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The Transportation Safety Board (TSB) has urged the federal government to implement stricter medical fitness assessment rules for railway employees, following a 2023 train collision near Wainwright, Alberta. The incident involved two Canadian National Railway trains, where a trainee was unable to adequately manage the situation due to the locomotive engineer's declining cognitive function.

The engineer had been cleared to work, despite having incomplete medical assessments related to his Type 1 diabetes, which he managed through insulin.

On August 8, 2023, the train passed a stop signal while under the engineer's supervision. The engineer failed to respond to the trainee's repeated requests for guidance because he was experiencing a significant cognitive decline, likely due to hypoglycemia (low blood sugar), which was consistent with his reported symptoms. This lack of adequate guidance meant the trainee had to take full responsibility for the train's operation, which was beyond his competency level.

The TSB report noted that no blood glucose testing or medical assessment was conducted on the engineer following the derailment, making it difficult to determine the exact cause of his cognitive decline. Additionally, the inquiry found that several required annual diabetes assessments were incomplete but still accepted by Canadian National (CN). Furthermore, Transport Canada had not audited CN's compliance with the Railway Medical Rules in the 12 years preceding the crash.

The TSB concluded that the guidelines used by railways for assessing the medical fitness of employees with diabetes are inconsistent with recommendations from Diabetes Canada or the medical certification guidelines employed in the air and marine transportation sectors. The report can be accessed on the TSB's website.