RAIB recommend improvements for Edinburgh Trams over fatal collision at Saughton

The latest report to be released by the RAIB is on the fatal collision at Saughton on Edinburgh Trams back on 11th September 2018 with a number of recommendations made to improve safety at various pedestrian crossings along the line. The report doesn’t make great reading with the suggestion made that there were two main things Edinburgh Trams should have done differently to help prevent incidents like this with both the sound levels of the audible warnings on the trams and the layout of the crossing suggested for improvements.

The background to the incident is that at 1210 on Tuesday 11th September 2018 a pedestrian, Carlos Correa, 53 and a bus driver, using the crossing close to the stop at Saughton was struck by tram 260 travelling at 33mph heading towards Edinburgh Airport. Tragically he was fatally injured as a result of the collision.

The report suggests that Mr Correa seemed to be unaware the tram was approaching when he walked onto the crossing with the evidence studied indicating that from the point where he would have had a clear view of the approaching tram he wasn’t looking out for trams. He may have looked earlier but wouldn’t have had a clear view of approaching trams from the footpath.

The tram driver did follow procedure in using the tram’s bell to sound warnings on the approach to the crossing but this was not loud enough for Mr Correa to react. Upon realising that Mr Correa was continuing the emergency brake was applied to the tram which also sounded the horn at which stage he did become aware of the tram. It wasn’t possible for the tram to stop in time and it had slowed to approximately 33mph at the time of impact. The tram came to a stand 18 metres beyond the crossing.

An urgent safety advice briefing had been released in February during the investigation so it was already known that the RAIB had concerns about the audible warnings on the CAF Urbos 2 trams so it comes as no surprise this again features having in the full report. Tests which took place after the collision discovered that the audible warning devices on the tram were not loud enough to provide an effective warning to passengers under many operational circumstances (tests showed that the maximum sound pressure was 91.5db(A) on 260 whereas similar tests undertaken on a tram in Nottingham back in 2012 was at 107 db(A) – this means in effect the sound in Edinburgh was less than half of that measured in Nottingham). Alongside the issue of the audible warnings it was found that Edinburgh Trams did not have a process in place for regularly reviewing the risks at its off-street pedestrian crossings; there was also said to be foliage which prevented pedestrians from having a clear view of the track at this specific location. Both of these issues have been included in the four recommendations made by the RAIB.

Since the collision Edinburgh Trams have cleared excess vegetation from around this crossing to improve sightlines both for pedestrians using the crossing and also for tram drivers of those about to step onto the crossing. They have also started to investigate alongside CAF ways to improve the sound levels of the audible warnings and temporary speed restrictions were applied to four locations including five unprotected crossings. In addition new safety measures (as we have previously reported on) were put in place at crossings including on floor ground markings and low fences to improve the demarcation of the crossings to pedestrians. Additional control measures will also be put in place at all off-street pedestrian crossings in the near future.

The recommendations made are:

* The audible warnings on the trams should be increased so they provide effective warnings to pedestrians and develop, document, brief and train instructions in which situations it expects drivers to use the horn as an audible warning

* Edinburgh Trams should undertake risk assessments of all pedestrian crossings and identify any necessary control measures. This should include improved demarcation of the crossing and barriers, chicanes or similar to turn pedestrians direction of travel, just before the crossing, to face oncoming trams on the nearest track. They should also develop a procedure for monitoring that these measures remain valid

* The Light Rail Safety and Standards Board (LRSSB) should develop guidance for audible warning devices on both current and future UK trams so they provide effective warning.

* The LRSSB should update and improve the current industry guidance for design, layout and management of off street pedestrian crossings on UK tramways. As a minimum this should include guidance on routine risk assessments of crossings taking into account sighting distances, line speed, tram braking characteristics and audibility of warning horns.

Responding to the reports findings, Lea Harrison, Managing Director of Edinburgh Trams, said: “Providing a safe tramway for the city is imperative for Edinburgh Trams. We have worked closely with the Rail Accident Investigation Branch throughout their investigation, and prior to the publication of today’s report Edinburgh Trams installed a new louder horn system across the fleet. Improvements have been made to the crossing at Saughton including additional signage, alerting pedestrians look both ways for trams and a small fence has been built to guide pedestrians to a safe crossing point. Foliage and hedges have also been removed to improve sightlines. An off street crossings review has been completed with all additional measures to be implemented by the end of 2019.”

Tragically these improvements have come too late for this incident which led to Mr Correa losing his life but it is hoped that they will help to prevent similar collisions in the future.

An investigation by the Scottish Fatalities Unit is also continuing into Mr Correa’s death.

* The full report can be viewed on the RAIB website.

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