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25 July 2003 - ATSB Epping rail accident report has broad safety significance
Media Release
ATSB Epping rail accident report has broad safety significance
25 July 2003
The ATSB's report into the Epping rail accident reinforces the
limitations of reliance on automatic train stops and 'deadman's
handle' devices in the event of driver incapacitation and
highlights the importance of improving these defences as well as
medical standards and processes for train crew.
The sole purpose of ATSB investigations is to improve future
safety and the Bureau acknowledges the safety actions taken through
the Victorian Department of Infrastructure as a result of ATSB's
investigation such as reviewing signalling systems and defences,
developing new medical standards and setting up an inquiry into
pilot valves such as the 'deadman's handle'.
At 0914 on 18 June 2002, a suburban electric train with
passengers collided with a suburban electric train without
fare-paying passengers at Epping. Both the trains and the rail
infrastructure sustained damage as a result of the collision. There
were no major injuries to either passengers or crew. The Victorian
Government asked the Australian Transport Safety Bureau to conduct
an independent investigation of the collision. The team of ATSB
investigators were supplemented by consultants engaged to provide
technical expertise on specific aspects of brake systems and
transport medicine.
The ATSB established that train maintenance was not a factor in
the accident. While the signalling system, which incorporates
automatic train stops, operated within its design criteria, it
could not maintain a minimum safety margin between trains to
prevent the collision at the speed involved.
Trains are fitted with pilot valve devices (including the
'deadman's handle') so that in the event of driver incapacitation
an additional defence operates so that the train should brake and
be brought to a halt. On this occasion the driver of train 1648 had
become incapacitated but the pilot valve did not activate to apply
the train's emergency brakes. Because train 1648 was travelling at
about double the posted speed of 40 km/h, the subsequent
application of automatic braking after passing a red stop signal
could not stop the train in time before it reached the collision
point.
The report also addresses factors that contributed to the driver
working when unwell and recommends improved medical standards and
procedures in addition to other recommendations.
The Investigation Team reviewed the factors surrounding the
Footscray collision on 5 June 2001 (available on the ATSB Web Site)
which involved some similar safety issues including with respect to
driver incapacitation and pilot valves such as the deadmans
handle.
The issue of drivers becoming incapacitated whilst driving a
train, and the train pilot valves not activating, are also factors
currently being considered in the Special Commission of Inquiry
into the Waterfall Rail Accident (New South Wales). In February,
the ATSB briefed officers of the Commission on the possible
significance of the Footscray and Epping accidents, including the
limitations of pilot valves.
Media Contact: Peter Saint B: (02) 6274 6590, M: (0408) 497 016
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