The UK MAIB issued an investigation report on the fatal fall of a fisherman, while boarding the fishing boat ‘Constant Friend’, at Kilkeel Harbour, on 23 September 2017. The report concludes that the risk of slip or fall was increased because it was dark, the surfaces were wet. The crewman’s consumption of alcohol had also probably adversely affected his reaction time and perception of risk.
The incident
At approximately 2342, on 23 September 2017 a Filipino crewman, Jory Lacuesta, from the fishing vessel Constant Friend fell into the water at Kilkeel Harbour while attempting to board the boat. He had been ashore during the evening socialising and drinking alcohol and, when his crewmates returned to the boat he remained ashore drinking.
[smlsubform prepend=”GET THE SAFETY4SEA IN YOUR INBOX!” showname=false emailtxt=”” emailholder=”Enter your email address” showsubmit=true submittxt=”Submit” jsthanks=false thankyou=”Thank you for subscribing to our mailing list”]
‘Constant Friend’ was berthed outboard of another fishing vessel and as the crewman attempted to climb over the deck rails he slipped and fell into the harbour. Despite a prompt rescue by his crewmates and the application of cardiopulmonary resuscitation (CPR), he succumbed to the effects of immersion and died in hospital several days later.
Conclusions
- Jory slipped and/or lost his grip when climbing over guardrails or stepping between Silver Harvester and Constant Friend, at night, when the moored vessels were moving significantly. Without any means of fall prevention in place, he passed between the vessels and entered the water.
- An immediate rescue attempt would not have been initiated had Jory’s crewmates not taken the initiative of monitoring his return to the boat.
- Had the risk assessment focused more thoroughly on the need to prevent crew falling in when boarding or leaving the boat, it might have recognised that the existing boarding arrangements were inherently dangerous and, therefore, might have prompted more appropriate controls to be developed. Such controls include the provision of guardrail gates and a formal arrangement for a nominated crewman to monitor and assist individuals boarding the boat.
- Although Jory had used the same method to board Constant Friend on many previous occasions, adverse environmental conditions combined with the level of alcohol in his system are likely to have affected his risk perception, reaction time and co-ordination, which caused him to fall.
- Clarification of any requirement to seek authorisation by Border Force and the procedure to be followed to meet that requirement would enable a more informed determination of the risk control options available to fishing boat owners in terms of granting crew shore leave and ensuring that safe access to and from the boat is maintained.
- The interruption to CPR and the delay in the arrival of the emergency services could have been prevented. However, it is uncertain what effect they had on the eventual outcome of the accident.
Safety lessons
- The crewman’s consumption of alcohol is likely to have adversely affected his ability to judge risk and co-ordinate his movement, which combined with the adverse conditions probably caused him to fall
- Climbing over the guardrails to cross between boats carried inherent risk. A more focused risk assessment might have recognised the risk of falling overboard under differing circumstances and identified more comprehensive risk controls
- Prompt recovery of a casualty from the water, coupled with early medical intervention is vital. Dedicated man overboard rescue equipment coupled with a contact card for emergency services and training in first aid including CPR is crucial in saving lives
Recommendations
After investigation, UK MAIB made recommendations to MCA to revise its guidance on the safe means of access to fishing vessels, and to clarify the requirement, or otherwise, to seek Border Force authorisation before allowing non-European Economic Area fishing crew to proceed ashore for local leave.
Recommendations have also been made to Constant Friend’s owner to take account of the increased risk of a crew member falling as a result of adverse environmental conditions when returning to the boat from shore leave, and to develop a contact card and procedure for crew use in dealing with emergency situations in port.
Further details may be found by reading the full report: