At 23:29 hrs on 22 October 2011, a young person was struck and killed by the train she had left 30 seconds earlier. She was leaning against the train as it began to move out of the station and when she fell, the platform edge gap was wide enough for her to fall through and onto the track. Her post-mortem toxicology report recorded a blood alcohol concentration nearly three times the UK legal drink drive limit.
The guard dispatched the train while the young person was leaning against it. The RAIB concluded it is possible that he did this because he had seen her but expected her to move away before the train moved or that he looked briefly in her direction but did not see her or that he did not see her because his attention was on his control panel and a large group of people on the platform.
Platform video camera footage shows him warning her to stand back in the moments before the train departs and it is likely he did this because he thought that it would be immediately effective and because he had no direct and immediate way to stop the train.
While the rail industry’s overall safety record has improved in recent years, accidents at the platform/train interface have increased, even when accounting for an increased number of passenger journeys over a period of time which saw a known industry hazard (trains with slam doors but no central locking) withdrawn from service. This indicates that the industry’s focus on operational matters has not delivered improved safety at the platform/train interface, and there is a need to consider technical as well as operational solutions to reduce the risk.
This report makes three recommendations: one is for Merseyrail to evaluate and where practical improve the means of train dispatch. The second is for Merseyrail, in consultation with other relevant organisations, to evaluate equipment and methods to reduce the likelihood of persons falling through the platform edge gap and to implement these measures when practical. The third is for the Office of Rail Regulation to ensure that there is industry guidance on reducing the risk at the platform/train interface; in particular the guidance should consider both equipment and methods of operation.
Response to recommendations:
- RAIB will periodically update the status of recommendations as reported to us by the relevant safety authority or public body
- RAIB may add comment, particularly if we have concerns regarding these responses.