Detecting potential safety issues

Detecting potential safety issues

3,236 Ro-Ro accidents reported to the Maritime Safety Agency (EMSA) between 2011 and 2018:

  • 20% of them are fire related
  • 15% are collisions
  • 14% regarding damage to ship 

Based on this research, EMSA has developed a methodology to analyse data reported in the European Marine Casualty Information Platform (EMCIP) with the view to detect potential safety issues. 

Eleven safety issues were identified for casualties and the safety issues for accidents with ro-ro ships including work operation methods, safety assessments, tools and hardware, procedures, maintenance, training and skills. 

Amongst others, the analysis identified that fire is the most investigated safety area contributing to several safety issues, particularly “Tools and hardware” and “Work / operation methods”.

Handling and securing of vehicles is a critical activity that affected several safety issues within the analysis. Vehicles not parked at a safe distance amongst them in the garage deck contributed to worsening the consequences of fires whereas inappropriate lashing caused cargo damage.

Installation/design of equipment that impaired the proper functioning and performance of critical devices like smoke and fire detectors.

Emergency response, including actions taken by the crew for quickly identifying an emergency situation and the source of the emergency, especially in events involving fires.

Lack of technical standards on critical ship equipment was reported regarding to fire detection and fire extinguishing systems like CCTV systems that are not required to be a part of fire detection systems although these might be effective to detect the start of a fire quickly.

Personal safety is not always the top priority for crew members, resulting in occupational accidents. In particular, the risks associated with the place and position held by crew members during ship operations, especially during vehicle/cargo operations, were not properly assessed.

About 50% of the Safety Recommendations issued following an investigation aimed at reinforcing safety barriers in areas like fire detection and fire-fighting systems, nautical conduct, cargo loading/unloading procedures and equipment for garage deck .

Why roro

Ro-ro ships are one of the most common types operating today. The specific constructive requirements of ro-ro ships (e.g. lack of internal bulkheads in cargo spaces, cargo access doors, cargo stowage) make this type of ship unique and different from other types.

These characteristics include an undivided vehicle deck (giving rise to stability and fire vulnerabilities), the very intense activity (with tight schedules), the risks of cargo shift, water-tightness issues with external ramps and concerns on hoistable ramps.

Even the cargo itself, on ro-ro vessels, is a more complex entity than in other types of vessels… It is common that some of the cargo transported requires continuous refrigeration. This means that some of the trailers need to be connected to the electrical network of the ship while sailing. Finally, the proliferation of the use of vehicles powered through electrical batteries is also a factor to be considered.

The 11 categories of Safety Issue (SI) identified for the present analysis, were based on the description of Contibuting Factors (CF)including emergencies on board (handling & equipment) which is defined as the processes or actions made during an emergency. An example would be the appropriateness of the action carried out to suppress a fire in the engine room including the poor design or placement of the control panel of the fixed fire extinguishing system. 

Analysis

The analysis looked into the selected SI and the information reported in some attributes (e. CF description, CF coding and Accident Event (AE) Description) supported the consolidation of Areas of Concern. Moreover, the study also considered the Safety Recommendations (and Action Taken) issued to reinforce the safety barriers.

Prioritisation of safety in daily operations is an area of concern that may include a variety of contributing factors for accidents related with numerous operations carried out on board, apart from the ones mentioned above. Examples
come from the daily operations that might be carried out on ro-ro vessels, including the cleaning of bilges which could have prevented fire or the unauthorised access to the CO2 room by a crew member that accidentally activated the main engine shut down system. 

Also, another example concerns a vessel under maintenance and repairs on which, while hot works were carried out, the sprinkler system could only be activated from the bridge and because the bridge was not manned, an uncontrolled fire broke out.

Safety assessment – review

Unlike other highly “proceduralised” industries, such as nuclear energy production, in the maritime industry decision-making of key persons within the different types of operations appears as an important factor and it has a great impact on the results of the relevant actions taken. Thus, if not preceded by at least a basic safety assessment it may lead to unexpected and unwanted events.

The SI relating to the design or operation of the vessel or its components, other than the emergency tools, highlighted safety standards for design: Missing insulation; the absence of a device to protect a thermal oil circuit from overheating; the proximity of a fluorescent light to a fire extinguishing system’s nozzle resulting in a malfunction; the crew responsible for safety not trained on characteristics of insulation (heat resistance) that existed under some welding points, which resulted in a fire breaking out.

In certain situations lack of maintenance has led to the failure of equipment or appliances contributing to accidents on ro-ro vessels. In most cases maintenance is a scheduled process, usually the manufacturer provides instructions on the maintenance periods; however this is not always the case. Relevant examples have to do with the non-existence of schedule for maintenance contributing to fires in all instances. 

Also maintenance carried out, but not effectively or not with sufficient quality standards. Lack of grease – in an otherwise maintained shaft block – of the main engine of a vessel caused a fire, while a missing antivibration clip of a fuel supply pipe to the cylinder of the main engine of another vessel aide a fire as well. A crack on a high pressure fuel pipe was not noticed during maintenance works, contributing to a fire during the vessel’s operation. 

Installation/design of equipment: this area includes mainly CF concerning issues in the placement, functioning or performance of smoke and fire detectors in emergency situation. In some cases, performance of smoke and fire detectors was considered impaired by the strong winds coming from the side opening of the garage. A CCTV monitor installed on the bridge did not contributed to the early detection of smoke due to its black/white display.

Lack of fire detectors or properly placed above the ceiling of accommodations spaces or in other critical areas of the garage thus preventing a rapid identification of the fire.

The fact that smoke detectors were not provided with heat or flame detectors (although not mandatory) contributed to delay the activation of the fire alarm.

Other examples include the lack of adequate fire protection to wires of emergency generator that contributed to its failure following a fire.

Emergency response: actions taken by crews for identifying an emergency situation or dealing with the danger of the emergency are the subject of this area of concern. Identifying the emergency or the source of the emergency is quite crucial to set up any following actions; situations where the crew did not check on spot smoke indications that were initially appointed to a vehicle exhaust smoke, which resulted in a fire. 

Communications and warning: this area concerns operability and design of tools supporting effective communication between key people involved in emergency. In this regard, insufficient range of portable VHF radio was reported as a factor impairing coordination between officers on the bridge and crew members acting as firefighters. 

Legislation and compliance

Ro-ro are a peculiar type of ship that must comply to several international conventions and EU legal instruments. Moreover, a wide set of technical standards and recommendations are developed by Classification Society to support the ro-ro industry. It is remarkable to note that the majority (12) are related to the SA “Fire / Explosion” specifically:

Technical standards (ship): this area includes lack of standards on critical ship equipment mainly related to fire detection and fire extinguishing. Examples include CCTV systems that are not required to be a part of fire detection systems as well as lack of standards for effective positioning of CCTV cameras.

CF concerning drenchers were also reported, in particular lack of requirements aimed at specifying the maximum capacity of drencher systems to avoid decreasing the water density and to withstand clogging and corrosion normally encountered.

Lack of specific regulatory requirement or guideline for nozzle arrangement to the funnel of the engine room contributed to the ineffective release of CO2 fixed fire system, thus preventing extinguishing the fire.

Inappropriate regulations concerning the proximity between the truck’s refrigeration unit and the cargo space ceiling and vessel systems and hydraulic oil pipelines suspended under that ceiling were quoted as a factor contributing to propagation of the fire to the ceiling of the vessel’s vehicle space.

Adequacy of technical requirements for the pumping system was also considered not adequate for the confrontation of a massive flooding involving a ship.

Safety recommendations 

Safety recommendations resulting from an investigation provide the relevant addressees with the remedial actions aimed at preventing marine casualties and incidents.

SR can be issued by an AIB as necessary following an investigation and should be based on the analysis of evidence collected within the investigation process and the identification of causal factors. Safety recommendations can also be issued as a result of abstract data analysis.

Through SR, AIB should clearly identify what needs to be done, who or what organisation or entity is to implement the change, and where possible, the urgency for completion and amongst others focuses on fire detection and firefighting systems. Several SR have been issued with a view to improve effectiveness of such devices. Companies were asked to examine a more capillary CCTV system for full coverage of closed garage spaces. Other SR provided an assessment of performance on drencher systems and fire sensors’ network. Companies as well as classification societies were recommended to review the suitability of dry powder as a fixed firefighting medium for use in thermal oil heater units.

The development of specific provisions concerning the installation of fire detection and firefighting systems on vessels involved in domestic voyages and effective inspection on fire extinguisher and detection systems.

Implementation of additional rules on loading, securing and carrying of trucks/vehicles on board ships including fireproof covers of trucks transported by ships and requirements for fireproof boxes protecting joint points connecting extension cables to reefer units.

53% of the safety recommendations were addressed to the Ships’ Companies while around 20% to the Maritime Administrations. About 50% of the SR issued following an investigation aimed at reinforcing safety barriers in areas like fire detection and fire-fighting systems, nautical conduct, cargo loading/unloading procedures and equipment for garage deck.

The EMSA report and analysis can be found here: bit.ly/2fxai3g



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