MAIB Releases Report of Investigation of June 2008 Fatality on Board Passenger Ship

UK Marine Accident Investigation Branch Report on the investigation of the fatality on board
passenger cruise ship Saga Rose in Southampton, England on 11 June 2008 now available.

SYNOPSIS OF REPORT

On 11 June 2008, a motorman found an experienced petty officer lying at the bottom of a ballast tank on board the passenger cruise ship Saga Rose while the ship was visiting Southampton, UK.

The petty officer was the vessel’s second bosun who had been sent to the tank to determine whether it contained fresh or salt water. The motorman raised the alarm and then returned to the scene and entered the tank to help the petty officer, who was a close friend. The motorman then also collapsed.

The onboard emergency response team quickly arrived with breathing apparatus, and the local emergency services were called to assist. The motorman was successfully revived and evacuated from the tank, but the second bosun died before he could be recovered.

The second bosun was instructed to test the water in the tank on the assumption that the tank was full and the water was within easy reach from outside the tank. As a result, a permit to work was not deemed to be necessary. However, the tank contained only a small amount of water and the second bosun entered it despite being aware of, and practised in, the vessel’s procedures for entering enclosed spaces. The atmosphere inside the tank contained insufficient oxygen to sustain human life due to the corrosion of the tank’s steel structure.

This is the sixth fatality in an enclosed space that the MAIB has investigated since September 2007. In view of these, and many other fatalities occurring in similar circumstances worldwide, the MAIB issued a Safety Bulletin in July 2008. The bulletin made recommendations to the Maritime and Coastguard Agency (MCA), ship owners, managers and other industry bodies and organisations aimed at improving the identification of potentially dangerous spaces, and the identification of measures to reduce this unnecessary loss of life. No further recommendations have been made in this report.