@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.
