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Accident Report Detail

 
Head-On Collision between Burlington Northern Railroad Freight Trains 602 and 603

Executive Summary

On August 30, 1991, the eastbound Burlington Northern Railroad (BN) freight train 602 departed Shelby, Montana, heading south. Westbound BN freight train 603 departed Great Falls, Montana, proceeding north. Both trains were routed over BN unsignaled single track line between Shelby and Great Falls. A branch line dispatcher in Seattle, Washington, controlled the trains' movements by issuing track warrants through a computerized track warrant control system.

At 5:50 p.m. mountain daylight time at milepost 85.55 north of Ledger, Montana, the two trains collided head on at a closing speed of 87 mph. After impact, fire ensued from spilled locomotive diesel fuel, burning locomotive units, two freight cars, and grass. Nine locomotive units and 22 cars were destroyed; 9 cars were damaged. Track damage, equipment replacement, and clean-up costs were estimated at $19 million. Three crewmen were killed, and four were severely injured.


Probable Cause

The National Transportation Safety Board determines that the probable cause of this head-on collision was the poor communication practices of the first-shift dispatcher and the train 603 conductor and BN's failure to establish an adequate management oversight and quality control program in its train control operations. Contributing to the accident was the combined failure of BN and the Federal Railroad Administration (FRA) to follow up on the dispatching concerns and recommendations of the FRA National Train Dispatcher Safety Assessment 1987-88.


Accident Location: Ledger , MN    
Accident Date: 8/30/1991
Accident ID: DCA91MR009

Date Adopted: 5/25/1993
NTSB Number: RAR-93-01
NTIS Number: PB93-916301

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