Page:Derailment of Amtrak Passenger Train 188 Philadelphia, Pennsylvania May 12, 2015.djvu/22

NTSB situations that might divert attention for an extended amount of time, such as what occurred in this accident.

Further research on prospective memory has identified countermeasures to reduce vulnerability to forgetting to perform deferred tasks. These strategies pertain to both the individual operator as well as the designers of systems and procedures. Some of the strategies relevant to this accident include the following:
 * Educating individuals and managers about prospective memory vulnerability and pointing out countermeasures individuals can take
 * Minimizing the juggling of multiple tasks concurrently if one of the tasks is vital
 * Pausing to encode an explicit intention to resume an interrupted task after the interruption has ended
 * Analyzing the specific operating environment to identify "hotspots" in which prospective memory and concurrent task demands are high and interruptions are frequent. To the extent possible, redesign procedures and systems to reduce demands, especially when the consequences of memory lapses are serious
 * Designing display and alerting systems for the status of tasks not active where the need for prospective memory is high

Training strategies to combat prospective memory errors exist. There is a need for advanced training for locomotive engineers, particularly those alone in the cab who must engage in operations (such as monitoring radio communications) typically assigned to, or shared with, another crewmember. Amtrak's training for locomotive engineers is comprehensive and incorporates state-of-the-art simulators that require engineers to operate on multiple territories and under varied conditions. The NTSB is also aware that many major railroads also have quality training programs for train operating crews. However, as noted earlier, those training programs do not generally include strategies for dealing with prolonged or emerging situations—such as the SEPTA incident—that may divert crewmember attention for an extended period of time and cause prospective memory errors. Therefore, the NTSB concludes that training focusing on prospective memory strategies for prolonged, atypical situations that could divert crewmember attention may help operating crews become aware of, and take measures to avoid, errors due to memory failure.

Therefore, the NTSB recommends that Amtrak incorporate strategies into its initial and recurrent training for operating crewmembers for recognizing and effectively managing multiple concurrent tasks in prolonged, atypical situations to sustain their attention on current and upcoming train operations. The NTSB also recommends that the American Public Transportation Association (APTA) and the Association of American Railroads (AAR) develop criteria for initial and recurrent training for operating crewmembers that reinforces strategies for recognizing 12