Poor hiring, vetting, supervision and training procedures.......

…are not exclusive to Amtrak.

This occurred on the former N.Y. N.H. & H. mainline.

https://www.ntsb.gov/investigations/AccidentReports/Reports/RAB1905.pdf

Seems like poor training is not limited to Amtrak. Boeing deliberately omitted any mention of the fatal, faulty system on the 737-Max from training manuals: profits and obscene compensation packages for executives over safety and human lives.

“Subtle cognitive impairment”

Of course, the real culprits in this accident were the idiot programmers who failed to incorporate emergent severe civil restrictions into a cab signal system. I see this has not been fixed because they’re going to ‘wait for PTC to do it’. Sure hope there isn’t another problem before then!

Could someone please activate the link? It’s hard to do from a phone.

https://www.ntsb.gov/investigations/AccidentReports/Reports/RAB1905.pdf

HTTP/1.1 200 OK
Server: Microsoft-IIS/7.5
Date: Wed, 30 Oct 2019 00:34:09 GMT
Connection: close

Someone out there doesn’t want us to read it.

https://www.ntsb.gov/

Does the same … hmmm

Link as formatted in the original post worked for me this afternoon. Like an idiot I did not save the downloaded PDF on this computer, and it disappeared just now when I tried to do so.

It’s a government server problem, and I expect it will be resolved when the government gets around to it. Link as provided will work when they do so.

What happened was a developing case of sun kink on track 3 (the most northerly track of the 4) on the Metro-North part of the old New Haven. Several increasingly urgent calls about hard riding were checked, and increasingly rigorous slow orders issued. Apparently at least one MU then zipped through the area at track speed, then some fellow says he outright ‘forgot’ about the issued slow order and went right at it doing 56mph. He ‘emergency braked’ when he saw the kink, but put his train on the ground going over it.

There is some mention in the report that this wasn’t considered an ‘accident’, perhaps because nobody died. I’m not sure I’d concur about the importance. “Forgetting” a 10mph emergency slow order for progressive track kink could have been almost unbelievably deadly with a full load of passengers at 55mph.

Usual excuses about sleep apnea, failure to use his CPAP, chronic diabetes but wouldn’t take his meds, etc.

I was able to access the report shortly after the thread was created with the cold link…what has happened since ???

100% Man Failure - that the report is trying to blame on everything except the person’s admitted failure.

I don’t know Metro-North’s procedures.

On my carrier - with a single person operating the ‘locomotive’; when a inroute Train Message (Slow Order) is issued - the train must be stopped - person operating the ‘locomotive’ is prohibited from ‘copying the mandatory directive’ (Slow Order) whi

If he is non-compliant with his disease treatments, this should be examined more regularly as a policy. It’s serious.

I wonder if there is some HIPAA provision that would allow him to keep his ‘lack of compliance’ secret from his employer until oops! it turns out he wasn’t taking critical meds or using critical equipment. It would also be somewhat hard, and probably invasive of some perception of medical privacy, to require some form of external oversight on the necessary basis (probably daily, and synchronized both home and ‘away’) that would “ensure” reasonably full compliance.

I do understand that ‘examined more regularly’ is not at all the same thing as enforcing dosing or administration compliance. The question is whether periodic regular examinations would catch the effects that are trying to be asserted here as an excuse, and I think they would not in either case … unless imposed on a basis like that for random drug screens. I interpret the excuses as being (1) he was inattentive and forgetful because he didn’t use his CPAP and was therefore ‘tired’ due to quality-of-sleep deprivation, and (2) he was inattentive and forgetful because of some kind of high blood sugar effect (low blood sugar not being a function of ignoring diabetes meds for the period given, unless I misunderstand current diabetes treatment modalities … which is possible.) Neither of these is likely ‘chronic’ in ways that periodic checkups would necessarily reveal, although the effects are certainly very real at the time, and would be important to detect or determine for obvious reasons.

If the results of his non-compliance with his medical situation are as g

This from NTSB report RAB1905: " The New Haven Line uses an electrified third rail between Grand Central Terminal and MP 14.9 in Pelham, New York."

The third rail territory ends east of Woodlawn interlocking and west of Mount Vernon station.

I forgot to add ‘poor supervision’ to the title.[#oops]

Well, go back and do it, then!

Third rail is the least of their factual problems; I believe they attributed ownership on the east end, in Connecticut, to Metro-North, and I think Amtrak now owns more of the west end than the NTSB said. This has little bearing on the actual ‘controversy’ addressed in the report, but it does show both sloppy research and a certain cavalier attitude in both fact-finding and fact-checking.

[quote user=“BaltACD”]

Overmod

charlie hebdo
If he is non-compliant with his disease treatments, this should be examined more regularly as a policy . It’s serious.

I wonder if there is some HIPAA provision that would allow him to keep his ‘lack of compliance’ secret from his employer until oops! it turns out he wasn’t taking critical meds or using critical equipment. It would also be somewhat hard, and probably invasive of some perception of medical privacy, to require some form of external oversight on the necessary basis (probably daily, and synchronized both home and ‘away’) that would “ensure” reasonably full compliance.

I do understand that ‘examined more regularly’ is not at all the same thing as enforcing dosing or administration compliance. The question is whether periodic regular examinations would catch the effects that are trying to be asserted here as an excuse, and I think they would not in either case … unless imposed on a basis like that for random drug screens. I interpret the excuses as being (1) he was inattentive and forgetful because he didn’t use his CPAP and was therefore ‘tired’ due to quality-of-sleep deprivation, and (2) he was inattentive and forgetful because of some kind of high blood sugar effect (low blood sugar not being a function of ignoring diabetes meds for the period given, unless I misunderstand current diabetes treatment modalities … which is possible.) Neither of these is likely ‘chronic’ in ways that periodic checkups would necessarily reveal, although the effects are certainly very real at the time, and would be important to detect or determine for obvious reasons.

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As does Metro North.

This specific discussion is about Metro-North; it was a commuter train that ‘went on the ground’. It’s possible that Amtrak has stricter procedures to preclude this sort of thing – but if they don’t, your point does stand.