The ambulance car, capable of up to 100 miles an hour, was converted from a former crack passenger train used on the Berlin-Munich run. It now can accommodate 30 litter and 32 ambulatory patients. Powered by two Diesel electric engines, the car also has an ice refrigeration plant, circulating hot water system, kitchen and quarters for a crew of three enlisted men.

The car will be used to assemble patients from scattered points for evacuation or for treatment at larger medical installations in Wiesbaden and Frankfurt.

The impetus which sets an evacuation trip in motion emanates from the USAREUR Medical Regulating Agency, which is located at the Landstuhl Army Medical Center. The train unit is notified each week of the train runs scheduled for the following week through the 57th Medical Battalion, which is also the headquarters for two other train companies, two ambulance companies, and one helicopter ambulance company.

EQUIPMENT AND SUPPLY

The two-car diesel train, which can be operated from either end, provides comfortable seating space for 22 ambulatory patients. It also is equipped with 22 stationary litters that have wide, foam rubber mattresses. There is a small but well-equipped kitchen, sufficient storage space for linen, medical supplies and special equipment, and adequate latrine facilities. Each train company also has a steam train which can be easily altered to accommodate the varying numbers and types of patients designated on the operational breakdown. The steam train also has a dining car and a personnel car.

A minimum supply level has been established. By way of training, the technicians are made responsible to maintain this level. We can handle most emergencies since we carry oxygen, suction equipment, emergency drugs, and intravenous fluids, as well as some of the common standard drugs. Special equipment and drugs necessary to provide continuous nursing care are supplied by the entraining facility. It is the policy, however, to detrain a patient at the nearest hospital facility if an emergency arises that cannot be handled on the train.

Patients are fed field A rations, and special diets are usually provided by the entraining facility. If, however, special diets are not provided, they are arranged from our food supplies. This is then recorded on the operational train report and the entraining hospital is informed. Since experience has taught us that there is frequently a considerable delay at an outpatient service or admission office between departure from the train and arrival at a hospital, every effort is made to feed patients before they are detrained.

PERSONNEL COMPLEMENT

According to the TO&E, there are 30 enlisted men assigned to each train company, 15 of whom have medical MOS's. The train nurse is the professional officer aboard the ambulance train, while an MSC officer fills the dual role of train and company commander. All personnel are assigned to on-the-job training by the commander. Six medical technicians are assigned to care for a varying patient load of from six to twenty patients. As is the case in many line outfits, the mature qualified men, regardless of their MOS, are assigned to responsible positions in supply, the motor pool, and the orderly room. One NCO is assigned as wardmaster to assist with professional requirements. Another is assigned as train NCO to supervise administrative details.

In order to standardize nursing service aboard ambulance trains, the 57th Medical Battalion has recently established the position of nursing consultant . Additionally, we are presently endeavoring to designate certain emergency conditions which should require a Medical Corps officer to be in attendance so that the train nurse could be supported in her judgment and decision to render interim treatment. Such emergencies might be the result of circulatory collapse, respiratory failure, diabetic coma, or shock as a result of a delayed reaction to sedation which is sometimes seen in acutely ill neuropsychiatric patients.

ADMINISTRATIVE DETAIL

The accomplishment of maximum continuity and coordination in any endeavor in the Army is enhanced by the use of the "SOP" (Standing Operating Procedure). Our battalion headquarters has therefore published such a document for ambulance train evacuation. Similarly, an activities list and orientation information have been prepared for the relief nurse.

The nursing service assignment sheet with duty lists has been adapted for use aboard the ambulance train. This has provided a more organized plan of nursing care, pointed out weaknesses and indicated additional training needs. After patients are entrained, the diagnosis and individual patient care needs are related to medical personnel. Charts are carefully checked for further information relating to definitive patient care.. This is one means by which technicians are trained to adapt care according to patient needs.

Standing operating procedure for isolation technique has also been adapted for use on the train. On the two diesel trains, facilities are provided for evacuating only two patients with communicable disease and then only when they are of the same sex and/or have the same disease. With more than two patients -- something which seems to be happening more and more frequently -- good or even adequate technique is most difficult to maintain. Discard gown technique is used, masks are worn, and hand washing is emphasized.

TRAINING OPPORTUNITY

Ambulance train duty can provide a real challenge to the nurse interested in training. The assigned enlisted personnel have on-the-job training with actual patient contact for only one-half of the standard 40-hour week. The remainder of the time must be carefully planned and fully utilized lest the men become bored and lethargic, thus weakening esprit de corps. Strong leadership, along with qualification and proficiency training can stimulate real interest, enthusiasm and motivation for good inter-personal relationships effecting in turn better patient care. Since August 1957, five men in our unit have completed qualification training for the 911.10 MOS. Proficiency training has been recommended and requested.

During the time that there are no patients aboard the train, classes are conducted in patient care procedures with demonstration and practice. In addition, two hours of instruction each week are given in the classroom -- one hour in Emergency Medical Treatment and one hour in Medical Technical Training. Participants for the most part are active and eager, although company details preclude a full attendance at the classes. Because their past experience and training may have been limited, the men appreciate the opportunity to acquire new knowledge; their application of the newly acquired knowledge has resulted in better patient care. Since our TO&E does not call for qualified neuropsychiatric technicians, training in the care of the neuropsychiatric patient has been given with emphasis placed upon the development of appropriate attitudes. Care of open and closed ward patients by untrained personnel greatly increases the responsibility for these patients, especially since ambulance train facilities differ greatly from those provided in hospitals. As a result of the training, our technicians have become more secure and thus more willing to share responsibility for the care of this type of patient.

Because all types of patients are confined to a small area, it is necessary that personnel be well qualified to provide varied types of care. Our responsibility does not end, however, with attention to the physical needs of our patients. Emotional needs too must be observed and attended. An emotional upset frequently coincides with transfer from one hospital

to another-especially if there has been little or no orientation. Therefore, appropriate explanations are given, and the personnel spend much time in an effort to assuage fears and re-establish confidence and a sense of well being in the patients.

CONCLUSION

A high standard of patient care is the result of not only well qualified personnel, but effective interpersonal relationships on the patient care team. It is the aim of our patient care team to provide continuous service following the nursing care plan established when the patient first entered the hospital. Although the train is correctly called "Ambulance Train," hospital procedures have been modified and adapted to the facilities available so that patient care requirements are satisfied just as they would be on the hospital ward. Training in nursing care procedures is a continuous process to equip the personnel to render the highest quality of patient care.

Story: Pic .John A. Williams, Jr., 57th Medical Battalion, APO 188, US Forces.
Photographs: Photo Section of the 28th Med Det (Illus), APO 188, US Forces.

The B&F Railroad

The B&F .... Back and Forth .... Railroad is a nickname for the 2-car diesel ambulance trains operated by the 31st Medical Group. "Back and forth" for the control cabins at both ends of the trains that give the trains the ability to change directions without switching.

There are 4 two-car ambulance trains in service in Germany today:
31st Medical Ambulance Train (Rail), USAH Muenchweiler (TOE 08-520GE01)
34th Medical Ambulance Train (Rail), USAH Neubruecke (TOE 08-520GE01)
37th Medical Ambulance Train (Rail), USAH Muenchweiler (TOE 08-520GE02)
80th Medical Ambulance Train (Rail), USAH Neubruecke (TOE 08-520GE02)

Each two-car diesel train has a ten-car steam train for emergency backup service.

Each two-car train is staffed with a crew of 8 American military personnel (a train commander; a nurse; a wardmaster; two ward assistants; three medical service attendants) and 3 German Bundesbahn employees (two engineers and one electrician). Each two-car train has facilities to handle 22 litter patients and (21) ambulatory patients. Each train includes an isolation compartment -- some of the patients are being transported for psychiatric treatment.

CO of the 31st and 37th Amb Trains is 2nd Lt Peter Trembley; CO of the 34th and 80th Amb Trains is 2nd Lt Austin D. Edwards.

The German-built diesel and steam trains were acquired by the US Army in the 1950s and ran (primarily the diesel trains) on a daily basis between many major troop areas in the late 1950s and early 1960s. Today, a two-car diesel runs each Tuesday between Neubruecke (98th General Hospital) or Muenchweiler (34th General Hospital) to Nuernberg, returning on Wednesday. A Saturday run is made between Neubruecke or Muenchweiler and Frankfurt a.M. (The Neubruecke trains alternate every other week with the Muenchweiler trains.)

The Tuesday run stops first at Landstuhl (Army Medical Center); makes a 40-minute refueling stop at Heidelberg (130th General Hospital); then heads for Frankfurt (97th General Hospital); next stops at Wuerzburg (33rd Field Hospital) to take on water; and then makes the last leg to Nuernberg (20th Station Hospital). After an overnight stay at Nuernberg, the train makes the return trip along the same route back to the home station, Muenchweiler or Neubruecke. Typically, the Tuesday run handles an average of 20-25 patients. The shorter Saturday run averages from 12 to 15 patients.

The stop at Frankfurt is at the Frankfurt-Bonames siding; the stop at Wuerzburg is at the Aumuehle siding.

(Webmaster Note: in reading the above article, I believe I have determined that 80th Amb Train used the diesel VT 08 train numbered "608-803". Can anybody confirm this? And if correct, does anybody know which VT 08's were used for the three other ambulance train units? And if we really want to get crazy, who knows more about the steam trains??? )