NTSB/RAB-03/06 

E PLURIBUS UNUM

NATIONAL TRA S PORTATIO

N

B OARD

SAFE T Y

N

National Transportation Safety Board 

Washington, D.C. 20594 

Railroad Accident Brief

Accident No.: DCA-02-FR-014 

Location: Jamaica, New York 

Date of Accident: September 27, 2002 

Time: 12:25 p.m. eastern daylight time 

Light Rail Transit: AirTrain-JFK (Port Authority of New York and New 

Jersey) (Bombardier Total Transit Systems) 

Fatalities: 1 

Injuries: None 

Property Damage: $7.65 million 

Type of Accident: Derailment 

Accident Synopsis 

At about 12:25 p.m., on September 27, 2002, AirTrain-JFK light rail transit test 

train No. 121 derailed in a curve on the aerial guideway that runs between the Howard 

Beach station and the Federal Circle station near JFK International Airport in Jamaica, 

New York. (See illustration.) At the time of the accident, AirTrain No. 121, with three 

cars and no occupants except the train operator, was participating in a power distribution 

system test under the authority of the transit system’s testing and commissioning 

supervisor (test supervisor). When the train derailed, large concrete slabs that had been 

placed in the lead car for added weight shifted and pinned the train operator against the 

operator’s console, severely injuring him. He was transported to a local hospital where he 

died at 3:05 p.m. on September 27, 2002. 

AirTrain-JFK System Overview

AirTrain-JFK, which has not yet been fully commissioned and placed into 

service, is owned by the Port Authority of New York and New Jersey. It is designed to be 

a fully automated, driverless transit system that runs from the JFK Airport to Howard 

Beach for connection to the New York City Transit System and to Jamaica, New York, 

for connection to the Long Island Railroad and the New York City Transit System. Of the 

10 passenger stations that will make up the 8.1-mile system, 6 will be at the airport’s 

central terminal area, 1 will be in the common corridor (Federal Circle), 2 will be on the 

Howard Beach branch, and 1 will be on the Jamaica branch. 
 

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Jamaica Station

Howard Beach

Station

JFK Airport

(Central Terminal

Area)

Lefferts Boulevard

Station

Federal

Circle

Derailment

The AirTrain-JFK system. For the September 27, 2002, test, train No. 202 departed the 

Howard Beach station at the same time train No. 121 departed Lefferts Boulevard 

station, both inbound toward Federal Circle. 

AirTrain-JFK trains, which will be electrically powered through a third rail, will 

operate along two parallel tracks, or guideways. The guideway on which the trains will 

travel from the central terminal area toward Howard Beach and Jamaica is referred to as 

the “outbound guideway.” The side on which the trains normally travel from Howard 

Beach and Jamaica to the terminal area is referred to as the “inbound guideway.” 

The system was designed and constructed by the Air Rail Transit Consortium. A 

member of the consortium, Bombardier Total Transit Systems (Bombardier), is 

responsible for cars and for the automatic train control and communications systems. 

Bombardier will also operate and maintain the system on behalf of the Port Authority. 

Preaccident Events 

At the time of the accident, as part of its testing and commissioning 

responsibilities, Bombardier was carrying out a test designed to calibrate the trip limits of 

certain transit power substation circuit breakers. The test involved the simultaneous 

starting and accelerating of two trains, one at the Howard Beach inbound platform and 

the other at the Lefferts Boulevard inbound platform. 

The test design called for two four-car trains to be started at the same time, 

accelerated to the maximum authorized speed, slowed, and then stopped. The duration of 

each test run was expected to be about 30 seconds. A supervisor in Bombardier’s 

engineering department informed the test supervisor that the test trains could be operated 

either manually or under automatic train control. 
 

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3 

On September 20, 2002, the test supervisor sent an e-mail to the Bombardier 

engineering department stating, “We are having a problem getting two four-car trains 

together and making them work properly. Could we use two two-car trains with an AW-2 

load?”1

 On September 23, 2002, the test supervisor sent an e-mail to the engineering 

supervisor stating, “We can use two three-car trains. Two cars of each three-car train will 

be AW-2 loads, and the third car will be an AW-0 load.” Later that same day, the test 

supervisor received approval via e-mail to use two three-car trains with the specified 

loading. To achieve the loading, eight 4 foot x 2 foot x 22 inch concrete slabs weighing 

approximately one ton each were placed in the lead and middle cars of the accident train 

(concrete slabs had been added to the other test train, train No. 202, for a previous test). 

The slabs were placed unsecured on sheets of ply-board in the passenger compartments 

of each of the loaded vehicles. 

Test officials agreed that the tests would be conducted with the test trains 

operating in manual (operator-controlled) mode.2

 It was also agreed that the speed 

governor that limited train speed to 15 mph in manual mode would be disengaged for the 

test so that the two test trains could accelerate to the maximum authorized speed and thus 

generate maximum electric current draw. 

Because the transit system was not yet in operation and was designed to be a 

driverless, fully automated system, neither of the two operators assigned for the test had 

experience operating on the main line. The operators were normally responsible solely 

for moving and positioning cars and trains within yards where they operated in manual 

mode and where the speed governor limited train speed to 15 mph. Although operators 

are trained to retrieve disabled trains from the main line, such retrievals are performed in 

manual mode with its 15-mph maximum speed. According to the AirTrain training 

officer at the time of the accident, operators received no training in operating trains at 

speeds greater than 15 mph. The test supervisor told investigators that he was 

disappointed when he learned that he would not be able to use more experienced 

operators for the test. 

The Accident 

On the morning of the test, test officials, including a supervisor from the 

operations center, the train operator supervisor, engineering test supervisors, the general 

manager from Bombardier, the manager of the operations control center, and a control 

 

1 AW (added weight) loading refers to the weight added to a vehicle to simulate passenger load. AW-0 

simulates an empty car; AW-1 simulates a load with seated passengers only; AW-2 simulates a load with 

some seated and some standing passengers; and AW-3 simulates a train with a crush load (the maximum 

number of passengers that can possibly be riding in the railcar, standing and sitting). 

2

 In a Safety Board interview, the testing and commissioning supervisor said manual mode was chosen 

because the test required that the two trains be started simultaneously, which could not be ensured during 

automatic operation. In other interviews, it was stated that one of the trains was not operating properly in 

automatic mode. 
 

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center operator, met to determine the limits for the test. They also coordinated test 

activities and confirmed that all requests for vehicles, track allocation, and train operators 

had been completed. 

The test supervisor had stationed himself at the Lefferts Boulevard station with 

the intention of riding train No. 121 during the test; however, the train doors 

malfunctioned, and he was forced to remain on the station platform during the test. 

Earlier that morning, he had issued test instructions to the first operator of train No. 202. 

When that operator was relieved for a lunch break, the test supervisor used his cellular 

telephone to issue the same instructions to the relief operator. The train No. 202 relief 

operator told the Safety Board that he was instructed to start from the Howard Beach 

inbound station. On the command “go,” he was to apply full throttle not to exceed 

maximum permissible speed and stop at the walkway just past the Lefferts Boulevard 

station. (Maximum allowable speed in the area was 45 mph, with a 15-mph speed limit 

over the switches.3

) 

The test supervisor said he issued his instructions to the operator of train No. 121 

while they were both standing on the Lefferts Boulevard Station platform. He stated that 

he instructed the operator to operate his train at full throttle out of the station, pass over 

the switches entering the yard tracks not exceeding 15 mph, operate his train at full 

throttle not exceeding maximum permissible speed, and stop at a walkway MD-45. The 

test supervisor said both train operators acknowledged his instructions. Both train 

operators were told that they would receive the “start” command via radio from the 

senior test engineer for a Bombardier electrical subcontractor. According to the written 

test procedures, the senior test engineer was also to issue “slow” and “stop” commands as 

the test runs concluded, but he did not issue these commands during the September 27 

test. 

Data for the first test run taken from speed graphs show that train No. 202 had a 

normal run, reaching a top speed of 35 mph before stopping at the Lefferts Boulevard 

station as the operator had been instructed. Train No. 121 reached speeds up to 54 mph 

and went beyond the limits established for the test. 

After the time when the first test run should have ended, the test supervisor 

radioed the operator of train No. 121 to ask his location and to instruct him to stop his 

train. The train operator replied, “I should stop?” The test supervisor repeated the 

command to stop and asked the train’s location. The train operator stated his location in 

the following taped conversation: 

Test supervisor: Train 121, where are you? Stop! 

 

3

 The AirTrain-JFK Operations Manual states that “go slow zones are put in place over every switch 

on the mainline at 15 mph and are not to be removed.” The manual also states that temporary permission 

may be given to exceed 15 mph for completion of testing. The test supervisor stated in his interview that he 

specifically told the operator of train 121 to pass over the switches at 15 mph. 
 

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Train operator 121: I should stop? 

Test supervisor: Roger, you can stop now. 

Train operator 121: Roger that. 

Test supervisor: Are you near a walkway? 

Train operator 121: Affirmative. I’m now near the walkway and right now train 

No. 121 stopped at track section 3623. 

The operator of train No. 121 repeated his location when he asked permission to 

change ends of his train at track section 3623. The test supervisor stated in interviews 

that he was not aware of train No. 121’s location when it stopped at the end of the first 

test run. 

The test supervisor stated that when train No. 121 returned to the Lefferts 

Boulevard station, the train operator told him he had exceeded 50 mph on his way back to 

the station. The test supervisor said he told the operator, “Oh no, don’t go 55 to 60 mph. 

You know, follow the guide–ATC [automatic train control] guideway speed.” 

During the second test run, train No. 202 reached a top speed of 42 mph within 

the 30-second window required for the test. According to the on-board data logger, train 

No. 121 reached a speed of 44 mph within the 30-second time frame but then continued 

to accelerate. The train traveled at speeds of 50 mph and above for another 30 seconds 

before derailing in a curve rated for a 25-mph maximum speed. This curve was more than 

1,500 feet past the point where the test design had called for the train to be stopped. 

Speed recorders indicate the train was traveling 58 mph just before it entered the curve. 

When the train derailed, the unsecured load of concrete slabs shifted forward, pinning the 

operator against the control console and causing fatal injuries. Toxicology tests 

performed on the deceased train operator were negative for alcohol and for all tested 

drugs. 

Regulatory Requirements 

Because AirTrain-JFK receives no Federal or State monies, it is not subject to 

either Federal or State safety oversight programs. In addition, the Public Transportation 

Safety Board of New York has no jurisdiction over the AirTrain-JFK system. 

Actions Taken Since Accident 

Since the accident, Bombardier has added a testing and commissioning manager 

with recent experience in the opening of a new line, hired a full-time training coordinator 

to identify employee training needs and organize required training, developed and 

implemented a train operator recertification training program for all operations and 

maintenance employees, and implemented workplace safety audits to identify safety 

hazards and take corrective actions. 
 

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Additionally, the Port Authority of New York and New Jersey has created an 

AirTrain-JFK oversight board to monitor conformance with established safety procedures 

and current industry standards for the operation and maintenance of AirTrain-JFK. 

Probable Cause 

The National Transportation Safety Board determines that the probable cause of 

the derailment of AirTrain No. 121 was the failure of the train operator, for undetermined 

reasons, to keep his train below maximum authorized speed and to stop his train at the 

location specified in the design of the test in which he was participating and the failure of 

Bombardier Total Transit Systems to take the actions necessary to ensure that the test 

trains were operated in accordance with the test protocols. Contributing to the severity of 

the accident was the failure to properly secure the load that had been added to the first car 

of the accident train. 

Adopted: September 17, 2003