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Better way for RR medical emergencies ?

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Better way for RR medical emergencies ?
Posted by blue streak 1 on Friday, February 17, 2017 3:15 PM

We are aware of the delays and sometimes detraining of an ailing passenger who does not need to get off or who gets off at a location that cannot take care of a  specific problem.  Ex::  Strokes very specific protols required.

The world's airlines now use a facility located near Phoenix, AZ. staffed by doctors, nurses, vaious locating specialists 24/7 all that  communicate with any airplane around the world that has a possible medical emergency.  It is called MEDAIR (sp?).  If a passenger needs to get on the ground immediately then MEDAIR recommends the closest facility that has proper equipment and if personel on duty then to deal with the problem.  That closest  appropriate airport includes time to airport and time from airport to hospital if appropriate.

If Amtrak used this MEDAIR then it might be able to reduce number of detrainings.  As well MEDAIR could even recommend and see that EMTs meet the train and that they either take ailing passenger off or accompany the passenger to a competent facility ?

MEDAIR is well established and can certainly provide more medical expertise than Amtrak or a freight RR can.  RR dispatchers can certaing locate a meet.  

Yes it might require imput to an expanded data base.  Amtrak's track a train certainly would help on locating train and available ( a very real time necessary operative word ) help.

BALT any comment ?

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Posted by BaltACD on Friday, February 17, 2017 3:33 PM

At present, Amtrak on board personnel identify the 'need for the emergency'.  Knowing the 'lay of the land' they know where EMS is located and where their normal station stops are located.

Amtrak Conductor notifies the Train Dispatcher of the emergency and where they want EMS to meet the train.  Train Dispatcher notifies the Police Command Center who in turn notify the local authorities. (Train Dispatchers do not have contact numbers for local authorities.)  Train makes it's station stop and EMS perform their service, either treating or removing the individual as their medical condition warrants. 

Auto Train which does not make station stops except at Florence, SC for crew change and engine fueling, will make their arrangements to meet EMS at existing Amtrak stations on their route.

Amtrak, being ground based with numerous recognized station points does not have the same problems as airliners at 30K feet have when dealing with medical emergencies.  Landing at a out of route airport generates many more problems for the air lines than does a few minutes of delay to an Amtrak train meeting EMS personnel.

 

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Posted by cx500 on Friday, February 17, 2017 11:16 PM

An airplane can head for a fully equipped medical facility rather more easily than a train, and most places where a big jet is even able to land will have a big hospital.  150 miles off route is little more than 20 minutes flying time.  For a train a change of route is not normally an available option, and certainly not a timesaver for the patient.

With trains, very detailed local knowledge is critical, basically between the local EMS personnel and the railroad to transfer the patient at a local station, or even a grade crossing.  EMS and the local hospital can then provide immediate care and stabilization, and if warranted arrange a further transfer, perhaps even by air ambulance, to a bigger facility.  Less delay to the train, and the fastest aid for the patient.

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Posted by rcdrye on Saturday, February 18, 2017 7:33 AM

As an EMT for several decades I have been involved in several on-board medical incidents, both as a responder and as a passenger assisting.  There are a number of things that influence where to stop the train and how to get help on board.  Here are a couple of incidents for examples.

Patient seizing on southbound Montrealer after leaving White River Jct. VT.  Here the problem was lack of available crossroads.  After talking it over with the conductor he made the decision to continue six miles to Windsor VT (not a stop then) and use the platform, which was also very close to the fire station so the ambulance was already waiting when the train pulled in.  Very little delay to the train.

Eastbound Lake Shore, woman having trouble breathing.  Crew called for ambulance at Utica, ambulance crew treated her, woman refused to leave train, signed refusal of care.  She was occupying a quad seat with a lot of luggage and had checked baggage.  Train left Utica with delay, later same woman complained again, this time with worse symptoms.  Conductor contacted dispatcher, train stopped within Hoffmans interlocking (that's where CSX heads off to Selkirk, a very busy place) and local Fire Dept and contract ambulance responded.  Assistant conductor fished her ticket out of his stack and crew assisted in moving her and her luggage across track 2 and up over the bank to NY Rt. 6 to the waiting ambulance, which most likely headed for Schenectady (our next stop).  I assume her checked baggage ended up in Boston.  Overall the train lost over 90 minutes between arrival at Utica and arrival at Schenectady, normally about a 100 minute run.  The Ambulance actually came from Amsterdam, where there was an existing Amtrak station, though not a stop for the Lake Shore.

The takeaway from the second call is that the train crew doesn't have the same control over the on-train scene that an aircraft crew does.  Patients have the right to refuse care and transport, and it's not all that easy for the crew to remove a passenger, especially if the passenger is (temporarily) stable.  On an aircraft, the law requires passengers to obey uniformed crew.  The crew is also at the mercy of the dispatcher in choosing a location to stop.

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Posted by blue streak 1 on Saturday, February 18, 2017 11:26 AM

It would seem that using MEDAIR to at least evaluate an ontrain medical problem would be much better with their depth of expertise and number of specialists.  The problem of getting stroke victims to a proper facility for treatment is probably the best example.  Most hospitals if stroke victim gets there within 3 hours the victim has chance of full recovery.  A few hospitals such as Grady in Atlanta can do the same within 4 hours.   Even if they don't have to set up dispatch they can provide best info to first responders that meet a train. Sorry   ---   but contacting a local general practice doctor in east whatever is not best diagnosis.  The enroute on board crew certainly can certainly get better help until getting to a first responder location.

As an aside what emergency medical equipment is on most trains including AEDs ? 

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Posted by schlimm on Saturday, February 18, 2017 1:51 PM

blue streak 1

It would seem that using MEDAIR to at least evaluate an ontrain medical problem would be much better with their depth of expertise and number of specialists.  The problem of getting stroke victims to a proper facility for treatment is probably the best example.  Most hospitals if stroke victim gets there within 3 hours the victim has chance of full recovery.  A few hospitals such as Grady in Atlanta can do the same within 4 hours.   Even if they don't have to set up dispatch they can provide best info to first responders that meet a train. Sorry   ---   but contacting a local general practice doctor in east whatever is not best diagnosis.  The enroute on board crew certainly can certainly get better help until getting to a first responder location.

As an aside what emergency medical equipment is on most trains including AEDs ? 

 

Absolutely!  The closest med facility is not necessarily what the patient needs.  It depends on someone on board figuring out what is the patient's condition, probably in consultation with something like MEDAIR.

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Posted by zugmann on Saturday, February 18, 2017 3:04 PM

schlimm
Absolutely! The closest med facility is not necessarily what the patient needs. It depends on someone on board figuring out what is the patient's condition, probably in consultation with something like MEDAIR.

Dammit Jim! I'm a conductor - not a doctor!

The opinions expressed here represent my own and not those of my employer or any other railroad, company, or person.

And why does the truth seem too hard to be true?

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Posted by BaltACD on Saturday, February 18, 2017 4:23 PM

zugmann
schlimm

Dammit Jim! I'm a conductor - not a doctor!

If the contract added a $5 arbitrary would you be a doctor then?

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Posted by zugmann on Saturday, February 18, 2017 6:00 PM

BaltACD
If the contract added a $5 arbitrary would you be a doctor then?

I get that for being a certified conductor.  Dig deeper.

The opinions expressed here represent my own and not those of my employer or any other railroad, company, or person.

And why does the truth seem too hard to be true?

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Posted by BaltACD on Saturday, February 18, 2017 6:08 PM

zugmann
BaltACD
I get that for being a certified conductor.  Dig deeper.

That fiver is on top of you 'certified conductor' arbitrary - but you may have to give up your lunch allowanceBig Smile

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Posted by zugmann on Saturday, February 18, 2017 6:11 PM

Do I at least get a hat?

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Posted by BaltACD on Saturday, February 18, 2017 7:11 PM

zugmann
Do I at least get a hat?

You get a pair of latex gloves!  But you'll have to buy a stethescope and a blood pressure cuff.

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Posted by zugmann on Saturday, February 18, 2017 7:14 PM

BaltACD
You get a pair of latex gloves! But you'll have to buy a stethescope and a blood pressure cuff.

Conductor, conductor, it hurts when I do this! 

 

So don't do that!

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Posted by Deggesty on Saturday, February 18, 2017 7:26 PM

BaltACD

 

 
zugmann
Do I at least get a hat?

 

You get a pair of latex gloves!  But you'll have to buy a stethescope and a blood pressure cuff.

 

Be sure the cuff has a digital readout so you will not have to look at a gauge to see what the blood pressure is.Smile

Johnny

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Posted by zugmann on Saturday, February 18, 2017 7:36 PM

Deggesty
Be sure the cuff has a digital readout so you will not have to look at a gauge to see what the blood pressure is.Smile

I got 90 pounds - let me know when your flow is down!

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Posted by rcdrye on Saturday, February 18, 2017 7:38 PM

Each Amfleet car has a basic first aid kit, with band-aids.  The box with the oxygen bottle is in the Amfleet Lounge.  On the Lake Shore, everything in it was outdated, and it did have latex gloves, which weren't usable.  Latex gloves have been replaced in general EMS use by newer generations of gloves.

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Posted by BaltACD on Saturday, February 18, 2017 8:46 PM

Not to sound callous about it  - but it is - Amtrak (or any other railroad) wants to get the 'medical emergency' off their train BEFORE the party dies.  If the party dies 'on the train' delay will be severe, with all the appropriate medical and investigative agencies having to respond and perform their own investigations of the incident.

Railroad personnel, none of them are trained medical professionals and are not really 'qualified' to speak with 3rd party personnel about the condition of those suffering a medical emergency.  A First Aid course does no qualify one as medically qualified.  That is why it is in everyone's best interests to get the medical emergency individual to the most readily available EMS organization.  Once the person is under the care of the EMS they are (hopefully) medically qualified to make the decision of whether the nearest medical facility or arrangements for a specialized medical facility will be needed.

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Posted by schlimm on Sunday, February 19, 2017 8:49 PM

BaltACD
Railroad personnel, none of them are trained medical professionals and are not really 'qualified' to speak with 3rd party personnel about the condition of those suffering a medical emergency. 

Right they are not qualified to perform medical procedures.  If trained for CPR, they can do that if indicated and save a life.  But someone with eyes and a modicum of intelligence can observe what a trained person on the phone can ask them to check out, again possibly getting the victim to the proper treatment facility more quickly.

Delays?   Surely passengers would tolerate that.

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Posted by AMTRAKKER on Monday, February 20, 2017 11:37 AM

We need to clear up some issues on this one. 

I have been a practicing paramedic since 1986 and have been around the block in the world of EMS. 

Getting the patient to care is the priority. Any ambulance crew can do more for a patient than people on a train talking to someone on the phone. What is needed is equipment that is not on the train, and possibly medications. 

Where the patient is transported to is subject to the EMS laws in the state of country where the emergency is occurring. Many places responders will transport to the closest approprite facility. In some cases now, new regulations are being written to allow transport to distant specialty centers (chest pain,stroke) if the patient meets certain parameters.  

In all places the responders work under Standing Medical Orders put in place and enforced by the local Emergency Medical Services system. Field responders must work within these guidelines. When on a call, the EMS crew communicates with their resource hospital for orders on patient care. They are talking with either an MD or RN who has been specially certified for the task, not a local general practice doc. 

If a patient is transported to a local hospital, and transfer is needed to a more comprehensive hospital, the patient can be transported by a Critical Care ambulance or by Medical Helicopter, both staffed by Critical Care Paramedics and Critical Care Nurses. 

 

 

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Posted by schlimm on Monday, February 20, 2017 5:16 PM

AMTRAKKER
If a patient is transported to a local hospital, and transfer is needed to a more comprehensive hospital, the patient can be transported by a Critical Care ambulance or by Medical Helicopter, both staffed by Critical Care Paramedics and Critical Care Nurses. 

That is why a remote triage to get the victim to the appropriate place could save precious time and lives, vs what you are posting.  With your plan, the train stops in some town, the patient is taken to the nearest hospital by an ambulance which may not have the needed personnel.  Then the local hospital ER determines J Doe needs to go to a comprehensive hospital.  By now, much time was wasted and the damage is done.

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Posted by BaltACD on Monday, February 20, 2017 5:56 PM

schlimm
AMTRAKKER

That is why a remote triage to get the victim to the appropriate place could save precious time and lives, vs what you are posting.  With your plan, the train stops in some town, the patient is taken to the nearest hospital by an ambulance which may not have the needed personnel.  Then the local hospital ER determines J Doe needs to go to a comprehensive hospital.  By now, much time was wasted and the damage is done.

Well 'The Love Boat' had the Ship's Doctor position.  I guess it's being suggested now that Amtrak have a Traveling Doctor position on their train crew, along with necessary technologies to support it.

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Posted by schlimm on Monday, February 20, 2017 8:55 PM

BaltACD

 

 
schlimm
AMTRAKKER

That is why a remote triage to get the victim to the appropriate place could save precious time and lives, vs what you are posting.  With your plan, the train stops in some town, the patient is taken to the nearest hospital by an ambulance which may not have the needed personnel.  Then the local hospital ER determines J Doe needs to go to a comprehensive hospital.  By now, much time was wasted and the damage is done.

 

Well 'The Love Boat' had the Ship's Doctor position.  I guess it's being suggested now that Amtrak have a Traveling Doctor position on their train crew, along with necessary technologies to support it.

 

That sounds like overkill.  Mischief

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Posted by zugmann on Tuesday, February 21, 2017 11:15 AM

schlimm
That is why a remote triage to get the victim to the appropriate place could save precious time and lives, vs what you are posting. With your plan, the train stops in some town, the patient is taken to the nearest hospital by an ambulance which may not have the needed personnel. Then the local hospital ER determines J Doe needs to go to a comprehensive hospital. By now, much time was wasted and the damage is done.

But the other side of the coin - somone decides to keep the patient on the train to the next major city.  But along the way, the engine craps out, or you get stuck behind a freight train that went into emergency.  Now you're stuck 4 miles from the nearest town or grade crossing in a remote area with no cell phone coverage. 

 Yeah, yeah, I know I'm playing the "what-if" game.

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Posted by BaltACD on Tuesday, February 21, 2017 1:17 PM

zugmann
schlimm

But the other side of the coin - somone decides to keep the patient on the train to the next major city.  But along the way, the engine craps out, or you get stuck behind a freight train that went into emergency.  Now you're stuck 4 miles from the nearest town or grade crossing in a remote area with no cell phone coverage. 

 Yeah, yeah, I know I'm playing the "what-if" game.

As is previously stated - in these kinds of situations - Amtrak's main goal is to get the patient off the train before they are declared dead and to see that they get recognized certified medical care with the earliest dispatch so that when the law suits come, and they will, Amtrak will be seen as having done everything possible to prevent the death.

It sounds cold, and it is, but that is what the 21st Century legitious society is all about

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Posted by AMTRAKKER on Monday, March 06, 2017 9:51 AM

Keeping someone on a train with no medical equipment or medications will not in any way save lives. Thinking it will is just not correct. A local er can stabilize a patient and prepare them for further transport if necessary. Riding them more miles in an Amtrak car does absolutely nothing. 

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Posted by schlimm on Monday, March 06, 2017 11:13 AM

AMTRAKKER

Keeping someone on a train with no medical equipment or medications will not in any way save lives. Thinking it will is just not correct. A local er can stabilize a patient and prepare them for further transport if necessary. Riding them more miles in an Amtrak car does absolutely nothing. 

 

It really depends on many factors:

1. What is the patient diagnosis?

2. Closest ER and hospital appropriate to patient's condition.

3. Fastest way to get patient there.

4. Competence of the EMTs.

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Posted by BaltACD on Monday, March 06, 2017 12:20 PM

schlimm
AMTRAKKER

Keeping someone on a train with no medical equipment or medications will not in any way save lives. Thinking it will is just not correct. A local er can stabilize a patient and prepare them for further transport if necessary. Riding them more miles in an Amtrak car does absolutely nothing.

It really depends on many factors:

1. What is the patient diagnosis?

2. Closest ER and hospital appropriate to patient's condition.

3. Fastest way to get patient there.

4. Competence of the EMTs.

None of which are staisfied by staying on Amtrak in the hands of a crew that are paid railroaders - not medical professionals.  The least competent EMT is light years more qualified than Amtrak personnel.  The EMT crew knows the answers to your questions and has the ability to act on those answers.

 

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Posted by ACY Tom on Monday, March 06, 2017 5:44 PM

While I can't give statistics, I can say for certain that the Auto Train has a longstanding reputation for transporting a very large number of passengers of advanced age and with physical difficulties. Medical emergencies on the Auto Train are not an everyday occurrence, but they happen often enough that the crews are used to dealing with them. When one occurs, the Conductor has the final word as to the proper course. This usually means calling the dispatcher and arranging to meet the paramedics wherever it makes the most sense to do so in a timely way. On occasion, we have stopped for this purpose at rural grade crossings where there was no visible sign of habitation. The ambulance meets the train, the patient is removed, and the professional health care providers take over. Sometimes the patient or the patient's family disagree with the Conductor's decision and want to stay aboard, but the Conductor makes the final decision.

While there are no actual health care professionals on the train staff per se, the OBS crew and Conductors do receive some first aid training. There have been Auto Train OBS crew members who have served as volunteer EMT's in their off-train time, so they have extra training beyond the usual. The Auto Train, being much longer than most trains, also carries more AED's than most trains. I can't speak for most trains, but I have never heard of out of date AED's being carried on Auto Train.

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Posted by CandOforprogress2 on Monday, March 06, 2017 6:14 PM

Use Drones to medicac people in and out

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Posted by schlimm on Tuesday, March 07, 2017 5:19 PM

BaltACD

 

 
schlimm
AMTRAKKER

Keeping someone on a train with no medical equipment or medications will not in any way save lives. Thinking it will is just not correct. A local er can stabilize a patient and prepare them for further transport if necessary. Riding them more miles in an Amtrak car does absolutely nothing.

It really depends on many factors:

1. What is the patient diagnosis?

2. Closest ER and hospital appropriate to patient's condition.

3. Fastest way to get patient there.

4. Competence of the EMTs.

 

None of which are staisfied by staying on Amtrak in the hands of a crew that are paid railroaders - not medical professionals.  The least competent EMT is light years more qualified than Amtrak personnel.  The EMT crew knows the answers to your questions and has the ability to act on those answers.

 

 

Depends on the EMTs' actual skills, which vary greatly.  Some are superb, others......Oops - Sign

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