PREVENTION OF THE NEGATIVE IMPACT ON RAILWAY CREW AFTER INVOLVEMENT IN A RAIL FATALITY Abstract: This study is part of a larger project which seeks to understand the circumstances and consequences of train related fatalities, particularly suicides, in order to propose, develop and eventually to test countermeasures to reduce the prevalence of railway suicides and to diminish the impact of railway fatalities. The purpose of the study reported here is to better understand the impact on railway employees of accidents and suicides by train and their implications for preventing negative impacts on workers. We present the results of retrospective interviews with train crew members across Canada. The analysis was performed on 40 interviews describing 132 incidents (mean: 3.4 incident described per person, ranging from 1 to 9) including 55 (41.7%) suicides. Train crew members confronted with a fatality experience intense emotional reactions, including many signs of acute stress disorder (ASD). These reactions can sometimes evolve to a Post Traumatic Stress Disorder (PTSD) over the following months (in 17.5% of crew members). Those who experienced suicides are more likely to have stronger symptoms such as PSTD, than those who experienced accidental deaths. Acute symptoms recede over time for most crew members. However, it is important to note that, for 40% of the incidents described, there are some residual effects after 3 months (flashbacks, hyper vigilance, dreams and anxiety). Several factors dramatically increase the intensity and duration of difficulties experienced by the train crew after a fatality. Other factors may alleviate the effects of fatalities and result in a quick recovery from the initial stress reaction are presented. We conclude by presenting an integrated workplace prevention model that will be tested in Canadian railways.

1. Prevention of the Negative Impact
on Railway Crew after Involvment in
a Rail Fatality
Cécile Bardon, M.Sc., CRISE
Brian L. Mishara, Ph.D., CRISE

2. Context
 Railway suicides and other fatalities
 In Canada
 Financed by Transport Canada
 1.5% of suicides involve a train
 Average : 43 per year
 38% of railway fatalities are suicide
 In the world
 14 studies on the incidence or characteristics of railway suicides
 Between 3 and 10% of suicide involve a train
 Impact of railway suicides and other fatalities
 16 studies in the world
 PTSD in 4% to 16% of cases (Cothereau et al., 2004, Farmer et al., 1992)
 Long term, low key trauma reactions (Briem et al., 2007)
 Recommendations and guidelines for intervention to reduce these negative effects
 Descriptive and evaluative studies for therapeutic interventions to reduce symptoms
 SOVERN Project (Abbott, 2003)
 Trauma mitigation scheme (Burrows, 2005)
 Railway industry trauma management framework (Phelps, 2012)
2 For detailed information :
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3. Objectives of the study
For detailed information :
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 Understand the various impacts of being involved in a
railway fatality for crew members
 Identify risk and protective factors to improve on support
and care practices
 Develop a protocol for support to crew members after a
railway suicide or accident

4. Methodology
4 For detailed information :
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• Semi structured interviews
• 40 interviews with train crews from various railway and
provinces (January to June 2010)
• 122 incidents described
• Factor analysis, Pearson correlations, path analysis

5. For detailed information :
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 Littérature review
 17 studies on the impact of railway fatalities
 16 studies on the effectiveness of mitigation strategies to
reduce the negative impact of railway fatalities
 Consultation with railway stakeholders
 Steering committee of the research project

6. Results – Potential negative effects of being
involved in a railway fatality
 No adverse effects : 9.8%
 Non diagnosed effects
 Mental health problems
 Traumatic reaction : 23.8%
 Depression, phobia, anxiety :
18.9%
 Duration
 Less than one week : 29.5%
 Less than one month : 38.7%
 More than 10 years : 18.3%
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Type of non
diagnosed effect
% of
variance
explained
% of
cases
where it
appears
Agitation (rumination, upset,
sleep problems and hyper-
vigilance)
14.95 80.3
Disturbed Functioning
(guilt, concentration problems
and general impairment)
13.53 28.7
Anger (irritability, anger,
flashbacks, and a low grief
reaction)
12.34 47.5
Fatigue 10.32 5.7

7. Results – Risk and protective factors
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 Summary of risk and protective factors identified by path
analyses
Risk factors Protective factors
Pre- incident conditions Being a conductor
Seniority
Work stress
Age (on duration of symptoms)
Incident characteristics Perceived vulnerability of victim
Seeing the face or eyes of victim
Number of victims
Number of injuries
Suicide (on duration of symptoms)
Incident management Negative management behaviour
Pressure to return to work
Good quality of interaction with the
company and police during incident
and the aftermath
Quality of work relations
On site reactions Emotional dissociation
On site fatigue
Coping mechanisms Externalised coping Avoidance coping
Attribution of fault to victim

8. Results – preventing the negative impacts of
railway fatalities
 Recommendations by crew members
 Establish clear and adapted protocols for incident management and treatment and
make a special effort to strictly respect those protocols.
 Improve access to and conditions offered byWorker Compensation Board.
 Improve access to proactive independent psychological help.
 Provide more flexible options for return to work.
 Train workers before they are involved in a fatal incident.
 Reduce risk factors
 Increase protective factors
For detailed information :
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9. Literature Review of Measures to Reduce the
Impact of Fatalities on Crew Members
 Review and Analysis of:
 Guidelines and regulations
 Railway companies policies (CIRP)
 Research studies
 Needs analysis and surveys with employees
 Results
 Few evaluations of support practices and company protocols
 Programmes and protocols are mainly based upon subjective recommendations and
common sense
 Studies have shown that some forms of therapy can be very useful to crew members after
a traumatic event (CTB, EMDR, Group therapy)
 Conclusion
 Therapeutic help is becoming well validated but there is a need to evaluate the effect of
pre-incident, on- site and post-incident interventions by supervisors , peers and EFAP
professionals
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10.  Strategies of interest
 Pre-incident training for crew and supervisors (trauma and reactions, CIRP)
 Comprehensive Critical Incident Response implemented and well known at all
levels of the organisation (director, safety, local supervisors, peers, EFAP, employees)
 Clear roles and expectations
 Compulsory 3 days off
 External evaluation of fitness to work
 Proactive offer to help and support from employer and EFAP
 Incident management on site to help reestablish a sense of control for the crew
(someone is clearly in charge to their advantage in a situation of absolute helplessness and
vulnerability)
 Comprehensive support by supervisors
 Involvement of the employee and outside evaluator in the return to work process
For detailed information :
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11. Assessment of the validity of interventions to prevent or reduce railway critical incident negative
effects
Studies Inadequate Uncertain Promising Efficient
Provided by the
Employer
Information and Training (Abbott et al., 2003; Margiotta, 2000; Mishara &
Bardon, 2013b; Neary-Owens, 2001; Teneul,
2009)
Incident Management (Abbott et al., 2003; Margiotta, 2000; Mishara &
Bardon, 2013b; Phelps, 2012)
Demobilisation (Abbott et al., 2003; Burrows, 2005; Mishara &
Bardon, 2013b; Phelps, 2012)
Time off work (Abbott et al., 2003; Burrows, 2005; Margiotta,
2000; Mishara & Bardon, 2013a)
Return to work policy (Burrows, 2005) (Briem et al., 2007; Phelps,
2012)
Follow-up by a company
medical officer
(Briem et al., 2007; Cothereau, 2004; Foss, 1994)
Peer support (Briem et al., 2007; Burrows, 2005; Margiotta,
2000; Mishara & Bardon, 2013a, 2013b; Neary-
Owens, 2001; Phelps, 2012)
Outsourced
clinical
Interventions
Debriefing (Antony, 2010; Cothereau, 2004; Mishara &
Bardon, 2013a; Williams et al., 1994)
Cognitive Behavioural
Therapy
(Rombom, 2006)
Eye Movement Desensitization
and Reprocessing
(Högberg et al., 2007; Hogberg et al., 2008;
Pagani et al., 2007)
Inpatient rehabilitation
programmes
(Mehnert et al., 2012)
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12. Proposal for an integrated incident
management programme
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 Training
 Prevention
 Work relations
 Incident management
 Post-incident follow-up

13. Factors associated with
the situation
Work related factors
Incident management factors
Mitigating impact strategies
Timeline of
events
Potential
reactions
and effects
of events
Risk factors
Protective
factors
Risk factors
1
Protective
factors 2
Prior to
incident
Personal life
events and
stressors
Previous
incidents
(fatalities and
close calls)
Seniority
Masculine
stereotypes
Strong
personal
network
High level of
stress on the
job
Training and information
Good working relations
Information and training (train crews, supervisors) on what
happens during and after incidents (possible reactions,
cumulative effects, protocols and offered support,
identification of support network)
Identification and training of outsourced specialised
resources for future referrals
Design and implementation of strict and detailed incident
management protocols that take into account the reduction
of risk factors and the promotion of protective factors, the
time off and all options pertaining with consequences and
benefits (pay, missed trips, return protocol)
Implementation of a comprehensive peer support program
(including regular training up dates and follow-ups and a
careful recruitment of peers) if possible supported as well by
the union (for strong involvement of the union)
Shor
t
term
Time of
incident
Shock
Horror
Seeing the
victim prior to
impact
Dangerous
materials
Helplessness
of the victim
Train Yard
incident
Fatality is a
Suicide
Supportive, uninterrupted and compassionate radio contact
Brief evaluation of the capacity of crew to proceed with the
emergency check (body and first aid)
On site
of
incident
Post
impact
Helplessness
Physiological
reactions
Disbelief
Total
exhaustion
Impairment of
cognitive and
emotive
abilities
Being alone at
the scene
Seeing the
victim
(especially if
injuries)
Dealing with
the body
Elements
that
emphasise
the
responsibility
of victim
(recklessnes
s, intent)
Being treated
as a suspect
by police
Inadequate
handling by
supervisor on
site
Compassionate handling by police
and emergency services
Strictly implemented incident management protocol
Immediate relief of the crew and speedy evacuation
No participation of crew in incident management
Compassionate handling by supervisor
Limiting access to the crew from others
Evaluation of crew member’s condition
Drive the crew home
[1] Risk factor for increased negative impact of fatality or maintaining negative impacts over time
[2] Risk factors for reducing impact of fatality
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14. Factors associated with the
situation
Work related factors
Incident management factors
Mitigating impact strategies
Timeline of
events
Potential
reactions
and effects
of events
Risk factors
Protective
factors
Risk factors 1 Protective
factors 2
Short
term
Within
one
Week
Anger
Difficulties
sleeping
ADS
Empathy for
the victim
Having to work on
the same route
again
Close calls and non
fatal accidents
Family support
Making sense of
the event
Pressure to
come back to
work
Assurance by
employer of not
being guilty
Receiving
immediate help
Follow-up on the options available but no immediate decisions
can be made within 24 hours
No pressure to come back to work within 72 hours
Time off 72 hours (to be flexible if needed), supervised and
accompanied by regular compassionate contacts from
employer and peers program
Evaluation of train crew’s condition
One Briefing session (individual or collective) and planning for
further assistance by the same professional if needed after
evaluation. The health professional should be proactive in
contacting and meeting the crew.
Peer support offered as soon as possible and for a long period
of time (several weeks if needed)
Activation of support network
Planning return to work strategy including a supervised first trip
if necessary, flexible options if possible and a post-return
evaluation of the crew’s condition (after a week)
Mid
term
Within
3
Month
PTSD
Anxiety
Flashbacks
Dreams
Hyper
vigilance
General
anxiety
Having to fight
with employer
and workers
compensation
Board for long
term support
Being involved
in legal
procedures
Evaluation of train crew’s condition
Delayed time off available if needed
Long term professional intervention based on CBT or EMDR
provided by outsourced professionals paid for by the employer
Long term
Depression
Substance
abuse
Social
withdrawal
Resignation
Follow-up
Evaluation of train crew’s condition
[1] Risk factor for increased negative impact of fatality or maintaining negative impacts over time
[2] Risk factors for reducing impact of fatality
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15. 15
 Thank you
 For more information,
 http://railwaysuicideprevention.com
 Cécile Bardon
 Brian L. Mishara