Surgical Trains

Mobile field hospitals provide rapid life support services when they are deployed to a disaster. The drawback to their utilization is the requirement of a large level area to set up in. The Department of Home Land Security had to hold off on final deployment of its mobile hospital due to the lack of suitable locations. Mobile field hospitals are not functional until they are set up. This set up time can be anywhere from two to 72 hours after arrival of equipment. A hospital train would fill the void that develops during the first few days of a disaster. A hospital train is functional anywhere it stops on the right of way, where a mobile hospital on the side of the highway is not.

During the relief efforts to Hurricane Katrina Doctors and surgical teams were left camped out on the side of the highway in northern Alabama for days while FEMA personnel surveyed locations for the hospital. Another factor was the movement of evacuees was occurring. If it takes 72 hours to set up a field hospital then it will take 72 hours to prepare it for movement. Hospital trains are not dependent on highways which can become grid locked from evacuees, and relief operations. As the target population is relocated the hospital train can advance in front of the mobile hospital treating high priority patients while the mobile hospital becomes functional. Hospital trains provide added flexibility during a disaster rail routes often provide alternate access to locations that are inaccessible by roads. When responding to a large scale medical disaster flexibility of resources is the key to saving lives. Response teams need a combination of medical resources from aid stations, hospital trains, vehicle portable hospitals, and mobile field hospitals to augment community hospitals.

With respect to the medical response to Hurricane Katrina, hospital trains could have provided the needed medical assistance. The six class I railroads that service the gulf region were able to provide service with in 10 miles of New Orleans and with in 14 miles of Mobile, two days after Hurricane Katrina had passed. Hospital trains could have been stationed near the major disaster zones and treated the wounded. The trains could have relocated without halting medical operations. Mobile hospitals which are much larger must stop medical operations to relocate. Additionally there are many industrial siding and yards that can accommodate a consist of 10 to 16 cars.

Operation Concept: Hospital Evacuation

Upon notification the medical personnel would meet the surgical train either at a predetermine location or would be picked up at stops along the route to the disaster site. The train would be spotted at the nearest operational location possible to the disaster site. The location would also be the most securable to allow relief personnel to manager the flow of wounded to treatment. Medical aid stations would be set up near the train and the train's power generation car would provide the aid stations with power. The aid stations would triage the wounded and transfer wounded requiring surgery to the patient preparation car. In the patient preparation car medical personnel would admit the patient and secure all of their personal items and prepare them for surgery. After surgery the patients would be transferred to the recovery cars and monitored. Once the patients were stable for transport they would be moved to the ward cars. Once the ward cars were full a medical evacuation train would exchange cars with the surgical train. The patients in the ward cars would be transported to areas hospitals outside of the disaster area for follow on treatment. The new cars left to the surgical train would allow for continuous operation.

The surgical train would remain on station until no longer needed or a mobile hospital is able to be set up in the area and take over operations. The surgical train would then be re-routed to the next needed location.

A secondary use for the surgical train would be for seasonal medical services to areas lacking in medical care facilities. The train could be loaned out to Health and Human Services for health fairs and immunization.

Consist Design Concept

The surgical train would consist of 17 cars:

  • 2 Surgery cars
  • 1 Patient preparation car
  • 2 Recovery cars
  • 4 Ward cars
  • 2 Sleeping cars (Could be substituted with Amtrak sleepers)
  • 1 Dinning car
  • 1 Power generation car
  • 1 Food storage car
  • 1 Ward supply car
  • 1 Surgical supply car
  • 1 Personal security car

Surgery Car
The trains surgical car would be a fully self-contained unit with redundant power and lighting with two operating rooms located are opposite ends of the car. The operating rooms would also be re configurable for utilization as a triage and trauma care, or intensive care unit. The car would have an integrated environmental control system with HEPA and NBC air filtration system in the event it was used near a chemical or refinery disaster, or a terrorist attack using chemical agents.

Supply and Storage Cars
The train will require the following storage cars: Food storage, ward car supply storage, surgical supply storage and secure storage for patients' personal property. Each car will allow through access of patients being transported by wheeled litters.

Patient Prep Car
One car will be dedicated to patient prep. This car will have one area for removal of clothing and washing the patient. This area will also serve for admission and securing patients personal items. The center section of the car will be the X-Ray room and film development. The remaining section of the car will be the surgical staging room where patients wait for surgery.