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PubMed1994

Evaluating public transport and road safety measures.

This paper discusses three approaches to the evaluation of transport safety measures--labelled cost-benefit analysis, industrial risk assessment and the elimination of all avoidable accidents--and the institutional settings in which each is dominant. This paper considers the application of these approaches primarily to road and rail safety measures in Great Britain. It is suggested that the elimination of all avoidable accidents should be rejected because of its large and open-ended resource requirement, but it is acknowledged that this is difficult because it implies the acceptance of avoidable accidents on public transport systems. The paper suggests a framework drawing on the other two approaches, in which cost-benefit analysis is combined with a limit on the tolerable risks to individuals.

Accident Prevention↗
PubMed1996

Estimating the consequences of accidents: the case of automatic train protection in Britain.

This paper considers estimates of the number of fatalities per year on rail lines operated by British Railways that could be expected to be saved by the installation of automatic train protection, based on historical data. The authors' preferred estimate is 3.66 fatalities per year, with an estimated 95% confidence interval of 1.44-5.89. It is possible to find orthodox probability distributions that fit the distribution of numbers of fatalities well. FN-graphs are not a suitable means of fitting such distributions.

Accidents, Traffic↗
PubMed1987

Sleepiness on the job: continuously measured EEG changes in train drivers.

Eleven train drivers participated in the study during 1 night and 1 day journey (4.5 h) over the same route. Their EEG, EOG and ECG were recorded on portable tape recorders. The EEG records were subjected to spectral analysis (FFT) and the EOG was scored visually for slow eye movements (SEMs). The results showed that rated sleepiness increased sharply during the night journey. A similar pattern was seen for spectral power density in the alpha band, SEM and, to a lesser extent, also for power in the theta and delta bands. Heart rate was low during the entire night drive. The day journey showed low values without any trend for all variables. The intra-individual correlations were very high between rated sleepiness and, particularly, alpha and theta power density, as well as SEM. Further analyses showed that most of the night time increases in EEG/EOG parameters were confined to the 6 most sleepy subjects. Among these, 4 admitted to dozing off during the night drive and 2 of these 4 subjects failed to act on signals while exhibiting large bursts of alpha activity. It was concluded that EEG and EOG parameters closely reflect variations in sleepiness on the job and that these parameters, together with self-ratings, demonstrate that severe sleepiness may occur in train drivers during night work.

Adult↗
PubMed1980

The Nuneaton derailment.

The Nuneaton derailment presents some unique problems as well as more common ones. The deployment of services presents a challenge and interrelationships are important (Keep, 1966). This challenge was mainly well met at Nuneaton, though there were difficulties in organizing medical care at the scene. Preparedness is of first importance both in hospital and at the scene of accident. Roles assigned should depart as little as possible from each person's usual job. Instructions to staff should be revised and new staff briefed on arrival. Reliefs must be arranged and should be labelled and have job cards passed on to them. Abbreviated colour-coded action cards might be useful.

Adult↗
PubMed1991

Released prophospholipase A2 activation peptides in the rapid early prediction of trauma outcome: a preliminary report.

Clinical scores of trauma severity may not be adequate measures of trauma-related systemic pathophysiology to be useful in the early prediction of individual patient outcome. This preliminary study evaluates the role of Prophospholipase A2 Activation Peptide (PLAP), measured in patient urine by modified enzyme-linked immunosorbent assay (ELISA), as an early prognostic in the severely injured. Of nine polytrauma patients requiring intensive care after a major accident, two died and one was permanently severely disabled (group 1), whilst six made a full recovery (group 2). These two groups had different ranges of urine PLAP concentration (P = 0.024). Phospholipase A2 (PLA2) activation may be an early event in tissue damage pathways that lead to multisystem organ failure (MSOF). We believe urine and plasma PLAP concentrations merit further evaluation for the early prediction of individual trauma outcome.

Accidents↗
PubMed1993

Acute injuries of the upper dorsal spine.

In an effort to define better diagnostic and treatment criteria, we reviewed the cases of 50 patients with injuries of the upper dorsal spine from T2-T9, seen between January 1983 and July 1988. The majority of injuries were caused by road traffic accidents, followed by falls from a height, and train accidents. More than 50 per cent had associated injuries, of which four were missed; 50 per cent had neurological deficits, and the majority of these cases had burst fractures and fracture-dislocations. Treatment was non-operative in the majority of cases, with only four cases undergoing anterior spinal decompression and fusion, and one had posterior instrumentation and fusion. At follow-up (1-3 years), only one patient, a child, had significant deformity. All patients with partial neurological deficit improved, whereas none of those with complete neurological lesions recovered. Five patients had significant back pain requiring analgesics but not significant enough to interfere with their activities. We concluded that most of these injuries are stable and should be treated non-operatively. Surgery is only indicated in cases with partial neurological deficit and significant spinal canal compromise or significant instability. Children should be followed up until maturity to look for late deformity.

Accidental Falls↗
PubMed1994

Cannon Street rail disaster--lessons to be learned.

We studied the types and mechanisms of injury suffered by passengers involved in the Cannon Street rail crash, by a telephone and postal survey of all passengers attending St Bartholomew's Hospital for treatment of their injuries, and retrospective examination of their hospital records. There were 104 patients of whom 91 had complete data sets. Of the 91 patients included in the study, 63 (69 per cent) had suffered craniofacial trauma. Of the 63 patients with this type of injury, 50 had been standing at the time of impact and 48 of these were able to say exactly how they had sustained their injuries. Of these 48 passengers, 34 said that they had collided with the luggage racks (71 per cent). Of the 32 passengers who had been seated at the time of impact, only 13 sustained craniofacial injuries and none had hit the luggage racks (P = 0.0001). Craniofacial trauma was the commonest type of injury. Those patients who suffered these injuries were most likely to have been standing at the time of impact and to have sustained their injuries following collision with a luggage rack. The type of luggage racks on this train were particularly dangerous and we recommend that the internal design of new British Rail rolling stock addresses this problem. This specific recommendation is in support of the more general measures discussed in the recently published official report of the incident. In the meantime, we consider that passengers should be advised to remain seated until trains have come to a halt.

Accident Prevention↗
PubMed1993

The effect of major railway accidents on the psychological health of train drivers--I. Acute psychological responses to accident.

The acute psychological reactions of 101 train drivers to on-the-track accidents were studied by means of clinical interviews and questionnaires (Impact of Event Scale, GHQ-20 and a questionnaire addressing stress symptoms, pre-accident expectancies and worries). More than half of the train drivers reported moderate to high intrusive distress (mean 11.3) within hours to days after the accident but only 1/3 reported symptoms of acute psychophysiological arousal. Intrusive symptoms related to visual impressions were most frequently reported. Avoidance was less prevalent (mean 8.8). Clinical interviews, relationship between pre-accident worries and severity of the acute responses and positive correlation between GHQ-scores relating to the fortnight preceding the accident and IES-intrusion scores, suggest that premorbid variables may influence the stress response. Involvement in more than two previous accidents invoked a feeling of vulnerability and produced stronger acute responses. Post-accident experiences involving various personal contacts did not correlate with the stress responses in this study and only a few drivers experienced such events in a negative way. Denial of the possibility of being involved in accidents was not associated with increased risk of strong acute responses, indicating that denial does not predict poor outcome in healthy persons exposed to situations where possibility of avoiding the event is outside the control of the person.

Accidents, Occupational↗
PubMed1993

The effect of major railway accidents on the psychological health of train drivers--II. A longitudinal study of the one-year outcome after the accident.

The psychological impact on 101 train drivers of accidents causing major injuries or death to persons was studied by means of clinical interviews and questionnaires (Impact of Event Scale, General Health Questionnaire and a questionnaire addressing stress symptoms plus past and pre accident expectancies of being involved in accidents). The drivers were examined within hours to a few days after the accident and later at 1 month and 1 year. One month after the accident the symptoms of distress were significantly reduced and most so among the drivers with no preaccident risk experience according to self reports during the acute phase. A minor further reduction of distress was found at 1 year. Drivers with two or more previous accident experiences and those who had worried about being involved in accidents showed highest symptoms of distress at follow-up. Eleven out of 101 drivers reported sick leave more of than 1 week after the accident and this was related to higher intrusion scores. The few drivers who report longterm psychological distress are best predicted by a combination of acute high IES scores, experience of previous accidents and risk expectancy prior to the current accident. The study suggests that premorbid and non-accident related variables are more important for the 1 year psychological outcome of healthy drivers after on-the-track accidents than the stress event itself.

Absenteeism↗
PubMed1985

Railways, disease and health in South Africa.

The role of South African Railways and Harbours in spreading disease and health care is examined. Attention is focused on the Railways' campaigns against malaria, plague and infectious diseases. A case study of the 1918 'Spanish Influenza' epidemic illustrates how the Railways diffuse disease and health care, and also demonstrates the disruption of services caused by the influenza.

Communicable Disease Control↗
PubMed1994

Railway suicide in England and Wales, 1850-1949.

According to the official statistics of the Registrar General, the first railway suicide occurred in 1852 and more than 10,000 suicides recorded during the period 1852-1949. Throughout this time the number of male cases always exceeded the number of female cases and the railway accounted for a greater proportion of male than female suicides in all but two years. By the early decades of the twentieth century, the railway was used in 5-6% of male suicides and 3-4% of female suicides. The incidence of railway suicide was correlated with the growth of the railway system offering some evidence for the relationship between availability of a lethal means and suicide rates.

Adult↗
PubMed1994

The epidemiology of suicide on the London Underground.

A database containing details of every incident of suicidal behaviour on the London Underground railway system between 1940 and 1990 was assembled from the records of London Underground Ltd and the British Transport Police. The total number of cases was 3240. The mean annual number of suicidal acts on the London Underground system increased from 36.1 (1940-1949) to 94.1 (1980-1989). There were significantly fewer incidents on Sundays than on the other days of the week and the daily rate was highest in the spring. 64% of incidents involved males and the peak age group for both sexes was 25-34 yr. Suicide verdicts were returned for a greater proportion of women than men. Overall case fatality was 55%. However, case fatality rates differed between stations, environmental factors appearing to influence survival. Possible strategies to prevent railway suicides and reduce the lethality of this method are discussed.

Adolescent↗
PubMed1994

Suicidal behaviour on railways in the FRG.

Between 1976-84 there were 6090 suicides and 391 attempted suicides on railways in the Federal Republic of Germany. This suicide method was compared to other methods with respect to seasonal and daily distributions and fluctuations by time of day for age and sex. The ratio of males to females was 2.54:1 and the relative incidence of this type of suicide as compared to the total number of suicides was high among the younger age groups. Investigation of seasonal variation revealed a peak for males in the autumn. There was a markedly higher incidence of railway suicides committed by males on Mondays and Tuesdays. This peak was less pronounced for females. Most incidents occurred in the evening hours (especially after sunset). An investigation of the relationship between the severity of injuries and the location of the suicide attempt revealed that those who attempted suicide on railway tracks in the countryside were more seriously injured than those whose attempt took place in or near main stations.

Aged↗
PubMed1994

Suicide in the Hong Kong subway.

Between 1979 and 1991, 56 suicides occurred within the Hong Kong subway system. Data on these fatalities, together with data on those who survived suicide attempts, are presented, along with guidelines established to assist the subway system staff in detecting, preventing and coping with such acts of self-destruction.

Adult↗
PubMed1994

Psychiatric and preventative aspects of rail fatalities.

A previous survey of national rail fatalities and a sample of fatalities in southern England revealed many probable suicides and a small proportion of accidents. Epidemiological and clinical characteristics of this survey are reviewed in the light of general safety on British railways.

Accidents↗
PubMed1994

A follow-up study of attempted railway suicides.

This paper reports the subsequent mortality of 94 persons who attempted suicide by jumping in front of London Underground trains between 1977 and 1979. The follow-up period was 10 yr. Despite the apparent seriousness of the method, completion of suicide was not found to be higher than in previous studies of attempted suicide by other methods. By the end of the follow-up period 18 persons had died, nine of natural causes. Coroners' inquests were held for the unnatural deaths. Seven verdicts of suicide and two of accidental death were recorded. Of the nine unnatural deaths four were from multiple injuries, three from drowning, one from asphyxia and one from acute narcotic poisoning. All four multiple injury deaths were women, three of these were from repeated incidents involving London Underground trains. The time interval between the index attempt and eventual death for the suicide/accident group ranged from 1 day to 43 months. For ethical reasons it was not possible to follow-up attempted suicides who were presumed to have remained alive.

Adolescent↗
PubMed1994

Preventing suicide on the London Underground.

A field study was carried out to investigate the possibility of preventing suicide on the London Underground. Four groups of potentially valuable measures were identified with the objectives of: (i) reducing public access to the tracks; (ii) improving surveillance by station staff; (iii) facilitating emergency stops; and (iv) reducing injury. These strategies are discussed.

Cause of Death↗