Interventions based on evidence – validation studies

Interventions offered to railway crew members and their employers should be based on the best available scientific knowledge in order to ensure that the intervention has been proven to be effective in reducing the negative impact of critical incidents for crew members, and railway companies.

Evaluation studies aim at assessing the effectiveness of prevention or treatment strategies to reduce the traumatic reactions in crew members after a critical incident. Unfortunately, there have not been many evaluation studies in this area, and many of the existing studies do not provide complete results or may only be relevant in certain countries or specific railway contexts.  This section provides an overview of the existing research on the effectiveness of these interventions.

Classification of evidence levels for interventions in general

Evaluation of interventions can be done in different ways, each providing different types of information that may be helpful when choosing intervention strategies:

Levels of evaluation

In the context of support and care after a railway critical incidents

Needs analysis studies assess the nature and extent of the problem faced by specific populations or groups and describe the various causes and potential solutions to help.  They are useful to describe what is needed, but do not identify which prevention and intervention strategies are most useful.

Needs analysis have been conducted mainly in retrospective  or prospective studies of the effect of railway Person-Under-Train (PUT) incidents  and railway fatalities.

Implementation studies describe the support or care strategies as they have been used in a specific context. They may also describe and analyse facilitators and obstacles to the implementation, the underlying theories that justify the use of the strategies, the level of success of the programme implementation, the feasibility in the context and the possible generalisation to other settings.

Several protocols have been described and implemented. However, the level of description of these protocols, their components and conditions of implementation is often insufficient to develop an in-depth understanding of the various components of these programmes

Effectiveness studies: They describe the effects of the support or care strategy on the problems it aims to solve. Effectiveness studies can have varied levels of scientific validity and can provide information about the effects of the programme ranging from subjective measures of satisfaction to scientific evidence of effects in reducing symptoms.  It is generally assumed that the best scientific evidence comes from comparisons in an experiment and control group of symtoms before and after the intervention using validated measurement tools, with a random assignment to experiemental and control conditions. Studies may examine short, mid or long term effects of the intervention.

Several interventions have been evaluated in the context of railway critical incidents, but rarely in the context of study with a control group. Most studies focus upon immediate short term effects, rather than assessing the long term impact of the interventions.

The more an evaluation uses valid scientific methodologies and standardised assessment tools, the more its results are generally considered to be scientifically valid. However, in order to fully understand how treatments are helpful and why, research using different methodologies and gathering different types of information and suing different methodologies can be useful..

Classification of interventions to reduce traumatic reactions in railway crew members

Our review was based upon an analysis of Guidelines and Regulations, railway company policies (CIRP), formal research studies published in scientific journals, and needs analyses and surveys with employees, including our analysis of based upon our interview study with Canadian rail workers.

Two levels of intervention were identified in the existing literature. First, there are numerous protocols published by governing bodies and railway companies, include guidelines for programmes and other actions to be taken by railway companies. Second, there are therapeutic interventions with conductors and engineers to reduce their individual symptoms.

The main activities to reduce traumatic reactions in railway crew members are described below. Our analysis indicates that prevention activities implemented within companies have almost never been evaluated. Therefore, although there are strong indications from needs analysis that they should be helpful., they cannot currently be included in best practices for lack of evidence. Clinical interventions have been subjected to empirical evaluations and EMDR and CBT seem to be the most efficient at reducing trauma related symptoms.  However, other potential clinical interventions have been rarely evaluated.


Levels of implementation in the railway industry

Evaluation of effect in the context of railway critical incidents

Information and training


Requested by crew


On site management

- Compassionate handling

-Taking charge of the scene

Not as company protocols (anecdotal)

Requested by crew

Indications that it reduces post incidents symptoms

Demobilisation– being taken off the train

Widely implemented

Compulsory or optional

Indications that it helps recovery

Insufficient on its own to prevent PTSD

Time off

Widely implemented

Compulsory or optional

Between 24h and 72h

Indications that it helps recovery

No empirical evaluation

No assessment of appropriate length of time off

Return to work policy


-Evaluation of fitness to work


Requested by crew


Peer support

In several companies

Indications that it helps recovery

Debriefing – individual or group debriefing after the incident with a clinician

In several companies

Indications that it helps recovery

Group therapy (Rombom 2006)


Effective in combination with individual therapy

Cognitive behavioural therapy (CBT) (Rombom 2006 )

In several contexts

Effective at reducing symptoms

Eye Movement Desensitization and Reprocessing (EMDR) 

In several companies

Effective at reducing symptoms