Fire can be traced back to a problematic design of the lubricating oil filter
Danish Maritime Accident Investigation Board (DMAIB) issued a marine accident report about the fire on FRIGGA on 5 May 2014.
On 5 May 2014, a fire broke out on the Danish tug FRIGGA due to a leaking lubricating oil filter in the engine room. Prior to the accident, the chief engineer had observed a minor leakage of the filter and wanted to fasten the bolts on its top flange. In order to gain access to the flange, he needed to remove a shield from the flange. While doing so, he unintentionally removed an air bleeding screw on the pressurized filter. This caused an oil jet to gush from the lubricating oil filter. Oil was sprayed on hot parts of the main engine, ignited and subsequently caused a deflagration.
In the marine accident report on the fire on board FRIGGA, the DMAIB focuses on two main subjects in the analysis of the accident:
- Design of and interaction with the lubricating oil filter.
- Influence of stress response mechanisms on the crew members’ emergency management performance.
The DMAIB concludes that the origin of the fire can be traced back to a problematic design of the lubricating oil filter. Also, it is concluded that the equipment and procedures that were to facilitate the on-board emergency management were not designed and arranged with consideration of the cognitive and motoric changes of human stress response, but added to the stress load during the emergency situation instead.
| Conclusions |
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The engine room fire on board FRIGGA was possible due to a problematic design of the lubricating oil filter. Because the machinery needed maintenance only rarely and due to a lack of space, the handle used to close off the oil flow was not fitted and the person interacting with the filter was not necessarily familiar with this specific design. As the placement of the air bleeding screw was not intuitive and its function neither clearly communicated nor protected by physical barriers, there was no functional warning or obstruction as the chief engineer unscrewed the air bleeding screw while the filter was pressurized. The fire on board FRIGGA did not cause great damage to the ship, and no crewmember was injured during the fire. Nonetheless, the fire was experienced as very serious on board due to the extent of the flames in comparison to the size of the ship. This meant that the crewmembers were at close range of the fire at all times, especially the persons on the bridge. The crewmembers were affected by the presence of the fire and experienced a stress response which, in various ways, influenced the crewmembers’ motoric and cognitive functions, and subsequently their decision making in the emergency situation. The fire on board FRIGGA illustrates how the design of on-board emergency equipment and procedures does not appraise the fact that the equipment is most likely to be operated by, or to facilitate the decision making of, persons who are experiencing cognitive and motoric impairments due to a stress response. Furthermore, alarms proved to be a substantial stress factor which might have impaired the crewmembers’ performance when handling the complex tasks of emergency management, e.g. communicating internally and ashore. The DMAIB has identified the problem of alarms being stressful to crewmembers in several previous marine accident reports, such as the report on the flooding of the engine room on EMMA MAERSK4 and the report on the fire on board BRITANNIA SEAWAYS. The position of FRIGGA near the harbour during the accident, the swift response and assistance from ships nearby as well as the immediate response from the fire brigade contributed to the positive outcome of the accident. |
Further information may be found by reading DMAIB Marine Accident Report by clicking on the image below:
Source:DMAIB / Image Credit:Svitzer A/S
