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Train crashes: consequences for passengers
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Globally, and in Sweden, passenger railway transport is steadily increasing. Sweden has been relatively free from severe train crashes in the last decades, but the railway infrastructure is alarmingly worn and overburdened, which may be one reason for an increasing number of reported mishaps. Worldwide, major train crashes/disasters are a frequent cause of mass casualty incidents. Several shortcomings, especially within the crash and post-crash phases cause severe consequences for the passengers.

Aim: To investigate the consequences of train crashes on passengers, focusing on factors of importance in the crash and post-crash phases. The specific aims are: (I) to identify the historical development and magnitude of passenger train disasters globally on various continents and countries, (II, III) to identify injury panorama and injury objects in two train crashes, (IV) to explore survivor´s experiences from a train crash, and (V) to explore their experiences of journalists and media coverage.

Methods: Study I is a register study based on 529 railway disasters worldwide, whereas studies II-V are case studies from the two latest severe train crashes in Sweden (Nosaby and Kimstad). These studies are based on 73 and 21 passengers respectively. Studies I-III is essentially quantitative where descriptive statistics (I, III), multivariate analysis (III), and content analysis (II, III) are used. Studies II and III are also supplemented by semi-structured interviews. Studies IV and V are qualitative and the interviews (n=14, n=30) have been analyzed with qualitative content analysis. Study IV is also supplemented with quantitative data.

Results: The number of railway disasters, fatalities, and non-fatally injured passengers has increased throughout the last hundred years - particularly during the last four decades (1970–2009) when 88% of all disasters occurred (I). Passengers in the first overturned carriage suffered most severe and lethal injuries (III). Internal structures such as tables, chairs, internal walls, as well as luggage, other passengers (II, III), glass (II), and wood pellets (III) induced many of the injuries. Those who traveled facing forward with a table in front of them, in carriages that did not overturn, were more likely to sustain injuries to their abdomen/pelvis than those without a table (III). Passengers who traveled rear facing had higher rates of whiplash injuries. Surviving a train crash was experienced as "living in a mode of existential threat". The long term consequences however were diverse for different persons (IV). All experienced that they had cheated death, but some became "shackled by history", whereas others overcame the "haunting of unforgettable memories." The centrality of others and the importance of reconstructing the turn of events were important when "dealing with the unthinkable". The media coverage were experienced as positive in the recovery process and the journalists were also perceived as helpful (V). By some the journalist’s nevertheless were also perceived as harmful or negligible, and the subsequent media coverage as either uncomfortable or insignificant.

Conclusion: Despite extensive crash avoidance systems severe railway crashes still occur. Improved interior safety, as has been implemented in the automobile and aviation industries, would have an important reduction in injuries and facilitate evacuation. Being surrounded by family, friends, fellow passengers and participating in crash investigations, and experiencing descriptive media coverage were some crucial factors when dealing with the traumatic event and should be promoted.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2012. , 56 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1528
Keyword [en]
Accident, crash, disaster, experiences, injuries, injury inducing objects, media coverage, railway, safety
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-61291ISBN: 978-91-7459-505-5 (print)OAI: oai:DiVA.org:umu-61291DiVA: diva2:565631
Public defence
2012-11-30, Sal B, 9 tr, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2012-11-09 Created: 2012-11-08 Last updated: 2012-11-14Bibliographically approved
List of papers
1. One hundred years of railway disasters and recent trends
Open this publication in new window or tab >>One hundred years of railway disasters and recent trends
2011 (English)In: Prehospital and disaster medicine, ISSN 1049-023X, Vol. 26, no 5, 367-373 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Globally, railway transport is increasing steadily. Despite the adoption of diverse safety systems, major railway incidents continue to occur. Higher speeds and increased passenger traffic are factors that influence the risk of mass-casualty incidents and make railway crashes a reality that merits extensive planning and training.

METHODS: Data on railway disasters were obtained from the Centre for Research on the Epidemiology of Disasters (CRED), which maintains the Emergency Events Database (EM-DAT). This descriptive study consists of 529 railway disasters (≥10 killed and/or ≥100 non- fatally injured) from 1910 through 2009.

RESULTS: The number of railway disasters, people killed, and non-fatally injured, has increased throughout the last hundred years-particularly during the last four decades (1970-2009), when 88% of all disasters occurred. In the mid-20th century, a shift occurred, resulting in more people being non-fatally injured than fatally injured. During 1970-2009, 74% of all railway disasters occurred in Asia, Africa, and South and Central America, combined. The remaining 26% occurred in Europe, North America, and Oceania, combined. Since 1980, railway disasters have increased, especially in Asia and Africa, while Europe has had a decrease in railway disasters. The number killed per disaster (1970-2009) was highest in Africa (n = 55), followed by South and Central America (n = 47), and Asia (n = 44). The rate was lowest in North America (n = 10) and Europe (n = 29). On average, the number of non-fatal injuries per disaster was two to three times the number of fatalities, however, in the African countries (except South Africa) the relation was closer to 1:1, which correlates to the relation found in more developed countries during the mid-20th century. The total losses (non-fatally and fatally injured) per disaster has shown a slight decreasing trend.

CONCLUSIONS: Despite extensive crash avoidance and injury reduction safety systems, railway crashes occur on all continents, indicating that this type of incident must be accounted for in disaster planning and training. Better developed safety, crashworthiness, and rescue resources in North America and Europe may be factors explaining why the number of crashes and losses has stabilized and why the average number of people killed per disaster is lowest on these continents.

Keyword
Falling, Fracture, Prevention, Bone density, Osteoporosis
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:umu:diva-57280 (URN)10.1017/S1049023X1100639X (DOI)21939583 (PubMedID)
Available from: 2012-07-11 Created: 2012-07-11 Last updated: 2012-11-09Bibliographically approved
2. Inre säkerheten i tåg eftersatt: fallstudie efter tågkraschen i Kimstad
Open this publication in new window or tab >>Inre säkerheten i tåg eftersatt: fallstudie efter tågkraschen i Kimstad
2012 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 1-2, 24-26 p.Article in journal (Refereed) Published
Abstract [sv]

Delar av tågnätet i Sverige är i dag överbelastat, vilket försvårar möjligheterna till underhåll samtidigt som slitaget ökar. Tåghastigheten ökar, liksom antalet skadehändelser och deras allvarlighetsgrad, medan säkerhetsarbetet halkar efter. Inredning, glas och bagage hade stor inverkan på skadebilden vid tågkraschen i Kimstad år 2010. Avståndet till banvallen utgjorde sekundär skaderisk vid evakueringen. Inredningen orsakade allvarligast skador, bagaget moderata skador och glas många, men lindriga skador. Energiabsorberande ytor, luckor för bagageförvaring samt antilacerativa fönster kan reducera antalet skador vid en tågkrasch. Evakueringen kan underlättas av tillgång till utfällbara stegar.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-51177 (URN)
Available from: 2012-01-12 Created: 2012-01-12 Last updated: 2017-12-08Bibliographically approved
3. A study of a mass casualty train crash, focusing on the cause of injuries
Open this publication in new window or tab >>A study of a mass casualty train crash, focusing on the cause of injuries
2014 (English)In: Journal of Transportation Safety & Security, ISSN 1943-9962, Vol. 6, no 2, 152-166 p.Article in journal (Refereed) Published
Abstract [en]

This case study includes 73 fatally and nonfatally injured passengers from a level-crossing train crash in Nosaby, Sweden, in 2004. The aim was to identify the injury panorama and the injury objects and to determine the injury-inducing variables. Data were analyzed with descriptive statistics, quantitative content analysis, and multivariate data analysis. The first carriage overturned, and its occupants were the ones who suffered the most severe and lethal injuries. Injury type and injury location for these passengers also differed significantly from the passengers on the other two carriages. Tables significantly influenced injury type and injury location in all carriages, whereas the injured persons’ seating position had significant effect only in the second and third carriage. Those who had travelled facing forward with a table in front of them in Carriages 2 and 3 were more likely to have sustained injuries to their abdomen or pelvis. Other injury-inducing objects were seats, interior structures, wood pellets from the truck, and other passengers. Neck sprains were significantly more prevalent among those who had travelled facing backward. Improved train crashworthiness also needs to include interior safety, which would have a potential to reduce crash injuries.

Place, publisher, year, edition, pages
Taylor & Francis, 2014
Keyword
accident, injury event, injury object, principal components analysis, partial least square discriminant analysis, railway
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-61293 (URN)10.1080/19439962.2013.831963 (DOI)
Note

Originally included in thesis in submitted form with the title: "A study of a mass casualty train crash focused on the cause of injuries using multivariate data analysis"

Available from: 2012-11-09 Created: 2012-11-08 Last updated: 2016-12-01Bibliographically approved
4. Survivors' experiences from a train crash
Open this publication in new window or tab >>Survivors' experiences from a train crash
2011 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 6, no 4, 8401- p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Stockholm: Co-Action Publishing, 2011
Keyword
Content analysis, experiences, interviews, nursing, train accident
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-50279 (URN)10.3402/qhw.v6i4.8401 (DOI)22125573 (PubMedID)
Available from: 2011-12-02 Created: 2011-12-02 Last updated: 2017-12-08Bibliographically approved
5. Survivors´ experiences of media coverage after traumatic injury events
Open this publication in new window or tab >>Survivors´ experiences of media coverage after traumatic injury events
2012 (English)In: International emergency nursing, ISSN 1755-599XArticle in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-61294 (URN)
Available from: 2012-11-08 Created: 2012-11-08 Last updated: 2012-11-09Bibliographically approved

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