this statement from Kennebeck Captain got me thinking that this is a big question to ask in the wake of the loss of the EL FARO in 2015. he states Davidson took on “excess” risk but what constitutes that? What level of risk at sea is an acceptable level and what is going too far? Is it somehow the balance of the potential loss vs. the potential gain? Certainly, to risk one’s own survival and that of your fellows is a massive risk to take which only could be justified in extremis times such as during war or if overtaken by violent weather. Maybe there is risk to loosing the ship in these cases but there already is that potential in play but in circumstances which are not in extremis, such as approaching a strong storm?
I guess it is critical that one must have awareness that there is risk and to be aware of the potential consequences of the decision made. I took a vessel out past Cape Spencer with storm warnings posted when there as no valid reason for me to. I failed to consider the consequences of that action both in comfort of those aboard but more importantly that the extreme motions in that massive sea might precipitate a failure or that there just might be a failure of a critical component of the ship even without the seas but being in such seas losing that system (such as say the steering gear) might be fatal although when in calm waters it would not be. I failed to perceive the risk I was taking. I believed the ship to be tight and able to take the seas but didn’t see the risk that if we went beam on then there might be downflooding resulting. again, nothing happened, there was no damage and other than one person who was so violently seasick had to be taken off in Seward no personnel loses.
so we come back to the EL FARO…was Davidson even aware of ANY risk he was taking? In the case of the EL FARO it was flooding, the ship could survive downflooding in calm weather but could not in a storm however there is nothing to indicate the master considered this or was even aware of the condition? if he was aware, he appears to have perceived the risk to be far less than it actually was but even if he perceived a small risk in pressing on, was even that justifiable? I cannot see it at all!
should ship masters be given training in evaluating risk and is there some way a person’s judgement be quantified so it can be measured his ability to safely command? how can this be evaluated other that through one’s past record of decisions? who would be the evaluator? the employer? should crewmembers be given the opportunity to provide their assessment of the master’s overall judgement? official logbooks allow for evaluation of crewmembers by a master but is there one single person at the CG MSC who looks at what is submitted in an official log? is there anyone at all in the USCG qualified to assess a master’s competency to command?
I say yes in part because as engineers we are along for the ride and subject to the whims of what you guys do in the wheelhouse and after this incident I would like to be able to sleep a little better at night. Was on a trip last year where the master kowtowed to scientists and sailed us into absolute shit weather (against Navy recommendations- that’s who we get our weather routing from) just so they could keep doing their thing “a few more days” and this happens more often than I care to admit. Nobody should have to risk life and limb to move containers or observe whales or whatever their primary function is.
In most cases mariners just follow traditional practice. For example requirements such as the 2 mile CPA at sea. In other cases there are regulatory requirements, such as the requirement for drills or safety equipment. No need to evaluate as this problem has already been solved.
This two-day interactive course is aimed at office and shipboard personnel who have responsibility for safety. Delegates will be shown how to carry out operational risk assessments and incident investigations.
The risk assessment methodology used is based on the UK Maritime and Coastguard Agency (MCA) Code of Safe Working Practices for Merchant Seamen.
Incident investigation is based on methodology used by the UK MCA and the United States Coast Guard (USCG).
If Davidson had done a serious risk assessment or analysis before blundering into the path of a hurricane he probably would have come to other conclusions then he did. Risk alertness is an occupational requirement for any manager and a ship’s captain, but in fact also for everybody in daily live. Driving a car in today’s traffic surely requires continuous risk analysis and alertness so why not in shipping? It would be benificial if risk management would be a normal part of the nautical education.
2.1 takes into account any relevant ships’ routeing systems
2.2 ensures sufficient sea room for the safe passage of the ship throughout the voyage
2.3 anticipates all known navigational hazards and adverse weather conditions; and
2.4 takes into account the marine environmental protection measures that apply, and avoids, as far as possible, actions and activities which could cause damage to the environment
In my experience the goal of marine transportation is to deliver cargo on time with no loss or damage. Delivering cargo late is preferred to no delivery or delivery of damaged goods.
On larger ships cargo will be damaged and boxes lost in weather far less severe then what could cause the loss of the vessel.
There should be information available to the master with regards to what the limits are with regards to ship motion or boarding seas. Either in the form of past experience or word or mouth if there is not specific guidance.
When I first got a job a master the owners rep told me if there was an unacceptable level of schedule delays, cargo damage or crew injuries / incidents I’d not be sailing captain long.
yet Davidson seems to have had no concern for this in the slightest. He took a risk but for what reward? Still hoping to remain master when the vessel went to Alaska? Maybe a backup master or chief mate on one of the new ships? Obviously we can see that he didn’t believe the risk was as great as it really was but did he believe there was NO risk in not slowing down a few knots. Was he so certain that they would not be in ANY danger? if this is the case then what a massive judgement error. No perceived risk when there was plenty?
I certainly would like to know the professional backgrounds of the masters they did select for the replacement vessels…if I recall TOTE hired them from outside their pool?
As far as risk management. Some companies I worked for required a two two day class in that subject as well as the five day heavy weather avoidance class. All the captains that I know professionally use sea height and wind speed limits.
My understanding from the MBI hearings was TOTE did not require any classes and the one master had never heard of wind speed limits.
but us professionals want to solve this to the best of our ability for no other end than to be a learning opportunity for future generations. From all big losses must come something of benefit for those who did not pay so they hopefully will not end up paying themselves
Aside from the technical errors there was also a huge problem with resource management. If there is that big of a gap in understanding of the situation between the junior and senior mates something is wrong. Especially in situations with high consequences.
There is a requirement for leadership and management classes but lots of mariners leave the class thinking it’s all about singing kumbaya around the campfire. It’s more about not sailing into the eyewall of a hurricane when the crew knows better. The crew would have been better off without Davidson.
I certainly agree but how is a crew brought into the assumption of risk since they are in fact stakeholders? how do we make those with differing opinions into the decision making process when the sea traditionally has been the epitome of top down management? I would certainly say that a master who is a true professional can listen to the opinions of subordinates if those opinions are voiced behind a door but when juniors start to openly question the decisions of the master and even go so far as to take actions contrary to the master’s directives leads to very weak management and a every man for themselves breakdown. A crew is a team and a team functions as a collective following a coach (or manager in the case of baseball)…simply put, winning teams have quality coaches.
so if you have a master who is not open to listen (like Davidson appears to have been) how does a crew save it’s own skin without outright refusal to follow orders? the anonymous call in line? how would that have worked in this case if it was available to the mates?
I have the feeling that sometimes the crew will simply have to “shut up and die like an aviator”. After, of course, having practiced their non-mitigated speech. But the master is the master is the master. I don’t think calling the shore is going to be the answer any more than it is on an aircraft.
And speaking from my wormlike position as a WAFI, I simply can’t conceive of a master refusing to come to the bridge when called. That flies in the face of his duty to his crew as well as to himself and his owners.
I show the mates how to plot the SAT-C wx messages on the chart. I tell them what the acceptable parameters are, for example stay outside the 35 kts wind field, or some mariners say a little as 60 miles from the center some say 100 miles.
Either way once that’s laid out the go, no-go decision has already been made by me in advance, then it’s just a matter of seeing how things unfold. But both the mates and I are going to do the plotting, once the acceptable parameters are violated, pull the plug.
and with that we have the entire EL FARO tragedy boiled down to its very essence. the failure to personally perceive the level of risk being taken, the failure to listen to the opinions of others, the failure to consider that one’s original plan might be flawed by erroneous information, the failure to look at new information to make changes to a plan as required. the dreadful failure to ensure the safety of the ship and all in her even at the expense of being proven wrong.
I’ve read a few of these and it’s always… "the capt. is compelled to make fast passage without damage as economically as possible … and of course: at risk to his job… after all. the threat of a accident is only a threat.
Some captains get confused. It’s not the captain’s job to “make decisions”. It’s broader than that. Instead the captain decides how decisions are going to be made.
This is the issue. If the captain is the “decider” what happens when he goes to bed? The routing decision needs to be made based on the latest wx updates and the forecast. There’s no reason this can’t all be laid out for the bridge watch.
If the captain makes it clear what he expects by actually laying it out on the chart, then when the unexpected happens the bridge can call with a clear message that the plan is not unfolding as expected.
Only when watchstanders know with precision what to expect can they recognise that something has gone wrong.
Here the exchange between the C/M and Captain just before the C/M is relieved by the 3/m about night orders.
CM
uhh can you uhh
–
do you wanna write any orders (down/or whatever)?
CAPT
(verbal) and then refer to that.
CM
okay.
CM
alright.
CAPT
just follow the rhumb line.
CM
got it.
CAPT
follow the rhumb line courses and steer to make good rhumb line
courses. (steer the) * * (route for) (weather/rudder).
CM
excellent.
CAPT
less is more.
CAPT
next thing you know you’re writin’ two or three pages on that and your
interpretation(s) a little bit different.
CM
yeah but you already did it. you wrote that * * see what we got with the
weather so.
Even if the captain planned to stay on the bridge during the night he still can lay out the plan so it can be evaluated by the mates. How does that undermine the captain’s authority?
This is the issue. If the captain is the “decider” what happens when he goes to bed?
On Dutch ships the usual practice was that the captain left his “Bridge orders” note on the chart table. I remember one captain who wrote in his orders amongst other things that if the radar had to be switched on he had to be awakened. Needless to say that there was some hesitation to switch on the radar too soon… Usually officers were required to sign for acknowledgement of the orders.
Bridge orders were general orders also valid during the day time. There were no special night time orders, perhaps only an additional entry for the night watch depending on the circumstances.
Are written standing orders and night orders a thing of the past? I don’t recall them being mentioned in the El Faro investigation. They normally would include that the captain must be called in the case of deviations to avoid potentially dangerous weather. Then again the master’s behavior leading to the tragedy was not normal.
Yes, the question “If the captain is the “decider” what happens when he goes to bed?” is easy to answer when pulled out of context of the rest of the post.
The captain said he didn’t leave night orders because it would take two or three pages and it would be misinterpreted.
In my view a better approach would be to do the avoidance plotting on the chart in the wheelhouse where it can be seen by the mates.
Then, for example a “red line” could be drawn on the chart. If the next forecast position plotted on the wrong side of the line then the avoidance plan needs to changed in order to maintain the set safety margin.
