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CRISE - IASP 2013 - Cécile Bardon & Brian Mishara

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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.

Publié dans : Santé & Médecine
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CRISE - IASP 2013 - Cécile Bardon & Brian Mishara

  1. 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. 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 : http://railwaysuicideprevention.com/
  3. 3. Objectives of the study For detailed information : http://railwaysuicideprevention.com/ 3  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. 4. Methodology 4 For detailed information : http://railwaysuicideprevention.com/ • 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. 5. For detailed information : http://railwaysuicideprevention.com/ 5  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. 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% For detailed information : http://railwaysuicideprevention.com/ 6 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. 7. Results – Risk and protective factors For detailed information : http://railwaysuicideprevention.com/ 7  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. 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 : http://railwaysuicideprevention.com/ 8
  9. 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 For detailed information : http://railwaysuicideprevention.com/ 9
  10. 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 : http://railwaysuicideprevention.com/ 10
  11. 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) 11
  12. 12. Proposal for an integrated incident management programme For detailed information : http://railwaysuicideprevention.com/ 12  Training  Prevention  Work relations  Incident management  Post-incident follow-up
  13. 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 13
  14. 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 14
  15. 15. 15  Thank you  For more information,  http://railwaysuicideprevention.com  Cécile Bardon  Brian L. Mishara