One Hundred Years of Railway Disasters and Recent Trends

The necessity for an integrated Emergency Operations Center (EOC) among first responders: Lesson learned from two Iranian railway accidents

Introduction

Several train accidents have occurred in Iran in the last twenty years, resulting in considerable loss of human lives. This study aims to investigate and analyze the response process and deficiencies thereof, of three responding organizations to two railway accidents in Iran.

Methods

The study was performed in 2 stages to examine the challenges faced by the first responders in the said accidents. In the first stage, a descriptive statistical analysis was conducted to estimate the injuries and loss of human lives. In the second stage, qualitative description (QD) was performed. Technical reports, official documents, and interviews contributed to the sources of primary data. Study participants were members of first responders who were interviewed.

Results

The lack of key components like coordination, information-sharing, a single unified command between responders from different organizations, a lack of relief and rescue railway train, and poor inter-organizational interactions in the deployment of relief teams, were found to be the most important challenges.

Discussion and conclusion

The analysis of these two accidents showed that the lack of an integrated emergency operations center (EOC) among the organizations involved in the emergency response appears to be the obvious cause of initial confusion and disruption in the response phase which caused a delay which proved fatal. Designing and developing an integrated response plan among responding organizations, preparing an information sharing network, centralized deployment of forces to the site of the accident, strengthening inter-organizational interactions in the form of an incident command system, designing, launching, and using rescue trains on rail routes and use of air emergency facilities in areas with poor accessibility can reduce mortality in future in similar kind of accidents.

A new approach to recording nasal fracture in skeletonized individuals

OBJECTIVE

This work describes a new method for recording nasal fracture in skeletonized individuals, suitable for use in biocultural studies of violence and fracture in past societies.

METHODS

The method consists in recording the 'side of fracture', 'side of deviation', 'type of fracture', 'other facial fractures', and stage of 'bone remodeling'.

RESULTS

A lateral impact force to the facial area is typical of interpersonal violence. This may result in a unilateral nasal fracture and/or a laterally deviated nose. Given the predominance of right-handedness in human populations, side of fracture and, especially, side of deviation, may be useful indices of interpersonal violence. As regards fracture type, although a distal fracture of the nasal bones is the most common type, their comminution may be associated with higher impact forces. The presence of other facial fractures may also be an indicator of high-energy impacts.

CONCLUSIONS

Different patterns of nasal trauma may be consistent with different etiologies.

SIGNIFICANCE

The method is focused at improving our ability to distinguish the direction and type of impact that caused the injury and, in particular, whether, at a population or sub-group level, such injuries are likely to be predominantly due to violence or to other causes.

LIMITATIONS

Well healed fractures of the nasal bones or injury to the septum may be difficult to identify. Also, it is not possible to confirm if nasal and other facial fractures are temporally concurrent.

SUGGESTIONS FOR FURTHER RESEARCH

To test this method using skeletal collections with known trauma history or 3D prints of modern nasal injuries of known etiologies.

Hospital, health, and community burden after oil refinery fires, Richmond, California 2007 and 2012

INTRODUCTION

Emergency Departments experience a significant census burst after disasters. The aim of this study is to describe patient presentations at Emergency Departments in Contra Costa County, California following chemical release incidents at an oil refinery in 2007 and 2012. Specific areas of focus include hospital and community burden with an emphasis on disease classes.

METHODS

Searching 4 weeks before through 4 weeks after each event, Emergency Department abstracts identified patients living in Contra Costa County and seeking care there or in neighboring Alameda County. City and ZIP-code of residence established proximity to the refinery. This provided the following contrast groups: Event (2007, 2012), time (before, after), location (bayside, rest of county), and within bayside, warned or not warned to shelter in place. Using the Multi-Level Clinical Classification Software, we classified primary health groups recorded 4 weeks before and after the events, then summarized the data, calculated rates, and made tables, graphs, and maps to highlight findings.

RESULTS

Number of visits meeting selection criteria totalled 105020 records. Visits increased modestly but statistically significantly after the 2007 incident. After the 2012 incident, two Emergency Departments took the brunt of the surge. Censuses increased from less than 600 a week each to respectively 5719 and 3072 the first week, with the greatest number 2 days post-event. It took 4 weeks for censuses to return to normal. The most common diagnosis groups that spiked were nervous/sensory, respiratory, circulatory, and injury. Bayside communities had statistically significant increases in residents seeking care. Specifically, visits of residents in warned communities nearest the refinery increased by a factor of 3.7 while visits of residents in other nearby un-warned communities increased by a factor of 1.5.

CONCLUSIONS

The 2012 Emergency Department census peaked in the first week and did not return to normal for 4 weeks. Diagnoses changed to reflect conditions associated with reactions to chemical exposures. Surrounding communities and nearby hospitals experienced significant emergent burdens. In addition to changes from such events in patient diagnoses and community burden, the discussion highlights the long-term implications of failures to require adequate monitoring and warning systems and failures of health planning.

A study on the safety evaluation of buphrenorphine administered through an autoinjector compared with manual injection using haematological and biochemical variables in rats

Buprenorphine drug cartridge was made for autoinjector device for use in emergency and critical situations to reduce the morbidity and mortality. Water-filled cartridges were prepared and buprenorphine was injected aseptically in the cartridge, to make 0.05 and 0.10 mg/mL. Rats were injected intraperitoneally, buprenorphine (0.3 and 0.6 mg/kg), repeatedly with the autoinjector and compared with manual injection (7 days and 14 days) using various haematological and biochemical parameters. No significant change was observed in the body weight, organ to body weight ratio and haematological variables in any of the experimental groups compared with the control group. Except serum urea and aspartate aminotransferase, no significant change was observed in glucose, cholesterol, triglycerides, bilirubin, protein, albumin, creatinine, uric acid, alanine aminotransferase, gamma glutamyltransferase and alkaline phosphatase. The autoinjectors deliver the drugs with spray effect and force for faster absorption. In the present study, the autoinjector meant for intramuscular injection was injected intraperitoneally in rats, and the drug was delivered with force on the vital organs. No significant difference was observed in the autoinjector group compared to the manual group showing tolerability and safety of the buphrenorphine autoinjector. This study shows that buprenorphine autoinjector can be considered for further research work.

A Case Study of the High-speed Train Crash Outside Santiago de Compostela, Galicia, Spain

INTRODUCTION

The worldwide use of rail transport has increased, and the train speeds are escalating. Concurrently, the number of train disasters has been amplified globally. Consequently, railway safety has become an important issue for the future. High-velocity crashes increase the risk for injuries and mortality; nevertheless, there are relatively few studies on high-speed train crashes and the influencing factors on travelers' injuries occurring in the crash phase. The aim of this study was to investigate the fatal and non-fatal injuries and the main interacting factors that contributed to the injury process in the crash phase of the 2013 high-velocity train crash that occurred at Angrois, outside Santiago de Compostela, Spain.

METHODS

Hospital records (n=157) of all the injured who were admitted to the six hospitals in the region were reviewed and compiled by descriptive statistics. The instant fatalities (n=63) were collected on site. Influencing crash factors were observed on the crash site, by carriage inspections, and by reviewing official reports concerning the approximated train speed.

RESULTS

The main interacting factors that contributed in the injury process in the crash phase were, among other things, the train speed, the design of the concrete structure of the curve, the robustness of the carriage exterior, and the interior environment of the carriages. Of the 222 people on board (218 passengers and four crew), 99% (n=220) were fatally or non-fatally injured in the crash. Thirty-three percent (n=72) suffered fatal injuries, of which 88% (n=63) died at the crash site and 13% (n=9) at the hospital. Twenty-one percent (n=32) of those admitted to hospital suffered multi-trauma (ie, extensive, severe, and/or critical injuries). The head, face, and neck sustained 42% (n=123) of the injuries followed by the trunk (chest, abdomen, and pelvis; n=92; 32%). Fractures were the most frequent (n=200; 69%) injury.

CONCLUSION

A mass-casualty incident with an extensive amount of fatal, severe, and critical injuries is most probable with a high-velocity train; this presents prehospital challenges. This finding draws attention to the importance of more robust carriage exteriors and injury minimizing designs of both railway carriages and the surrounding environment to reduce injuries and fatalities in future high-speed crashes.

Impact on life after a major bus crash--a qualitative study of survivors' experiences

BACKGROUND

Crashes occur regularly throughout the world and can result in multiple fatalities and many injuries. Research into how survivors experience a crash is very limited.

AIM

To describe and analyse the nonphysical consequences of a multifatality bus crash in Sweden and the subsequent effect on the surviving passengers' lives.

METHOD

The participants were all (n = 56) of the survivors of a major bus crash. The passengers were interviewed approximately one month after the bus crash. The interviews were analysed using a qualitative content analysis.

RESULTS

Prior to the arrival of rescue personnel at the crash site, helpfulness emerged among the passengers. Further, the crash generated an impact on the surviving passengers' lives from a short-term perspective. The passengers displayed a diverse need for crisis support; informal support from family and friends was essential for the early healing process. Sleep difficulties and a change in travel routines were the most common consequences. Lastly, passengers sought closure in order to move on with their lives.

CONCLUSION

The passengers' reactions to and behaviour following a crash offer an insight into the, relatively unexplored, interaction between people experiencing a major road traffic crash. It is necessary to have a flexible crisis support system, and the vital role of family support ought to be upgraded.

Survivors' experiences from a train crash

Rarely described are people's lived experiences from severe injury events such as train crashes. The number of train crashes named disasters with ≥10 killed and/or ≥100 nonfatally injured grows globally and the trend shows that more people survive these disasters today than did so in the past. This results in an increased number of survivors needing care. The aim of the study was to explore survivors' experiences from a train crash. Narrative interviews were performed with 14 passengers 4 years after a train crash event. Qualitative content analysis was used to analyse the interviews. Experiences were captured in three main themes: (1) Living in the mode of existential threat describes how the survivors first lost control, then were thrown into a state of unimaginable chaos as they faced death. (2) Dealing with the unthinkable described how survivors restored control, the central role of others, and the importance of reconstructing the event to move forward in their processing. (3) Having cheated death shows how some became shackled by their history, whereas others overcame the haunting of unforgettable memories. Furthermore, the result shows how all experienced a second chance in life. Experiencing a train crash meant that the passengers experienced severe vulnerability and a threat to life and interdependence turned out to play a crucial role. Focusing on helping other passengers on site was one way to regain the loss of control and kept the chaos at bay. Family, friends, and fellow passengers turned out to be extremely important during the recovery process why such closeness should be promoted and facilitated.