The casualty profile from the Reading train crash, November 2004: proposals for improved major incident reporting and the application of trauma scoring systems.
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OBJECTIVE: To report the casualty profile of the major incident at the Royal Berkshire Hospital, Reading, following the Ufton Nervet Train crash, November 2004. To make further proposals regarding major incident reporting and implementation of trauma-scoring systems. METHOD: Retrospective analysis of emergency department and hospital notes. Calculation of index Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS) in all patients. RESULTS: Of 61 casualties, the majority (74%) were seen in the minors area of our emergency department with a mixture of blunt impact and penetrating glass injuries. One died and 16 were admitted. 10% had an ISS >16. All surviving patients had a TRISS predicted probability of survival >90%. CONCLUSION: We propose mandatory major incident reporting within 6 months of a major incident to aid development of a national database. As previously proposed, this will aid education and facilitate future major incident planning. We further propose the widespread use of trauma scoring systems to facilitate comparative analysis between major incidents, perhaps extrapolating this to develop a major incident score. (+info)
Pilot survey of subway and bus stop noise levels.
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Excessive noise exposure is a serious global urban health problem, adversely affecting millions of people. One often cited source of urban noise is mass transit, particularly subway systems. As a first step in determining risk within this context, we recently conducted an environmental survey of noise levels of the New York City transit system. Over 90 noise measurements were made using a sound level meter. Average and maximum noise levels were measured on subway platforms, and maximum levels were measured inside subway cars and at several bus stops for comparison purposes. The average noise level measured on the subway platforms was 86 +/- 4 dBA (decibel-A weighting). Maximum levels of 106, 112, and 89 dBA were measured on subway platforms, inside subway cars, and at bus stops, respectively. These results indicate that noise levels in subway and bus stop environments have the potential to exceed recommended exposure guidelines from the World Health Organization (WHO) and U.S. Environmental Protection Agency (EPA), given sufficient exposure duration. Risk reduction strategies following the standard hierarchy of control measures should be applied, where feasible, to reduce subway noise exposure. (+info)
Chronic obstructive pulmonary disease mortality in diesel-exposed railroad workers.
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Diesel exhaust is a mixture of combustion gases and ultrafine particles coated with organic compounds. There is concern whether exposure can result in or worsen obstructive airway diseases, but there is only limited information to assess this risk. U.S. railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II, and by 1959, 95% of the locomotives were diesel. We conducted a case-control study of railroad worker deaths between 1981 and 1982 using U.S. Railroad Retirement Board job records and next-of-kin smoking, residential, and vitamin use histories. There were 536 cases with chronic obstructive pulmonary disease (COPD) and 1,525 controls with causes of death not related to diesel exhaust or fine particle exposure. After adjustment for age, race, smoking, U.S. Census region of death, vitamin use, and total years off work, engineers and conductors with diesel-exhaust exposure from operating trains had an increased risk of COPD mortality. The odds of COPD mortality increased with years of work in these jobs, and those who had worked >/= 16 years as an engineer or conductor after 1959 had an odds ratio of 1.61 (95% confidence interval, 1.12-2.30) . These results suggest that diesel-exhaust exposure contributed to COPD mortality in these workers. Further study is needed to assess whether this risk is observed after exposure to exhaust from later-generation diesel engines with modern emission controls. (+info)
Historical estimation of diesel exhaust exposure in a cohort study of U.S. railroad workers and lung cancer.
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We have previously shown an elevated risk of lung cancer mortality in diesel exhaust exposed railroad workers. To reduce exposure misclassification, we obtained extensive historical information on diesel locomotives used by each railroad. Starting in 1945, we calculated the rate each railroad converted from steam to diesel, creating annual railroad-specific weighting factors for the probability of diesel exposure. We also estimated the average annual exposure intensity based on emission factors. The U.S. Railroad Retirement Board provided railroad assignment and work histories for 52,812 workers hired between 1939-1949, for whom we ascertained mortality from 1959-1996. Among workers hired after 1945, as diesel locomotives were introduced, the relative risk of lung cancer for any exposure was 1.77 (95% CI = 1.50-2.09), and there was evidence of an exposure-response relationship with exposure duration. Exposed workers hired before 1945 had a relative risk of 1.30 (95% CI = 1.19-1.43) for any exposure and there was no evidence of a dose response with duration. There was no evidence of increasing risk using estimated measures of intensity although the overall lung cancer risk remained elevated. In conclusion, although precise historical estimates of exposure are not available, weighting factors helped better define the exposure-response relationship of diesel exhaust with lung cancer mortality. (+info)
The epidemiology of the railway related casualties.
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BACKGROUND: Railway related accidents and incidents account for 150-200 deaths per 100 million passengers annually in Turkey. The aim of this study was to evaluate the epidemiological aspects of these casualties. METHODS: The data about railway related casualties between January 1997 and December 2003 were retrospectively analyzed in Turkey. RESULTS: Railway related accidents and incidents resulted in 213,3 deaths per year per 100 million passengers during the study period. Train-pedestrian accidents caused highest number of mortality and level crossing accidents caused highest numbers of casualty. Furthermore, suicide attempts had highest mortality ratio in railway related accidents. The majority of the fatalities and injuries occurred in males for every type of incident and most of the injuries have taken place in the 25-60 age group. Summer time was the season with the highest number of fatalities and injuries. CONCLUSION: Measures should be taken to improve railway safety. These include prevention of direct exposure of pedestrians to the railway tracts and conditioning the level crossings. (+info)
Planning and implementing a community-based public health advocacy campaign: a transport case study from Australia.
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Facilitating community action is a key goal of health promotion. This paper describes a public health advocacy framework. It then presents a case study of its application for planning community action by a community alliance concerned about increased heavy traffic on roads through a small regional city in the South West region of Western Australia. The case study illustrates defining the public health problem, the solution and the target for action; and the implementation of a comprehensive range of strategies including a media advocacy strategy to attract public attention, to reframe media messages, and to provide a policy alternative to government and industry. The campaign was evaluated in terms of process and outcomes, and was successful in putting pressure on key stakeholders and achieving the alliance's two main goals. The case study demonstrates the value of a well-planned campaign and including public health advocacy in public health practice, as an important strategy to facilitate the creation of healthy environments through healthy public policy. (+info)
Vocational rehabilitation of locomotive engineers with ischaemic heart disease.
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BACKGROUND: There is resistance among railway companies and their occupational health services to rehabilitating locomotive engineers with ischaemic heart disease to their former driving work. AIM: To study the outcome of vocational rehabilitation for locomotive engineers with ischaemic heart disease. METHODS: In seven European countries, selected locomotive engineers with ischaemic heart disease were compared to a matched group of healthy engineers. At the end of each calendar year between 1990 and 1999, questionnaires were completed by local occupational health physicians to provide information on accidents, incidents (professional mistakes), sick leave, (recurrent) cardiac events, death and early retirement. We used the life table method with five follow-up years to calculate the risk of accidents, incidents and recurrent cardiac events. RESULTS: The accident rate for the cardiac group was 3.8 accidents per 100 person-years, as compared to a rate of 6.0 in the reference group. The rates for incidents were 0.9 and 2.0, respectively. Neither of these differences were statistically significant. The duration of sick leave was significantly longer among the cardiac group than it was among the reference group, but only in the first follow-up year. Thirteen recurrent cardiac events occurred in the cardiac group, as compared to a single cardiac event in the reference group. There was no difference in the proportion of retirement cases. One engineer in each of the two groups died of cardiac disease. CONCLUSIONS: Locomotive engineers can safely resume driving duties following onset of cardiac disease. (+info)
High-altitude gastrointestinal bleeding: an observation in Qinghai-Tibetan railroad construction workers on Mountain Tanggula.
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AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis. METHODS: From 2001 to October 2003, we studied GIB in 13502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workers evacuated to Golmud (2808 m) and Xining (2261 m). The available data on altitude GIB were analyzed. RESULTS: The overall incidence of GIB was 0.49% in 13502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia, and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery. CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized. (+info)