Report on 640 victims of the Tokyo subway sarin attack.
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Adult↗
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Hours to hell and back: a social epidemiology of railway injury in a South African city, 1890-1995.
This paper describes fatal and non-fatal injury on the Cape Town metropolitan rail system between 1890 and the present day. This is examined from the perspective of the community, rail operators and authorities, in the light of the expansion of the rail system and the risk that exposure to sophisticated infrastructure has placed on the poor. Injury is discussed as a public health issue and historical data are juxtaposed against the current situation. The study identifies recurrent themes of limited safety enforcement by the rail operator, victim blaming and public concern.
Accidents↗
Higher earnings, bursting trains and exhausted bodies: the creation of travelling psychosis in post-reform China.
This paper examines the biomedical construction of "travelling psychosis" (TP), a contested psychiatric diagnosis pertaining to a severe mental disturbance that occurs among migrant workers who travel long distance in China's overcrowded trains. Although TP can produce substantial psychiatric morbidity, it is also a socially constructed entity that serves social uses. By subscribing to a ritualistic model of validation and by invoking the rhetoric of scientific authority, Chinese psychiatrists who created TP have been able to accomplish such goals as legitimating its forensic function, securing research funds, enhancing their academic status and raising railway authorities' consciousness about passengers' safety issues. But the "biopsychosocial" paradigm they espouse supplies only a parochial form of social analysis and a spurious sense of comprehensiveness. By privileging proximate risk factors, it fails to address the wider environment of the post-reform political economy that ultimately governs population movement and put migrant workers at risk of health problems. This paper submits that a critical examination of this sanitised biopsychosocial paradigm will enliven biomedical research as well as augment its impact on policy development in China.
Adolescent↗
High-tension electrical-arc-induced thermal burns caused by railway overhead cables.
Eleven patients with high-tension electrical-arc-induced thermal burns due to railway overhead cables were treated at the Bratislava Burn Department during a relatively short period of 18 months. All the injuries occurred by the same mechanism, that is persons climbing on top of railway carriages and approaching the 25,000 V a.c. overhead cables. All the burns were the result of an electrical arc passing externally to the body, with subsequent ignition of the victim's clothes. The cutaneous burns, ranging from 24 to 79 per cent of the BSA, were mostly deep partial to full skin thickness injuries. One patient died on day 5 postburn, the other survived. In spite of high-tension aetiology, no true electrical injuries appear to have occurred and no amputations were necessary. The pathophysiology and possible preventive measures are discussed. It must be stressed that arcing can be induced by an earthed object approaching, but not touching, a cable carrying a high voltage.
Adolescent↗
Electrical injury from subway third rails: serious injury associated with intermediate voltage contact.
BACKGROUND: Railway and subway-associated electrical trauma is rare and typically involves high voltage (> 20,000) arc injuries. Not all rail systems utilize such high voltage. We report 16 cases of electrical trauma due to 600 V direct contact with subway 'third' rails. METHODS: A case series of injured patients presenting to Shriners Burns Institute, Boston or Massachusetts General Hospital between 1970 and 1995 was retrospectively analyzed. RESULTS: A total of 16 cases was identified. Among seven subway workers, the mechanism of rail contact was unintentional by a tool, a hand or by falling; no deaths occurred. Among nine non-occupational victims, injuries involved suicide attempts, unintentional falls, or risk-taking behavior. This group suffered greater burn severity, operative procedures, and complications; three deaths occurred. CONCLUSIONS: This is the largest report series of direct electrical trauma from a subway third rail. The high morbidity and mortality from this 600 V contact suggests that the traditional classification of low voltage (< 1000 V) exposure can be subdivided to reflect the serious and lethal potential of intermediate range exposures compared to household range exposures (0-220 V).
Accidents↗
"Train surfers": analysis of 23 cases of electrical burns caused by high tension railway overhead cables.
The term "train surfers" describes a group of adolescents from the outskirts of the city of Rio de Janeiro, who are compelled by the overcrowded railway trains to travel on the roofs of the wagons. Collision with electrical high-tension wires is a relatively frequent occurrence, causing extensive and complex injuries. This study analyzes this clinical and surgical phenomenon which has caused over 100 fatalities in more than 200 registered accidents over the past 10 years.
Accidents↗
Burnout and alcohol problems among urban transit operators in San Francisco.
Although occupational burnout has been linked with numerous psychosomatic symptoms and mental health problems, few studies have examined the association between burnout and substance use. This study assessed the contribution of burnout (Emotional Exhaustion--Maslach Burnout Inventory) to the risk of alcohol dependence and alcohol-related harm among a sample of urban transit operators. The study population consisted of 993 current drinkers who participated in the 1993-1995 San Francisco Muni Health and Safety Study. A series of multivariate logistic regression models were developed to analyze the association between burnout and risk of alcohol problems after adjustment for seniority, sociodemographic factors, and mean daily ounces of ethanol. The results indicate that burnout is associated with elevated risk of alcohol dependence (odds ratio [OR] = 1.03; 95% confidence interval [CI] = 1.01, 1.06). The association between burnout and alcohol-related harm, however, was attenuated. These findings suggest that transit operators with higher levels of burnout may be at increased risk for alcohol problems, particularly alcohol dependence. The temporal relationship between the development of burnout and the onset of alcohol problems among occupational cohorts warrants further investigation.
Adult↗
Herbicide use on railway tracks for safety reasons in Germany?
A short overview on the occurrence of herbicides in groundwater and drinking water located in the vicinity of railway tracks in Germany is presented. The study has been conducted using the experience of various water supply companies and includes a literature research on the subject. It has been documented that in Germany only 1% of the total area treated with pesticides was under management of the former Deutsche Bundesbahn before 1990. The specific amount applied on the railway tracks was, however, a factor of 6 higher than that used in agriculture, although it must be borne in mind that the retaining capacity of railway tracks for pesticides is much lower. The herbicides applied ranged from 2,4-D and 2,4,5-T, triazine derivatives, e.g. atrazine and urea derivatives such as diuron. Traces of almost all of the herbicides applied could be detected in samples of groundwater and drinking water in the vicinity of railway tracks. Since 1997 only glyphosate has been used.
Germany↗
About morphological findings in fatal railway collisions.
The autopsy findings in fatal cases of railway collisions of the Bonn Institute of Legal Medicine in 1992-1999 were investigated and compared to the statements in the investigation files of the public prosecutor with regard to classification as accident or suicide as well as with regard to type and speed of collision. Of the 38 deaths, 10 were hit in an upright position, 11 fatal collisions affected persons lying outside the track and 13 were hit and overrun lying inside the track. According to the investigation classification 21 persons committed suicide (56%), while 10 died in an accident (26%). Our survey confirmed the leading role of being over-rolled in a lying position as an indication for suicides, while in accidents the upright hit was most important. With exception of the persons primarily affected between the rails in upright position and over-rolled consecutively an unequivocal assignment of injury patterns to the hit categories was possible. In cases of persons being primarily over-rolled in a lying position especially the criteria (i) opening of body cavities, (ii) organ injuries and (iii) loss of parts of the body allowed for careful conclusion on hit, respectively, overrunning speed.
Accidents↗
Fatal accidents due to train surfing in Berlin.
This study was undertaken for the purpose of analysing under the aspect of legal medicine, fatal accidents due to train surfing in the local transport system of Berlin (S-Bahn and underground). The period of investigation was from 1989 through 1995, with 41 train surfing accidents, among them 18 with fatal outcome. Evaluation included those 14 deaths which were forensically autopsied. It was based on autopsy records of Berlin-based university institutes (Humboldt University and Free University) as well as the Brandenburg State Institute of Legal Medicine. Also used were data obtained from the Berlin Transport Police Record. The casualties were aged between 13 and 25 years, most of them between 16 and 20. The male-female gender ratio was 13:1. Accidents occurred above all in the warmer season of the year, most of them between 20:00 h and midnight. More than 50% of all cases were affected by alcohol, but centrally acting medicaments or other addictive drugs were not noticed at all. Most of the fatal accidents occurred to users of the Berlin S-Bahn network. Older train models were the preferred surfing objects due to their structural peculiarities. Collision with close-to-track obstacles and slipping from the train proved to be the major sources of danger. An analysis of injuries revealed polytraumatisation but for one exception, with craniocerebral injuries being the most common and severest events. The longest survival time amounted to 24 h. As the psychosocial causes of high-risk behaviour of adolescents will hardly be controllable, withdrawal of technical, that is structural design possibilities appears to be the most important approach to prevention of accidents in the future. This demand is met by the new series of the Berlin S-Bahn. The model of the old series, suitable for surfing, still accounts for about 10% of the rolling stock and is to be decommissioned in 1998.
Accidents↗
Man-made electromagnetic noises causing difficulty in geomagnetic and geoelectric observations in city area.
In city area, there are several types of electromagnetic noises originated in daily activities of human beings. The noises possibly cause difficulty to detect geomagnetic and geoelectric signatures. It is important for investigators who are studying geomagnetic effects for biology, medicine and so on to be aware that such noises are present in city area. Among these noises, the one due to electric railways driven by direct-current electric power supply might give the largest influence because this type of noise continues almost all the time and have complex wave forms. The characteristics of the noises are briefly introduced by showing a theoretical background and some experimental studies.
Electricity↗
[Thromboembolic events related to travel, with the train too].
INTRODUCTION: The risk of thromboembolic events related to travel is not exclusively due to air travel. We report the case of a patient who presented pulmonary embolism after prolonged train travel. OBSERVATION: An 82 Year-old patient had a significant past history of ischemic heart disease. He traveled by train, in a sitting position, for around 12 hours from Barcelona (Spain) to Paris (France). Approximately 24 hours after the journey, he presented pain in the right leg and dyspnea, which increased during the following 48 hours. Ultrasonographic cardiac examination revealed pulmonary arterial hypertension (54mm Hg), acute right ventricular failure and showed a thrombus located in the pulmonary artery, confirming the diagnosis of pulmonary embolism. Ultrasonography diagnosed deep venous thrombosis of the right leg. Treatment with heparin and oral anticoagulant was initiated. Evolution was favorable and the patient was discharged home 14 days later. No further medical event occurred during the Year that followed. DISCUSSION: The mechanisms that precede the development of a venous thrombosis are not specific to the method of transport. Blood vessel wall lesions, venous stasis and blood clotting component abnormalities, principle elements in the development of thrombosis according to Virchow's triad, are enhanced by prolonged sitting position, during travel, whether in planes or not. The role of other risk factors, personal or depending on the condition of travel, remains unknown. Simple prophylactic measures should be widely proposed during long travel, whatever the mode of transport. CONCLUSION: The development of a venous thrombosis, enhanced by prolonged sitting position, can occur whatever the form of travel. Prophylactic measures should be widely prescribed for prolonged travel, taking in consideration personal thromboembolic risk factors and circumstances of travel.
Aged↗
Prediction of the occurrence and intensity of post-traumatic stress disorder in victims 32 months after bomb attack.
INTRODUCTION: Our objective was to identify factors that predict occurrence and severity of post-traumatic stress disorder (PTSD) after a terrorism attack. POPULATION: We evaluated 32 victims of a bomb attack in a Paris subway in December 1996 at 6 and 32 months. METHOD: Sociodemographic characteristics, clinical data and physical injuries were used to predict PTSD occurrence and severity in 32 victims. The Watson's PTSD Inventory (PTSD-I) and the Impact of Event Scale (IES) by Horowitz were used to evaluate occurrence and severity of PTSD, respectively. RESULTS: Thirty-nine percent of participants met PTSD criteria at 6 months, 25% still had PTSD at 32 months. Women had PTSD 32 months after the bomb attack more frequently than men. Employment predicted PTSD severity at 32 months. PTSD scores assessed by PTSD-I at 6 months were significantly and positively associated with IES scores at 32-month follow-up (r = 0.55, P = 0.004). Psychotropic drug use before the bomb attack significantly predicted PTSD occurrence and severity at 6 and 32 months. In a linear regression model, physical injuries, employment status and psychotropic drug use before the bomb attack were independent predictors of severity of PTSD at 32 months. CONCLUSIONS: Bomb attack exposure resulted in persisting PTSD in a significant proportion of victims; the severity was predicted at 32 months by physical injuries and psychotropic drug use before the terrorism attack and by the PTSD score few months after the bomb attack.
Adult↗
Chronic neurobehavioral and central and autonomic nervous system effects of Tokyo subway sarin poisoning.
To evaluate delayed (prolonged) neurobehavioral and neurophysiological effects of acute sarin poisoning, nine male and nine female patients of the Tokyo subway sarin poisoning in Japan were examined by neurobehavioral tests, posttraumatic stress disorder (PTSD) checklist, brain evoked potentials, computerized static posturography, and electrocardiographic R-R interval variability, 6-8 months after the poisoning. Their serum cholinesterase activities on the day of the poisoning (March 20, 1995) were 13-131 (mean 72.1) IU/L. The results suggested delayed effects on psychomotor performance, the higher and visual nervous system and the vestibulo-cerebellar system with psychiatric symptoms resulting from PTSD.
Autonomic Nervous System Diseases↗
The Paddington rail crash: identification of the deceased following mass disaster.
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Accidents↗
The fire damage at the Paddington rail crash.
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Accidents↗
Brief screening instrument for post-traumatic stress disorder.
BACKGROUND: Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. AIMS: To test and cross-validate a brief instrument that is simple to administer and score. METHOD: Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview 1 week later. RESULTS: Excellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims. CONCLUSIONS: Performance of the new measure was equivalent to agreement achieved between two full clinical interviews.
Accidents↗