Amtrak nurse (proposal for the future)

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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)
 

Cal

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Please no.
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.
 

pennyk

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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).
 

caravanman

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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?
 

Saddleshoes

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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.
 

PVD

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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.
 

Cal

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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.
 

PVD

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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.
 

Ziv

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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?
 

PVD

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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.
 

Willbridge

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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.
 

Rambling Robert

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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.
 

WWW

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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 ! ! !
 

OBS

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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.
 

Rambling Robert

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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.
 

PVD

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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.
 

Trollopian

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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.
 

jis

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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

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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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