Container Shifters To Get Bloody Knuckles For Napoli Grounding?

Whatever the details of the UK’s Maritime Accident Investigation Branch report on the 18th January 2007 structural failure and grounding of the MSC Napoli, scheduled for release on 22nd April, the container industry can expect to be walking around with painfully rapped knuckles for sometime afterwards. The size of the investigation and the importance that the MAIB places on it can be judged by the fact that 8m euro, around $13m, is understood to have been spent on computer simulation alone.

Last September saw the first shot across the industry’s bows with the release of the MAIB’s report on the February 2007 Annabella incident in the Baltic in which several containers in a stack collapsed during heavy weather with damage to three containers carrying a hazardous cargo, butylene gas. The usually restrained MAIB forcefully called for a code of practice for the industry to prevent further disasters: “(Napoli and Annabella) identify a compelling need for a code of practice for the container shipping industry”.

That call is likely to be reiterated with even greater force in the Napoli report itself. Early this year a MAIB official told MAC: “The investigation has been complex and has required in-depth research in several areas including the vessel’s structure and container vessel operation.”

These incidents are far from new. MAIB itself investigated similar issues surrounding a stack collapse, and leakage of a tank of hazardous material, in 2001. In 2006 at least 300 containers were lost in a half dozen incident in European waters and some estimated put the worldwide level of losses at 10,000 teu.

It is expected that the report will, in part, focus on how the speed of container operations has outstripped the speed of communications between the various parts of the transport chain, leading to the loss of control of stacking operations due to poor information flow between shippers, planners, the loading terminal and the ship itself arising from the ‘need for speed’.

Container accidents are expensive. According to the North of England P&I Club, of 16 cargo claims in 2007/2007 only two involved containers but those two accounted for 30 per cent of the $1m losses. Many of the increasing number of container-related claims occur in heavy weather. “Container losses and collapsed stows in heavy weather continue to occur,” says the club’s head of loss-prevention Tony Baker. ‘Such weather is not altogether unexpected and it has highlighted a number of areas of poor practice that need to be rectified if the industry is to keep a lid on spiralling claims costs.”

Baker says there are four principal factors behind recent incidents: failure of automatic twist-locks in lashing systems; failure to stow and secure containers in accordance with the ship’s cargo securing manual; mis-declared overweight containers; and failure to anticipate and minimise the effect of heavy weather.

Another issue that may be explored in the MAIB report is the lack of knowledge about the dynamic forces affecting container lashing systems. There has been little study of how the real-world compares to computer models and how they are affected by ship design. Marin, the Netherlands Maritime Institute, has a two-year ongoing study, Lashings@Sea, supported by eight ship owners, three lashing suppliers, three class societies and the Dutch Department of Transport.

At the moment, is seems, nobody really knows quite what’s going on when heavy seas and containerships get together at a time when the pressure is on to reduce lashing to cut turnaround times and costs.

Of concern also is that the rise in container accidents appears to parallel the introduction of fully automated locks, International Standards Organisation standards have not kept pace with the development of FAL systems, and destandardisation of container sizes have added more complexity to the mix.

Of course, the real question isn’t what the MAIB will say, it will certainly run along the lines of “get your act together”. The real question is whether anyone will be listening.

MAIB hits container dangers

Container Crunch Too Much

Odd Story – How Napoleonic Shipbuilders And Zulu Bible Thumpers Gave Somerset Cider the Napoli Spirit

Enclose Space Entry – Complacency Cannot Be Allowed To Grow

Commenting on the recent meeting of the Maritime Accident Investigators International Forum in Beijing, Stephen Meyer, Chief Inspector of Marine Accidents for the UK’s MAIB writes in the latest Safety Digest, released this month,

“Please read these cases and then consider, if accident investigators from around the world all see these same issues time and again in accidents, how confident are you that you/your ship/your company are getting them right?

The other key concern we all shared was the apparent growth in the number of accidents involving entry into enclosed/confined spaces. Although there are no examples in this Safety Digest, MAIB is currently dealing with three such cases, two of them fatal, and many other countries at MAIIF reported similar. Please look again at your systems and re-brief your crews on the importance of correct ventilation and entry procedures. This is a critical area, where complacency cannot be allowed to grow.”

Enclosed space entry accidents are a hot button for MAC. They’re covered specifically in two episodes (The Case Of The Silent Assassin and the Case Of The Electric Assassin – due for broadcast 7th December) as well as the related Case Of The Lethal Lampshade – all available on the podcasts page.

Sadly, such cases often involve multiple casualties: the seafarer who was first effected followed by the would-be rescuer/s.

Of the incidents we’ve looked at to date one theme seems to be consistent: ship’s officers who think they’re smarter than the people who wrote the enclosed space safe entry procedures and set poor safety standards that they pass on those those under their command. Poor monitoring of safety procedures by the ship’s management and an almost total lack of competency assessment compound the problem.

Be pro-active. Always assume an enclosed space is dangerous, because it is, know the rules about safe entry and stick to them.

More on VTS-Assisted Accidents

John Clandillon-Baker at UK Pilot Magazine sent me a link to the collision/allision between the general cargo ship Karen Danielsen and the Great Belt Bridge in Denmark that’s very timely given the call for ships to obey VTS Operators in the same way that aircraft obey air traffic controllers. In this case the Croatian Chief Officer fell asleep alone on the ship’s bridge and sadly died in the incident. The area was covered by a VTS system but, at the critical moments, the VTS operator was distracted and didn’t know the ship had hit the bridge until he heard a Mayday on the VHF.

The Karen Danielsen before… 

This was the bridge

…and after. The Chief Officer, the single watchkeeper on the bridge, died. 

The official report concludes that VTS could not have prevented the collision. John’s magazine article says: “In my opinion there is a bit of whitewash over the finding that the VTS could probably not have prevented this disaster since the investigators have seemingly revealed that no operators were monitoring shipping on the relevant display for over 30 minutes. If it is considered unlikely that the operator could have prevented the collision even if he had been keenly monitoring the ship it does rather beg the question why bother with having the VTS and expensively manning it since it is seemingly not fit for purpose?

“One common factor amongst all the VTS centres that I have visited is that VTS operators are allocated many administrative duties which inevitably distract the VTS operator from monitoring the displays. If the procedural changes introduced in the Danish Belt centre following the collision were implemented as general VTS policy the increase in manpower required to separately cover the administrative functions could have a significant impact on cost effectiveness of VTS.“

You can read his article here.

An otherwise occupied VTS operator also played a role in the grounding of the P&O-Nedlloyd Magellan in Southampton Water, as mentioned in a previous post.

Despite the inevitable howls of protest and indignation from the industry the paradigm shift from VTS as advisers to VTS as controllers is sure to come. It will probably be the biggest change since VTS system began in Liverpool in 1948. Clearly, those who manage VTS will have to pull their socks up, too.

One issue that tends to be overshadowed in the Karen Danielsen case is fatigue. The Chief Officer had been working for 11 hours, taking breaks only for meals. As it happens, new crew had joined the ship on the day of the collision. None were involved in the accident but john has some forceful comments about how they joined the ship:

“…investigators noted a disturbing factor around how crew changes are now undertaken in total contravention of the Working Time Directive which results in ships’s personnel joining the vessel in an already extremely fatigued state. The report notes:

The 2^nd officer together with four other new crew members joined the vessel around 1000 hours on 3 March 2005 after travelling by mini-bus from Split in Croatia to Svendborg, in Denmark. This was a direct drive of 26 hours, they were accompanied by two drivers and a crew manager from the manning agency. Upon arrival at the ship they went through their respective handovers and the departing crew members left to return to Croatia with the same mini-bus shortly after 1400 hours on 3 March. The joining crew went straight on duty upon arrival at the vessel.

Due to the busy work schedule planned for the 3^rd March, all on board, both existing and newly joined crew worked throughout the day on the 3 March 2005.

I understand that this appalling disregard of the ‘Human Element’ is apparently now common practice as a means of saving the cost of hotel bills and air fares.“

Says it all, really.

MAC Answers: I was wondering if investigations such as that for the Explorer are ever open to the public

Paul Hulford, who says he’s a ‘sub-Antarctic sailor’ asks:

“I was wondering if investigations such as that for the Explorer are ever open to the public or are they always held behind closed doors. By the way how does one get to read the findings?”

MAC Answers:
Much depends on the vessel’s registry, ie. flag the ship flies, and the state which has jurisdiction where the incident occurred, both of which will normall conduct an enquiry. As well as these, the ship’s classification society may have its own investigation so will its owner’s P&I Club. If there is a pilot on board the ship, as was the case with the recent Cosco Busan contact with the San Francisco-Oakland Bridge, then the pilotage authority may carry out its own investigation.

Of these, usually only the flag state and the territorial state reports are made publicly available.

The Bransfield Strait, where the Explorer went down, is disputed territory claimed by Britain, Argentina and Chile. The flag state is Liberia and an investigation is underway. Britain’s Maritime Accident Investigation Branch, MAIB, says it is not investigating the incident but Liberian authorities say that MAIB has expressed an interest in the investigation and they are co-operating, so it’s fairly confusing at the moment.

In times past it was common, at least in the UK, to hold a Board of Inquiry which would study the incident, call witnesses and so forth to determine what happened and why and who was responsible. When the Titanic sank in 1912 Boards of Inquiry were set up in the UK and the US. It was rather like a law court and if you can ever find a copy of BP’s excellent ‘Fire Down Below’ film, narrated by Allan Whicker, you’ll get an idea of how they worked.

These days Boards of Inquiry are rare and only called in exceptional cases. One example is the inquiry into the capsizing of the Bourbon Dolphin in Norway, which is open to the public.

I doubt there will be a Board of Inquiry for the Explorer so there won’t be anything physical for the public to attend.

Normally the terroitorial state and the flag state will carry out independent inquiries carried out by a team of investigators which conducts interviews, studies recorded data and whatever physical evidence is relevant. The Maritime Accident Investigators International Forum, MAIIF, has an excellent manual on its website (New link).

Investigators cannot normally subpoena witnesses etc. and their reports are intended to establish how and why something happened, not to establish liability.

If the ship’s on the bottom the physical evidence might be hard to get. Divers might be sent down, or an ROV if it’s too deep for divers, which may be done for the Explorer, which is around 600 metres down, or side-scan sonar (We’ll have an example of an investigation using side-scan sonar in the first of the new series of MAC episodes in January).

Don’t hold you breath, though, these investigations take months.

The outcome will be a draft report which is distributed to those who were involved, for instance the crew, the shipowner and so forth for their comments and a final report is then issued.

Depending on the investigating agency the report may be put online and you can find some examples at the Maritime Accident Investigation Branch, MAIB, Austrlian Transport Safety Board ATSB and National Transportation Safety Board NTSB websites.

In other cases, such as the Bahamas and Liberian registry, only hard copies are available and are usually in limited numbers. In my experience it’s only taken an email to get a copy sent for free. So these are publicly available ‘while stocks last’.

We are in contact with the Liberian registry so, with luck, we’ll be able to get a copy of the report when it comes out. Watch this space.

Got a question for MAC? email mac@mairitmeaccident.org