BUS ROLLAWAY ACCIDENTS GET ‘BIGGER PICTURE’ INVESTIGATION

By: Fabian Cotter, Photography by: courtesy OTSI and NSW Ambulance


THE NSW Office of Transport Safety Investigations (OTSI) has launched a “systemic investigation” into seemingly perennial bus rollaway events in the state following a 2021 incident near Wollongong and previous Southern Sydney incidents at Hurstville (2016) and Oatley (2017).

BUS ROLLAWAY ACCIDENTS GET ‘BIGGER PICTURE’ INVESTIGATION
OTSI determined that there would be safety benefits from investigating bus rollaway events from a “systemic perspective”, rather than as several “isolated incidents and accidents,” it explains.

According to OTSI, the investigation will: Identify the factors, both primary and contributory, which lead to bus rollaway events; Determine the effectiveness of any controls that are in place to manage the related risks; Advise on any matters arising that would enhance the safety of bus operations.

OTSI’s decision to initiate this systemic investigation follows a review of recent incidents and the findings of the abovementioned past investigations, it explains.

In recent years, the Office of Transport Safety Investigations (OTSI) has investigated several bus rollaway incidents, including those resulting in either fatalities or serious injuries, it says. OTSI commenced an investigation in January, 2021, as the result of a serious bus rollaway accident that occurred at Cordeaux Heights, NSW, after the driver became medically incapacitated, it states.

After reviewing evidence associated with this accident and analysing incident data collected by OTSI, it was determined that there would be safety benefits from investigating bus rollaway events from a "systemic perspective", rather than as several "isolated incidents and accidents", it explains.

dc0c7dddf0def73d352945cc015fad8a.jpg

 INVESTIGATION SCOPE

Based on these findings, OTSI’s chief investigator determined that the incidence of bus rollaway events warranted investigation in accordance with Section 46 of the Passenger Transport Act 1990 (NSW).

The scope of the investigation includes, but is not limited to:

• An evaluation of the extent and trends associated with bus rollaway incidents;

• Engineering and other technologies available to limit the risk or consequence of these incidents;

• Practices related to the operational status of a bus when left unattended; and

• The method of collection and information sharing of data in the heavy vehicle industry.

The chief investigator has required the investigator in charge (IIC) to:

• Identify the factors, both primary and contributory, which lead to bus rollaway events;

• Determine the effectiveness of any controls that are in place to manage the related risks;

• Advise on any matters arising from the investigation that would enhance the safety of bus operations.

The IIC will consult with all directly involved parties (DIPs) during the course of the investigation, OTSI confirms.

696656b4b430a9c80680675e097fec9c.jpg

756b572a83796f16f142023d47dfdb4c x.jpg

PARLIAMENT TABLING

OTSI produces a written report on every investigation for the Minister for Transport, as required under section 46BBA of the Passenger Transport Act 1990.

Investigation reports strive to reflect OTSI’s balanced approach to the investigation, explaining what happened and why in a fair and unbiased manner, it says. All DIPs will be given the opportunity to comment on the draft investigation report, it highlights.

The final investigation report will be provided to the Minister for tabling in both Houses of the NSW Parliament in accordance with section 46D of the Passenger Transport Act 1990. The Minister is required to table the report within seven days of receiving it.

Following tabling, the report is published on the OTSI website and information on the safety lessons promoted to relevant stakeholders. The published report will replace this Interim Factual Statement, OTSI confirms.

0cddf0f23ce4d1080d81f74f4786b01d.jpg

THE WOLLONGONG EVENT

As documented via Fire and Rescue NSW’s account of the Cordeaux Heights incident of 04 January, 2021, at 10:09am (though curiously only published online 17 October, 2021, at 08:05am), FRNSW crews from Unanderra and Wollongong were on the scene of an incident where a bus carrying passengers had crashed into a house on Staff Road, Cordeaux Heights.

It states: "FRNSW arrived shortly after receiving the Triple Zero (000) call at 10.09am, where it is believed the driver of the bus suffered a medical episode, causing him to lose control and crash into a power pole and the house."

"The bus was carrying passengers at the time and one other person has been treated for injuries by NSW Ambulance.

"NSW Police are also on scene and traffic on the road is partially blocked due to the damaged power pole.

"FRNSW are currently working to stabilise the two-storey house."

OTSI’s ensuing Interim Factual Statement likewise assessed the driver suffered an incapacitating medical episode. 

It explained: "As a result the bus rolled uncontrollably in a reverse direction down South Road, Cordeaux Heights. The bus struck several parked vehicles and damaged infrastructure along South Road coming to rest against the front of a domestic residence."

It added: "Based on  findings  from  OTSI’s  preliminary  enquiries,  the chief  investigator  determined that  the incident  warranted investigation  in accordance  with  Section 133  of  the  Passenger Transport  Act  2014  (NSW)."

DSC_3748edit x.jpg

ABOUT OTSI

OTSI is an independent NSW authority which contributes to the safe operation of bus, ferry and rail passenger and rail freight services in NSW by investigating safety incidents and accidents and transport safety risks, identifying system-wide safety issues and sharing lessons with transport operators, regulators and other stakeholders, it states.

OTSI is empowered under the Transport Administration Act 1988 to investigate rail, bus, and ferry accidents and incidents in accordance with the provisions of the Passenger Transport Act 1990 and Marine Safety Act 1998. It also conducts rail investigations on behalf of the Australian Transport Safety Bureau under the Transport Safety Investigation Act 2003 (Cth), it adds.

OTSI investigations are independent of regulatory, operator or other external entities. It investigates using a ‘no-blame’ approach to understand why an occurrence took place and to identify safety factors that are associated with an accident and incident, to make recommendations or highlight actions that transport operators, regulators and government can take to prevent recurrence and improve safety, it says.

OTSI investigators normally seek to obtain information cooperatively when conducting an investigation; however, where it is necessary to do so, OTSI investigators may exercise statutory powers to conduct interviews, enter premises and examine and retain physical and documentary evidence, it confirms.

Subscribe to our newsletter

Sign up to receive the ABC e-newsletter, digital magazine and other offers we choose to share with you straight to your inbox

You can also follow our updates by liking us on Facebook