USCG El Faro Investigation Report

Real time memoryholing brother get used to it.

@Pikeman can slide in my DM’s for an earful about his comment.

and here I was wondering if I was having another “senior moment” again?

@Pikeman should’ve recognized the name and left well enough alone. Maybe he just hasn’t read and reread all the reports to be as intimate with the tragedy as the rest of us.

Agreed and they are not alone in operating this way. While a company like Maersk may have a fully staffed operations team actively monitoring the fleet and standing ready to assist during emergencies… small operators can’t afford this luxury. Even some of the large companies that do man these centers with operations guys with MBA’s rather than masters and chiefs.

What I would like to see is an emergency monitoring collective among small operators lead by actively sailing masters and chiefs given a one year sabatical. Each company would pay a modest subscription fee for the system. The facilities could be found at a government or academic establishment to start. I would also like to see topic experts man the facility including a weatherman, salvage master, communications expert and a naval architect with shiyard experience (who else?).

The center would serve as a resource any master or chief could utilize that would assist the ship as needed. The center would be aware of the financial and regulatory requirements of the ship and the pressures on the master but would not be looking at the problems from the perspective of cost savings or regulatory punishment.

We, of course, have this system already. As a senior officer and master I frequently encouraged our officers to pick up the phone and called the masters of other ships in the fleet. We’ve called NOAA directly and challenged their forecast. We’ve called VTS the day before arrival to check port conditions. We’ve called the GPS watchstander in Colorado. And we were constantly on the phone with equipment manufacturers to ask questions about a radar setting, dp algorithm or hidden menu in the ecdis.

Once we all crowded around the phone speakerphone as the bosun dialed the local coast guard station to ask a question that came up in a safety meeting about how an FRC could best assist a helicopter during an mob search. And the pilot we talked with was thrilled that we called.

But I do not think that calling other ships or topic experts directly and admitting your ignorance in a specific area of your job is something that most masters do. And I don’t think my own company would have allowed it if we didn’t have an unlimited satellite calling plan paid for by the client (all calls to the center I proposed would have to be toll free to iridium callers and paid for by the collective or donated by sat phone providers).

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That’s my experience as well. A few years ago the office asks the captains to do more information sharing about new ports. I sent some emails to the other ships with a summary of the ports I was calling but only one captain responded. I did continue to exchange with the individual and got some good info.

The younger officers seem to get it a little more.

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This could have been avoided with a FIRM decision to turn south at the sea buoy and head through the Old Bahama Channel. If my memory serves me correct, I think its an extra 150 nm…at least they would’ve arrived alive.

I worked tugs out of NY Harbor for a good number of years and we routinely called the other company boats for weather updates, used the NDBC (a great tool!!!), and utilized the old reliable barometer, the clouds, the approaching swell, to make decisions that pissed the office off.

We left NYC for Boston with a 135,000 bbl barge loaded about 9 years ago in mid-July, 36 hours later in Block Island Sound, the company dick scratcher calls and asks if we got enough food and fuel to make it to Yabacoa, Puerto Rico. I told him we did, and we headed that way. The next day my boss called questioning my route…gotta love these arm-chair quarterbacks in the office. They were vehemently opposed to my route running to Hatteras and down to Old Bahama Channel. I FIRMLY held my guns and refused to go a straight line from Montauk to The Virgin Passage with a loaded barge on the tow wire. By the way, there was a couple of those storms out there in the Atlantic when we were transiting.

It takes 20 years to get 20 years experience.

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Recommendation #18 – Evaluation of Mariner Training Institutions and Coast Guard Merchant
Mariner Credentialing Process. It is recommended that Commandant direct a review of the EL
FARO VDR transcript and this Report of Investigation, specifically focusing on the effectiveness
of the Coast Guard credentialing exams and third party provided training including navigation
simulators, heavy weather avoidance, cargo lashing/securing, stability, damage control, and
bridge resource management. The Coast Guard should use the review to identify potential areas
and competencies needing improvement and expeditiously develop a plan to implement those
findings into the mariner credentialing process

I don’t think you can credential out complacency.

Recommendation # 13 Anonymous Safety Reporting to Shore for Ships at Sea has been discussed, it makes more sense in combination with #15. I’ve had ABS audit the SMS but the CG has never looked at it.

Recommendation #15 – Clarification of Flag State Expectations for SMS Implementation. It is
recommended that Commandant direct the development and implementation of policy to make it
clear that the Coast Guard has a shared responsibility to assess the adequacy of a company’s
SMS. This responsibility includes, but is not limited to, assessing identified risks and
contingency plans (as described in IMO Resolution A.1072(28)), and ensuring that the duties, , authorities, and qualifications of the Designated Person Ashore and other shore side management
who support vessel operations while underway are specifically described.

I found with one company that attempted to pressure me to sail by phoning me every half hour. When I suggested that they fax me the instructions the phone calls stopped. I left their employment on my own terms soon afterwards and was hired by a very well run German company .

That reminds me of times I’ve sent an email to the ops manager asking something, the answer to which I wanted in writing, to get a phone call a minute later. These guys aren’t stupid.

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The CG summed it up, “underestimating the strength of a hurricane and overestimating the ship’s strength.”

There is no need to conjure up pressure from the company to explain. It’s the captain’s job to use a route that minimizes lost time while keeping the risk at a reasonable level. Taking on too much risk is an error as is adding distance/time/cost with no corresponding decrease in risk.

Any experienced mariner who has read the VDR transcript with care should be able to see that the crew was in fact seeking this route, but “underestimating the strength of a hurricane and overestimating the ship’s strength”.

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