Mind the gap: 11 years of train-related injuries at the Royal London Hospital Major Trauma Centre

Understanding the Mental Health Impacts of the COVID-19 Pandemic on Railway Workers: Risks and Protective Factors

OBJECTIVE

Railway workers have provided an essential service throughout the COVID-19 pandemic. This study explored the effects of COVID-19 on the mental well-being of railway workers (N = 906) in the United Kingdom during the third lockdown period.

METHOD

The online survey included measures of COVID-19-related risk factors (perceived risk, stress, burnout, trauma) and protective factors (resilience coping, team resilience, general help seeking) associated with mental well-being. Responses were analyzed using multiple regression and content analysis.

RESULTS

COVID-19-related risk factors negatively predicted well-being. Higher scores on adaptive resilience, intentions to seek help, and team resilience significantly predicted higher mental well-being scores. Mental health decline throughout the COVID-19 pandemic and concerns for the future were reported.

CONCLUSIONS

Building a resilient railway workforce requires attention to staff mental well-being and to ensuring that support systems are robust and accessible.

Preventing railway suicides through level crossing removal: a multiple-arm pre-post study design in Victoria, Australia

PURPOSE

Rail level crossing removals to improve transport performance across metropolitan Melbourne (state of Victoria) resulted in new rail fencing and grade-separation of tracks from the surrounding environment at several sites. These design changes restricted pedestrian access to the rail tracks, which is a countermeasure known to prevent railway suicide in other settings. We examined whether any such suicide prevention effect followed the removals.

METHODS

We used a multiple-arm pre-post design to test whether a decrease in monthly frequency of railway suicides occurred at level crossing removal sites (intervention sites), compared to randomly matched sites where level crossings had not yet been removed (control sites). We used data available in the Victorian Suicide Register covering the period 1st January 2008 to 30th June 2021.

RESULTS

The mean monthly number of railway suicides decreased by 68% within a 500 m radius of intervention sites (RR: 0.32; CI 95% 0.11-0.74) and by 61% within a 1000 m radius of intervention sites (RR: 0.39; CI 95% 0.21-0.68). There was no evidence that the mean monthly number of railway suicides changed at the control sites, either within a 500 m radius (RR: 0.88; CI 95% 0.47-1.56) or a 1000 m radius (RR: 0.82; CI 95% 0.52-1.26).

CONCLUSION

The reduction in railway suicides at locations where level crossings were removed, demonstrates the suicide prevention benefits that can be derived from a major infrastructure project even if not initially intended. Planning for major infrastructure projects should include consideration of these benefits, with designs incorporating features to maximise suicide prevention impact.

Train-Associated Injuries Pose a Significant Burden on Trauma Care Systems of Emerging Economies

BACKGROUND

The Indian railway system is the fourth largest in the world and causes about 15 deaths every day, due to intentional or unintentional reasons. This study presents a 5-year retrospective analysis of patients injured due to train-associated events, managed at a level-1 trauma center in India.

MATERIALS AND METHODS

Hospital-based trauma registry data of train-associated injuries presenting between 2012 and 2016 were analyzed. Data from 726 patients were analyzed for demographics, injury events, injury regions, their management and outcomes. ISS and NISS were used to quantify the injury severity.

RESULTS

Mean age was 33 years, with male-to-female ratio 86 to 14%. The majority of patients (62%) were between 20-40 years. The median ISS was 9 (IQR 4-16), median hospital stays 11 days (IQR6-23), with in-hospital mortality of 17.4%. Presence of head injury; ISS > 9 and CPR in ED were independent risk factors of mortality. Trespassers on the rail track had significantly more severe injuries compared to passengers (Median ISS 13 vs. 9, p = 0.012; Median NISS 22 vs.17, p = 0.015); however, mortality and hospital length of stay were not significantly different. Location of injury event (on platform or tracks) showed no difference between the severity of injuries, mortality and hospital length of stay.

CONCLUSIONS

Current study reports comprehensive injury patterns and outcomes of train-associated injuries from a low- and middle-income country (LMIC). Apart from the mortality, there is a high incidence of permanent disabilities from extremity amputations. No significant difference was noted in the severity and outcomes among patients injured on or off train platforms, emphasizing the need for comprehensive safety measures including enforcement and promoting safe behavior not only on locations like train tracks but equally at platforms.

Emergencies on the train and railway stations managed at a railway station emergency care center

Background:

With the increasing focus on setting up emergency care centers in railway stations across India by the government, there are no baseline data in India, or the world, about the profile of patients presenting with emergencies on the trains and at the railway stations.

Materials and Methods:

This retrospective study included all people who presented with any medical emergency to the Emergency Care Center (ECC), Katpadi Railway Station in South India, between January 2017 and December 2017. Details were obtained from the register maintained by the emergency nurses stationed at the ECC.

Results:

Among 1076 patients who presented to the ECC during the study period, the mean age was 37 years (standard deviation: 19.01) with two-thirds (66.1%) being males. A quarter (23.4%) were trauma-related and 76.6% were medical emergencies. Sharp force injuries [58.8% (151/252)] was the predominant mode of trauma, while laceration [57.1%] (144/252) was the predominant type of injury sustained. Common nontrauma presenting complaints included fever (27.5%), headache (17.9%), nausea/vomiting (17.9%), and abdominal pain (15%). The maximum number of cases was in the summer months of May–June with heat-related symptoms, while the maximum number of fever cases was recorded during the monsoon season. The majority (905/1076; 84.1%) were able to continue their journey further, and 13.9% required referral to a nearby hospital. During the 1-year study period, 2 patients with trauma and 18 with various medical conditions died at the railway station or at a hospital after resuscitation at the ECC.

Conclusions:

Trauma, fever, headache, and vomiting are the most common emergencies among patients traveling by rail and at the railway stations. Establishing well-equipped ECCs across the country to handle trauma and other medical emergencies during travel is part of primary care provided and is the need of the hour.