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I Nih Photo: alarabiya.com IRSC Vancouver October 2013 Ian Naish Naish Transportation Consulting, Inc.

INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

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Page 1: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

I N i h

Photo: alarabiya.com

IRSC VancouverOctober 2013

Ian NaishNaish Transportation Consulting, Inc.

Page 2: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

What is meant by “data”Wh it i ll t d Why it is collected

The various kinds of data collected The uses of the data The uses of the data Some examples and case studies Conclusions and lessons learned Conclusions and lessons learned

Page 3: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

factual information (as measurements or statistics)

information output by a sensing devicei f i i i l f h b information in numerical form that can be digitally transmitted or processed

Source: Merriam-Webster online DictionarySource: Merriam Webster online Dictionary

In investigations it is synonymous with evidenceAll of the above have to be analysed to be

useful

Page 4: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

It is fundamental to the scientific method

To establish chain of events To confirm investigative hypotheses To determine accident causality

T id tif f t d fi i i To identify safety deficiencies To make recommendations to improve safety

Page 5: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Operational Technical Environmental Human factors Organization

Perishable / non-perishable Good data / bad data / limited data Good data / bad data / limited data

Page 6: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Verbal information Operational Operational Photographic Site measurements Site measurements Environmental Material (components, documentation)( p , ) Electronic (loco event recorder; digital video

recordings) Witness interviews and records

Photos: TSB

Page 7: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency
Page 8: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency
Page 9: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency
Page 10: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Event recorder downloads Railway company documentation Railway company documentation Materials examination – failure analysis Historical accident, audit and inspection data Historical accident, audit and inspection data Police reports/Witness statements Media records Table 1. Events between Mai and Dorée

Speed

Railway accidentreports

Time Location Speed(mph) Event

1327 Mai 0 LIM-55 departs Mai. 1510 Mile 81.20 28 The dynamic brakes are applied.

1525 Mile 75.50 27 The locomotive engineer applies the brakes in preparation for the grade.

1527 Mile 74.30 22 The brakes are released. 1537 Mile 72.50 13 The brakes are applied. The train starts to descend the grade. 1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00 38 The emergency brakes are applied1547 Mile 68.00 38 The emergency brakes are applied. 1549 Mile 67.20 0 LIM-55 stops. 1653 Mile 67.20 1 LIM-55 starts to roll. 1702 Mile 66.30 14 The dynamic brakes are fully applied. 1718 Mile 58.40 63 LIM-55 reaches a speed of 63 mph. 1727 Mile 52.80 0 LIM-55 stops.  

N.B. Investigators have to have legal authority

Page 11: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Advancing transportation safetyBy (inter alia): Establishing the chain of events

C fi i i ti ti h th Confirming investigative hypotheses Identifying systemic deficiencies Identifying trends Identifying trends Comparing performance Identifying false information Refuting incorrect statements Assisting in legal issues (finding fault?)

Page 12: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Whenever a reportable accident occurs Whenever an accident is investigated Whenever a reportable incident occurs Whenever safety regulations require it Whenever investigators research an issue

Photos: TSB

Page 13: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Analyse it in order to make conclusions

Record it in a database Review the data periodically for trend analysis Review the data periodically for trend analysis Analyse fields which relate to issues in a

specific investigation p g Formalize laboratory examinations in a report Communicate to safety professionals, public &

dimedia Discard any bad data when it is identified

Page 14: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Organizational dataE i (D il Whi b O i ) Equipment (Derailment – Whitby, Ontario)

Perishable data (Level Crossing - Sarnia)Limited data (Level Crossing Al Kharj Kingdom Limited data (Level Crossing – Al Kharj, Kingdom of Saudi Arabia)

Bad data (first 24 hours) and noisy Bad data (first 24 hours) and noisy communications records – Al Khurais, KSA

Page 15: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

2012 Statistical highlights: railway occurrences2012 Statistical highlights: railway occurrences

A total of 1,011 rail accidents under federal jurisdiction were reported to the TSB in 2012, similar to the 2011 total f d d f hof 1,022 and a 10% decrease from the 2007-2011 average

of 1,128. Accidents involving dangerous goods totaled 118 in 2012,

the same as in 2011 but down from the five-year averagethe same as in 2011 but down from the five year average of 147.

In 2012, there were 48 accidents involving passenger trains, down from the 2011 total of 68 and down from the five year (contd)five-year….(contd)

Source: TSB Canada

Page 16: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Main-Track Collisions

Main-Track Derailments

M i

Other7%

13%on-Main-

Track railments

7%

Crossing d

40%

Accidents21%

TrespasserAccidents

9%Non-Main-

Track Collisions 10% Source: TSB Canada

Page 17: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Photos: waymarking.com and TSB Canada

Page 18: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Photo: TSB

Page 19: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency
Page 20: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Source: pnninews.com.pk.

Page 21: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Source: constructionweek.com

Page 22: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Source: Saudi Gazette

Page 23: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Good data is a basic prerequisite for investigations analysis and to produce investigation reports

Data records allow trend monitoring Data records allow trend monitoring Investigation reports and statistical reports

communicate safety issuescommunicate safety issues There are an increasing number of ways to

obtain data Data gaps must be identified and ways found

to address them Discard bad data whenever it is found!

Page 24: INih Ian Naish IRSC Vancouver Naish Transportation ......1541 Mile 71.40 25 Brake pipe pressure is reduced. 1547 Mile 68 00Mile 68.00 38 The emergency brakes are appliedThe emergency

Photo: VIA Rail Canada