Hospital Evacuation Trains

Evacuating elderly and bedridden patients is a difficult challenge before during and after a disaster. The failure to pre-evacuate bedridden patients during Hurricane Katrina resulted in numerous deaths including patients who were drown to death in nursing homes. Hurricane Katrina is not the only example where mass evacuation of patients has been required. During the 1971 San Fernando earthquake two wings of the Sylmar VA collapsed killing 35 patients, causing the whole hospital to be evacuated.

Another scenario is a terrorist attacks using chemical weapons. Such an attack would quickly overwhelm community medical assets. Victims of a chemical attack would have to be transported out of the affected area. Sealed ward trains could perform the mission requiring fewer people to be exposed to the contamination than a fleet of ambulances.

Elderly and bedridden patients can not withstand the travel time required to move them by bus, which can only accommodate ambulatory patients, to safe locations. Ambulances and helicopters which are acceptable for transporting bedridden (litter) patients long distances are still required to support other medical emergencies in the community. The solution is to utilize a limited number of ground ambulances to transport bedridden patients to a rail evacuation center where ward cars would transport them to other treatment locations. When planning pre-disaster medical evacuations patients should be taken to the furthest treatment center possible. This will preserve bed space at local treatment centers for the disaster's aftermath of wounded. The goal is to reduce travel time to level III medical facilities, and to have enough bed space available for the anticipated wounded.

During the initial evacuation of Hurricane Katrina Amtrak sleeper cars could have been used to transport elderly and bedridden patients. Evacuation at this time would have been unsuccessful by ground ambulances because the highways were in complete grid lock. However the rail lines were clear and capable of handling the evacuation traffic.

hurricane katrina

The flexibility of rail allows trains to occupy sidings with in the city close to areas of evacuations while ground ambulances navigate on surface streets which are not congested. Trains are move efficient for short haul evacuations having the ability to stop at communities along the right of way to transfer patients. Where military air craft such as C-17 of C-130s require commercial runways which only major cities have.

Utilizing air craft for medical evacuation requires a substantial amount of resources which are at a premium during a disaster. Airports and Air Force Bases can also fall victim to Hurricanes which happened to Keesler and Moody AFBs. Conservation of transportation resources is critical during the first few days of relief efforts. Utilizing an airport to stage medical evacuations is in direct competition with other services the airport can provide such as transporting refugees and receiving National Guard Troops and other relief personnel, and critical medical supplies. The same holds true when dedicating aircraft to medical evacuation the aircraft can't be used for other purposes. Military air and airport facilities should be reserved for those patients that require transportation to specialized care facilities that are located a substantial distance from the disaster site, while the bulk of medical evacuees are transported via rail.

The United States needs ten Ward trains one for each FEMA region. Even though Amtrak Sleepers could be utilized for this mission it is very difficult to maneuver stretchers on and off the cars. Sleeper cars are also limited to transporting patients who do not need life support system due to the electrical requirements. Specially designed ward cars are required for mass evacuation of patients with the required electrical service for life support machines, and the space to accommodate the machinery. During times of national emergency trains would be pulled from each region to the disaster site. By stationing one train per region survivability of assets is assured. If all of the trains were stored together it is possible that one disaster could destroy all of the trains or block their access to the National Rail network. A residual use of Ward cars would be for fire crew housing during forest fires. The same electrical used for life support equipment could be used to support automation and communication equipment.

U.S. Army 80 foot Ward cars could accommodate 54 litter patients utilizing a design of 9 three bunks bays on either side of the car. Double doors on the end of the cars allowed for stretchers to be carried into the car. At typical hospital train could carry between 400 to 500 patients with crew quarters.

During WWII the U.S. Army Medical Corps had several Hospital trains manufactured by American Car and Foundry. After WWII most of the United States hospital trains were sold to the Monon Railroad and converted into passenger cars. A few cars were converted into office cars for use at Seal Beach Naval weapon's depot.

Operation Concept: Hospital Evacuation

The charter operation of the medical evacuation train would be to transport patients to hospitals within eight hours of the evacuation site. Thus ensuring enough on board supplies to support 500 patients and that each car's potable water supply would be sufficient enough to cover all of the anticipated hygienic requirements of the patients.

Evacuation procedures would require 30 ground ambulances to ferry patients from the effected hospital(s) to the train. This would allow for one ambulance to be off loading patients per each ward car, ten ambulances in route from the hospital to the train, and ten ambulances receiving patients at the hospital. This arrangement will allow for continuous flow of patients without bottlenecking at either end of the process. Once the evacuation train is filled to capacity it will proceed to the nearest receiving hospitals along its evacuation route. Receiving hospitals will exchange linen with the evacuation train for each patient they receive. Medical staff will then ready the vacant bed for the next patient. Once the evacuation train reaches the end terminus a 30 person cleaning detail will assist the medical team in cleaning the train and re-supplying it. The most capable hospital at the end evacuation terminus will coordinate for re-supplying with pre-cooked meals, medicines. The lead agency for the evacuation will coordinate for the servicing of the trains skeptic tanks and potable water. It should be assumed that the end terminus will not have sewer hook-up or potable water supply. Agency planners need to coordinate for sewage pump trucks and delivery of potable water tankers with hoses capable of re-filling the train's tanks.

An option for servicing the train is to have cleaning crews board the train while in route to clean then disembark on the return trip at their point of origin.

Operational Concept: Supporting a Field Hospital

The evacuation train would be able to support an emergency field hospital by providing electrical power from its power generation car, meal service from its dining car, and ward space for patients recovering from surgery. The evacuation train would be spotted on a siding adjacent to a field hospital site.

Consist Design Concept
The consists (the dedicated cars the make up the train) of the train would be comprised of ten ward cars capable of carrying 48 patients each, and six support cars to include: two sleeping cars for medical staff, one diner for cooking meals for medical staff and heating pre-cooked meals for patients, two supply car (baggage), and one power generation car.

Power Generation Car
A wider resource pool of locomotives are available when the consist has its own electrical generation system. Without a power generation car the medical evacuation train would be limited to operating with passenger locomotives which are in short supply, and wouldn't be capable of stand along operations on a siding. Stand alone operations would allow the train to be used as a patient overflow for local hospitals or as a ward for a field hospital.

The power generation car would be equipped with a sub station to receive power from commercial utilities or other power generations sources, distribution panels located on either side of the car for power distribution if used in support of a field hospital.

Sleeping Car
The Sleeping car for medical staff needs to be mechanically compatible with the ward cars. Medical staff should be able to assess ward cars and other support cars from inside the train. Sleeping cars need to be self contained with sanitation facilities to include showers. Medical staff may not have the opportunity to leave the train for 7 to 10 days depending on the intensity of the mission.

Ward Cars
Operation concept must be kept in mind when contrasting the ward car design proposed here with hospital trains used during WWII by the U.S. and British. The WWII designs varied with a patient capacity ranging from 18 to 54 patients per car. The length of the car was one factor in capacity. Shorter cars could traverse tighter curves allowing for greater access to small yards and sidings. A 60 foot car could hold 38 patients while the 80 foot cars could hold 54 patients. Other design factors that attributed to capacity was the inclusion of isolation wards, office space and supply storage.

The proposed ward cars should be designed to accommodate 48 litter patients. This will allow for sanitation space and a small amount of ready supply storage. Beds would be designed to be secured against the wall for modification of the ward area to accommodate other needs. Such as additional life support equipment or transporting patients who are wheel chair bound but are not bed ridden. Each bunk space would have 110 V electrical service available for life support equipment. The double litter doors would be out fitted with hydraulic lifts to raise patients up from street level to the car. Cars would be equipped with Head End Power and intercom systems along with VHF, UHF, and HF radio systems to communicate with receiving hospitals while en route.

During WWII the U.S. Army Medical Corps had several Hospital trains manufactured by American Car and Foundry. After WWII most of the United States hospital trains were sold to the Monon Railroad and converted into passenger cars. A few cars were converted into office cars for use at Seal Beach Naval weapon's depot.

Dining Car
The dining car would be staffed with three cooks to provide hot meals to the medical staff, and to heat pre-cooked meals for patients. Food storage would be located in one of the two supply cars. Capacity for meal storage should be for two light meals per patient, and seven days food supply for the medical staff. The dining car can also be used when support field hospital operations.

Staffing

  • One Doctor per train
  • One RN per car
  • One equipment technician per train
  • Three cooks per train
  • One supply clerk
  • One Operations Officer
  • One conductor supplied by the supporting railroad
  • Five sanitation personnel

Personnel required for loading and unloading of patients will be augmented by ground ambulance personnel.