Amtrak nurse (proposal for the future)

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cirdan

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In addition to the smoke, even when no one was smoking many places continued to have a pretty noticeable smell of stale nicotine or something - including some Sleeper compartments on trains. And then they sprayed some mintish smelling thing to try to cover that other smell, so that produced a unique combined scent :)
Mx first apartment after leaving uni had previously been inhabited by a chain smoker and it took me about a year and five coats of paint until it finally stopped smelling of stale smoke.
 

cirdan

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With a bus full of college students, he was probably more worried about the kids smoking something else. :) I wonder what that driver would think if he was zapped forward in time to the present day where weed in Illinois is legal, but, of course, smoking anything (including tobacco) in a bus is not.
One of the down sides of weed legalization is that some people interpret this to mean they can smoke it anywhere where it is not explicitly forbidden. Many don't realize how disgusting and lingering that smell is.
 

cirdan

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When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. Taking a cruise is the only time I can think of where a nurse or a doctor is available. A plane has to divert and land to get someone medical attention. A train has to stop in the closest place possible with medical attention, etc. I personally think it would be good for the LSA to have completed an actual first aid course, be certified on CPR, and be trained and signed of on using an AED.
I don't think being on a train puts you further from help than, say, driving cross country. Having a train make an unscheduled stop for emergency medical purposes is definitely less of a deal than having an airliner make an emergency landing.
 

Barb Stout

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I agree. But even so there is massively less smoking overall. I remember the day that you could walk into any pub or bar and the air would be so thick that you would struggle to see across to the other side of the room. Or that it was normal for people to smoke in offices at work, on airliners etc etc.
I remember that people smoked in medical clinics and doctor's offices. When I was a kid, I had to be hospitalized after enduring a wait in the waiting room at the medical clinic due to people smoking there. It's just so unbelievable to think about and I found it unbelievable even back then that it was allowed (1973).
 

Trollopian

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When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. Taking a cruise is the only time I can think of where a nurse or a doctor is available.
The Cherry Ames books, which my sister and I devoured as kids (is that why my sister became a nurse? I didn't), followed our heroine to her various posts as Student Nurse, Army Nurse, Flight Nurse, Cruise Nurse, Boarding School Nurse, Camp Nurse, even Dude Ranch Nurse. (Lots of job-hopping. The series doesn't follow her into a retirement of penury caused by not staying anywhere long enough to vest in a pension.) But never "Train Nurse."

 

jis

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When you are flying, taking a train, etc., you are accepting the fact that you are away from medical attention. Taking a cruise is the only time I can think of where a nurse or a doctor is available. A plane has to divert and land to get someone medical attention. A train has to stop in the closest place possible with medical attention, etc. I personally think it would be good for the LSA to have completed an actual first aid course, be certified on CPR, and be trained and signed of on using an AED.
But a cruise is not a general transport service so comparing what is available there with commercial service is an apples to oranges comparison. Specially considering that many train cruises in Central Asia and India do carry a doctor and a nurse as part of the service.
 
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@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.
 

Night Ranger

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I remember that people smoked in medical clinics and doctor's offices. When I was a kid, I had to be hospitalized after enduring a wait in the waiting room at the medical clinic due to people smoking there. It's just so unbelievable to think about and I found it unbelievable even back then that it was allowed (1973).
When I was a lad in the middle 1950s, TV news was a 15 minute nightly broadcast anchored by John Cameron Swayze, the forerunner of the Huntley-Brinkley Report. It was sponsored by Camel cigarettes and called the Camel News Caravan or something like that. Every Friday, Swayze would announce the list of VA hospitals that were receiving that week's allotment of cigarettes. Yes, every patient at a named hospital who wanted them received a carton of Camel cigarettes even the respiratory patients.

In those days, our area hospitals had only one rule about smoking. No smoking where oxygen was in use. Even back then, I wondered how much damage was being done by cigarette smoke.
 

jimdex

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During the 1960's B&O's Capitol Limited and National Limited each carried a stewardess-nurse.
 

Nick Farr

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During the 1960's B&O's Capitol Limited and National Limited each carried a stewardess-nurse.
The literature suggests this was more of a marketing gimmick than a public safety measure. They were only around for a few years in the 1950s.
 

MARC Rider

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But a cruise is not a general transport service so comparing what is available there with commercial service is an apples to oranges comparison. Specially considering that many train cruises in Central Asia and India do carry a doctor and a nurse as part of the service.
Back in the late 1980s and early 1990s my Dad managed medical services for the NOAA Corps, who operate all sorts of charting and scientific research vessels that sail the "Seven Seas." While some of the ships that were on extended missions in remote waters had a doctor on board (and Dad got to do that on a cruise off the coast of South America researching El Nino,) most of the ships did not have a doctors on board, though they did have a "pharmacist's mate" and pretty good communications links that allowed them to use telemedicine years before most people heard of the term. I guess a lot of his job, aside from making assignments of doctors and pharmacist's mates, was dealing with the unexpected stuff that came up on board the ships when they were out at sea. On the other hand, from the stories he told, he really wasn't that busy, medically speaking, during his cruises.

Of course, a government research vessel has a slightly demographic than a cruise ship, which might make the medical risks a bit different.
 

cirdan

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But a cruise is not a general transport service so comparing what is available there with commercial service is an apples to oranges comparison. Specially considering that many train cruises in Central Asia and India do carry a doctor and a nurse as part of the service.
Depends. In some cases there is overlap. For example the Norwegian postal ships. Sometimes cruise ships do regular passengers runs between Europe and the USA as well. Maybe to recoup some of the expenses of what would otherwise be costly deadhead moves. In fact AFAIK there are no longer any trans Atlantic passenger ships that are not actually cruise ships.
 

MARC Rider

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I should mention that on my trip home from the Gathering on the Texas Eagle back in 2019, there was a couple in the room across the hall from me who had what appeared to be a quasi-medical problem. When the person was having trouble getting up, and the partner could help, I went to find the SCA, who responded immediately. I think the train crew offered to get them medical help at an intermediate stop, but they declined and went though to Chicago. Not sure what happened to them, as I deboarded before the redcaps came for them. This would certainly be a case where some first aid/EMT training for crew would be helpful, plus access to telemedicine service. And given that some of the long distance trains run through places with no cell service, perhaps issue at least one good satellite phone for the train crew.
 

Bob Dylan

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When it comes to causes of heart disease, one major exception is smoking. Smoking rates have fallen dramatically over the past few decades.
But the processed food is much more unhealthy, and Cancer is a continuing problem due to all the Crap put into them and the poor diets so many people, especially youngsters, are following!😥🤬
 

Mailliw

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I wonder how the railroads did it in the 50s and 60s.
There wasn't a nationwide nursing shortage and labor was cheaper (especially female labor). Also the training model for nurses was different. Instead of paying tuition at colleges or universities RNs were trained in hospital nursing schools (with student nurses being paid hospital employees). Also modern RNs have a greater scope of practice; alot of the duties they had in the past are now delegated to LPNs or nurse's aids.
 

jpakala

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Years ago when the Northern Pacific's North Coast Limited had a Stewardess Nurse, she helped a cousin of mine who had a stye in his eye. His parents and siblings were going from Chicago to Portland and they were grateful.
 
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jis

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You might be able to call for an ambulance using a radio, but I'd sure hate to have to use it for telemedicine. When I listen to the radio chatter on a scanner, I can barely make out what a lot of people are saying.
This suggests that perhaps allocating a satellite telephone to each train conductor at least on passenger trains would be prudent and possibly even cost effective.
 

Danib62

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I’m used to work as an EMT until 2018 (and still hold my license). In my service area we used radios daily to contact hospitals to notify them of what we were bringing into them. It’s not an issue. They still use this system.

It will never cease to amaze me that even the most absurd idea will garner 100 posts here from “experts” seeking to fix something that’s not broken.
 

jimdex

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The literature suggests this was more of a marketing gimmick than a public safety measure. They were only around for a few years in the 1950s.
I know it lasted into the early 60s, because I remember a stewardess-nurse when I rode the Capitol Limited.
 

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