The Rail Accident Investigation Branch (RAIB) has released its report into an accident near Twerton, a suburb of Bath, on Saturday 1 December 2018. A passenger suffered fatal injuries when her head came into contact with a lineside tree branch while she was leaning out of the window of a moving train.
The incident occurred at approximately 22:04 while the train was travelling at approximately 75mph (120km/h), en route from London Paddington to Exeter St David’s.
On the Mark 3 coaches making up the HST train, opening windows are provided to allow passengers to reach through and operate the external door handles when the train is in a station. This is the only means by which passengers can open the train doors. However, other than warning signs, there is nothing to prevent passengers from opening and leaning out of such windows when trains are away from stations and moving.
The accident occurred because the passenger did this when branches from a lineside tree were in close proximity to the train.
According to the RAIB report, the passenger involved was a 28 year-old woman travelling to Penarth via Bristol Temple Meads from Bath Spa station, where she joined the train with a group of friends.
They gathered in the vestibule of between coaches C and D. One of the group opened the window and at least one other friend leant out of the window before the passenger who was injured did so. Witness evidence indicates that the passenger had her head out of the window for a few seconds before falling back into the vestibule having sustained a serious head injury.
The report states that at least one passenger rang 999 and informed the South West Ambulance Service (SWAS) of the accident. Others came directly to the injured passenger’s aid. An off-duty GWR train manager travelling on the service became aware of distressed passengers in the vicinity of the vestibule. As a result of hearing comments made by them, he believed that someone was trying to leave the train, so he pulled the train’s ‘emergency alarm’ handle which stopped the train.
The on-duty train manager was alerted to the activation of the emergency alarm when he felt the unexpected application of the train’s brakes. He made his way along the train in an attempt to identify what had caused someone to use the alarm. On arrival at the vestibule he quickly ascertained the nature of the accident and made an announcement on the train’s public address system for passengers with medical training to assist. A number of passengers, some with extensive medical qualifications and experience, attended and did all they could to help the passenger.
The off-duty train manager implemented GWR’s ‘ambulance to train’ procedure for dealing with ill and injured passengers and used a mobile telephone to call a dedicated number that facilitated a simultaneous conversation with both the train control centre and SWAS. This procedure allows train crews, train controllers, signallers and emergency services to agree the most appropriate railway station for a train to stop at so ambulance crews can attend to ill or injured passengers as quickly as possible.
It was agreed that the train should proceed directly to Bristol Temple Meads station. The train arrived at Bristol at 22:21 and was met by SWAS crews who were assisted by station staff and officers from the BTP but, despite the efforts of the passengers on the train and SWAS staff, the passenger could not be saved.
The RAIB has made four recommendations and identified two learning points.
One recommendation is addressed to operators of mainline passenger trains, including charter operators, and seeks to minimise the likelihood of passengers leaning out of droplight windows when a train is away from stations.
A second recommendation is addressed to operators of heritage railways and seeks to improve their management of the risks associated with passengers leaning out vehicles.
The third recommendation is addressed to Great Western Railway and seeks to reduce the potential for hazards associated with its operations being overlooked.
The fourth recommendation is addressed to RSSB and seeks to ensure that its advice on emergency and safety signs reflects the level of risk associated with the hazard being mitigated.
The learning points reinforce the importance of undertaking regular tree inspections and the value of train operators having well briefed procedures for dealing with medical emergencies on board trains.