This, in blue, is from the fifth conversation in the link I posted above. This is after the discussion between Harding and his supervisors about the fire on the engine and consequent shutdown of the engine due to the fire, and leaving it shut down after the fire was put out. Here, RJ asks the engineer how many handbrakes he applied, and he answered that question:
TH: How the [blank] did that thing start to roll down, RJ?
RJ: I don’t know. How many brakes did you put on?
TH: The units, the V.B., and the first car, seven brakes.
RJ: I don’t know what will happen. The best I can tell you is that Daniel Aubé is on his way there
TH: Okay, well what’s, what you want to do with me, RJ? Don’t leave me out in the cold here.
Here the conversation continues and Harding is assured that the train was secure when it was left after the fire was put out. Also, at this point, Harding has been informed from earlier conversation that the engine had been shut down. Yet even knowing that fact, it does not appear at this point that he has considered that the loss of air pumping might have led to the loss of securement:
TH: That the [blank] fuel train rolled down, it was a question of, anyways. …Were there any railway people that went up there to put the fire out?
RJ: Jean-Noël Busque.
TH: And everything was secure when he was there? Everything was fine? Everything was …
RJ: Everything was fine, yeah.
TH: And then it rolled down, what, two hours later? Three hours later?
RJ: Fire was up at midnight, and I got a call at 1:30 that there was a fire in downtown.
Now excuse me, through this whole thread I have failed to recall exactly what the MMA's train tie-down rules were. Additionally, as you read the following, I am only examining the engineer's actions and culpability, not the remainder of the case against the other railroaders, the railroad, and the crude oil companies themselves, who are all also liable in part for this disaster - no disaster ever has a single cause.
The long and short of it is this: if the engineer did NOT follow the printed rules for tying down his train, then he is at least partially at-fault for this disaster. It's ethics 101, and it's printed in every railroad rulebook I've ever read: these rules supercede anything anybody tells you, and when in doubt, the safe course must be taken. There is room for good-faith challenging, at least in the US, but I'm not sure if Canada has a similar rule. Perhaps somebody can fill us in on that count.
Given that, here is a small sampling of these safety clauses from active or slightly-out-of-date rulebooks. They're all literally the first rules in the book - that is how important safety is! The breaking these rules is inexcusable!
From CN's US Operating Rules, 8th Edition (currently in use)
Rule A: Safety. Safety and a commitment to obey the rules are the most important elements in performing duties. If in doubt, the safe course must be taken.
Rule 100: Employees must be familiar with and obey all rules, regulations, and instructions. [...bunch of stuff about training...] ...They must properly report any violations to the proper supervisor. Employees must ask their supervisor for an explaination of any rule, regulation or instruction of which they are unsure.
Or, from CSX's Operating Rules & Signal Aspects and Indications, Jan 2010 (since superceded but unlikely to have amended these sections!)
Rule A: Empolyees must know and obey rules and special instructions that relate to their duties. When in doubt as to the meaning and application of any rule or instruction, employees must ask their supervising officer for clarification
Also from GCOR 7th Edition (currently in use AFAIK)
Rule 1.1 Safety: Safety is the most important element in performing duties. Obeying the rules is essential to job safety and continued employment.
Rule 1.1.1 Maintaining a Safe Course: In case of doubt or uncertainty, take the safe course
-------------
So, I'm not sure what rulebook was in use on the MMA at the time (decent chance that it was GCOR), but these ideas are universal to the railroad industry - if these sorts of clauses were not present in the rulebook, I'd think it'd be a good case for negligence by the company, as it would be so contrary to standard industry practice, and obviously deficient from a safety perspective.
So at any rate, if the engineer did not follow the printed rules (rulebook, timetable, special instruction, or dispatcher message), then he is culpable by breaking the rules, period. There's some small wiggle room if his superiors explained the tie-down rules incorrectly, but it is hard to argue that your supervisor could overrule the idea that you've gotta set "x" number of handbrakes, which I imagine was part of the MMA rulebook, and almost certainly not weakend by special instruction, bulletin or dispatcher message. If it was, that'd be a huge count against the railroad.
Even still, if the engineer had reason to suspect that the train might not be fully secure, and it was a risk to public safety, then generally ethics code and the rulebook would hold him at least partially liable.
Whether or not the jury comes to this conclusion is another matter. But from a rulebook perspective, he is guilty if he did not follow the printed rules, and is not guilty if he followed them.
Again I don't recall specifically what rules were followed or broken - you'll have to take the above case and apply those facts.
And these hold true for any railroad incident, minor or catastrophic. I know there is a lot of discussion about "trainmasters in the bushes" and other similar tactics to get 100% compliance, but getting on and off moving equipment or not walking the full distance out and around the end of a car is minor compared to tie-down rules, which have to be right up there with following signal rules and mandatory directives, in terms of thou must follow or else, because that's how you create corn-field meets and level urban cores.
BaltACD Electroliner 1935 SD70M-2Dude I also realize that I have given a very simplistic explanation of the air brake system, and have left out the emergency reservoir and other portions like quick service, quick charge, retainers, load/empty features, and pressure maintaining etc. Just trying to keep this from getting out of hand. Yes you are "Articulate" and so is Jeff. I thank both of you for enlightening me and I suspect many others. The 3/8' orifice was new to me and your explanation very good. Thanks to both you and Jeff. PS Jeff. I presume you can see the DP units pressures from the front unit on a monitor. It gives you all the data? IE, you (or your conductor) didn't have to walk the train> Don't know UP Rules. On CSX - train in emergency - with HAZMAT - even if air restores immediately must be walked to verify that the HAZMAT is still on the rail. If the air doen't immediatly restore on ANY train, it must be walked. Conductors frequently reported finding 'stuck vent valves' in situations where the air didn't restore and they cut the brakes out on the offending car.
Electroliner 1935 SD70M-2Dude I also realize that I have given a very simplistic explanation of the air brake system, and have left out the emergency reservoir and other portions like quick service, quick charge, retainers, load/empty features, and pressure maintaining etc. Just trying to keep this from getting out of hand. Yes you are "Articulate" and so is Jeff. I thank both of you for enlightening me and I suspect many others. The 3/8' orifice was new to me and your explanation very good. Thanks to both you and Jeff. PS Jeff. I presume you can see the DP units pressures from the front unit on a monitor. It gives you all the data? IE, you (or your conductor) didn't have to walk the train>
SD70M-2Dude I also realize that I have given a very simplistic explanation of the air brake system, and have left out the emergency reservoir and other portions like quick service, quick charge, retainers, load/empty features, and pressure maintaining etc. Just trying to keep this from getting out of hand.
Yes you are "Articulate" and so is Jeff. I thank both of you for enlightening me and I suspect many others. The 3/8' orifice was new to me and your explanation very good. Thanks to both you and Jeff.
PS Jeff. I presume you can see the DP units pressures from the front unit on a monitor. It gives you all the data? IE, you (or your conductor) didn't have to walk the train>
Don't know UP Rules. On CSX - train in emergency - with HAZMAT - even if air restores immediately must be walked to verify that the HAZMAT is still on the rail.
If the air doen't immediatly restore on ANY train, it must be walked.
Conductors frequently reported finding 'stuck vent valves' in situations where the air didn't restore and they cut the brakes out on the offending car.
Key trains, yes always. Other non-Key trains with Hazmat, maybe. If certain conditions are met, a walking inspection is not required. Fortunately, the times that trip I lost the air we fulfilled the conditions.
Jeff
SaturnaliaNow excuse me, through this whole thread I have failed to recall exactly what the MMA's train tie-down rules were.
Here is the accident report and the section on the handbrake rules begins near the top of the document with this:
1.12 Rules and instructions on securing equipment
http://www.tsb.gc.ca/eng/rapports-reports/rail/2013/r13d0054/r13d0054.asp
My understanding is that the engineer failed to comply with the rules and/or the special instructions of MM&A. There may be that conclusion stated in the report somewhere without the need to go through the rules.
We know that the engineer failed to perform a proper effectiveness test because he performed it with the independent brakes set.
It is specifically to be noted in the report, both in the discussion and in the quoted MM&A rule, that railroad policy clearly states no air is to be applied when a pull test is made. It is difficult for me to comprehend how any 'failure of training' could leave an engineer able to conclude that a pull test with independent air applied, with or without the piddling contribution due to the QRB valve red herring, could satisfy this rule.
Something I still haven't seen is the 'necessary' change to the number of applied brakes when the train is left standing on a grade. It is obvious, only partly in retrospect, that a rule giving adequate standing resistance to a consist on the level would be grossly inadequate to purpose on a 2% grade, and this is clearly shown in both the CP and CN instructions; it is strange to me that no mention of this is seen in the quoted parts of the MM&A rules.
Euclid Saturnalia Now excuse me, through this whole thread I have failed to recall exactly what the MMA's train tie-down rules were. Here is the accident report and the section on the handbrake rules begins near the top of the document with this: 1.12 Rules and instructions on securing equipment http://www.tsb.gc.ca/eng/rapports-reports/rail/2013/r13d0054/r13d0054.asp My understanding is that the engineer failed to comply with the rules and/or the special instructions of MM&A. There may be that conclusion stated in the report somewhere without the need to go through the rules. We know that the engineer failed to perform a proper effectiveness test because he performed it with the independent brakes set.
Saturnalia Now excuse me, through this whole thread I have failed to recall exactly what the MMA's train tie-down rules were.
Thanks for the link to that document. First off, it confirms that the rules in effect were CROR, which is a time-tested rulebook which contains the same clauses as I previously mentioned about the safe course of action and the supremacy of the written rule over anything else.
It also confirms that indeed, the engineer broke the rules when tying down the train.
It is usually difficult to make a full assessment on something like this, but based on the cited rulebooks and the known facts of his actions that night, the engineer is guilty of a major rule violation, the violation of which added a pillar upon which the disaster was created. And because of the fact that tying down the train correctly would almost certainly have prevented the disaster, the engineer is at partial fault for the disaster, personally, due to his failure to properly carry out his duties, as required by the rules of his workplace.
If you contributed a pillar upon which a disaster was created by not following published rules and practices, and the removal of said pillar would have prevented the accident, then it is extremely difficult to show that you are not at-fault for the resulting calamity.
And in this case, everything I've seen points to the aforementioned conclusion.
No doubt, this disaster proves how important the rules of the railroad are, how they're written in blood, and how everybody has a duty to read and understand the rules related to their line of work, no matter what industry they're in.
Guys, we're starting to drift off a very important aspect of the topic. This thread is not about who was or wasn't likely to blame for the Lac Megantic accident; that horse was pretty well beaten years ago, when we first took up and discussed the accident report and some of the other findings.
This thread is about the trial of the engineer and the culpable RTC personnel, and what is (and isn't) brought up or established during the course of those proceedings. Euclid's original questions specifically referred to this (he was considering things that he wanted to see specifically addressed to the engineer in cross, and answered specifically by him. All we're doing by revisiting the language in the TSB report is looking carefully at what he 'should' be asked, even to clarify the situation, during the trial.
I have not quite established whether this trial is being 'geared' somewhat toward facilitating aspects of subsequent civil suits, but considering the bankruptcy of MM&A the previous emphasis on 'blame the big bad American management for all the problems' might not help the Canadian victims much if at all.
Here is the elaboration from the accident report covering details in depth including the number of handbrakes required and and number of handbrakes set by the engineer:
2.3.1 Number of hand brakes
As demonstrated in this accident, railway rules related to the securement of trains are important because of the potential consequences of improperly secured equipment.
MMA followed Canadian Rail Operating Rule (CROR)112, which stated that a “sufficient” number of hand brakes must be applied and an effectiveness test must be performed to verify that the retarding force is adequate. In addition, MMA had supplementary rules in its General Special Instructions and Safety Rules. These rules reference a chart detailing the minimum number of hand brakes to be applied—the “10% + 2” instruction. Since all air brake systems leak, MMA’s instructions also explicitly stated that air brakes “must not be depended upon to prevent an undesired movement.”Footnote 133
Furthermore, the chart detailing the minimum number of hand brakes was only meant to be a guideline and, as stated in the Safety Rules, “additional hand brakes may be required” because of factors such as grade, the number of cars, the weight of a train, and weather conditions.
In addition, TSB tests have demonstrated that a variety of other factors can affect the performance of individual hand brakes, including the amount of force applied by a person, the mechanical condition and the efficiency of the hand brake, as well as the presence of foreign matter between the brake shoes and the wheels. It is therefore imperative that an LE properly verify the securement of a train by performing a hand brake effectiveness test.
In this accident, the 7 hand brakes that were applied correlated to approximately 10% of the cars. This number proved insufficient once the air from the brake system leaked off and the independent brakes no longer provided supplementary retarding force.
Therefore, this investigation examined why work is not always performed in accordance with written procedures, and how adaptations of procedures sometimes occur. More specifically, the investigation examined why the LE considered 7 hand brakes to be sufficient, and why he did not perform a proper effectiveness test.
One reason for this decision may have been that the LE was not fully conversant with relevant rules and special instructions on train securement. Although the LE’s results from his requalification tests indicated that he had correctly answered questions relating to the minimum number of hand brakes, these questions were relatively simple and did not demonstrate that the LE possessed knowledge of the significance and rationale behind the rules. Furthermore, the LE was never tested on the procedures for performing a hand brake effectiveness test, nor did the company’s Operational Tests and Inspections (OTIS) Program confirm that hand brake effectiveness tests were being conducted correctly. In addition, the LE did not have all of the required documents with him on board the train, and could not easily refer to rules and company instructions.
The LE’s previous experiences might also have been a factor in his selection of the number of hand brakes. The LE had previously secured trains at this location using hand brakes on just 10% of the cars. Furthermore, at other locations, circumstances were different (less challenging terrain and gentler grades), and applying only 10% may well have been sufficient or permitted by special instructions. The absence of previous problems may have been taken as an indicator of future success.
The TSB’s investigation revealed that the LE’s use of the independent brakes at Nantes on previous occasions influenced his perception of the force provided by the hand brakes, leading him to conclude that just 10% was sufficient. The LE was not alone in this belief; some other MMA LEs also did not release the independent brakes when securing trains, which is indicative that poor train securement practices were not isolated to this accident.
In order to determine how many hand brakes would have been sufficient to hold MMA‑002 on a 0.92% average descending grade—that is, without using the independent brakes on the locomotive consist—the TSB performed an extensive series of tests, taking into account a variety of factors affecting hand brake performance. The main conclusion of these tests was that 9 hand brakes, which is the minimum number set out in the MMA chart, would not have been sufficient to hold the train at Nantes.
In a scenario in which there was no application of automatic air brakes, and depending on the force applied,Footnote 134 the TSB concluded that the LE would have needed to apply between 18 and 26 hand brakes on the cars and locomotive consist.
Given that a 13-psi automatic air brake application was used to stop the train, the TSB concluded that, in this situation, the LE would have needed to apply between 15 and 20 hand brakes on the cars and locomotive consist.
The TSB also concluded that, since the hand brakes on the tank cars were more effective than the hand brakes on the locomotives, between 12 and 18 hand brakes would have been sufficient if the hand brakes were applied only to the cars.
The detailed results of these tests are shown in Appendix J.
However, as noted in the company’s Safety Rules, the numbers set out in the chart are only minimums, and some conditions may require additional hand brakes. For this reason, the LE must determine, through a proper hand brake effectiveness test, the sufficient number of hand brakes.
Before the Lac-Mégantic accident, there had been no runaway trains as a result of unoccupied trains being left at Nantes or Vachon, Quebec. This was likely due to the fact that independent brakes were being used in addition to hand brakes to secure trains. Nonetheless, if a proper hand brake effectiveness test is not performed, equipment may not be adequately secured, increasing the risk of a runaway.
When in a hole - Stop Digging!
Never too old to have a happy childhood!
BaltACD When in a hole - Stop Digging!
He does not have enough "street smarts" to stop.
Norm
In the fifth conversation partly quoted on at the top of this page, the main concern of Harding and R.J. seems to be the fact that the engine caught fire. Now that they know that the train ran away, R.J. asks Harding how many handbrakes he set. Harding said he set seven, and note that he makes no mention of also setting the independent. Neither person seems to feel that seven handbrakes was inadequate.
This series of audio/text transcripts also includes the point where Harding was told by R.J. that it was the oil train that rolled down and set the town on fire. Prior to that, Harding had seen that the a big fire had broken out in Lac Megantic, but he did not know what caused it. Harding called R.J. and told him about the fire. Harding thought it might be a broken gas line, and his concern was that much MM&A rolling stock had been burned up in the yard which was included in the fire.
At that point, R.J. seems to question whether it could be the oil train that Harding left at Nantes that rolled down and started the fire. However, Harding assures R.J. that the oil train was secure at Nantes. Harding was convinced that the fire had nothing to do with the oil train.
Then in a subsequent conversation, while Harding was still speculating on the cause of the fire, R.J. carefully informed Harding that it was his (Harding's) train that rolled down and caught fire. Harding's reaction is profound astonishment. R.J. confirmed that he had factual information that it was the oil train that was burning in Lac Megantic.
Well my take is that is plenty of blame to go around and even the regulatory agencies are included. If you read the whole story, they talk about the risk management, the safety management system, etc. The locomotive had been improperly maintained (bad repair on the cam with some improper material (bondo) the locomotives braking system ("Because the quick release brake (QRB) valve on MMA 5026 was defective") had a flaw, the track was defective, (worn down to where flanges could impact splice bars). The shippers didn't rate the cargo properly, etc. It seems the TC and other agencies didn't enforce the rules in any meaningful way. The MMA had a very lax safety culture. Their trainging & testing was deficient. And as always, when there is no checks and balances, things come together to cause an accident fhat kills 47 people.
Now they are trying the engineer who failed to properly secure a defective train on a track that was defective and with no one to help him in the dark of night after being on duty until the hours of service caught up with him. As the expression goes, "IT'S A HELL OF A WAY TO RUN A RAILROAD!" It sure looks to me that he is being made the goat, and yes he did fail to properly secure his train, but the deck was stacked against him. I have sympathy for him sent out to do a job with bad training, bad testing, bad equipment, bad culture, and no support. And now he has to take the fall.
This trial is about whether the blame lies with the last person who failed to perform his duty or with a larger company culture failed to perform several duties that contributed to the ultimate failure of the last person. I do not know how this can logically be decided. There are very persuasive arguments on both sides.
There are a lot of detailed instructions on how to properly secure trains, including advising that trains should be left secured in the least dangerous locations possible. The instructions are in layers of stipulations and conditions that must be evaluated in order to reach a proper conclusion.
Generally, there are two parts to the instructions:
1) The tables and information that recommends the number of handbrakes to be applied.
2) The practical handbrake effectiveness test made by pushing and pulling on the train with the locomotive to see if the number of handbrakes applied is adequate.
It is part #2 that counts, so part #1 is not even necessary except to make the process a bit less labor intensive. Part #1 is just a guide to get into the ballpark of the correct number of handbrakes to set before stopping to test. Yet with its complex details, part #1 might easily be interpreted in carrying a lot of weight. A person might consider part #1 to carry so much weight that he perceives that part #2 is merely a confirmation of what should true about Part #1. This leads to the belief that part #2 (the test) can be downplayed as only confirming the complex tables and formulas for the number of handbrakes required in part #1.
This subordination of part #2 to part #1 appears to be what Engineer Harding and the MM&A culture produced in securing the oil train at Nantes. The MM&A formula for part #1 is called “10% + 2”. That formula results in the application of 9 handbrakes being needed to secure the train. For some reason, Harding applied just 7 handbrakes.
But the formula result of part #1 is only nominal. It is accompanied by the notice that the actual number required may be either over or under the nominal number. The only way to find the true number if to set handbrakes and then test them to see if the number set is sufficient. Harding set 7 handbrakes, and then set the independent locomotive air brakes as added assurance. And because he combined the handbrakes with the added assurance of air brakes, he tested the total combination, which can easily seem logical since both braking elements are working together. Clearly, he passed the test under those terms of combining the two braking elements.
But why did Harding use the independent brakes as part of his securement? The TSB says that air brakes are not to be relied on as securement. This is standard in most railroad rules. But rules often allow the use of an application of the automatic brake as a backup measure when the train is fully secured by handbrakes. So it is an option to use as backup, but you just cannot use it to substitute for handbrakes needed for 100% handbrake securement.
MM&A has a rule that instructs engineers not to use the automatic brake during securement no matter whether it is being relied on as part of the securement, or is simply added to sufficient handbrake securement as a secondary backup. It has been suggested by some that the reason for the MM&A rule forbidding use of the automatic brake is that it takes more time to get the train moving again after the securement period is over.
In this case, Harding did not use an application of the automatic air brake to either provide a portion of the securement; or to just backup the 100% handbrake securement. In that decision, he followed the MM&A rule. But he did use the independent air brake to supplement the handbrake securement. So, in effect, he was conscientiously following the MM&A rule to refrain from using the automatic brake. And he probably knew the reason was to avoid a delay in proceeding with the train after the securement period ended; and he also knew that applying the independent brake does not cause any delay in resuming the run after securement has ended.
I wonder if this MM&A rule caused the engineer to not comprehend the reason for the TSB rule forbidding the use of air brakes (either automatic or independent) to provide securement. Unlike the TSB rule, the MM&A rule do not forbid the use of the independent brake for either direct securement or for a safety backup. Probably, the MM&A special instructions do not specify this matter because it specified by the TSB rule 112. But also, the MM&A rule against using the automatic brake during securement is apparently not intended to address the safety of the securement. Instead, it is to prevent a delay in resuming train movement after securement.
If the engineer did not understand these fine points, it would be easy and likely for him to do exactly what he did, that is to follow the MM&A rules and assume he was also following the similar TSB rule. I think it would be easy to overlook the difference between using air for a portion of the securement rather than using it as a backup for 100% securement by handbrakes. A person engaged in these practices has to understand the big picture. Otherwise, he is just reading little blocks of information and is very likely to somewhat improperly assemble them into the whole.
Considering all of this, I cannot imagine just handing the written rules to an employee who was not familiar with the practice and expecting him to read it and grasp the proper interpretation. During this trial,Michael Horan, the Montreal, Maine and Atlantic Railway's Assistant Director, said he told police after the Lac-Mégantic disaster that nine handbrakes should have been applied to the train. He said that nine handbrakes should been applied according to a chart in a handbook on railway safety regulations. Yet this number stated by the Assistant Director of the MM&A is incorrect. The chart he refers to is the so-called “10% + 2” chart, and other special instructions clarify that this number specified in the chart is only a minimum and that the actual required number of handbrakes set depends on other factors such as grade of track. The TSB has stated that nine handbrakes would not have been sufficient to secure the train. They say the correct number would have been between 12 and 26, depending on several other variables. But again, there is no way to know until it is tested by pulling on the train. Michael Horan was the MM&A Assistant Director, and he did not understand the train securement rules of the company. So it is not surprising that other employees would also fail to understand those rules.
The TSB report says this:
…the TSB performed an extensive series of tests, taking into account a variety of factors affecting hand brake performance. The main conclusion of these tests was that 9 hand brakes, which is the minimum number set out in the MMA chart, would not have been sufficient to hold the train at Nantes.
In a scenario in which there was no application of automatic air brakes, and depending on the force applied, the TSB concluded that the LE would have needed to apply between 18 and 26 hand brakes on the cars and locomotive consist.
The MM&A rule does not forbid automatic air only; it forbids any use of air.
The Canadian rule forbade the use of automatic ON a secured train, whether in addition to handbrake securement or not. MM&A did have the practice of leaving the automatic released so the single-man would not have to do the required brake test after 4 hours application, but (1) law would not allow it to be used to hold the train anyway ... but note independent application wasn’t forbidden ... and (2) it was assumed by rule that the train would be pull-tested without air to be secure.
Harding had long experience on a railroad with explanation of the need to increase ‘number of handbrakes’ on grades (that was mentioned in the TSB report in a different context). To say he was somehow ignorant because of ‘faulty company training’ is patently ridiculous; to say he took the easy way out of securement by following only the simplest rules guideline is ... well, the sort of thing I hope they evoke properly in context in the trial testimony.
Overmod The MM&A rule does not forbid automatic air only; it forbids any use of air. ... but note independent application wasn’t forbidden ...[by MM&A]
... but note independent application wasn’t forbidden ...[by MM&A]
I am not sure I understand what you are saying. These two comments from your above post seem to be in conflict.
Also, I did not know that Canadian rules forbade the use of automatic on a secured train. I had understood they only forbade using automatic to take the place of handbrakes required for 100% securement by handbrakes. I thought Canadian rules allowed option of setting the automatic for backup protection after the train was secured by handbrakes. And now I understand that since the Lac Megantic wreck, the Canadian rules require the setting of the automatic brakes as backup protection—the so-called Ten-Second-Procedure.
You have mangled my quote: it’s the Canadian rule forbidding automatic application that did not include independent, not MM&A’s which disallowed any use of air for securement.
I believe the Canadian prohibition of automatic brake was discussed again in one of the pathetically few trial-coverage stories or discussion thereof.
I recall at the time thinking this was a bit like the 1937 prohibition on new four-wire switches — because folks who might ‘forget’ three-wire was legal might assume a fixture was de-energized as if on four-wire when it wouldn’t be. It was as if Canadian authorities ‘knew’ crews would get sloppy with full handbrake application and pull-test securement if they “could” set the automatic to cover ... so setting the automatic was forbidden. Unsurprisingly they have crawfished and made it SOP to recommend that ‘ten-second procedure’ all the time ... now that the train is down the hill.
Overmod The MM&A rule does not forbid automatic air only; it forbids any use of air. The Canadian rule forbade the use of automatic ON a secured train, whether in addition to handbrake securement or not. MM&A did have the practice of leaving the automatic released so the single-man would not have to do the required brake test after 4 hours application, but (1) law would not allow it to be used to hold the train anyway ... but note independent application wasn’t forbidden ... and (2) it was assumed by rule that the train would be pull-tested without air to be secure.
I don't know about the U.S. or other jurisdictions, but there is no such rule in Canada. On CN trains are routinely parked for far longer than that (sometimes for several days) with a full service application of the automatic brake, and all the new crew has to do is release it and start pulling, after the Conductor releases the handbrakes of course. No air test, the only requirement is for the tail end pressure to reach 75 PSI and the flow to drop below 60 CFM.
The only requirement for an air test en-route is if equipment has been left off air for more than 24 hours, then a No. 1A brake test is to be performed by the train crew. This consists of the Conductor walking the train and verifying that all the brake pistons apply and release properly.
And as I noted in an earlier post, before Lac-Megantic we would leave trains unattended with a full service application of the automatic, full application of the independent and only one handbrake on the lead locomotive. Legal at the time, not anymore.
Greetings from Alberta
-an Articulate Malcontent
Euclid And now I understand that since the Lac Megantic wreck, the Canadian rules require the setting of the automatic brakes as backup protection—the so-called Ten-Second-Procedure.
And now I understand that since the Lac Megantic wreck, the Canadian rules require the setting of the automatic brakes as backup protection—the so-called Ten-Second-Procedure.
The current train securement rule, from the CROR. Note how it differentiates between on air or off air (Locomotive attached or unattached), and between yards and main track, sidings & high risk locations:
In the application of this rule:
(i) Equipment is considered unattended when an employee is not in close enough proximity to take effective action to stop the unintentional moving of equipment.
(ii) Physical securement or mechanical devices are:
hand brakes;
air brakes;
derails;
mechanical emergency devices;
locomotive equipped with a reset safety control (RSC) with roll-away protection where air pressure is maintained by continuous operation or auto start is provided;
bowled terrain; and
if in a yard: retarder, stop-block, wheel chocks and skates.
(iii) High risk locations, as determined by a risk assessment, must be identified in company instructions.
(a) When equipment, including a locomotive without an air source, is left unattended on a main track, subdivision track, siding or high risk location, at least the minimum number of hand brakes as indicated in the hand brake chart in (k) must be applied and determined to be sufficient through an effectiveness test described in (e), and at least one additional physical securement or mechanical device must be used. When air brakes are used as an additional means of physical securement:
(i) the air brake system must be charged to ensure proper brake application; and
(ii) the brake pipe must be fully vented at a service rate or have an emergency application and, on freight equipment, the angle cock left open.
(iii) the equipment may only be left unattended for up to a maximum of two hours.
If required to be left longer, an employee must conduct a visual verification to confirm that the equipment remains secure. The verification must confirm the air brake pistons are fully extended and the hand brakes remain applied. This verification must be carried out at consecutive intervals of two hours or less. If any motion is detected during the verification, additional hand brakes must be applied. The results of that verification must be communicated to another employee.
(b) When unattended equipment is left coupled to a locomotive with an air source on a main track, subdivision track, siding or high risk location, at least the minimum number of hand brakes as indicated in the hand brake chart in (k) must be applied and determined to be sufficient through an effectiveness test described in (e), and at least one additional physical securement or mechanical device must be used. When air brakes are used as an additional means of physical securement:
(i) the locomotive controlling the air brake system must maintain pressure;
(ii) the air brake system must be charged to ensure proper brake application and the equipment must be left with air brakes applied; and
(iii) the independent brake must be fully applied.
(c) When equipment is left unattended in a yard, at least one physical securement or mechanical device must be utilized.
(d) When equipment is left unattended on non-main track, at other than a yard, siding, subdivision track, or high risk location, a sufficient number of hand brakes must be applied and determined sufficient through an effectiveness test described in (e). Special instructions must indicate the minimum hand brake requirements for these locations where equipment is left unattended.
(e) When hand brakes are used, an effectiveness test must be performed as follows: release all air brakes and,
(i) allow or cause the slack to adjust. It must be apparent when slack runs in or out, that the hand brakes are sufficient to prevent the equipment from moving; or
(ii) apply sufficient tractive effort to determine that the hand brakes provide sufficient force to prevent the equipment from moving when tractive effort is terminated.
(f) Hand brakes must be applied on all locomotives in the lead consist of an unattended movement.
(g) Application of hand brakes must not be done while equipment is being pulled or shoved.
(h) Before leaving equipment at any location, the employee securing such equipment must confirm with another employee the manner in which the equipment has been secured.
(i) Exceptional weather situations, such as high winds or other unusual conditions, must be considered and factored into securement decisions. When exceptional weather situations emerge, previously secured equipment may require additional means of securement. Special instructions may contain location specific instructions where extreme weather events are prevalent.
(j) When advised that trespasser(s) or emergency responder(s) have been in contact with unattended equipment, the person responsible for the territory must make arrangements to have an employee verify the equipment remains secured without delay.
(k) In the application of this chart, the number of hand brakes on locomotives in the lead consist shall not to be included in the number of hand brakes required by the chart.
This chart provides the minimum number of hand brakes for securing equipment or movements left unattended.
Overmod The MM&A rule does not forbid automatic air only; it forbids any use of air.
According to your more recent comment, I assume that here you mean forbids any use of air during securement that is intended to prevent undesired movement.
As I understand it, many railroads allowed the use of air brakes during securement as long as it was not intended to prevent undesired movement.
The MM&A had a rule that prohibited the automatic brake from being applied during securement even if it was not intended to prevent undesired movment. I assume that it was okay on the MM&A to leave the independent brakes applied during securement as long as it was not intended to prevent undesired movement.
Therefore: On all railroads, no air brakes at all to be applied with the intention of preventing undesired movement.
On all railroads except MM&A, automatic and independent air brakes allowed to be applied during securement as long as it is without any intention of preventing undesired movement.
On MM&A, independent air brakes allowed to be applied during securement as long as it is without any intention of preventing undesired movement.
On MM&A automatic air brakes not allowed to be applied during securement for any reason.
This is why I made the distinction a few posts up about the difference in the way MM&A rules apply to the automatic and independent applications during securement.
SD70M-2Dude Euclid And now I understand that since the Lac Megantic wreck, the Canadian rules require the setting of the automatic brakes as backup protection—the so-called Ten-Second-Procedure. The current train securement rule, from the CROR. Note how it differentiates between on air or off air (Locomotive attached or unattached), and between yards and main track, sidings & high risk locations: 112. Leaving Equipment Unattended In the application of this rule: (i) Equipment is considered unattended when an employee is not in close enough proximity to take effective action to stop the unintentional moving of equipment. (ii) Physical securement or mechanical devices are: hand brakes; air brakes; derails; mechanical emergency devices; locomotive equipped with a reset safety control (RSC) with roll-away protection where air pressure is maintained by continuous operation or auto start is provided; bowled terrain; and if in a yard: retarder, stop-block, wheel chocks and skates. (iii) High risk locations, as determined by a risk assessment, must be identified in company instructions. (a) When equipment, including a locomotive without an air source, is left unattended on a main track, subdivision track, siding or high risk location, at least the minimum number of hand brakes as indicated in the hand brake chart in (k) must be applied and determined to be sufficient through an effectiveness test described in (e), and at least one additional physical securement or mechanical device must be used. When air brakes are used as an additional means of physical securement: (i) the air brake system must be charged to ensure proper brake application; and (ii) the brake pipe must be fully vented at a service rate or have an emergency application and, on freight equipment, the angle cock left open. (iii) the equipment may only be left unattended for up to a maximum of two hours. If required to be left longer, an employee must conduct a visual verification to confirm that the equipment remains secure. The verification must confirm the air brake pistons are fully extended and the hand brakes remain applied. This verification must be carried out at consecutive intervals of two hours or less. If any motion is detected during the verification, additional hand brakes must be applied. The results of that verification must be communicated to another employee. (b) When unattended equipment is left coupled to a locomotive with an air source on a main track, subdivision track, siding or high risk location, at least the minimum number of hand brakes as indicated in the hand brake chart in (k) must be applied and determined to be sufficient through an effectiveness test described in (e), and at least one additional physical securement or mechanical device must be used. When air brakes are used as an additional means of physical securement: (i) the locomotive controlling the air brake system must maintain pressure; (ii) the air brake system must be charged to ensure proper brake application and the equipment must be left with air brakes applied; and (iii) the independent brake must be fully applied. (c) When equipment is left unattended in a yard, at least one physical securement or mechanical device must be utilized. (d) When equipment is left unattended on non-main track, at other than a yard, siding, subdivision track, or high risk location, a sufficient number of hand brakes must be applied and determined sufficient through an effectiveness test described in (e). Special instructions must indicate the minimum hand brake requirements for these locations where equipment is left unattended. (e) When hand brakes are used, an effectiveness test must be performed as follows: release all air brakes and, (i) allow or cause the slack to adjust. It must be apparent when slack runs in or out, that the hand brakes are sufficient to prevent the equipment from moving; or (ii) apply sufficient tractive effort to determine that the hand brakes provide sufficient force to prevent the equipment from moving when tractive effort is terminated. (f) Hand brakes must be applied on all locomotives in the lead consist of an unattended movement. (g) Application of hand brakes must not be done while equipment is being pulled or shoved. (h) Before leaving equipment at any location, the employee securing such equipment must confirm with another employee the manner in which the equipment has been secured. (i) Exceptional weather situations, such as high winds or other unusual conditions, must be considered and factored into securement decisions. When exceptional weather situations emerge, previously secured equipment may require additional means of securement. Special instructions may contain location specific instructions where extreme weather events are prevalent. (j) When advised that trespasser(s) or emergency responder(s) have been in contact with unattended equipment, the person responsible for the territory must make arrangements to have an employee verify the equipment remains secured without delay. (k) In the application of this chart, the number of hand brakes on locomotives in the lead consist shall not to be included in the number of hand brakes required by the chart. This chart provides the minimum number of hand brakes for securing equipment or movements left unattended. Minimum Required Number of Hand Brakes for Securing Equipment or Movements Left Unattended Total Tons:Average Grade is Equal To or Less Than 0.2%0.4%0.6%0.8%1.0%1.2%1.4%1.6%1.8%2.0%2.2%2.4%> 2.4% 0 - 2000 2 2 2 4 6 6 8 10 10 12 12 14 100% Hand Brakes > 2000 - 4000 2 2 4 6 8 12 14 16 18 20 22 26 > 4000 - 6000 2 6 6 10 14 16 20 24 28 30 34 38 > 6000 - 8000 4 6 8 12 18 22 26 32 36 42 46 52 > 8000 - 10000 4 6 10 16 22 28 34 40 46 52 58 66 > 10000 - 12000 4 8 12 20 26 34 40 48 56 64 72 80 > 12000 – 14000 6 8 14 22 30 40 48 58 66 76 84 96 > 14000 - 16000 6 10 16 26 36 46 56 66 76 88 98 110 > 16000 - 18000 6 10 18 28 40 50 62 74 86 100 112 126 > 18000 - 20000 8 12 20 32 44 58 70 84 98 112 128 146 > 20000 - 22000 8 12 22 36 50 64 78 94 110 100% Hand Brakes > 22000 – 24000 8 12 24 38 54 70 86 104 122 > 24000 - 26000 10 14 26 42 58 76 94 112 134 > 26000 - 28000 10 14 28 46 64 82 104 124 148 > 28000 - 30000 12 16 30 50 68 90 110 136 162 > 30000 12 16 34 52 74 96 120 148 172
Sounds like they won't be storing unneeded cars on sidings until business returns with the application of 112 (iii) a (iii), with the equipment needing to be inspected every two hours.
BaltACD Sounds like they won't be storing unneeded cars on sidings until business returns with the application of 112 (iii) a (iii), with the equipment needing to be inspected every two hours.
Still happens, they just send Engineering out to install a portable derail. That's the "additional physical method of securement", and as air brakes are not the other method the two hour inspection bit does not apply. Many sidings have also had "special" derails installed, sounds exciting but they are just a regular derail which the rules allow to be left in the non-derailing position when there is no equipment for it to protect.
Gotta be a lawyer to understand these rules.
This is getting too Talmudic for me. I interpreted the MM&A rule to say, in essence, no air (independent or automatic) could be applied during the last of what may be several pull tests, the one that finally confirms enough handbrakes are set to ‘secure’ the train. The relevance is that Harding apparently violated that rule, and apparently had done so almost systematically and so, by report, had other engineers. It ‘should’ not really matter if you apply independent, automatic, or both AFTER the train is confirmed secure... as long as you used no air when finalizing that confirmation.
Note all the careful notes on what happens now if you choose to apply the automatic on a train secured on the main line... pay careful attention to that two-hour rule, which I think is far less there for ‘safety’ than for making it so financially and operationally unpalatable for a railroad to apply the brakes in that way as to functionally eliminate it; compare the intent (and success!) of the Red Flag ‘safety’ law with road steam in Britain.
We need a ‘rail Shem Tov’ for the Talmudic aspects of what rules apply when rules aren’t followed, or what rules apply when rules are interpreted outside their stated scope using some inchoate principle of exegesis or other. I am not that person.
Overmod This is getting too Talmudic for me. I interpreted the MM&A rule to say, in essence, no air (independent or automatic) could be applied during the last of what may be several pull tests, the one that finally confirms enough handbrakes are set to ‘secure’ the train. The relevance is that Harding apparently violated that rule, and apparently had done so almost systematically and so, by report, had other engineers. It ‘should’ not really matter if you apply independent, automatic, or both AFTER the train is confirmed secure... as long as you used no air when finalizing that confirmation.
Exactly.
Also note that the two-hour rule does not apply to trains left on the main track with handbrakes properly applied and both the automatic & independent brakes applied.
In reality, the two-hour rule is there to allow switching operations where the crew leaves the train unattended on the mainline and proceeds away from it, into a yard or up a spur. Before Lac-Megantic we did not have to apply handbrakes at all in that situation, just leave the train vented or in emergency (two-hour limit still applied).
Someone at work made up a handy flowchart to explain the new Rule 112, but now I can't find a copy online. It really is much simpler than it looks, or maybe I've just gotten used to it over time.
SD70M-2Dude Overmod The MM&A rule does not forbid automatic air only; it forbids any use of air. The Canadian rule forbade the use of automatic ON a secured train, whether in addition to handbrake securement or not. MM&A did have the practice of leaving the automatic released so the single-man would not have to do the required brake test after 4 hours application, but (1) law would not allow it to be used to hold the train anyway ... but note independent application wasn’t forbidden ... and (2) it was assumed by rule that the train would be pull-tested without air to be secure. I don't know about the U.S. or other jurisdictions, but there is no such rule in Canada. On CN trains are routinely parked for far longer than that (sometimes for several days) with a full service application of the automatic brake, and all the new crew has to do is release it and start pulling, after the Conductor releases the handbrakes of course. No air test, the only requirement is for the tail end pressure to reach 75 PSI and the flow to drop below 60 CFM. The only requirement for an air test en-route is if equipment has been left off air for more than 24 hours, then a No. 1A brake test is to be performed by the train crew. This consists of the Conductor walking the train and verifying that all the brake pistons apply and release properly. And as I noted in an earlier post, before Lac-Megantic we would leave trains unattended with a full service application of the automatic, full application of the independent and only one handbrake on the lead locomotive. Legal at the time, not anymore.
In the US trains also may be tied down for a day or so. Same thing for us, normally no air test required. Only difference is we use a 20 psi set instead of full service. If the train somehow comes off air for over 4 hours, then an initial terminal test is required. Off air is not only a complete loss of pressure in the brakepipe, but also if the brakepipe falls below 60 psi.
jeffhergertSame thing for us, normally no air test required. Only difference is we use a 20 psi set instead of full service. If the train somehow comes off air for over 4 hours, then an initial terminal test is required. Off air is not only a complete loss of pressure in the brakepipe, but also if the brakepipe falls below 60 psi.
For the lazy, and the phone-afflicted who cannot search GCOR/NORAC effectively, what are the exact rules (and if possible carrier-specific safety ‘extensions’ that describe this practice? I presume this 20lb set is in addition to full manual securement confirmed by pull test?
Overmod It ‘should’ not really matter if you apply independent, automatic, or both AFTER the train is confirmed secure... as long as you used no air when finalizing that confirmation.
I agree that it does not matter according to the confines of this MM&A rule which is shown in the TSB report:
Crew members are responsible for securing standing equipment with hand brakes to prevent undesired movement. The air brake system must not be depended upon to prevent an undesired movement.
However, it does matter according to MM&A rules IF MM&A has a rule that says you cannot apply the automatic brake after the train is confirmed secure by the by the push-pull test. I have not actually seen this rule, but it has been reported many times in the news, and the reason given for that rule is that MM&A wanted to save money by avoiding any delay in releasing the automatic brake. I would like to see that rule.
This is my point in bringing this up:
Harding violated the rule forbidding the use of air to produce intended securement when he left the independent brake applied during the push pull test, and applied insufficient handbrakes needed to pass that test.
He could have easily extended this faulty practice by also applying the automatic brake. If he was mistakenly willing to rely on air in the form of the independent, he could have easily and quite likely extended that mistake by adding more air by using the automatic. Clearly, he wanted to secure the train.
Yet he refrained from setting the automatic for some reason. The most obvious reason is that MM&A had a rule forbidding setting the automatic for a reason unrelated to securement. I speculate that he would have set the automatic if it were not for that rule. But in his mind, he did the next best thing, and that was setting just the independent brake for the intention of preventing undesired movement.
So he followed the rules by not setting the automatic during the securement but violated the rules by setting the independent. This inconsistency suggests that he did not understand the securement rules that prohibit the use of air intended to prevent undesired movement.
I am only looking at this point to try to understand the engineer’s thought process. You made the point that he had previous experience in mountain railroading prior to MM&A, and therefor knew the securement rules. I don’t think he did know them. I think the MM&A rule prohibiting the application of the automatic brake during securement (for any reason) had been drummed into his head by the company because its purpose was to save money. So he knew and abided by that rule.
If a person truly knows the securement rules, they won’t violate them because they will know that the consequences of violation are simply unacceptable. If a person were so irresponsible that they knew the securement rules, but was too indifferent or lazy to execute them, they would not last in the industry.
Overmod jeffhergert Same thing for us, normally no air test required. Only difference is we use a 20 psi set instead of full service. If the train somehow comes off air for over 4 hours, then an initial terminal test is required. Off air is not only a complete loss of pressure in the brakepipe, but also if the brakepipe falls below 60 psi. For the lazy, and the phone-afflicted who cannot search GCOR/NORAC effectively, what are the exact rules (and if possible carrier-specific safety ‘extensions’ that describe this practice? I presume this 20lb set is in addition to full manual securement confirmed by pull test?
jeffhergert Same thing for us, normally no air test required. Only difference is we use a 20 psi set instead of full service. If the train somehow comes off air for over 4 hours, then an initial terminal test is required. Off air is not only a complete loss of pressure in the brakepipe, but also if the brakepipe falls below 60 psi.
You wouldn't find it in the GCOR book, beyond general requirement. Securement procedure rules will be in Air Brake and Train Handling rule books. Supplemented by local directives.
Tie hand brakes as directed by system and/or local specific instructions. Release automatic and independent air brakes. Allow time for air brakes to release and slack to adjust. (We don't do a push/pull type test.) Once satisfied that train is secure, apply automatic with a 20psi set and fully apply independent. Isolate locomotives in lead consist using isolatation switch on each unit, dp consists through dp remote screen. Open generator field switch, remove reverser. Close and lock windows and doors (when possible) on lead locomotive when outside of terminal areas. For KEY trains, if the door(s) can't be locked take the reverser with you. Notify the dispatcher (or other authority) train is secured. For KEY trains there is a specific checklist that must be gone over with the dispatcher. The specific KEY train requirements have come about because of Lac-Megantic. I've seen a few other road's instruction and they are pretty much the same, at least before Lac-megantic. All such rules and instructions reflect Federal requirements. Our AB&TH rules have listed the number of the CFR that applies to it.
One thing we also have to do (that is a company directive) is to shut down all but one engine in the lead consist for fuel conservation when temperature is expected to be 35 degrees or above. There are exceptions for engines that may have a condition that might keep it from be able to be restarted, like weak batteries. One is left running to maintain air in the brake system.
In this link: https://www.desmogblog.com/2017/10/24/deadly-lac-megantic-oil-train-disaster-was-avoidable-corporate-crime
It is reported that the train that ran away at Lac Megantic was heavier than regulations allowed. It says that the train's maximum allowed weight was 6,300 tonnes. The actual weight was 9,100 tonnes.
I have noticed that issue being commented on in other reports as well. What regulations are they talking about? Are they government regulations or MM&A rules? If they are government regulations, what is the penalty for violating them?
Don't know what angle Daigle is trying to play beyond having operated the locomotive that caught fire a day or two previously and having made a 'work report' on the failings of that locomotive at the conclusion of that particular trip - as a engineer is required to do (at least in the US). It isn't stated if the Work Report was turned in at a US or Canadian terminal (the name mentioned sounds French-Canadian).
I have no idea where the 6300 tons enters the picture. I am going to presume this was not the first oil train that had been handled on this route and I would expect the prior trains to have been in the 9100 ton area, if not heavier.
I will agree that MM&A Management - from the Trainmaster & Road Foreman of Engines to and including the President should be the ones on trial for the roads demonstrated lack of a safety culture. Their actions and inactions set the stage for Harding's and the others failures to SECURE the train, despite what each individual may have thought when they performed their actions.
I find a lot of advocacy journalism in the Internet that is defending Harding and the others on trial, and blaming the accident on the upper management for a safety culture that was compromised for the sake of profit. I can see both sides and I have no idea how the court will rule.
There is a feeling that the prosecutors are under pressure to blame the disaster on someone because the public wants someone held accountable. And so it is assumed that the prosecutors are going after the little guy because that will be the easiest case to make. After all, it was Harding alone who broke the rule on securing the train.
But what the prosecutors may not have realized is that the public may see through this scheme of going after the easiest target; and like some advocates speaking out now, the public too may feel that the MM&A caused the disaster by corporate greed.
The public may sympathize with Harding and think he did the best he could as a one-man crew. Harding was apparently well known and well liked in Lac Megantic. So if he is made a scapegoat for what the public considers greedy management, there may be a public backlash.
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