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NEW REPORT: Assessment of various critical incident management and support protocols for railway employees after a serious incident.

Full report: https://www.irsst.qc.ca/media/documents/PubIRSST/R-1035.pdf?v=2019-06-14

Summary

The Canadian railway industry must regularly deal with critical incidents (CI) involving collisions with people or vehicles. Such incidents may result in serious injuries or even fatalities, in addition to causing mental health problems for the locomotive engineers and conductors involved. Every year, approximately one hundred people in Canada, including some 20 in Québec, lose their lives in collisions with trains. In addition to fatal events, an unknown number of incidents also occur in which people are injured or property is damaged. Most locomotive engineers and train conductors will be exposed to this type of event at least once in their careers. When a critical incident of this nature occurs, they are witnesses, victims, participants and often first responders, all at the same time. 

A significant proportion of locomotive engineers and train conductors soon return to satisfactory personal and occupational functioning levels and have very few psychological, social or functional after-effects. However, the recovery time after a CI can be quite long, and employees require support during this period. In addition, between 4% and 17% of these employees will experience more serious problems, including depression, acute stress disorder, posttraumatic stress disorder or anxiety.

Several clinical approaches are effective in mitigating posttraumatic symptoms, and a great deal of the research has focused on them. In contrast, needs are less well known and there are
fewer resources for those who do not suffer posttraumatic stress, but who struggle with major undiagnosed adverse effects.

Some studies have examined the critical incident management and support protocols (CIMSPs) implemented by employers, and they often recommend the adoption of practices to reduce the potential impact of critical incidents on employees and to shorten their recovery period. However, although these protocols are based on studies of CI after-effects and employees’
needs, they have not yet undergone empirical evaluation. Assessments of this kind are necessary to determine the key elements of these protocols that have a positive impact on
employee recovery and to promote recommendations based on scientific findings. 

The aim of this project was to assess the CIMSPs that have been implemented in the Canadian rail industry and their impact on the recovery of employees who have been involved in critical incidents and to propose key practices to reduce the adverse effects.

Seventy-four locomotive engineers and train conductors who had experienced a CI were recruited to take part in the study. They were interviewed four times over a six-month period. As
well, nine managers of train operations (MTOs) who met the same inclusion criteria were interviewed twice over a three-month period. A mixed-method approach was used to analyse
the data collected, combining statistical and qualitative analyses to fully understand the relationships between critical incidents, CIMSPs and post-CI recovery. The perceptions, needs
and recommendations of MTOs who are responsible for applying protocols and providing support are also presented.

The results indicate that existing CIMSPs are implemented partially or unevenly, depending on employer, province and CI type. In CIs without fatalities, for instance, management and support protocols are not completely followed, even when employee health is affected.

CIs affect employees in a wide variety of ways. The research team was able to establish five distinct recovery trajectories: no adverse effects, adverse effects that disappear within the
month following the CI, adverse effects that gradually decline and disappear within the three months following the CI, adverse effects that reach a plateau between one and three months
afterwards and then disappear, and adverse effects that are still present after six months. Overall, among two thirds of employees, the adverse effects of a CI dissipate more or less
rapidly in the month following the CI, 20% still feel significant effects after three months (course of the plateau and effects that persist after six months), while that proportion falls to 13% after six months. These effects are not negligible and affect employees’ cognition (concentration, rumination, distraction), energy (fatigue, trouble sleeping) and emotions (guilt, grief). They may also interfere with employees’ ability to perform their jobs effectively.

Differences in the application of CIMSPs provide opportunities for assessing their role in the post-CI recovery process. The study results show that management protocols can have an
effect on the recovery process. The following factors tend to foster an acceleration of the process: the presence of a manager on site; a manager taking charge at the scene of the CI;
the various stakeholders showing respect and empathy toward those affected; no pressure on employees to continue working or to return to work before they are ready; demobilization
(automatically removing employees from the scene of the CI and taking them home) and granting them recovery leave; a proactive offer of support by the employee assistance program
(EAP); a clear procedure for return to work and assessment of the employee’s readiness to resume occupational duties; deferred offer of support if needed; follow-up after return to work
and a positive work environment.

The study shows that CI management and the support provided by employers are key factors in promoting employee recovery. These are attitudes and actions that employers can act on and that can be applied fairly easily, without entailing prohibitive costs for companies. Employers have less control over other factors, such as social support or the complexity of the CI. Railway companies have protocols that already include most of the actions deemed to be effective. 

Following those protocols assiduously is a first step toward improving current practices and mitigating the adverse effects of CIs.

Reference

Bardon, C., Mishara, B.L., and Soares, A. (2019) Assessment of Various Critical Incident Management and Support Protocols for Railway Employees After a Serious Incident. Studies and Research Projects, Rapport R-1035, IRSST, 107 pages.

 

New article: Evaluating the effectiveness of platform screen doors for preventing metro suicides in China

Full text: https://www.sciencedirect.com/science/article/pii/S0165032718323784?via%3Dihub

ABSTRACT

Background
Metro suicide can cause tremendous effects on the general public. Platform screen doors (PSDs) have been identified as one of the most effective methods of suicide prevention at metro stations. However, there are few studies focusing on their effectiveness in preventing suicides. In particular, the effect of types of PSDs, including full-height and half-height PSDs, has rarely been assessed and compared.

Methods
Based on the suicide data provided by the Shanghai metro operator, the effectiveness of installing different types of PSDs for preventing metro suicides was investigated using a Poisson regression model. Ten-year monthly panel data for 94 metro stations from 2008 to 2017 were used in this study.

Results
The number of metro suicides declined by 90.9% after the PSDs were installed at metro stations. In addition, different types of PSDs had different effects on decreasing the number of suicides, and a higher half-height PSD was more effective in preventing suicides. Specifically, full-height PSDs could eliminate metro suicides by completely preventing passengers from entering the track area, while half-height PSDs that were 1.5 m and 1.2 m high could decrease the number of suicides by 79.2% and 60.2%, respectively. Moreover, there was no significant indication that the installation of PSDs at metro stations displaced suicides to railway stations without PSDs (p = 0.706).

Limitation
The potential economic benefits of different types of PSDs were not considered in our study. In addition, we did not examine whether suicide attempters would try to take their own lives by using other methods of suicide.

Conclusion
The installation of PSDs, especially full-height PSDs, could be very effective in preventing suicides at metro stations. Although half-height PSDs are less effective than full-height PSDs, increasing the height of half-height PSDs could be an effective way of enhancing their effectiveness in reducing the number of suicides.

KEYWORDS
Metro suicide, Suicide prevention, Platform screen door, China

 

Reference: Yingying Xing, Jian Lu, Shengdi Chen. (2019) Evaluating the effectiveness of platform screen doors for preventing metro suicides in China. Journal of Affective Disorders, Volume 253, P. 63-68. https://doi.org/10.1016/j.jad.2019.04.014

Partnership in Australia to prevent railway suicides

Traditionally unreported, suicide on rail is an alarming issue for those involved. It deeply affects wider communities and rail industry staff.

Since 2016, a partnership has developed between Lifeline Australia and TrackSAFE, which represents a strong, ongoing commitment to reduce suicides in the rail environment through collaboration, research and public awareness raising.

Lifeline Australia committed to providing specialist knowledge and supports on suicide prevention as a partner with the TrackSAFE Foundation to pursue this joint objective.

The partnership aims to address suicide on our network in an attempt to reduce the number of incidents and begin to mitigate the trauma caused to the families, communities and our employees.

The actions taken include the annual "Rail R U OK?" Day. April 11, 2019 was the fifth edition of this event.

Click here to learn more about the Lifeline/TrackSAFE partnership.

New article: Collecting evidence from distributed sources to evaluate railway suicide and trespass prevention measures

Abstract

It can be difficult to select from available safety preventative measures, especially where there is limited evidence of effectiveness in different contexts. This paper describes application of a method to identify and evaluate wide-ranging preventative measures for rail suicide and trespass fatalities. Evidence from literature and industry sources was collated and reviewed in a two stage process to achieve consensus among experts on the likely effects of the measures and factors influencing their implementation. Multiple evaluation criteria were used to examine the measures from different perspectives. Fencing, awareness campaigns and different types of organisational initiatives were recommended for further testing. This is the first time evidence has been collected internationally across such a range of preventative measures. Commentary is provided on using this type of approach to select safety measures from a pool of prevention options, including how re-framing the scope of the exercise could identify alternative options for prevention. Practitioner summary: The findings give insight to how different measures work in different ways and how industry can consider this in strategic initiatives. The method could be used in future studies with different frames of reference (e.g. different timescales, level of ambition and safety context e.g. railway crossings or highway fatalities). Abbreviation: RESTRAIL: REduction of Suicides and Trespasses on RAILway property.

KEYWORDS:
Rail fatalities; evaluation; experts and consensus methods; prevention; suicide; trespass

Reference: Brendan Ryan, Veli-Pekka Kallberg, Helena Rådbo, Grigore M. Havârneanu, Anne Silla, Karoline Lukaschek, Jean-Marie Burkhardt, Jean-Luc Bruyelle, El-Miloudi El-Koursi, Eric Beurskens & Maria Hedqvist (2018) Collecting evidence from distributed sources to evaluate railway suicide and trespass prevention measures, Ergonomics, 61:11, 1433-1453, DOI: 10.1080/00140139.2018.1485970

To read full article: https://www.tandfonline.com/doi/full/10.1080/00140139.2018.1485970

New article: Factors deterring and prompting the decision to attempt suicide on the railway networks

Full article: https://bit.ly/2TVHrh4

 

ABSTRACT:

Background
There is a suicide on the British railways every 36 hours. However, the reasons why people choose to die by train are not well understood.

Aims
To explore factors influencing and discouraging the decision to attempt suicide on the railway networks.

Method
We conducted an online survey and qualitative interviews with individuals who had contemplated or attempted suicide by train.

Results
A total of 353 survey responders had considered and 23 had attempted suicide at rail locations (including railways and metro/underground); a third of these cases were impulsive. The most frequently reported motivations for contemplating or attempting suicide were perceptions of quick and certain lethality (54 and 37%, respectively) and easy access to rail settings (33 and 38%, respectively). The main factor discouraging people from rail suicide was its wider impact, especially on train drivers (19%). In qualitative interviews (N = 34) the desire to avoid intervention from others was also a common motivating factor for attempting suicide on the railway networks.

Conclusions
People attempt suicide by train because railway settings are easy to access and because of an inaccurate perception of certain and quick lethality. Tackling exaggerated perceptions of lethality may help reduce suicides by train.

 

REFERENCE: Lisa Marzano, Jay-Marie Mackenzie, Ian Kruger, Jo Borrill, Bob Fields (2019). Factors deterring and prompting the decision to attempt suicide on the railway networks: findings from 353 online surveys and 34 semi-structured interviews. British Journal of Psychiatry, E-pub ahead of print, https://bit.ly/2TVHrh4

The RESTRAIL Toolbox: a problem-solving guide for implementation of measures to prevent railway suicides and trespassing accidents

The RESTRAIL Toolbox is a problem-solving guide for implementation of measures to prevent railway suicides and trespassing accidents and to mitigate the post incident consequences. It is the main output of the RESTRAIL research project and it aims to be a helpful, intuitive and user-friendly tool. It summarises practical information collected and produced during the project (synthesis, guidelines, best practice, lessons learned and empirical evidence for effectiveness). The content also makes links with scientific publications which support the recommended measures, providing a wide list of references (peer-reviewed articles, research reports, reviews, etc.).

The Toolbox is designed to help railway undertakings (RUs), infrastructure managers (IMs), station managers and other concerned decision makers in three ways:

1. lead them through the process of selecting from the range of preventative and mitigation measures,
2. provide more detailed guidance on the implementation of those measures and
3. provide a framework for collecting and structuring information in order to feed an accessible and documented database on measures for implementation and efficiency across the rail community and beyond.

To access the complete RESTRAIL toolbox, visit: http://www.restrail.eu/toolbox/

 

Railway suicide in England and Wales 2000–2013: a time-trends analysis

To read the full article:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791921/

 

ABSTRACT:

Background

In 2010, the “Tackling Suicide on the Railways” programme was launched as a joint initiative among Network Rail, the Samaritans and other key organisations such as the British Transport Police and train operators to achieve a 20 % reduction in railway suicides from 2010 to 2015 in Great Britain. We report the most recent age and sex specific trends in railway suicide in England and Wales from 2000 to 2013 and examine whether the initiative’s target reduction in railway suicides is likely to be achieved.

Methods

Population data and suicide mortality data (all methods combined and railway) for England and Wales were obtained from the Office for National Statistics (ONS) and used to calculate age and gender specific rates for deaths registered from 2000 to 2013. Data on railway suicides were also obtained from the Rail Safety and Standards Board (RSSB) and compared with ONS data. We used joinpoint regression to identify changes in suicide trends across the study period.

Results

The railway was used in 4.1 % of all suicides in England and Wales (RSSB data were similar to ONS data for most years). Suicides in all persons from all causes decreased from 2000 to 2007, with small increases from 2008 until 2013; this rise was entirely due to an increase in male suicides. Railway suicide rates increased over the entire study period; the proportion of railway suicides in all persons increased from 3.5 to 4.9 % during the study period. This trend was also mainly driven by increases in male suicides as female railway suicide rates remained steady over time. The highest age specific railway suicide rates were observed in middle aged men and women. Although there was no conclusive evidence of an increase in ONS railway suicides, RSSB data showed a statistically significant increase in railway suicides in males from 2009 onwards.

Conclusion

The continued rise in male railway suicide in England and Wales is concerning, particularly due to the high economic costs and psychological trauma associated with these deaths. The initiative’s target of a 20 % reduction in railway suicide is unlikely to be achieved.

Keywords: Suicide, Railways, England and Wales, Epidemiology, Train

 

REFERENCE: Taylor, A.K., Knipe, D.W., Thomas, K.H. (2016). Railway suicide in England and Wales 2000–2013: a time-trends analysis. BMC Public Health, vol. 16, p. 270.

Predictors of using trains as a suicide method: Findings from Victoria, Australia

To read the full article: https://www.ncbi.nlm.nih.gov/pubmed/28395228

 

Abstract

This study aimed to investigate the factors associated with the choice of trains over other means of suicide. We performed a case-control study using data on all suicides in Victoria, Australia between 2009 and 2012. Cases were those who died by rail suicide and controls were those who died by suicide by any other means. A logistic regression model was used to estimate the association between the choice of trains and a range of individual-level and neighbourhood-level factors. Individuals who were never married had double odds of using trains compared to individuals who were married. Those from areas with a higher proportion of people who travel to work by train also had greater odds of dying by railway suicide compared to those from areas with a relatively lower proportion of people who travel to work by train. Prevention efforts should consider limiting access to the railways and other evidence-based suicide prevention activities.

Reference

Too, L.S., Bugeja, L., Milner, A., McClure, R., Spittal, M.J. (2017). Predictors of using trains as a suicide method: Findings from Victoria, Australia. Psychiatry Res. 2017 Jul;253:233-239. doi: 10.1016/j.psychres.2017.03.057. Epub 2017 Apr 4.

New article: Developing a framework of behaviours before suicides at railway locations

Reference: Brendan Ryan (2018). Developing a framework of behaviours before suicides at railway locationsErgonomics, 61(5), 605-626.

Abstract

Better knowledge of behaviours of people at railway property could help with identifying those at risk of suicide. Literature has been reviewed from a range of disciplines on what is known about studying behaviour in this type of public location. Secondary analysis has been carried out on descriptions of behaviour from structured exercises with experts and other pre-existing sources. A framework has been produced with five main classes (display of emotion, appearance, posture/movements, activities and interactions) and associated sub-classes. Commentary has been provided on factors that influence identification of suspicious behaviours, how to distinguish these from normal behaviours and the circumstances that inhibit timely reactions to the behaviour amidst the complexity of the operational railway. Opportunities to develop and use the framework are discussed, including using this to prompt collection of additional behavioural data from wider resources, enhancing staff training and developing requirements for effective use of surveillance technologies.

Practitioner Summary: Many railway suicides could be prevented with better understanding of behaviours before events. Pre-existing data sources have been analysed, producing a framework highlighting five aspects of behaviour. This can prompt the collection of better evidence on pre-suicidal behaviours, with future applications in developing surveillance technologies, training staff and public awareness.


Keywords: Suicidal behaviour, railway, reporting, observation, surveillance technologies

Access full article: https://www.tandfonline.com/doi/full/10.1080/00140139.2017.1401124?scroll=top&needAccess=true

Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach

To access full article: https://bmjopen.bmj.com/content/bmjopen/8/4/e021076.full.pdf

ABSTRACT

Objectives

Suicides by train have devastating consequences for families, the rail industry, staff dealing with the aftermath of such incidents and potential witnesses. To reduce suicides and suicide attempts by rail, it is important to learn how safe interventions can be made. However, very little is known about how to identify someone who may be about to make a suicide attempt at a railway location (including underground/subways). The current research employed a novel way of understanding what behaviours might immediately precede a suicide or suicide attempt at these locations.

Design and methods

A qualitative thematic approach was used for three parallel studies. Data were gathered from several sources, including interviews with individuals who survived a rail suicide attempt (n=9), CCTV footage of individuals who died by rail suicide (n=16) and qualitative survey data providing views from rail staff (n=79).

Results

Our research suggests that there are several behaviours that people may carry out before a suicide or suicide attempt at a rail location, including station hopping and platform switching, limiting contact with others, positioning themselves at the end of the track where the train/tube approaches, allowing trains to pass by and carrying out repetitive behaviours.

Conclusions

There are several behaviours that may be identifiable in the moments leading up to a suicide or suicide attempt on the railways which may present opportunities for intervention. These findings have implications for several stakeholders, including rail providers, transport police and other organisations focused on suicide prevention.

Reference: Mackenzie J, Borrill J, Hawkins E, et al. (2018). Behaviours preceding suicides at railway and underground locations: a multimethodological qualitative approach. BMJ Open, 8: e021076. doi: 10.1136/bmjopen-2017-021076

Suicide patterns on the London Underground railway system, 2000-2010

To access full article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623887/

ABSTRACT: 

Aims and Method Suicidal acts on underground railway networks are an area of public health concern. Our aim was to review recent epidemiological patterns of suicidal acts on the London Underground to inform future preventive interventions. Data from 2000 to 2010 were obtained from the British Transport Police via a Freedom of Information request.

Results The mean annual rate of suicidal acts from 2000 to 2010 was 5.8 per 100 million passenger journey stages. Of those who died by suicide, 77.3% were of White Northern European ethnicity. A fifth had a history of mental illness.

Clinical implications The widening gap between the number of recorded suicide attempts and completed suicides is encouraging. Further research is required regarding the role of drug and alcohol use, psychiatric history and area of residence. Installation of platform screen doors should be considered in future railway network expansion.

Reference: Martin, S., & Rawala, M. (2017). Suicide patterns on the London Underground railway system, 2000-2010. BJPsych bulletin41(5), 275-280.