It is the 24th of February, 2007.

And one of the richest people in the UK

is standing in a field talking to the

press. His company has been involved in

a tragic incident, but it's not how you

might think. The company, and by

extension its owner, was not to blame.

He is standing near the aftermath of a

horrendous train disaster. It looks as

if the train was just flicked off the

track, strewing carriages all over the

place, in which 109 people were aboard.

Needless to say, this event was not at

all a fun experience for those thrown

around inside the train.

The train, shortly before the crash, was

traveling at 95 mph, within the maximum

permissive speed for the route.

The location is along one of the busiest

intercity lines in the UK, the West

Coast Main Line.

What's more, the train was very new and

was an important landmark in train

design, the famous tilting Pendolino

train Class 390.

So, if the train wasn't speeding and was

modern,

what was the cause of the crash? Well,

watch on to find out. Our crash today

was just outside the bloody years of

early British Railway's privatization,

in the year 2007.

The disaster today is the infamous

Grayrigg train crash. My name is John,

and welcome to Train ly Difficult.

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below.

The West Coast Main Line. So, our story

will unfold around this small village in

Cumbria, United Kingdom, named Grayrigg,

which is around here on the map. More

precisely, the railway line that runs

just a 985 m to the south of it.

The line that runs through here is the

West Coast Main Line. It is a major

arterial route that connects London to

the rest of the country along the

western part of England all the way up

to Scotland. Now, Grayrigg, although

having a railway running near it, it

doesn't actually have a station.

Instead, the nearest ones are Oxenholme,

5 mi to the south, and Penrith, 27 mi to

the north. Needless to say, this little

village is not very well connected. Now,

along the line was a place called

Lambrigg Crossing. This, up until the

1970s, was a level crossing. However, it

was removed in order to have

unobstructed running of trains.

However, the level ground around the X

crossing was perfect for an access point

for railway workers to, well, work on

the railway tracks. These kinds of entry

points litter the network and offer

useful spots for track workers to park

their vehicles, have lunch, and just

generally get access and egress to the

railway property.

Now, around this point, there were also

two sets of points. These were named 2A,

2B, and 3A, 3B respectively. These

points are not used in regular

operation. Instead, they are what's

called an emergency crossover. They're

described as by Network Rail, "A

crossover provided to allow trains to

cross between running lines during times

of degraded operation or single line

working."

They're kind of a get-out-of-jail-free

card for trains that otherwise might be

stranded in instances of a line

blockage. In our case, these points are

not controlled by the signaler, instead

operated locally via a ground frame.

However, a release needs to be issued

and permission needs to be issued by the

signal before

actually being put into use.

Now, let's quickly look at the makeup of

these points. Don't worry, I won't keep

you too long here, as I have had

comments before, especially one saying

that watching my train videos is like

watching paint dry. So, points help

trains move from one track to another.

The parts that move are the switch

rails.

One for each wheel.

Now,

to keep these rails connected to work

uniformly and thus keep the track gauge

stretcher bars are used. There are a

number of these, and each one is used to

hold the gauge and to keep everything

together.

First, the lock bar is attached to the

things called detector bars. These work

as points detection for the signal box.

The next stretcher bars are called

permanent way bar, and the first and

third permanent way bars are driven by

the points machine. The second just

holds the gauge. All the stretcher bars

are needed to be intact to resist the

force of trains smashing along the line.

The line has two speed restrictions,

interestingly. For normal trains, it is

85 mph, but for certain trains, an

enhanced permissible speed of 95 mph is

applicable. This EPS is important for

our story, as a Class 390 train involved

in our accident was able to run at the

higher speed due to its pretty nifty

tilting mechanism, where the train tilts

over and around curves.

Much like a motorbike going around a

corner.

Now, there are drawbacks, especially on

UK railways, with things like reduced

cabin size because of the restricted

loading gauge due to the tilting. But

maybe that's a story for another time.

The trains came into service in roughly

2002, and the line near Grayrigg was

upgraded to EPS running in 2005.

Now, having a set of points along a

high-speed running line requires regular

inspections. This was the case at the

crossing. They were subjected to an

inspection and maintenance regime. The

points were meant to be checked out

every week by track patrollers working

for Network Rail.

The points get a pretty harsh battering

with some 60 trains passing northbound

through Lambrigg per day. This included

over half of which being the higher

speed Class 390 services and also other

tilting trains like the Class 221 and

220 trains. This was an increase from

when the points were installed in the

1970s, which had around a maximum 50

movements per day. This section of line

is controlled by the UK standard for

aspect color light signaling operated by

the signalers at the Carlisle power

signal box. The line is also electrified

again using the UK standard of 25

kilovolts of AC overhead line equipment.

Which now neatly leads us on to the

disaster.

The disaster.

So, the disaster started here at Euston

Station in London, which is not far from

friend's house.

That's your quick fact for the day.

Anyways, the train has a head code of 1

Sierra 83. It is a Class 390 nine

carriage electric multiple unit run by

Virgin Trains. It commenced its journey

from Euston on the 23rd of February 2007

at its scheduled time of 15 minutes past

5 in the evening on route to Glasgow.

The service ran on time and without any

issue. At Preston, there was a scheduled

change of driver. The train departed at

40 minutes past 7 in the evening with

the next stop scheduled being Carlisle.

There are 109 people aboard, which was

made up of 104 passengers and five

members of staff.

The driver who took over was based at

Polmadie

in Glasgow and had been driving for five

years. That day, he had booked on at

52 minutes past 1 in the afternoon and

was halfway through his shift.

The Class 390 has a quite neat speed set

feature, kind of like cruise control for

trains, that will hold the train at,

well, the set speed. The driver applied

the brakes on the approach to Oxenholme

for a 90 mph speed restriction through

the station. Once past, the driver sped

up to and set the speed back to 95 mph.

The train was fast approaching the

Lambrigg crossovers, running at the 95

mph permissive speed. This was at 15

minutes past 8:00 in the evening. The

first carriage derailed on the 2B points

on either the first or second bogie. The

front carriage then derailed into points

3A and 3B.

The second carriage went onto the

opposite line, i.e. the up line. At the

same time, the front carriage jackknifed

and ran diagonally across both tracks.

First carriage turned over and ran down

the embankment that flanked the railway.

Carriage two became detached from the

leading vehicle and continued to run

misaligned.

The trailing end struck an overhead line

equipment mast and began to roll onto

its left-hand side. It then dragged the

following carriages with it, all of them

which then fall fell down the

embankment. After the train finally came

to a rest, the rear few carriages

remained upright.

From start to finish, the crash had

unfolded in just 13 seconds.

As a result of the crash, train

detection in the area was lost. As such,

all of the signals in the vicinity on

both lines automatically went to danger,

and this stopped approaching trains

before they reached the site of the

accident.

The train driver had been made

unconscious during the derailment. He

regained consciousness, and in spite of

his extensive injuries, which would

render him in hospital for a significant

amount of time, managed to reach the

only communication equipment he could

find, his personal mobile phone.

He called an off-duty employee of train

Virgin Trains to relay a message to

Virgin Trains Operations Control, asking

for trains to be stopped on the up line.

This effort is truly impressive, as

he'll be trapped in the driver's cab

unable to escape.

Other staff aboard the train, including

the train manager, called Virgin Trains

Operation Control to report the crash,

but was unable to give a precise

location.

The staff then proceeded to assist the

passengers and the eventual arrival of

emergency services. However, access to

the full train was restricted due to its

mangled up final resting spot.

Alarms on the panels at the Network Rail

Electrical Control room and crew and the

signal at Carlisle respectively hinted

at something was wrong. However, the

moment of the crash, they were unaware

of exactly what. An electrical emergency

switch off was made and all the lines in

the area were blocked by a signals being

held at danger.

The exact location of the crash was

communicated to the emergency services

by locals who had heard the accident and

passengers on board calling 999.

The first ambulance and fire crew got to

the train at 46 minutes past 8:00 in the

evening.

The remote location would hinder the

emergency response. The last person

would be removed from the train by 47

minutes past 10:00 in the evening with

triage happening at the crash site.

Eventually, all the injured were removed

by ambulance or helicopter by 11 minutes

past 12:00 in the morning.

An 84-year-old passenger was fatally

injured from the accident. They were in

the leading carriage and died on route

to hospital.

In total, 88 people were injured from

wounds ranging from minor all the way up

to very major in severity. However,

although the injured number was large,

the train actually held up pretty well

on crash resistance. Bear in mind the

train derailed at 95 mph and multiple

carriages hit stationary objects and

turned over.

The line was shut down for recovery and

investigation of the crash.

The line wouldn't be reopened until the

2nd of March under a speed restriction

of 50 mph.

The crossovers would be removed as part

of the reopening.

So, this leads us onto the

investigation.

As how did a busy intercity route with

some of the most, at the time, modern UK

trains running along it result in such a

massive balls-up?

Well, let's have a look.

The investigation.

So, being a train crash in the UK, the

Rail Accident Investigation Branch would

be the ones to dig into the disaster.

And with some assistance of the BTP and

the ORR, the RAIB would take the lead,

reaching the site the same day as the

crash. Investigation of the site would

point towards the source of the crash.

They would see wheel gauges along the

railway sleepers, and this had showed at

some point that the train's wheels on

the first carriage had derailed after

the first part of the crossover.

The RAIB took multiple photographs and

samples of the site, and then the whole

switch section of 2B points was

transported complete to a secure

laboratory for testing and analysis.

They found that on points 2B, the second

and first stretcher bars had failed and

fractured ligaments were found on the

first stretcher bar. In addition, the

lock bar and left-hand detector rod had

been disconnected from the left switch

rail. They also found some of the bolts

had fallen off from the stretcher bars

and had shown evidence that the fastener

had loosened and the nut had

progressively wound off the bolt

rather than suddenly snapping.

In addition to this, all nine vehicles

of the train were recovered and removed

to a secure covered storage for

investigation.

Here the crashworthiness of the train

would be investigated, and in addition,

any faults that might have contributed

to the crash was checked.

The RAIB found that the points prior to

the crash had all restraint on the

left-hand switch rail lost

due to a gradual degradation of the

pointwork. This allowed the left-hand

switch rail to move, initiated by the

failure of the third permanent way

stretcher bar.

Right-hand bracket to switch rail joint.

Interestingly, the failure was

undetected by the signaling system.

Now, the gradual failing of the points

should have been picked up by trackside

walks. However, an inspection plan for

the 18th of February was not undertaken.

But, it does go deeper than that. On the

7th of January, a full team had attended

points 2B in response to a report of

nuts being wound off.

The failed fasteners were replaced on

the third permanent way stretcher bar,

and the cause was not investigated.

You see, the bars had experienced severe

corrosion, which would have given more

friction on the frets of the bolt.

This would have given the impression to

the workers of the bolts being properly

fastened. However, this was far from the

case. After replacement of the

fasteners,

they undid themselves again between the

7th

of January and the 12th of February

2007,

which was when a structure gauging train

ran over the line. The scan data showed

the position of the stock rail relative

to the switch rail, and indicated a

flange back contact event happening.

This is where the back of the wheel is

contacting the switch, which is not

meant to happen.

Meaning, the points were out of

alignment.

The points were slowly failing. As we

know, a visual inspection was missed on

the 18th,

which could have caught the failure in

time.

The line was inspected by another

measurement train, which saw

the second permanent way stretcher bar

joints had failed and were missing, and

evidence of severe flange back contact

was seen.

Only the first permanent way bar

remained intact, which must have failed

in between the 21st of February, when

the previous inspection train had run

over the line, and the disaster day of

the 23rd of February. Wasn't really the

failure of the points, but more the

failure to notice and act correctly to

the failure of the points.

Network Rail will be hit with a court

case for its negligence in the crash. At

the first court hearing on the 28th of

February, 2012, at Lancaster Magistrates

Court, Network Rail played guilty to the

charges and on the 4th of April, 2012,

was fined a total of 4.

1 million pounds, including costs

following the court case.

So, that's my video on the Grayrigg

train disaster. It's going to be a free

on my scale. This is what I've got for

my root cause analysis card. Do you

agree? Let me know in the comments

below. This is a Plain Dealing

Production. All videos on the channel

are Creative Commons

Attribution-ShareAlike License. Plain

Dealing videos were used by me, John,

and I'm currently mild corner somewhere

in the UK.

I will also say as thank you very much

watching and Mr. Music, play us out,

please.