Dr. Hugh Koch considers the psychological effects of accidents on trains and railway lines
There is a small but significant incidence of untoward accidents related to train transit systems, whether working as a train driver, customer service provider or train track operative (e.g rail welder), or travelling on a train as a passenger. Individuals can rapidly develop significant psychological stress as a result of experiencing trauma in one of these settings.
Unavoidable impact of train with individuals
CASE STUDY
"I was driving the 9.42 express through the station as normal. There were half a dozen commuters on the station. At the edge of the platform, a man was standing near the edge. He fleetingly caught my eye and, just before I passed, he jumped in front of the train – I had no chance to stop before I hit him at 60mph. I applied the brakes and the train came to a halt 100 metres down the track. I blamed myself and could not bring myself to drive a train for three months. I returned on a phased basis over the next two weeks. I still have flashbacks at night and worry when driving my train."
The Criminal Injuries Compensation Board make awards to train drives according to the level of mental anxiety and stress. Stress reactions last typically one to six months, which includes certificated time away from work. Milder stress can persist for a further one to three months on return to work, aided by a short, phased return to supervised train driving. The initial lack of personal threat to life can reduce the ongoing disability. Residual low, variable mood may require brief therapeutic intervention. In some circumstances stress reactions can exceed the above durations.
Malfunction in train working systems
"I was working as usual as a rail welder with my colleague on the downline from the station, repairing track with an electric arc set with big generators running. We were wearing headphones to protect us from the noise. We rely on the electronic and manual systems of train warning while we do this work (day or night). My colleague later told me he caught a glimpse of the train coming in the corner of his eye and pulled me out of the way three seconds to spare. I had panic attacks day and night over the next four weeks. I am still off work and taking medication for my anxiety."
The vulnerability of working with no protection (i.e. not inside a vehicle) contributes to the severity and duration of psychological reactions in this setting, in addition to the expected stress responses of mood and sleep disturbance and work-related anxiety. Specific aspects of post-accident anxiety are startled responses to sudden and unexpected noises and flashing lights, and feelings of personal vulnerability in crowded spaces.
Sudden derailment of train
Frequently, train incident passengers develop specific fears and phobias of subsequent train travel. This avoidance, although disruptive, is managed by the use of alternative modes of transport (i.e, car, bus, coach) by commuters. Train operatives involved in similar incidents typically have stress reactions, which are most short-lived due to the pressure they feel to return to work that then helps a more rapid 're-exposure' to train travel.
Implications for assessment and treatment
CASE STUDY
"I was travelling in the first class carriage at the front of the 7.54 to London. The train was travelling on a relatively straight stretch of track when the gentle 'bumpiness' of the journey was replaced by significant heavy vibration and noise.' 'The carriage began to veer over and I was thrown out of my seat, hitting first my head, then my shoulder on the seat opposite and then the window. The next minute was a blur of chaos, noise and pain. The train eventually came to a halt on its side – I've no idea what happened."
The most frequent psychological disorders diagnosed include depressive disorders, specific phobia and adjustments and disorders and occasionally post-traumatic stress disorder. If the victim can accommodate the pressure to return to work and travel healthily and desensitise themselves to a phased return to train travel or work proximity, then the traumatic response can be of shorter duration. Brief cognitive behavioural therapy (CBT) is the treatment of choice and can, if accessed quickly, result in a rapid return to largely pre-accident functioning.