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Accident Analysis and Prevention 81 (2015) 30–50

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Accident Analysis and Prevention


journal homepage: www.elsevier.com/locate/aap

A systematic review of the literature on safety measures to prevent


railway suicides and trespassing accidents
Grigore M. Havârneanu a, * , Jean-Marie Burkhardt b , Françoise Paran b
a
International Union of Railways (UIC), Security division, 16 rue Jean Rey, F-75015 Paris, France
b
IFSTTAR, AME, LPC, F-78000 Versailles, France

A R T I C L E I N F O A B S T R A C T

Article history: This review covers a central aspect in railway safety which is the prevention of suicides and trespassing
Received 16 May 2014 accidents. The paper attempts to answer the following research question: ‘What measures are available
Received in revised form 9 April 2015 to reduce railway suicide and trespass, and what is the evidence for their effectiveness?’ The review is
Accepted 11 April 2015
based on 139 relevant publications, ranging from 1978 to 2014. The analysis aimed to identify the past
Available online 6 May 2015
and current trend in the prevention practice by looking both quantitatively and qualitatively at the
recommended measures. According to the results, there has been a constant focus on suicide prevention,
Keywords:
and only relatively recent interest in trespass countermeasures. The content analysis revealed 19 main
Train-pedestrian fatalities
Railway suicide
preventative categories which include more than 100 specific measures. We identified 16 common
Trespass categories against railway suicide and trespass, and 3 categories of specific measures to prevent suicide.
Prevention There are only 22 studies which provide empirical support for the effectiveness of measures. Actual
Countermeasures combinations of measures are barely evaluated, but several challenges emerge from the literature. The
discussion focuses on the need for a unified approach to suicide and trespass prevention, and on the
importance to consider the effect mechanism of the measures in order to design better interventions.
ã 2015 Elsevier Ltd. All rights reserved.

1. Introduction delays. When a person is struck by a train, the traffic shut down
time may range from 30 min in Japan (Kadotani et al., 2014) to
Train-pedestrian collisions are a major concern for railway about 2 h in most of the EU countries (ERA, 2014). In short, railway
safety, as they have become the leading cause of fatality in railway suicides and trespassing accidents have the highest frequency
accidents (European Railway Agency, ERA, 2014; Evans, 2003; relative to all fatal incidents occurring in the railway system and
Lobb, 2006). Every year, close to 3000 suicides and 800 additional have a negative impact on society and rail operators.
trespassing accidents occur on EU railways, representing 88% of all
fatalities within the railway system (ERA, 2014). In addition to the 1.1. Suicide and trespass as origins of train-pedestrian collisions
human loss, train-pedestrian collisions cause trauma and work-
related stress to the railway staff and rescue employees, and A train-pedestrian collision can occur only when one or more
discomfort to passengers and eye witnesses (Baumert et al., 2005; persons have entered the railway tracks accidentally or inten-
Mishara, 2007; Rådbo et al., 2005). The severe consequences for tionally. The presence or absence of intent in getting hit by the train
train drivers include somatic problems, anxiety, sleep disruption, is the common theoretical criterion to distinguish between
and sometimes societal disturbance problems (Briem et al., 2007; suicides and trespassing accidents (Mishara, 2007). Railway
Farmer et al., 1992; Limosin et al., 2006). After such events, 70% of suicide is the act to deliberately injure oneself resulting in death,
the drivers are given a temporary sick leave of about 4.4 days long as recorded and classified by the competent national authority
(Cothereau et al., 2004). Furthermore, there are the costs for (Directive, 2004/49/EC). In contrast, trespassing accidents are
emergency services, investigation, insurance administration, and involuntary collisions between a train and a person whose
legal procedures (Bureau of Transport and Regional Economics, presence on the railway tracks is unauthorised (ERA, 2014),
BTRE, 2002) as well as the indirect costs like the time loss and resulting in death or injury. Trespassing behaviour is manifested by
crossing the tracks in illegal places (Silla and Luoma, 2009) and
walking or loitering along the tracks (Lobb et al., 2001; Pelletier,
* Corresponding author. Tel.: +33 1 44 49 21 25; fax: +33 1 44 49 20 59. 1997), mostly for taking a shortcut across the railway tracks (e.g.
E-mail address: havarneanu@uic.org (G.M. Havârneanu). Rail Safety and Standards Board, RSSB, 2011a,b,c; Robinson, 2003).

http://dx.doi.org/10.1016/j.aap.2015.04.012
0001-4575/ ã 2015 Elsevier Ltd. All rights reserved.
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 31

In practice, the European Railway Agency (ERA, 2008) has including the intention to commit suicide (Burkhardt et al., 2014).
developed guidelines for determining intent (e.g. existence of a This paper supports this unifying approach.
suicide note, behaviour demonstrating suicidal intent, previous
suicide attempts or prolonged depression). 1.3. Theoretical approaches to prevention measures

Preventative measures associated with railway-pedestrian


1.2. Common or dedicated interventions to prevent suicide and safety have been characterised at a very broad level as the E’s of
trespass? safety. The most common example is the three E’s (e.g. BTRE, 2002;
C.A.R.E., 2006; DaSilva and Caroll, 2011; Horton, 2009; RSSB,
Despite the classification difficulty, some authors (e.g. Mishara, 2011a) that stem for engineering, education, and enforcement.
2007) have argued that the distinction between suicides and Although using various labels, several authors have suggested a
accidents in the context of train-pedestrian collisions can be simpler dichotomy according to the measures’ main mechanism of
essential in advancing prevention efforts tailored in accordance influence on behaviour: engineering (direct barrier) or behavioural
with the various types of injuries. The rationale is that, as opposed intervention. For example, Brown et al. (2012) and RSSB (2012)
to accidents, suicides consist of persons deliberately putting distinguish between ‘situational’ and ‘influential’ measures, while
themselves in situations where they will be struck by a train. For Offler et al. (2009) and Thompson et al. (2012) separate ‘technical’
other authors (e.g. Rådbo et al., 2005), suicides and accidental deterrents from ‘non-technical’ (social) ones in the prevention of
collisions do not show such differences that would motivate vandalism and graffiti in the railway industry. Similarly, Ladwig
essentially different technical, organisational, or environmental et al. (2009) refer to ‘structural’ means and ‘communicative’ means
measures. Similarly, Limosin et al. (2006) show that regardless of in prevention of suicides. Focussing on the nature of preventative
location or intent, train-pedestrian collisions are frequently caused measures and the targeted stage in the suicide process, Rådbo et al.
by the same mechanisms of injury and can be regarded as ‘person (2012a,b) have published a theoretically derived and detailed set of
hit by train’ events with the same severe consequences. In line with railway suicide prevention strategies, organised around five barrier
this perspective, our position is that although suicide is rather themes: (1) measures reducing the attractiveness of railways as a
different from trespass because it derives from a fundamentally means of suicide, (2) measures obstructing accessibility to the
different and unique motivation, suicide intentions imply partially track area, (3) measures influencing the victim’s determination
similar actions like entering the tracks. Therefore, the measures while awaiting the train, (4) early warning systems, enabling the
aimed to reduce trespassing accidents might also work for suicide, train to brake sufficiently for the victim to be removed before
and vice versa, hence the reason for the current review. For the collision, and (5) measures to make the collision less violent. An
infrastructure managers or railway undertakings it may be useful attempt to extend this approach to account for both railway suicide
to approach suicide and trespass as one single problem since and trespass prevention has been proposed recently and is
trespassing can be driven by various reasons (RSSB, 2011a,b,c) discussed elsewhere (see Burkhardt et al., 2014).

Records identified through database Additional records identified through


Identification

searching other sources (reference lists, hand


(n = 8,577) searching, other websites)
(n = 42)

Records after duplicates removed


(n = 4,183)
Screening

Records screened on title Records excluded


and abstract (n = 3,954)
(n = 4,183)

Full-text articles excluded


Eligibility

(descriptive epidemiology
Full-text articles assessed
studies, commentaries, case
for eligibility
reports, no proposed
(n = 229)
measure)
(n = 90)

Full-text publications included in qualitative


synthesis (proposing at least one measure)
Included

(n = 139)

Individual studies included in quantitative


synthesis (evaluating at least one measure)
(n = 22)

Fig. 1. PRISMA flow chart.


32 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

In the context of this paper, we consider as safety preventative change and to support correct decisions. Finally, there is no
measures all interventions, initiatives, or policies that are universally accepted classification of existing measures based on
recommended to (a) reduce the number of railway suicides and the mechanisms underlying their effect. It is thus difficult to have a
trespassing accidents or (b) mitigate the consequences of these clear and global view of what is proposed and how it is effective.
incidents by reducing the injury severity, facilitating the post-crash This systematic review seeks to address this gap by examining the
interventions, and minimising the service disruption. Engineering recommendations and evidence on the preventative measures in
measures include all physical, technological, or environmental the relevant literature. The paper attempts to answer the following
artefacts aimed to prevent train-pedestrian collisions by means of research question: ‘What measures are available to reduce railway
directly impeding the risky behaviours or by facilitating the suicide and trespass, and what is the evidence for their effectiveness?’
intervention of the railway staff. On the other hand, behavioural
measures are influential, social, enforcement or psychological 2. Material and methods
measures dedicated to influence the person's knowledge and
attitudes and to call for more responsible actions and voluntary Our approach was twofold. First, we examined the core
decisions towards safety. publication characteristics, the particular relationships between
Despite the large number of countermeasures proposed and these characteristics (through chi-square and lambda symmetric
used to prevent train-person collisions (for details see Clarke and tests), and conducted a quantitative synthesis of the studies that
Poyner, 1994; Kerkhof, 2003), there is still no obvious conclusion provide empirical support for different measures. Second, from a
on which solution is more effective or relevant for particular qualitative perspective, we analysed the content of the recom-
contexts. Most of the proposed measures currently rely on physical mendations to reveal the general and specific measures proposed
or technological components which aim to change the environ- by different authors, the focal points in the literature, and possibly
ment or deter the risky behaviour. In contrast, only a limited body unique measures to prevent suicide or trespass. This review was
of literature deals with measures aiming to encourage behavioural conducted in accordance with the preferred reporting items for

Table 1
An overview of the identified categories of measures, their citation rate in the literature, and associated references for existing empirical studies.

ID Categories of measures Citation frequency Existing evidence in evaluation studies

Absolute Relative No. of References suicide References trespass


(%) studies
Common measures against railway suicide and trespass
1 Fencing and other physical barriers 90 65% 6 Law and Yip (2011); Law et al. (2009); Lobb et al. (2001); Silla and Luoma
Pirkis et al. (2013); (2011)
Beautrais et al. (2009)
2 Collaboration between institutions 72 52% 1 Baumert et al. (2011)
3 Environmental design 59 42% 1 Silla and Luoma (2011)
4 Monitoring and detection systems 45 32% 1 DaSilva et al. (2006)
5 Education and information at 41 29% 2 Lobb et al. (2001); Lobb et al. (2003)
individual level
6 Enforcement, punishment and patrols 38 27% 2 Niederkrotenthaler et al. (2012) Lobb et al. (2003)
7 Public safety communication 34 24%
8 Signage 31 22% 3 Lobb et al. (2001); Lobb et al. (2003);
Silla and Luoma (2011)
9 Technical design to reduce the effects 31 22% 2 Coats and Walter (1999); O’Donnell and Farmer
of impact (1994)
10 Staff training 29 21% 1 RSSB (2013)
11 Risk assessment 17 12%
12 Learning from previous research and 17 12%
best practice
13 Lighting systems to influence 17 12% 2 Ichikawa et al. (2014); Matsubayashi et al. (2013)
behaviour
14 Additional technologies for train 16 12%
drivers
15 Design and aesthetics to influence 12 9%
behaviour
16 Operational traffic management 11 8% 1 van Houwelingen et al. (2013)

Measures to prevent only railway suicide


17 Appropriate reporting or broadcast of 37 27% 6 Hegerl et al. (2013) and Ladwig et al. (2012);
critical incidents Yang et al. (2013); Kunrath et al. (2011);
Niederkrotenthaler and Sonneck (2007);
Etzersdorfer and Sonneck (1998); Schmidtke
and Häfner (1988)
18 Emergency information and outreach 22 16%
support at hotspots
19 Decrease the attractiveness of the 2 1%
railways as lethal method
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 33

systematic reviews and meta-analyses (PRISMA) statement mentioned the same measure. To our knowledge, no integrative
(Moher et al., 2009) (see Fig. 1). classification systems of preventive measures against suicide and
trespass are available. Consequently, we started from a framework
2.1. Selection of studies elaborated and employed in the RESTRAIL project (REduction of
Suicides and Trespasses on the RAILway): a categorisation frame
The reviewed material is based upon searches of the databases which includes a list of 38 subsets of measures sharing common
most relevant for behavioural science, social science and medicine: mechanisms and contexts to influence suicidal and trespassing
Web of Science, Scopus, PsycINFO, Medline, and PubMed) covering behaviours (Burkhardt et al., 2013). Thus, each category corre-
peer reviewed journal articles published in English language until sponds to a general preventative strategy which includes several
February 2014. The title, abstract and keywords were searched specific measures that are relatively similar to one another and that
using the following terms: ‘suicid*’ OR ‘trespass’ OR ‘accident’ OR can be mainly engineering, behavioural, or a combination of these.
‘injur*’ OR ‘crossing’ matched in pairs with ‘rail’ OR ‘train’ OR At the end of the classification process, we checked for
‘metro’ OR ‘subway’ OR ‘tube’ OR ‘underground’. Relevant railway redundancies or errors across categories and some specific
reports, research deliverables, safety guidance documents, confer- measures were reassigned to other main categories. The final
ence proceedings, dissertations and other working papers were data set consisted of 19 main categories corresponding to general
also included in the review. We included the ‘grey literature’ preventative measures against suicide and trespass (see Table 1).
because it was highly relevant for the scope of this review. Many
railway safety organisations or national administrations carry out 3. Results
projects and publish valuable reports on their own websites, not in
peer-reviewed journals. These documents were downloaded from This review found 139 eligible full-text publications which
relevant websites (e.g. RSSB) which were identified by searching discussed railway suicide or trespass and which mentioned at least
the references of the initially retrieved articles. Although the one safety measure against suicide, trespass or both problems.
general literature on level crossings (LCs) was excluded from the Among these there were only 23 publications describing 22 studies
scope of the review, we included the papers which had level which actually evaluated the proposed interventions (see
crossing (LC) as main topic, but made some clear reference to Tables 4–7).
suicide or illegal crossing in the vicinity of the LC.
3.1. Descriptive analysis of the corpus of papers
2.2. Classifying the characteristics of studies and the preventative
measures The first set of analysis concerned the core characteristics of the
139 eligible publications.
Several characteristics of the publications were recorded:
publication year, country of origin, main thematic area (rail safety, 3.1.1. Type of documents
suicide literature, general), specific topic (suicide, trespass, both For 69% of the papers the main thematic area was the railway
suicide and trespass, crossing/other), and the type of publication context. Sixteen percent of the publications concerned suicide in
(scientific publication, grey literature). Scientific peer-reviewed general, but made some reference to rail or underground suicides.
publications included original research articles published in The rest of the papers (15%) reported studies conducted in related
journals, theoretical reviews, conference proceedings and book fields (e.g. suicide by jumping from a bridge or recommendations
chapters. about safety campaigns) but included transferable recommenda-
The content of each paper was analysed in order to identify the tions for the railways. Most publications were from the scientific
recommended preventative measures. We used a typical frame for literature (76%, n = 105) and the rest belonged to the grey literature.
content analysis, employing categories and subcategories with
absolute frequencies that counted how many different sources
Table 3
Table 2 The number of publications per time period, main topic and type of proposed
The number or publications per country and time periods. measure.

Country Time period Time period Topic Type of measure

1978–2003 2004–2008 2009–2011 2012–2014 Total Behavioural Engineering Both Total


United Kingdom 8 4 8 6 26 1978–2003 Suicide 5 7 4 16
USA 6 5 5 16 Trespass 3 1 1 5
International 2 6 5 3 16 Suicide and trespass 3 3 5 11
Germany 2 5 5 2 14 Crossing/other 1 1
Australia 3 2 1 5 11 Total 11 11 11 33
Sweden 1 2 4 7
Austria 2 1 2 1 6 2004–2008 Suicide 6 6 10 22
Finland 2 3 5 Trespass 3 5 8
The Netherlands 2 1 2 5 Suicide and trespass 2 5 7
New Zealand 2 2 1 5 Total 11 6 20 37
South Africa 3 2 5
Belgium 2 1 3 2009–2011 Suicide 8 3 7 18
Canada 1 2 3 Trespass 1 5 6
France 2 1 3 Suicide and trespass 3 1 2 6
Hong Kong 1 2 3 Crossing/other 1 6 7
Japan 3 3 Total 11 6 20 37
Switzerland 1 2 3
Turkey 1 1 2 2012–2014 Suicide 5 2 17 24
India 1 1 2 Trespass 1 4 5
Taiwan 1 1 Suicide and trespass 1 2 3
Total 33 37 37 32 139 Total 6 3 23 32
34 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

Table 4
Summary of the studies which provide empirical support for the most cited measures against suicide and trespass.

Reference Location and specific Study design and measures Sample and data Significant results reported and implications for the
(authors, setting collection period effectiveness of the measure
date)
Fencing and other physical barriers: platform screen doors (PSDs)
Law and Yip Hong Kong, railway Study design: quasi-experimental, ecological study 369 incidents in the The PSD installation has effectively reduced railway
(2011) system with before and after measurements, based on railway system injuries (adjusted 5-year average percentage
injury data between 1997–2007 change: 68.8%) with no apparent substitution
effect to the other platforms observed.
Intervention: installation of platform screen doors in 30 stations in year
2002
Outcome variable: number of railway injuries at
platforms (suicidal/accidental) and the severity
(fatal/non-fatal)

Law et al. Hong Kong, Study design: quasi-experimental, ecological study 76 suicides in the Railway suicides decreased by 59% since the
(2009) underground system with before and after measurements, based on underground between installation of platform screen door, adjusted for
suicide data 1997–2007 age and gender.
Intervention: installation of platform screen doors in 30 stations in year 2002 No sign of suicide substitution to unsealed
platforms.
Outcome variable: number of railway suicides Railway suicides decreased by 84% for people with
psychiatric profile.

Fencing and other physical barriers: nets and physical barriers at bridges to avoid climbing and jumping
Pirkis et al. International Study design: meta-analysis Data from 9 studies The reduction in deaths from jumping following the
(2013) literature review of interventions is greater than any increases at
suicide by jumping at neighbouring sites.
known hotspots
Factor: installation of structural means to restrict There was an 86% reduction in jumping suicides per
access at bridges year at the sites in question (95% CI 79–91%).
Outcome variable: number of suicides by jumping There was a 44% increase in jumping suicides per
year at nearby sites (95% CI 15% to 81%), but the net
gain was a 28% reduction in all jumping suicides per
year in the study cities (95% CI 13–40%).

Beautrais New Zealand, Study design: experimental, ecological study, with 24 suicides during Barriers in place (1991–1995): 5 suicides; barriers
et al. Auckland, Grafton before and after measurements in A–B–A reversal 3 time periods from removed (1997–2002): 19 suicides; barriers
(2009) Bridge design (A = intervention, B = baseline) 1991 to 2006 reinstalled (2003–2006): 0 suicides.
Intervention: removal of old barriers (in 1996) and reinstallation of new Removal of barriers was followed by a fivefold
barriers (in 2003) increase in the number and rate of suicides from the
bridge. Since the reinstallation of barriers there
have been no suicides from the bridge.
Outcome variable: number of suicides by jumping

Collaboration between institutions: National Suicide Prevention Strategy (The German Railway Suicide Prevention Project)
Baumert Germany, railway Study design: quasi experimental, longitudinal Year 1998 to 2006. A significant fall in rail suicides compared with the
et al. system ecological study evaluating the impact of the Index period (1998– general reduction in Germany.
(2011) prevention programme, by comparing two 4-year 2001); control period
periods, one before and one after the intervention. (2003–2006)
Intervention: implementation of the German Railway Suicide Prevention The absolute number of railway suicides decreased
Project in 2002 from 1006 in 1998 to 724 in 2006. The mean suicide
Outcome variable: number of railway suicides rate in the control years was 13.9% (95% CI 6.9–20.4)
lower compared to the index years (p < .001).
Adjusting for the overall suicide rate attenuated the
decline of the railway suicide rate (annual
percentage change 4.8%, 95% CI 1.8–7.8) but
significance remained (p = .002).

3.1.2. Spatial and time distribution of the literature Africa, Hong Kong, and India. The publication year ranged from
Data and results provided in the papers were usually specific to 1978 to 2014. Half of the papers were published after 2008 and the
one country or area (city, part of a network, etc.) within the most common year was 2011 (n = 24). One may note that the
considered country, with the exception of 16 international number of publications varies considerably between countries
publications. Most of the papers came from the UK and the independent from the size of the railway network or the country’s
USA, followed by Germany and Australia (Table 2). Other countries geographical position. For example, even though India has a large
with five to seven publications were Sweden, Austria, Finland, the railway network, daily millions of passengers are commuted, and
Netherlands, New Zealand, and South Africa. The countries many accidents occur on the network (see Wasnik, 2010) the
represented by less than five papers were Belgium, Canada, reporting system is rather poor, which may determine the small
France, Hong Kong, Japan, Switzerland, India, Turkey, and Taiwan. number of papers available in the international literature.
Suicide has been addressed mostly in Germany, Austria, the Furthermore, it is not clear if more suicide papers were authored
Netherlands, Belgium, Sweden, Switzerland, Japan, France, and in in countries with more railway suicides (and reciprocally for the
international studies. Trespass has been addressed mostly in topic of trespass). Our results show for example that the
Finland and New Zealand. Suicide and trespass have been Netherlands and Sweden have high number of publications
addressed together mostly in UK, USA, Turkey, Australia, South on railway suicide, yet the number of suicide fatalities per
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 35

Table 5
Summary of the studies which provide empirical support for the common measures against suicide and trespass with medium and low citation frequency.

Reference (authors, Location and Study design and measures Sample and data collection Significant results reported and implications for
date) specific period the effectiveness of the measure
setting
Monitoring and detection systems: automated security system composed of video camera, infrared illuminator, speaker, motion detector and magnetometer
DaSilva et al. (2006) USA, a railway Study design: observational, ecological study, with 3726 alarm events involving Overall decrease in trespassing behaviour
bridge in repeated measurements within 3 years 172 actual trespassing cases was experienced over time: 46 trespassing
Pittsford, New during 3 years (from August events for the first year, 18 for the second year,
York 2001 to August 2004) and 38 for the third year.
Intervention: installation of the automated 60% drop in trespass from the first to the
interactive system on a railway bridge in August second year and just a 17% drop in the third
2001. year compared to the first. An increase from
the second to the third.
Outcome variable: trespassing behaviour

Enforcement, punishment and patrols: visible human presence and surveillance


Niederkrotenthaler Austria, Study design: quasi experimental, ecological study, 292 subway suicidal The presence of a surveillance unit had a
et al. (2012) Vienna measuring the associations between several behaviours: 107 suicide positive effect (crude rate ratio for railway
underground independent station characteristics and subway attempts and 185 suicides in suicide = 1.65; crude rate ratio for railway
suicidal behaviours 1979–2009 suicide attempt = 1.93).
Factor: presence of a surveillance unit
Outcome variable: number of subway suicidal
behaviours (suicides and suicide attempts)

Technical design to reduce the effects of impact: design of tracks (i.e. pits between rails)
Coats and Walter UK, London Study design: quasi experimental, ecological study, 58 cases occurred over 33 patients died (overall mortality 57%) and
(1999) underground based on mortality data recorded in patients hit by 15 months (January 1996 to 25 survived.
trains at platforms with and without a drainage March 1997)
pit.
Factor: presence or absence of a drainage pit The mortality was 44% for platforms with a
pit compared with 76% for platforms without
a pit. This difference was significant
(p = 0.026). The presence of a pit halves the
number of deaths in patients who are hit by a
train.
Outcome variables: number of collisions and
mortality rate

O’Donnell and UK, London Study design: quasi experimental, longitudinal 3240 subway suicidal 66% of incidents happening at stations
Farmer (1994) underground ecological study, based on accident reports, behaviours from 1940 to without suicide pits ended in death as
measuring the association of several 1990 compared to 45% at stations with pits (a
epidemiological factors and environmental statistically significant difference).
contexts with subway suicidal behaviours
Factor: presence or absence of a drainage pit
Outcome variable: number of subway suicidal
behaviours and mortality rate

Staff training: gatekeeper training to identify and approach people at risk of suicide
RSSB (2013) UK, railway Study design: experimental, ecological study, Year 2010 to 2013. By mid - General positive attitude about the training
network in comparing the intervention group with a control 2013, nearly 3500 front line (an average of 4.8 out of 5 on a satisfaction
Great Britain group railway staff had taken the scale): 63.1% of respondents appreciated that
training. the training may decrease the number of
suicides, 5.5% rated that it might increase the
number of suicides and 31.4% thought it
would have no effect either way.
Intervention: a 1-day training course provided by Samaritans to front line railway Attitude about suicide prevention: participants
staff to help them gain confidence in feeling able to approach someone who they reported an increased likelihood of taking
think may be at risk of suicide and to get them to a place of safety, and to make the actions seen to be 'desirable' upon
necessary referral. encountering a potentially suicidal person.
Outcome variables: attitude about the training and Participants had a lower rating in terms of
about suicide prevention, confidence, engaging viewing suicide being a long-lasting issue,
behaviour indicating they were more likely to believe
that once a person has had suicidal thoughts,
these can be overcome.
Confidence: staff felt more confident
following training in making an intervention.
The majority of front line staff are generally
willing to use the programme activities.
Changing staff behaviour: 14% of participants
returning evaluation feedback sheets (n = 66)
reported that they had engaged with a
potentially suicidal person and used the skills
they had learnt
Lighting systems to influence behaviour: calming blue light on station platforms
Ichikawa et al. Japan, railway Study design: quasi experimental, ecological study, 4013 railway deaths and Of the total railway deaths and injuries, 55%
(2014) system based on mortality data, looking at the time and injuries from 2002 to 2009 were suicide attempts, whereas 21% were
spatial distribution of railway incidents to cases of accidentally being hit by a train at the
edge of a platform and another 10% were falls
36 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

Table 5 (Continued)
Reference (authors, Location and Study design and measures Sample and data collection Significant results reported and implications for
date) specific period the effectiveness of the measure
setting
estimate the suicide probability near a blue light onto the track. More than half of railway
lamp. suicide attempts occurred during the day,
with many occurring away from station
premises. According to the most conservative
estimate, only 28% of suicide attempts within
station premises occurred at the end of a
platform at night.
Factors: time (night-time) and location (end of
station platform)
Outcome variables: total number of railway deaths The number of station platforms equipped
and injuries vs. number of railway suicides with blue lights is too small to generate the
occurring at night and at platform end effect reported by Matsubayashi et al. (2013).

Matsubayashi et al. Japan, railway Study design: quasi experimental, ecological study, 71 railway stations between Railway suicides decreased by 84% after
(2013) system based on suicide data measured before and after 2000–2010 installation of blue lights, after controlling for
the installation of blue light the number of suicides in the previous years,
use of faster train and proximity to a
psychiatry hospital.
Intervention: installation of blue light on railway platforms in 11 stations. Comparison with 60 stations without blue light
Outcome variable: number of railway suicides. The
average number of suicides per station-year
observations was 0.164

Operational traffic management: reducing train traffic intensity


van Houwelingen Railway Study design: ecological study, comparing Dutch 1475 Dutch and 6105 German Positive association of railway suicides with
et al. (2013) systems in the and German railway suicides in terms of railway railway suicides in 2000– the train frequency (Dutch–German rate
Netherlands and population parameters 2007 ratio = .74)
and Germany
Factor: train frequency
Outcome variable: number of railway suicides

million-train kilometres in the Netherlands has been the second number of measures, usually up to three. By far, the most extended
highest in Europe, while in Sweden it has been below the EU-28 and comprehensive information came from the Rail Safety and
average (ERA, 2014). In line with Reynders et al. (2011), further Standards Board (RSSB) reports. First, these documents focus on
research is needed to clarify this issue. very specific topics concerning prevention (e.g. improving anti-
trespass signage, lessons learnt from safety campaigns, securing
3.1.3. Content and evolution of covered topics in the literature platform ends, etc.). Second, they usually discuss several preven-
The publications addressed four major topics in the following tative measures and provide more details about implementation,
order: suicide only (58%), both suicide and trespass (19%), trespass effectiveness, shortcomings, costs and occasionally include infor-
only (17%), and LC or other accidents (6%). A lambda symmetric test mation about combination of measures.
was conducted between the main topic categories (suicide, The lambda symmetric test between the categorical variable
trespass, both, LC) and the publication year (absolute ordinal type of measure (behavioural, engineering, both) and the publica-
values). The association between the two variables revealed tion year (absolute ordinal values) indicated no significant
unequal distribution of the main topics across the 35-year period association between the two (l = .067; p = .067; Cramer’s
(l = .086; p = .056; Cramer’s V = .486). The marginally significant V = .450), but suggested two tendencies in prevention across time:
association suggests (1) a constant concern for railway suicide there is an increased focus on behavioural measures particularly
across time, (2) a common approach of suicide and trespass since 2003 and there is a higher preference for recommending
particularly since 1994, and (3) a relatively recent interest in behavioural and engineering measures simultaneously since 2011.
trespass prevention (since 2003). In summary, the effort to study A chi-square test was conducted between the categorical
railway suicide has been constant, whereas trespass prevention is a variables type of measure (behavioural, engineering, both) and the
newer research interest. These results reflect the tendency of the main topic categories (suicide, trespass, both, LC) to check if any
whole corpus of papers, but may not be representative for all measure type is more or less associated with suicide or trespass.
countries. This tendency may also be affected by the under- Overall, the association was not statistically significant (x2 = 7.20;
reporting specific to some countries, the publication bias, or the p = .302; Cramer’s V = .161), suggesting no prevailing solution for a
absence of published work in English language (Table 3). particular problem.

3.1.4. Type of measures, their distribution in time, and association with 3.2. Content analysis of preventative measures
the main topics
According to the type of preventative solutions, the publica- The second set of analyses concerned the content of the
tions could be classified into three categories and ranked in 139 papers which proposed at least one measure and those
decreasing order: both behavioural and engineering measures individual studies among them that evaluated the measures for
(53%), behavioural measures only (28%), and engineering measures their effectiveness (n = 22). The level of detail about preventative
only (19%). The papers in the first category usually proposed measures ranged from general recommendations or implicit
separate behavioural and engineering measures rather than an assumptions of the author (e.g. ‘education seems to be the only
actual integration between them. Most papers address a small hope’, Nixon et al., 1985, p. 221; ‘other measures are needed such as
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 37

Table 6
Summary of the studies which provide empirical support for several measures tested independently or in combination.

Reference Location and Study design and measures Sample and data collection period Significant results reported and implications for
(authors, specific setting the effectiveness of the measure
date)
Evaluation of several measures (independent implementation): fencing at hotspots, landscaping, signage
Silla and Finland, 3 different Study design: experimental, ecological study, 2612 trespassing cases. Before- Fencing reduced trespassing by 94.6%,
Luoma locations in the with before and after measurements phase measurements were carried followed by landscaping (91.3%) and
(2011) city of out in May 2006 and after-phase prohibitive signs (30.7%).
Lappeenranta measurements in May 2007
Fencing: fences were installed on both sides of
the railway line were approximately 1.0m high
and extended roughly 100m from the
unofficial path in both directions.
Landscaping: removal of the existing path
across the railway line, steepening the sides of
the railway line, planting trees and bushes to
form a natural fence, planting grass and
decorating the sides with a few large stones.
The landscaping was approximately 1.5m high
and 200m long, the unofficial path being
roughly in the middle of it.
Signage: prohibitive signs widely used in rail
and road transportation were erected on both
sides of the railway line.
Outcome variable: number of trespassers

Evaluation of several measures (successive implementation): communication + education + enforcement


Lobb et al. New Zealand, Study design: experimental, ecological study, 172 male pupils observed during Communication did not decrease unsafe
(2003) inner city platform with repeated measurements 8 months crossings.
close to a school in
Auckland
Communication: large billboard placed near Education significantly reduced trespass
the platforms; distribution of leaflets around behaviour.
the school; and the placement in the school of
posters.
Education: talks during a 4-week period, a Punishment reduced trespass behaviour even
general statement about rail safety made more.
during the school assembly and follow-up
activities during class time.
Enforcement: for 2 weeks, every boy observed
crossing unsafely by the teacher on duty was
given a Friday detention. Rewards (pens and
chocolate bars) were given out intermittently
to boys observed crossing safely.
Outcome variable: trespassing behaviour

Evaluation of several measures (simultaneous implementation): fencing at hotspots reinforced with measures to soil clothes + signage + education
Lobb et al. New Zealand, Study design: experimental, ecological study, 2120 trespassing cases observed The rate of trespass decreased substantially
(2001) Auckand, with before and after measurements during 3 moments: prior to (from 59% to 40%) and the decrease was
Henderson railway campaign, 2-weeks into campaign sustained and even greater three months later
station in and 3-month follow-up. (from 40% to 36%). Educational measures may
Waitakare City have had less effect than the increased access
prevention.
Fencing: installation of new fences and
repairing of old ones. The bars on each side of
the gap were smeared with heavy grease.
Signage: large warning signs on and near
platforms. Posters placed in nearby factories
and similar; larger posters placed on billboards
in the vicinity of the station.
Education: talks given by City Council and Rail
safety officers to pupils at local schools.
Leaflets distributed to workers at railside
factories, and in surrounding residential,
commercial and industrial areas. Planned
media coverage about the safety programme
including comments, photographs of the new
signs and posters in local newspapers.
Outcome variable: trespassing behaviour

an education campaign backed up by enforcement in problem descending citation frequency, which essentially reflects the
areas’, Patterson, 2004, p. 14) to specific figures in evaluation measures’ popularity in the literature and the degree of debate
studies. The content analysis of measures described in this corpus and endorsement in the research community. This should not be
resulted in a panel of 100 specific measures distributed in 19 main understood as a measure of effectiveness, quality of research or
categories (see Table 1). These categories are reported by impact on prevention. Sixteen categories of measures are common
38 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

to suicide and trespass prevention, and other three are dedicated to the boundary of an area with restricted access (Bhui et al., 2013).
suicide prevention. All these categories of measures are discussed This specific approach of using fences is mainly discussed in the
in the following section according to the problem they target, their context of suicide prevention. For example, Rådbo et al. (2008)
effect mechanism, and the specific examples that have been argued that less rigorous fences may as well influence people's
identified. behaviour by indicating the boundary of an area with restricted
admission, while van Houwelingen (2011) suggested putting
4. Discussion transparent intermittent fences on the platforms, which do not
obstruct boarding and getting off the train, and which mark a no-
4.1. Common measures against suicide and trespass standing area on the platform until a train has stopped. Symbolic
fencing is less costly than traditional fencing and indicates that
4.1.1. Fencing and other physical barriers measures with a clear physical effect (e.g. access restriction) can be
Physical barriers are by far the most popular measure against implemented as psychological barrier for suicide candidates (van
both suicide and trespass. Access restriction to the tracks is Houwelingen, 2011) and probably implicit prohibitive sign for
frequently recommended without providing any details about potential trespassers. However, there is no evidence concerning
implementation, whereas other authors propose specific physical the effectiveness of these symbolic barriers and it remains unclear
barriers according to the target-problem or location. A large part of how they would influence the decision to enter the tracks.
the literature recommends fencing at suicide hotspots: priority Particular types of fences at stations are equally recommended
should be given to locations where open-line suicides occur more against suicide and trespass. For example, fencing at platform ends
frequently (Routley et al., 2004), densely populated areas (Rådbo has been proposed as a useful method to reduce suicide attempts
et al., 2012a), suicide bridges (Lindqvist et al., 2004) and areas close (Holdaway et al., 2012; Lindberg, 2012; van Houwelingen, 2011)
to psychiatric hospitals (van Houwelingen, 2011). To be effective and should be considered for any specific location where trespass is
fences at suicide hotspots should be ‘fairly high and wide-ranging’ a major factor (RSSB, 2005). However, the level of evidence is
(Rådbo et al., 2008) or ‘high over long distances’ (Bhui et al., 2013). questionable since fencing in Cape Town rail stations has done
One may note that these recommendations are still vague to be little to reduce injury rates (Lerer and Matzopoulos, 1996).
operational. Although the proximity of psychiatric institutions to Some physical barriers are specifically targeted towards
the railways is acknowledged as a high-risk factor, to date there is trespass: for example, anti-trespass grids are recommended only
no study that have assessed how fencing measures at these to prevent trespass behaviour by making potential shortcuts
locations actually prevent suicide in psychiatric inpatients. In impracticable (RSSB, 2005), with unknown effects on suicidal
contrast, there is a consistent support for the effectiveness of safety people. These grids can be steel or wood and can be mounted onto
barriers at bridges (see Table 4 for details): Beautrais et al. (2009) the platform ramp surface between the edge of the ramp and the
reported a 100% suicide reduction at a bridge in New Zealand and security fence (RSSB, 2005). It is also recommended to lock up
Pirkis et al. (2013) found a global 86% decrease at several fenced service entrances and unofficial pedestrian paths (Bhui et al., 2013;
bridges with some increases in neighbouring sites, but with an Debbaut et al., 2013) to prevent people from entering the tracks or
overall significant reduction in all suicides by jumping. Similar reaching tunnels or technical cabinets. Additionally, higher fences
effects of this measure are reported by Reisch and Michel (2005) are recommended at train holding areas to prevent vandalism and
and Hepp et al. (2012) in Switzerland. The theory behind fencing at the associated trespassing behaviour (Offler et al., 2009). These
bridges is that by impeding access, it may ‘buy time’ for the physical barriers are recommended to prevent trespass in absence
individual to reconsider his or her actions, particularly in situations of clear evidence for effectiveness. In contrast, two studies have
where these actions are associated with impulsivity or ambiva- shown that fencing at trespass hotspots is highly effective (see
lence (Cox et al., 2013). Table 6 for details). In Finland, trespassing behaviour dropped by
At stations, suicide can be prevented through dedicated barriers 94.6% after 1.0 m high fences were installed on both sides of the
such as intermediate fencing between platforms (Lindberg, 2012) railway line 100 m in both directions from an unofficial path (Silla
or mid-platform fencing restricting access to fast lines where trains and Luoma, 2011). In New Zealand, fencing reduced trespassing
pass through without stopping (RSSB, 2013). The latter was rated behaviour at a station hotspot from 59% to 36% (Lobb et al., 2001)
65.9% effective by British respondents who believed that it would when combined with signage and education measures. At
decrease the number of suicides on fast lines (RSSB, 2013). trespassing locations the physical effect of a fence may be boosted
However, there is no published study that shows that the number by different adjustments to reinforce their restrictive effect:
of suicides at stations with mid-platform fencing is actually lower smearing the bars with heavy grease in order to soil the clothes of
compared to stations not equipped with this measure. Platform trespassers (Lobb et al., 2001) or making deep trenches on both
screen doors (PSD), are another type of anti-suicide fencing (e.g. sides of the fence (Silla and Luoma, 2009). However, the effect of
O’Donnell and Farmer, 1992). Two studies have shown positive these adjustments was not evaluated in comparison to simple
results in Hong Kong (see Table 4 for details), where it reduced fencing.
suicide with 59–84% (Law et al., 2009) and all injuries at platforms
with 68.8% (Law and Yip, 2011) with no displacement of suicide 4.1.2. Collaboration between institutions
attempters to unsealed platforms. This measure might not only Collaboration between institutions at local or national level to
restrict access but also ‘delethalise’ the image of railway suicide by prevent suicide and trespass is frequently mentioned with no
giving the railway environment a much safer ‘look’ (Law et al., detailed recommendations. At a very general level, it is proposed
2009). However, it is only applicable to underground railways or that railway stakeholders find new partners for collaboration: local
subways, but not to open railway networks (Too et al., 2014). The businesses, parent and other community groups (Federal Railroad
installation of noise barriers has been proposed as another anti- Administration, FRA, 2011), chambers of commerce, local stores,
suicide solution to reduce accessibility to the tracks because they unions, youth services, city planners, transportation engineers,
are usually robust structures, harder to surmount than traditional manufacturers, survivors and bystanders (Cohen et al., 2003). The
fences (Rådbo et al., 2012a). However, they can be problematic involvement of businesses in both intentional and unintentional
since they might provide undesired visual seclusion (Rådbo et al., injury prevention efforts can indeed raise awareness of prevention
2012a) and their effectiveness as physical barrier has not been issues, while bystanders can discourage risk taking (Cohen et al.,
evaluated yet. Fences can also be used in symbolic ways, indicating 2003).
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 39

Finding and establishing collaboration between institutions The remaining means of collaboration were associated to both
and stakeholders is actually a transversal measure which under- trespass and suicide prevention, although they were proposed by
pins or supports the implementation of other categories of different publications. Collaboration can be established with mass
measures. For example, cooperation achieved across different media as they can assist in educating the public about the potential
levels of government, railway companies, public safety organ- hazards of trespassing on the railways and build awareness and
isations, police, unions and community groups to promote rail support for problem-solving efforts. Establishing a good working
safety is essential for carrying out effective education campaigns relationship with local editors and reporters can help get
(BTRE, 2002). Similarly, school boards and local school officials can community trespass prevention activities prominently displayed
partner by participating in educational programs such as in the media (FRA, 2011). The collaboration may focus on particular
presentations, sending notices home to parents, and by ensuring trespass-related issues such as media reporting positively on
the safety of children in schoolyards adjacent to rail operations successes in alleviating vandalism and graffiti (Offler et al., 2009).
(FRA, 2011). Other partners may include police forces, local Collaboration with media should also be part of the public health
government representatives, agencies and councils, non-profit strategy (Leenaars, 2005) and may encourage people who
organisations, mental health services, specialized professional contemplate suicide to seek help (Andriessen, 2011). Collaboration
resources, emergency services and primary care trusts (Brown with media is also recommended to avoid publicising the high-risk
et al., 2012; C.A.R.E., 2006; Lobb et al., 2001; RSSB, 2005). locations and railway suicide cases (Debbaut et al., 2013 Yip et al.,
The proposed ways of collaboration to prevent suicide are 2012), and can result in media guidelines to avoid copycat suicide
twofold. The former is consultation with psychiatric hospitals (Media guideline is discussed later as the measure ‘Appropriate
situated in the proximity of railway lines (Lindekilde and Wang, reporting or broadcast of critical incidents’, see Section 4.2.1).
1985; van Houwelingen et al., 2010) and health authorities such as Collaboration with police, other law enforcement authorities,
epidemiologists, injury specialists, and health care providers and justice departments has been recommended against trespass
(Cohen et al., 2003). It encompasses several principles or goals (e.g. Offler et al., 2009) and applied to rail suicide prevention
that might be achieved thanks to such collaboration. Planning and (Brown et al., 2012; RSSB, 2013). The police can be very helpful in
development of psychiatric facilities at a distance within a circle of conducting site evaluations of problem areas and tracking of
about 2–3 miles from a railway line should be prevented by law incidents; officers can assist in trespass enforcement and educa-
and the visibility of railway tracks from psychiatric facilities should tion efforts, assist in data collection, and provide specialized
be strictly inhibited (Ladwig et al., 2009). In addition, communi- knowledge of rail operations and crime prevention (FRA, 2011).
cation to mental health professionals in psychiatric hospitals near Thus, one specific recommendation is that schools should
railways should raise awareness about the devastating effects of collaborate with police (Offler et al., 2009). Local law enforcement
suicides on train drivers and promote measures that these can assist with information about social and economic problems
hospitals can take to prevent their patients' access to the nearby within the community, which may be beneficial in reaching out to
railway track (Kerkhof, 2003) such as actions to monitor in-patient specific neighbourhoods and population groups (FRA, 2011).
whereabouts and suicidal intent (Ratnayake et al., 2007). Mental Collaboration with police forces has been proposed for preventing
health services could proactively inform rail companies of any suicides as well. One good example is the British Transport Police
changes occurring in the accommodation of populations at risk or PIER plans (Brown et al., 2012; RSSB, 2013). British Transport Police
of new housing plans (van Houwelingen, 2011). The introduction of (BTP) is the key organisation undertaking Great Britain’s nation-
procedures and guidelines regarding identification and treatment wide work on railway suicide outside the Network Rail/Samaritans
of suicidal patients, and relevant staff training, might also programme (Samaritans is the largest suicide prevention charity
contribute to a lower number of railway suicides among the network in the UK, providing support to people in distress through
patients (Debbaut et al., 2013). However, no study has clearly helpline, local interventions in the community, etc.). PIER plans
evaluated this type of collaboration. include four actions plans (prevention, intelligence, enforcement
The second collaborative measure against suicide is having a and reassurance) generated by BTP for identified vulnerable
national suicide prevention strategy (e.g. Florentine and Crane, persons. These plans include amending the missing persons
2010). In England for example, this strategy has three goals procedure, such that they can now be notified of any missing
(Holdaway et al., 2012): (1) to reduce risk of suicide in key high person where there is some concern that they may use the railway
groups, with men under 25 years of age as the priority group; (2) to network to attempt suicide; establishing a third party referral
establish a cross-government network to address a range of social protocol with Samaritans, whereby they can facilitate a contact
issues that have an impact on people with mental health problems between a vulnerable person and Samaritans; and the production
(inter-agency work); (3) to help local services identify their suicide and management of PIER Plans for identified vulnerable people
hotspots and to take steps to improve safety at them. In the known to be a suicide risk to the rail system (Brown et al., 2012;
Netherlands, the national strategy resulted in introducing an RSSB, 2013).
online suicide prevention service in September 2009 (www.113on- Local community partnership is another type of collaboration. It
line.nl) with the aid of an 18-month government subsidy (van can provide an effective and relatively low cost means of deterring
Houwelingen, 2011). This service offers direct help to suicidal trespass (RSSB, 2005). Local authorities, government and commu-
persons, to those who are worried about a person at risk of suicide nity based agencies (e.g. mayors, city managers, or local leaders
and to those who have lost a family member or friend by suicide. In involved in developing solutions) can provide key resources since
Belgium, a strategy is run by a national working group (Andriessen, they know who is likely to help and because protecting the citizens
2011) and includes nine distinct actions among which awareness in their community is an important part of their job. They also
events, radio and poster campaigns, annual publications, and know the representatives at regional and local government
trainings. One study (Baumert et al., 2011) shows the positive agencies who are uniquely qualified to address rail or community
result of the German national railway suicide prevention strategy. issues (FRA, 2011). A volunteer workforce from the local
This project carried out in 2002 reduced the number of suicides on community can take responsibility for stations and their environ-
the German Railway network by almost 14% by implementing a ments, for example in community mural projects that intend to re-
combination of measures like inter-agency meetings, media focus the attention of graffiti writers (Offler et al., 2009). As the
communication strategy and access restriction (see Table 4 for volunteers are resident in the local community, the level of
details). attention paid to vandalism issues is greatly increased
40 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

(RSSB, 2005). For suicide prevention, developing local suicide footbridges can be made more ‘inviting’ by adding suitable viewing
prevention plans (RSSB, 2013) and working in partnership with panels allowing view of the track, of a type easily maintained and
local authorities (Brown et al., 2012) are also recommended. Public serviced from the bridge walkway (RSSB, 2005). Authorised
health agencies like local government, Health and Wellbeing walking routes should be established along the illegal short cuts
boards, commissioners of health and social care services, and and the authorised routes should be made more attractive to use
providers of health and social care services can work more closely (RSSB, 2005). These measures would support the correct behaviour
with other agencies (Bhui et al., 2013). for trespassers. Once again, no study has clearly established their
Strategies for better inter-agency communication are recom- effectiveness on the actual trespassing behaviour.
mended to improve suicide (Andriessen and Krysinska, 2011) and Closing LCs (Nixon et al., 1985) or replacing them with over or
trespass prevention (RSSB, 2006). Cohen et al. (2003) recommend under-passes is recommended to prevent suicide (Debbaut et al.,
sharing resources, reducing duplication of efforts, coordinating 2013; van Houwelingen, 2011, 2013) and trespass especially in
services, and attaining greater credibility on the issue. Brown et al. areas with dense train traffic (Silla and Kallberg, 2012). The safety
(2012) report that communication might raise difficulties in the operation of remaining LCs should be improved by ensuring
collaboration to prevent railway suicides and that a good appropriate physical conditions and sufficient warnings (Ozdog an
communication is needed between: (a) the infrastructure manager et al., 2006), as well as active warning devices (Evans, 2011; Savage,
and train operating companies, (b) train operating companies and 2006). Redesigning LCs to increase visibility is recommended to
(c) between Samaritans head office and its local branches. prevent suicide (Rådbo et al., 2012) and trespass (Horton, 2009;
Regarding the prevention of trespass, clarification of responsibili- Silla and Kallberg, 2012), allowing pedestrians to be detected more
ties for different agencies and organisations is essential (RSSB, easily if they enter the tracks illegally from a LC. The least safe
2006). LCs – the passive ones – should be designed is such ways that
pedestrians are able to judge whether or not it is safe to enter the
4.1.3. Environmental design tracks (BTRE, 2002).
Environmental design refers to changing the landscape or the
terrain near the railway, so that suicide becomes more difficult and 4.1.4. Monitoring and detection systems
trespass less attractive. For example, demolishing abandoned The literature is divided between publications that refer to this
buildings or kiosks situated close to the tracks will discourage measure in general (e.g. Holdaway et al., 2012; Lindberg, 2012;
trespassers motivated by occupying a quiet place (RSSB, 2005), will Rådbo and Andersson, 2012), publications that provide some sort
reduce opportunities for graffiti by removing potential surfaces of recommendations and others focus on rich technical details, for
(Thompson et al., 2012) and will eliminate concealment places for example about the implementation of closed-circuit television
suicidal persons (Brown et al., 2012; van Houwelingen, 2011). In (CCTV). In most cases the systems are recommended to detect (and
addition, vegetation hindering the driver’s view and providing sometimes warn) the persons at risk. The papers focus either on
hiding place for suicidal people should be removed (Debbaut et al., trespass or suicide prevention; therefore we keep this distinction
2013). in what follows.
Spatial separation and structural design can be used to prevent Regarding trespass, RSSB (2005) points out that CCTV will not
suicides by maximising the distance between fast tracks with non- necessarily stop intrusions on its own. CCTV has the potential to
stopping trains and densely populated areas (Rådbo et al., 2008) or reduce the incidence of teenage trespass, provided that offenders
platforms with waiting commuters (Brown et al., 2012; van are apprehended and publicly dealt with (RSSB, 2006). The
Houwelingen, 2011). This measure may create practical difficulties coverage area of the surveillance cameras should be extended to
for the capacity of railway networks (Holdaway et al., 2012) and monitor the platform end (RSSB, 2005) with the image visible to
has not been evaluated yet. staff at both the platform level and in the control room (Holdaway
Impeding access with impenetrable vegetation, ditches or et al., 2012). There are many technical possibilities to improve the
slopes (Lindberg, 2012) or elevated tracks or tunnels (Rådbo et al., effect of surveillance cameras. The first is to combine CCTV with
2008) is thought to be effective against suicide although no study sound warnings or megaphones (DaSilva, 2011). However, linking
has evaluated its effect on suicide cases. Silla and Luoma (2011) CCTV with public address-system-announcements may be effec-
evaluated the effectiveness of landscaping on trespass behaviour in tive in deterring children but less effective for adults (RSSB, 2005).
one study (see Table 6 for details): they removed of the existing Other recommended systems are composed of motion detectors
path across the railway line, steepening the sides of the railway combined with sound warnings (RSSB, 2005) or flashcams which
line, planting trees and bushes to form a natural fence, planting take photographs of trespassers (RSSB, 2005). DaSilva et al. (2006)
grass and decorating the sides with a few large stones. The have shown the effectiveness of video camera combined with
landscaping was approximately 1.5 m high and 200 m long, and led infrared illuminator, speaker, motion detector and magnetometer
to a 91.3% reduction in the number of trespass (Silla and Luoma, on a railway bridge in the USA (see Table 5 for details): the trespass
2011). rate dropped by 60% from the first to the second year and by 17% in
Other environmental solutions against trespass are to replace the third year compared to the first one. A low-cost alternative to
high risk or unauthorised footpaths with footbridges (Morse and these intelligent CCTV systems is to use dummy cameras
Taberneso, 2013), underground tunnels or more safe and ‘inviting’ (Thompson et al., 2012) to deter the access to high risks areas
footpaths. In Finland, building of an over- or underpass was by means of implied surveillance. However, it is unknown from the
supported by 65.3% of people living close to a railway line as one of literature what the cost difference is and whether fake cameras
the most effective countermeasures against trespass (Silla and indeed have short-term or long-term effectiveness at preventing
Luoma, 2012b). However, Finnish train drivers somewhat hesitated trespass.
to recommend underpasses because of the high building costs Regarding suicide, surveillance systems have been recom-
(Silla and Luoma, 2009). RSSB (2005) suggests that with well- mended mostly to detect suicidal or pre-suicidal behaviour and to
presented, enclosed footbridges there is less temptation to cross at alert the railway staff. For example, Burrows and Laflamme (2007)
track level. Well-designed footbridges should provide good sight- proposed surveillance to be used to better understand the
lines across the station, include ramp access or lifts, and epidemiological information on suicide mortality statistics. This
accommodate the requirements of disabled passengers and station means that the cameras are used to collect information about the
staff who need to cross the tracks (RSSB, 2005). Enclosed occurring suicide events. Similarly, Kerkhof (2003) recommends
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 41

the use of cameras at hotspots close to psychiatric hospitals to people at early risk of suicide (du Roscoät and Beck, 2013).
warn the staff in the proximity. Passengers waiting on the platform However, no evidence was published until now.
may also contribute to suicide prevention by being provided with
video feedback to encourage them to be more vigilant in detecting 4.1.6. Enforcement, punishment and patrols
peers at risk and to notify the station staff when they see abnormal The enforcement of safety rules through visible human
behaviours (Bhui et al., 2013). The effectiveness of surveillance in presence and surveillance is recommended as a general preventa-
preventing suicides depends upon the availability of vigilant tive direction, with a few papers making specific recommenda-
observers monitoring the video screens and the potential to tions for suicide or trespass prevention. Police presence and
dispatch help to the scene or notify train drivers in time to prevent suicide patrols are recommended at hotspots to intervene when
the suicide, thus a railway system with hundreds of cameras to suicide attempts are identified (Cox et al., 2013). Video surveillance
monitor requires many people available throughout the day and CCTV systems to facilitate the intervention of security staff at
(Mishara, 2007). There is no published evidence that such systems stations may increase the difficulties for suicide attempters to
have actually reduced the number of suicidal behaviours. complete the act (Lindberg, 2012; Ratnayake et al., 2007). This is
supported by Niederkrotenthaler et al. (2012) who have shown
4.1.5. Education and information at individual level that the presence of a surveillance unit at stations is associated
Mainly proposed for trespass prevention, this measure has been with a decrease of suicidal behaviours (see Table 5 for details). In
sometime proposed with specific contents dedicated to suicide addition, the mere presence of human personnel at stations is
prevention. Trespass and suicide prevention are discussed believed to be a deterrent in itself: station staffing and the presence
sequentially in what follows. of human personnel at stations may discourage suicide (Clarke and
To prevent trespass, increasing individual knowledge about Poyner, 1994), but also trespass (RSSB, 2005). To improve suicide
risks and safe behaviours in railways area is most frequently prevention, Kadotani et al. (2014) recommend the station staff to
mentioned (e.g. DaSilva and Carroll, 2011; FRA, 2011; Lobb, 2006; increase railway surveillance after several consecutive days
RSSB, 2005; Silla and Luoma, 2009). It is also proposed as a general without sunshine when suicides are more likely to occur.
safety strategy against accidents (Horton, 2009; Mohanty et al., Additionally, Lindberg (2012) recommends that personnel from
2007; Nixon et al., 1985; Patterson, 2004). Education can be the track area wears visible clothing (e.g. reflective jackets); on the
conducted in and outside of schools. In schools, various one hand this communicates to potential suicide candidates that
educational tools are used, separately or jointly, to this purpose: they can be seen and stopped during the attempt. On the other
lessons, communication specifically aimed at teachers, educational hand and more generally, the systematic use of visible clothing by
tool kits, thematic school calendars and even the integration of railway staff contributes to trespass prevention since it dictates
safety messages and information about track safety in disciplines that those people are authorised to be in the track area.
within different curricula such as mathematics, science, literacy, Improved enforcement procedures are also recommended to
history or geography (Patterson, 2004; RSSB, 2003a). Education prevent trespass and vandalism. In this respect, Offler et al. (2009)
programs in schools may also employ drama, filmmaking, and and Thompson et al. (2012) propose an increased presence and
lectures to make students aware of the dangers and impact of visibility of staff on trains, introduction of a professional security
vandalism on others and the environment (Offler et al., 2009). service, employing young people to staff patrols, or establishing a
Education at school about the dangers of trespassing was ‘railwatch’ for staff and public. Some recommendations are similar
supported by 36.5% of the people living close to a railway line to those from suicide prevention; for example patrolling should be
(Silla and Luoma, 2012b), and helped reduce trespass behaviour done particularly during the peak periods for trespass and
when combined with communication and enforcement (Lobb vandalism (Offler et al., 2009; RSSB, 2002). Other recommenda-
et al., 2003) or fencing and signage (Lobb et al., 2001; see Table 6 tions to prevent trespass are different; for example Thompson et al.
for details). Additionally, it has been proposed to carry out (2012) recommend that security staff should wear plain clothes
interventions outside of schools, i.e. the development of education because it is more effective to identify and stop trespassers,
programs for adults, communities or social workers. For example, a although passengers frequently report feeling more safe when
campaign amongst the parents of very young children may security staff are highly visible. Visible clothing is still required
improve their awareness of the dangers of railway trespass and when intervening out of the authorised pathways. Trespass
encourage them to prepare their children better to avoid these prevention requires the additional ability of security patrols to
(RSSB, 2006). Risk awareness should be raised at ‘strategic’ detect and fine illegal and unsafe behaviour (Akkaş et al., 2011; C.A.
locations close to the tracks such as bars and taverns (Savage, R.E., 2006; Lobb, 2006) which may also include legislative efforts
2007), or places where vandalism is the main root of trespassing (DaSilva and Carroll, 2011). The risk of being caught has the power
behaviour (Thompson et al., 2012), although one may question if to act as a real deterrent in some area, but only if the risk is real
education would really work on intoxicated people or vandals. (RSSB, 2006). Implementation of special security patrols in the
Other recommendations point to the combination of education Cape Town rail system has failed to show any reduction in both
with enforcement (Patterson, 2004) or environmental interven- suicide rates and trespassing injury (Lerer and Matzopoulos, 1996).
tions (Wasnik, 2010). For example, Lobb et al. (2001) reported that A study by Lobb et al. (2003) indicated that combining punishment
educational message distributed to workers at railside factories, with intermittent reinforcement of desired behaviour (i.e.
and in surrounding residential, commercial and industrial areas in rewards) significantly reduced trespass behaviour in male pupils
combination with fencing and signage significantly reduced (see Table 6 for details). One questionable measure involving
trespass, although education may have had a weaker effect than punishment to prevent suicide is to charge the victim's family for
the other two measures. disrupting the rail system (Routley et al., 2004).
Suicide prevention using education has been recommended in a
few cases to improve individual awareness about suicide risks (e.g. 4.1.7. Public safety communication
Rådbo et al., 2008). Such recommendations include programs to The literature refers to mass media campaigns, public
increase suicide awareness in general (helping peers, knowledge communication, or public awareness raising, defined as any
about suicide) (Leenaars, 2005) and among clinicians in commu- purposeful attempts to inform, persuade and motivate a targeted
nities (Yip et al., 2012). Interventions in schools can be used to raise subgroup of the population to change its attitudes and behaviours
awareness among pupils and school teachers and to identify young to improve rail safety. Segmentation of vulnerable groups is
42 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

recommended for trespass (RSSB, 2003b; Searle et al., 2012) and Finland and found that trespass dropped by 30.7% providing
suicide (Baumert et al., 2008). Pedestrian high-risk categories support for this measure (see Table 6 for details). RSSB (2011b)
comprise school children, youth, people with physical disabilities recommends extending the yellow warning lines from the high-
or mobility aids, and elderly over 60 years (Searle et al., 2012). speed platforms to the non-high-speed platforms as other
Survivors of railway and metro suicide attempts are at particular important markings at stations. Station signage can be an effective
risk of repetition, thus represent a high-risk group (Mishara, 2007) way of reducing trespass (RSSB, 2005) but the potential of signs to
that requires specific communication to prevent future attempts. change behaviour in the absence of any other activity is limited
Education campaigns have a higher likelihood of success for (RSSB, 2006), therefore they are usually part of wider interven-
pedestrians (Morse and Taberneso, 2013; Searle et al., 2012) and tions. For example Lobb et al. (2001) evaluated the effect of
mass media is a key partner in promoting them. Safety warning signs and posters in combination with fencing and
communication against trespass (RSSB, 2012) consists of organised education and found that it significantly decreased trespass at a
communication through different media channels in a given time railway station from New Zealand (see Table 6 for details).
period, describing the dangers related to being on the tracks and In the context of suicide prevention, signage is most often used
the consequences of an accident (BTRE, 2002; Pelletier, 1997). as posters and signs placed at priority locations to encourage
Planned media coverage may also include comments of local people at risk of suicide to contact help (RSSB, 2013). We will
authorities or photographs of other implanted measures through- discuss this as a separate measure (point 4.2.2). In addition,
out the campaign (Lobb et al., 2001). Lobb et al. (2003) evaluated Andriessen and Krysinska (2011) propose ‘No Entry’ signs placed at
the effectiveness of public communication (safety message the most dangerous places, while visible markings and warning
displayed on billboards, leaflets and posters) in combination with signs may keep people away from platform edges (Bhui et al., 2013;
school education and enforcement and showed that communica- Lindberg, 2012). These recommendations are quite general, and it
tion was the least effective of the three measures (see Table 6 for is not clear if they are really effective on people who contemplate
details). suicide. Lindberg (2012) notes that even though signs prohibiting
While public communications to prevent trespass typically access can hardly in themselves prevent suicide attempts, they do
evokes danger or death on the railways to influence the knowledge provide an indication that something is wrong when someone goes
of regulations and awareness of risks, it does not necessarily take out onto the tracks, providing people in the area with an
into account the issues related to suicide (e.g. the need to be opportunity to react.
positively primed). Their effect on the latter can thus be negative
by spreading the message that entering the tracks can be fatal, but 4.1.9. Technical design to reduce the effects of impact
there are no studies to evaluate if this is indeed the case. In Some publications recommend an improved ergonomic design
contrast, targeted safety communications to prevent suicide work of trains against general injury without providing further details or
differently, since they are included into wider action plans such as evidence for effectiveness (e.g. Akkaş et al., 2011; Lerer and
national/local prevention campaigns along with other measures Matzopoulos, 1996; Matzopoulos and Lerer, 1998; Nixon et al.,
(e.g. posters, helplines, gatekeeper training). Community media 1985). The train front should be designed to dissipate the collison
campaigns advertise local crisis intervention centres (Symonds, energy as greatly as possible, considering the human tolerance of
1994) or inform commuters what they can do to help prevent mechanical impacts: instead of a blunt crash into persons on the
railway suicides (Kerkhof, 2003). The internet and the new social tracks redesign of fronts may help to push them aside (Beskow
media can also be used to promote helplines for people at risk of et al., 1994). In addition to the front geometry (Routley et al., 2004),
suicide (Hepp et al., 2012). As yet, little research has tested this can be achieved through smooth surfaces, shock absorbing
whether all forms of today’s media can be used to positively affect structures, deflecting devices (Rådbo et al., 2008), or trains with
vulnerable individuals in a way that promotes good mental health more ground clearance (Coats and Walter, 1999). Specific examples
or adaptive help seeking at times of distress (Yip et al., 2012). include nets on trains (Ladwig et al., 2009), the redesign of the axel
Public communication should be tailored more precisely to the box dampers along the sides of the rolling stock (Rådbo et al.,
need of specific locations (Dinkel et al., 2011). For example, in- 2012a), and inflatable airbags mounted in front of trains (Beskow
hospital communication (Ladwig et al., 2009) may help increase et al., 1994; Kerkhof, 2003; Rådbo et al., 2012a). An airbag, which
awareness in psychiatric units (Mishara, 1999) on the identification inflates after the use of an emergency brake, can cushion and
of suicide risk and the need to educate patients about the false reduce the impact of collision between a body and a train, and a
beliefs that rail suicides provide for a certain, painless, and rigid skirt can prevent the body from falling underneath the train
immediate death (Mishara, 2007). A public health campaign may (Clarke and Poyner, 1994). It has been suggested that a well-
have a dual role to play in simultaneously raising public awareness designed protective skirt also has a psychological effect on people
of mental health concerns, while also reducing the possibility of contemplating train suicide by reducing the appeal of the front of a
copycat suicides (Bhui et al., 2013). An improved public health train as a tool for suicide (Clarke and Poyner, 1994). However, it is
policy should focus not only on mental health problems but also on not clear to which extent these recommendations are actually
the use of alcohol and drugs (Silla and Luoma, 2012a). implemented in practice or even considered by designers and
engineers in the industry. Moreover, we could not identify any
4.1.8. Signage study to show the effect of such measures.
Signage is mostly an anti-trespass measure, but some The design of tracks to reduce the injuries to people hit by trains
recommendations can be found in the suicide literature as well. (Beskow et al., 1994; Rådbo et al., 2008) is also taken into account.
In the context of trespass (e.g. DaSilva and Carroll, 2011; Lobb et al., One recommendation is to place the third electric rail further from
2001; RSSB, 2005), the measure is partly linked to education in the platform (Hawton, 2007) to decrease the chances of
order to support people's interpretation and awareness about electrocution, but it is yet unknown if this measure would really
prohibited actions or about risks and/or recommended actions. make a difference. Nevertheless, the most common and effective
Warning signs and prohibitive signs are equally recommended (e.g. measure is to deepen the space between the rails at stations in
C.A.R.E., 2006; DaSilva and Carroll, 2011; RSSB, 2005; Silla and order to create a pit (Hawton, 2007; Holdaway et al., 2012; Ladwig
Luoma, 2009; RSSB, 2011a; Savage, 2007) and should be placed at et al., 2009; Mishara, 2007; Ratnayake et al., 2007; Rådbo et al.,
hotspots (BTRE, 2002; RSSB, 2005, 2006). Silla and Luoma (2011) 2008; Routley et al., 2004; van Houwelingen, 2011). This pit has the
evaluated the effectiveness of prohibitive signs at a hotspot in same length as the platform (Coats and Walter, 1999) and is usually
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 43

Table 7
Summary of the studies which provide empirical support for appropriate reporting or broadcast of suicides.

Reference (authors, Location and Study design and measures Sample and data collection period Significant results reported and implications
date) specific for the effectiveness of the measure
setting
Hegerl et al. (2013); Germany, Study design: quasi experimental, 498 railway suicidal behaviours in the Significant increase in rail suicide, and
Ladwig et al. railway ecological study, based on suicide data same index period of 4 different years higher than the general increase in German
(2012) system measured before and after the railway (index period = 11 November to suicide. Railway suicidal behaviours in the
suicide of a famous German football 31 December of the year): 310 suicidal index period increased by 1.81 (incidence
player behaviours in index period of 2006– ratio), after adjusted for daily temperature,
2008 and 188 in index period of 2009 leading to an overall percentage change of
81%.
No intervention: observation of the Comparing the number of suicides 28 days
copycat effect by comparing the suicide before and after the incidence revealed a
rates two-years before and two-years more pronounced increase. Railway
after the celebrity’s suicide suicidal behaviours increased by 2.2
(incidence ratio) after 28 days of the
incidence, after adjusted for daily
temperature. Railway suicidal behaviours
increased by 18.8% in the following two
years.
Outcome variable: number of railway
suicidal behaviours (suicides and suicide
attempts)

Yang et al. (2013) Taiwan Study design: quasi experimental, All suicides in Taiwan (n = 31,364) between Increased suicide deaths during major
longitudinal ecological study, based on 2003–2010 suicide events such as celebrity death and
suicide rates in the general population delayed effect of copycat suicide following
media reports of minor suicide events. The
means of suicide reported in the media
diversely affected the suicide models:
media reports of jumping had a wide
association with various suicide models.
Media reports of suicide had a higher
association with suicide deaths in urban
than in rural areas.
No intervention: observation of the
copycat effect by correlating the number
of suicides with news reports of suicide
Outcome variable: number of general
suicides

Kunrath et al. Germany, Study design: quasi experimental, 747 railway suicidal behaviours in The daily number of suicidal acts was
(2011) railway ecological study, based on suicide data 2004–2007. 43–53% higher during the 2 month index
system measured before and after a presumed period (following extensive media
railway suicide incident coverage of a disastrous accident) in
comparison to the control period days.
Intervention: widespread media Index period: first 2 months after the Daily railway suicidal behaviours increased
reporting of a presumed critical railway presumed railway suicide incident by 44% following extensive media coverage
incident involving suicide; two control (January and February 2007) of the presumed railway suicide incident in
periods compared with study period the index period, after controlling for
unemployment rates and temperature.
Outcome variable: number of railway
suicidal behaviours (suicides and suicide
attempts)

Niederkrotenthaler Austria, Study design: quasi experimental, Year 1982–1983 to 2004–2005 Subway suicides decreased by
and Sonneck Vienna ecological study, with before and after approximately 62 cases following the
(2007) underground measurements, based on injury data introduction of media guidelines, after
controlling the passenger number.
Intervention: introduction of media guidelines in 1987–1988.
Outcome variable: number of subway
suicides

Etzersdorfer and Austria, Study design: quasi experimental, 155 subway suicidal behaviours between A sharp drop of suicides and attempts can
Sonneck (1998) Vienna ecological study, with before and after 1980–1996 be found after the intervention. The
underground measurements, based on injury data decrease from the first half of 1987 to the
second half is 84.2% for suicides and
attempts taken together (n = 19 to n = 3). In
the subsequent years the number of
suicides and attempts stayed low, although
up to five events per half-year can be found.
The level of 1983 to 1987, nevertheless, has
not been reached until 1996.
Intervention: implementation of guidelines for responsible media reporting on suicide
in mid-1987.
Outcome variable: number of subway
suicidal behaviours (suicides and suicide
attempts)
44 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

Table 7 (Continued)
Reference (authors, Location and Study design and measures Sample and data collection period Significant results reported and implications
date) specific for the effectiveness of the measure
setting

Schmidtke & Häfner Germany, Study design: quasi experimental, From 1976 to 1984 Imitation effects were most clearly
(1988) railway ecological study, based on suicide data observable in the groups whose age and
system measured before and after a twice- sex were closest to those of the model. Over
broadcast of a railway suicide in a extended periods (up to 70 days after the
A–B–A–B–A design (A = baseline, first episode), the number of railway
B = broadcast phase) suicides increased most sharply among
15- to 19-year-old males (up to 175%).
Factor: a twice-broadcast 6-episode The effect steadily decreased in the older
weekly serial showing the railway age groups, so that no effect was
suicide of a 19-year old male student; observable for males over 40 years and
first broadcast in 1981; second broadcast females over 30 years.
in 1982
Outcome variable: number of railway
suicides

one-metre deep (Bhui et al., 2013). The ditch may decrease the However, there are no studies which show an effect of this measure
contact between train and body (Beskow et al., 1994), but even on the actual suicide figures.
when present, if the casualty has not fallen into it then he or she is In addition, a more general and not so intensive training (Cohen
unlikely to survive (Coats and Walter, 1999). This measure is et al., 2003) not restricted to suicide could brief the staff at stations
popular in underground systems which have pits for water or LCs (RAIB, 2011) to increase awareness (Wasnik, 2010), identify
drainage. There is evidence that pits are highly effective in and report signs of previous trespass such holes in access fences
reducing injury and mortality following a collision. In the London (RSSB, 2005). In the UK, a quick initial training with volunteers
underground they reduced suicide mortality from 66% to 45% encouraged to report ‘live’ trespass, proved a cost-effective
(O’Donnell and Farmer, 1994) and the overall number of deaths addition to existing formal monitoring and reporting systems
from 76% to 44% (Coats and Walter, 1999; see Table 5 for details). (RSSB, 2005). Another important dimension of staff training
Although most recommendations come from the suicide concerns secondary or tertiary prevention such as: raising
literature, this category of measures is effective against both awareness about the impact of post-traumatic events and the
suicide and trespassing accidents by decreasing the mortality rate prevention of post-traumatic stress (e.g. BTRE, 2002; RSSB, 2013)
after collision. The effect is however not to prevent the incidents and providing the necessary psychological support in response to
but to mitigate the consequences. the trauma caused by suicide or trespass events (see Cothereau
et al., 2004; Limosin et al., 2006; Occupational Health and Safety
4.1.10. Staff training Group – UIC, 2011, for details).
Staff training involves at least two distinct directions that cover
the primary, secondary and tertiary prevention of suicides and 4.1.11. Risk assessment
trespassing accidents. The gatekeeper training teaches specific Risk assessment is frequently mentioned as an indispensable
groups of people to identify and approach people at risk of suicide procedure in suicide and trespass prevention, because it helps
and to manage the situation appropriately. Local gatekeepers can stakeholders in deciding what measures are appropriate, what
be staff, police, traffic officers, security guards or ambulance their aim is or where they should be implemented. Organisations
personnel, who might in the course of their day-to-day work or industries can identify the risk of suicide associated with
encounter suicidal individuals (Beautrais, 2007). Railway staff are particular groups or individuals: patients in services that are
trained to understand the behaviour patterns of subjects at suicide located near railways (Bhui et al., 2013), patients with affective and
risk (Andriessen and Krysinska, 2011; Dinkel et al., 2011) and psychotic disorders (van Houwelingen and Kerkhof, 2008), drug
vulnerable time windows of excess risk for railway suicides (Erazo users in subway stations (Niederkrotenthaler et al., 2012), or the
et al., 2004b). They are also trained to manage suicidal contacts causes of suicide in different age groups (Routley et al., 2004).
(RSSB, 2011c) and to assist them by initiating relevant protocols Other risk assessment recommendations include the identification
and managing the situation until emergency services arrive and monitoring of regional and local suicide hotspots (Brown et al.,
(Ratnayake et al., 2007). These educational efforts can take into 2012; Debbaut et al., 2013; Erazo et al., 2004a) and station audits
account the knowledge and skills of experienced police officers (RSSB, 2013). Although most recommendations come from the
regarding recognisable risk factors (Lukaschek et al., 2011) and give suicide literature, one report (RSSB, 2012) discusses risk assess-
the staff the tools and the confidence to intervene in a potential ment in a wider context which includes both suicide and trespass
suicide attempt where appropriate (Brown et al., 2012). Such prevention, in particular related to safety performance monitoring
programmes have led to successful primary and secondary and follow-up processes. Furthermore, the approach described by
interventions (for example in the Montreal metro system) Debbaut et al. (2013) to characterize suicide hotspots can be easily
resulting in a substantial number of people being intercepted adapted to identifying trespass hotspots: analysing and mapping
before a possible suicide attempt (Ladwig et al., 2009). A more incident data, gathering information during field visits, and
thorough evaluation of a 1-day gatekeeper course conducted in the conducting semi-structured interviews with relevant actors. We
UK (RSSB, 2013) indicates that participants had a positive attitude could not identify any study evaluating the effectiveness of risk
about the training and gained confidence to take action if needed. assessment procedures per se.
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 45

4.1.12. Learning from previous research and best practice ditch lights (Savage, 2006) and auxiliary alerting lights in addition
This measure refers to forms of organisational learning to to the headlight for all fast locomotives (Horton, 2009). Other
acquire and update knowledge for prevention practice. This papers refer to improved speed control and ability to brake earlier
includes learning from research studies (Botha et al., 2010; Searle by facilitating emergency stops (Clarke and Poyner, 1994).
et al., 2012), developing specific research topics (RSSB, 2012), Magnetic brakes on more trains to shorten the stopping distance
collecting data on incidents type and frequency (Thompson et al., (Rådbo et al.,, 2012a) could be a technical solution in this respect,
2012), and sharing and completing databases (Lerer and Matzo- but there are no details about the cost difference and technical
poulos, 1996). Learning can benefit from international experience difficulties related to implementation. Another solution is to alert
(ERA, 2011) for example by creating an international train suicide the driver beforehand thereby given a chance to brake earlier and
database with standardized definitions, similar to the International avoid the collision (Rådbo et al., 2008). This can be achieved
Road Traffic and Accident Database (van Howelingen, 2011). through in-cab CCTV (Beskow et al., 1994; Holdaway et al., 2012;
Previous national experience (Andriessen and Krysinska, 2011) is Mishara, 2007; RSSB, 2010) displaying in advance the current
also important for learning, considering all the information picture of risk locations (bridge, station, LC, etc.) which allows
collected through systematic case investigations (Rådbo et al., drivers to monitor the situations and to react if needed. An
2012c). Although no study has directly evaluated their effective- alternative can be the reduced spot speed limits for trains
ness for suicide or trespass, some publications provide a few (Holdaway et al., 2012; Silla and Kallberg, 2012) giving the drivers
successful examples in this direction. Anderson et al. (2003) have some extra reaction time and the possibility to stop the train faster.
shown for instance that benchmarking has proven to be a valuable However, it is unknown how much time would be needed to make
methodology to improve performance in the railway sector, and a difference. Rådbo et al. (2012a) propose warning feedback from
that safety is one mandatory success factor for the key perfor- train drivers, when they observe trespassers, to train-dispatchers
mance indicators. Similarly, RSSB (2013) provides a good and other train drivers in order to reduce speed and increase
collaborative practice between several stakeholders to improve watchfulness at the actual spot. Although most recommendations
suicide prevention methods on the rail network in Great Britain come from the suicide literature, these technologies for train
(i.e. infrastructure manager, railway undertakings, Samaritans, drivers are expected to have the same effect for trespass. The level
British Transport Police, and organisations outside the rail of evidence is weak since evaluations are missing.
industry).
4.1.15. Design and aesthetics to influence behaviour
4.1.13. Lighting systems to influence behaviour New stations should be designed to reduce the probability of
The use of lighting systems to influence behaviour is a relatively people to move into high risk locations (Ratnayake et al., 2007), to
recent measure recommended against both suicide and trespass. avoid overcrowding and to ensure a culture of safety and care
For suicide prevention, the goal is to increase the visibility of the signalled to all passengers through a transformed environment
potential victim, decrease the privacy and anonymity, and that mitigates impulsivity (Bhui et al., 2013). This category of
positively influence the impulsive/ambivalent suicidal phase interventions includes specific measures such as redesigning the
(e.g. Mishara, 2007). Specific examples include improved lighting platforms by removing old unused platforms used as ‘spring-
in dark sections of the platform and high-risk locations (van boards’ for suicide (Andriessen and Krysinska, 2011; Debbaut et al.,
Houwelingen, 2011), using photoelectric breams or flash lights at 2013) or enforcing the gap (of at least 2 ft) between the edge of the
stations (Erazo et al., 2005), combining lighting with movement platform and where passengers can stand (Holdaway et al., 2012).
tracking sensors (van Houwelingen, 2011), and increasing light The measure also includes visual artefacts to influence the moods
exposure (bright white or blue light) in railway platforms or in and behaviours of people such as the installation of mirrors to
trains when consecutive days without sunshine are forecasted reduce the feeling of privacy (Erazo et al., 2005; Ladwig et al., 2009)
(Kadotani et al., 2014). The installation of ‘calming’ blue light at or painting of the platform sides (Lindberg, 2012). A calmer colour
station platforms and crossings is a new and intriguing measure (such as green or blue) may be less likely to trigger impulsive and
that has only been examined in one location. An initial study from self-destructive acts and should be used to paint the exterior of the
Japan (Matsubayashi et al., 2013) reported that blue light reduced trains; moreover, painting trains in red should be avoided since red
railway suicide with 84%, but a follow-up study by Ichikawa et al. is perceived as a demanding or aggressive colour, and associated
(2014) criticises this result and argues that it is severely with blood (Bhui et al., 2013).
overestimated (see Table 5 for details). As Too et al. (2014) point The aesthetic interventions are mostly discussed in the context of
out the longer-term effect of this measure, the underlying causal suicide prevention, with only a few recommendations in the
mechanism of why this is effective and substitution effect to other trespass literature. Improving the physical and social environment of
stations and other suicide methods over time should be evaluated. stations, carriages and public walkways and establishing a colour
Blue light is the only measure with some empirical support in this palette for public spaces is assumed to reduce trespassing behaviour
category. For trespass, light has a different effect mechanism: it derived from vandalism intentions. Stations should be designed with
signals to the people who cross the tracks that the area is an open layout and in such a way to reduce the opportunities for
monitored by the railway organisation. In this case, lighting is graffiti by removing potential surfaces or by planting vegetation in
proposed to be used at high-risk railway locations (Savage, 2007) front of the walls (Offler et al., 2009). The surfaces should not be very
such as holding yards (Offler et al., 2009) where it is useful to light coloured since light surfaces are targeted more than dark ones
prevent vandalism (Thompson et al., 2012). No published study has (Offler et al., 2009). In addition, mobile teams of graffiti spotters and
evaluated the effect of light on trespassers. clean-up trailers should regularly identify and remove graffiti from
station surfaces and trains (Offler et al., 2009; Thompson et al., 2012),
4.1.14. Additional technologies for train drivers ensuring a clean railway environment. There is no published
Technology for train drivers to help them take some actions to evidence that these interventions actually reduce the incidence of
reduce the risk of collision are another recommended measure. suicides or trespassing accidents.
Some technologies are installed outside the cabin and used to warn
and encourage people to leave the track (e.g. horns; BTRE, 2002) or 4.1.16. Operational traffic management
improve visibility for train drivers. The latter may include This measure consists of traffic planning and special procedures
spotlights on the front of trains (Savage, 2007), locomotives with in accordance with risks already identified to prevent further
46 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

incidents. Some recommendations are to reduce the average speed reduction by 62 completed suicides, after controlling for passenger
of trains as they approach station platforms (Mishara, 2007; numbers (Niederkrotenthaler and Sonneck, 2007). An additional
Ratnayake et al., 2007; Routley et al., 2004; van Houwelingen, approach is to reward the well behaving journalists or good quality
2011) or previously identified hotspots (Erazo et al., 2005; Silla and reporting on suicides with ‘Media Awards’ (Andriessen, 2011; Dare
Luoma, 2012a). Others propose to reduce train traffic intensity et al., 2011). The awards can increase the likelihood that media
(BTRE, 2002), although this may be difficult or even inappropriate professionals will embrace the guidelines and can help raising
to implement especially in densely populated suburban areas at community awareness about suicide (Dare et al., 2011). Although
rush hour. A study by van Houwelingen et al. (2013) provides some its effect on actual suicide rates is still unknown, Media Award was
support for this recommendation since it identified a positive well received by journalist associations in Belgium, hence is a
association between the train frequency and railway suicide in the promising method to improve collaboration between suicide
Netherlands and Germany (see Table 5 for details). The lower prevention and media sector (Andriessen, 2011).
frequency of commuter trains can be compensated by increasing Appropriate reporting also concerns announcements made in
the capacity of each individual train, for example by making trains trains or at stations about suicide and subsequent delays (Bhui
longer, using double-decker trains, or introducing compartments et al., 2013). These announcements may reach tens of thousands of
with standing places (van Houwelingen, 2011; van Houwelingen passengers simultaneously, thus railway companies are advised to
et al., 2013). design announcement protocols that inform passengers and
This measure is proposed mostly in the suicide literature but bystanders about a critical incident but avoid promotion and
also applies to prevent trespass accidents. In fact, operational further implementation of railway suicide into the subconscious of
measures are implemented more extensively than it appears in the the passengers (Ladwig et al., 2009). The message should be
literature at least because they refer to safety rules that any driver neutral about the nature of the incident (e.g. ‘Delay because of an
should follow (included in the usual driver training). In practice, accident’) (van Houwelingen, 2011).
many railway undertakings have clear rules which request train Finally, it is recommended that death memorials should be
drivers to reduce the speed in case they see persons in the vicinity removed from the railway environment due to risk of copycat
of tracks. This measure partially overlaps with other general suicides and upset to staff involved (RSSB, 2013). We can observe,
measures identified in the current review. For example it may however, that in related areas such as road safety memorials for
require the collaboration and efficient communication between the deceased have occasionally been used to remind road users of the
multiple concerned institutions such as railway undertaking, danger. Research is thus required to clarify this issue in the railway
infrastructure manager, police, fire services, etc. It may also rely on context.
previous risk assessment and the additional technologies for train
drivers which facilitate their information and communication with 4.2.2. Emergency information and outreach support at suicide
train-dispatchers and other train drivers. hotspots
This measure aims to encourage the people who contemplate
4.2. Measures to prevent railway suicides suicide to seek help and find support (du Roscoät and Beck, 2013;
Holdaway et al., 2012; Ladwig et al., 2009; Mishara, 2007). This
In this section we discuss three suicide-specific interventions measure is particularly recommended at station platforms
which have not been addressed previously. (Routley et al., 2004), LCs (Savage, 2007) and bridges (Beautrais,
2007). Specific interventions include installing signs and tele-
4.2.1. Appropriate reporting or broadcast of critical incidents phones (Cox et al., 2013), posters to promote hotlines, crisis
This measure is mentioned in the suicide literature as an intervention and mental health services (Debbaut et al., 2013;
important intervention (e.g. Beskow et al., 1994; Cox et al., 2013; Krysinska and De Leo, 2008; Mishara, 1999) and assuring an
Daigle, 2005; Etzersdorfer and Sonneck, 1998; Hepp et al., 2012; outreach support by trained staff on call (Brown et al., 2012).
Holdaway et al., 2012; Leenaars, 2005; Mishara, 2007; Niederkro- Outreach work consists of a rapid response by prevention services,
tenthaler et al., 2009, 2012; Sarchiapone et al., 2011; Sonneck et al., who will visit stations to offer emotional support to those
1994; Sisask and Värnik, 2012; Stack, 2005; Too et al., 2014; Yip identified in need 24 h a day, 7 days a week (RSSB, 2013). This is
et al., 2012). The main goal of this measure is to provide mass based on a call to prevention services by railway staff (Brown et al.,
media with guidelines and tips on how to adequately report 2012) and requires enhanced response readiness among train-
suicides in order to avoid a copycat effect. The first and most dispatchers and rescue services (Rådbo et al., 2012a).
popular recommendation is to withhold information about This measure also enables people who notice problematic
suicides from the public (Rådbo et al., 2008), in particular the behaviour to ensure a rapid intervention, before the suicidal
details about the method and site (Beautrais, 2007), in order not to person collides with the train (e.g. Kerkhof, 2003) by signalling the
inspire future suicide candidates. The competitive reporting of risk or triggering an alarm. Placing communication poles with
minor suicide events must also be avoided (Yang et al., 2013). instructions on platforms could serve as a clear intermediate for
Media should insist on the successful coping strategies of people commuters to ask for help when spotting a possible suicide
who intended to commit suicide (Niederkrotenthaler et al., 2010) candidate on the station platform (van Houwelingen, 2011). Stop
and on persons with suicidal ideation who succeeded not to plungers (Routley et al., 2004) and emergency buttons on
attempt suicide (van Houwelingen, 2011). Evaluation studies platforms allow staff to stop trains before they come into stations
conducted in different countries (see Table 7 for details) have (Holdaway et al., 2012). Electronic information billboards for
reported significant increase in railway suicide following media passengers, equipped with an emergency button allow passengers
reports of suicide incidents (Kunrath et al., 2011), strong copycat to quickly contact railway safety services aims to improve safety at
effect following celebrity suicide (Hegerl et al., 2013; Ladwig et al., suicide hotspots (Andriessen and Krysinska, 2011). No evidence
2012), imitation of suicide means reported in the media (Yang has been published yet concerning the effectiveness.
et al., 2013), and contagion especially in the groups whose age and
sex were closest to those of the model (Schmidtke and Häfner, 4.2.3. Decrease the attractiveness of the railways as lethal method
1988). Implementation of media guidelines in Vienna under- This category has sometimes been referred as ‘alternative’ to
ground in 1987 determined an immediate 84.2% drop in suicidal railway suicide, since people who contemplate suicide can be
behaviours (Etzersdorfer and Sonneck, 1998) and more recently a provided with the possibility to choose another method than the
G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50 47

railways (Sarchiapone et al., 2011; van Houwelingen, 2011). This and socio-economic value of safety measures against rail suicide
scarcely mentioned measure is controversial due to legal and and trespass.
ethical issues and has not been evaluated. Some authors question
the probability of ‘replacement’ of one suicidal method with 5.2. Considering potential interactions between measures early in the
another (e.g. Beskow et al., 1994), and its implementation remains selection step
problematic.
The countermeasures evoked in the literature on suicide and
5. Challenges for the future prevention practice those from the publications on trespass often overlap. This brings a
major advantage for the safety practice because most measures
5.1. Investigating the whole range of measures with evidence-based help preventing suicide and trespass simultaneously. However, the
and theory-based approaches specific way of implementation and the effect mechanism of a
given measure may be different for suicide and trespass and this
Despite more than 35 years of research into rail-pedestrian should be carefully considered before the implementation stage.
safety, current prevention practice lacks consistent empirical Physical measures like fencing or landscaping make the access to
support for effectiveness and relies on general recommendations the tracks more difficult, with no large differences in how they are
or mere assumptions. The actual effect of most measures on the implemented against suicide or trespass. Similarly, technical design
number of railway suicides and trespassing accidents is not clear, to reduce the effects of impact is implemented in similar ways and
and this calls for more research on the whole range of proposed has similar effects on suicide and trespass, with no risk of negative
measures. The general classification and the specific approaches interference between the two. Other engineering measures, such
described in this paper can serve as a frame to structure the future as lighting systems or design and aesthetics influence suicidal and
research and evaluation. Most of the available evidence comes trespassing behaviours in fundamentally different ways. The same
from the scientific literature, with only one study (RSSB, 2013) can be said for collaborative and behavioural measures, where the
from the grey literature, of these only 4 of the 22 are from trespass different effect mechanisms should be carefully considered before
literature (DaSilva et al., 2006; Lobb et al., 2001, 2003; Silla and the implementation process together with the potential negative
Luoma, 2011). outcomes on either suicidal people or trespassers (see for example
Two measures have evidence coming from multiple studies the previous discussion on education, public safety communication,
conducted in various countries: (a) fencing and other physical or staff training). Decision makers should carefully choose the
barriers and (b) appropriate reporting or broadcast of suicides to measures most adapted to the target-problem or location
avoid a copycat effect. Fencing has been shown to reduce fatalities characteristics and consider their potential interactions or side
at suicide hotspots between 59% (Law et al., 2009) and 100% effects in regard to the various categories of people at risk.
(Beautrais at al., 2009) and trespassing behaviour between 23%
(Lobb et al., 2001) and 95% (Silla and Luoma, 2011) at trespass 5.3. Integrating measures into systems of intervention against both
hotspots. Six studies about media guidelines have been conducted suicide and trespass
in different time periods and during longer and shorter time
intervals in Germany, Austria and Taiwan, and suggested that In the last decade there has been a high preference for
guidelines might reduce suicidal behaviour between 19% on the recommending both behavioural and engineering measures. Even
long term (i.e. two years after the broadcast) (Hegerl et al., 2013) if multiple measures are proposed in the same paper, the authors
and about 84% on the short term (i.e. six months after usually discuss them separately and not in combination. There are
implementation) (Etzersdorfer and Sonneck, 1998). two direct consequences of this: there are actually few publica-
The measures with stronger evidence still leave room to tions which suggest a real ‘multi-method’ approach and there is
unanswered questions. For example, the current review was not little knowledge about the effects of combining multiple measures
able to identify any study that compares trespasser and suicide into a strategy aimed at reducing train-pedestrian collisions in
rates in the UK (where all railways are fenced by law) with rates in specific circumstances. In fact, only two studies on trespassing
similar countries where railways are not fenced. For the rest of the have evaluated the effect of combined measures (Lobb et al., 2001,
measures, the level of evidence is weaker because (a) the results 2003) and showed that it significantly improved the outcome. The
come from fewer or single studies, (b) the studies were conducted results of this review are thus in line with the literature which
in one country or limited contexts, and (c) the effect of the posits that injury prevention is a complex problem that cannot be
measure was not quantified as the reduction in the number of solved with simple solutions (Cohen et al., 2003). A multifaceted
suicide or trespass cases. Future evaluations could benefit from approach, using a mix of measures directed at specific issues, can
the elaboration of a theory-based evaluation framework (Weiss, be effective in discouraging access to the railway lines (RSSB,
1997) dedicated to rail suicide and trespass prevention. This is an 2005). It is noteworthy that some behavioural measures are
explicit conceptualisation of the chosen prevention measures in actually interdependent and are most likely to naturally work in
terms of the desired effect (e.g. increasing risk awareness in a combination. For example, education-related measures are closely
specific target-group; improving detection rate of persons at risk linked to media communication and to other means of information
through CCTV and surveillance staff) in relation to the expected such as posters or signs and can be used altogether during a
outcomes (e.g. significantly decreasing the number of train- preventative campaign as they eventually serve the same purpose.
pedestrian collisions) as well as the impact on other consequen- The engineering/behavioural classification points out that meas-
ces (e.g. time loss and delays). Recently a model has been ures influence behaviour in fundamentally different ways. One
proposed to describe the chain of events leading to railway major challenge for the prevention practice is to achieve an optimal
suicides and trespassing accidents (Burkhardt et al., 2014). It is effect by considering the complementarities between these two
the first attempt to integrate both suicide and trespass sequential types of measures. Engineering measures create a first line of
processes and the corresponding classes of prevention measures defence against hazards by blocking or detecting risky behaviours
depending on their type of effect mechanism (e.g. influence but might be more effective when supplemented with behavioural
decision, deter access, influence behaviour in the track area or measures which point towards the correct behavioural alternative
reduce the collision consequences). This model could provide the (Ladwig et al., 2009; Offler et al., 2009; Thompson et al., 2012) as
basis for a theory-based approach to evaluate the effectiveness shown in one study (Lobb et al., 2001).
48 G.M. Havârneanu et al. / Accident Analysis and Prevention 81 (2015) 30–50

In practice, it is important to consider that one engineering circumstances when measures to prevent suicides can stimulate
measure can achieve multiple functions. For example, detection trespassing and vice versa, as well as those when there is no
systems may deter trespassers, warn trespassers, alert the safety interaction between combined measures. From a practical
staff and facilitate their intervention in case of suspect behaviour, viewpoint, an integrative overview of all cost-effective measures
record information about the occurring incidents, and allow to pretested and organised in a single application guideline could be
better understand the behaviour of people or the incident helpful for the future preventative interventions. This work has
statistics. In addition, such technical systems are rarely fully begun during the RESTRAIL project through the development of a
automatic. Unless they use intelligent CCTV, they require human toolbox for decision-makers (www.restrail.eu/toolbox).
assistance and intervention, which means they are most likely to
be combined with behavioural measures such as staff training and
Acknowledgements
enforcement and patrols. Moreover, their effect on behaviour is
mainly behavioural because they only deter risky behaviour and do
This study has been conducted as part of the project RESTRAIL
not physically block it. Although detection systems are technical
(REduction of Suicides and Trespasses on RAILway property) which
measures at origin, from the implementation viewpoint they are
was coordinated by the International Union of Railways (UIC). This
actually a mixture of technical and behavioural elements. <**In
project has received funding from the European Union’s Seventh
sum, combined solutions should include engineering and behav-
Framework Programme for research, technological development
ioural measures and consider their multiple functions.
and demonstration under grant agreement no. 285153. The
authors would like to thank all collaborators for their support
6. Conclusions
during the development of this work.
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