British Rail has been asked to improve emergency procedures on all its trains following criticisms in a report into a fire on board a train in Maidenhead, Berkshire, last year.
One man died in the incident on 8 September, when he jumped out of the train into the path of an oncoming train, after fire broke out on the high- speed train travelling from Paddington to Swansea.
Mike Holmes, the inspector who investigated the accident for the Health and Safety Executive, found that the cause of the fire was that a diesel tank fell off the front engine and the spilt fuel resulted in a severe fire which affected two coaches but fortunately, according to Mr Holmes, "did not spread on to seating".
As a result of faulty maintenance, the bolts holding the tank had fallen off or sheared and when all other similar trains were inspected a "small number of bolt deficiencies" were found, but "none posed a danger".
Mr Holmes's report says that there should be "improved instructions and procedures" for the fitting of fuel-tank securing bolts and that changes in the way tanks are held on to engines should be considered.
However, the main focus of his 10 recommendations is on the way that emergencies are dealt with by train crew.
The passenger who died, Ian Jones, a civil servant, was killed in the ensuing panic which was made worse by the difficulties of communication between train staff and passengers.
There were criticisms from some passengers that the crew had been too busy identifying the cause of the fire to communicate instructions to passengers. One passenger later wrote to the Independent saying other deaths had only been narrowly avoided.
Terence Cudbird said: "A passenger in front of me half opened the carriage door on the `wrong side' but was persuaded not to jump. Seconds later the express from Bristol came by at high speed."
Mr Cudbird asked: "Do the rail companies have an evacuation policy at all?"
In fact, Mr Holmes clearly states that the emergency procedures are inadequate and recommends "a review of emergency equipment and detraining facilities provided for passengers should be undertaken".
He adds that procedures concerned with "the control of passengers in emergency situations" should be reviewed.
One specific problem was that the staff can, at present, only communicate with all passengers through loudspeaker systems from a very limited number of locations and in an emergency it may be necessary to communicate quickly with the passengers. Mr Holmes has recommended that the use of pre-recorded or automatic announcements should be considered.
Mr Holmes also said the role, effectiveness and accessibility of hammers should be reassessed, as should be the accessibility of door handles and the use of signs and instructions. At present, British Rail is the sole train operator, although private companies are due to take over the Paddington InterCity services next month.
t An electrical short-circuit was blamed for a fire on board the 5.35am Bristol to London InterCity train yesterday. The blaze was put out by automatic fire extinguishers. There were no injuries and passengers were taken back to Bristol to continue their journey on another train.
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