Rebecca Forsberg

KAMEDO Report 90: terrorist attacks in Madrid, Spain, 2004.

This is a descriptive study of the medical responses to the bombings by terrorists in Madrid on 11 March 2004. The nature of the event, the human damage, and the responses are described. It describes the: (1) nature and operations associated with the alarm; (2) assignment of responding units and personnel; (3) establishment and operations of casualty collection points; (4) medical transport and distribution of injured victims; (5) prioritization and command; (6) hospital care; (7) psychosocial care; (8) identification of the dead; and (9) police investigation and actions. Each of these descriptions is discussed in terms of what currently is known and the implications for future planning, preparedness, and response.

One hundred years of railway disasters and recent trends

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.

Survivors’ experiences from a train crash

Rarely described are peoples 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.

Effectiveness of finite-element modelling of damage and injuries for explosions inside trains

ABSTRACT The rail-bound sector has become a preferred target of terrorist attacks because of its vulnerability, and the most frequent way to carry out these attacks has been the use of explosive devices. The aim of this study is to investigate the effectiveness of modelling detonation effects inside train carriages using explicit finite element techniques. The numerical simulations consider fluid-structure interaction phenomena and several parametric studies are conducted. Carriage damage and injuries to the passengers are examined. Displacements in the model of the carriage structure do not vary greatly for small changes of the charge size, its location, or by open doors. Changing charge size, the location of the detonation, and door setting, however, had significant impact on the risk of eardrum rupture and fatality. Comparison of the simulation and real life data demonstrate a good agreement between the real and calculated displacements of the carriage, whereas the risk of death and eardrum rupture is slightly higher in the calculations. The model presented can reproduce a reliable actual situation if more parameters that influence injuries of blast waves were considered.

A study of a mass casualty train crash, focusing on the cause of injuries

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.