Jun 29 2022
Missouri Amtrak Derailment – Force of Impact Will Cause Brain Injury
Missouri Amtrak derailment will likely leave many with significant brain injury, as the biomechanics forces to the brain of being thrown around without a seat belt is a source of significant brain damage. See https://braininjuryhelp.com/brain-damage-biomechanics/
Monday, June 27, an Amtrak train carrying 243 passengers and 12 crew members collided with a dump truck at a train crossing in Missouri resulting in an Amtrak derailment. Three passengers and the driver of the truck were killed, and more than a hundred were injured. Overturned carriages at the aftermath confirmed a passenger’s recollection of the event as “hell on earth”.
“I was riding backwards, so that was a blessing because I didn’t fly forward on the impact, but all I heard was a bam, bang, boom,” he said. “And all of a sudden the train dropped down, which I thought was probably when it went off track.” https://www.npr.org/2022/06/28/1108391218/amtrak-train-derailed-missouri
The key word in this account is ‘impact’. While train derailments can occur due to other factors, in this case we have the initial point of impact with the dump truck and the forces involved in the train derailment that ensued.
“It overturned, fell to the left, and it skidded, skidded, skidded forever. I felt like it, anyway.” https://www.npr.org/2022/06/28/1108391218/amtrak-train-derailed-missouri
The National Transportation Safety Board dispatched a team of 15 to investigate the Amtrak derailment and download the “event recorder” to determine the engineer’s actions prior to impact, the speed of the train and any other clues which might shed light on the events which led to the derailment. According to the US Department of Transportation, there are approximately 5800 train-car crashes annually, the majority of which occur at train crossings. Approximately 600 deaths and 2300 injuries occur annually from these incidents.
Train transportation is one of the safest modes of transportation yet derailments occur more often than one might think. The Bureau of Transportation Statistics analyzes and compiles information about all modes of transportation in the United States for the United States Department of Transportation. Since 1990, there have been 54,539 accidents in which a train derailed. The statistics are difficult, however. They include incidents involving freight trains which do not include train passengers, deaths of drivers of vehicles, and incidents such as the 2002 derailment in North Dakota which involved hazardous materials which injured hundreds. Factoring out these other data sets, and focusing on the impact on train passengers alone, 131 people have died in train derailments from 1990 to 2021. https://cw33.com/news/nexstar-media-wire/how-often-do-trains-derail-more-than-you-think/
Our concern here is the impact of a train derailment, due to impact with a heavy vehicle, on the survivors of the crash. A very old adage in our profession is “if an accident is significant enough to break a bone, it is significant enough to cause brain damage.” And this is, in reality, an understatement. While the human body is a miracle of biological engineering, it was not designed to withstand the forces of modern transportation mishaps. While the external body may walk away relatively unscathed from an impact, the biomechanical forces within the body can produce damage and this is especially true in the brain.
The brain itself is housed within the skull and can be damaged at both the point where it impacts the interior of the skull and on the rebound from such an impact. These are known as coup and countercoup injuries and can occur at both the time of impact or due to a rollover type incident. This can result in cerebral contusions and/or more diffuse injury to the brain. Additionally the different layers of the brain have different masses which travel at differing speeds during impact. When these layers move at different speeds, the axons which transverse these layers can be damaged.
“Diffuse axonal injury is the shearing (tearing) of the brain’s long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull. DAI usually causes coma and injury to many different parts of the brain. The changes in the brain are often microscopic and may not be evident on computed tomography (CT scan) or magnetic resonance imaging (MRI) scans.” https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury
Once damage occurs within the brain there can be secondary sequelae. This is referred to as secondary brain injury.
“Secondary brain injury refers to the changes that evolve over a period of hours to days after the primary brain injury. It includes an entire series of steps or stages of cellular, chemical, tissue, or blood vessel changes in the brain that contribute to further destruction of brain tissue.” https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury
In the story of the Missouri Amtrak derailment, there is a statement which stands out to me regarding the aftermath of those who walked away from the accident. In such a traumatic event, how does one differentiate the emotional impact of surviving such an ordeal and physical sequelae which result from a brain injury? From the interview in the NPR article-
After a day in the emergency department, Hoffman said he finally made it home.
“The whole night when I was trying to fall asleep I kept getting flashbacks, and like visuals and things running through my head and it made it very hard to sleep,” he said.
“I will say I’ll never be on a train again for many years, many, many years.”
“I feel blessed to be alive, but bumped up, bruised up, and kind of tattered and sore.” https://www.npr.org/2022/06/28/1108391218/amtrak-train-derailed-missouri
Symptoms of a closed head injury may occur quickly, within 24 hours, or they may emerge days or weeks after an injury.
“Sometimes the symptoms are subtle. A person may notice a problem but not relate it to the injury. Some people will appear to have no symptoms after a TBI, but their condition worsens later.” https://www.medicalnewstoday.com/articles/179837#symptoms
According to MedicalNewsToday some of the more subtle symptoms to be aware of are:
- changes in mood
- memory problems
- inability to remember what happened before or after the incident
- fatigue (tiredness) and lethargy
- getting lost easily
- persistent headaches
- persistent pain in the neck
- slowness in thinking, speaking, reading or acting
- moodiness, for example, suddenly feeling sad or angry for no apparent reason
- sleep pattern changes, such as sleeping more or less than usual, or having trouble sleeping
- light headedness, dizziness
- becoming more easily distracted
- increased sensitivity to light or sounds
- loss of sense of smell or taste
- tinnitus, or ringing in the ears
These secondary symptoms also require urgent attention and should not be discounted as due to the adrenaline-induced, emotional state following a traumatic event.
The mechanics of a train experiencing a collision and the subsequent derailment and carriage rollover is sufficient to cause closed head injury. And as we see, even negative imaging studies in the emergency room setting may not be sufficient to rule out a brain injury. Brain injuries can have life-long implications and consequences.
The last consideration is in regard to Amtrak’s responsibility to its passengers. A train is considered a common carrier and under the law, owes all passengers a duty of care. This means that in any incident that passengers are injured or killed that all actions taken by the crew prior to and during impact were in total accordance to guaranteeing safety of the passengers. This is at the root of the investigation into the accident and why the train’s speed, the length of time it took the engineer to sound a warning to the vehicle on the tracks and the actions of the crew as a result come into question.