Getting at the Underlying Systemic Causes of SPADS: A New Approach
نویسندگان
چکیده
Now, more than at any other time in the history of the railways, there is an urgent need for the industry to learn lessons from near misses and incidents. In this first of two articles, we examine the extent to which the current procedures for gathering data on accidents such as SPADs provide support for the identification of underlying causes. An alternative approach is outlined, which we believe has the potential to allow a much more comprehensive and structured assessment of underlying causes to be made during SPAD investigations. This process is based on the research findings on the causes of SPADs, combined with the practical knowledge possessed by experienced personnel such as drivers and Driver Standards Managers.
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