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Train 188 Tragic Accident – What is the Complete Story? Locked

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Posted by BaltACD on Friday, September 7, 2018 8:23 PM

243129
 
BaltACD
 
243129 
BaltACD

Poor is a easy word to throw out for glittering generalities.  It doesn't pass muster when it comes to specifics. 

So in your opinion what wre the causes of these two disasters? 

You are not interested in mine or any other individual's statements of causes.  Only your own - that you don't want to quantify beyond glittering generalties.  Specifics - we aren't going to do your research for you. 

You dodge just like charlie, it must be 'contagious'. I challenged both of you and both of you ran.

Brandon Bostian and Stephen Brown lost situational awareness due to poor training, poor vetting and poor supervision. Dispute those "generalities".

Prove their failures without the incident they were involved in - then you have a case.  The incidents are not proof of anything other than an individual failures.

It is estimated that there were more than 40K motor vehicle deaths in 2017.  By your reckoning all those are a fault of lost situational awareness due to poor training, poor vetting and poor supervision.  Generalities are generalities no matter how you spout them.

Never too old to have a happy childhood!

              

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Posted by 243129 on Friday, September 7, 2018 8:42 PM

BaltACD

 

 
243129
 
BaltACD
 
243129 
BaltACD

Poor is a easy word to throw out for glittering generalities.  It doesn't pass muster when it comes to specifics. 

So in your opinion what wre the causes of these two disasters? 

You are not interested in mine or any other individual's statements of causes.  Only your own - that you don't want to quantify beyond glittering generalties.  Specifics - we aren't going to do your research for you. 

You dodge just like charlie, it must be 'contagious'. I challenged both of you and both of you ran.

Brandon Bostian and Stephen Brown lost situational awareness due to poor training, poor vetting and poor supervision. Dispute those "generalities".

 

Prove their failures without the incident they were involved in - then you have a case.  The incidents are not proof of anything other than an individual failures.

It is estimated that there were more than 40K motor vehicle deaths in 2017.  By your reckoning all those are a fault of lost situational awareness due to poor training, poor vetting and poor supervision.  Generalities are generalities no matter how you spout them.

 

Running when confronted has become, or is, your modus operandi.

So poor training,poor vetting and poor supervision had nothing to do with the two disasters? They were just "individual failures"?

You attempt to debunk my argument while offering none of your own.

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Posted by 243129 on Friday, September 7, 2018 8:50 PM

Disputing my opinion as to the causes of these two disasters is open to anyone. Any takers?

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Posted by zugmann on Friday, September 7, 2018 8:51 PM

243129

Disputing my opinion as to the causes of these two disasters is open to anyone. Any takers?

 

There have been plenty of takers.  You don't want a debate.  You want a soapbox.

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


  

The opinions expressed here represent my own and not those of my employer, any other railroad, company, or person.t fun any

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Posted by Euclid on Friday, September 7, 2018 11:10 PM

The crashes of 501 and 188 have in common the fact that each train derailed on a curve and turned over due to excessive speed.  Even though both crashes had those factors in common, I would not conclude that they have the same cause. The NTSB said that the engineer of 188 lost situational awareness.  I would say that he forgot that he had not passed the curve at Frankford Jct. 

I have noticed that it is very easy to forget if you have just recently performed an action that you habitually perform every day for instance.  If I just daydream for a moment, I forget what step I am at in the process of making coffee. To make coffee, I have to think about every step and nothing else.  And yet the process is so repetitive and well known that it seems like I could do it in my sleep. It is the same thing with locking doors; or locking switches.

With regularly repeated actions, there is nothing about the act that separates it from the experience of performing it in the recent past. In a way, the experience is in the eternal present whether you perform it or not because it is so habitual.  So, in order to remember performing it, you have to attach a marker to it that gives it a unique identity to separate it from all past performances.  I believe that this pinning a unique marker on a repetitive act is what the Japanese railroads are doing with their “Point and Call” system.  It makes the repetitive act uniquely conscious with each repetitive performance.  That way, it will be remembered that it was actually performed.     

Losing situational awareness is a catchy phrase, but does it have a clear meaning?  When you lose awareness of a situation, the situation has to be defined, and usually the situations in one’s life are an ever evolving stream of experience that include a vast number of quickly moving thoughts and ideas all working in concert with the senses and performed actions.  I would say that losing situational awareness means losing some degree of awareness of some parts of the ever-flowing steam of consciousness and performance of actions.  So I would say that everyone “loses situational awareness” several times each minute. 

The term, “losing” also has to be defined.  Is situational awareness either on or off?  Or does it have shades of gray?

The NTSB has not yet said whether the engineer of 501 lost situational awareness.  It seems like he obviously did, but again, what would his losing of situational awareness really mean?  He might not have known enough about his location to ever have a complete situation to be aware of.  Also, we are told that working nightshifts can cause sleep disorders that result in people spontaneously falling asleep during their work shift without warning or a feeling of being tired.  And these periods of unexpected sleep can be very short.

What if Bostian’s supposed loss of situational awareness was actually a matter of suddenly falling asleep as caused by nightshift sleep disorder?  In that case, it may not have had anything to do with Bostian being upset and distracted by hearing the radio transmission about the other train being hit by rocks and suffering a broken windshield, as the NTSB assumes.  Bostian has said that he cannot remember events during the final distance of approach to the curve.

I would conclude that with the crashes of 501 and 188, both engineers failed to act when it was required.  Both may have been a so-called loss of situational awareness, but it may have been in very different forms including spontaneous sleep or medical conditions. The role of Amtrak’s inadequate training seems to play an obvious part in the wreck of 501 because many have described the training for the new train and route to have been rushed and inadequate.  But I don’t see a direct connection between Amtrak’s safety culture and the wreck of 188.  There may be one, but I just don’t see the evidence.  

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Posted by Anonymous on Saturday, September 8, 2018 4:10 AM

Euclid
What if Bostian’s supposed loss of situational awareness was actually a matter of suddenly falling asleep as caused by nightshift sleep disorder?

Just as a reminder, the NTSB Final Report regarding the Amtrak #188 accident is available: https://ntsb.gov/investigations/AccidentReports/Reports/RAR1602.pdf

3.1 Findings
1. None of the following was a factor in this accident: the mechanical condition of the train; a foreign object striking the locomotive; the condition of the track; the weather; medical conditions of the Amtrak engineer; alcohol, other drugs, or any other type of impairment; cell phone use; and fatigue.

BTW no mentioning of poor vetting or poor supervision. Only one recommendation for Amtrak:
Incorporate strategies into your initial and recurrent training for operating crewmembers for recognizing and effectively managing multiple concurrent tasks in prolonged, atypical situations to sustain their attention on current and upcoming train operations. (R-16-37)

And at a different location in the document: Many railroads, including Amtrak, have incorporated distraction management into their training programs. The engineer of train 188 received Amtrak’s distraction management training. However, the Amtrak training could be expanded to more effectively address prolonged, atypical situations that might divert attention for an extended amount of time, such as what occurred in this accident.

Regards, Volker

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Posted by 243129 on Saturday, September 8, 2018 8:02 AM

BaltACD

 

 
zugmann
 
243129

Disputing my opinion as to the causes of these two disasters is open to anyone. Any takers? 

There have been plenty of takers.  You don't want a debate.  You want a soapbox.

 

View of his soap box had been inhibited by all the bubbles being created from his crazed spurting and hot air.  Such is life - foaming boxes in the middle of nowhere.

 

I've confronted you numerous times on what your 'take' would be on the causes of these disasters and each time you have avoided (read run from) replying. Why? Is it because you have no answer? You make snarky and juvenile insults and asides instead of contributing anything of substance to the topic.

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Posted by Backshop on Saturday, September 8, 2018 8:09 AM

So what exactly are the shortcomings of Amtrak's hiring, training and supervision programs?

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Posted by 243129 on Saturday, September 8, 2018 8:35 AM

Backshop

So what exactly are the shortcomings of Amtrak's hiring, training and supervision programs?

 

I wish I could randomly pick an employee to show you. The level of competence would shock you. I do not indict all employees and supervisors, there are some good ones but overall they are in the minority.

I have ridden Amtrak trains since retirement and on numerous occasions I have 'felt' ACSES(PTC) 'running' the train. What does that tell you?

On another occasion I took the auto train, which was like riding the caboose of a 10,000 ton freight train, and upon arrival at Sanford the auto carriers were to be seperated from the coaches. The air brakes were not set on the standing coaches and when uncoupled the coaches(occupied) rolled about 10-15 feet before going in to emergency and jerking to a stop. What does that tell you?

There are operating employees that are so obese and uncoordinated that they could not evacuate themselves never mind assisting passengers. I have witnessed one requiring a step stool in order to board a locomotive at the servicing facility. What does that tell you?

I reported a condition on a yard track to a trainmaster and observed him walking aimlessly with map in hand trying to locate the track I reported. What does that tell you?

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Posted by BaltACD on Saturday, September 8, 2018 8:38 AM

243129
I've confronted you numerous times on what your 'take' would be on the causes of these disasters and each time you have avoided (read run from) replying. Why? Is it because you have no answer? You make snarky and juvenile insults and asides instead of contributing anything of substance to the topic.

So sayeth the Snark.  You are the one that has never expanded or detailed your lack of plan beyond your key words.  One of the motto's I take seriously - Never too old to have a happy childhood.  Such a childhood it is in dealing with someone that won't say anything beyond 'I have a plan' and then never detailing that plan.  Seems that we are hearing similar statements in the daily news by another blow hard.

Never too old to have a happy childhood!

              

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Posted by 243129 on Saturday, September 8, 2018 8:53 AM

BaltACD

 

 

 

 
243129
I've confronted you numerous times on what your 'take' would be on the causes of these disasters and each time you have avoided (read run from) replying. Why? Is it because you have no answer? You make snarky and juvenile insults and asides instead of contributing anything of substance to the topic.

 

So sayeth the Snark.  You are the one that has never expanded or detailed your lack of plan beyond your key words.  One of the motto's I take seriously - Never too old to have a happy childhood.  Such a childhood it is in dealing with someone that won't say anything beyond 'I have a plan' and then never detailing that plan.  Seems that we are hearing similar statements in the daily news by another blow hard.

 

You act as you are still in your "happy childhood". You should take the time to read all three threads on this matter and you will find 'details'. Understanding them might be another matter being as how you were 'chained to a desk' all those years and never experienced operations 'in the trenches'.

It is safe to assume that you will not give your thoughts, perhaps you have none, on the causes of these disasters as you have avoided (read run from) answering despite being asked countless times.

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Posted by Euclid on Saturday, September 8, 2018 9:21 AM

From the NTSB report on the wreck of 188:

“After evaluating the circumstances of the accident, the NTSB found that the most likely reason the engineer failed to slow for the curve was he believed he was beyond the curve where the authorized speed was 110 mph, because of his loss of situational awareness.

He lost his situational awareness because his attention was diverted to an emergency situation with a nearby Southeastern Pennsylvania Transportation Authority (SEPTA) train that had made an emergency stop after being struck by a projectile.”

 

I agree with the first sentence, which is qualified with the words, “most likely.”  It also mentions that Bostian lost situational awareness, and that point too is qualified with the words, “most likely.”

The second sentence, however, is stated as a factual assertion, independent of the qualifier, “most likely,” which is included in the first sentence.  But even so, NTSB has carefully structured the two sentences with the words, “situational awareness” in each one, but the words, “most likely” only in the first sentence. 

This creates the illusion that reasoning for the loss of situational awareness detailed in the second sentence is also covered by the qualifier, “most likely.”  And yet that is not actually part of the wording.  Therefore the second sentence is being asserted as a proven fact, while it actually is only an assumption that seems “most likely.” 

I see this as being highly manipulative, intentional deception on the part of the NTSB.  They have no way of knowing for fact that the engineer lost situational awareness because his attention was diverted to the emergency situation with the SEPTA train. 

They say that medical conditions or fatigue were not factors.  Yet, they have no way of knowing that for certain.  The latest research on shiftwork disorder shows that a person can spontaneously fall asleep without having any sense of fatigue.  How do they know that did not happen?  How could Bostian know that did not happen? 

The NTSB doesn’t have an explanation for why the engineer failed to slow for the curve, so they have made one up.

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Posted by Anonymous on Saturday, September 8, 2018 9:38 AM

It is always problematic to pick single sentences from the report. Here is the propable cause:

3.2 Probable Cause
The National Transportation Safety Board determines that the probable cause of the accident was the engineer’s acceleration to 106 mph as he entered a curve with a 50 mph speed restriction, due to his loss of situational awareness likely because his attention was diverted to an emergency situation with another train. Contributing to the accident was the lack of a positive train control system. Contributing to the severity of the injuries were the inadequate requirements for occupant protection in the event of a train overturning.

The is a final report, there will be nothing else. Nobody has the same information the NTSB had.

So why speculate and not accept the NTSB's judgement? Need another conspiracy theory?
Regards, Volker

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Posted by 243129 on Saturday, September 8, 2018 9:57 AM

VOLKER LANDWEHR

It is always problematic to pick single sentences from the report. Here is the propable cause:

3.2 Probable Cause
The National Transportation Safety Board determines that the probable cause of the accident was the engineer’s acceleration to 106 mph as he entered a curve with a 50 mph speed restriction, due to his loss of situational awareness likely because his attention was diverted to an emergency situation with another train. Contributing to the accident was the lack of a positive train control system. Contributing to the severity of the injuries were the inadequate requirements for occupant protection in the event of a train overturning.

The is a final report, there will be nothing else. Nobody has the same information the NTSB had.

So why speculate and not accept the NTSB's judgement? Need another conspiracy theory?
Regards, Volker

 

So his loss of situational awareness "because his attention was diverted to an emergency situation with another train" is not reflective of poor training, poor vetting and poor supervision? 

The task the engineer should be focused on is the safety of his train . That is primary. A well trained engineer would not allow himself to be distracted by something that does not affect his train. As far as being distracted by a projectile hitting your locomotive that is momentary. That would not distract a well trained, experienced engineer (read vetted) for the period Bostian was.

Herr Landwehr: Define what you mean by "another conspiracy theory".

 

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Posted by Anonymous on Saturday, September 8, 2018 10:35 AM

If you read carefully you realize that I responded to someone else with (in my opinion) a tendency to conspiracy theories.

243129
So his loss of situational awareness "because his attention was diverted to an emergency situation with another train" is not reflective of poor training, poor vetting and poor supervision?

I see no reason to doubt the NTSB's final report. They don't mention poor vetting and poor supervision. About training see my posts above.

I don't see a way to get through one's working life without making mistakes.

243129
The task the engineer should be focused on is the safety of his train . That is primary.

Here I agree.

243129
A well trained engineer would not allow himself to be distracted by something that does not affect his train. As far as being distracted by a projectile hitting your locomotive that is momentary. That would not distract a well trained, experienced engineer (read vetted) for the period Bostian was.

I think here you are wrong. The best trained person can make mistakes. If you really never made a mistake (which I doubt) you were very lucky. We have a saying in Germany: If someone  claims he never made mistakes he never worked.

What you need in the locomotive with your expectations is a robot not an engineer. But herewith you seemto have even more problems:
Regards, Volker

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Posted by 243129 on Saturday, September 8, 2018 10:51 AM

Herr Landwehr, where do I say or imply that no one makes mistakes? Because I stated would instead of should? I want you to prove that allegation.

My mission is to minimize those mistakes through proper vetting, training and supervision. Amtrak is inadequate in those processes.

PTC et al are fine and minimize error as long as they are working. When they are not working is when proper training kicks in. Most of today's Amtrak trained engineers will become lost due to automated addiction. Therein lies the danger.

Robots are only as good as the person who programmed them.

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Posted by Euclid on Saturday, September 8, 2018 11:03 AM

VOLKER LANDWEHR

It is always problematic to pick single sentences from the report. Here is the propable cause:

3.2 Probable Cause
The National Transportation Safety Board determines that the probable cause of the accident was the engineer’s acceleration to 106 mph as he entered a curve with a 50 mph speed restriction, due to his loss of situational awareness likely because his attention was diverted to an emergency situation with another train. Contributing to the accident was the lack of a positive train control system. Contributing to the severity of the injuries were the inadequate requirements for occupant protection in the event of a train overturning.

The is a final report, there will be nothing else. Nobody has the same information the NTSB had.

So why speculate and not accept the NTSB's judgement? Need another conspiracy theory?
Regards, Volker

 

The popular discrediting of opinions of insight by labeling them as “conspiracy theories” gets a little tedious.  Obviously the tactic is to associate opinions that one disagrees with as being of the nature of what is claimed by so called, “conspiracy kooks” who are stereotypically dim witted lowlifes.  It is nothing but a cheap insult. 

There is no evidence that Bostian failed to slow for the curve because he was distracted by the emergency of the SEPTA train. There is no evidence that it was “likely,” as the NTSB asserts.  If an investigation has evidence proves a conclusion, they should say so.  If not, they should say that.  If the evidence is merely consistent with a possible cause, they should say that.  It is pretty obvious what the NTSB is up to, and it is hardly a conspiracy theory to say so.

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Posted by 243129 on Saturday, September 8, 2018 11:17 AM

Euclid

 

 
VOLKER LANDWEHR

It is always problematic to pick single sentences from the report. Here is the propable cause:

3.2 Probable Cause
The National Transportation Safety Board determines that the probable cause of the accident was the engineer’s acceleration to 106 mph as he entered a curve with a 50 mph speed restriction, due to his loss of situational awareness likely because his attention was diverted to an emergency situation with another train. Contributing to the accident was the lack of a positive train control system. Contributing to the severity of the injuries were the inadequate requirements for occupant protection in the event of a train overturning.

The is a final report, there will be nothing else. Nobody has the same information the NTSB had.

So why speculate and not accept the NTSB's judgement? Need another conspiracy theory?
Regards, Volker

 

 

 

The popular discrediting of opinions of insight by labeling them as “conspiracy theories” gets a little tedious.  Obviously the tactic is to associate opinions that one disagrees with as being of the nature of what is claimed by so called, “conspiracy kooks” who are stereotypically dim witted lowlifes.  It is nothing by a cheap insult. 

There is no evidence that Bostian failed to slow for the curve because he was distracted by the emergency of the SEPTA train. There is no evidence that it was “likely,” as the NTSB asserts.  If an investigation has evidence proves a conclusion, they should say so.  If not, they should say that.  If the evidence is merely consistent with a possible cause, they should say that.  It is pretty obvious what the NTSB is up to, and it is hardly a conspiracy theory to say so.

 

One of your posts mentioned that he had lost situational awareness for a "couple of minutes" (6?). I can see losing it for a couple of seconds but minutes??? In all that time he never considered slowing down??? This sort of reaction can be gauged(vetted) by an experienced operations supervisor during training with a procedure such as blindfolding and seeing the reaction when the blindfold is removed.

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Posted by Backshop on Saturday, September 8, 2018 11:28 AM

I disagree with Euclid's post above comparing forgetting you have slowed down for a 50mph curve with forgetting you locked a door or shut off the lights.  One is an involved process while the other takes place in less than a second.  It seems like the engineer suffered from cranial rectosis.

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Posted by Anonymous on Saturday, September 8, 2018 1:17 PM

Euclid
Obviously the tactic is to associate opinions that one disagrees with as being of the nature of what is claimed by so called, “conspiracy kooks” who are stereotypically dim witted lowlifes.

That is your take. I have seen highly intelligent conspiracy theorists.

Euclid
There is no evidence that Bostian failed to slow for the curve because he was distracted by the emergency of the SEPTA train. There is no evidence that it was “likely,” as the NTSB asserts.

On the other hand they found no evidence for other reasons. For some causes you don't find direct evidence, you are led to them by excluding all other causes. I think that has happened here.

That is a common procedure in medicine (e.g. irritable bowel sydrome) and other siences.

Euclid
If the evidence is merely consistent with a possible cause, they should say that. It is pretty obvious what the NTSB is up to, and it is hardly a conspiracy theory to say so.

How do you read 3.2 Propable Cause? I understand it as likely.

What is NTSB up to?
Regards, Volker

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Posted by Anonymous on Saturday, September 8, 2018 1:32 PM

243129
Herr Landwehr, where do I say or imply that no one makes mistakes? Because I stated would instead of should? I want you to prove that allegation.

First, I need to proof nothing to you. IIRC you were asked in the Amtrak 501 thread if you ever made a mistake on duty. Your answer was no. You should know better than me where it was, I won't search 59 pages.

243129
My mission is to minimize those mistakes through proper vetting, training and supervision.

Till now I had the impression you were going to eleminate human errors by training. When going to minimize the errors the question arrises, how much training is enough.

243129
Amtrak is inadequate in those processes.

Here I let others like NTSB judge.
Regards, Volker

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Posted by Euclid on Saturday, September 8, 2018 3:36 PM

VOLKER LANDWEHR
 
 
Euclid
There is no evidence that Bostian failed to slow for the curve because he was distracted by the emergency of the SEPTA train. There is no evidence that it was “likely,” as the NTSB asserts.

 

On the other hand they found no evidence for other reasons. For some causes you don't find direct evidence, you are led to them by excluding all other causes. I think that has happened here.

 

 
Euclid
If the evidence is merely consistent with a possible cause, they should say that. It is pretty obvious what the NTSB is up to, and it is hardly a conspiracy theory to say so.

 

How do you read 3.2 Propable Cause? I understand it as likely.

What is NTSB up to?
Regards, Volker

 

No evidence for other reasons is essentially no evidence for any reason.  I too read probable cause as likely cause, but neither one are true in this case.  What they have found is a possible cause, and nothing more.

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Posted by Anonymous on Saturday, September 8, 2018 4:42 PM

Euclid
No evidence for other reasons is essentially no evidence for any reason.

Then you don't understand exclusion procedures (diagnosis by exclusion).

I think you will never find proof for loss of situational awareness only indications. NTSB researches all possible causes. Sometimes one by one can be eleminated and in this case loss of situational awareness remained as probable cause.

A number of diseases can only get diagnosed this way.
Regards, Volker

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Posted by 243129 on Saturday, September 8, 2018 4:47 PM

VOLKER LANDWEHR
First, I need to proof nothing to you. IIRC you were asked in the Amtrak 501 thread if you ever made a mistake on duty. Your answer was no. You should know better than me where it was, I won't search 59 pages.

Then your allegation is baseless. When one makes an allegation one should be able to prove it. You did not.

VOLKER LANDWEHR
Till now I had the impression you were going to eleminate human errors by training. When going to minimize the errors the question arrises, how much training is enough.

That is your impression not mine. To answer the question of how much training, substantially more than they are getting now.

VOLKER LANDWEHR
Here I let others like NTSB judge.

I'm with Euclid on the NTSB.

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Posted by Overmod on Saturday, September 8, 2018 4:53 PM

243129
One of your posts mentioned that he had lost situational awareness for a "couple of minutes" (6?). I can see losing it for a couple of seconds but minutes??? In all that time he never considered slowing down???

Here's the problem:  Bostian had just come off running an Acela into Philadelphia westbound with a defective cab signal -- restricted to 45mph and having to be prepared to stop at any next signal.  He did not just 'miss' the restriction, he was actively accelerating into it, which tells me that the 'situational awareness' was that he mistook a section of track after the curve for a section just before it.  Joe, I think, is familiar with that section and therefore uniquely qualified to confirm or deny whether the two sections look enough 'alike' in the dark to be mistaken if a tired engineer distracted by the reports of potential nearby vandalism forgets briefly where he is.

Now, I have to agree with Joe that a properly trained engineer (one who is taught the landmarks and characteristics of the route by one who already knows them, over a period long enough to gain full familiarity even when tired, at zero dark thirty in bad weather) would probably not have made such a mistake.  I don't think there is even a shred of death wish or flippant carelessness in how Bostian ran trains, and I have little but contempt for the legal machinations that are attempting to find his actions criminal.  Circumstantial evidence (the horn blasts) indicate to me that he recognized the importance of warning crews who might be in the adjacent yard.

Now, do I think there is some whitewash going on to shield him from 'the outside', in the same way that sleep apnea becomes a convenient or facile excuse?  I would like to think not.  Let's see if I can summon enough faith.

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Posted by 243129 on Saturday, September 8, 2018 5:05 PM

Overmod
I have little but contempt for the legal machinations that are attempting to find his actions criminal.

Brandon Bostian and Stephen Brown are also 'victims'. Victims of Amtrak's grossly inadequate training regimen.

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Posted by charlie hebdo on Sunday, September 9, 2018 3:32 AM

 

 

I doubt if you can, but what would be some specific, concrete examples of changes your plan would call for in what you call the vetting process?

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Posted by 243129 on Sunday, September 9, 2018 6:48 AM

Do you really expect me to answer you after you have run from every question I have posed to you?

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Posted by Euclid on Sunday, September 9, 2018 8:38 AM

VOLKER LANDWEHR
 
Euclid
No evidence for other reasons is essentially no evidence for any reason.

 

Then you don't understand exclusion procedures (diagnosis by exclusion).

I think you will never find proof for loss of situational awareness only indications. NTSB researches all possible causes. Sometimes one by one can be eleminated and in this case loss of situational awareness remained as probable cause.

A number of diseases can only get diagnosed this way.
Regards, Volker

 

Can you cite some examples of “diagnosis by exclusion” being used for accident investigations?  Perhaps in a medical application, it makes sense to treat the most probable disease suggested by the symptoms simply because a need for treatment is essential.  So treatment that may be off target is better than no treatment. 

Why would there be such an essential need for reaching a conclusion as to the cause of an accident?  My basic point is that I do not believe that the NTSB is able to rule out all potential causes for the crash of 188 besides the one they have chosen as probable. 

For instance, they say they asked the engineer if he was fatigued, and he said no.  Is the engineer’s word on a question loaded with such consequences reliable?  And what about shiftwork sleep disorders?  The NTSB has promoted the dangers of that affliction in past rail crash investigations.  The most dangerous symptom of that condition is the possible spontaneous loss of consciousness by falling asleep when there are no symptoms of fatigue or drowsiness being experienced. These sleep periods can last only a short time, and then the person wakes up with no memory of having fallen asleep.  And in the case of 188, Bostian even said he had no memory of events approaching the curve over the last couple miles. 

Under these complex circumstances, I think that the NTSB’s conclusion that the engineer forgot about where he was due to being disturbed by report from the SEPTA train is a reach; even if they call it a “probable” cause.  The NTSB is a public sector organization and they have a need to promote themselves and their performance in their own self-interest. 

  • Member since
    September 2017
  • 5,636 posts
Posted by charlie hebdo on Sunday, September 9, 2018 9:01 AM

243129

Do you really expect me to answer you after you have run from every question I have posed to you?

 

No. you are simply  trolling.  You have no plan as Amtrak quickly discovered.

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