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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 4  |  Page : 135-139

Evaluation of pedestrian–train fatalities in the State of Maryland: A 5-year retrospective study


1 Office of the Chief Medical Examiner, State of Maryland, Baltimore, Maryland; Master of Science in Forensic Medicine Program, Graduate School, at University of Maryland Baltimore, Baltimore, Maryland, USA
2 Office of the Chief Medical Examiner, State of Maryland, Baltimore, Maryland, USA

Date of Submission01-Aug-2020
Date of Acceptance29-Oct-2020
Date of Web Publication05-Jan-2021

Correspondence Address:
Ling Li
Master of Science in Forensic Medicine Program, Graduate School at Graduate School, University of Maryland Baltimore, Baltimore, Maryland
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfsm.jfsm_75_20

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  Abstract 


Few studies have been done on the incidences of train-related pedestrian fatalities throughout the United States, with no previous studies reported in the State of Maryland. A retrospective study was conducted at the statewide medical examiner's office in Maryland to evaluate the characteristics of train-related pedestrian fatalities from 2014 to 2018. The aim of the study was to analyze circumstances of deaths through the medicolegal death investigation and postmortem examination findings, including toxicological study, to help identify epidemiological characteristics of pedestrian–train-related fatalities. A total of 48 pedestrian-train deaths were identified. Of the 48 cases identified, 21 deaths (43.75%) were determined to be accident, 20 deaths (41.67%) were suicide, and 7 deaths (14.58%) whose manner of death could not be determined. Of the 21 accidental victims, 17 were male and 4 were female (M:F ratio = 4.3:1), 11 (52.38%) were white, 6 (28.57%) African American, and 4 Hispanic (19.05%), with age ranging from 16 to 58 years (mean age = 35). Of the 20 suicide victims, 17 were males and 3 females (M:F ratio = 5.7:1), 16 (80%) were white, 2 (10%) African American, and 2 (10%) Hispanic, with age ranging from 22 to 60 years (mean age = 40). The majority of accidents occurred during weekday evening rush hours between 4:00 pm and 7:00 pm, while the suicides showed no specific time frames. No specific peak for seasons of year was found in suicides or accidents. Postmortem toxicological studies showed that 52.38% (11/21 cases) of accidental victims were positive for alcohol and 30% (6/20 cases) of suicide victims were positive for alcohol. Manner of death could not be determined in 7 cases because of unclear circumstances of death. Thorough death scene investigation and complete postmortem examination, including comprehensive toxicological testing, is very important in all train-related pedestrian fatalities. Determining the manner of death can directly affect the outcome of civil ligation and dispersal of insurance benefits. The characteristic profiles of train-related pedestrian fatalities can also assist effective preventive measures on railway suicides and accidents.

Keywords: Pedestrian, train, accident, suicide, forensic investigation


How to cite this article:
Carias E, Hammerschmidt C, Hall T, Zhang X, Phipps R, Li L. Evaluation of pedestrian–train fatalities in the State of Maryland: A 5-year retrospective study. J Forensic Sci Med 2020;6:135-9

How to cite this URL:
Carias E, Hammerschmidt C, Hall T, Zhang X, Phipps R, Li L. Evaluation of pedestrian–train fatalities in the State of Maryland: A 5-year retrospective study. J Forensic Sci Med [serial online] 2020 [cited 2021 May 15];6:135-9. Available from: https://www.jfsmonline.com/text.asp?2020/6/4/139/306185

Elvira Carias, Claire Hammerschmidt, Taylor Hall contributed equally and are co-first authors





  Introduction Top


According to the Federal Railroad Administration, from 2014 to 2018, there were a total of 59,316 train accidents at railroad crossings, resulting in 3910 fatalities and thousands of injuries over the course of that 5-year span.[1] Studies conducted in several countries revealed that suicide cases consisted of majority of pedestrian–train-related fatalities, with 80% of train pedestrian collisions being determined suicide in previous studies both in Sweden[2] and Finland.[3] Few studies have been conducted on the incidences of train-related pedestrian fatalities throughout the United States, with no previous studies reported in the state of Maryland. In many of these cases, the cause of death is very distinctive and clear based on the investigation and autopsy report. The manner of death, however, is often much more difficult to determine in pedestrian–train fatalities. We conducted a retrospective study of all the train-related deaths in the State of Maryland from 2014 to 2018 to identify the characteristics of train-related fatalities.


  Subjects and Methods Top


The State of Maryland consists of 23 counties and a Baltimore city, with a population of 5,773,552 according to the 2010 U.S. Census. The Office of the Chief Medical Examiner (OCME) is a statewide medical examiner system that is responsible for conducting medicolegal death investigations and certifying the cause and manner of all the nonnatural deaths in the State of Maryland. All the nonnatural deaths investigated by the OCME are subject to thorough death scene investigation, reviewing medical history, and postmortem examination including toxicology testing.

This report was a retrospective study of all the autopsied cases of pedestrian–train-related deaths investigated by the OCME in Maryland over a 5-year period from January, 2014 to December, 2018. The police reports, forensic investigation reports, medical records, and postmortem findings for each of the victims were reviewed and analyzed. The following information was extracted for each case: (a) demographic data, including age, race, and gender; (b) death scene findings, including the circumstances of death and known medical history prior to death; (c) autopsy findings; (d) toxicology results; and (e) cause and manner of death.


  Results Top


Demographics

Between January 1, 2014, and December 31, 2018, a total of 2492 transportation-related deaths were reported by the OCME in the State of Maryland. [Figure 1] shows the distribution of transportation-related deaths from 2014 to 2018 in Maryland. There were a total of 543 pedestrian deaths during the 5-year period. Of the 543 pedestrian cases, 48 (8.8%) were pedestrian–train fatalities.
Figure 1: Transporation.related deaths in Maryland (2014–2018)

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[Table 1] shows the demographic characteristics of pedestrian–train fatalities in the State of Maryland. Of the 48 pedestrian–train cases, 21 deaths (43.7%) were determined to be accident, 20 deaths (41.7%) were suicide, and 7 deaths (14.6%) whose manner of death could not be determined whether it was an accidental event or suicidal act or due to criminal act after thorough death scene investigation and complete autopsy examination. A majority of the 48 victims were male, with 41 of them being males and 7 females (M:F ratio = 5.8:1). The age of the victims ranged from 16 to 67 years (mean age = 38). A total of 30 the victims were white (62.5%), 10 of the victims were African-American (20.83%), and 8 were Hispanic (16.67%).
Table 1: Race, gender, and age of pedestrian-train cases by the manner of death in Maryland

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Time of occurrence

Upon evaluating time of day, day of the week, and month of the year, the data illustrated a majority of accidents occurred during weekday evening rush hours between 4:00 pm and 7:00 pm, while the suicides showed no specific time frames [Figure 2]. Time of day for suicide deaths was evenly distributed throughout the 24-hr day, showing no correlation or pattern. Time of day for accident deaths was significant, with 73.68% of deaths occurring after 4:00 pm (1600 h). The majority of the accidents occurred between the hours of 4:00 pm and 7:00 pm (1600–1900 h), which is the period of day often referred to as “rush hour.”
Figure 2: Time of pedestrian–train fatalities by the manner of death

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[Figure 3] shows the distribution of pedestrian–train fatalities by day. There was an increase in the number of fatalities on Mondays (25%) and Wednesdays (22.9%). No specific peak for seasons of year was found in suicides nor accidents, although the month of May demonstrated a slight increase in pedestrian–train fatalities [Figure 4].
Figure 3: Distribution of pedestrian–train fatalities by day

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Figure 4: Distribution of pestrain–train fatalites by months

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Toxicology results

Toxicology specimens were collected for each descendant at the time of autopsy. The postmortem toxicological study showed that 45.8% (22/48 cases) of victims tested positive for alcohol and 35.4% (17/48 cases) tested positive for drugs. Accidental victims were 52.4% (11/21 cases) positive for alcohol (9 cases with blood or vitreous alcohol concentration ranged from 0.15% to 0.47%) and 28.6% (6/21) positive for drug(s), while suicide victims were 30% (6/20) positive for alcohol and 40% (8/20) positive for drug(s) [Figure 5].
Figure 5: Positive alcohol and drug testing results in pedestrian–trian death victims

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The types of drugs detected in the victims' systems were classified into five categories: (1) antidepressants/anxiolytics: amitriptyline, nortriptyline, fluoxetine, paroxetine, citalopram, trazodone, and diazepam; (2) narcotics: fentanyl, methadone, and tramadol; (3) stimulants: methamphetamine/amphetamine and cocaine; (4) hallucinogen: phencyclidine; and (5) other drugs: dextromethorphan, zolpidem, diphenhydramine, chlorpheniramine, and metoprolol.

As shown in [Figure 6]a, of the 48 cases, 27 were positive drugs. Of 27 positive cases, 25.9% (7/27) were antidepressants/anxiolytic, 18.5% (5/27) stimulants, 22.2% (6/27) narcotics, 11.1% (3/27) hallucinogens, and 22.2% (6/27) were other drugs. As shown in [Figure 6]b, of the 20 suicide cases, 8 (40%) were positive for drugs, including antidepressants/anxiolytics (12.3%), stimulants (6.2%), narcotics (3.1%), and hallucinogens (6.2%). As shown in [Figure 6]c, of the 21 accident cases, 6 (28.6%) were positive for drugs, including antidepressants/anxiolytics (9.5%), stimulants (6.4%), narcotics (6.4%), and hallucinogens (3.2%).
Figure 6: Drug distributions in all pedestrian–train (a) death victims, (b) suicide victims, (c) and accident victims

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  Discussion Top


Data from the United States National Safety Council indicated that a total of 407 pedestrian–train deaths occurred in the United States from 2014 to 2018.[4] Of those deaths, 48 (11.8%) occurred in the State of Maryland. The pedestrian–train death rate ranged from 0.2 to 0.29 per 100,000 population in the United States, while in Maryland, the death rate was from 0.13 to 0.19 per 100,000 population [Table 2]. The populations of Maryland and the United States of America were collected from Annual Reports from the Maryland Department of Health and the United States Census Bureau. Maryland's population increased from 5,976,407 residents in 2014 to 6,042,718 residents in 2018.[5] The United States population increased from 319.6 million in 2014 to 327.5 million in 2018.[6] Comparing the populations of Maryland to that of the country, Marylanders make up <2% of the United States population and 11.8% of the total pedestrian–train fatalities.[7],[8],[9],[10]
Table 2: Comparison of pedestrian-train death between the United States and Maryland State

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A trend in time of day was documented for accidental deaths which typically occurred during rush hour between 4:00 pm and 7:00 pm, which could be associated with the increased number of commuters, trains, and traffic during this time period. Comparing our results in Maryland to similar studies conducted in Charleston, South Carolina,[11] Finland,[3] and Portugal,[12] there were numerous dissimilarities. However, a common finding in our data that corresponded with two of the other studies was the notion that a majority of accidents occur during rush hour. The definition of rush hour varied by location: 3 pm–6 pm in Finland,[3] and 6 am–10 am and 5 pm–9 pm in Portugal.[12] More extensive studies will be performed to develop strategies to prevent pedestrian–train collisions, especially during the rush hours.

The majority of Maryland pedestrian–train victims were in their 30s and 40s. In the previous studies,[3],[11],[12] males were more likely than females to die from pedestrian–train collisions. Our study showed that a majority of pedestrian–train victims were white males. Report from Finland illustrated that pedestrian–train fatalities accounted for 5.2% of all suicides.[3] In Maryland, pedestrian–train fatalities consisted of 0.69% (48/2878) of all Maryland suicides. In our study, the number of suicides (20 cases) and accidents (21 cases) were similar; however, in Charleston[11] from 1982 to 1992, accidents consisted of 92% of their 25 reported cases. In Finland[3] from 2005 to 2009, suicides consisted of 84.9% of their 311 cases, and in Portugal[12] from 2008 to 2012, suicides consisted of 60.8% and accidental 30.9% of the 97 cases. The problem of rail suicides appears to be worse in Europe than it is in the United States. Dense rail passenger networks and restrictions on gun ownership result in trains being chosen as the method in a higher proportion of total suicides.[3] In the Unites States, firearms are the most common means of suicide in the United States, followed by suffocation and poisoning.[13]

Suicide victims were more likely to have drugs such as antidepressants/anxiolytics in their system, while accident victims were more likely to test positive for alcohol. These data could be explained by the initial purpose of the antidepressant drugs for the treatment of depression which could lead to suicide and the adverse side effects of alcohol in the body leading to accidents.

Although the cause of death is rarely in doubt in train–pedestrian fatalities, the manner of death is often a challenger to the medical examiners/forensic pathologists.[11] In the current study, of the 48 pedestrian–train cases, 21 deaths (43.7%) were determined to be accident, 20 deaths (41.7%) were suicide, and 7 deaths (14.6%) whose manner of death remained undetermined. Determining the manner of death can directly affect the outcome of civil ligation and dispersal of insurance benefits. It is imperative to carefully review the history, to evaluate death scene investigation findings including eye-witness statement and video recordings, and to analyze the autopsy and toxicology findings when the manner of death is determined in a pedestrian–train-related death.

Acknowledgments

The authors' sincere appreciation goes to the medical examiners, toxicology department, crime scene investigators, and medical record department and IT support staff for their work at the Maryland Office of the Chief Medical Examiner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
U.S Department of Transportation Federal Railroad Administration. Overview Reports; 2020. Available from: https://railroads.dot.gov/accident-and-incident-reporting/overview-reports/overview-reports. [Last accessedon 2020 Mar 04].  Back to cited text no. 1
    
2.
Rådbo H, Svedung I, Andersson R. Suicides and other fatalities from train-person collisions on Swedish railroads: A descriptive epidemiologic analysis as a basis for systems-oriented prevention. J Safety Res 2005;36:423-8.  Back to cited text no. 2
    
3.
Silla A, Luoma J. Main characteristics of train-pedestrian fatalities on Finnish railroads. Accid Anal Prev 2012;45:61-6.  Back to cited text no. 3
    
4.
National Safety Council Injury Facts. Railroad Deaths and Injuries; 2019. Available from: https://injuryfacts.nsc.org/home-and-community/safety-topics/railroad-deaths-and-injuries/. [Last accessed on 2020 Mar 04].  Back to cited text no. 4
    
5.
Maryland Department of Health. n.d. Maryland Vital Statistics Annual Report 2018. Available from: https://health.maryland.gov/vsa/Documents/Reports%20and%20Data/Annual%20Reports/2018annual_rev3.pdf. [Last accessed on 2020 Mar 04].  Back to cited text no. 5
    
6.
U.S. Census Bureau. U.S. and World Population Clock; 2020. Available from: https://www.census.gov/popclock/. [Last accessed on 2020 Mar 04].  Back to cited text no. 6
    
7.
Maryland Department of Health and Mental Hygiene. n.d. Maryland Vital Statistics Annual Report 2014. Available from: https://health.maryland.gov/vsa/Documents/Reports%20and%20Data/Annual%20Reports/2014annual.pdf. [Last accessed on 2020 Feb 25].  Back to cited text no. 7
    
8.
Maryland Department of Health and Mental Hygiene. n.d Maryland Vital Statistics Annual Report 2015. Available from: https://health.maryland.gov/vsa/Documents/Reports%20and%20Data/Annual%20Reports/2015annual_rev.pdf. [Last accessed on 2020Feb 25].  Back to cited text no. 8
    
9.
Maryland Department of Health. n.d. Maryland Vital Statistics Annual Report 2016. Available from: https://health.maryland.gov/vsa/Documents/Reports%20and%20Data/Annual%20Reports/216annual_rev.pdf. [Last accessed on 2020 Feb 25].  Back to cited text no. 9
    
10.
Maryland Department of Health. n.d. Maryland Vital Statistics Annual Report 2017. Available from: https://health.maryland.gov/vsa/Documents/Reports%20and%20Data/Annual%20Reports/2017annual_rev3.pdf. [Last accessed on 2020 Feb 25].  Back to cited text no. 10
    
11.
Cina SJ, Koelpin JL, Nichols CA, Conradi SE. A decade of train-pedestrian fatalities: The Charleston experience. J Forensic Sci 1994;39:668-73.  Back to cited text no. 11
    
12.
Sousa S, Santos L, Dinis-Oliveira RJ, Magalhães T, Santos A. Pedestrian fatalities resulting from train-person collisions. Traffic Inj Prev 2015;16:208-12.  Back to cited text no. 12
    
13.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS); 2020. Available from: https://www.cdc.gov/injury/wisqars. [Last accessed on 2020 Dec 10].  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2]



 

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