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Amtrak 501 Derail in Washington State

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Posted by Euclid on Friday, February 2, 2018 8:08 PM

Milepost 19 is a mystery because the latest NTSB report makes no mention of it, nor do they mention whether the engineer said he did, or did not recall seeing it.  Yet milepost 19 was the last resort, so to speak.  It was the last chance for the engineer to realize where he was by referring to a milepost.  Milepost 19 is the most critical of all mileposts.  It was .2 miles beyond where the engineer had planned to begin braking, but still far enough ahead of the curve to allow the train to slow down to 30 mph before reaching the curve. 

So how the NTSB can fail to mention milepost 19 is beyond me.  It seems obvious that the engineer also missed seeing milepost 19 in addition to missing milepost 18, and the advance warning sign at mile distance 17.8.

In any case, the engineer sped past mile distance 19, apparently still believing that he had not yet reached milepost 18.  Next, he arrived at the 30 mph curve traveling at 80 mph.

Therefore, the engineer, while depending on mileposts to know his location, passed milepost 17 and ran 2.8 miles further than milepost 17 while perceiving that he had not run more than one mile past milepost 17.  How do you run 2.8 miles and perceive the time it takes to be less time than you perceive that it takes to run one mile? 

There must have been something wrong with his internal alarm clock that Balt mentioned.

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Posted by Murphy Siding on Friday, February 2, 2018 8:46 PM

Euclid

 

 

Rather than getting your pants in a bunch over me repeating the phase, “navigating by milepost,” why don’t you spend your energy on understanding my meaning?

Here is what Balt said, and I agree 100% with his points here.  I think I am saying about the same thing that Balt said. So why are you not jumping on his case like you jump on mine


 

 

 

     BaltACD is a retired railroader. His experience, his knowledge and his opinions are well respected on this forum. I understand what he says. I believe he has the backgound to back up what he is saying. He is an asset to this forum. You sir, are no BaltACD

Thanks to Chris / CopCarSS for my avatar.

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Posted by Euclid on Friday, February 2, 2018 9:22 PM

Okay fine, I see how that works.Coffee

Got it.  I am no BaltACD.  Others may be BaltACDs, but I am not one of those. 

 

 

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Posted by Euclid on Friday, February 2, 2018 9:32 PM

When the engineer says he does not recall passing milepost 18 or the advance warning sign, it is natural to assume that means that he never saw, identified, and assimilated those markers as he passed by them.   However, the fact may be that he did see and assimilate those marker points, but has had a loss of memory since the experience.  So he would now say that he does not recall seeing those marker points as he passed them. That would be similar to Engineer Bostian losing memory of the details of approaching the fatal curve in the Philadelphia wreck. 

So this Amtrak engineer may have fully seen and idenditifed mileposts 18 and 19, and also the advance warning sign; but has since forgotten seeing them due to some type of memory loss resulting from the derailment. 

It would take a lot of intense questioning of the engineer going far beyond just asking him if he remembered passing certain marker points.  For instance, it would be helpful to ask the engineer if he can recall anything that might explain why he does not remember passing milepost 18.  For instance, can he recall that he was answering a question asked by the conductor trainee in the cab with him? And was this around the time he probably would have passed milepost 18?  Maybe there was some other type of small distraction that he can recall. 

Otherwise, if nothing like that happened, then it seems hard to explain why he would have missed the milepost when he was intently looking for it.  Identifying the point where he had to begin slowing for the curve was deadly critical.  And that was only 8/10ths of a mile beyond milepost 18.  It should be obvious that if you miss that, the train is doomed. 

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Posted by Anonymous on Saturday, February 3, 2018 8:40 AM

Euclid
Milepost 19 is a mystery because the latest NTSB report makes no mention of it, nor do they mention whether the engineer said he did, or did not recall seeing it.

Why should it be a mystery?

Quote from latest NTSB press release: The engineer said that he did see the wayside signal at milepost 19.8 (at the accident curve) but mistook it for another signal, which was north of the curve.

The signal distance should be more than a mile. Braking distance for signalling purposes is about 1.16 miles according to Caltrans.

The signal before that at MP19.8 would have been between MP17 and MP18. Ergo he didn't recognize the MP19.

Why should NTSB express it explicitly?
Regards, Volker

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Posted by Euclid on Saturday, February 3, 2018 8:56 AM

VOLKER LANDWEHR
 
Euclid
Milepost 19 is a mystery because the latest NTSB report makes no mention of it, nor do they mention whether the engineer said he did, or did not recall seeing it.

 

Why should it be a mystery?

Quote from latest NTSB press release: The engineer said that he did see the wayside signal at milepost 19.8 (at the accident curve) but mistook it for another signal, which was north of the curve.

The signal distance should be more than a mile. Braking distance for signalling purposes is about 1.16 miles according to Caltrans.

The signal before that at MP19.8 would have been between MP17 and MP18. Ergo he didn't recognize the MP19.

Why should NTSB express it explicitly?
Regards, Volker

 

But did he not pass milepost 19?  Was there a milepost 19?

If there was a milepost 19, and if the engineer saw it, he would have realized that he had missed milepost 18 and was ahead of where he thought he was.  Therefore, spotting milepost 19 would have saved the day by telling the engineer to immediately start braking to reach 30 mph within the next 8/10th mile.  So, milepost 19 was the most critical milepost of all.  Yet, the NTSB did not say anything about asking the engineer whether he saw milepost 19.  That is the mystery I am referring to.

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Posted by Murphy Siding on Saturday, February 3, 2018 9:25 AM

Euclid

Okay fine, I see how that works.Coffee

Got it.  I am no BaltACD.  Others may be BaltACDs, but I am not one of those. 

 

 

 

  And I agree 100% with your point here.

Thanks to Chris / CopCarSS for my avatar.

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Posted by zugmann on Saturday, February 3, 2018 9:29 AM

Murphy Siding
And I agree 100% with your point here.

I do, too.  Coffee is good.

 

That's the point, right?

It's been fun.  But it isn't much fun anymore.   Signing off for now. 


  

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Posted by Jim200 on Saturday, February 3, 2018 9:46 AM

Euclid

Milepost 19 is a mystery because the latest NTSB report makes no mention of it, nor do they mention whether the engineer said he did, or did not recall seeing it.  Yet milepost 19 was the last resort, so to speak.  It was the last chance for the engineer to realize where he was by referring to a milepost.  Milepost 19 is the most critical of all mileposts.  It was .2 miles beyond where the engineer had planned to begin braking, but still far enough ahead of the curve to allow the train to slow down to 30 mph before reaching the curve. 

So how the NTSB can fail to mention milepost 19 is beyond me.  It seems obvious that the engineer also missed seeing milepost 19 in addition to missing milepost 18, and the advance warning sign at mile distance 17.8.

In any case, the engineer sped past mile distance 19, apparently still believing that he had not yet reached milepost 18.  Next, he arrived at the 30 mph curve traveling at 80 mph.

Therefore, the engineer, while depending on mileposts to know his location, passed milepost 17 and ran 2.8 miles further than milepost 17 while perceiving that he had not run more than one mile past milepost 17.  How do you run 2.8 miles and perceive the time it takes to be less time than you perceive that it takes to run one mile? 

There must have been something wrong with his internal alarm clock that Balt mentioned.

 

Milepost 19 is indeed very important, and after a month, we still don't know if there was one. Using Google's distance marker, I was able to determine where mp19 should be, since I knew from Google's street side view the location of mp18. After mp19 the train would have gone under the Nisqually Rd bridge, and the engineer would have seen the wayside signal at mp19.8 and now think he was at the previous wayside signal. As far as I can determine, the previous wayside signal was on the north side of the 41st Division Dr. grade crossing, but there may have been something in the DuPont yard which I did not see.

After the 41st Division Dr. crossing comes mp16, mp17, and the Clark Rd grade crossing, which along with checking the locomotive display or some other distraction could have messed up his "internal alarm clock". Then there is the question of what was his previous "internal alarm clock" which he had from his three to five southbound trips and his one southbound run. We have not been told the speed of any of this training. Was it 40 mph? Was it 30mph? If the training was at one of these slower speeds, then the 45 seconds between mileposts at 80mph would increase to 90 seconds or 120 seconds at these slower speeds.

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Posted by Anonymous on Saturday, February 3, 2018 9:59 AM

Euclid
But did he not pass milepost 19? Was there a milepost 19? If there was a milepost 19, and if the engineer saw it, he would have realized that he had missed milepost 18 and was ahead of where he thought he was. Therefore, spotting milepost 19 would have saved the day by telling the engineer to immediately start braking to reach 30 mph within the next 8/10th mile. So, milepost 19 was the most critical milepost of all. Yet, the NTSB did not say anything about asking the engineer whether he saw milepost 19. That is the mystery I am referring to.

As I said there is no mystery. When he said he mistook the signal at MP19.8 for one that was at best between MP17 and MP18 it should be clear to everyone that he didn't see MP19. At least it seemed to be clear to NTSB. If he had seen the MP19 he couldn't have mistaken the MP19.8 signal for one between MP17 and MP18.

Why all the ifs? He clearly didn't see MP19.
Regards, Volker

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Posted by Euclid on Saturday, February 3, 2018 10:26 AM

I’m no BaltACD, but it seems to me that the critical nature of the engineer knowing where he was in approach to the curve would require more than just relying on an internal alarm clock.  The problem with just spotting mileposts is that you might miss one and not realize it.  So why not use the odometer to count distance traveled between mileposts? 

That way when you pass milepost 17, and see it; you watch the odometer count out the next mile and look for milepost 18 as the odometer approaches one mile past milepost 17. 

That way, if the odometer passes one mile and you have not seen milepost 18 go by, then you know you have missed it.  If that had happened in this case, it would have been prudent for the engineer to begin slowing down right after the odometer counted out one mile past MP 18 and no MP 18 was observed. 

But instead he relied on his internal alarm clock to anticipate each mile.  But he ran 2.8 miles and went into the ditch at 80 mph because his internal alarm clock never went off.  Maybe he had an internal snooze button. 

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Posted by Anonymous on Saturday, February 3, 2018 11:36 AM

Euclid
But instead he relied on his internal alarm clock to anticipate each mile. But he ran 2.8 miles and went into the ditch at 80 mph because his internal alarm clock never went off. Maybe he had an internal snooze button.

When do you accept that we don't know what he did or what he relied on. All your what if can't undo the accident.
Regards, Volker

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Posted by Euclid on Saturday, February 3, 2018 11:38 AM

VOLKER LANDWEHR
 
Euclid
But instead he relied on his internal alarm clock to anticipate each mile. But he ran 2.8 miles and went into the ditch at 80 mph because his internal alarm clock never went off. Maybe he had an internal snooze button.

 

When do you accept that we don't know what he did or what he relied on. All your what if can't undo the accident.
Regards, Volker

 

I am just looking at the possibilities to understand how the accident might have occurred.  I do not expect to undo the accident. 

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Posted by Lithonia Operator on Saturday, February 3, 2018 1:09 PM

Euclid
I am just looking at the possibilities to understand how the accident might have occurred.

 
Inadequate training, unfamiliarity with route, inattention, speed, sharp curve.

Still in training.


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Posted by zugmann on Saturday, February 3, 2018 1:26 PM

Euclid
I do not expect to undo the accident.

What a let down.

It's been fun.  But it isn't much fun anymore.   Signing off for now. 


  

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Posted by 243129 on Saturday, February 3, 2018 4:26 PM

LithoniaOperator

 

 
Euclid
I am just looking at the possibilities to understand how the accident might have occurred.

 

 
Inadequate training, unfamiliarity with route, inattention, speed, sharp curve.
 

I agree with the above. My question is where was supervision on the first revenue trip for this service ?

According to the record this engineer has minimal experience. This engineer along with Brandon Bostian are also 'victims'. They are victims of Amtrak's hiring and inadequate training procedures. Amtrak has the unknowing teaching the unknowing and nowhere is it more obvious than in the recent disasters.

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Posted by Lithonia Operator on Saturday, February 3, 2018 8:49 PM

I’m with you. I know nothing about Amtrak’s training practices. But I seem to be learning . . .

There definitely should have been supervision for each engineer for the first few revenue runs in each direction. The lawsuit settlements will make the cost of such supervision look like chicken feed.

Still in training.


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Posted by 243129 on Sunday, February 4, 2018 9:57 AM

In reference to Amtrak's inadequate training program I quote Chairman Mao.

" All genuine knowledge originates in direct experience".

Railroad operations cannot be taught in the classroom. The operating rules may be taught in the classroom but the territory must be experienced by on-the-job training. Sadly Amtrak has squandered it's vital resource the veteran operations personnel.

Another disaster has befallen an Amtrak train it will be interesting to see how this plays out.

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Posted by BaltACD on Thursday, March 1, 2018 4:24 PM

Good words about real world engineer and conductor training.

https://www.railwayage.com/news/training-one-size-doesnt-fit/

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Posted by Deggesty on Thursday, March 1, 2018 4:45 PM

I am glad to see more of Mr. Riddell's writing. Is he still working for CSX?

Johnny

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Posted by BaltACD on Thursday, March 1, 2018 5:51 PM

Deggesty
I am glad to see more of Mr. Riddell's writing. Is he still working for CSX?

He left CSX many years ago to work for Amtrak - I believe he has retired from Amtrak.

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Posted by petitnj on Thursday, March 1, 2018 7:22 PM

I hate to rattle the cage but I agree with Euclid that you should watch the odometer and clock for milage. A couple of points:

1) If the crew had concussions, then questioning all day will not yield any further information. Some have been watching too much CSI. 

2) Familiarity may not be an effective way to train. Both crew in the cab should be watching every sign and calling it out to the other. Crew members eventually become acquainted with the route, but they should still see and call out everything. If you are familiar (which the engineer may have felt), you make assumptions about where you are. Never assume. 

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Posted by Euclid on Thursday, March 1, 2018 8:15 PM

petitnj

I hate to rattle the cage but I agree with Euclid that you should watch the odometer and clock for milage. A couple of points:

1) If the crew had concussions, then questioning all day will not yield any further information. Some have been watching too much CSI. 

2) Familiarity may not be an effective way to train. Both crew in the cab should be watching every sign and calling it out to the other. Crew members eventually become acquainted with the route, but they should still see and call out everything. If you are familiar (which the engineer may have felt), you make assumptions about where you are. Never assume. 

 

Yes, familiar is not not quite the right word for what is needed.  It falls short.  

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Posted by 243129 on Thursday, March 1, 2018 8:23 PM

BaltACD

Good words about real world engineer and conductor training.

https://www.railwayage.com/news/training-one-size-doesnt-fit/

 

Here are some words about "real world engineer and conductor training"

Amtrak portrays a clear and present danger to the traveling public with their inadequate vetting and training procedures and nowhere is it more evident than in the recent rash of operator error disasters.
How many more lives will be lost due to the arrogance of Amtrak management who historically have ignored input from their now dwindling veteran operations workforce? If one were to quiz today’s operations employees one would be astounded at what they don’t know.
The warning signs have been there and Amtrak has paid no heed despite repeated pleas from their veteran workforce to examine and revamp their training regimen.
Here are some of the warning signs Amtrak ignored:
June 3, 2011 Amtrak train collides with Chicago Metra train 12 hurt.
October 13, 2011 Amtrak San Joaquin collides with Coast Starlight 17 injured.
November, 2013 Amtrak had a New York to Washington Regional train accept the wrong route and wander six miles in the wrong direction to the end of the line on a foreign railroad.
May 12, 2015 Amtrak train 188 derails due to excessive speed 8 killed, 200 injured.
April 3, 2016 Amtrak train hits company backhoe killing 2 and injuring 39.
July 6, 2016 Amtrak train arrives Charlottesville 1 hour and 45 minutes late after accepting wrong route towards Richmond.
December 12, 2017 Amtrak Cascades train 501 derails killing 3 and injuring 77.
All of the above are attributed to human error yet Amtrak still made no changes to it’s vetting and training procedures.
The public outcry for Positive Train Control is not the be all to end all. It creates dependency and erodes what skills the engineer (operator) might possess.
Positive Train Control can and will fail and a good percentage of engineers will become ‘lost’. Couple that with Amtrak’s inadequate vetting and training procedures and you have a prescription for disaster, a ‘perfect storm’ if you will.
Nothing precludes proper training and Amtrak seems incapable of providing it.
What will it take for Amtrak to review and assess it’s hiring and training procedures? More death and injuries? Amtrak is in dire need of oversight from experienced operations personnel. Something must be done soon or there will be more disasters.
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Posted by BaltACD on Thursday, March 1, 2018 9:20 PM

petitnj
I hate to rattle the cage but I agree with Euclid that you should watch the odometer and clock for milage. A couple of points:

1) If the crew had concussions, then questioning all day will not yield any further information. Some have been watching too much CSI. 

2) Familiarity may not be an effective way to train. Both crew in the cab should be watching every sign and calling it out to the other. Crew members eventually become acquainted with the route, but they should still see and call out everything. If you are familiar (which the engineer may have felt), you make assumptions about where you are. Never assume. 

When you are at the controls of a train moving at track speed with 800 to 20K tons behind you - Familarity doesn't cut it.

You need experienced knowledge of train handling to safely move the train over the territory.  A 'ride along' with someone else operating the control does not count as a qualifying trip to my way of thinking.  Being at the operating controls of the train you are in the position to 'hear and feel' what YOUR TRAIN is telling you.  You have to plan your train handling moves well in advance of their need.  If you don't you end up on I-5.

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Posted by rdamon on Friday, June 1, 2018 4:54 PM

She risked her safety to aid Amtrak victims. Now she's an official U.S. Army hero

http://www.thenewstribune.com/latest-news/article212360174.html

<snip>

A Madigan Army Medical Center nurse who came to the aid of victims after happening upon last year's Amtrak derailment in DuPont has received the Army Award for Valor.

<snip>

 

 

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Posted by charlie hebdo on Friday, June 1, 2018 10:04 PM

243129
243129 wrote the following post 3 months ago: In reference to Amtrak's inadequate training program I quote Chairman Mao. " All genuine knowledge originates in direct experience".

Mao did not trust experts, whether in medicine, agriculture, metallurgy, universities or other areas.  What were the consequences:  1. Hospitals incapable of treating anyone with more than an ingrown toenail because the doctors were pushed out; 2. Massive crop failures leading to famine and millions dying of starvation; iron and steel produced in backyards that was unusable; 3. Universities closed from 1966-76, professors "struggled" and often beaten to death by Red guard students, with years to recover. 

Referring to Mao to support almost any contention betrays a lack of knowledge of historical reality.

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Posted by 243129 on Saturday, June 2, 2018 8:06 AM

charlie hebdo

 

 
243129
243129 wrote the following post 3 months ago: In reference to Amtrak's inadequate training program I quote Chairman Mao. " All genuine knowledge originates in direct experience".

 

Mao did not trust experts, whether in medicine, agriculture, metallurgy, universities or other areas.  What were the consequences:  1. Hospitals incapable of treating anyone with more than an ingrown toenail because the doctors were pushed out; 2. Massive crop failures leading to famine and millions dying of starvation; iron and steel produced in backyards that was unusable; 3. Universities closed from 1966-76, professors "struggled" and often beaten to death by Red guard students, with years to recover. 

Referring to Mao to support almost any contention betrays a lack of knowledge of historical reality.

 

I was applying Mao's quote to a discussion on Amtrak's inadequate training regimen. I am not a disciple of Mao nor do I agree with his 'teachings'. I merely used his quote as it is apropos to my observations. Got that?

Naming oneself after a horrible tragedy displays a lack of reality.Wink

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Posted by charlie hebdo on Saturday, June 2, 2018 8:18 AM

243129

 

 
charlie hebdo

 

 
243129
243129 wrote the following post 3 months ago: In reference to Amtrak's inadequate training program I quote Chairman Mao. " All genuine knowledge originates in direct experience".

 

Mao did not trust experts, whether in medicine, agriculture, metallurgy, universities or other areas.  What were the consequences:  1. Hospitals incapable of treating anyone with more than an ingrown toenail because the doctors were pushed out; 2. Massive crop failures leading to famine and millions dying of starvation; iron and steel produced in backyards that was unusable; 3. Universities closed from 1966-76, professors "struggled" and often beaten to death by Red guard students, with years to recover. 

Referring to Mao to support almost any contention betrays a lack of knowledge of historical reality.

 

 

 

I was applying Mao's quote to a discussion on Amtrak's inadequate training regimen. I am not a disciple of Mao nor do I agree with his 'teachings'. I merely used his quote as it is apropos to my observations. Got that?

Naming oneself after a horrible tragedy displays a lack of reality.Wink

 

Your knowledge of history is very poor.  I like many others, use that pen name to honor the victims of the tragedy in Paris.  Using a quote from Mao for almost anything is an insult to the millions who died under his crazy regime. Mao, a man who harbored lifelong resentment against experts because he could not get promoted in his first job as a librarian since he lacked sufficient education. 

Who's next? Can we expect a quote from Pol Pot?  Saddam Hussein?  Joe Stalin?

It is a given that Amtrak employees need good training.  But all the training in the world would not have prevented the accident in Washington, which seems to have been caused by the two crew engaging in conversation and not paying attention to their jobs.  The derailment in Philadelphia was the result of the engineer being distracted for some reason and not paying attention.  What training would address those problems?

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Posted by BaltACD on Saturday, June 2, 2018 9:48 AM

charlie hebdo
It is a given that Amtrak employees need good training.  But all the training in the world would not have prevented the accident in Washington, which seems to have been caused by the two crew engaging in conversation and not paying attention to their jobs.  The derailment in Philadelphia was the result of the engineer being distracted for some reson and not paying attention.  What training would address those problems?

Just having employees 'take a qualification trip' without handling the controls and actually operating a train similar to what they will be operating 'in real time' is a exercise in self dillusion.  My understanding is that the 'qualification runs' that were made, were done at the pre-existing speed limit of 30 MPH as the track had yet to be approved for 79 MPH operation at the time of the 'qualification runs'.

Sufficient QUALITY training would have injected situational awareness in their actions.  Situational awareness is not a laughing matter.  Proper training of engineers on a route sets in their mind significant landmarks and the timing between those landmarks.  Actions of the crew in this incident indicates they were totally unaware of where they were or what needed to be done and they were totally UNQUALIFIED to be operating this train at this time in their careers.

Trainng for engineers means you know what to do anywhere on your designated route given the normal situations that develop on that route as well being able to handle the unexpected conditions that may arise during a trip.

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