Mars Reports 2014
The Nautical Institute has issued Mars Report No.02 for 2014 regarding a maritime accident in which an engineer attempted to open the incinerator door while underway. His thumb was trapped and crushed between the door holder lever and the stopper plate. He was quickly transferred to the ship’s hospital and first aid was administered. The victim was disembarked and at the hospital a fracture of the thumb was diagnosed and orthopaedic surgery was necessary.
There were no reported difficulties in opening the door, and it is not known why the engineer placed his left hand at the indicated location. The engineer had two prior contracts with the same ship so he was familiar with this incinerator unit. However, the day before the incident there had been an unexpected engine room Unmanned Machinery Space (UMS) suspension. Due to this UMS suspension he had to stand watches in the engine room and as a consequence had inadequate rest for the period leading up to the accident.
Direct causes
- Inappropriate handling of the equipment.
- Improper decision-making and lack of judgement.
- Fatigue due to violation of resting hours the previous day without adequate compensatory rest.
Also, it appears the risks involved were not taken into consideration. Since the duties of operating the incinerator were considered ‘routine’, no risk assessment had been done on the task. Therefore, the company also found the following:
Contributing factors
- Inappropriate management of engine staff.
- Inadequate training and familiarisation.
- Lack of a risk assessment on the use and handling of the incinerator.
It should be noted that the first two direct causes are in fact probably due to the third factor – fatigue. Fatigue has been said to be the equivalent of working while under the influence of alcohol, as both judgement and reaction time are impaired. In this case, the unexpected UMS suspension meant more work and less rest for the engineer. When unplanned extra work is incurred, mariners are encouraged to make every attempt to recuperate their needed rest hours to avoid unexpected negative consequences. |
View relevant photos by clicking Mars Report 201402 – Incinerator door deals a crushing blow
Source: The Nautical Institute