Abstract Over the past year, our ethics service has had numerous consultations involving patients who use the emergency department for regular dialysis. Sometimes, they have access to outpatient hemodialysis that they forgo; other times, they've been “fired” from this kind of outpatient facility, and so the ED is their last option. In most of these cases, we're called because the patient is disruptive once admitted to the ICU and behavior plans haven't helped. But the call from a resident this March 2020 morning was different, the patient had end‐stage renal disease and often missed hemodialysis, but he wasn't disruptive. “It's just that he comes in after using cocaine, and given scarcity with the coronavirus and ICU beds….” I have come to think that this is one of the more insidious effects of the pandemic: that there will be a resurgence of the view that some patients deserve health care by virtue of their compliant behavior and that those who are nonadherent don't .
Currently, multiple operating authorities are proposing the introduction of high-speed rail service in the United States. While high-speed rail service shares a number of basic principles with conventional-speed rail service, the operational requirements on a high-speed rail system are typically more demanding than those for conventional-speed operations. The operating environment will require specialized maintenance and inspection procedures, enhanced protection or grade-separation of highway-rail crossings, effective separation of other rail traffic, and detection of potential hazards along the track to help ensure the safety of the system. With the required implementation of positive train control (PTC) by passenger-carrying rail operators, the frequency and/or severity of several types of railroad accidents can be decreased. While all of these measures will contribute to the overall system safety, incidents that pose a threat to passenger and crew safety may still occur that cannot be prevented through the design of the operating environment alone. It is important to consider these types of incidents when selecting the rail vehicles for use in a particular operation, and include appropriate crashworthiness and occupant protection measures. This paper presents a series of example scenarios of some of the potential hazards that may affect the safe operation of high-speed passenger trains in the United States. These situations are drawn from actual accidents that have occurred in the U.S. and abroad. The scenarios provide a starting point for discussing system safety features, which includes vehicle crashworthiness and occupant protection features. As an operating environment may be designed to limit the likelihood of certain types of incidents from occurring, three different hypothetical high-speed operating environments are discussed in this paper. While the number of potential scenarios varies with each operating environment, in all environments it is important to consider the need for a train’s crashworthiness features to mitigate the consequences of potential incidents.
The Federal Railroad Administration’s Office of Research and Development is conducting research into fuel tank crashworthiness. Fuel tank research is being performed to determine strategies for increasing the fuel tank impact resistance to mitigate the threat of a post-collision or post-derailment fire. In accidents, fuel tanks are subjected to dynamic loading, often including a blunt or raking impact from various components of the rolling stock or trackbed. Current design practice requires that fuel tanks have minimum properties adequate to sustain a prescribed set of static load conditions. Current research is intended to increase understanding of the impact response of fuel tanks under dynamic loading. Utilizing an approach that has been effective in increasing the structural crashworthiness of railcars, improved strategies can be developed that will address the types of loading conditions which have been observed to occur in a collision or derailment event. U.S. rail accident surveys reveal the types of threats fuel tanks are exposed to during collision, derailments and other events. These include both blunt impacts and raking impacts to any exposed side of the tank. This research focuses on evaluating dynamic impact conditions for fuel tanks and investigating how fuel tank design features affect the collision performance of the tank. Research activities will include analytical modeling of fuel tanks under dynamic loading conditions, dynamic impact testing of fuel tank articles, and recommendations for improved fuel tank protection strategies. This paper describes detailed finite element analyses that have been developed to estimate the behavior of three different fuel tanks under a blunt impact. These analyses are being used to understand the deformation behavior of different tanks and prepare for planned testing of two of these tanks. Observations are made on the influence of stiffeners, baffles, and other design details relative to the distance from impact. This paper subsequently describes the preliminary test plans for the first set of tests on conventional passenger locomotive fuel tanks. The first set of tests is designed to measure the deformation behavior of the fuel tanks with a blunt impact of the bottom face of the tanks. The test articles are fuel tanks from two retired EMD F-40 locomotives. A blunt impact will be conducted by securing the test articles to a crash wall and impacting them with an indenter extending from a test cart. This set of tests is targeted for late summer 2013 at the Transportation Technology Center (TTC) in Pueblo, Colorado. Both blunt and raking impact conditions will be evaluated in future research. Tests are also being planned for DMU fuel tanks under dynamic loads.
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