# Amtrak nurse (proposal for the future)



## coleallen (Oct 23, 2021)

Tell me if you think this would be a good idea. Someone who has worked for a long time (on the Empire Builder) recently told me that before COVID, long distance trains like the Coast Starlight or the Southwest Chief would have up to 500 people on the train every day (sometimes more) including staff. That’s more than the entire population of my elementary school back when I was there. Most ordinary public elementary schools have an average of 450+ students enrolled, and there’s a school nurse at every school (not surprised). Since long distance trains pre-COVID had at or around the same number of passengers on the train, I think it would be a good idea for Amtrak to hire registered nurses to ride long distance train on rotating shifts. They could switch out at various point along the route just like conductor and engineers do, so that those nurses would always be awake during the trip in case a passenger has a medical issue. As I mentioned before, there was a case where a pregnant woman ended up going into labor and giving birth on the California Zephyr while the train was traveling through a remote area where it would take a long time for an ambulance (or a helicopter) to show up. I was told that this happens a lot more often than people think, about 4-6 times a year is what I was told, and apart from that, I’m sure there are so many other medical issues that have occurred within passengers and crew while trains are en route. Amtrak nurses could not only be required to have an RN degree as a condition of hiring, but have the training to intervene in the most extreme situations, such as when a woman goes into labor, when someone has a heart attack, or stroke, anaphylactic shock, etc….. and be prepared to administer meds. The lower level of the Transition Sleeper has one handicap bedroom, but in the future, if new Superliner equipment was acquired or if Transition Sleepers went through a full overhaul at the Beech Grove shops, the handicap room could become an infirmary (nurse’s office) with one flexible bed, a chair for the nurse, a sink, as well as a cabinet filled with supplies such as wipes, bandages, and of course, vaccine doses ready for emergency administering (that infirmary would be off limits to passenger unless an Amtrak nurse or a conductor escorted them there). That nurse could also be trained to help in psychiatric emergencies as well, like when a passenger is having an anxiety attack, mental breakdown, or having suicidal thoughts, etc…..thus relieving the conductors of their current obligation to focus on those passengers. Even though Amtrak nurses could swap out at crew change points, unlike the conductor/engineer, those nurses would not be responsible for controlling the train’s movement, so their union contracts could be different in terms of maximum hours and shifts. For instance, on the California Zephyr, there’s a T&E crew that goes from Reno to Winnemucca (Reno based) then another going from Winnemucca to Salt Lake City (SLC based). The Amtrak nurse could go from Salt Lake City, all the way to Reno (10-hour run), which would spare the cost of hiring a third nurse to work a shift that’s less than 6 hours. I understand that the SLC crew that goes west to Winnemucca used to go all the way to Reno, but due to frequent UP delays on that section of the route, very often they wouldn’t reach their end point in time for the 12-hour limit. Nurses would not be under FRA hours of service, so the scheduled shift would not be too much of an issue unless they ended up working for more than 12 hours on a single run. The uniforms could consist of a light blue Amtrak jacket, as well as Amtrak-style scrubs (regular hospital scrubs with the Amtrak colors on them). They, likewise could be required to wear a lanyard as well with their employee ID. Do you think any of this would be a good idea for long distance trains? (except in the Northeast Corridor)


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## danasgoodstuff (Oct 23, 2021)

Just like the Northern Pacific, or the B&O, back in the day.


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## Just-Thinking-51 (Oct 23, 2021)

Please no.


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## Oaxacajo (Oct 23, 2021)

Why not? What would be the disadvantages? I only see advantages.


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## coleallen (Oct 23, 2021)

Just-Thinking-51 said:


> Please no.


Why???


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## Cal (Oct 23, 2021)

Just-Thinking-51 said:


> Please no.





Oaxacajo said:


> Why not? What would be the disadvantages? I only see advantages.


Agreed. But I don't think it's necessary, nor do I think that Amtrak would go for it. Nurses aren't required to go on every flight, even ones going across the Pacific Ocean. Why do we need them for trains? I think it'd be better to just encourage or require OBS to have some more first aid training (as I understand they already have medical training?), maybe even encourage them to have a paramedic's license and have more first aid equipment on board. That would not require Amtrak to hire dozens more employees, which I don't think they would be too keen to do. And I would think that paramedics and nurses could find a better job anyway.


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## pennyk (Oct 23, 2021)

Cal said:


> I think it'd be better to just encourage or require OBS to have some more first aid training (as I understand they already have medical training?), maybe even encourage them to have a paramedic's license and have more first aid equipment on board.


The LSA on the Crescent, on which several AU/OTOL members were traveling in July 2018, had been a paramedic in New Orleans prior to working for Amtrak. He was alerted immediately by the conductor when she was informed that a passenger (AlanB) was having a heart attack. The LSA did his best. (I have been trained in first aid and likely was still certified at that time, and am glad I did not have to provide assistance). I do not think a nurse could have done a better job than the LSA did. (However, dinner may have been interrupted a bit in the dining car).


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## Brian Battuello (Oct 23, 2021)

I've witnessed dozens of medical removals to ambulances at grade crossings, sometimes in the middle of nowhere. The dispatchers seem pretty good at locating the nearest EMT source.


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## caravanman (Oct 23, 2021)

I don't see why a nurse would be specified for this role? Why not a proper doctor, or a surgeon? Amtrak could have a hospital car attached to each train, given the age demographic of the passengers. 
Nothing in life is without some risk, but at least let some of us take the minor risk of train travel without any more safety nets?


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## Saddleshoes (Oct 23, 2021)

I worked with an RN who's first job was as a passenger train nurse on a Chicago to Washington DC run in the 60's. She said she would ride the whole route then spend the night in DC and return. Then she had 2 nights off before she repeated the process. She reported a lot of heart attacks during her time. 
---She loved the job but gave it up with marrage.


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## PVD (Oct 23, 2021)

The cost and complexity would be staggering. Medical personnel are regulated on a state by state basis, and must be certified by the jurisdiction they are operating in, and what they are allowed to do may be different in each state... continuing ed would be required, people rendering care as a volunteer are usually covered under Good Samaritan laws, but when it is done for pay, insurance $$ is a must. The number of hours of training for the different disciplines varies considerably, but in NYS a basic EMT would need between 150 - 180 hours of training and practical examination, a paramedic could be 12-1800 notwithstanding continuing ed and refresher requirements. Working out crossborder recognition would be nightmarish. It is a nice concept, but just not practical on many levels.


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## Cal (Oct 23, 2021)

PVD said:


> The cost and complexity would be staggering. Medical personnel are regulated on a state by state basis, and must be certified by the jurisdiction they are operating in, and what they are allowed to do may be different in each state... continuing ed would be required, people rendering care as a volunteer are usually covered under Good Samaritan laws, but when it is done for pay, insurance $$ is a must. The number of hours of training for the different disciplines varies considerably, but in NYS a basic EMT would need between 150 - 180 hours of training and practical examination, a paramedic could be 12-1800 notwithstanding continuing ed and refresher requirements. Working out crossborder recognition would be nightmarish. It is a nice concept, but just not practical on many levels.


New nurse/paramedic for each state? 

On the Southwest Chief route, they would operate between the following stations: 

LA to Needles
Needles to Gallup 
Gallup to Trinidad
Trinidad to Garden City 
Garden City to Kansas City 
Kansas City to Fort Madison
Fort Madison to Chicago

There would be spots where they would not be able to work to their fullest capabilities due to the local laws, but the majority of the trip would be covered and they can still provide basic first aid help. 


Still, can be confusing on other routes and Amtrak would not go for it.


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## PVD (Oct 23, 2021)

Unless you could broker some kind of interstate compact, it would be difficult. An RN at minimum is the equivalent of a 2 year college program, there is already a shortage nationally, as much as I would love to see it, from a comfort standpoint, adding an expensive additional staff person is unlikely. They don't even want to have adequate staffing of OBS.


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## Ziv (Oct 23, 2021)

I think adding another requirement for Amtrak trains is ill advised. Especially considering that most LD route trains have less than 300 passengers most of the time and many have considerably less than that. The Empire Builder that derailed in Montana had just 147 passengers on board, and the EB is more heavily traveled than most LD routes.
Getting the LSA to take basic first aid classes? Maybe. But I think adding requirements for onboard nurses is just asking for additional cost. 
How are the low bucket fares going this year? Seeing many of them? Would onboard nurses help or hurt that going forward? What would the marginal utility of having a nurse on board give you vs. the standard of care Amtrak has now? Little gain? None when compared to the probable increase in price?


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## PVD (Oct 23, 2021)

From a passenger comfort standpoint, it is excellent. From a practicality standpoint, no. Some type of emergency responder such as an EMT would be possible, but costly. Consider that only 40% of US high schools have a certified athletic trainer, and many competitions at those schools may be uncovered due to scheduling conflicts, and those are situations where emergencies are not uncommon.


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## Willbridge (Oct 23, 2021)

danasgoodstuff said:


> View attachment 25092
> 
> Just like the Northern Pacific, or the B&O, back in the day.


And by the time I rode Portland to Minneapolis on the NCL in 1967 the Nurse requirement had been lifted and she was just Sue the Stewardess. She spent much of her time chatting with a brakeman.

At the same time the GN had a Train Passenger Agent on the EB who narrated scenery, resolved coach seat reservation issues, made announcements, etc. So two different approaches in similar markets.

A random check turned up Stewardesses (not Nurses) on the _City of Portland, City of Los Angeles, _and east of Ogden on the _City of San Francisco _in 1949 (the City of SF was still a separate train then).

In a 1936 schedule for UP Train 2nd 7/8, the coach and tourist sleeper section of the _Los Angeles Limited, _the UP had rebranded it as the economy _Challenger. _That Depression-era train had a stewardess-nurse and catered to women travelers with a women's and children's coach and economical dining car meals. An ad states that these were the only stewardess-nurses on American railways at that time.


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## Rambling Robert (Oct 24, 2021)

A defibrillator is worth its weight in gold. Wall mounted and very potable and friendly to use. The cost of one starts at about $2000. Maybe have three per train.

The safety card in the seat pocket could explain them and where they’re located.


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## WWW (Oct 24, 2021)

Back in the days of early aviation flight attendants (stewardesses) a hiring requirement was being a nurse.
With the speed of modern aircraft just set the plane down at the closest air field and ambulance away to the nearest medical facility.
What Amtrak could do is hire car attendants with medical certification at a premium hiring wage.
And the infrequency of medical intervention just proceed and stop the train at the nearest point of medical relief - it can't be all that complicated.
All the newfound medical devices and training can easily be applied to train travel.
There is no reason for not having the basic life saving equipment on every train.
Even without trained personnel in this day and age of communication instructions can be read and given to make an effort to save the patient - - -
A CPR instructor in a course I took said in the worse case scenario - even bad CPR is better than none or no effort taken.

Cruise ships have helicopter medical evacuation from time to time - - - 

This is not a time of Mission Impossible - perhaps if the patient can't be brought to a medical facility then the medical facility doctor nurse health
professional can be brought to the moving vehicle car train cruise ship.
However when your time is up only the Good Lord can extend life as it is known.
Please give his angels an opportunity some room to work with - - - Don't be cheap with supplying the life saving equipment ! ! !


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## OBS (Oct 24, 2021)

Rambling Robert said:


> A defibrillator is worth its weight in gold. Wall mounted and very potable and friendly to use. The cost of one starts at about $2000. Maybe have three per train.
> 
> The safety card in the seat pocket could explain them and where they’re located.


There already is one in every food service car.


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## hlcteacher (Oct 24, 2021)

nope..and what schools have nurses on site every day? not in many a year


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## Rambling Robert (Oct 24, 2021)

That’s good there’s at least one defibrillator (AED) - I seem to remember now - one in the cafe under the observation car - by the stairwell.

it might help to have info in the pocket of every seat. Twenty year ago I did a brief fyi video fir local cable TV - not the vid link below. I am fairly sure when you complete the short Red Cross and pass certification - the Red Cross will back you if you’re sued for using the AE.... perhaps Amtrak will back people who try to use it.



My first LD trip on the TE - coming into San Antonio a guy died of a heart attack seated a few rows back. Also, on my second LD trip - on the CZ we waited for an oncoming train to offload a heart attack patient.


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## PVD (Oct 24, 2021)

When a volunteer makes a reasonable attempt at first aid or assistance, they are protected in almost every situation by good samaritan laws in effect in some form in all 50 states +D.C. People who are getting paid to provide services are not protected the same way, and depending on their situation either carry insurance on their own, or are covered by their employer. This costs money.


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## Trollopian (Oct 24, 2021)

My sister's a retired school nurse, and (though admittedly I haven't run this past her), I don't think the comparison is quite apt. Her responsibilities included checking compliance with vaccination requirements, managing prescription medications (with few exceptions, such as epi-pens, children do _not_ carry their RXs around with them but report to the nurse's office for their dose), watching over students who had left class because of illness and contacting their parents if necessary, teaching first-aid and CPR classes, caring for kids who injured themselves at recess or athletic practice, (memorably, one kid bit through his tongue on the swings), even dispensing feminine-hygiene supplies. Those don't really have a parallel on the train. Amtrak passengers are presumed to be adults or to be children riding with responsible adults.

The number of times WMATA trains in the greater DC area seem to be stopped entirely for medical emergencies seems absurd. (Metro policy is generally to hold the train while waiting for local first responders, because it may be risky, medically and legally, to move the passenger.) But I haven't seen proposals to put a nurse on each train. Nor, frankly, would that probably alter the policy of holding and awaiting EMTs.


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## jis (Oct 24, 2021)

On one of the nonstop Newark - Delhi flights on United we had a medical incident inflight when an elderly gentleman suffered a cardiac incident over Turkmenistan. With surprising alacrity the cabin crew and all available medical doctors on board got into the act of reviving him and managed to do so pretty quickly using medical equipment that is carried on board - a defibrillator and such. The cabin crew are trained and qualified to handle the equipment on board.

Then they held a conclave to decide whether to land in Turkmenistan or Afghanistan or carry on to Delhi or at least Peshawar. They decided in consultation with his family that the gentleman had been revived to a point where he would survive the less than two or so remaining hours of flight to Delhi, so we charged on at expedited speed. Upon landing at Delhi we were expedited to our designated gate in T3 and a fully equipped mobile medical crew was waiting to take him to the airport medical facility and possibly then onto a hospital. After he was disembarked, the rest were allowed to disembark. On the whole I was very impressed with the handling of the situation.

These incidents on long ETOPS 180 or 220 flights can require considerable medical expertise on board should something go sideways. Even if there is an airport available, it could be in the sticks in the middle of Siberia with no medical facility in sight.


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## basketmaker (Oct 24, 2021)

There is always a good chance that there is an MD, RN, NP or EMS professional as a passenger on board that could assist. The automatic defibrillator (AED) should be on every train. They run from $599 and up. And probably less in large bulk orders.


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## PVD (Oct 24, 2021)

An AED is carried in each food service car. Not sure what happens on a Keystone.


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## daybeers (Oct 24, 2021)

OBS said:


> There already is one in every food service car.


Like PVD said above, what happens on trains with no food service car? Empire Service, Keystone, Hartford Line, any others? Is it thought those trains have closer station spacing and/or more reliable and fast-response EMTs available in the territory they run through? Seems to me at least some stations are far enough apart to make installing an AED worthwhile.


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## MARC Rider (Oct 24, 2021)

PVD said:


> Unless you could broker some kind of interstate compact, it would be difficult. An RN at minimum is the equivalent of a 2 year college program, there is already a shortage nationally, as much as I would love to see it, from a comfort standpoint, adding an expensive additional staff person is unlikely. They don't even want to have adequate staffing of OBS.


I wonder how the railroads did it in the 50s and 60s.


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## PVD (Oct 24, 2021)

I would imagine the rules were very different.


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## PVD (Oct 24, 2021)

daybeers said:


> Like PVD said above, what happens on trains with no food service car? Empire Service, Keystone, Hartford Line, any others? Is it thought those trains have closer station spacing and/or more reliable and fast-response EMTs available in the territory they run through? Seems to me at least some stations are far enough apart to make installing an AED worthwhile.


Empire Service trains have a food service car, it is not staffed on the trains that don't go past Albany, but the cars are still in the set.


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## MARC Rider (Oct 24, 2021)

PVD said:


> I would imagine the rules were very different.


Indeed, they may have been, but the essential part, that medical personnel are licensed by each state, was true back then, too.


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## basketmaker (Oct 24, 2021)

We (at least some-not me though?) are overall healthier than we were in the 1950's - 2000's for heart issues. AEDs should still be common on all modes of commercial transportation.


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## pennyk (Oct 24, 2021)

OBS said:


> There already is one in every food service car.


During the medical emergency on the Crescent in July 2018, the LSA used the AED, on which he had been properly trained.


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## mp492_5 (Oct 24, 2021)

Road crossings and EMS. Why a nurse on a train?


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## Seaboard92 (Oct 24, 2021)

Rambling Robert said:


> A defibrillator is worth its weight in gold. Wall mounted and very potable and friendly to use. The cost of one starts at about $2000. Maybe have three per train.
> 
> The safety card in the seat pocket could explain them and where they’re located.



I would say that is excessive but I can remember one day in my railroad career where we used two of them in one day within five hours of each other. So I could see an argument for at least two. 



jis said:


> The cabin crew are trained and qualified to handle the equipment on board.
> 
> These incidents on long ETOPS 180 or 220 flights can require considerable medical expertise on board should something go sideways. Even if there is an airport available, it could be in the sticks in the middle of Siberia with no medical facility in sight.


We get significant training on this. And if we can't pass actual physical tests not just word tests we will not earn our wings. As far as lack of medical experience on board we are able to call to Med Link which is like a phone bank of doctors who only work for aviation problems. And they are the ones who make most of the decisions based upon what is relayed to them. I believe they are in Arizona if I remember correctly. 

As far as the middle of Siberia may I recommend Novosibirsk the third largest city in the country, Krasnoyarsk another large city, and Irkutsk home of Lake Baikal. Honestly I would just follow the rail line to find hospitals. Most trans Russian flights tend to follow the rail line anyway. I know my Aeroflot flight from VVO to SVO did. We didn't even overfly China which would have cut some time off.


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## Willbridge (Oct 25, 2021)

Seaboard92 said:


> As far as the middle of Siberia may I recommend Novosibirsk the third largest city in the country, Krasnoyarsk another large city, and Irkutsk home of Lake Baikal. Honestly I would just follow the rail line to find hospitals. Most trans Russian flights tend to follow the rail line anyway. I know my Aeroflot flight from VVO to SVO did. We didn't even overfly China which would have cut some time off.


Before my 2010 Russia trip, my doctor, who had experience in the former Soviet Union, recommended hepatitis shots first in case I ended up in a Russian emergency room. He said that his firm used medevacs to Hungary for care.

On the other hand, Aeroflot used to advertise itself as "First in the skies of Siberia" so some airlines' crews might have more knowledge of alternatives than would others.


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## Willbridge (Oct 25, 2021)

MARC Rider said:


> I wonder how the railroads did it in the 50s and 60s.


One clue is the old schedules that I dug up. Each of the lines that had a stewardess-nurse either dropped the idea or switched to non-nurse stewardesses. It may have just been a headache. (No medical pun intended.)


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## ehbowen (Oct 25, 2021)

Some ideas stimulated by this thread:

While having a trained medical responder aboard is a great idea, swapping them out every 8 hours like T&E crew is gilding the lily. T&E have constant work to do throughout their stint. There's no reason why you can't wake someone up with a knock on the door in the middle of the night if a passenger has an emergency. If he/she dies in the two minutes it takes to throw on some clothing & sandals, the responder probably wouldn't have been able to save him/her anyway.
Rather than a registered nurse, how about offering a $7 (or so) an hour premium to any crew member who takes EMT training and maintains his/her certification?
How about a discreet announcement or seat pocket card which says, in essence, "If you are a licensed medical professional or EMT and are willing to assist in the event of an onboard emergency, please make your presence known to the conductor now. You will receive a complimentary selection from the cafe car."


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## jis (Oct 25, 2021)

Seaboard92 said:


> I would say that is excessive but I can remember one day in my railroad career where we used two of them in one day within five hours of each other. So I could see an argument for at least two.
> 
> 
> We get significant training on this. And if we can't pass actual physical tests not just word tests we will not earn our wings. As far as lack of medical experience on board we are able to call to Med Link which is like a phone bank of doctors who only work for aviation problems. And they are the ones who make most of the decisions based upon what is relayed to them. I believe they are in Arizona if I remember correctly.
> ...


But non stops from India to US quite often fly perpendicular to the rail trunk routes in Siberia, i.e. South to North and then over Arctic Ocean. They fly way far north of the great circle route westbound to avoid the jet stream on the nose.


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## Cal (Oct 25, 2021)

ehbowen said:


> How about a discreet announcement or seat pocket card which says, in essence, "If you are a licensed medical professional or EMT and are willing to assist in the event of an onboard emergency, please make your presence known to the conductor now. You will receive a complimentary selection from the cafe car."


I don't think the last part should be added. Someone who isn't actually licensed will say they are.


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## danasgoodstuff (Oct 25, 2021)

Cal said:


> I don't think the last part should be added. Someone who isn't actually licensed will say they are.


And it might invalidate good Samaritan protection.


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## ehbowen (Oct 25, 2021)

Cal said:


> I don't think the last part should be added. Someone who isn't actually licensed will say they are.



You can ask that they show documentation.
The selection I'm thinking about is a non-alcoholic beverage. If you've got someone willing to perjure themselves for a soda or a cup of coffee, well...welcome to 2021!


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## Cal (Oct 25, 2021)

ehbowen said:


> The selection I'm thinking about is a non-alcoholic beverage. If you've got someone willing to perjure themselves for a soda or a cup of coffee, well...welcome to 2021!


As @danasgoodstuff, it might invalidate good Samaritan protection. And I'd sincerely hope any medically trained people would make themselves known without needing incentive.


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## cirdan (Oct 25, 2021)

Oaxacajo said:


> Why not? What would be the disadvantages? I only see advantages.



There is a huge shortage of nurses in hospitals and clinics as it is, meaning many patients are not getting the care they deserve.

Diverting nurses to work in other, less essential, places would only make it worse.


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## cirdan (Oct 25, 2021)

basketmaker said:


> There is always a good chance that there is an MD, RN, NP or EMS professional as a passenger on board that could assist. The automatic defibrillator (AED) should be on every train. They run from $599 and up. And probably less in large bulk orders.



The more people on the train, the higher the odds that somebody among them will have medical qualifications.

This would be a soft argument for longer consists.


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## cirdan (Oct 25, 2021)

jis said:


> Then they held a conclave to decide whether to land in Turkmenistan or Afghanistan or carry on to Delhi or at least Peshawar. They decided in consultation with his family that the gentleman had been revived to a point where he would survive the less than two or so remaining hours of flight to Delhi, so we charged on at expedited speed. Upon landing at Delhi we were expedited to our designated gate in T3 and a fully equipped mobile medical crew was waiting to take him to the airport medical facility and possibly then onto a hospital. After he was disembarked, the rest were allowed to disembark. On the whole I was very impressed with the handling of the situation.



Odds also are that a hospital in Delhi would be better equipped to deal with such an emergency than a hospital in Afghanistan or Turkmenistan.

If that was me I know where I would prefer to be treated.


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## cirdan (Oct 25, 2021)

basketmaker said:


> We (at least some-not me though?) are overall healthier than we were in the 1950's - 2000's for heart issues. AEDs should still be common on all modes of commercial transportation.
> View attachment 25116



Wow, that's quite an amazing statistic.

Any idea what the reason is?

It can't be food as that has got less healthy if anything.


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## jis (Oct 25, 2021)

cirdan said:


> Odds also are that a hospital in Delhi would be better equipped to deal with such an emergency than a hospital in Afghanistan or Turkmenistan.
> 
> If that was me I know where I would prefer to be treated.


That is exactly what one of the most major consideration was. Delhi has world class hospitals. Not so much in Ashgabat or Kabul. Peshawar, Islamabad in Pakistan and Amritsar in India were possible alternates if an emergency arose. All have good hospitals, but not quite as good as Delhi.


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## Ryan (Oct 25, 2021)

I'm late to the party, so you folks have done a great job of enumerating why this is not a great idea.

This thread bolster's AU's unofficial motto: "Bad solutions in search of non-existent problems".


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## Danib62 (Oct 25, 2021)

Rambling Robert said:


> A defibrillator is worth its weight in gold. Wall mounted and very potable and friendly to use. The cost of one starts at about $2000. Maybe have three per train.


Three per train? Are you expecting three simultaneous cardiac arrests?


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## cirdan (Oct 25, 2021)

Danib62 said:


> Three per train? Are you expecting three simultaneous cardiac arrests?



If there is a derailment or some other incident, some parts of the train may be unreachable.


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## Danib62 (Oct 25, 2021)

In the event of a derailment an AED is gonna be about about as useful as tits on a bull for a traumatic arrest.


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## Danib62 (Oct 25, 2021)

Not to mention that if there was a derailment that would be considered a mass casualty incident (MCI) and under triage rules you wouldn’t stop to work someone in cardiac arrest as it would be considered a waste of resources that could be used on someone who is actually save-able.


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## Barb Stout (Oct 25, 2021)

cirdan said:


> Wow, that's quite an amazing statistic.
> 
> Any idea what the reason is?
> 
> It can't be food as that has got less healthy if anything.


The fitness/exercise "craze" started in the 1970s and also the move to start looking at improving your own diet. I got on the healthy foods bandwagon in 1978 or 9 and was able to stay on that wagon. But my efforts to get on the exercise bandwagon didn't go as well until the 2000s. I kept trying to climb on, but then I would fall off.

Plus starting in the 1980s, I would say, there was a push for people, especially employees of certain companies, to learn CPR. I suppose that helped too. I learned it, but I didn't stick with it because I would tire easily and am pretty weak, so I didn't keep up any certification.


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## basketmaker (Oct 25, 2021)

Barb Stout said:


> The fitness/exercise "craze" started in the 1970s and also the move to start looking at improving your own diet. I got on the healthy foods bandwagon in 1978 or 9 and was able to stay on that wagon. But my efforts to get on the exercise bandwagon didn't go as well until the 2000s. I kept trying to climb on, but then I would fall off.
> 
> Plus starting in the 1980s, I would say, there was a push for people, especially employees of certain companies, to learn CPR. I suppose that helped too. I learned it, but I didn't stick with it because I would tire easily and am pretty weak, so I didn't keep up any certification.


Yeah they need to install seatbelts on the exercise bandwagon. Seems like so many have a tendency to fall off! I was required to be certified in first aid along with CPR as a manager for UPS in the early 90's. But that certification has long since run out.


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## cirdan (Oct 25, 2021)

Barb Stout said:


> The fitness/exercise "craze" started in the 1970s and also the move to start looking at improving your own diet. I got on the healthy foods bandwagon in 1978 or 9 and was able to stay on that wagon. But my efforts to get on the exercise bandwagon didn't go as well until the 2000s. I kept trying to climb on, but then I would fall off.
> 
> Plus starting in the 1980s, I would say, there was a push for people, especially employees of certain companies, to learn CPR. I suppose that helped too. I learned it, but I didn't stick with it because I would tire easily and am pretty weak, so I didn't keep up any certification.



I'm surprised it had such a huge impact, as it was probably offset (if not caused) by the general trend towards fewer manual jobs and more people in offices which led to many not getting the minimal activity required to maintain a healthy lifestyle.


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## Barb Stout (Oct 25, 2021)

cirdan said:


> I'm surprised it had such a huge impact, as it was probably offset (if not caused) by the general trend towards fewer manual jobs and more people in offices which led to many not getting the minimal activity required to maintain a healthy lifestyle.


Yeah, maybe, but I have been told that housework doesn't count as exercise even if you get physically tired doing it. Doesn't make sense to me, but...


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## Devil's Advocate (Oct 25, 2021)

basketmaker said:


> We (at least some-not me though?) are overall healthier than we were in the 1950's - 2000's for heart issues.


Americans are as unhealthy today as we have ever been but medical technology is getting better at keeping unhealthy people alive.



cirdan said:


> There is a huge shortage of nurses in hospitals and clinics as it is, meaning many patients are not getting the care they deserve. Diverting nurses to work in other, less essential, places would only make it worse.


Not to mention that most nurses looking for a job right now are those who refuse to vaccinate.


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## Exvalley (Oct 25, 2021)

Devil's Advocate said:


> *Americans are as unhealthy today as we have ever been* but medical technology is getting better at keeping unhealthy people alive.


When it comes to causes of heart disease, one major exception is smoking. Smoking rates have fallen dramatically over the past few decades.


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## Devil's Advocate (Oct 25, 2021)

Where I live smoking has been replaced by smokeless tobacco and vaping which remain highly addictive and also employ untested off-label chemicals. It's clear that we've only tackled the symptom by telling people that smoking is bad rather than teaching people how to identify and avoid unhealthy behavior.


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## John from RI (Oct 25, 2021)

Amtrak must exist in the political environment allowed by the Congress. A few years ago John Mica, a Florida Congressman, made a national issue of the price of a hamburger on Amtrak. He ignored the fact that Florida is served by 3 Amtrak trains each day; the Silver Meteor, the Silver Star and Autotrain. All he cared about was how much does Amtrak charge for a hamburger. 

Amtrak provides an essential service not only for people who post on this website but also for many low income people who need to travel between cities and have no other transportation options. Our rail passenger system should focus on providing transportation that is affordable for all Americans. Part of that focus is providing first class (sleeping car) service which more than pays for itself and is popular. But there should be no compromise with the goal of affordable transportation for all.


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## cirdan (Oct 25, 2021)

Devil's Advocate said:


> Where I live smoking has been replaced by smokeless tobacco and vaping which remain highly addictive and also employ untested off-label chemicals. It's clear that we've only tackled the symptom by telling people that smoking is bad rather than teaching people how to identify and avoid unhealthy behavior.



I agree. But even so there is massively less smoking overall. I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.


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## basketmaker (Oct 25, 2021)

Exvalley said:


> When it comes to causes of heart disease, one major exception is smoking. Smoking rates have fallen dramatically over the past few decades.


Oh how I wish I was in those reduced numbers!


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## jis (Oct 25, 2021)

cirdan said:


> I agree. But even so there is massively less smoking overall. I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.


Indeed! I wish I had some quality N95 masks back then. At least here it was mostly cigarettes. In India on intercity buses and non-AC trains (specially in lower class carriages) it was armies of people smoking Bidis which is basically tobacco wrapped in a tobacco leaf. It is a wonder I and many others survive that without getting asphyxiated.


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## joelkfla (Oct 25, 2021)

jis said:


> Indeed! I wish I had some quality N95 masks back then. At least here it was mostly cigarettes. In India on intercity buses and non-AC trains (specially in lower class carriages) it was armies of people smoking Bidis which is basically tobacco wrapped in a tobacco leaf. It is a wonder I and many others survive that without getting asphyxiated.


CDC says bidis are not wrapped in a tobacco leaf, but rather "a tendu or temburni leaf (plants native to Asia)."

"Smoke from a bidi contains three to five times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction. "


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## jis (Oct 25, 2021)

joelkfla said:


> CDC says bidis are not wrapped in a tobacco leaf, but rather "a tendu or temburni leaf (plants native to Asia)."
> 
> "Smoke from a bidi contains three to five times the amount of nicotine as a regular cigarette and places users at risk for nicotine addiction. "


Well if CDC says so then it must be so. I don't claim any knowledge that is irrefutable about Bidis, or any other Tobacco products. Never used one. Only suffered through having them in the environment. Still do when back in India


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## Devil's Advocate (Oct 25, 2021)

cirdan said:


> I agree. But even so there is massively less smoking overall. I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.


Good point. The dismal era of the passive aggressive cigarette smoker exposed nearly everyone to secondhand poisoning. At least that factor has abated despite the proliferation of dipping and vaping. It just amazes me how some parents defended teen vaping as if they had never learned anything.


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## jis (Oct 25, 2021)

cirdan said:


> I agree. But even so there is massively less smoking overall. I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.


The situation in the Lounges on LD trains was as bad until finally smoking was disallowed. I remember a screen of blueish smoke that hit you in the face as you entered the much vaunted Le Pub on the Montrealer back in the days.


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## MARC Rider (Oct 25, 2021)

jis said:


> The situation in the Lounges on LD trains was as bad until finally smoking was disallowed. I remember a screen of blueish smoke that hit you in the face as you entered the much vaunted Le Pub on the Montrealer back in the days.


Now, I don't know. I remember going into the lounge car on the Crescent in 1990 when they still allowed smoking and was pretty impressed at whatever hardcore ventillation system was in place. Didn't smell any tobacco smoke at all.


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## flitcraft (Oct 25, 2021)

cirdan said:


> I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.


I remember as a kid going to night baseball games at Fenway Park where you could see a literal cloud of smoke arising from across the ballpark. And, at my first full-time job, I shared an office with a chain-smoker. When I was pregnant, I recall feeling that it was an imposition to ask if he could please not smoke in the office. How times have changed! (And, for once, for the better!)


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## jis (Oct 25, 2021)

In addition to the smoke, even when no one was smoking many places continued to have a pretty noticeable smell of stale nicotine or something - including some Sleeper compartments on trains. And then they sprayed some mintish smelling thing to try to cover that other smell, so that produced a unique combined scent


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## MARC Rider (Oct 25, 2021)

Apparently, when they renovated Grand Central Terminal, in the early 2000s, removing almost a century of accumulated cigarette smoke from the ceiling was a major job.


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## MARC Rider (Oct 25, 2021)

Devil's Advocate said:


> Good point. The dismal era of the passive aggressive cigarette smoker exposed nearly everyone to secondhand poisoning. At least that factor has abated despite the proliferation of dipping and vaping. It just amazes me how some parents defended teen vaping as if they had never learned anything.


I was a real bad boy about that in the days of my irresponsible youth, though I smoked a pipe and not cigarettes. Heck, I once lit up my pipe in the air on a TWA flight between PHL and ORD sometime in 1973 or 1974. Nobody told me I couldn't, and I wasn't bothered about it by the flight attendants. 

My favorite memory about smoking, though, was the Greyhound driver on the bus from Chicago to Beloit telling us as we left the Chicago Greyhound terminal, "_*tobacco *_smoking is allowed in the last 5 rows of the bus..." with a real emphasis on the word "tobacco." With a bus full of college students, he was probably more worried about the kids smoking something else.  I wonder what that driver would think if he was zapped forward in time to the present day where weed in Illinois is legal, but, of course, smoking anything (including tobacco) in a bus is not.


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## JoshP (Oct 25, 2021)

This idea would cost millions of dollars so the best bet is have them dispatch EMT and let them take care of it. Cost savings.


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## johnmiller (Oct 26, 2021)

When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. Taking a cruise is the only time I can think of where a nurse or a doctor is available. A plane has to divert and land to get someone medical attention. A train has to stop in the closest place possible with medical attention, etc. I personally think it would be good for the LSA to have completed an actual first aid course, be certified on CPR, and be trained and signed of on using an AED.


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## cirdan (Oct 26, 2021)

jis said:


> In addition to the smoke, even when no one was smoking many places continued to have a pretty noticeable smell of stale nicotine or something - including some Sleeper compartments on trains. And then they sprayed some mintish smelling thing to try to cover that other smell, so that produced a unique combined scent



Mx first apartment after leaving uni had previously been inhabited by a chain smoker and it took me about a year and five coats of paint until it finally stopped smelling of stale smoke.


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## cirdan (Oct 26, 2021)

MARC Rider said:


> With a bus full of college students, he was probably more worried about the kids smoking something else.  I wonder what that driver would think if he was zapped forward in time to the present day where weed in Illinois is legal, but, of course, smoking anything (including tobacco) in a bus is not.



One of the down sides of weed legalization is that some people interpret this to mean they can smoke it anywhere where it is not explicitly forbidden. Many don't realize how disgusting and lingering that smell is.


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## cirdan (Oct 26, 2021)

johnmiller said:


> When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. Taking a cruise is the only time I can think of where a nurse or a doctor is available. A plane has to divert and land to get someone medical attention. A train has to stop in the closest place possible with medical attention, etc. I personally think it would be good for the LSA to have completed an actual first aid course, be certified on CPR, and be trained and signed of on using an AED.



I don't think being on a train puts you further from help than, say, driving cross country. Having a train make an unscheduled stop for emergency medical purposes is definitely less of a deal than having an airliner make an emergency landing.


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## PVD (Oct 26, 2021)

MARC Rider said:


> Apparently, when they renovated Grand Central Terminal, in the early 2000s, removing almost a century of accumulated cigarette smoke from the ceiling was a major job.


In one corner of the ceiling, there is a small extremely dark square that was left untouched to show the contrast


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## Barb Stout (Oct 26, 2021)

cirdan said:


> I agree. But even so there is massively less smoking overall. I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.


I remember that people smoked in medical clinics and doctor's offices. When I was a kid, I had to be hospitalized after enduring a wait in the waiting room at the medical clinic due to people smoking there. It's just so unbelievable to think about and I found it unbelievable even back then that it was allowed (1973).


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## Trollopian (Oct 26, 2021)

johnmiller said:


> When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. *Taking a cruise* is the only time I can think of where a nurse or a doctor is available.



The Cherry Ames books, which my sister and I devoured as kids (is that why my sister became a nurse? I didn't), followed our heroine to her various posts as Student Nurse, Army Nurse, Flight Nurse, Cruise Nurse, Boarding School Nurse, Camp Nurse, even Dude Ranch Nurse. (Lots of job-hopping. The series doesn't follow her into a retirement of penury caused by not staying anywhere long enough to vest in a pension.) But never "Train Nurse."









Cherry Ames - Wikipedia







en.wikipedia.org


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## jis (Oct 26, 2021)

johnmiller said:


> When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. Taking a cruise is the only time I can think of where a nurse or a doctor is available. A plane has to divert and land to get someone medical attention. A train has to stop in the closest place possible with medical attention, etc. I personally think it would be good for the LSA to have completed an actual first aid course, be certified on CPR, and be trained and signed of on using an AED.


But a cruise is not a general transport service so comparing what is available there with commercial service is an apples to oranges comparison. Specially considering that many train cruises in Central Asia and India do carry a doctor and a nurse as part of the service.


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## jcoons (Oct 26, 2021)

@coleallen has proposed Nurses (or professional medical staff on board Amtrak trains). Let’s drag this thread kicking and screaming back to it’s original topic. I’ll outline the argument as to why, on the face this seems practical, is largely impractical and addressing a particularly minor problem in relative scale. 

The notion of hiring medical staff to incorporate in to crew complement will be incredibly expensive from a salary and benefits perspective when posited against the relative risk of medical events necessitating trained assistance, versus assistance from a good samaritan, or, from a member of train crew with limited additional training and a reasonably resourced on board medical kit. One must also consider the substantial operating expense implications: revenue loss resulting from creating the private medial space necessary; cost to provision on board medicines and equipment for the provider to be able to treat the types of concerns it appears you envision; the costs of reprovisining those items given many have fixed expiration and must be replaced. There is also the question of whether it’s is a “no-go” item - if so, then your staffing costs increase substantially in order to support an “extra-board” of medical folks. 

What types of issues could we realistically and reasonably expect? I don’t know what data Amtrak makes available around on-board illness/injury and wasn’t able to find any with a cursory search. The global airline industry does, however, keep very detailed records. The customer base of the airline industry also provides a reasonable comparator to Amtrak, and the general health quality of that customer base. Airlines spend inordinate amounts of time thinking about and being concerned with the response to inflight medical emergencies (IME). Why? The cost of a diversion to an unplanned airport can be quite expensive let alone disruptive to the rest of the customers. A long haul international flight, as someone was describing earlier in the thread, with a critical medical emergency may well necessitate an immediate diversion. That diversion could well be to an offline airport. If the crew duty period is such, it can be that the crew runs out of time (or, “on the law” in railroad speak) and must go on rest. Now, the airplane sits and 300 people scramble for hotel rooms. Obviously this is an example that is more on the margins, but is part of airline planning. 

Why is this discussion of airline planning relevant? The similarities we can draw between an airline operation and that of Amtrak. Both are highly distributed networks that have fixed points of resources available to them. The volume of customers can be quite similar, along with a customer mix that is, in the aggregate, similar. In both networks, tending to a sudden illness of a customer can be quite disruptive, potentially costly to the enterprise, and both are obviously very concerned that they do everything possible to assist the ill customer. 

Discussion thus far, at least that which is even remotely related to the OPs suggestion, centers around the presumption that the medical needs are acute and severe enough on a frequent basis such that only trained medical professionals with adequate resources are the correct course of action. Let’s examine how airlines successfully handle this as there are elements there that can reasonably bridge to Amtrak. 

Having reviewed the online copy of the Amtrak on board services manual it appears that the type of training that train crew receives is very fundamental. This is not a criticism, just stating what appears to be fact. The medical “kits” on board appear to be quite limited to tools for cuts and scrapes primarily, along with a single AED which may or may not be a dispatch limiting item. Perhaps an Amtrak crew member can elaborate if they have access to any kind of “phone a friend” medical services - by this I don’t mean 911 or their buddy who might be an EMT, a service structured to remotely deal with medical emergencies. It seems on the surface that does not exist, but I’d love to know the real answer. 

Contrast that to the airline environment. Flight attendants have significant portions of their initial and recurrent training dedicated to medical training and refresher. Broadly speaking this training is similar across all airlines and includes detailed training of what is in the medical kit (think more like a first aid kit on steroids), what is in the Extended Medical Kit (XMK), complete AED qualification, use and administration of therapeutic oxygen as well as basic guidelines to recognize various medical conditions - overdose versus heart attack, etc. The Extended Medical Kit (XMK) contains items that are dispensable by trained medical personnel - which could be a nurse, EMT, Veterinarian, OBGYN, PA, NP, MD, DO, DDS… the list goes on. Contents of the XMK vary slightly from airline to airline but are likely to include basics like CPR breathing masks and inflation bags, stethoscope, BP Cuff. It will also include items tied to the most likely scenarios - airways, tourniquet, saline, needles and syringes, epinephrine, lidocaine, atropine, nitroglycerin and other medications. There is also the AED Along with hands-off heart monitors that simply lie on a patients chest and give detailed ECG readings. Virtually all airlines subscribe to MedAire or one of several competitors. MedAire provides 24/7/365 airborne access to a team of MD for consultation on any medical situation.

So let’s take the unlikely road and say I present as if I may be having a heart attack on my flight. Once alerted, cabin crew will split up. One solicits for medical personnel (virtually every flight has someone with medical background and experience - see the list above), the second (and third if needed) tend to the passenger and the fourth communicates alternatively with the flight deck and initiates a call to MedAire via satellite phone. With the items in the kits, the medical personnel that are on board, the trained flight attendants and the ability to real time consult with doctors on the ground not only can interventional treatment be administered but a next step course of handling can be determined. The treatment in this scenario could be monitoring the heart initially to determine electrical activity which then leads to AED use (which is entirely automatic), and then supplemental acute medications can be administered by the on board medical personnel. In parallel a discussion and planning begins for whatever the diversion needs may be and where the best location to divert is. 

Now, the scenario I outlined is actually exceptionally rare even on the large U.S. airlines that carry 170-180 million people a year (pre-pandemic). The vast majority of the issues that need some kind of medical attention on board are gastro/nausea, fainting (and really the result of the fainting spell - hit head, etc.)…. Then you get to the extremely infrequent items which would be respiratory or circulatory in nature. 

Knowing the issue types that are commonly experienced, knowing that there are established methods for carrying and securing key medical items that stabilize a patient until they can be seen by more well equipped medical staff, and knowing that there is a 24/7/365 MD resource available to aid in symptom evaluation, triage and next step determination, there is really very little if any need to pursue on board employed medical personnel. What may be beneficial for Amtrak is, based on their actual customer illness data, to explore an expanded medical kit type of solution along with contracting with someone like MedAire. More practically, however, as someone upthread mentioned, the proximity of Amtrak to the next crossing and therefore a potential location to meet an Ambulance or EMTs is significant and in many cases may be as quick as trying to work through solicitation of medical staff, XMK opening, etc.


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## Night Ranger (Oct 26, 2021)

Barb Stout said:


> I remember that people smoked in medical clinics and doctor's offices. When I was a kid, I had to be hospitalized after enduring a wait in the waiting room at the medical clinic due to people smoking there. It's just so unbelievable to think about and I found it unbelievable even back then that it was allowed (1973).


When I was a lad in the middle 1950s, TV news was a 15 minute nightly broadcast anchored by John Cameron Swayze, the forerunner of the Huntley-Brinkley Report. It was sponsored by Camel cigarettes and called the Camel News Caravan or something like that. Every Friday, Swayze would announce the list of VA hospitals that were receiving that week's allotment of cigarettes. Yes, every patient at a named hospital who wanted them received a carton of Camel cigarettes even the respiratory patients.

In those days, our area hospitals had only one rule about smoking. No smoking where oxygen was in use. Even back then, I wondered how much damage was being done by cigarette smoke.


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## jimdex (Oct 26, 2021)

During the 1960's B&O's Capitol Limited and National Limited each carried a stewardess-nurse.


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## Nick Farr (Oct 26, 2021)

jimdex said:


> During the 1960's B&O's Capitol Limited and National Limited each carried a stewardess-nurse.



The literature suggests this was more of a marketing gimmick than a public safety measure. They were only around for a few years in the 1950s.


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## MARC Rider (Oct 26, 2021)

jis said:


> But a cruise is not a general transport service so comparing what is available there with commercial service is an apples to oranges comparison. Specially considering that many train cruises in Central Asia and India do carry a doctor and a nurse as part of the service.


Back in the late 1980s and early 1990s my Dad managed medical services for the NOAA Corps, who operate all sorts of charting and scientific research vessels that sail the "Seven Seas." While some of the ships that were on extended missions in remote waters had a doctor on board (and Dad got to do that on a cruise off the coast of South America researching El Nino,) most of the ships did not have a doctors on board, though they did have a "pharmacist's mate" and pretty good communications links that allowed them to use telemedicine years before most people heard of the term. I guess a lot of his job, aside from making assignments of doctors and pharmacist's mates, was dealing with the unexpected stuff that came up on board the ships when they were out at sea. On the other hand, from the stories he told, he really wasn't that busy, medically speaking, during his cruises.

Of course, a government research vessel has a slightly demographic than a cruise ship, which might make the medical risks a bit different.


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## cirdan (Oct 26, 2021)

jis said:


> But a cruise is not a general transport service so comparing what is available there with commercial service is an apples to oranges comparison. Specially considering that many train cruises in Central Asia and India do carry a doctor and a nurse as part of the service.



Depends. In some cases there is overlap. For example the Norwegian postal ships. Sometimes cruise ships do regular passengers runs between Europe and the USA as well. Maybe to recoup some of the expenses of what would otherwise be costly deadhead moves. In fact AFAIK there are no longer any trans Atlantic passenger ships that are not actually cruise ships.


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## MARC Rider (Oct 26, 2021)

I should mention that on my trip home from the Gathering on the Texas Eagle back in 2019, there was a couple in the room across the hall from me who had what appeared to be a quasi-medical problem. When the person was having trouble getting up, and the partner could help, I went to find the SCA, who responded immediately. I think the train crew offered to get them medical help at an intermediate stop, but they declined and went though to Chicago. Not sure what happened to them, as I deboarded before the redcaps came for them. This would certainly be a case where some first aid/EMT training for crew would be helpful, plus access to telemedicine service. And given that some of the long distance trains run through places with no cell service, perhaps issue at least one good satellite phone for the train crew.


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## joelkfla (Oct 26, 2021)

MARC Rider said:


> And given that some of the long distance trains run through places with no cell service, perhaps issue at least one good satellite phone for the train crew.


Don't they have the ability to contact medical assistance thru their radios?


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## Bob Dylan (Oct 27, 2021)

Exvalley said:


> When it comes to causes of heart disease, one major exception is smoking. Smoking rates have fallen dramatically over the past few decades.


But the processed food is much more unhealthy, and Cancer is a continuing problem due to all the Crap put into them and the poor diets so many people, especially youngsters, are following!


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## Mailliw (Oct 27, 2021)

MARC Rider said:


> I wonder how the railroads did it in the 50s and 60s.


There wasn't a nationwide nursing shortage and labor was cheaper (especially female labor). Also the training model for nurses was different. Instead of paying tuition at colleges or universities RNs were trained in hospital nursing schools (with student nurses being paid hospital employees). Also modern RNs have a greater scope of practice; alot of the duties they had in the past are now delegated to LPNs or nurse's aids.


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## MARC Rider (Oct 27, 2021)

joelkfla said:


> Don't they have the ability to contact medical assistance thru their radios?


You might be able to call for an ambulance using a radio, but I'd sure hate to have to use it for telemedicine. When I listen to the radio chatter on a scanner, I can barely make out what a lot of people are saying.


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## jpakala (Oct 27, 2021)

Years ago when the Northern Pacific's North Coast Limited had a Stewardess Nurse, she helped a cousin of mine who had a stye in his eye. His parents and siblings were going from Chicago to Portland and they were grateful.


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## jis (Oct 28, 2021)

MARC Rider said:


> You might be able to call for an ambulance using a radio, but I'd sure hate to have to use it for telemedicine. When I listen to the radio chatter on a scanner, I can barely make out what a lot of people are saying.


This suggests that perhaps allocating a satellite telephone to each train conductor at least on passenger trains would be prudent and possibly even cost effective.


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## Danib62 (Oct 28, 2021)

I’m used to work as an EMT until 2018 (and still hold my license). In my service area we used radios daily to contact hospitals to notify them of what we were bringing into them. It’s not an issue. They still use this system.

It will never cease to amaze me that even the most absurd idea will garner 100 posts here from “experts” seeking to fix something that’s not broken.


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## jimdex (Oct 29, 2021)

Nick Farr said:


> The literature suggests this was more of a marketing gimmick than a public safety measure. They were only around for a few years in the 1950s.


I know it lasted into the early 60s, because I remember a stewardess-nurse when I rode the Capitol Limited.


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