Surgical Trains

	by David Kelly

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.

Surgical Train Operational Concept

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.

Power generation car

A wider resource pool of locomotives are available when the consist has its own electrical generation system. The concept of the surgical train is for stand along operations. In the aftermath of natural disaster public utilities are often destroyed and portable generators are in high demand. Passenger locomotives can supply electrical power, but they will be in demand for passenger use. 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

There are several options for billeting medical personnel during operations. The first would be to have dedicated self contained sleeping cars that are mechanically compatible with the surgical train. This would allow medical staff quick access to the train. The second option would be to augment the surgical train with sleeping cars from Amtrak. This approach would lower the capital cost of constructing a hospital train, but not all cars are mechanically compatible with each other. Bi level cars do not allow passenger access to standard level cars thus restricting access. The final approach is to house medical personnel in tents set up next to the train. The best solution would be on board the train for the best rest possible.

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 would be 800 light precooked meals per day, and seven days food supply for the medical staff. When in fixed site operations the surgical train would depend upon daily re-supply be either rail or truck.

Ward Cars

The surgical train would utilize the same ward car design as the hospital evacuation trains. This will allow operations to switch out cars to transport patients to area hospitals and fresh cars delivered to continue to receive patients. Two ward cars would be permanent cars for the surgical train for patient recovery. These cars would have additional medical equipment assigned to them; the standard ward cars would not have special equipment as part of their configuration.

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.

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. Photo U.S. Army Medical Corps