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PubMed1995

The acute psychological impact on survivors following a train accident.

Sixty-six passengers surviving a collision of two trains were investigated concerning relevant background data, degree of personal injury, experience of a threat to life, symptoms and problems immediately after the accident, and thoughts about difficulty in coping. The most obvious impact on the survivors was the experience of being close to death. One result of this was that they developed a new coping strategy to minimize emotional pain. Some survivors also suffered problems of "re-living" the accident. This is important for the coping process. The process includes psychological integration of the accident as an important life event. The findings indicate that "re-living" of the accident through nightmares and intrusive thoughts is responsible for problems in carrying out ordinary tasks. The observations are in accordance with those made after other types of accidents and disasters.

Accidents↗
PubMed1995

The Kings Cross fire: psychological reactions.

The psychological reactions of 50 survivors of the King's Cross fire, which hit London's underground railway system on the 18th day of November 1987, are described. Results are presented for the Impact of Event scale, the General Health Questionnaire (28-item version), the Eysenck Personality Questionnaire and a King's Cross Event Schedule. These are investigated in relation to (a) validity measures, (b) relationships between exposure and personality, and (c) spontaneous de-briefing. Two thirds of the sample had significant levels of psychological distress (meeting the "caseness" criterion on the GHQ). Both personality (neuroticism and L-scale) and degree of trauma exposure were related to subsequent reaction. Spontaneous debriefing was associated with subjective benefit. Transportation disasters present particular problems in relation to research and service delivery.

Adaptation, Psychological↗
PubMed2005

Fingernails as biological indices of metal exposure.

Metal determination in human tissues is the most common application of biological monitoring for screening, diagnosis and assessment of metal exposures and their risks. Various biopsy-materials may be used. This paper deals with the quantitative determination of Cd, Pb, Cr, Mn, Fe, Ni, Cu, and Zn concentrations in nails of male subjects exposed to these metals along with their respective controls, while working in locomotive, carriage and road ways workshops, and lead battery factories. The levels of Cd, Pb, Cr, Mn, Fe, Ni, Cu and Zn in fingernails, assayed by atomic absorption spectrophotometry, were compared with their respective controls by student 't' test. All the obtained values were correlated to the personal and medical history of the subjects under study. Significantly high levels of Cd, Pb, Cr, Fe, Ni, Cu and Zn were present in smokers, compared to nonsmokers. The concentrations of Cd, Pb, Cr, Mn and Fe were not significantly high in vegetarian subjects. It was also observed that there is no contribution of liquor towards nail-metal concentration. Significant correlations were observed between skin disease and Cr, Mn, Fe, Cu; hypertension and Cd, Mn, Cu; mental stress and Cd, Pb, Mn, Ni, Cu, Zn; diabetes and Cr, Mn, Ni; chest pain and Pb; respiratory trouble and Cr, Mn, Fe, Ni, Zn; tuberculosis and Zn; acidity and Cd; and ophthalmic problems and Mn, Fe, Ni, and Zn.

Adolescent↗
PubMed2003

[Replantation at lower leg level].

INTRODUCTION: Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. METHODS: We report five cases of orthotopic and two of heterotopic lower limb replantations. Functional outcome concerning sensibility, mobility, pain, and aesthetic result were assessed clinically and using a questionnaire. RESULTS: Functional outcome and patient satisfaction were good. The psychological situation of the patients as well as mobility and stability of the replanted limbs were satisfying. Heterotopically replanted patients found the replanted legs superior to the prostheses. CONCLUSIONS: We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.

Accidents, Occupational↗
PubMed1998

[Facts regarding the Eschede catastrophe].

On 3 June 1998 a high-speed train (Inter City Express, ICE) collided with a bridge at a speed of 200 km/h. The bridge collapsed and the rear wagons of the train were pushed into it with the power of the rear engine. The accident caused 101 deaths and 103 injuries. Four minutes after the accident the alarm was raised, and 16 minutes after the accident the first doctor was on the scene, arriving from Cells, approx. 20 km away. In the first 4 hours after the crash 1844 people from different organisations were at the site of the accident; 461 of these were ambulance personnel and paramedics. 39 aircraft (incl. helicopters and army aircraft) were available at the scene. Many passengers with multiple injuries were stuck in the train and had to be rescued from the severely damaged wagons. Nevertheless all patients with one exception were on the way to hospitals or in the trauma centers 2 hours after accident. 95 passengers passed away on site. The casualties were distributed among 22 hospitals, 2 of them had to be transferred to other hospitals later on for medical reasons. This speaks for the correct selection of hospitals. There were many reasons for the quick rescue and the success of Eschede, namely good weather conditions, the time of the accident (normal working day) the availability of rescue by air, the great number of doctors, ambulance personnel, paramedics and search and rescue teams on site, as well as the excellent cooperation between the different organisations, mainly fire brigades, police, army, border patrol, technical assistance teams and search and rescue coordinators).

Accidents, Traffic↗
PubMed2004

[Regional and local clusters of railway suicides].

BACKGROUND AND METHOD: Suicide research has identified regional and local clusters of increased suicide prevalence. As part of a comprehensive prevention strategy to fight railway suicides, we sought to identify such particular clusters on the German Railway net (total length 37,080 km) during a 6-year observation period (1997-2002). Data stem from the central registry of all person accidents on the German Railway net. RESULTS: During the observation period, a total of 5,731 suicides (in average 18 cases per week) were registered. Against expectation derived from distribution patterns in the general suicide research, we found a preponderance in the southern part compared to the northern part of Germany and a significant downward trend from west to east ( p=0.004). Most suicides occurred on open track (66%) compared to suicides at railway platforms (34%). We identified 16 places of high risk with 6 to 29 suicides per railway km. Of these high risk places, 75% were in the proximity of psychiatric hospitals. CONCLUSION: Increased awareness for regional and local suicide clusters, initiatives to reduce the accessibility and warning infra-red beams are among recommendations for suicide prevention derived from these data.

Cause of Death↗
PubMed1998

[Social medicine expert assessment of post-traumatic stress disorder].

The concept of a posttraumatic stress disorder (PTSD) has become important for psychiatric diagnosis and research, particularly following US-american studies on Vietnam war veterans. Recently, studies on traindrivers involved in suicide accidents have shown symptoms of anxiety and depression in more than 30% of concerned drivers and typical symptoms of a PTSD in 15%. Here, we present the case of a traindriver who was involved in 6 suicide accidents within 17 years of traindriving (the average is 2 suicide accidents). Following the 3rd accident, the driver developed increasingly symptoms like anxiety, sleep disturbances, flashbacks and irritability. Following the 6th accident, he has been unable to work. A former expert opinion saw no relationship between the symptoms of the driver and the suicide accidents. Therefore, further information about the concept of a PTSD seems necessary to ensure early psychotherapeutic and pharmacological treatment of patients with such a disorder.

Accidents, Traffic↗
PubMed2004

Toward a sectorwide design for environment support system for the rail industry.

Rail has an important role to play in the development toward a sustainable transportation system. In this perspective, the European Brite Euram Project RAVEL (Rail Vehicle Eco-Efficient Design) has developed a rail sectorwide Design for Environment system to be used and standardized throughout the full supply chain. At the core of the system, quantitative environmental performance indicators for rail vehicles and components are used to incorporate environmental performance target levels in the product requirements and to measure and communicate achieved environmental performance. The concept of eco-efficiency is used to integrate both environmental and economical considerations. The methodology further builds on a standardized material list, standardized data formats, and proactive design guidance. To date, first steps are already taken to integrate the RAVEL project results into sector initiatives toward industrywide acceptance and standardization.

Communication↗
PubMed1997

Asymptomatic sequelae to acute sarin poisoning in the central and autonomic nervous system 6 months after the Tokyo subway attack.

Six to eight months after the Tokyo subway attack in March 1995, the neurophysiological effects of acute sarin poisoning were investigated in 18 passengers exposed to sarin (sarin cases) in the subways to ascertain the focal or functional brain deficits induced by sarin. The event-related and visual evoked potentials (P300 and VEP), brainstem auditory evoked potential, and electrocardiographic R-R interval variability (CVRR), together with the score on the posttraumatic stress disorder (PTSD) checklist, were measured in the sarin cases and the same number of control subjects matched for sex and age. None of the sarin cases had any obvious clinical abnormalities at the time of testing. The P300 and VEP (P100) latencies in the sarin cases were significantly prolonged compared with the matched controls. In the sarin cases, the CVRR was significantly related to serum cholinesterase (ChE) levels determined immediately after exposure; the PTSD score was not significantly associated with any neurophysiological data despite the high PTSD score in the sarin cases. These findings suggest that asymptomatic sequelae to sarin exposure, rather than PTSD, persist in the higher and visual nervous systems beyond the turnover period of ChE; sarin may have neurotoxic actions in addition to the inhibitory action on brain ChE.

Acute Disease↗
PubMed2005

Magnetic field exposure and arrythmic risk: evaluation in railway drivers.

Recent studies suggest that professional exposure to Extremely Low Frequency-Electro Magnetic Field (ELF-EMF) can increase the risk of sudden cardiac death. Aim of our work was to find predictive parameters of arrhythmic risk in a population of 28 railways drivers exposed to ELF-EMF. Our findings were that the exposure did not reduce HRV and did not increase the risk of arrhythmias.

Arrhythmias, Cardiac↗
PubMed2006

Contributions of occupational hazards and human factors in occupational injuries and their associations with job, age and type of injuries in railway workers.

OBJECTIVES: To assess the contributions of environmental hazards, technical dysfunctions, lack of work organization, know-how and job knowledge, and other human factors in occupational injuries and their relationships with job, age and type of accidents in railway workers. METHODS: The sample included 1,604 male workers, having had at least one occupational injury with sick leave during a 2-year period in voluntary French railway services. A standardized questionnaire was filled in by the person-in-charge of prevention, with the injured worker. Data analysis was performed via the chi(2) independence test and adjusted odds ratios (OR) with Mantel-Haenszel test. RESULTS: The environmental hazards were implicated in 24.7%, technical dysfunctions in 16.0%, lack of work organization in 13.7%, lack of know-how in 17.6%, lack of job knowledge in 5.2%, and the other human factors in 31.9% of occupational injuries. The injuries caused by lack of know-how or job knowledge were more represented in workers aged less than 30 (ORs adjusted for job 1.45, 95% CI 1.02-2.06 and 2.06, 1.22-3.49, respectively), those by environmental hazards in energy and electrical traction maintenance operators and train drivers (ORs adjusted for age 2.04, 1.16-3.58 and 1.80, 1.01-3.20, respectively), and those by lack of work organization in mechanical maintenance operators and in energy and electrical traction maintenance operators (ORs adjusted for age 2.24, 1.13-4.45 and 1.83, 1.30-2.57, respectively). The causes considered were strongly related with the type of injuries. CONCLUSIONS: This study found that environmental hazards, technical dysfunctions, lack of work organization, lack of knowledge and other human factors had important contributions in injuries, and they were related to job, age and type of injuries. These findings are useful for prevention. Training is necessary for young workers. The occupational physician could help the workers to be more aware of the risks.

Adult↗
PubMed2000

Dust exposure in Munich public transportation: a comprehensive 4-year survey in buses and trams.

OBJECTIVES: Published data obtained from outdoor stationary sampling stations cannot be applied directly to the exposure situation in vehicles. The aim of this study, therefore, was to assess the dust exposure relevant to passengers and drivers in public buses and trams. METHOD: In the years 1993 to 1996, PM10 samples were taken during 201 journeys of typically 4 h duration on 14 routes (nine bus routes, five tramways) which were representative for the overall Munich transportation system with respect to area characteristics and traffic density. The concentrations of the samples were compared with those collected at the same time at sampling stations of the Bavarian State Office for Environmental Protection (OEP). Dust exposure was continuously and synchronously recorded by means of a tyndallometric device. Traffic and passenger density, weather conditions, special events, etc. were noted by our personnel, travelling on every journey. RESULTS: The average PM10 dust concentration for all rides was 155 microg/m3 (single journey max. 686 microg/m3, min. 13 microg/m3). Interior concentrations were 1.7 to 4.0 times above those collected at the static outdoor stations. We found only minor associations between dust concentrations and traffic density or time of day. During several journeys continuous recording disclosed anomalies, dependence on weather conditions and cyclic track characteristics. CONCLUSIONS: Interior PM10 particulate concentrations were comparable to those found elsewhere in truck drivers' cabs and are in the region of German regulative limits established for the general population's long term outdoor exposure. Indoor concentrations were well above the values found at stationary outdoor stations. Additional continuous recording of dust concentrations proved to be helpful in unveiling anomalies and dependencies on external effectors.

Air Pollutants↗
PubMed2005

Influence of electromagnetic interference on implanted cardiac arrhythmia devices in and around a magnetically levitated linear motor car.

This study was designed to determine the susceptibility of implanted cardiac arrhythmia devices to electromagnetic interference in and around a magnetically levitated linear motor car [High-Speed Surface Transport (HSST)]. During the study, cardiac devices were connected to a phantom model that had similar characteristics to the human body. Three pacemakers from three manufacturers and one implantable cardioverter-defibrillator (ICD) were evaluated in and around the magnetically levitated vehicle. The system is based on a normal conductive system levitated by the attractive force of magnets and propelled by a linear induction motor without wheels. The magnetic field strength at 40 cm from the vehicle in the nonlevitating state was 0.12 mT and that during levitation was 0.20 mT. The magnetic and electric field strengths on a seat close to the variable voltage/variable frequency inverter while the vehicle was moving and at rest were 0.13 mT, 2.95 V/m and 0.04 mT, 0.36 V/m, respectively. Data recorded on a seat close to the reactor while the vehicle was moving and at rest were 0.09 mT, 2.45 V/m and 0.05 mT, 1.46 V/m, respectively. Measured magnetic and electric field strengths both inside and outside the linear motor car were too low to result in device inactivation. No sensing, pacing, or arrhythmic interactions were noted with any pacemaker or ICD programmed in either bipolar and unipolar configurations. In conclusion, our data suggest that a permanent programming change or a device failure is unlikely to occur and that the linear motor car system is probably safe for patients with one of the four implanted cardiac arrhythmia devices used in this study under the conditions tested.

Defibrillators, Implantable↗
PubMed2005

Testicular cancer, occupation and exposure to chemical agents among Finnish men in 1971-1995.

OBJECTIVE: To find associations between testicular cancer, occupation and chemical exposure. METHODS: A cohort of all economically active Finnish men born between 1906 and 1945 was followed-up for 19.7 million person-years during 1971-1995. Incident cases of testicular cancer (n=387) were identified in a record linkage with the Finnish Cancer Registry. The Census occupations in 1970 were converted to chemical exposures with a job-exposure matrix (FINJEM). Cumulative exposure (CE) was calculated as the product of prevalence, level, and duration of the exposure. Standardised incidence ratio (SIR) was calculated for each of the 393 occupations, and for CE categories of the 43 chemical agents, using average male population as reference. Relative risks (RR) comparing various CE-categories with unexposed ones were defined for selected agents by Poisson regression analysis. RESULTS: Elevated SIRs were observed among railway traffic supervisors (5.8, 95% CI 1.6-14.7), programmers (4.3, 1.4-9.9), university teachers (4.1, 1.3-9.5) and electrical engineers (3.9, 1.1-10.1). A significant exposure-response trend (mainly contributed by seminoma) was observed for pesticides, textile dust, aliphatic and alicyclic hydrocarbons, and some other organic solvents. CONCLUSIONS: Risk of testicular cancer increased only in four occupations. Pesticides, textile dust, and some organic solvents may be related to an excess risk of seminoma.

Adult↗
PubMed2006

Pilot survey of subway and bus stop noise levels.

Excessive noise exposure is a serious global urban health problem, adversely affecting millions of people. One often cited source of urban noise is mass transit, particularly subway systems. As a first step in determining risk within this context, we recently conducted an environmental survey of noise levels of the New York City transit system. Over 90 noise measurements were made using a sound level meter. Average and maximum noise levels were measured on subway platforms, and maximum levels were measured inside subway cars and at several bus stops for comparison purposes. The average noise level measured on the subway platforms was 86 +/- 4 dBA (decibel-A weighting). Maximum levels of 106, 112, and 89 dBA were measured on subway platforms, inside subway cars, and at bus stops, respectively. These results indicate that noise levels in subway and bus stop environments have the potential to exceed recommended exposure guidelines from the World Health Organization (WHO) and U.S. Environmental Protection Agency (EPA), given sufficient exposure duration. Risk reduction strategies following the standard hierarchy of control measures should be applied, where feasible, to reduce subway noise exposure.

Environmental Health↗
PubMed1988

Driver behavior at flashing-light, rail-highway crossings.

The risk of accident at flashing-light, rail-highway crossings has been found to be ten times higher than at crossings equipped with barriers. The purpose of the present investigation was to study driver behavior in rail-highway crossings and to relate measures of driver behavior to variables believed to be associated with increased risks of accident. About 2,000 drivers were observed in 16 different crossings with driver head movements as the major dependent variable. This variable exhibits wide variability among drivers as well as satisfactory interobserver reliability. The results showed that many drivers turned their head to look for trains in rail-highway crossings although the crossings were equipped with flashing warning lights. However, fewer drivers looked when the visibility was restricted, a factor that is associated with increased risk of accident, and in crossings with few trains per day. The conclusion from the present study is that flashing-light crossings should be designed in a way that redundant information about approaching trains should be easily available to the drivers.

Automobile Driving↗
PubMed1990

The Hinton train disaster.

In February of 1986 a head-on collision occurred between a freight train and a passenger train in western Canada killing 23 people and causing over $30 million of damage. A Commission of Inquiry appointed by the Canadian government concluded that human error was the major reason for the collision. This report discusses the factors contributing to the human error: mainly poor work-rest schedules, the monotonous nature of the train driving task, insufficient information about train movements, and the inadequate backup systems in case of human error.

Accident Prevention↗
PubMed1995

Field observation of advance warning/advisory signage for passive railway crossings with restricted lateral sightline visibility: an experimental investigation.

This study evaluated a newly proposed series of signs intended for passive crossings with restrictions to lateral sightline visibility. These signs provide advance warning of a crossing and the restriction to lateral visibility. In addition, the signs advise motorists to come to a complete stop before crossing. Motorist behaviour was examined before and after installation of these signs at a rural passive crossing. A second site was observed in parallel to control partially for any confounding effects. Results indicated that motorists reduced speed and searched approach quadrants longer at points in the approachway after installation of the signs. However, there was no reliable increase in the number of motorists coming to complete stop, engaging in search behaviours, or classified as safe. The results are discussed in terms of reasons for the lack of compliance with the sign advisory.

Accidents, Traffic↗