Improving Medical Standards for Railroaders

By Dr. Mary Pat McKay

Photo of Tank car shoved through the bumping post (right), into the building, and through the back wall (left).
Tank car shoved through the bumping post (right), into the building, and through the back wall (left).

On August 7, 2014, a certified locomotive engineer was operating a locomotive to push train cars into a warehouse railroad loading dock in Arden, Nevada. Although the conductor, who was standing on the ground, told the engineer to push the train three-car lengths and then stop, the train continued moving forward—first through a bumping post and then through the wall of the warehouse. Thankfully, no one was injured.

Our investigation revealed the engineer was known to have epilepsy (also known as recurrent seizures) since 1992. He told the Union Pacific Railroad (UP) about his epilepsy when he was hired in 2003. Although the engineer had an observed seizure at work in 2008, it did not happen while he was operating a train and he was back to full working status by April, 2009.

The engineer told NTSB investigators he believed he blacked out immediately before the accident. Evidence from the event-data recorder indicated that during the accident, the throttle was moved repeatedly when the train should have stopped. During the engineer’s follow‑up medical evaluation, an abnormal focus of electrical activity was found in his brain. We concluded that the probable cause of the accident was the engineer’s failure to stop the train before it collided with the bumping post and the inside wall of the building because he was incapacitated by a seizure (See: The Rail Accident Brief RAB1507).

UP followed all required medical regulations when the engineer was hired and when he was allowed to return to work after his 2008 on-the-job seizure. Although the engineer had chronic back pain and had filled prescriptions for high doses of narcotic medication nearly every month for several years prior to the accident, UP did not ask him about his use of medications after his 2003 pre-employment physical because there were no regulations requiring it. Despite the engineer’s prescription narcotic medication, his post accident urine toxicology test came back negative.

According to the current Federal Railroad Administration (FRA) regulations, a locomotive engineer with epilepsy—or any other medical condition that causes intermittent episodes of unresponsiveness—may operate a train on any railroad in the United States. In fact, the only occupational medical evaluation required by the FRA for engineers is to have a vision and hearing test every 3 years. Also, although locomotive engineers may not possess controlled substances while at work, they may take any type of prescription medications as long as the prescribing physician knows that the engineer operates trains. The trains these engineers could operate include those carrying crude oil and hazardous materials through highly populated areas and those carrying passengers.

For comparison, pilots (including most recreational pilots), merchant mariners, and commercial drivers must regularly pass a medical evaluation that includes a review of their medical history, evaluation of their current medications, measurement of their vital signs, and a physical examination before they can operate in their modes of transportation. In addition, in virtually every other transportation mode, medical standards include a list of medical conditions and medications that an operator may neither have nor use to qualify for work.

Because of a series of railroad accidents where a medical condition or its treatment contributed to the probable cause, for 15 years the NTSB has been recommending that the FRA enhance the medical evaluation of railroad employees in safety-sensitive positions (primarily engineers and conductors). The most recent recommendations include requiring a review of their medical history, evaluation of their current medications, measurement of their vital signs, and a physical examination before working in safety-sensitive positions—just like other commercial transportation operators. Over the years, the FRA has held meetings on medical requirements, but has not reported any success in addressing these NTSB safety recommendations, which remain in unacceptable status. As a result, the NTSB determined that the FRA’s failure to establish medical certification standards, other than the hearing and vision tests, contributed to the cause of the accident in Arden, Nevada. Without action by the FRA, such accidents will continue to occur.

Fortunately, no deaths or injuries resulted from this particular accident but that was pure luck. Until railroad engineers and conductors are required to meet the same medical standards as operators in other transportation modes, these sorts of accidents will continue to happen. Hopefully, the next one won’t lead to deaths, injuries, or an environmental catastrophe.

Dr. McKay is the NTSB’s Chief Medical Officer.

One thought on “Improving Medical Standards for Railroaders”

  1. Unfortunately Dr. McKay is almost certainly right on the money about this. And, equally unfortunately, this is a good example of why another person in the cab might have been a good idea–either that or some kind of operative dead man device. “Safety is the first consideration in the performance of your duty. When in doubt the safe course must be taken.”

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