Fatal Injuries To Crew Member in the Steering Gear Room

Transport Malta has revealed an investigation report relating to an incident that came about on 18 July 2022, while Sunny Isles was en route from Al Jubail, Saudi Arabia, to Durban, South Africa, in a loaded situation, the second engineer was organizing and inspecting chain blocks within the engine-room, together with two different crew members.

The incident

Whereas on the lookout for further materials required for the duty, the opposite crew members discovered the second engineer trapped and unresponsive between a collapsed stack of spare metal plates and a guard rail, within the steering gear room. The second engineer suffered critical accidents and was evacuated to a shore hospital, by helicopter. Nonetheless, he was pronounced useless on arrival. The security investigation thought-about it doubtless that the stack of metal plates collapsed onto the second engineer, after a turnbuckle securing pin and its cut up pin slipped out, whereas he was both eradicating or inspecting a series block within the plates’ securing preparations. In view of the protection actions taken by the Firm, no suggestions have been issued by the MSIU.

Evaluation

Goal

The aim of a marine security investigation is to find out the circumstances and security components of the accident as a foundation for making suggestions, and to forestall additional marine casualties or incidents from occurring sooner or later.

Reason for deadly accidents

Within the absence of medical and post-mortem stories, the protection investigation believes that the second engineer suffered deadly accidents, shortly after the stack of spare metal plates tipped over and fell onto him.

Possible explanation for the tipping over of the metal plates

The info accessible to the protection investigation recommended that the securing association for the stack of metal plates had been launched. Since there have been no witnesses to this incidence, the protection investigation was unable to find out whether or not this was accomplished deliberately and subsequently, 4 hypothetical eventualities had been thought-about wherein the second engineer could have:

deliberately launched the turnbuckle securing pin and slackened the chain block;
deliberately launched the turnbuckle securing pin to entry the chain block, following which, the chain block hook could have slipped;
deliberately slackened the chain block, throughout which, the cut up pin adopted by the turnbuckle securing pin could have by chance fallen out; or
by chance launched the chain block hook and the cut up pin, which resulted within the launch of the turnbuckle securing pin.

It should be acknowledged that the stack of metal plates was secured by wire slings and a turnbuckle, with the chain block meant to behave as a further technique of securing. Taking into account the duty that the second engineer was finishing up, the protection investigation thought-about it doubtless that his intentions had been to launch the chain block for inspection. Contemplating that the wire slings and turnbuckle had been in place, he could have believed that the discharge of the chain block wouldn’t pose any hazard.

It’s also potential that the second engineer could have considered the usage of the chain block within the securing association as redundant and subsequently, he supposed to take away it altogether and retailer it on the newly put in hangers within the engine-room retailer. Because the turnbuckle and chain block had been securing the stack of spare metal plates, the protection investigation thought-about it extremely unlikely that the second engineer would have deliberately launched each preparations (i.e., state of affairs ‘a’). Fairly, it’s extra doubtless that he could have deliberately launched solely one among them.

Within the case of state of affairs ‘b’, the intentional launch of the turnbuckle could have been carried out to realize entry to the chain block for a visible or bodily inspection. This could have been a extremely doubtless state of affairs, if the chain block, or any a part of it was tightly wedged between the turnbuckle and the metal plates. For an unknown purpose, the hook(s) of the chain block could have slipped out throughout this inspection as soon as the turnbuckle was launched.

If any a part of the chain block was not wedged between the turnbuckle and the metal plates, and the chain block was simply accessible, it’s doubtless that the second engineer could have deliberately launched the chain block to examine and / or switch it to the shop, throughout which the cut up pin and the turnbuckle pin slipped out (state of affairs ‘c’). It couldn’t be excluded that the second engineer could have tried to examine the chain block with out releasing it, and that the discharge of its hook could have been unintentional. If this was the case, it’s potential that the cut up pin and turnbuckle securing pin could have slipped out whereas he was inspecting the chain block (state of affairs ‘d’).

For eventualities ‘c’ and ‘d’, it is usually doubtless that the cut up pin could have slipped out a lot earlier earlier than the incidence and will have gone unnoticed.

Conclusions

The second engineer was discovered trapped between a stack of spare metal plates and guard rails within the steering gear room, with deadly accidents.
The crew members discovered that the securing association’s turnbuckle securing pin and its cut up pin weren’t in place.
The turnbuckle securing pin and its cut up pin could have both been eliminated or slipped out at one level, ensuing within the collapse of the stack of spare steelplates.
It’s doubtless that the second engineer was both inspecting or eradicating the chain block, which was meant to function a further technique of securing the stack of spare teel plates, when the stack collapsed onto him.
No damages had been noticed to any of the gear within the securing association.
No formal threat evaluation was carried out and recorded.
It’s extremely doubtless {that a} dynamic threat evaluation by the second engineer wouldn’t have enabled him to establish all related hazards, thus decreasing the effectiveness of his threat evaluation.

Security actions taken through the course of the protection investigation

Following the accident, the Firm took the next security actions:

Firm’s representatives attended the vessel, and carried out numerous coaching classes and security briefings with the crew members;
a security bulletin with particulars of the accident, was circulated throughout the Firm’s fleet; new storage racks had been fabricated for the spare metal plates, pipes, and different heavy materials on board Sunny Isles, adopted by all different vessels within the Firm’s fleet;
the standing of the storage / racking and protected dealing with of heavy materials on board all vessels within the Firm’s fleet, was reviewed / verified by superintendents within the fourth quarter of 2022;
pointless heavy materials, was landed ashore at handy ports, from all vessels within the Firm’s fleet;6. the Firm added numerous computerbased coaching programmes to their competency administration system, for shipboard and shore employees;
the Firm’s security administration system was revised, and a brand new management of labor course of (emphasizing toolbox talks, threat assessments, use of permits and checklists, reporting procedures, and so forth.) was launched as a part of the allow to work system; and
threat assessments had been ready and / or revised for the preparation of storage racks and for the protected dealing with of heavy materials on board all vessels within the fleet.