The speeding Amtrak train that crashed in Philadelphia last year, killing eight people, most likely ran off the rails because the engineer was distracted by word of a nearby commuter train getting hit by a rock, federal investigators concluded Tuesday.
The National Transportation Safety Board also put some of the blame on the railroad industry's decades-long delay in installing Positive Train Control, equipment that can automatically slow trains that are going over the speed limit.
Engineer Brandon Bostian was apparently so focused on the rock-throwing incident he heard about over the radio that he lost track of where he was and accelerated full-throttle to 106 mph as his train went into a sharp curve with a 50 mph limit, investigators said at an NTSB hearing convened to pinpoint the cause of the May 12, 2005, tragedy.
"He went, in a matter of seconds, from distraction to disaster," NTSB board member Robert Sumwalt said.
Bostian, who has been suspended without pay since the crash for speeding, did not attend the hearing. His attorney didn't return an email seeking comment.
Had Positive Train Control been in use along the stretch of track, "we would not be here today," said Ted Turpin, an NTSB investigator.
"Unless PTC is implemented soon," NTSB chairman Christopher Hart warned, "I'm very concerned that we're going to be back in this room again, hearing investigators detail how technology that we have recommended for more than 45 years could have prevented yet another fatal rail accident."
Among other things, the NTSB recommended research into seat belts in railcars and ways to secure luggage that can become missiles in a derailment; training for railroad crew members on multitasking; and the use of new equipment and procedures to help crew members keep track of their location in spots where Positive Train Control is not in place.
In a statement, Amtrak said it has "taken full responsibility for and deeply regrets the tragic derailment" and will carefully review the NTSB findings and recommendations and quickly adopt them where appropriate.
The railroad noted that Positive Train Control is already in place on most of Amtrak's portion of the Northeast Corridor and that it has also installed inward-facing video cameras on locomotives.
The tragic chain of events illustrated the potential for tragedy when people throw rocks at trains — a problem railroads are almost powerless to stop but is so common the industry has a term for it: "getting rocked."
Bostian told investigators after the wreck that he remembered radio traffic from a Philadelphia commuter train operator who said a rock had shattered his windshield. He was monitoring the radio traffic until about a minute before his Amtrak train reached 106 mph, and at one point passed the commuter train on an adjoining track, investigators said.
The engineer's acceleration would have made sense for someone who thought he had already passed the curve, NTSB investigator Steve Jenner said. After the curve, the tracks open up into a straightaway with a speed limit of 110 mph.
Bostian had told investigators that he didn't recall what happened between pushing the throttle to pick up speed and then braking when he felt the train going too fast into the curve.
A blow to the head suffered when he was thrown around the cab of his overturned locomotive probably prevented him remembering, NTSB medical officer Mary Pat McKay.
Early in the investigation, the NTSB focused on whether the Amtrak train had also been hit with a rock or other projectile minutes before the crash. But investigators confirmed Tuesday that it was not.
Bostian told investigators that he was concerned about the welfare of the commuter train's engineer and "a little bit concerned" for his own safety, but he never indicated in either NTSB interview that his train had been struck, too.
Duy Nguyen, of Teaneck, New Jersey, a passenger who suffered a cut on his head and fractures in his back, attended the NTSB hearing. The Temple University professor said he was stunned by the findings.
"The part that doesn't make sense is how does one accelerate when you're distracted?" Nguyen said. "The inclination is to slow down." He added: "Part of me is mad at Amtrak. Part of me is resigned that there's something that happened and you have to endure and survive and move on."
Bostian, known among his friends for his safety-mindedness and love of railroading, apparently commented in an online forum for train enthusiasts on a range of industry issues, including safety. Some of the posts lamented that railroads hadn't been fast enough to adopt Positive Train Control.
Amtrak has installed Positive Train Control on all the track it owns on the Northeast Corridor from Boston to Washington. A 56-mile stretch from New Rochelle, New York, to New Haven, Connecticut, is owned by other entities and is expected to have automatic controls installed by a deadline at the end of 2018.
The southbound stretch of track near the accident site had an earlier-generation type of automated control for slowing trains. But the northbound stretch, where the wreck occurred, did not. The more-advanced PTC had been installed on that section but was still being tested when the crash happened.
The investigation also pointed up the need to make passenger trains safer. In the derailment, the train's emergency windows dislodged as the cars slid on their sides, and four people were ejected and killed, according to NTSB investigator Dana Sanzo.