Center for Research and Intervention on Suicide and Euthanasia Université du Québec à Montréal

1. Cécile Bardon, M.S., ProjectCoordinator tron-bardon.cecile@uqam.ca Reducing the Impact of Railway Fatalities on Crew Members*Preliminary report. Please contact the researchers before copying or distributing. Part of the ongoing project: Research and Counter Measures to Reduce Suicide on Railway Rights of Way, financed by Transport Canada Center for Research and Intervention on Suicide and Euthanasia Université du Québec à Montréal

2. Today’spresentionis part of a series of studiesconducted by the Centre for Research and Intervention on Suicide and Euthanasia supported by Transport Canada, in collaboration withrepresentatives of the railwayindustry, under the direction of the Principal Investigator, Professor Brian Mishara, (mishara.brian@uqam.ca), co-author of today’s talk

3. Plan • Context • Railway fatalites in Canada • Assessing the impact of fatal incidents on crew members • Impact • Risk and protective factors • Prevention and interventions to reduce the impact of fatalities • Best practices

4. Context

5. Railway fatalities in Canada • Transport Canada • ContractAwarded 2008: Research and countermeasures to reduce suicide on railwayrights of way • CRISE • Project began in 2009 as a suicide preventionproject • Modification to include all fatalities 2010 • Modification to includestudy of the impact of fatalities 2009 • IndustryPartners • SteeringCommitteinvolving all major stakeholders (CN, CP, VIA, Go-Transit, RAC, Teamsters, TC) • Plus participation of FRA and Volpe Center (US)

6. Overview of the project

7. Today’s Presentation

8. Assessing the impact of fatalities on railwaycrewmembers

9. Method • Semi structured interviews • Qualitative content analysis based on variables identified in the literature and derived from interviews • Thematic analysis • 40 interviews with train crews (January - June, 2010) • 3 interviews withrailway police officers (June – July, 2010) • Please refer to the written paper for more detailed description of the research methodology or ask me during the question period.

10. Interview content : • 32 incidents (mean: 3.4 incidents described per person, ranging from 1 to 9), including • 55 (41.7%) suicides • 48 (36.3%) accidents, • 20 (15.2%) non fatal incidents • 5 (3.8%) cases of found body, • 4 (3.0%) close calls, and. • Those incidents took place between the early nineteen seventies and 2010.

11. Reactions to Fatalities Based Upon Interviews with Canadian Rail Engineers and Conductors • ASD (Acute Stress Disorder) • Most hadsymptoms, although no diagnoses were made • Doctorsseem to prefer PTSD diagnosis • PTSD (Post Traumatic Stress Disorder) • 17% of participants • Consistent withotherfindings • Subthresholdsymptoms • Most important problem • Difficult to measurewithcurrent instruments • Not in the DSM-IV • But seems to beinvolved in the maintaining long termdifficulties • « Long termlowkey trauma » • Interestingway of categorising the impact of railwayfatalities • Needs more research and properdefinition in thiscontext

12. Reactions to Fatalities Based Upon Interviews with Canadian Rail Engineers and Conductors (continued) • Delayed trauma • Symptomsweregenerally not delayed • However, delayedreactionsexpressed in exageratedreactions to subsequentminorevents • Resilience • Recoveryis the normal course after a traumaticevent • Recoverycanbehelped or hindered by contextual and preventive actions and circumstances • Use of CopingStrategies and Help • Influence of masculine stereotypes • Social support frompeers and friends (familyisperceivedless as a source of support) • Emotion suppression • Do not use availableclinical support unless trust isstrong • Help isusedwhenproactivelyoffered by employer

13. Accidents versus Suicides • 50% experienced intense short term reactions • Total exhaustion • Feelings that the sequence of events could have led to a different outcome – sadness, rumination – « what if… » • Perception of avoidability • More traumatic – 2/3 experience intense short term reactions • PTSD (minority) • Disbelief • Empathy for the victim • Intent of the person lessens feelings of responsibility • Feeling they have been chosen by someone to end their life – anger - easier to handle Accidents Suicides

14. Impact of differentfactors on the nature and intensity of reactionsafter a fatality Important becausethesefactorsbefore, during and aftereventscanbemodified

15. Main recommendations by train crew to reduce the short and long term consequences of being involved in a fatality • 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 by Worker 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.

16. Prevention and interventions to reduce the impact of fatalities

17. LiteratureReview of Measures to Reduce the Impact of Fatalities on CrewMembers • Issues in using data from studies of other types of traumatic reactions • Military • Catastrophies (natural or human made) • First responders • Relevance for other traumas needs to be clarified in theory and research • 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 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

18. There are some indications that preventive measures and incident management interventions could be effective in reducing the negative impact after a fatality • However, no evaluations of these strategies have been conducted to date • 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 to supervisors • Involvement of the employee and outside evaluator in the return to work process

21. Conclusion • Support to crew members • Should begin during their training • Should be planned in advance and integrated in the organization’s policies and practices • Research in other areas has found that prevention can be very efficient, cheaper and have profound positive secondary impacts • There is no research to provide evidence based best trauma prevention practices in railways • But there are many promising possibilities • We have planned a rigorous evaluation study which we hope will be funded, in collaboration with the union and Canadian railways

22. Further activities

23. Knowledge application phase of the project (2012-2014) • Dissemination of Reports on suicide prevention and help for rail workers from our studies • Website for all stakeholders • Network of stakeholders • Implementation of our recommendations by VIA Rail (and others?) • Proposed evaluation of trauma prevention and support practices in Canadian railways to empirically determine best practices (pending funding) • Seek funding to evaluate promising strategies to reduce the incidence of railway suicides (the other parts of our research project, which we did not talk about today)

24. Cécile Bardon, M.S., ProjectCoordinator tron-bardon.cecile@uqam.ca Brian L. Mishara, Ph.D., Principal Investigator Director, CRISE mishara.brian@uqam.ca Reducing the Impact of Railway Fatalities on Crew Members*Preliminary report. Please contact the researchers before copying or distributing. Part of the ongoing project: Research and Counter Measures to Reduce Suicide on Railway Rights of Way, financed by Transport Canada Center for Research and Intervention on Suicide and Euthanasia Université du Québec à Montréal