ACY Euclid --- You say they had no reason to expect a problem. Human beings get tired. Human managers should know that, and should understand that one tired person at the end of a long and lonely shift might be tired, and perhaps not as sharp and alert as we would like. Long hours and one-man crews are seen as efficient, but maybe they should more properly be seen as red flags. Tom
Euclid ---
You say they had no reason to expect a problem. Human beings get tired. Human managers should know that, and should understand that one tired person at the end of a long and lonely shift might be tired, and perhaps not as sharp and alert as we would like. Long hours and one-man crews are seen as efficient, but maybe they should more properly be seen as red flags.
Tom
How would a conductor, probably, equally tired, have helped prevent what happened?
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I was referring to you saying this: “This was complicated by incorrect information from a railroad representative (not a qualified engineer) who allowed fire fighters to leave the train unattended and without power after putting out the first fire.”
In the first place, the fire fighters shutting down the engine and the MM&A employee who left the train unattended after the fire had absolutely nothing to do with the runaway.
In the second place, no supervisor is responsible for making sure that an employee does not fail to do his job because he might be tired after long hours on duty.
If the MM&A engineer was too tired or lacked the time to secure the train, he should have told his supervisors, so they could arrange help or relief.
Ullrich you sure you werent a CN manager around the time of the DM&IR takeover? "I know how to do things and I don't care that you did things a certain way for 70 years I am going to change it!"
Mechanical Department "No no that's fine shove that 20 pound set all around the yard... those shoes aren't hell and a half to change..."
The Missabe Road: Safety First
........and while they're arranging help or relief, they would probably also organize a disciplinary hearing. In this industry, it's always the guy at the bottom of the food chain. Nobody at the top takes the heat if they can push it to someone lower on the totem pole.
EuclidIn the first place, the fire fighters shutting down the engine and the MM&A employee who left the train unattended after the fire had absolutely nothing to do with the runaway.
Alas, I must disagree.
There is no question that the engineer did not properly secure the train. Setting sufficient handbrakes on the cars would certainly have prevented the runaway.
BUT - it certainly appears that the engineer did secure the train, however incorrectly. The train did not run away until after the firefighters and non-T&E employee left the scene (having shut down the locomotive which was keeping the independent brakes applied - the loss of which I surmise caused the runaway).
I suggest that it's doubtful that this was the first time this engineer had employed this short-cut to secure the train (I'm sure that will come out in the trial(s)). It was, however, apparently the first time that a train at that location had run away under those circumstances. Given the timeline as we know it, I would opine that the actions of the firefighters and non-T&E employee had everything to do with the runaway.
Since we don't yet know if the practice was wide-spread among the engineers who routinely parked trains at that location, we can't say how lucky it is that such an incident didn't happen earlier.
This in no way relieves the engineer of responsibility for what happened (assuming our assumptions are correct about insufficient brakes - and it appears they are).
I would also opine that barring evidence to the contrary, that the DS and the supervisor, undoubtedly believing that the train had been properly secured, have little responsibility in the incident. That assumes that they were unaware of the practices that caused the runaway (apparently relying on the independent brakes to hold the parked train). Another factor may be whether any checks and balances (ie, the engineer reporting number of brakes set) were in place and properly observed.
Now - let's get back to our regularly scheduled programming.
Larry Resident Microferroequinologist (at least at my house) Everyone goes home; Safety begins with you My Opinion. Standard Disclaimers Apply. No Expiration Date Come ride the rails with me! There's one thing about humility - the moment you think you've got it, you've lost it...
tree68 EuclidIn the first place, the fire fighters shutting down the engine and the MM&A employee who left the train unattended after the fire had absolutely nothing to do with the runaway. Alas, I must disagree. There is no question that the engineer did not properly secure the train. Setting sufficient handbrakes on the cars would certainly have prevented the runaway. BUT - it certainly appears that the engineer did secure the train, however incorrectly. The train did not run away until after the firefighters and non-T&E employee left the scene (having shut down the locomotive which was keeping the independent brakes applied - the loss of which I surmise caused the runaway).
When I use the term “secure,” I am referring only to proper securement in compliance with MM&A special instructions and Canadian Rule 112.
By using the term “secure,” I do not intend it to include holding a train with air brakes supplementing handbrakes even though this may indeed prevent the train from rolling away.
One could say that if a train does not roll away, it is secured, but I use the term “secure” exclusively to refer to its technical meaning of proper securement according to the rules.
Saying the train ran away because it lost its airbrakes is like saying it ran away because of gravity.
Perhaps that semantic point is your only intent. So just to clarify, when you say:
"The train did not run away until after the firefighters and non-T&E employee left the scene (having shut down the locomotive which was keeping the independent brakes applied - the loss of which I surmise caused the runaway)" ---do you mean that you surmise that the MM&A employee and firefighters are at fault?
Euclid Perhaps that semantic point is your only intent. So just to clarify, when you say: "The train did not run away until after the firefighters and non-T&E employee left the scene (having shut down the locomotive which was keeping the independent brakes applied - the loss of which I surmise caused the runaway)" ---do you mean that you surmise that the MM&A employee and firefighters are at fault?
Given our current understanding of the situation, engineer set up the firefighters and the non-T&E employee to fail. Had he properly secured the train, it would have stayed put.
But, if the firefighters had not followed what appears to be established procedure (shutting down the unit that was having problems) and had left the unit running, the train would likely have stayed put. If the non-T&E employee had the ability to start another unit, thus maintaining main res air, the train would likely have stayed put.
The firefighters and non-T&E employee took the actions they took unaware that their actions would be the straw that broke the camel's back. I would opine that their actions did, indeed, cause the runaway. However "fault" implies that they acted in a negligent way, and I don't believe that's the case. I believe they acted within their training, unaware of the deficiency, and with no obligation to ensure that the train was otherwise properly secured.
For now, though, we just have to wait to see what comes out of the legal proceedings.
Come on bucyrus. Are we going to re fight this battle on every thread?
Thanks to Chris / CopCarSS for my avatar.
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Murphy Siding Come on bucyrus. Are we going to re fight this battle on every thread?
It is a point that needs continuous clarification. I understand what Larry is saying and agree with his point that the train would not have run away if the air brakes did not release. However, on this forum and in others, people often continue to blame the runaway on the firemen shutting down the engine. I correct that every time I see it.
Euclid Murphy Siding Come on bucyrus. Are we going to re fight this battle on every thread? It is a point that needs continuous clarification. I understand what Larry is saying and agree with his point that the train would not have run away if the air brakes did not release. However, on this forum and in others, people often continue to blame the runaway on the firemen shutting down the engine. I correct that every time I see it.
We would never have noticed.
Norm
ACY Euclid --- ........and while they're arranging help or relief, they would probably also organize a disciplinary hearing. In this industry, it's always the guy at the bottom of the food chain. Nobody at the top takes the heat if they can push it to someone lower on the totem pole.
I understand your point, but I would not conclude that the engineer would be disciplined for saying that he was too tired to secure the train. What is the alternative? Certainly he cannot walk away from it, leaving it unsecured, and not tell anybody.
The issue may have been not that he was too tired, but rather, that he was out of time. Certainly his supervisors would have known if that were the case. If it was, that puts the onus on them, and not on the engineer.
So for the engineer, I don’t see how being tired or lacking a second man on the crew can be an excuse for not securing the train. I can see two scenarios:
1) The engineer failed to properly secure the train and told nobody so.
2) The engineer failed to properly secure the train and told his supervisors so.
Euclid ACY Euclid --- ........and while they're arranging help or relief, they would probably also organize a disciplinary hearing. In this industry, it's always the guy at the bottom of the food chain. Nobody at the top takes the heat if they can push it to someone lower on the totem pole. I understand your point, but I would not conclude that the engineer would be disciplined for saying that he was too tired to secure the train. What is the alternative? Certainly he cannot walk away from it, leaving it unsecured, and not tell anybody. The issue may have been not that he was too tired, but rather, that he was out of time. Certainly his supervisors would have known if that were the case. If it was, that puts the onus on them, and not on the engineer. So for the engineer, I don’t see how being tired or lacking a second man on the crew can be an excuse for not securing the train. I can see two scenarios: 1) The engineer failed to properly secure the train and told nobody so. 2) The engineer failed to properly secure the train and told his supervisors so.
You forgot #3
Engineer 'secured' train in the manner he had successfully used multiple times in the past - without understanding that the train was not 'actually secured' when the operation of the locomotive was stopped by the fire department.
I have read that 7 hand brakes had been tied on the train, if so, a effort was made to secure the train. The effort wasn't successful.
Never too old to have a happy childhood!
The following is an opinion, full of assumptions and educated guesses….
First, I think the engineer tied up the train in the manner it had always been secured, based on this assumption, I would also opine that the management never checked the securement of the train, which they should have done, FRA requires every employee to undergo several safety test per month, and depending on the number of employees a carrier has, they require a given amount of safety tests per month covering the entire carrier.
No one ever told him he was doing it incorrectly.
Now, whether he knew he was not securing the train properly or if he believed he was, the lack of testing and checking by management plays a role in this…not that blame or fault is removed from him, but it can be spread out some.
I seriously doubt you will ever hear a T&E employee tell management they are too tired to complete their work, and if they did, the next words they would hear from management is ,”that’s ok, your out of service for 30 days pending an investigation, so you will have plenty of free time to rest up”.
We are expected to report for duty rested and ready to complete our duty time work, up to 12 hours.
Telling management you are too tired to finish just isn’t an option.
As for him hitting the hours of service before he could secure the train, if that was the case, the rules require him to remain on the train until such time as a relief crew arrives, by rule he can’t leave, even if he hogged out, until one of the following has occurred…either the train is properly secured, (which I assume he thought it was) or a relief crew arrived and takes possession and control of the train.
Based on that, and the fact he did leave, I can only assume he though the train was secure…he had called in the bad order locomotive, and from statements already made, had been instructed to leave it as it was, that someone was on the way to check it, so again, I am pretty sure he was under the assumption that things were going as usual.
There are so many events in the time line of all of that that any one single incident or action, performed at a different time or in a different manner would have drastically altered the outcome…had the firemen not shut down the unit, had the carrier sent say, Randy instead of a Mow guy out to check, had management checked the securement beforehand, had the engineer tied a few more hand brakes…the list goes on, but from my point of view, there is no one single event that caused this, but rather a series of events that coincidentally lined up to cause it.
And, for the record, I don’t think he intentionally failed to secure the train, even though that appears to be the root cause, I think he simply followed the established practice as he had been shown, and management never checked to see if that practice was safe or sufficient.
23 17 46 11
Yes......but......
edblysardAnd, for the record, I don’t think he intentionally failed to secure the train, even though that appears to be the root cause, I think he simply followed the established practice as he had been shown, and management never checked to see if that practice was safe or sufficient.
I believe that is true. I don’t think the engineer intentionally failed to secure the train. I believe that he was following a practice that had proven successful in the past, and was habitually repeated with success to the point where it was never questioned as being inadequate.
I do not know whether the engineer alone developed this methodology or if it was developed by other engineers as well, or even requested by MM&A supervisors and management. I believe that the securement method relied on air brakes to hold the train, and some handbrakes were added just to make sure, and to concede to the requirement to set a minimum number of handbrakes. If this was the case, I assume that the saving of time and money played a part in the motivation for the rationalization for such a compromise in proper securement.
If this is what happened, the careless securement routine must have become extremely comfortable, or else it would have been obvious to the engineer and any others who happened to know about it that the shutdown of the engine would have set the stage for a high probability of disaster. So I suspect that company culture and peer pressure reinforced the complacency.
Yes. Yes we are.
The opinions expressed here represent my own and not those of my employer, any other railroad, company, or person.
Ed ---
Thanks for backing me up on the tiredness/disciplinary action issue. It's an important factor that is conveniently ignored by an awful lot of folks who aren't in the industry.
Aside from splitting hairs and regurgitating the "securing train" issue, no one has shown how a 2nd onboard crewman, tired or not, would have prevented the runaway.
Well,
You and I and every other railroader knows once the train sheet is in your hands, you work until
A: The work is finished.
B: you run out of time on the hours of service, or
C: A relief crew takes the train from you.
There is no “Too tired”, even if you are.
The first thing we were told on the first day of training was, “Never report for duty late or drunk.”
The second thing we were told was “you can expect to be out here for 12 hours, each and every day, so plan your personal life accordingly”
schlimm Aside from splitting hairs and regurgitating the "securing train" issue, no one has shown how a 2nd onboard crewman, tired or not, would have prevented the runaway.
Well, one man didn't work. Since the trains can't run themselves yet, have to go to at least 2 people. Or maybe one man and a dog?
Uhhh, one guy ties ten hand brakes, the other guys ties ten and so forth and so on, lots faster than one guy doing it all..add in the fact that if you’re working with someone, they expect you to follow the rules and do it right because you have their life and livelihood in your hands, and you expect the same from him, and you both are going to check each other as you go.
There is a tremendous amount of trust between engineers and conductors, there has to be to get anything done, and that trust is not betrayed lightly or out of laziness, you kill your friends that way.
ACY Ed --- Thanks for backing me up on the tiredness/disciplinary action issue. It's an important factor that is conveniently ignored by an awful lot of folks who aren't in the industry. Tom
Ignorant folks who don't understand the railroad industry....on this forum???
That's unpossible!!!!
Not intending to regurgitate anything, but the topic of Lac Megantic being caused by the lack of a two person crew has come up repeatedly in this thread, the other one called Goodbye Conductors, and a third one in Fred Frailey’s blog. The point has always been that the Lac Megantic runaway was caused by not having a second man on the crew. I think that is complete nonsense.
The point about being too tired was introduced not by me, but by poster, ACY contending that the engineer should be excused for failing to secure the train because he was too tired. He continued by saying that the engineer’s supervisors should be held responsible for the runaway because they should know better than to expect a tired man to secure a train. My point in responding to that was that if he was too tired, he had the obligation to tell his supervisor that he failed to secure the train because he was too tired. You don’t get to just walk away from it because you are too tired.
Certainly it is less work for two men to set the handbrakes than for one man. But a lack of a second man does not excuse the Lac Megantic negligence.
edblysard Uhhh, one guy ties ten hand brakes, the other guys ties ten and so forth and so on, lots faster than one guy doing it all..add in the fact that if you’re working with someone, they expect you to follow the rules and do it right because you have their life and livelihood in your hands, and you expect the same from him, and you both are going to check each other as you go. There is a tremendous amount of trust between engineers and conductors, there has to be to get anything done, and that trust is not betrayed lightly or out of laziness, you kill your friends that way.
schlimm You seem to be saying that by splitting the workload of setting handbrakes, they would have done the job properly? Do you actually mean that, because you are also strongly suggesting that the engineer was lazy and following the rules because there was no one to check up on him? And that since there would be no one else on the train who trusted him with life and livelihood, he left caution to the wind? Please clarify.
You seem to be saying that by splitting the workload of setting handbrakes, they would have done the job properly? Do you actually mean that, because you are also strongly suggesting that the engineer was lazy and following the rules because there was no one to check up on him? And that since there would be no one else on the train who trusted him with life and livelihood, he left caution to the wind? Please clarify.
RRKen Murray ACY Ed --- Thanks for backing me up on the tiredness/disciplinary action issue. It's an important factor that is conveniently ignored by an awful lot of folks who aren't in the industry. Tom Ignorant folks who don't understand the railroad industry....on this forum??? That's unpossible!!!! Very possible, just ask the Perfessor.
Murray ACY Ed --- Thanks for backing me up on the tiredness/disciplinary action issue. It's an important factor that is conveniently ignored by an awful lot of folks who aren't in the industry. Tom Ignorant folks who don't understand the railroad industry....on this forum??? That's unpossible!!!!
Very possible, just ask the Perfessor.
schlimm As you know, we don't know anything, are ignorant.
As you know, we don't know anything, are ignorant.
Admitting your shortcomings is part of the first steps Professor.
schlimm If you had read the thread, you would know that it was ACY who said the engineer was too tired, not a non-railroader. Or do you consider ACY a non-railroader now? As you know, we don't know anything, are ignorant and not entitled to voice an opinion.
At least an opinion with some basis, and not upon a whim. ACY has experience. You, not so much.
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