Automatic External Defibrillators and Amtrak

[Joel N. Weber II]

This article and this article discuss Automatic External Defibrillators being installed on the MBTA Commuter Rail system.

Is Amtrak doing anything similar?

 

[AlanB]

Not that I've heard.

 

[Dutchrailnut]

Not that I've heard.

Installing these devices only will shift liability to railroad. currently a radio call to nearest EMT's will shift liability away from Railroad.

besides anything not welded , rivited or glued down gets stolen.

 

[Shawn]

Not that I've heard.

Installing these devices only will shift liability to railroad. currently a radio call to nearest EMT's will shift liability away from Railroad.

besides anything not welded , rivited or glued down gets stolen.

Not exactly true. Being that AED's are available in most public places, the lack of them on a train is deemed a liability as well. The use of the AED's is covered under the Good Samaritan Act, as long as it is used as trained.

So, I would expect to see these on board an Amtrak train soon.

And yes, I work in the EMS field...so, not just flapping my jaws!

 

[Joel N. Weber II]

Not that I've heard.

Installing these devices only will shift liability to railroad. currently a radio call to nearest EMT's will shift liability away from Railroad.

besides anything not welded , rivited or glued down gets stolen.

An AED is one of the few things which is so time sensitive that waiting for an ambulance to show up is just not fast enough to get the best possible results.

 

[Joel N. Weber II]

Not exactly true. Being that AED's are available in most public places, the lack of them on a train is deemed a liability as well. The use of the AED's is covered under the Good Samaritan Act, as long as it is used as trained.

But I suspect Amtrak and commuter rail systems have a duty to rescue and the Good Samaritan Acts therefore generally do not protect such railroads from such liability.

 

[RRrich]

I am glad that wifey has an internal defibrillator. I am NOT happy that she needs one, but since she does ..........

 

[jackal]

I'm actually quite surprised that Amtrak doesn't have AEDs already.

The Alaska Railroad does, and all crew members are trained in its use as part of recurring CPR and first aid training (still have my now-expired card in my wallet!). Not sure about the on-board services staff.

They're located in the conductor's office in the rear of the two ex-UP dome cars on any given train.

 

[Joel N. Weber II]

The other thing I'm curious about is whether anyone has really thought hard about whether external defibrillators with a manual mode are ever worth putting on trains. There's a lot more training required to properly use a manual defibrillator than an automatic one in the cases where the automatic one isn't sufficient, but it might be worthwhile to have that training and equipment if a train were a half hour away from the nearest ambulance.

 

[PetalumaLoco]

The other thing I'm curious about is whether anyone has really thought hard about whether external defibrillators with a manual mode are ever worth putting on trains. There's a lot more training required to properly use a manual defibrillator than an automatic one in the cases where the automatic one isn't sufficient, but it might be worthwhile to have that training and equipment if a train were a half hour away from the nearest ambulance.

I have a Feb 2009 issue of Consumer Reports "On Health" in front of me, with an article about home defibs. These units are similar to AEDs in public places. A study looked at 7000 patients at increased risk of cardiac arrest. Half were given home AEDs, for the other half someone in the home was trained in cardiopulmonary resuscitation. Over three years of the study, the AED group had 27 cardiac-arrest deaths at home while the CPR group had 31, basically a tie. Resuscitation worked 8 times in each group. The article recommends learning CPR along with AED training as some cardiac arrests won't respond to AED.

As a side note, my employer told me of an emergency last year with a neighbor. The man next door suffered a heart attack, my boss performed CPR while waiting for the EMT crew to arrive. Unfortunately the man died. The EMTs told my boss not to feel like he failed, as more often than not victims cannot be resuscitated (contrary to what tv would lead you to believe, they said) - as the above study says.

Not a condemnation of AEDs, but my opinion that crews should be trained in both AED and CPR. And even the best scenario has the odds stacked against you if you suffer cardiac arrest, just so you know.

 

[transit54]

The other thing I'm curious about is whether anyone has really thought hard about whether external defibrillators with a manual mode are ever worth putting on trains. There's a lot more training required to properly use a manual defibrillator than an automatic one in the cases where the automatic one isn't sufficient, but it might be worthwhile to have that training and equipment if a train were a half hour away from the nearest ambulance.

I have a Feb 2009 issue of Consumer Reports "On Health" in front of me, with an article about home defibs. These units are similar to AEDs in public places. A study looked at 7000 patients at increased risk of cardiac arrest. Half were given home AEDs, for the other half someone in the home was trained in cardiopulmonary resuscitation. Over three years of the study, the AED group had 27 cardiac-arrest deaths at home while the CPR group had 31, basically a tie. Resuscitation worked 8 times in each group. The article recommends learning CPR along with AED training as some cardiac arrests won't respond to AED.

As a side note, my employer told me of an emergency last year with a neighbor. The man next door suffered a heart attack, my boss performed CPR while waiting for the EMT crew to arrive. Unfortunately the man died. The EMTs told my boss not to feel like he failed, as more often than not victims cannot be resuscitated (contrary to what tv would lead you to believe, they said) - as the above study says.

Not a condemnation of AEDs, but my opinion that crews should be trained in both AED and CPR. And even the best scenario has the odds stacked against you if you suffer cardiac arrest, just so you know.

All AED training also includes CPR certification. An AED is fairly useless without being accompanied by CPR. In fact, AEDs will instruct the user when it is appropriate to begin CPR. Usually they will deliver a series of shocks of increasing voltage and then require a minute or so of CPR before the next series of shocks is delivered. Of course all this is interrupted if the individual regains a pulse as a result of the shocks. I, too, have seen a few studies of AED usage. In the home many times they are not effective because 1) there is no one else around to witness a collapse, and 2) individuals don't always remember there is an AED in the home and try to use it. In public places, however, AEDs have been shown to be very effective, especially if administered quickly. After the point of collapse, chance of successful resuscitation by AED dramatically declines each minute the individual is left untreated.

As an EMT (though at the moment I'm not active), I have seen multiple instances when resuscitation was successful and many when it was not.

 

[PetalumaLoco]

The other thing I'm curious about is whether anyone has really thought hard about whether external defibrillators with a manual mode are ever worth putting on trains. There's a lot more training required to properly use a manual defibrillator than an automatic one in the cases where the automatic one isn't sufficient, but it might be worthwhile to have that training and equipment if a train were a half hour away from the nearest ambulance.

I have a Feb 2009 issue of Consumer Reports "On Health" in front of me, with an article about home defibs. These units are similar to AEDs in public places. A study looked at 7000 patients at increased risk of cardiac arrest. Half were given home AEDs, for the other half someone in the home was trained in cardiopulmonary resuscitation. Over three years of the study, the AED group had 27 cardiac-arrest deaths at home while the CPR group had 31, basically a tie. Resuscitation worked 8 times in each group. The article recommends learning CPR along with AED training as some cardiac arrests won't respond to AED.

As a side note, my employer told me of an emergency last year with a neighbor. The man next door suffered a heart attack, my boss performed CPR while waiting for the EMT crew to arrive. Unfortunately the man died. The EMTs told my boss not to feel like he failed, as more often than not victims cannot be resuscitated (contrary to what tv would lead you to believe, they said) - as the above study says.

Not a condemnation of AEDs, but my opinion that crews should be trained in both AED and CPR. And even the best scenario has the odds stacked against you if you suffer cardiac arrest, just so you know.

All AED training also includes CPR certification. An AED is fairly useless without being accompanied by CPR. In fact, AEDs will instruct the user when it is appropriate to begin CPR. Usually they will deliver a series of shocks of increasing voltage and then require a minute or so of CPR before the next series of shocks is delivered. Of course all this is interrupted if the individual regains a pulse as a result of the shocks. I, too, have seen a few studies of AED usage. In the home many times they are not effective because 1) there is no one else around to witness a collapse, and 2) individuals don't always remember there is an AED in the home and try to use it. In public places, however, AEDs have been shown to be very effective, especially if administered quickly. After the point of collapse, chance of successful resuscitation by AED dramatically declines each minute the individual is left untreated.

As an EMT (though at the moment I'm not active), I have seen multiple instances when resuscitation was successful and many when it was not.

rnizlek, thanks, I appreciate your knowledge and experience. What you say about home use and its results makes sense now, and I didn't know CPR was part of AED training. Full steam ahead!

 

[Ryan]

Not that I've heard.

Installing these devices only will shift liability to railroad. currently a radio call to nearest EMT's will shift liability away from Railroad.

besides anything not welded , rivited or glued down gets stolen.

This would be the absolute dumbest possible reason for making a decision on equipping trains with an AED.

Also, most AEDs that I've seen in public places are in some type of a box that has an audible alarm/strobe attached to it (it stands to reason that a situation need an AED would want to be visible and easily located), so your concerns about theft are equally misplaced.

 

[Walt]

The EMTs told my boss not to feel like he failed, as more often than not victims cannot be resuscitated (contrary to what tv would lead you to believe, they said) - as the above study says.

That pretty much what I have found too. Even when used in a hospital, by experienced doctors, they rarely help save a life. Again, as you pointed out, quite contrary to what we see on TV (is there any "medical" show on today, that doesn't use one of these in like very episode? " CLEAR! "").

 

[GG-1]

As an EMT (though at the moment I'm not active), I have seen multiple instances when resuscitation was successful and many when it was not.

Aloha

As a EMT maybe you can comment on my fear. Most People get trained, once, for emergency procedures. the when the need is there they panic fail to remember what they were taught x years ago. I would much prefer a active trained Medic to be available.

Eric

 

[transit54]

As an EMT (though at the moment I'm not active), I have seen multiple instances when resuscitation was successful and many when it was not.

Aloha

As a EMT maybe you can comment on my fear. Most People get trained, once, for emergency procedures. the when the need is there they panic fail to remember what they were taught x years ago. I would much prefer a active trained Medic to be available.

Eric

While you may be correct about individuals not going back to get retrained (I haven't seen statistics on this), I'll offer the following:

Typically, employers who implement AEDs in the workplace offer general training to employees once, but also offer reoccurring training to individuals in the organization that are responsible for responding to emergencies. This training usually involves having them maintain active CPR+AED training, which is routinely offered by the American Heart Association and the American Red Cross in practically every community in America. Individuals are certified for either 1 or 2 years and then they must attend a recertification session. I used to work for an airline, and our flight attendants were certified in CPR+AED and received regular retraining on a yearly basis. I assume Amtrak would do the same. As an EMT, I am certified in CPR yearly and am retested for my EMT certification every other year.

Secondly, CPR isn't that difficult to perform. Even if you forget the correct number of compressions and breaths, the CPR you do will still be effective, just not as effective as possible. Improper CPR is much better than no CPR at all. If you've dialed 911, all 911 dispatchers are trained in CPR and can instruct you what to do over the phone.

From an AED perspective, the device tells you what to do. So even if you forget the correct procedure, a voice actually walks you through it. Once you turn it on, it will tell you to "connect electrodes," then to place them on the chest (a picture is shown where they go), and to press the analyze button and stand back. If a shock is advised, it will tell you then to push the shock button and if not, it will instruct you to continue CPR.

Now, as far as your comment about wanting a trained medic, that obviously is desirable. However in a typical urban situation, you're looking at response times of 4-7 minutes at best for a 911 call (and in a rural situation, you'll talking about a lot more time). By the time you've reached the seven minute mark, you have an almost impossible chance of reviving a heart attack victim, especially if CPR hasn't been performed. If they are revived, chances are they will never regain full function. An AED allows you to respond to a situation very quickly, beginning treatment before trained personnel can arrive and dramatically increasing someone's chance of survival. Applying an AED cannot harm someone - they are specifically designed to never shock anyone with a pulse. Additionally, it doesn't make much sense to train Amtrak personnel as EMTs or paramedics. Really, you learn the necessary skills not just in the classroom but with lots of field experience. Even if Amtrak personnel were put through an EMT-B course, its much preferable to have trained, experienced responders on scene. Paramedics, in particular, can administer a wide range of medications to restart a stopped heart (which a defibrillator cannot do - contrary to popular belief - they simply correct ventricular fibrillation). In order for paramedics to administer most of these medications, they need authorization from a doctor (otherwise known as 'medical control'). Every area has different protocols of what medications can and can't be used and which can simply be administered and which require authorization from medical control. Additionally, certification for EMTs is done on the state level. I hold licenses for CT and VT, for instance, but cannot be an EMT anywhere else.

So as far as Amtrak is concerned, having AEDs on board along with employees trained regularly in CPR+AED is the most practical solution, and its the solution that I've seen adopted in many areas of the transportation industry.

 

[gswager]

Trained once? I disagree with you. CPR/AED card is good for three years, in most cases.

 

[transit54]

Trained once? I disagree with you. CPR/AED card is good for three years, in most cases.

Agreed. Mine are good for less, but I think that's a result of being an EMT - its a slightly different course. In my experience, many large employers who have them do a presentation on them when they are purchased, but only formally train a select number of employees, who then recertify every time their card expires. Of course some employers have everyone trained, but I wouldn't say that every company that has AEDs has every employee CPR/AED trained. That simply isn't the case.

 

[battalion51]

I believe in the case of commuter rail, they are generally a good idea. You have literally thousands of people who will be on each trainset, each day. However, with the average Amtrak train this is not the case. The odds of having to stop an Intercity train for a medical emergency are much lower than they are for a commuter service. I will not argue that CPR certification should be part of being checked out as a Conductor, but past that the law of diminishing returns comes into play on Intercity trains.

 

[Joel N. Weber II]

I believe in the case of commuter rail, they are generally a good idea. You have literally thousands of people who will be on each trainset, each day. However, with the average Amtrak train this is not the case. The odds of having to stop an Intercity train for a medical emergency are much lower than they are for a commuter service. I will not argue that CPR certification should be part of being checked out as a Conductor, but past that the law of diminishing returns comes into play on Intercity trains.

Amazon sells the Philips HeartStart Home Defibrillator (AED) for $1275. That's noise in the grand scheme of the cost of a $10 million or $20 million trainset. It's probably also noise compared to the cost of keeping conductors certified in CPR.

(Whether it's appropriate to use the ``home'' models in a non-home setting is appropriate from a liability perspective is certainly an interesting question, but the technology really is pretty much the same, and then the only other question is whether you want some fancy box with a strobe light to drive the price up. And then there's the labor cost of putting these things onto the train.)

And I think the number of passenger-hours a trainset experiences each year is the key thing, and Amtrak trainsets probably get at least as many passenger-hours per year as the average commuter trainset.

Also, do the railroads tend to certify just the conductors, or also the assistant conductors? Since the point of the excercise is to keep the patient alive until the EMTs reach the patient, and in parallel you want to be getting EMTs ASAP (who in turn are mostly concerned with keeping the patient alive until they can get to the hospital) you really want the person administering first aid to not be absolutely critical to getting the train to the right station or grade crossing. Which also makes me wonder, on trains with no assistant conductor, if the conductor is busy attempting CPR, does the FRA say the train isn't allowed to keep rolling?

 

[Joel N. Weber II]

I'm actually quite surprised that Amtrak doesn't have AEDs already.
The Alaska Railroad does, and all crew members are trained in its use as part of recurring first aid training (still have my now-expired card in my wallet!). Not sure about the on-board services staff.

They're located in the conductor's office in the rear of the two ex-UP dome cars on any given train.

Are you talking only about the Alaska Railroad's passenger trains, or also the freight trains?

 

[Joel N. Weber II]

Applying an AED cannot harm someone - they are specifically designed to never shock anyone with a pulse.

This is true as long as nobody is touching the patient while the AED is administering shocks.

 

[battalion51]

The Conductor can be doing a multitude of things and the train can keep moving. A Conductor's in a much more precarious position when they're in the can vs. giving CPR to someone.

 

[gswager]

Applying an AED cannot harm someone - they are specifically designed to never shock anyone with a pulse.

This is true as long as nobody is touching the patient while the AED is administering shocks.

The AED will analyze the patient if there's a heart beat, not pulse. It measures in electrical activity. EMTs always check for pulse before advising for shock. One thing is tachycardia (heart beats very fast). If there's no pulse, then the EMT will shock the patient. If there's pulse, the EMT will override the AED or SAED (semi-automatic), not to shock. Same thing to Ventricular fibrillation (V-fib), which is usually no pulse. In most AED units, they will not shock on patient with tachycardia at all.

Also, do not touch the patient while the AED is analyzing, to avoid a false reading. Even a movement of body will give a false reading.

 

[jackal]

I'm actually quite surprised that Amtrak doesn't have AEDs already.
The Alaska Railroad does, and all crew members are trained in its use as part of recurring first aid training (still have my now-expired card in my wallet!). Not sure about the on-board services staff.

They're located in the conductor's office in the rear of the two ex-UP dome cars on any given train.

Are you talking only about the Alaska Railroad's passenger trains, or also the freight trains?

Well, obviously the AEDs are only equipped on passenger trains (there is no separate conductor's office on freights, since the engineer and conductor both sit in the locomotive cab).

However, since any train service employee can be called for a passenger train at any time (they don't differentiate between passenger and freight; I worked the yard all summer but I still have a passenger uniform I never used!), all train service employees maintain CPR/AED certification. And because (since sometime in the '90s) all train service and engine service employees are dual-qualified, that means that all TY&E employees (perhaps with the exception of the old heads that are single-qualified in engine service) maintain certification.

So yes, that means that both the conductor and the brakeman (assistant conductor, in Amtrak parlance) should be qualified.

I'm actually not 100% sure about the requalification procedures, as I was only there for one summer. We did have our own training and development manager on staff who previously worked for the Red Cross, and she provided all of the certification training. (She's still there--I've seen her name in newsletters.)

One thing about the ARR: there is a large proportion of blue-hairs on the train, so heart failure and other problems are possibly more likely to happen than on Amtrak. Perhaps this is why they emphasize the training and Amtrak doesn't. Still, it surprises me that crew members responsible for people's safety in this manner aren't qualified for something like this.