Lac-Mégantic Disaster Report Issued

Flames rise above Lac-Mégantic after the derailment
A report reveals new facts about the Lac-Mégantic disaster.

On July 6, 2013, a freight train parked with the engine running and left unattended at Nantes, Quebec began rolling, pulling 72 tank cars carrying Bakken crude, a highly flammable oil, behind it. All cars were the old dangerous DOT-111A/CTC-111A type which have a capacity of 30,000 gallons of oil each.

That something was wrong with the locomotive was obvious to people driving by at 11:45 that night. They saw a dark diesel smoke cloud and sparks coming from the locomotive’s exhaust as it sat there on the track. Fire Departments from Nantes and near-by Lac-Mégantic were called by a witness, quickly responded, shut off the train engine and doused the fire. They also called the Montreal, Maine and Atlantic Railway (MMA), owner of the train. MMA sent in a few employees who determined that the train was ok and departed, leaving the train unattended once again.

Soon afterward, around 1:00 am EST, the train began rolling, gathering momentum as it headed down a 1.2% grade toward the town of Lac-Megantic, almost 7.2 miles down track. About 15 minutes later, right in the heart of Lac-Mégantic, 63 tank cars holding Bakken’s finest derailed, 59 of them began spurting oil, and the conflagration began. Oil streamed into storm sewers—resulting in explosions of towers of flame from manholes and even chimneys up into the black night—and into the nearby river, setting it on fire.

In the aftermath, 47 people were determined to be dead or missing. 42 bodies were found. Five others were never found and are presumed to have been vaporized by the conflagration. 40 buildings, including the town library and other historic structures, were destroyed, along with legal documents such as the wills of a few of the victims. By the end of the week, all Lac-Mégantic residents had been allowed to return to their homes, though some 20 families were unable to, their homes having been destroyed by the fires. MMA filed Chapter 11 bankruptcy in the month following the disaster and was finally sold in January of this year.

Canada’s Transportation Safety Board (TSB) has released its comprehensive report on what happened that night in Nantes and Lac-Mégantic. The 190-page report includes photographs with key details highlighted by arrows or circles, charts and timelines. Particular attention is devoted to the brake systems and their use (or not) that night. The lead locomotive was examined, track inspected, DOT-111 cars and the “Dangerous goods” they were carrying assessed, regulations and enforcement reviewed.  (Adobe version of the report is here.)

Page 129 of the report contains the Findings. TSB noted 18 specific factors that led to the conflagration in Lac-Mégantic. First, the train was left “on a descending grade” and with a locomotive “not in proper operating condition.” Several specific points pertain to the brakes, which were “insufficient to hold the train without the [locomotive’s] additional braking force” and which hadn’t been tested to ensure the brakes would actually stop all movement. Since no other locomotive was started while the train sat at Nantes, “no air pressure was provided to the independent brakes.” Moreover, the lead locomotive wasn’t wired for reset safety controls, and so forth.

And those DOT-111 tank cars? Once derailed, they “had large breaches, which rapidly released vast quantities of highly volatile petroleum crude oil, which ignited, creating large fireballs and a pool fire.”

MMA was criticized for lack of training and supervision of appropriate staff, poor risk management, and inadequate safety management. Transport Canada also came under fire for not providing “adequate regulatory oversight to ensure the associated risks were addressed,” for failure to ensure that “recurring deficiencies” at MMA were being addressed and corrected, and for conducting an insufficient number of audits which also had limited scope.

So there you have it, in a nutshell. Forty-seven victims of a horrendous oil fire in a small Canadian town which had its heart consumed by intense flames that spread from poorly designed and maintained oil tank cars carrying very volatile fuel, tugged along by a locomotive which had unaddressed problems and a braking system seemingly near tatters. Inadequate regulations and lack of rigorous oversight and enforcement complete this tragic picture.

Aerial view of Lac-Mégantic burning by Sûreté du Québec released under a Creative Commons Share Alike license.

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