Thursday, December 1, 2011

Lessons Learned —Failed Assumptions Lead to a Fatal Sinking at Sea—Part 1

Excerpt from U.S. Coast Guard Proceedings of the Marine Safety & Security Council magazine by Ms. Krista Reddington, technical writer.

Lessons learned from USCG casualty reports are regularly featured in Proceedings of the Marine Safety & Security Council magazine. These articles explore marine incidents and the causal factors, outline the subsequent U.S. Coast Guard marine casualty investigations, and describe the lessons learned as a result.

The Voyage Begins
Early in the morning of January 18, 2006, the uninspected tug Valour sank into the chilly, wind-blown sea off the coast of Wilmington, N.C. Three crewmembers aboard the vessel lost their lives in the incident. Several factors contributed to the sinking of the tug; unfortunately, almost all can be attributed to human error.

On January 17, 2006, the chief mate noticed the vessel was listing slightly to port and ordered the assistant engineer on watch to pump 15 minutes’ worth of ballast into the #18 starboard ballast tank. Nearly five hours later, the captain took over the watch and ordered the chief engineer to pump the #18 starboard ballast tank dry. At 10:30 p.m., the chief mate entered the wheelhouse to inform the captain of the slight starboard list that was consistent with the vessel’s stability letter; the wind and waves pushing the tug and barge due north may have increased this natural list.

Between 11:00 a.m. and 11:15 p.m., the second mate and captain noticed the tug had first begun to level, then list to port, then roll to port. The captain contacted the chief engineer to determine what actions were being taken at the time and ordered him to pump out all ballast. The captain sounded the general alarm at 11:20 p.m., and crew was informed via the public announcement system that there was an emergency in the engine room and to assist the chief engineer as necessary. At this point, the vessel was listing approximately 15 degrees to port in the increasingly rough waters.

Miscommunication Leads to Mistrust
At 11:30 p.m., the captain radioed the tug Independence, which was approximately 30 miles away, to report they had taken on water but the engineer was working on it. As the captain sent a “mayday” transmission to the Coast Guard, the chief mate went below to retrieve his survival gear. On his way, he fell down the ladder from the wheel house to the stack deck passageway. The captain heard a noise and rushed from the wheel to investigate. He found the chief mate lying on the deck where he had landed.

The second mate immediately went to assist the chief mate while the captain returned to the wheelhouse. He notified the Coast Guard that the tug had an injured crewmember and may require a helicopter. The second mate found the chief mate dazed, with his legs awkwardly folded and apparently broken; he was clutching his chest and said he could not feel his legs and was having trouble breathing.

The story continues in part 2.

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jaylen watkins said...

Failed assumptions can always lead to fatal results so as in this case.

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