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Derailment in Kent between Ashford and Canterbury (26/07)

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tsr

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Meanwhile, based on what did happen at the accident site, rather than what didn't, I'm wondering the following... any discussion welcome! If I've overlooked anything, let me know...

1. When the driver laid the short-circuiting bar, what information did the ECO receive, and what action did they take? The report states that the signaller was attempting to arrange an emergency isolation of both lines, so was there either an assumption being made by them that there was no such thing in place, or did the ECO not have any information about problems detected with the electrical supply? I would hope that upon arranging a switch-off/isolation, the signaller would have been informed that the ECO had already been notified of the short-circuiting but that assumes the driver had laid the SCB correctly and that the power system failed safe. It looks like we are not told what the sequence of events was here.
2. Could the short-circuit of the power supply have adversely affected an already fragile onboard GSM-R system? Would it be possible that such a radio, already tripped out and without a secondary battery system, could be made more vulnerable with the 750V DC power supply in the vicinity being violently interrupted?
3. Once the signaller was aware, via various parties including the KICC, that there had been a serious incident, they attempted to resolve the problem by stopping traffic and contacting the ECO. Unless I am misreading things, it seems that nobody involved in the control of the electrical supply voiced much concern until they were contacted some minutes after the incident. In the area I work, ECOs generally get in touch with the signaller within moments of any indication of a problem. Often this is either as a driver is on the phone to the signaller, or sometimes before.

I suspect we will actually never know the answers to some of these, but it seems that other than the driver laying the short-circuiting bar, we do not know much about how electrical safety was maintained, and what other actions the ECO took. This is actually of more concern to me than TCOCs not being laid... the train appears to have derailed in a manner that it was of potentially more harm if other factors then played out other than the obstruction it was causing. The main problem I am thinking of is the presence of multiple animal carcasses near a complex electrical system. Had these caught fire, say for example on a damaged third rail, potentially a large amount of animal would have been burning underneath a stranded train with passengers onboard. Sorting out electrical problems is thus of high importance here. All that said, though, it remains that my training and that of other safety-critical staff is to stop traffic and block lines first, and arrange other things later, which is something which didn't quite happen right here - again, as above, probably largely due to the mental trauma of the incident, which I totally understand.
 
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AndyNLondon

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Revenue and catering bods wouldn't generally be trained in anything to do with train working, although supposedly Virgin do train their buffet crews in some safety procedures, so I believe?

I would hope that all on-board staff receive at least basic training in emergency safety procedures, regardless of whether their job involves anything safety-critical or not. There are two reasons that seem obvious to me (as someone outside the industry):
1. The train is their workplace, and so they should know what to do if an emergency happens while they're at work. (Just like someone in a boring office building should know where the fire escapes are.)
2. In an emergency, passengers are likely to turn to anyone they can see in a uniform for help.
 

Llanigraham

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Where does it say in the rule book the signaller MUST caution at least one train in each direction?

What happens when there is only one train available anyway?

Quite!
Certainly on our line we would caution the next train to pass over the line, which ever direction it was going. The drivers were told what to look for and roughly where.
--- old post above --- --- new post below ---
I think the "semi-criticism" is entirely justified (and not just of the driver).

The driver, guard, travelling driver and signaller all made errors which, had circumstances been slightly different, might have resulted in the oncoming train ploughing into the stricken 2R66.

Why? Was the derailed train fouling the other line?

Why did the signaller only caution one train before returning to normal working (and why were control satisfied with this)?

Because that is all that is required.

Why did neither the driver, guard or travelling driver use the most efficient methods of protecting their train - making a GSM-R REC (using a different handset/by tripping MCBs), applying a TCOC to the opposite line, contacting the signaller directly?

Justifiable question.

Did the driver, guard or travelling driver have the signal box phone number stored in their mobiles - if not, why not?

Because they didn't, and it is not unusual.

Why did it take ten minutes to alert the signaller that a train was heading towards the scene of a derailment?

See above.

Why did the signaller not use the highest priority of GSM-R call to stop the oncoming train? All valid questions, IMO...

Ask the RAIB.
 

61653 HTAFC

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I would hope that all on-board staff receive at least basic training in emergency safety procedures, regardless of whether their job involves anything safety-critical or not. There are two reasons that seem obvious to me (as someone outside the industry):
1. The train is their workplace, and so they should know what to do if an emergency happens while they're at work. (Just like someone in a boring office building should know where the fire escapes are.)
2. In an emergency, passengers are likely to turn to anyone they can see in a uniform for help.

A very sensible post. Not to mention that drivers, being at the very front of the train, are more likely to be incapacitated in the event of an incident and even if they aren't they have responsibilities relating to preventing an escalation such as another train colliding with the stricken one.
 

BestWestern

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I would hope that all on-board staff receive at least basic training in emergency safety procedures, regardless of whether their job involves anything safety-critical or not. There are two reasons that seem obvious to me (as someone outside the industry):
1. The train is their workplace, and so they should know what to do if an emergency happens while they're at work. (Just like someone in a boring office building should know where the fire escapes are.)
2. In an emergency, passengers are likely to turn to anyone they can see in a uniform for help.

There are inductions, fire courses, and of course general awareness of basic safety features such as Passcoms and, for catering staff, their own equipment within the buffet or kitchen area. Beyond that, the detailed stuff is down to the traincrew. Catering and revenue staff are not safety critical and are not (certainly in most cases) PTS trained, which restricts what they can be expected to do in an emergency situation. Assist the Guard and/or Driver is the overall policy for the mostpart.
 

talldave

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2. Could the short-circuit of the power supply have adversely affected an already fragile onboard GSM-R system? Would it be possible that such a radio, already tripped out and without a secondary battery system, could be made more vulnerable with the 750V DC power supply in the vicinity being violently interrupted?

The tripped out radio wasn't connected to anything so power interruption couldn't have affected it further in any way.
 

Sunset route

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Why did the signaller not use the highest priority of GSM-R call to stop the oncoming train?

I would say that looking at my own location and area, there is not a great deal of confidence in the new "REC" procedure as it's quite time consuming and long winded. Those of us that transferred over from the old CSR system remembered how easy it was to open up a point to point emergency call or receive one, send a single or group energency stop, just a couple of keyboard presses. Now days you have roughly the same amount of keyboard presses but you have to try a remember the exact wording to REC call (This is a railway emergency group call, I repeat the a railway emergency group call, from the signaller at X to all trains in the Y area. All trains stop immediately, I repeat, all trains stop immediately. all the while your trying to make the area safe, get an emergency switch off, talk to control and from observing the many inward REC calls at my place you soon end up with a dozen drivers all talking at once trying to ascertain the situation instead of just leaving the airway open for the lead signaller and effected train driver. In practice we have found on more than one occasion that we have to spend a good couple of minutes shutting the other drivers up before we even deal with the problem. This why you find a lot of signallers using the "urgent" call facility instead, as it's the nearest thing to the old CSR point to point emergency call.

We were able to train in the use of the sending and receiving of emergency calls and sending an emergency stop (not general stop) on a live railway if the driver was happy to do so, on the old CSR system, This is something you can't do on the new GSMR system, I'm willing to bet that the only time that signalling has sent a REC call was on there initial training which could of been at least 6 months before it went live in the south east. Then suddenly roughly 2 years down the road with adrenaline pumping and pressure now mounting your faced with trying to remember how to send it and what to say.

If the new REC call has to be a voice com instead of a text command why can't it be a pre recorded voice in the same way that we have on CIS/PIS on stations and trains just triggered by using the emergency buttons. Leaving the signaller to protect the line and get any emergency switch off arranged. Then when the driver/s effected call in then start with any exact information required followed by closing down the call as we do now.

I would say that at my location which is a large multi panel signalling centre with many signallers, we have only one or two signallers total confident and the rest confident enough to wing it the best and safest they can.

RAIB should of looked into human factors in the radio use and then broaden it out in to the rest of the railway. The lack of realistic practice is a major issue in something you might only get once or never in your whole career. I've been the non lead signaller on many REC calls now and it's a very confusing mess.

When I had my train on fire I chose to use an urgent call instead of a REC call, then again we were using both CSR and GSMR side by side and it was a lottery as to what train was on what system and relying a REC call to stop all trains would of been useless, compared to just replacing signals to danger.
 
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ComUtoR

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1. When the driver laid the short-circuiting bar, what information did the ECO receive, and what action did they take?

(...)

I suspect we will actually never know the answers to some of these, but it seems that other than the driver laying the short-circuiting bar, we do not know much about how electrical safety was maintained, and what other actions the ECO took.

From what I was told of when I was training. When you lay the SCB the current should trip. The ECO then immediately tries to reinstate the current. As the bar is still down the current will trip again. The ECO then waits 1 minute before trying to reinstate the current again. If it trips again they have to wait another period of time whilst investigating the trip.

The reasons why we leave the bar in place and still treat it as live at all times is because the ECO will try to reinstate the current in accordance with their procedure before its treated as a potential incident.

Hopefully an ECO could confirm, enhance or debunk my answer.


@Sunset route. As I understand it; we still get a text message on the radio.

The new REC is much better than the CSR because in this instance. IF the GSMR was working then a single press of the big red button would have been all that's required. All lines protected with a single press of a button resolves all the rigmarole of emergency protection.

The tripped out radio wasn't connected to anything so power interruption couldn't have affected it further in any way.

What about the other cabs ?
 
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SpacePhoenix

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Long term could a backup GSM-R (on a seperate electrical circuit from the main one), be combined with a g-force censor (kinda like an electronic version of them g-force/impact sensor things that used on the TV series Mythbusters, so that if an impact of enough force is detected the backup GSM-R sends out an emergency all-stop?
 

BestWestern

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Long term could a backup GSM-R (on a seperate electrical circuit from the main one), be combined with a g-force censor (kinda like an electronic version of them g-force/impact sensor things that used on the TV series Mythbusters, so that if an impact of enough force is detected the backup GSM-R sends out an emergency all-stop?

Would play havoc with rough attachments!
 

tsr

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The tripped out radio wasn't connected to anything so power interruption couldn't have affected it further in any way.

Yes... but I wonder if there could be any power faults transmitted due to the SCB being laid which could affect the MCB being reinstated, or as has been posted just above this, anything which could affect other cabs.

From what I was told of when I was training. When you lay the SCB the current should trip. The ECO then immediately tries to reinstate the current. As the bar is still down the current will trip again. The ECO then waits 1 minute before trying to reinstate the current again. If it trips again they have to wait another period of time whilst investigating the trip.

The reasons why we leave the bar in place and still treat it as live at all times is because the ECO will try to reinstate the current in accordance with their procedure before its treated as a potential incident.

Hopefully an ECO could confirm, enhance or debunk my answer.

Indeed, I have never heard anything other than that TCOCs or SCBs should only be removed when it is certain they are no longer needed for any form of protection. In agreement with what you say, I was also told that you should wait for the current to trip the third time before even so much as considering approaching the third rail, and that only under the direst circumstances with sufficient insulation (as an aside, I am always amused by the ancient first aid posters on the back walls of some cabs of older stock, which have the details in minute detail, which make for interesting reading); normally you would still stay clear, step over it as per PTS training & advise all concerned to do the same. All that being said, I am not currently required by my company to lay an SCB in any incident anyway, so it would only be on my own initiative (I only get examined on use of TCOCs).

My query really is that this scenario evidently went on for a number of minutes longer than one or two, before the signaller arranged to isolate the power, so it would be interested to know what the ECO was actually doing in that time. I would also welcome input from anyone of this profession who can shed light on this, and how much information they get on previous incidents which may affect a given area (eg. trains cautioned due to cattle -> unexplained loss in running in the same area -> train stands, two successive short circuits in area then seen by ECO).
 
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edwin_m

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My query really is that this scenario evidently went on for a number of minutes longer than one or two, before the signaller arranged to isolate the power, so it would be interested to know what the ECO was actually doing in that time. I would also welcome input from anyone of this profession who can shed light on this, and how much information they get on previous incidents which may affect a given area (eg. trains cautioned due to cattle -> unexplained loss in running in the same area -> train stands, two successive short circuits in area then seen by ECO).

Not in the know, just more speculation I'm afraid...

The ECO didn't know about the report of cattle as that went to the signaller. The signaller probably didn't know about the power trip, at least until the ECO had tried to reset it at least once. Having the two co-located in the ROC should help with this - in these centres does the signaller also deal with trips and isolations in their own area?

I also have a nagging doubt in my mind that on a long rural section the resistance of the rail means a SCB might not draw enough current to trip the breakers. However it did mention a substation nearby so maybe that wasn't a problem.
 

Sunset route

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Having the two co-located in the ROC should help with this - in these centres does the signaller also deal with trips and isolations in their own area?

Wont really help at my local ROC as Control & ECRO are on one floor and the signalling is on another. So Coms will still be by phone only and because of the nature of the differing work ECRO will be screened off from Control to cut down on the noise pollution.

Only get involved in tripping if ECRO request a block to electric traffic.
 
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fergusjbend

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After the disastrous 'Herald of Free Enterprise' sinking in 1987, the judge in charge of the inquiry, Mr Justice Sheen, identified 'the disease of sloppiness' as the root cause of the tragedy. It seems that sloppiness the still a major problem, as exemplified by the Godmersham near-miss. In this particular case the failure to repair a fence was a root cause.

I would like to know why the line-side inspector deemed the defective fence not to need immediate repair. I would like to know what pressure he was under from his managers to minimise expenditure. I would like to know whether the terms of their contract with NR favoured them overlooking safety considerations in favour of cost saving.

I would also like to know what the outcome might have been if the train had not carried a guard and (fortuitously) a travelling driver. The train staff seem to have behaved heroically.
 

talldave

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Yes... but I wonder if there could be any power faults transmitted due to the SCB being laid which could affect the MCB being reinstated, or as has been posted just above this, anything which could affect other cabs.

Unless trains have a radically unique MCB design they can't reinstate themselves as they're sprung loaded. I'm not up on the effects of SCBs so can't hazard a guess as to what could happen.
 

tsr

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Unless trains have a radically unique MCB design they can't reinstate themselves as they're sprung loaded. I'm not up on the effects of SCBs so can't hazard a guess as to what could happen.

I mean if the driver/guard had tried to reinstate the MCB, for clarity. In other words, could anything that the SCB did to the power supply then go on to affect the possibility of a member of train crew reinstating the appropriate MCB.
 

talldave

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I mean if the driver/guard had tried to reinstate the MCB, for clarity. In other words, could anything that the SCB did to the power supply then go on to affect the possibility of a member of train crew reinstating the appropriate MCB.

Ok I see what you're getting at. I'd have to defer to an infrastructure expert!

In this particular instance, I can't help feeling that a battery in the GSM-R would have negated the impact of the MCB trip, to the extent that the driver might not even have been aware of the trip (but I'm speculating as someone who's never set foot in a driver's cab!).
 

09065

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I would hope that all on-board staff receive at least basic training in emergency safety procedures, regardless of whether their job involves anything safety-critical or not. There are two reasons that seem obvious to me (as someone outside the industry):
1. The train is their workplace, and so they should know what to do if an emergency happens while they're at work. (Just like someone in a boring office building should know where the fire escapes are.)
2. In an emergency, passengers are likely to turn to anyone they can see in a uniform for help.

If all the staff working on trains worked for the Train Operator then it could be possible.

Of course when some services are offloaded to Rail Gormet and their friends.....
 

30907

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I would also like to know what the outcome might have been if the train had not carried a guard and (fortuitously) a travelling driver. The train staff seem to have behaved heroically.

On a fully track-circuited line, the risk is from an oncoming train, which the driver acted on. While it might have been frightening for the passengers not to have staff on board, I see no evidence that their presence made a difference to the actual outcome.

Had the driver been incapacitated, or had their been a fire under the train, it might have been different, but neither is very likely. (Before any hares are started, I do think a second crew member on board is desirable, and they should be familiar with emergency procedures).
 

philthetube

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I would have thought that, where available, in this situation it would be a good idea to have the guard in the cab to be a second, and undistracted pair of eyes.
 

TEW

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The rules do allow for the guard to ride in the leading cab to assist the driver in the examination of the line during the hours of darkness, when it is foggy or during falling snow.
 

tsr

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I would have thought that, where available, in this situation it would be a good idea to have the guard in the cab to be a second, and undistracted pair of eyes.

The rules do allow for the guard to ride in the leading cab to assist the driver in the examination of the line during the hours of darkness, when it is foggy or during falling snow.

Indeed. This can in fact be particularly important when visibility may be obstructed on Electrostars with retracted gangway equipment in the middle of the cab, such as 375s. I have been asked to assist in examining a dark section of track for exactly this reason in the past. It is up to the driver's discretion to request assistance if immediately available; unfortunately they cannot always get it, and a few also do not always make use of the resource even if it does exist.

I should imagine one explanation is, but obviously can't and won't say for certain, that the driver of the train which examined the line before the incident being discussed had thought that a cow would be obvious enough to be seen at slow speed. Evidently other factors were at play.
 

edwin_m

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The initial report was of a single cow in the down cess. The accident involved several cows and happened an hour or so later and several hundred metres away, and the RAIB discovered evidence of cows having been present at several locations (one suspects the RAIB inspectors didn't expect to be counting cowpats when they signed up).

So the cows were moving around and it may be that when the examining train and the two other trains passed them, they were all down the bank or somewhere else where they were not visible.
 

jayah

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Did the driver, guard or travelling driver have the signal box phone number stored in their mobiles - if not, why not?

It was a clear recommendation after Lavington that they should have these as mitigation against a loss of GSM-R during an impact. Para 99 explains that the facility was lost when the company moved from one type of company mobile to another.
 
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