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Safety Recommendation Details

Safety Recommendation R-96-006
Details
Synopsis: ABOUT 5:38 P.M. ON 2/16/96, EASTBOUND MARYLAND RAIL COMMUTER (MARC) TRAIN 286 COLLIDED WITH WESTBOUND NATIONAL RAILROAD PASSENGER CORPORATION (AMTRAK) TRAIN 29, THE CAPITOL LIMITED, AT MILEPOST 8.55 ON CSX MAIN TRACK NEAR SILVER SPRING, MARYLAND. THE MARC TRAIN WAS OPERATING IN THE PUSH MODE IN REVENUE SERVICE BETWEEN BRUNSWICK , MARYLAND, & WASHINGTON, D.C.; IT CONSISTED OF A LOCOMOTIVE & THREE COMMUTER CARS. THE AMTRAK TRAIN, OPERATING IN REVENUE SERVICE BETWEEN WASHINGTON D.C., & CHICAGO, ILLINOIS, CONSISTED OF 2 LOCOMOTIVES & 15 CARS.
Recommendation: THE NTSB RECOMMENDS THAT THE MASS TRANSIT ADMINISTRATION OF THE MARYLAND DEPARTMENT OF TRANSPORTATION: INSTALL RETROREFLECTIVE SIGNAGE ON CAR INTERIORS & EXTERIORS AT EMERGENCY EXITS THAT CONTAIN EASILY UNDERSTOOD INSTRUCTIONS & CLEARLY MARKS ALL EMERGENCY EXITS (DOORS & WINDOWS). (URGENT)
Original recommendation transmittal letter: PDF
Overall Status: Closed - Exceeds Recommended Action
Mode: Railroad
Location: Silver Spring, MD, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA96MR004
Accident Reports: Collision and Derailment of Maryland Rail Commuter MARC Train 286 and National Railroad Passenger Corporation AMTRAK Train 29
Report #: RAR-97-02
Accident Date: 2/16/1996
Issue Date: 3/12/1996
Date Closed: 7/3/1997
Addressee(s) and Addressee Status: State of Maryland, Transit Administration (Closed - Exceeds Recommended Action)
Keyword(s):

Safety Recommendation History
From: NTSB
To: State of Maryland, Transit Administration
Date: 5/25/2001
Response: In the Safety Board’s final report of the Silver Spring accident, Safety Recommendation R-96-5 was classified “Closed--Acceptable Action.” Safety Recommendation R-96-6 was classified “Closed--Exceeds Recommended Action.”

From: State of Maryland, Transit Administration
To: NTSB
Date: 11/29/2000
Response: Letter Mail Controlled 12/05/2000 6:31:19 PM MC# 2001752 R-96-6 recommended the installation of retro-reflective signage on the exterior and interior of each car, to improve instructions to emergency responders and passengers in the operation of emergency exits and emergency equipment. MTA designed and installed additional retro-reflective exterior signs to provide clear directions to emergency responders in gaining access. MTA also designed luminescent signage for interior application, for improved directions to passengers in emergency egress, location of exits, and use and location of emergency equipment. All signage installation was completed on August 30, 1997. Signage is upgraded and replaced, as new safety features are installed. In addition to the MT A response to NTSB recommendations, a number of other safety enhancements have been installed or are in design, including: testing of a battery pack ballast for use with florescent lighting to provide emergency lighting in the event head end power and car battery power are lost; redesign of emergency toolbox covers to allow immediate access; installation of additional emergency exit windows, well in excess of the 4 windows per car mandated by FRA regulation (100% emergency windows in MARC I cars, and more than 50% emergency windows in MARC II and MARC III cars); installation of seatback pockets to hold passenger safety brochures, and a color coded system to ensure that car-specific informational brochures are correctly placed; design and installation of a safe storage area for bridge plates used to board passengers in wheelchairs; design and installation of an omni-directional kick plate in restroom doors. A complete listing of vehicle safety enhancement projects and current status, is enclosed for your information.

From: NTSB
To: State of Maryland, Transit Administration
Date: 7/3/1997
Response: In the final Report on the Silver Spring Accident, the Board classified Safety Recommendation R-96-006 as "Closed--Exceeds Recommended Action." This was done based on the information the MTA provided in its letter dated November 7, 1996. See page 59 of the report NTSB/RAR-97/02.

From: NTSB
To: State of Maryland, Transit Administration
Date: 10/21/1996
Response: THE BOARD IS PLEASED TO LEARN THAT THE MTA HAS DEVELOPED A NEW SIGNAGE PACKAGE THAT COMPLIES WITH THE RECOMMENDATION. THE BOARD NOTES THAT THE NEW SIGNAGE WILL BE INSTALLED CONCURRENTLY WITH THE ADDITIONAL EXIT WINDOWS & THAT MTA EXPECTS TO FINISH BY 2/28/97. PENDING INSTALLATION OF THE SIGNAGE, THE BOARD HAS CLASSIFIED R-96-6 "OPEN--ACCEPTABLE RESPONSE."

From: State of Maryland, Transit Administration
To: NTSB
Date: 7/5/1996
Response: The Maryland Mass Transit Administration (MTA) submitted a response to the National Transportation Safety Boards (NTSB) recommendations R-96-4 through -6, in a letter dated June 12, 1996. At the recent NTSB Public Hearings in RockviIIe, NTSB informed MTA that this response had not been received, so a second copy was provided to NTSB staff on June 26, 1996. This letter is to formally convey to the Board a third copy of the letter dated June 12, 1996.

From: State of Maryland, Transit Administration
To: NTSB
Date: 6/12/1996
Response: MR. JOHN A. ARGO, ADMINSTRATOR, MTA, RESPONDED ON 7/5/96, THAT THE MTA HAS TESTED ALL EMERGENCY WINDOWS ON ALL MARC CARS, & INSPECTED ALL CURRENT SIGNAGE ON ALL CARS REPLACING ANY MISSING OR ILLEGIBLE SIGNS. MTA HAS DEVELOPED A NEW SIGNAGE PACKAGE, INCLUDING LUMINESCENT INTERIOR SIGNAGE, RETROREFLECTIVE EXTERIOR SIGNAGE, & SIMPLIFIED INSTRUCTIONS FOR ALL SIGNAGE. ADDITIONALLY, MTA HAS INSTALLED POSTERS PROVIDING INFO ON EXISTING SAFETY EQUIPMENT & EMERGENCY EXITS. MTA TESTED EXTERIOR REMOVAL OF CAR WINDOWS USING SCREWDRIVERS VERSUS BREAKAGE OF WINDOWS USING A FIRE AXE & CONCLUDED THAT AN UNTRAINED PERSON WAS ABLE TO BREAK THE WINDOW USING A FIRE AXE FIRE IN LESS THAN TEN SECONDS, BASED UPON GIVEN INSTRUCTIONS AS TO THE PROPER LOCATION ON THE WINDOW TO STRIKE. THEREFORE, MTA IS CHANGING ALL EXTERIOR WINDOW SIGNAGE TO SHOW THE PROPER USE OF A FIRE AXE TO ENTER A THE CAR THROUGH ANY WINDOW. EXISTING INSTRUCTIONS FOR REMOVAL WITH A SCREWDRIVER WILL REMAIN ON METAL SIGNAGE AT CAR ENDS. MTA IS WORKING WITH AMTRAK & CSX TRANSPORTATION TO IMPROVE METHODS FOR EMRGENCY NOTIFICATION, TO IMPROVE EMERGENCY RESPONSE TRAINING FOR ONBOARD CREW MEMBERS, & TO DEVELOP WAYS TO MORE BROADLY DISSEMINATE EMERGENCY RESPONDER TRAINING INFO TO THOSE ORGANIZATIONS WHICH DO NOT HAVE THE OPPORTUNITY TO ATTEND SCHEDULED ON-SITE TRAINING.