Federal report shows train derailment near De Soto last year caused by high water, lack of inspections and miscommunication

DE SOTO, Wis. – A report from the Federal Railroad Administration (FRA) that investigated the derailment of an almost mile long train in April of last year along the Mississippi River shows that the derailment was caused by a high water washout, lack of inspections and miscommunication by railroad maintenance crews. At the time of the accident the Mississippi River was at near record flood levels with water surrounding the railroad bed on both sides.

The report states the Burlington Northern Santa Fe (BNSF) train was 5,060 feet, weighing 3,809 tons and included three locomotive engines and 26 loaded railcars. According to the report all three locomotives and nine cars derailed with several cars ending up in the water and some of them floating away until they could be corralled by emergency personnel . Some of those cars were carrying lithium ion batteries and paint but there was no contamination from those materials. There were four crew members aboard the train and all four experienced non-life-threatening injuries, with two being transported to the hospital for evaluation and later released.

There was some question about whether high water had actually washed out the tracks under the rail bed causing the derailment but the report contains a series of maintenance actions and photos that shows BNSF was aware of the washouts and were actively working to shore up those spots, but a miscommunication about the severity of the washout at mile marker 268.8 caused the dispatchers to remove a lockout of the area giving the go ahead for the train to pass through.

The sequence of events started at 10:30 a.m. when a work group (WG) entered the area that needed shoring up and began placing rock along the track to stop further erosion. Below is the photo that crew took of the area and repair crews determined it was still safe for rail traffic.

At approximately 11:00 a.m a different train (Train-53) passed through the area the crew of that train informed dispatch that the erosion had gotten worse and ballast falling into the river at mile post 268.8 with the scour only two feet away from the ends of ties.

At 11:18 am, the crew of Train-53 informed the train dispatcher of the scouring ballast. The dispatcher placed a “service interruption on Main-2” tag in the system. This tag requires an inspection by maintenance-of-way personnel before operations may continue. This is where the confusion and miscommunication comes into play.

The report states:

“At 11:20 a.m. RW1 contacted RW1 via text message to inform him that the BNSF maintenance desk had a report of a possible washout near MP 268.8. In response, RW1 and RW2 exchanged text messages confirming that MP 268.8 was the spot where the WG was currently dumping ballast and riprap and RW1 sent RW2 the photo taken by RW3 (Figure 1). At 11:23 am, RW2 removed the service interruption tag on the Main-2 with the chief dispatcher.“

In other words the service interruption (that stopped train traffic) was removed based on the earlier information from 10:30 a.m. that had not shown that the erosion had advanced to the point that the 11:00 a.m. photo shows.

Elected officials react

The report also points to federal regulations that require more frequent inspections during severe weather events and conditions.

“The primary contributing factor underlying this accident was RW1’s failure to inspect the track or take other appropriate remedial action to ensure safe operations over the track prior to authorizing Train-25 to proceed through the WG’s limits. These actions constitute failure to comply with: (1) 49 CFR §§ 213.5 and 213.239 (requiring special inspections of track in the event of flood or other occurrences that might have damaged track structure); (2) BNSF’s Chicago Division System Special Instruction 33 (SSI 33) which requires special weather inspections in the event of sudden natural events, such as flooding; and (3) BNSF’s on-track protection (Form-B) rules by not verifying track conditions were safe before permitting a train to proceed through the WG’s limits without additional instructions.“

The report goes on the say that BNSF has taken action to retrain employees on actions needed similar situations.

“In response to this accident, BNSF reinforced and retrained employees on the requirements of SSI 33 and revised that rule to include specific procedures to ensure concerns about track communicated by train crews are adequately investigated and evaluated before train traffic is allowed to continue over the subject track. Additionally, FRA is pursuing appropriate enforcement action. Additionally, although not specifically in response to this accident, FRA issued Safety Advisory 2023-07, recommending that railroads review existing policies, procedures, and operating rules related to predicting, monitoring, communicating, and operating during severe weather conditions or subsequent to extreme weather conditions.”

It is not clear what the FRA means by pursing “enforcement action” at this time.

Following the derailment train traffic resumed by April 30 but State Highway 35 remained closed and traffic was rerouted for about a week.

In the wake of the derailment a number legislators made comments and took steps to make sure rail inspections were sufficient to ensure public safety.

In May of last year U.S. Senator Tammy Baldwin released a statement that she had co-sponsored and voted to advance rail safety legislation. The bill was known as the Railway Safety Act of 2023 and included a number of provisions including:

1. Mandates the use of defect detection technology which could have prevented the East Palestine derailment, making them more frequent near dense urban areas.
2. Expands the types of hazardous materials, like the vinyl chloride carried by the East Palestine train, that trigger increased safety regulations, including speed restrictions, better braking, and route risk analysis.
3. Improves emergency response by providing states information about the hazardous materials being transported by rail through their communities and strengthening railroad emergency response plans.
4. Prevents 30-second railcar inspections and mandates a new requirement that ensures railcars are properly maintained.
5. Increases penalties for violations of rail safety law to ensure safety laws are taken seriously.
6. Requires two crewmembers to operate a train to prevent a situation where only one person is on the train in an emergency.
7. Ensures firefighters are made whole after responding to major derailments.
8. Expands the existing Hazardous Materials Emergency Preparedness grant to allow fire departments to purchase the personal protective gear that keeps them safe.

Baldwin sent a letter to all the major railroads inlcuding Union Pacific Railroad, Burlington Northern Santa Fe Corporation, Norfolk Southern, CSX Transportation, Canadian Pacific Kansas City, Canadian National Railway Co., asking them address staffing shortages that compromise safety and service for Americans.

The letter states in part:

“Since the implementation of precision scheduled railroading, a strategy to reduce costs by using longer trains and fewer staff, Class I railroads have reduced their overall number of staff by nearly 30 percent from 2011 through 2021. Union Pacific, for example, went from 37,501 employees in 2016 to 26,713 in 2022 – a 28.76% decrease. This is compared with only a 3% decrease in carloads and 1% decrease in tons of freight over the same period. According to the Surface Transportation Board in an April 2022 hearing, staffing shortages were often cited as a major reason for exceptionally poor service levels.”

Baldwin goes on to say:

“Farmers, manufacturers, paper mills, energy producers and many other industries are dependent on efficient and cost-effective freight rail. In recent years, service levels from Class I railroads experienced severe disruptions and certain metrics, particularly staffing, have yet to return to pre-pandemic levels,” wrote Senator Baldwin. “Unfortunately, recent trends suggest much of the industry is reversing any progress that was made, leaving the system brittle and vulnerable to future service problems and safety incidents moving forward.”

Governor Tony Evers also visited the site of the derailment and made comments at that time about holding companies accountable for accidents stating “Accountability for this situation will happen. We have to wait for federal agencies to determine how this happened, before we can assess what we can do to improve things.”

We contacted State Senator Brad Pfaff about the findings in the report and he stated:

“Railroad safety is of the utmost importance for our residents, communities and natural resources along rail lines. we need to make sure there is adequate inspection, oversight and coordination to keep our communities safe and endure incidents like this do not happen again.”