GUARD’S DEATH “COULD HAVE BEEN AVOIDED”
THE death of a guard in a collision between two trains on the Settle-Carlisle line could have been avoided if he had concentrated on protecting his derailed train rather than attending to the needs of passengers, according to an investigation into the crash by the Health and Safety Executive.
The accident happened on 31st January, 1995, when two passenger trains collided near Ais Gill, about six miles from Kirkby Stephen, in remote moorland in darkness and bad weather.
A passenger train travelling from Ribblehead to Carlisle hit a landslide and was derailed on to the opposite track, trapping the train driver in the cab. An approaching passenger train on the opposite line then collided with the derailed train.
The guard of the first train, Stuart Barry Wilson, from Leeds, was killed in the crash, while both drivers and 25 passengers were injured. An inquest jury returned a verdict of accidental death.
The report from Mr. E. N. Clarke, HM Principal Inspector of Railways, shows that action has already been taken on key points. It concludes that the collision could have been avoided, or its severity reduced, if a member of the train crew of the derailed train had immediately set out to protect it.
The HSE investigation revealed problems with communications between Railtrack control, Regional Railways North East and the train crew and, in particular, with the operation of the National Radio Network.
Key actions quickly emerged from the early stages of the investigation and they have already been progressed by Railtrack and the train operating companies. A reminder has been issued on the urgency of physical protection of the line, there are new instructions on dealing with emergency calls from NRN radios and staff have been retrained in the use of NRN radios.
Mr. Clarke said in his report that there was no reason why the driver of the derailed train should not drive it as speeds up to the 60mph limit in the darkness and atrocious weather. The inspector said he was satisfied that the driver received virtually no warning of the obstruction and was powerless to reduce the effects of the derailment.
“Although injured, he promptly made an emergency NRN radio call after the derailment,” said Mr. Clarke.
Following the derailment, the first duty of the train crew was to protect the up line fouled by the derailed train, with a track circuit operating clip, detonators and a hand danger signal, advising the signalman as soon as possible.
If both driver and guard were fit, the driver was responsible for protecting the up line and Mr. Wilson, the guard, the down line. If only one man was capable, then protection of the up line became the priority.
“It is my opinion that if one man had immediately set out to protect the up line in the six/seven minutes between derailment and collision, then the collision may have been avoided or at least the speed of the impact significantly reduced.
“One must conclude that this fatal accident to the guard may not have happened had he been protecting the derailed train,” said Mr. Clarke.
The report reveals that the transcript and recording of the call from the driver of the derailed train to Crewe control was terminated with, “We’ll arrange all that, driver”, which might have given a false assurance to him, and so to Mr. Wilson, that the control had arranged for the lines to be blocked.
“In this case I can understand Mr. Wilson’s actions in assisting the passengers rather than protecting the train. Nevertheless, the only assurance that train crew should take is directly from the signalman controlling that line.
“The passengers commended Mr. Wilson’s actions in moving passengers from the unlit vehicle to the relative safety of the other (rear) coach, but his primary responsibility was to stop the train,” said Mr. Clarke.
The inspector says that not all control office staff at Crewe had been trained in the operation of NRN radio, as its use was not, and is not, a requirement of the rule book for the protection of detailed trains.
A section controller not trained in the use of NRN radio, and with little knowledge of the line from Carlisle to Settle, answered the emergency call from the driver of the derailed train, but his lack of knowledge of the NRN emergency arrangements meant he was unaware of group call facilities to broadcast a message to advise all trains in the area.
The transmission of such a message immediately after the receipt of the call from the driver may have been received by the crew of the second train in time to prevent the collision, concludes the inspector.
As there was no direct link, the controllers at Crewe found telephone numbers to contact both the Railtrack and Regional Railways North East controls at York to advise them of the derailment.
Mr. Clarke says that the Railtrack centre at York took quick action to inform Cumbria police of the derailment, but the controller there did not think of asking Crewe control to use their NRN radio system to make an emergency group call to the radio area to advise other trains of the derailment.
His section controller had not been trained in the use of NRN radio, so was unaware of the group call arrangements.
“It is unsatisfactory for a Railtrack zonal control not to be provided with all means of communication for the area for which it is responsible, including NRN radio and direct telephone links with neighbouring control offices.
“Regional Railways North East had provided a special NRN phone in their York control office to receive messages from train crews. However, it is unacceptable that the information relating to the radio channel codes was obsolete for areas in which their trains operate, so that attempts made to contact trains in the emergency used incorrect codes,” said Mr. Clarke.
The report concludes: “It is considered that there is insufficient evidence of a breach of legislation to justify legal proceedings against any of the parties involved.
“While HMRI is content that railway companies took action soon after the accident and well before the inquest, many of the key actions indicate continuing activity. The publication of this report will be followed by a further review, as part of HMRI routine monitoring activity, of the present position in Railtrack and all train operating companies.
“HMRI will expect an update from all these railway companies within two months of publication of this report.
“HMRI will continue to monitor the development and implementation of plans by Railtrack to improve the radio system on its network and the development and use of such systems beyond the basic provision of non-secure communication links as currently provided by NRN radio.”
Copies of the report, price £9.95, are available from HSE Books, PO Box 1999, Sudbury, Suffolk.