• Public awareness, strict enforcement of the law, and implementation of effective protective mechanisms are key to reducing fatalities 

Since the majority of railroad deaths are accidental, public awareness is key to reducing such incidents, while the strict enforcement of the law and the implementation of effective protective mechanisms will significantly contribute to preventing fatalities.

These findings and recommendations were made in an original article on “Deaths due to locomotive injuries in the Jaffna District – Eight-year retrospective study: Are we prepared to change our attitude?” which was authored by U. Mayorathan (attached to the Jaffna Teaching Hospital's Judicial Medical Officer's [JMO] Office) and published in the Jaffna Medical Journal's 35th Volume's First Issue in August, 2023.

A.K. Somasundaraswaran's “Accident statistics in Sri Lanka” notes that the increasing population, the sudden rise in vehicles, poor infrastructure, and the public’s negative attitude are the main contributing factors to the growing number of transportation deaths. Among this, railway-related fatalities are also rising, and are reported throughout the year. According to statistics from the Railways Department (2011), around 250 people die annually from railway-related deaths.

Still, the general understanding is that most deaths do not occur due to the fault of the train or rail track, such as a signal failure, derailment, and mechanical defects in the train, but that the reckless behaviour of the public or using it for suicides is the primary cause of these deaths. Fatalities are rarely reported among train passengers and Railways Department workers while on duty. P. Paranitharan and W.N.S. Perera's “Deaths on railroads: A study from the Colombo North Teaching Hospital (Ragama)” emphasised that unguarded-level crossings are vulnerable to pedestrian-train and vehicle-train collisions as these are the common places where people cross the tracks carelessly, without noticing the signals or while using mobile phones.

In contrast to other modes of transportation trauma, locomotive injuries are very severe due to the train’s high momentum (weight into speed). We have witnessed extensive musculo-skeletal and visceral injuries following locomotive trauma, including decapitation, degloving injuries, and the severe mutilation of the face and the body.

Nature of railway-related deaths reported

Mayorathan's retrospective, descriptive study based on decedents of locomotive trauma was carried out on all the cases reported in the post-mortem reports examined at the Jaffna JMO's Office, from January 2015, to January of last year (2022). The study sample was from convenient sampling. 

A total of 30 decedents were included in this study. The majority (29/97%) was males, and one/3% was female. The age of the decedent ranged from 16 to 73 years, and among them, 17/57% were between 20 and 40 years. The majority was unmarried (17/57%) while 12/40% were married. Considering the occupation, most were unemployed (17/57%) while 10/33% were employed, and two/7% were students. There were 20/67% accidental fatalities, nine/30% suicidal fatalities, and one/3% death where the manner of death could not be ascertained. Among the accidents, 12/60% of the deaths were due to vehicle-train collisions, 16/80% have occurred at the railway crossing, and one/5% death was due to a fall from the train. A total of three/10% individuals had hearing defects while two/7% were suffering from psychiatric illness and were wandering the streets, and three/15% of the decedents were under the influence of alcohol during the accident. Most (six/67%) of the suicidal deaths occurred alongside the rail tracks, away from the stations or railway crossings, while three/33% occurred near railway crossings. Due to the high momentum of the train, the injuries sustained were also very severe. A total of 28/93% of the victims succumbed to the injuries before reaching the Hospital. A total of 29/97% of the decedents were positively identified while one/3% death was recorded as unidentified. Most (22/73%) deaths occurred between 12 noon and 8 p.m. The highest number of deaths happened in the Chavakachcheri (seven/23%) area, followed by the Ariyalai (six/20%) area. 

Nature of injuries reported

The study also presents that the nature of the injury in the head and neck area, chest, abdomen and the upper and lower limbs includes abrasions, contusions, lacerations, fractures, mutilations, decapitations, transections, and traumatic amputations. All the decedents in both accidents (20/100%) and suicides (nine/100%) had lacerations over the head and neck area. All of the accident cases (20/100%) sustained fractures of the head and neck, while three/33% in suicides experienced the same. One/10% case of decapitation was noted in the self harm group. The internal organs involved include the brain, heart, lungs, liver, spleen and kidney. Over the chest region, more than 50% of the deaths had fractures in both accidents (16/80%) and suicides (five/56%). One/10% case of the transection of the body at the level of the chest was seen in a suicide case. The number of cases of abdominal injuries was less in both accidents and suicides. 

The transection of the body at the level of the abdomen was seen in an accident (one/5%) and a suicide (one/10%). The distribution and nature of the injuries were almost identical in both the upper and lower limbs. The brain is the internal organ that is primarily affected in both accidents (19/90%) and suicides (seven/78%). Next to the brain, the lungs were the most affected. In 24/80% of the cases, the cause of death has been determined as cranio-cerebral injuries, while in six/20% of the cases, multiple injuries were given as the cause of death.

Medico-legal investigation of railway-related deaths

The history of the incident is of paramount importance in the medico-legal investigation. The history can be obtained from an eyewitness, a guard, a train driver, or the Police. Though the driver is a very suitable person to get a reliable history, in routine practice, the history is given by the relatives and the Police. Unless the fatalities are witnessed, railway deaths should be investigated as homicides until proven otherwise. 

To determine the manner of death, corroborating the injury pattern with the given history is essential and should be done with great caution. In some cases, establishing the decedent’s identity is challenging, as in mutilated bodies. Extensive external and internal examination, injury interpretation, and event reconstruction would resolve most medico-legal issues. A total of 29/97% were male, and most were between the ages of 20 to 40 years. Young males are commonly victims in these deaths. 

Alcoholism, other types of substance abuse, using mobile phones while driving, and violating safety measures such as crossing the railway line while the signals were on are the major contributing factors to the deaths of youths. Most of the deaths, including accidents and suicides, occurred between 12 noon to 8 p.m. In the Jaffna Peninsula, most trains operate in the afternoon and evening. This may be the reason for this observation. The intercity trains running in the afternoon are mainly involved in these incidents as the speed of these trains is very high. At the same time, the visibility of the Jaffna railway crossings is compromised due to curved roads, buildings adjacent to the crossing, and poor illumination. 

Global studies conducted

H. Ghomi, M. Bagheri, L. Fu and L.F. Miranda Moreno's “Analysing injury severity factors at highway railway grade crossing accidents involving vulnerable road users: A comparative study” revealed that the train’s speed is the critical factor contributing to this fatality. Accidents (20) are more common than suicides (nine). But, P.T. Lin and J.R. Gill's “Subway train related fatalities in New York City, United States of America: Accident versus suicide” found that suicides are more common than accidents. Strict regulations and discipline in Western countries may be the reason for reducing railway accidents. But, the severity of the injuries and instantaneous death following a hit by a train could be the reason for choosing this method as a suicidal tool. Head and neck injuries were seen in all the decedents. Lacerations and fractures were more common in both accidents and suicides. Decapitation was only observed in suicidal deaths. Usually, they keep their head on the track to be run over by the train. Therefore, as seen in R.W. Byard and J.D. Gilbert's “Characteristic features of deaths due to decapitation”, minimum injuries will be noted in the other parts of the body. The transection of the body at the level of the chest was also only noted in suicidal deaths, while multiple injuries were comparatively more in accidental deaths. The transection of the body is typical for suicides. Here, as mentioned in M.I. Sheikh, J.V. Shah and R. Patel's “Study of death due to railway accident”, individuals lie across the railway track to commit suicide. The transection of the body at the level of the abdomen was noted once each in an accident and a suicide. In the accident case, a pillion rider of a motorbike was ejected due to the impact and landed on the track and then he was run over by the train. The transection of the body at the level of the chest and abdomen is often associated with the traumatic amputation of the limbs due to the relative positions of the limbs during the incident. The brain is the internal organ primarily injured in accidents and suicides. Lungs are also significantly affected. But, there was no difference in the internal organ injuries in accidents and suicides. Decapitation and the transection of the bodies are more suggestive of suicide. 

In railway fatalities, the circumstances of the death are more crucial than finding the cause of death. A detailed history, extensive external and internal examination, the interpretation of the injuries, and the reconstruction of the events are the key to establishing the manner of death. The common cause of death was cranio-cerebral injuries (80%). Most of the decedents had multiple injuries, but only 20% were given multiple injuries as the cause of death. Locomotive trauma is commonly severe, especially head injuries that are rapidly fatal where sometimes, it can cause instantaneous death. Due to this reason, cranio-cerebral injuries were given as the cause of death. Transections of the neck and chest were more common in suicides than in accidents. The nature of the external injuries and internal organ damage did not show a significant difference in accidents and suicides.

In conclusion, Mayorathan suggested that psycho-social support for vulnerable people and rehabilitation could help to reduce suicidal fatalities related to locomotives, and will help to control suicidal deaths in the society also.