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.