Scientific Approaches to the Study of
the "Human Factor" in the Railway
Safety Medical System
Vice President of JSCo «Russian Railways»
Doctor of Medicine, Professor
Oleg Atkov
CZ-OA@CSS-RZD.RU
Moscow, 16.10.2012
Healthcare Scientific Potential
of JSCo «RZD»
Non-Governmental Healthcare Institution «Scientific Medical
Center of JSCo «RZD»
More than 245 chairs of Medical Universities and research
institutes are functioning on the basis of healthcare facilities of
JSCo «RZD»
The number of employees of 235 non-governmental
healthcare institutions of JSCo «RZD» is 68 thousand persons,
including 13 thousand doctors, with more than 800 specialists
having an academic degree
In order to improve healthcare services provided to
employees, the Health Care Advisory Council under the President
of JSCo «RZD», consisting of heads of the best medical schools of
Russia, successfully functions since 2006
2
Specific Features of the Healthcare System of JSCo «RZD»






The medical component of the Rail Safety System includes
medical and psycho-physiological support, rehabilitation after
emergency situations on the railway, automated pre-trip medical
check-ups,
Comprehensive healthcare solutions include prevention,
diagnosis, treatment, rehabilitation, health resort treatment
Scientific developments
New organizational forms of health care include mobile
consulting and diagnostic centers
Extensive use of information technologies, including
telemedicine
Participation in mitigating health and sanitary consequences of
emergencies on the railway
3
Reasons for the Improvement of Health of
Transport Workers
• The most important task of the medical support in transport is to
determine the high-risk group liable to occurrence and
development of pathological states, sudden deterioration of
health and inadequate response, including detection of fatigue,
stress and depression symptoms
• Improvement of health of transport workers should ensure the
maintenance of mental and physical performance during the work
shift, normalization of daily rhythms and sleep disorders,
controlled recovery after work shifts, enhancement of stress
resistance and tolerance for monotony
• Pharmacotherapy is rather specific due to the adverse effect of
some drugs on the cognitive function
4
Rail Safety System
About 1500 pre-trip medical check-up
rooms are functioning in the
healthcare structure of JSCo «RZD».
Automated systems (APTMCS) that
allow an objective assessment of a
worker’s state of health when
admitting to a trip have been
implemented
(GP)
5
5
SCIENTIFIC MEDICAL CENTER OF JSCo «RZD»
Main tasks:
- Solution of problems of railway medicine (rail safety,
including psychophysiological problems, sudden death, etc.)
and their scientific support
- Enhancement of the effectiveness of diagnosis and treatment
for occupational diseases
- Examination for occupational fitness and occupation-related diseases
- Development of measures aimed at reducing the incidence of workers and
increasing their
career longevity
- Solution of problems of occupational medicine
- Telemedicine
- Development of principles of safe use of drugs
- Clinical testing of drugs
- Interactions with Russian and foreign medical universities
and research institutes
- Clinical work
Clinics of JSCo «RZD»
JSCo «RZD»ZDOROVIE»
Medical Universities and
Research Institutes
6
6
List of Researches Dedicated to Medical Rail Safety for 2010-2012
•
Methods of Psychophysiological Support of Locomotive Crew Workers of
JSCo «RZD»
•
Determination and Assessment of Factors Affecting the Professional
Longevity of Locomotive Crew Workers of JSCo «RZD» Development of
Prevention Programs... ( list of disease risk factors, criteria and programs for
their detection)
•
Development and Justification of Methods for the Calculation of Locomotive
Drivers’ Working Time and the Length of Route Depending on Conditions and
Type of Train Operation. Development of Methods and Recommendations...
(draft guidelines for professional performance improvement, recovery rules)
•
Influence of Infrasound as a Harmful Occupational Factor on the Health of
Locomotive Crew Workers of JSCo «RZD» and Risks for the Development of
Occupational Diseases
7
List of Planned Researches Dedicated to Medical Rail Safety for
2013-2014
• Development of Methods and Guidelines for Health Maintenance
and High Working Capacity of Railway Employees Working at Night
Shifts
• Development of Guidelines for Psychological Profiling of
Locomotive Crew Workers of JSCo «RZD»
• Development of Methods for the Assessment of Influence of
Perturbation of the Earth's Magnetic Field on the Cardiovascular
System of Railway Workers of JSCo «RZD» in Northern Regions
• Development of Guidelines for the Prevention of Fatigue and
Maintenance of Job Performance in Locomotive Crew Workers of
JSCo «RZD» during Labor Activities
8
SCIENTIFIC MEDICAL CENTER OF JSCo «RZD»
New generation simulator
“Driver's Cabin of Locomotive
EP-1M”
9
9
Possibility to control physiological functions in locomotive drivers
Holter monitoring
ABP and ECG
Pulse oximetry (attached to the ear
lobe)
EEG recording
Electronystamograph
EEG
ABP, heart rate monitoring and ECG
Nystagmogram
10
Telemedicine Technologies in Health Care Delivery, Including in
Emergency Situations
оn the Railway
2
1
3
4
11
REGULATORY MECHANISMS AND CORRECTION METHODS IN THE
CONDITION OF CHANGING CIRCADIAN RHYTHMS IN LOCOMOTIVE
CREW WORKERS
Purpose of the study:
Determination of the specificity of regulatory
mechanisms in locomotive crew workers in the condition
of changing circadian rhythms
Objectives of the study:
To identify clinical and neurophysiological features
of changes in the functions of the parasympathetic and
sympathetic autonomic nervous systems and their
regulatory mechanisms associated with altered circadian
rhythms due to operational needs
To identify the relationship between the vegetative
regulatory function and the psycho-emotional state of
locomotive crew workers in the condition of changing
circadian rhythms
To assess the possibility of restoring the functional
adaptation mechanisms of the body and methods of their
optimization in individuals with altered circadian rhythm of
life against low-frequency transcranial magnetic
stimulation (TMS) and use of melatonin drugs
12
Early diagnosis of diseases
•
Possible solutions:
1. Determination of diagnostically important markers of disease, using
an integrated approach that takes into account
- genetic
- traditional clinical and laboratory signs;
2. Creation of diagnostic and prognostic models based on modern data
processing methods: Artificial Neural Networks, Principle Component
Analysis (PCA), Support Vector Method (SVM)
Accuracy > 90%
when genetic
and non-genetic
traits are included
Accuracy < 90%
when only non-genetic
traits are
included
Informativity indexes
of prognostic models
of coronary atherosclerosis
and coronary heart disease
A double-layer perceptron with
four neurons in each buried layer
13
CIRCADIAN GENES AND DISEASES RELATED TO
PROFESSIONAL LONGEVITY
Atherosclerosis
Clock rs1801260
Per1 rs2735611
Per2 rs2304672
Bmal1
CRY1
Rev-erb
Obesity
Diabetes mellitus
14
15
15
Characteristics of the « Arfa» system allow
providing a stable level of the magnetic field,
which is about 48 µT in the latitude of Moscow
,for a few hours and compensating the
geomagnetic field to zero.
The Arfa system allows recording the (3)
components of the low frequency magnetic field
in the working volume of the exposure block in
real-time mode. The subject of the study is in the
chair inside the exposure block in the screening
of the electrostatic and electromagnetic fields up
to 1 GHz.
The study showed the possibility to
measure the impact of hypomagnetic
conditions on the performance of the
cardiovascular system of examined
volunteers. It was possible to estimate
individual sensitivity of the subject, as well
as indicators liable to the greatest
variability in the changing ambient
magnetic environment.
16
PRINCIPAL ACTIVITIES OF THE SCIENTIFIC CLINICAL CENTER
IN CLINICAL PHARMACOLOGY
• Study of adverse effects of pharmacotherapy on professionally relevant functions
•
•
of operators for their classification and implementation of common
international standards
Development and introduction of personalized medicine technologies
Coordination of clinical studies conducted by the NGHI of JSCo «RZD»
24 NON-GOVERNMENTAL HEALTHCARE INSTITUTIONS OF JSCo «RZD»
HAVE BEEN ACCREDITED TO CONDACT CLINICAL STADIES
Saint Petersburg
MEDICINAL DRUGS
AND RAILROAD TRAFFIC SAFETY
Yaroslavl
Ivanovo
Nizhny Novgorod
Moscow - 5
Voronezh
Smolensk
Samara
Volgograd
Saratov
Rostov-on-Don
Yekaterinburg
Chelyabinsk
MOSCOW - 2011
Krasnoyarsk
Khabarovsk
Kemerovo
Novosibirsk
Barnaul
Irkutsk
17
At present, there is a sign of intensive collaboration in the sphere of railway
medicine with the International Union of Railway Medical Services (UIMC),
which is a substructure of the International Union of Railways (UIC).
The Russian delegation took part in the UIMC Congress (Helsinki, September
2012) and the medical department has become a member of this organization.
In addition to the exchange of information on researches, the opportunity to
develop common instruments and recommendations based on the railway
medical scientific researches in various countries and within international
scientific groups may also be very useful.
18