Handling of Emergeny Medical Events

[Fireman_Steve]

Here is a copy of a letter I recently sent via AMTRAK's homepage to offer a suggestion to further increase the popularity of using trains.

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Message: I have a suggestion for your company to consider. Have you ever considered providing an onboard EMT or paramedic on your trains? One EMT or paramedic on board a train can offer immediate first aid or emergency medical service for any of your riders within a matter of seconds.

From simply a marketing aspect, this service would be worth its weight in gold. EMT's are allready trained in the use of the automatic defibrilators that I have been reading AMTRAK has been purchasing but has no plan to put them on board trains.

As a career firefighter/paramedic AND commuter on AMTRAK in south florida I know the importance of rapid defibrilation in saving countless lives.

AMTRAK could utilize off duty firefighters, paramedicas and EMT's to ride your trains and offer this service. Most of our nations firefighters allready have part time employment on their days off and AMTRAK could utilize this great source of trained personel who would jump at the chance to work in this capacity.

Use them as part time employees and there is no need for AMTRAK to offer many benefits since they all have benefits from their full time job. Very cost saving in this time of financial uncertainty

A EMT or paramedic that could be summond to the seat of a passenger having a medical emergency within seconds can then relay vital information to the train's conductors and let them know the importance and the speed in which the passenger needs further assistance. eg ( transportation to a hospital via ambulance) Many on board emergencies could be handled right on the spot to eliminate the stopping of the train and the disruption of the trip for both the rest of the train crew and the person having the emergency.

The on board medical person could also be given a list of those passengers who would like to be checked on periodically during their trip on AMTRAK and this public relations and marketing idea would be very well recepted by the traveling public, especially the elderly.

I would be happy to discuss this topic in more detail if interested. Best wishes,

S. K.

Firefighter/Paramedic

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[Amfleet]

Steve that is a good idea, but I don't think Amtrak could afford the service right now. Also if there were a medical emergancy on-board then the conductors could call and have EMT crews awaiting at the next grade-crossing or station.

 

[Viewliner]

Steve that is a good idea, but I don't think Amtrak could afford the service right now. Also if there were a medical emergancy on-board then the conductors could call and have EMT crews awaiting at the next grade-crossing or station.

I agree with Amfleet, as good an idea as it is, we just don't have the money, between worrying about not getting the 1.2 Billion, and fixing our equipment.

 

[tp49]

I concur that the idea is excellent but besides money I can think of one other potential problem that being if the EMT were to ride the train the length of the route he would have to be certified in every state that the train passes through on the route because every state has slightly different standards. However, if they changed EMT's at crew stops they might only have to be certified in some of the states.

 

[Amfleet]

How come instead of putting EMT on the trains Amtrak just trains it's crews like airline attendents.

 

[Viewliner]

How come instead of putting EMT on the trains Amtrak just trains it's crews like airline attendents.

I was thinking that too, it probably would cost less in the long run.

 

[Chatter163]

Another issue here is liability. I am not sure that Amtrak would want, or would be able, to carry the liability that inevitably goes along with such a scheme.

 

[tp49]

How could I completely forget the liability issue. What would the cost be of installing Automated Defibralators on trains? If they did this how would they be distributed one per car or two to three per train depending upon the length?

 

[Amfleet]

Another issue here is liability. I am not sure that Amtrak would want, or would be able, to carry the liability that inevitably goes along with such a scheme.

Your right. This past summer the MBTA had an incident in which a man had a heart attack on board. The crew did not follow any of the correct safety procedures and continued to make stops into Boston. The man did recieve CPR and once in Boston was transported by an abulance to a near by hospital. The man died almost imedeitly and it was an Amtrak crew.

 

[AlanB]

Your right. This past summer the MBTA had an incident in which a man had a heart attack on board. The crew did not follow any of the correct safety procedures and continued to make stops into Boston. The man did recieve CPR and once in Boston was transported by an abulance to a near by hospital. The man died almost imedeitly and it was an Amtrak crew.

However, if there had been an EMT on that "T" train, along with a defibrillator, that story might have still had a happy ending. Plus with a EMT on board, he probably would have impressed upon the conductor the seriousness of the situation.

Additionally, since he would have been a local EMT, he might well have known that they could get a stretcher down the stairs at those intermediate stops. That was one of the reasons that the conductor kept going, he thought that a rescue would be too hard from those stations.

Yes liability is a potential problem, however there are things that you can do about that. Plus I think that at least within certain states, simply passing the EMT courses and tests does to some extent limit liability provided that the EMT follows the correct procedures in an emergency.

 

[gswager]

It would be great if the conductors and attendants are certified for first aid, CPR, defib, and some other stuff. These are not too hard to take.

However, the hardest part is taking a gut to treat the passengers, i.e. blood, people looking at you, etc.

I've done that before. It took me several attempts to help, even with the EMTs, at the scene.

 

[Chatter163]

But the liability issue does not go away. Amtrak is not a muncipality that already has an EMT services division or fire rescue department, and is to a large extent indemnified against misdeeds by its members, as are city and county fire departments. No, this type of coverage would need to be purchased from an insurance carrier. I doubt that many would be willing to underwrite such costs for a reasonable amount , nor would the federal government likely wish to get involved. Then there is the issue of state-by-state EMT requirements, which has already been raised. These would be crucial in any liability case.

While notifying authorities to respond is not perfect, it does represent the safest and smoothest course, in terms of liability protection.

 

[tp49]

The liability issue might possibly be dealt with if there were a way to get Amtrak covered under the Federal Tort Claims Act which would make suing Amtrak in that situation more difficult. Then again I don't think Congress would be inclined to do this.

 

[Fireman Steve]

I was away for the weekend after making this original post. The family and I took the train from Sebring down to West Palm Beach and stayed the weekend at the Sheraton right next to the train station.

All the replies have valid and important ideas. From what I know, if Amtrak ever decided to offer this type of service it would be best handled by contracting it out to a private party. This would eliminate alot of the liabillity and other related problems. To speak of liability, what kind of liability do you think that Amtrak opened themselves up to recently in Boston when the man suffered a heart attack and the train continued to make several more stops?

If this service was contracted out to a private party Amtrak is pretty much in the clear. There are many private ambulance services in this nation that operate with their own liability insurance.

The point brought up that EMT's would have to be certified in each state that amtrak travels through can be handled by staffing the trains with what is known as a "first responder" A first responder can be trained to use the important Automatic Defibrilator and that is the most important tool needed to save lives. They are starting to put these in airports and other places of businesses. They are using them because they save lives.

Amtrak has allready begun to purchase these devices but still have no plans to put them onto the trains. This is where they are needed.

Amtrak crews could be and should be trained in the use of these devices. You don't need to be certified in any state EMT program to be able to be certified in the use of the Defibrilator.

Any time there is a delay in the application of the electrical shock needed to correct ventricular fibrillation the survivablity of that person lessens very rapidly.

I realize that the associated costs of this type of project would probably keep it from ever getting off of the drawing board, but I feel it is something that Amtrak should at least consider and keep in the back of their minds.

In my opinion, liabiltiy would actually be less if there was a trained person able to use this type of equipment on board the train and able to deliver this important cardiac shock within seconds of the person needing it.

The part about the EMT needing to be certified in each state would be handled by the private contractor of this service. Just like they do with all of the air ambulance companies that transverse not only states but countries.

Automatic defibrilators save lives, pure and simple and they should not be in some Amtrak office or storage facitlity as they are now, they need to be on board trains and at minimum, the train staff needs to be trained in their use.

Have a great week everyone.

 

[tp49]

To speak of liability, what kind of liability do you think that Amtrak opened themselves up to recently in Boston when the man suffered a heart attack and the train continued to make several more stops?

Four words, out of court settlement. This is a suit that should it go into court that Amtrak has absolutly no possibility of winning.

Amtrak has allready begun to purchase these devices but still have no plans to put them onto the trains. This is where they are needed.
Amtrak crews could be and should be trained in the use of these devices. You don't need to be certified in any state EMT program to be able to be certified in the use of the Defibrilator.

No argument here. If Amtrak is purchasing these devices are they waiting to distribute them when they get all of them in or have they just not figured out how to distribute them yet. It is not unreasonable for Amtrak crews to be trained in the use of these devices, especially if they are already trained in first aid or CPR. At the very least this will increase the chance of survival for someone in this situation.

I realize that the associated costs of this type of project would probably keep it from ever getting off of the drawing board, but I feel it is something that Amtrak should at least consider and keep in the back of their minds.

I believe that from the quoted excerpts from your post you have solved for the most part the major problem that would make this cost prohibitive. If they implement the program by training the crews how to recognize the problem and installing the automatic defibrilators on the trains the cost would not nearly be as high. Again, the idea is a good and practical one and hopefully it will be implemented soon.

 

[AlanB]

To speak of liability, what kind of liability do you think that Amtrak opened themselves up to recently in Boston when the man suffered a heart attack and the train continued to make several more stops?

Four words, out of court settlement. This is a suit that should it go into court that Amtrak has absolutly no possibility of winning.

Don't forget though that if there is a suit brought, and so far I haven't heard that the family has filed one, that there is a third party involved in all this the MBTA. So even if Amtrak wanted to settle, and I doubt that Amtrak would want to settle since it's the T's problem, the T might want to go to court in the hopes of pinning the whole thing on Amtrak.

This is especially true, since the current T contract with Amtrak indemnifies Amtrak from being liable in any suit. Part of the federal laws that created Amtrak, say that they can't pay for insurance for routes that are not considered intercity. This is one of the reasons that Amtrak is not pursuing the new T contract, because the T changed the terms of the bid such that Amtrak would have to pay for insurance. By law they can't do that, so they can't bid unless the T changes the bid terms.

 

[Chatter163]

Sorry, Steve, I hate to be negative with a fellow Miamian, but then again, that's what living in Dade County does to one........ B)

>>To speak of liability, what kind of liability do you think that Amtrak opened themselves up to recently in Boston when the man suffered a heart attack and the train continued to make several more stops?<<

A great deal--an out of court settlment, as one member said. But this case---one of incredibly poor judgment--does not in any way make the case for an on-board EMT, nor would it mitigate liability, in any event. Put another way, the foolishness of the conductors on board that train is a separate issue--clearly they would have mishandled any situation. Had common sense prevailed and EMS called ASAP, Amtrak would be completely blameless, all without the services of an EMT.

>>If this service was contracted out to a private party Amtrak is pretty much in the clear. There are many private ambulance services in this nation that operate with their own liability insurance.<<

I beg to differ. While it would reduce Amtrak's liablity somewhat, they would still likely be named a co-defendant in any civil action. Great questions would be raised as to how closely and regularly Amtrak monitored the EMS and checked the credentials of its employees. While situations vary from city to city, most transports by private ambulances are considered an elective transport, since the municipal rescue unit would normally transport in a true life-or-death situation. The patient or his family members make the choice to go by private ambulance if rescue will not take the patient, a fact that would be raised in any liability proceeding. There would be no such municipal option on an Amtrak train that would fit the same analogy. In cases where private carriers do transport patients at the behest of local fire rescue personnel, you can bet that the city or county is named, along with the ambulance service, in a variety of lawsuits.

>>The point brought up that EMT's would have to be certified in each state that amtrak travels through can be handled by staffing the trains with what is known as a "first responder" A first responder can be trained to use the important Automatic Defibrilator and that is the most important tool needed to save lives. They are starting to put these in airports and other places of businesses. They are using them because they save lives.<<

OK, but now you are going down a different track (sorry!). Having a first responder is different from having an EMT.

>>Amtrak has allready begun to purchase these devices but still have no plans to put them onto the trains. This is where they are needed. Amtrak crews could be and should be trained in the use of these devices. You don't need to be certified in any state EMT program to be able to be certified in the use of the Defibrilator.<<

Again, this is a related, but different, discussion. Though there is still liability here, costs and practicality start coming into play.

>>Any time there is a delay in the application of the electrical shock needed to correct ventricular fibrillation the survivablity of that person lessens very rapidly. <<

True, of course, but now we are moving into clinical matters, which I would say is a great distance from where we started.

>>I realize that the associated costs of this type of project would probably keep it from ever getting off of the drawing board, but I feel it is something that Amtrak should at least consider and keep in the back of their minds. <<

That sounds nice, of course, but as a city employee, you know certain realities. Amtrak has so many other pressing needs. What you desire could be proposed for any large office building, but I doubt that many would be willing to deal with it, who are not already doing so. Compound that with the mobile nature of a train and you really begin to have many reasons why it will not likely ever happen.

>>In my opinion, liabiltiy would actually be less if there was a trained person able to use this type of equipment on board the train and able to deliver this important cardiac shock within seconds of the person needing it.<<

OK, now we are back to liability. This scenario is far more narrow than the original EMT-on-board scheme. Now we seem to be talking exclusively about cardiac situations. I agree completely that your idea would help save lives, but I don't see it as lessening liability. Amtrak, like any other business, would simply need to show that it made every reasonable effort to contact EMS personnel. The Boston situation notwithstanding, this is not difficult to do. But like chain-link fences placed along tracks, start adding layers of precautions, and you also heighten the legal expectations, responsibilities and liabilities with it.

>>The part about the EMT needing to be certified in each state would be handled by the private contractor of this service. Just like they do with all of the air ambulance companies that transverse not only states but countries.<<

There is a big difference between interstate air ambulance companies, which operate exclusively under federal aviation law, and trains, which are subject to federal and the many state statutes. Such air services perform their services almost exclusively, whereas Amtrak, being a general conveyance, would have to contract such services and would not completely lose their co-defendant status when acting on their own trains.

>>Automatic defibrilators save lives, pure and simple and they should not be in some Amtrak office or storage facitlity as they are now, they need to be on board trains and at minimum, the train staff needs to be trained in their use. <<

OK, but this claim is made from a life-saving perspective, rather than a legal liability or financial one.

I like the intention, but find it wreeks a bit too much of fantasy, as far as $$$ is concerned. Believe me, I wish it were otherwise.

 

[Fireman_Steve]

No hard feelings Chatter, I know what you mean about disagreeing is the South Florida way.

I know this concept is a pie in the sky wish on my part but it is good to get people thinking about new ideas and concepts. I really started thinking about this when I read the events that happened on the T up in the Boston area. I don't even know how much Amtrak has control over that operation but Amtrak is reacting and starting to buy the automatic defibrillators.

At minimum, Amtrak should be working towards furnishing one defibrillator on each train and training the crew to use. I have used these machines many times and they are so easy to operate and they Do save lives. I have seen first hand how at the simple push of a button, these machines have converted a doomed patient back into life.

Automatic defibrillators are beginning to show up in malls, airports and aboard some airlines. Why should train travelers not be given this service?

Here is an article that sparked my attention to the fact that Amtrak is starting to purchase these machines.

http://www.utu.org/worksite/detail_news.cf...?ArticleID=3752

 

[Amfleet]

The MBTA only employees Amtrak conductors and engineers for commuter rail operations. The subway and bus drivers are contracted out or just hired by the MBTA. I forget which of the two.

The last I heard the MBTA/Amtrak will be putting an automatic defibrillator into each cab car. Each train must have a cab car in order to run in push-pull operation so your garanteed atleast one defibrillator per train. However, some trains may run with more than one cab car or in a rare occurnece, no cab car, just a locomotive at each end of the train, meaning no defibrillator.