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Transportation Safety Board of Canada (TSB) investigation report (R23D0108), released on September 16, 2025, highlighted the lack of fail-safe engineering controls ensure to trains follow signal indications as a key factor in the collision between a Canadian National locomotive and an Exo commuter train at the St-Léonard-Montréal-Nord station on November 21, 2023.
The investigation found that the CN crew had passed a signal displaying a Restricting aspect, requiring them to limit their speed and be prepared to stop. However, believing the track ahead was clear, they accelerated. This would not have been possible if an Automatic Train Protection (ATP) system had been in operation. By the time the stationary commuter train became visible, it was too late to avoid the collision. Thankfully, only minor injuries resulted, although the Exo locomotive and one coach were damaged beyond repair.
A longstanding safety gap
For nearly 25 years the TSB has been calling for the adoption of physical fail-safe train controls—Automatic Train Protection—that automatically slow or stop trains when crews miss or misinterpret signal indications. Canada is an outlier in not adopting such technology and continuing to rely solely on the diligence of locomotive engineers and conductors. ATP systems are used worldwide, including Positive Train Control in the United States, which was mandated in Rail Safety Improvement Act of 2008 and has been fully operational since 2020, although most countries have had fail-safe controls in place for far longer, with the first system patented in 1873, more the 150 years ago.
Several other recent incidents, including the near-collision between a CN train 372 and VIA train 67 with 167 passengers onboard at Cornwall, Ontario on April 13, 2023 (R23H0006), could have been prevented by a modern ATP system like Interoperable Electronic Train Management System (i-ETMS) or European Train Control System (ETCS).
Transport Canada announced plans to require “Enhanced Train Control” on the highest-risk corridors in 2022, following the issuance of TSB Recommendation R22-04. However, the TSB has now issued a statement expressing concern that progress appears stalled, and that critical steps including corridor risk assessments remain incomplete.
Full implementation of Enhance Train Control across Canada will take several years due to the complexity of the technology and availability of resources, including engineering expertise, and the TSB has therefore issued a further statement expressing concern about the absence of interim safety measures while Enhanced Train Control systems are being explored, and an additional recommendation:
Transport Canada to immediately implement additional interim measures to mitigate the risks associated with train crews not complying with railway signal indications, such as collisions between trains, until adequate and permanent physical fail-safe defences are implemented.
TSB recommendation R25-01
Transport Action Canada expects that Transport Canada will publish the regulations for Enhanced Train Control in early 2026, and it is likely that the industry will deploy i-ETMS on shared corridors and ETCS on high-speed and commuter networks. We urge the government and all Canada’s railways to decisively commit the resources necessary to roll out the technology as rapidly as possible.