Diagnoses and their consequences

On-train duties are regulated by the Safety Critical Position rules within the Railway Safety Act.

RAILWAY MEDICAL RULES FOR POSITIONS CRITICAL TO SAFE RAILWAY OPERATIONS can be obtained using the following link

A safety critical position involves mandatory mental and physical fitness requirements in order to guarantee proper alertness, judgment, sensory and motor functions. In order to make certain that safety critical position holders have the required fitness, the Railway Medical Rules Handbook has prescribed specific guidelines. These guidelines address some of the mental health issues that may arise from experiencing critical incidents.

Diagnosis

Ability to work in safety critical position

Condition for returning to work

Elements that need to be assessed in the context of a safety critical position

Acute Stress Disorder

no

1 month symptom free

Recurrence

Hyper-arousal

Affective problems

Judgement

Attention

Alertness

Predictability

Side effects of medications

Post Traumatic Stress Disorder

no

3 months symptom free

Recurrence

Hype-rarousal

Affective problems

Judgement

Attention

Alertness

Predictability

Side effects medications

Panic Disorder

no

6 months symptom free

Judgement

Attention

Alertness

Side effects of medications

Depressive Disorder

no

Being asymptomatic (no delays)

Judgement

Attention

Alertness

Insight

Side effects of medications

These rules have a strong impact on the willingness of crew members to seek help after they had a critical incident because they often feel that they will be trapped in long procedures before they can come back to working normally. They often also fear the loss of income from a long period of time off. Finally, most of the time, they feel they do not need so long to get better and do not see other alternatives: either they come back too soon, or they stay off too long. The medical rules, based upon diagnostic manuals and the practices of Workers Compensation Boards seem to dichotomise the possibilities, either:

1.  The worker is fit to work within 72 hours after incident, or

2. The worker is diagnosed with a traumatic reaction and is off work for at least one month, with the responsibility to prove themselves fit in order to return to work

As we can see in our analysis of the impact of critical incidents[t1] , most crew members find themselves in situations that are “in-between”. Taking these variations into account within the medical rules would increase the use of support and decrease recovery delays and difficulties.

Recommendations to Medical Doctors:

When evaluating and diagnosing a railway worker who has experienced a critical incident, it isimportant to assess with him the consequences of various diagnoses and the likelihood of him following your recommendations, when considering the consequences of those recommendations on his ability to earn his living.

Recommendations to crew members:

Before you consult with a Medical Doctor, discuss the various possible diagnoses and their consequences with your union representative and family members. Do not hesitate to inform your MD of the safety critical position rules and discuss options with him before he writes a prescription.   However, a diagnosis is for your care and protection. It is important that you take it into account and act accordingly for your own health, safety and the safety of others.