch you.
Well, I came accross him collapsed down the side of the canal, and he was completely unresponsive, and DIDN’T smell of alcohol. I called an ambulance, informing them of the patients name, and various other details I could remember.
Well it took 30min of me sitting by him - still unresponsive, before two ambulance crew came strolling down the canal.
They told me he was just a p*ss head and not to bother calling him again if I found him passed out…..
The following day I did a shift on ITU - where the said patient was being treated….for his epilepsy……….
So sometimes the bystander does the right thing but the crew are too busy laughing at the student who has sat in the freezing cold looking after someone……
February 7th, 2007 at 7:28 pm
Mark..you’re absolutely right,the call takers don’t do the dispatching (except at very small agencies,where they do everything) they operate the same as LAS,where the call gets typed up and passed to the dispatcher. That was the main complaint,that they were taking far too long to pass the calls onto the dispatchers
February 7th, 2007 at 8:00 pm
That’s the thing though - we don’t pass the call up to the dispatchers. Everything we do is seen by the dispatchers from the second the call starts to come in. The dispatchers can even listen in to the call. There is absolutely no way a call taker at the LAS *could* delay an ambulance be sent, even if they wanted to. They have no control over it at all.
February 7th, 2007 at 8:01 pm
Simon Gray, if what you say is true (and I have no reason to doubt you!
), then that SJA trainer should be out of their arse! That is not the official line of St John, and they should have pointed that out to you!
Regards
Nick
http://nickhough.blogspot.com
February 7th, 2007 at 9:38 pm
I see,then l stand corrected. The system here is slightly different.
February 7th, 2007 at 9:50 pm
Ah, I see. Sounds like the system there needs updating, then. It must put call takers in an impossible position if they’re supposed to get all the information but can’t pass the calls up until they do…
February 8th, 2007 at 12:04 am
Hmm, sounds familiar. I remember one bloke proclaiming loudly that ‘they’ (St John) would only shock VF/Pulseless VT 12 times before calling it a day.
I pulled him up on it fairly sharpish and checked with St John National HQ exactly what their interpretation of the RCUK guidelines was.
It turned out that they would lift and shift to the nearest A&E if they weren’t backed up after 12 shocks, fair enough.
Just goes to show the problems that can arise when someone only half listens to what they are taught and repeats their misunderstanding.
For the record, no ambulance crew is going to be upset if they turn up to find any sort of CPR being done. It makes a pleasant change.
No-one in the UK has ever been sued successfully for providing lay-CPR or emergency first aid. It’s difficult/impossible to prove malice against someone who is trying to help and stays within the boundaries of what is expected of any reasonable person in the same situation. Don’t go placing Bic tracheotomies and you’ll be just fine.
SD
February 8th, 2007 at 5:37 am
becktimms - you don’t happy to work in holby city a/e do you?
February 8th, 2007 at 12:25 pm
Other Life saving organisations are available.
February 8th, 2007 at 4:38 pm
My experience with 999 calls, aside from on duty with SJA ["No, they're breathing fine, no response whatsoever, they've been drinking, yes, terribly sorry to have to call you. No rush." or "Not fully conscious, vomiting 14 years old, can't get hold of a responsible adult at home I'm afraid. Sorry"] happened just before Christmas, on my way home from an office party.
A couple of gentlemen were arguing in the street, when one proceeded to start stamping on the other’s head. Crime in progress, I kept my distance, and called for the police, and was told they were experiencing high demand. Whilst on hold, the attacker jumped into a car. Crime over, and Danger gone, I got closer, and found someone on the phone to the ambulance service. Hung up on the police and set to work on RABC, getting some pressure on the wounds. Police patrol turned up by chance, let me get on with it, (”leave the paramedic alone and let him do his job!”) and once I’d handed over to the LAS I got out of their way (after checking the police were happy for me to go)
The police operator called me back, and I explained there were now loads of emergency services on scene, no need to send more.
Not a ‘typical’ bystander reaction, but only because I’ve had the process properly explained by neenaw. Public education’s sadly lacking.
Simon Gray, that’s really worrying, please drop a line to St. John national HQ, we train so many first aiders it’s essential that we maintain standards. Occasionally, trainers misinterpret things, and a memo has to be issued nationally.
Hi Nick! *waves*
February 8th, 2007 at 8:55 pm
ecparamedic, what you talk about is all too common. People think that because they’ve done a course with St John that they know everything, and can tell the ‘pros’ what to do! I also think that’s one of the big problem areas that we (’St John’) have - public perception of the organisation…
Oh, and hi David! *waves back*
Sorry to go off topic Mark! Back on:
I remember one job over the New Years period where we turned up to a drunk teenager who had serious lacerations to his hand from a window he’d broken. The ‘friends’ with him were more concerned about calling him an idiot and giving him a hard time, rather than letting us treat him properly! Despite the amount of blood.
Regards
Nick
http://nickhough.blogspot.com
(7 years with St John Ambulance, Divisional Sergeant and a Patient Transport Attendent)
February 9th, 2007 at 9:54 pm
I think its fair to say that in any organisation you get your fair share of complete idiots, and St John is no different. Please remember that for every muppet, there are at least 9 good experienced first-aiders. Honestly.
February 10th, 2007 at 1:22 pm
All sounds too familiar. Bystanders (or ex-bystanders as often the caller is now nowhere near the alledged incident and not too sure whether it was a child or dog lying in the road) are not the only pests to the ambulance service. I hate taking calls from carelines. Its usually people sitting in some council control room who answer the old dears who pull their emergency alarm cords. They rarely have very little information about what has happened. When you get the telephone number of the person who is meant to have fallen or whatever, you cant ring them because the alarm cord system usually uses the persons phone line to connect to their local council or warden service.
I had a call last week from a careline saying that one of their residents had stopped breathing. It was an old man and woman in the house and the old man was in cardiac arrest. Luckily (or at least I thought so at the time), the residents alarm system was on a seperate line and the careline was able to supply me with a seperate number to call the woman on. I called her with the intent of giving instructions to start cpr. When I got through, the lady was in quite a state but I managed to give her the chest compressions instructions and told her to return to the phone once she had done them. Off she went to attempt the compressions and then I heard the careline in the background telling the lady to calm herself down and go and make a cup of tea until the ambulance came! I think the old dear was confused and thought it was us telling her to do this. She never returned to the phone and needless to say it was DOA.
It raises the point- if carelines are going to tie up phone lines- surely they should have some basic training in cpr instructions and also what information they should try and gather so that we have some sort of idea of what is happening!
February 10th, 2007 at 3:14 pm
A couple of years ago all phone lines in our area were out of action for over three days. After 48 hours my mums care line warden, PUSHED A NOTE through her door, telling her to use a mobile phone to contact them in an emergency, no one knocked to check she was OK. How handy is that for a housebound OAP?
My brother had already fixed a mobile for her (and got her to practice using it.) But I feel sure a lot of their customers (mum pays £25.30 a month for this service) hadn’t the wherewithal to sort them selves out with a mobile, let alone master using it.
The letter of complaint I wrote on mums behalf was a strongly worded. Their response; ‘We had too many people to visit each of them individually.’
They probably had a few less by the time the phones were reconnected.
I hope they have a better ‘crisis plan’ in place now, but I doubt it.
February 12th, 2007 at 11:16 pm
Think it largely depends where you are.
Having been at an incident many moons ago at a football ground where unfortunately the patient passed away, it slightly (no I’ll change that - really) annoyed me that as myself and colleagues where doing all we could, the select few in the crowd seemed more intent on a pie or pint (or both) at half time and saw the unfortunately patient as a total hinderance.
Bystanders can’t work with them and unfortunately at times can’t live wothout them!
February 14th, 2007 at 1:58 am
As an unprofessional, untrained and unqualified bystander, I have been known to be useful a few times, and not just at gawping! Once these 2 LAS personell (i think they were both women and tiny) had trouble lifting a guy on a backboard - I offered them a hand, and they accepted…and other time, I made quite a good c-collar for someone who decided to introduce their noisy moped into a brick wall (was tempting to see if his neck was broken, and if not, “assist” in its break, as he and his “homies” were racing up and down the road)
February 15th, 2007 at 3:16 pm
Interesting what Marcus is saying about the Careline thing. I had a very different experience
A couple of christmases back I as visitng my Mum and Dad in a Yorkshire town and were just packing the car to head back to Scotland when a lady appeared at our door. She was from the Council’s Homecare team and was responding to one of Mum’s neighbours pulling the alarm cord.
The Lady couldn’t get into the house and as my Mum had a key had come to get help.
We found the person had left the key in the lock, but we could hear them some where in the house.
We managed to get her key out of the door and mum’s key in, found the lady upstairs with a ?broken arm sustained in a fall. While I treated her the Council lady called 999.
I assumed all care line systems worked like this … apparently not!
March 21st, 2007 at 2:15 am
Well, you’re lucky. In America, step one doesn’t exist. I went into a seizure in the library at college in front of the librarians desk, in a doorway while doing some technical support. Because I was the techie for the library, I had access to the security footage. I was there for 10 minutes before someone walked over and checked on me. Meanwhile, 4 different people stepped around/over my body. Then another 10 minutes before someone picked up the phone. By the time the ambulance actually got there, the seizure was actually over, and I was unconscious. I knew the librarians, none of them did anything to help me, even though they later told me they saw me the whole time. Then I had to be nice the next time their printer jammed or computer crashed.
March 22nd, 2007 at 9:35 am
Redhead, that is shocking! I may whinge about multiple calls but you’re right, it’s better than no calls at all. I just don’t know how someone could ignore someone having a fit! They should be thoroughly ashamed of themselves. I don’t know how you managed to be nice to them afterwards. I would have given them whatfor and then refused to fix their stupid printers!
May 2nd, 2007 at 7:45 am
Redhead, that is awful! I work in the IT industry in the USA. I would not be able to handle your situation.