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SAME LETTER TO:
International Maritime Organization IMOAtt.: Secretary-GeneralE-Mail: [email protected]
European Maritime Safety Agency EMSAE-mail: [email protected]
Regional Port State Control MOU organizations:[email protected]; [email protected]; [email protected]; [email protected]; [email protected] ; [email protected] ; [email protected]; [email protected]; [email protected]; [email protected]; [email protected];
Oslo, 4. august 2016
CRUISE SHIPS SAFETY STATUS: NEED FOR MORE EFFECTIVE CONTROL OF THE VARIOUS FLAGSTATE’S COMPLIANCE WITH THE IMO REGULATIONS
The Skagerrak Safety Foundation is concerned about how to enhance the safety of navigation and rescue operations under emergency conditions for cruise and passenger ships, and recommends IMO to develop a public “white list” of the cruise ships ’s compliance with new and amended IMO regulations, for possible self-assessment by the passengers or by passenger’s travel agencies.
In the wake of the Costa Concordia disaster it has come to our knowledge that there have been several examples of non-compliancy with the IMO’s various regulations as the ISM Code, the STCW conventions and the SAR Search and Rescue Convention for quite many of the international cruise ships (see the following appendix for reference). This should be dealt with by the IMO and EMSA regimes, the Port State Control, and the relevant flagstates.
We address this attention to relevant international maritime bodies, including the maritime administrations in Italy, Sweden, Denmark and Norway, rather than addressing the specific ships, companies and flag states.
Our concern in this matter is to take particular care of the interest of cruise ship passengers, how to ensure their safety onboard, including a fair treatment of loss compensation to the victims when fatal accidents happens. Our concern is of course also the crew, material values and the environment. We have recognized that the cruise ship companies in their marketing is very happy to demonstrate the safety aspects of their cruise ships by referring to compliance with the various IMO regulations.
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When cruise ship accidents happen, the investigations often reveal a lot of deviations from the IMO’s rules and regulations. Such practice demonstrates a misleading of the passengers in their own evaluation of the safety aspect of sea cruising, and is supporting an unfair competition between the less and more prudent cruise companies, and also between the relevant Flag Administrations.
We also see a great variation between the new and elder cruise ships with respect to the compliance with the new or amended safety regulations, issued by the principle of “the grandfather clause”, which is granting an exemption to existing ships to comply with the new regulations.
We understand that it is not the IMO policy that such exemptions shall be everlasting for regulations concerning safety aspects. Quite the contrary, as IMO recommends that the flag states should follow up the state of the grandfather clauses quite frequently to avoid undue gaps in standards between new and existing ships, recommending a re-evaluation up to five year periods in general.
“The Interim guidelines for the systematic application of the grandfather clauses, hereafter “the guidelines”, provide a strategy for avoiding undue gaps in standards between new and existing ships. The strategy aims to ensure that when such gaps could increase through the adoption of more stringent constructional requirements for new ships, the standards of existing ships would be likewise improved to an acceptable extent, although the measures to be taken may differ in nature from those agreed for new ships. Ideally, this would in the long run result in equivalent standards for new and existing ships.”
MSC/Circ 765Annex: Interim guidelines for the systematic application of the grandfather clauses, page 1
In order to ensure the safety aspect of the cruise and passenger ships, The Skagerrak Safety Foundation is therefore requesting IMO to develop a more easy available verification (mandatory “white list”) of the relevant cruise ships ’s compliance and ratifications of the various IMO rules and regulations, thereby giving the cruise ships passengers and their travel agencies a fair picture of the state of safety of the relevant cruise- and passenger ships.
We will below illustrate some typical examples from cruise ships, which are indicating various breach or need for clarification of the various IMO rules and regulations concerning passenger safety:
1. NAVIGATION
The Costa Concordia disaster reveals a need for clarification of the state of compliance with IMO requirements for training and bridge procedures for ECDIS navigational system used as the primary system for navigation and as a navigational aid only, for cruise ships.
Based upon the very limited information about the bridge procedures which is available from the Italian MAIB Accident Investigation Reports, The Skagerrak Safety Foundation has made an analysis of the situation on the bridge prior to the first collision with the reef of Giglio Island.
The conclusion of this analysis is that the situation on the bridge of Costa Concordia with 4229 persons onboard, prior to the reef collision the 12th of January, 2012, at a speed of 16 knots with a distance of four ship-lengths from the shore, was in fact as follows:
In about a three minutes period prior to the collision with the reef, due to the language barriers between the helmsman and the bridge navigational team, the vessel was in reality under the sole control of a not competent helmsman
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As the Costa Concordia navigational equipment and bridge procedures (to man the helmsman’s console in critical navigational situations), is a rather common navigational practice for cruise ships operating with ECDIS, the Skagerrak Safety Foundation fears that this risk of creating an unsafe situation, is not restricted to the Costa Concordia case, but may also be relevant for a great number of cruise ships in service today.
This critical situation also stresses that the ECDIS requirement for training and certification should not be restricted to the bridge team navigators, but should also include the selected helmsmen, as they are important members of the bridge team. For cruise ships, with very few duties of practical operation as helmsman, special training facilities should be arranged.
2. IMO SAR, RESCUE OPERATIONS: COMMAND AUTHORITY OF THE RESCUE OPERATIONS:
In the Costa Concordia case, the national coast guard rescue coordinator (MRCC) discharged the captain of the ship and, took over the command of the ship in the midst of a rescue operation.
The Costa Concordia accident reveals a need for clarification of the IMO SAR requirements for national coast guard’s assistance to ships in an emergency situation, with respect to the requirements for command of the rescue operation, when the rescue operation of the ship in emergency is under command by the ship’s captain.
3. CRIMINALIZATION OF SEAFARERS:
During the rescue operation of Costa Concordia, the national coast guard rescue coordinator (MRCC) discharged the captain of the ship, took over the command of the ship and rescue operation, and performed a personal defamation of the captain by a public statement, which was immediately released to the press media.
The MECC’s authority is not clarified in the SAR operating procedures (Chapter 4). More specific, it is not clear whether the national coast guard captain (MRCS) do have the authority to perform a character assassination of the ship’s captain and release this to the press media.
The Skagerrak Foundation claims that the immediate blame of guilt and character assassination of Costa Concordia’s captain, as presented by the Italian Coast Guard’s captain De Falco during the rescue operation, is a breach of both IMO regulations and EU Directives for fair treatment of seafarers, as this will be totally devastating for a fair treatment of the captain in any possible court proceedings.
The Skagerrak Safety Foundation fears that without any public withdrawal or factual correction of the Italian Coast Guard’s public defamation of the captain of Costa Concordia, the captain will consequently be deprived his right of fair treatment in any Italian courtroom. This is a breach of the EU Directive 2009/18/EC, which states:
“Member states should, in accordance with their national legislation, take into account the relevant provisions of the IMO guidelines on fair treatment of seafarers in the event of maritime accidents.
EU Directive 2009/18/EC, Preamble, item 9
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4. INSUFFICIANT STABILITY COMPUTERS (DECISION SYSTEMS) FOR SHIP ABANDONMENT:
The Costa Concordia disaster reveals a serious weakness or even defects in the installation and use of an integrated Decision Support System in a flooding emergency for cruise ships, which should instigate an amendment in the IMO’s regulations for stability measurement.
In general, it is commonly known from the literature about passenger ships stability, that fulfilling of the existing regulatory requirements alone does not offer the master of the ship a solid ground for decision making of ships abandonment in a distress situation. This is because some key factors, such as utilization of real time flooding level sensor and door status data (see below item 5), are currently not a requirement.
This key factors as the fitting of time flooding sensors and door status data should be made mandatory for all cruise ships, both newbuildings and existing ships.
4. REQUIREMENTS FOR OPERATION OF CRUISE SHIPS WATERTIGHTS DOORS
From the report of The Italian Maritime Investigative Body of Marine Accidents investigation of Costa Concordia accident, it appears that the collision between the port side of the hull and the eastern reef of “Le Scole” punctured the ship in three contiguous compartments (compartments 5, 6 and 7)
Furthermore, after some 10-15 minutes following the first impact, it was also observed water flow leaking out through the watertight door no. 24, flooding the compartment no. 4.
We understand from the final conclusions that it is likely that the ship should be surviving the flooding of three punctured compartment, and that the flooding of the fourth compartment, caused by the leaking of the watertight door (no 24), was crucial to the final capsizing of the ship.
In the last years we have observed that an unacceptable great number of cruise ships have sunk of capsized, caused by the well-known operational procedure to keep the watertight doors open for the convenience of longitudinal passing or transportation (se following appendix for references).
The IMO Part B-4, Regulation 22, requires that all watertight doors is to be kept closed at sea. But this requirement may be overturned by the Flag Administrations, which have a more relaxed position to this requirement, and may permit that certain doors may be remain open during navigation if considered absolutely necessary, determined essential to the safe and efficient operation of the ship”.
The Skagerrak Safety Foundation fears that the operation or watertight doors, as kept open or closed during navigation is in realty a conflict between operational efficiency and passenger safety, and should be reconsidered by the IMO regime.
5. COURT PROCEEDINGS INDICATES LACK OF IMPLEMENTATION OF THE ISM CODE IN THE FLAGSTATE’S JUDICIAL SYSTEM
The public reference to the court proceedings against the captain of Costa Concordia gives the impression that the captain is the sole responsibility of the Costa Concordia accident. This is a misconception of the ISM Code, as the intention of the code is that the Company should have the overall responsibility for the safe I operation of the ship.
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The ICS International Chamber of Shipping’s “Guidelines on the application of the ISM Code” gives the following statement in the introduction of the ISM Code:
“The operation of merchant shipping is specialised and complex, governed by comprehensive rules and conventions developed by national and international authorities. Nevertheless, regulation of the technical aspects of shipping can only achieve part of the objective of safe operations.
In the final analysis, while the master is clearly responsible for the safety of the ship and her crew, the final responsibility for the administration and safe operation of each ship rest with the Company”
ICS “Guidelines on the application of the ISM Code”
However, the ongoing trial of captain Schettino after the Costa Concordia disaster indicate that in spite of the fact that the Italian Administration has ratified the ISM Code, it seems like the ISM Code has not been fully implemented in the Italian judicial system.
The issues mentioned above may be relevant for all ship types, but we have restricted our attention to the cruise- and passenger ships which are carrying a very large number of mixed passengers, which is not trained or physically and medically fitted for practical seamanship needed in an emergency situation, as the professional seafarers is supposed to be.
The Skagerrak Foundation appreciate that the IMO regime is not practicing any police authority of the Flag State members, as the ratification process is subject to the individual and sovereign states interpretation. Consequently, we underline the importance of the Port State Control authorities to take care of the issues we have brought to your attention in this letter and the following appendix.
Finally, the personal safety of the cruise ship passengers is very much depending upon an appropriate implementation of the ISM Code, both for the ships and the company administration.
Therefor we recommend that the cruise ship passengers and the travel agencies representing them, should have the opportunity to assess the state of implementation of the IMO rules and regulations for cruise ships. This should also include the continuous follow-up of the grandfather clauses for the existing ships by an easily accessible database information system.
For further elaboration, we refer to the attached “Skagerrak Technical Note of 30.07.2016.”
On behalf of all of us concerned with the safety of passengers and crew of vessels in peril, we are now hoping for the IMO and the shipping industry’s careful consideration of our requests.
Yours sincerely
Jan Harsem Arne Sagen Chairman Accident Investigator, MNI
The Skagerrak Safety Foundation was founded in 2004 as a continuation of the sea safety work from the support group for the families of 159 lives lost by the fire of “Scandinavian Star” in 1990. The Skagerrak Foundation is a non-profit organization, with the commitment to give support to the victims of ships accidents and seafarers, and to work for the continuous amendment of maritime rules and regulations to avoid reoccurrence of the same accidents. Jan Harsem, the president of the Skagerrak Foundation, which was one of the victim families of the “Scandinavian Star“ disaster, was rewarded the Emile Zola Price in 2014 for his outstanding work for safety at sea.
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COPY TO:
The Italian Maritime Administration. E-mail: [email protected] The Italian Coast Guard. E-mail: [email protected] Norwegian Maritime Administration. E-mail: [email protected] Swedish Maritime Administration. Email: [email protected] Denmark Maritime Authority. Email: [email protected] NI Nautical Institute. Att. Chief Ex. Philip Wake. E-mail: [email protected] IFSMA, Att. Captain Paul Owen. E-mail: [email protected] CESMA, Att. Captain van Wijnen. E-mail: [email protected] MEDIA
SKAGERRAK SAFETY FOUNDATIONOFFICE: Gml. Drammens vei 227 ● Asker sentrum / POST: Postbox 23 ● 1371 Asker ● NorwayWEB: www.skagerrak.org (new site will come) / EMAIL: [email protected] / [email protected]
TELPH.: Jan Harsem +47-95 77 11 99 / Arne Sagen + 47 67 54 17 10
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APPENDIX: Technical Note of 30 July 2016
The Costa Concordia accident reveals a need for amendments of several IMO regulations:
Background
The Norwegian Safety Foundation Skagerrak (www.skagerrak.org) is concerned about how to enhance the safety of navigation and rescue operations of passengers and crew under accident conditions for cruise and passenger ships.
In the wake of the Costa Concordia accident it has come to our knowledge that there have been several examples of non-compliancy of IMO’s regulations as SOLAS, the ISM Code, the STCW conventions and the SAR Search and Rescue Convention for quite many of the international cruise ships, which should be dealt with by the IMO and EMSA regime.
Accordingly, we therefore address this attention to the most relevant international maritime bodies, including the administrations in Italy, Sweden, Denmark and Norway, rather than addressing the specific ships, companies and flag states. Our concern in this matter is to take care of the passenger’s interest, and how to ensure their safety onboard, including a fair dealing for loss compensation to the victims, when fatal accidents happens. We have recognized that the cruise ship companies in their marketing is very happy to demonstrate the safety aspects of their cruise ships by assuring the compliance with the various IMO regulations. But when cruise ship accidents happen, the investigations often reveal a lot of violations of IMO’s rules and regulations. Such practice is misleading the passengers in their evaluation of the real safety aspect of sea cruising, and is also creating an unfair competition to the prudent cruise companies.
In order to ensure of the safety aspect of the passengers in sea cruising, The Skagerrak Safety Foundation is therefore requesting an easily access to a more uniform and transparent verification of the relevant cruise ships ’s compliance of the various IMO rules and regulations, including a continuous follow-up of the “grandfather clauses” for de existing ships.
We will below illustrate some typical examples from cruise ships, which are indicating a lot of various breach or major non-compliance with the IMO rules and regulations:
1: The navigational aspect of Costa Concordia’s accident the 13. January 2012.
Based upon information from the Italian Maritime Investigation Body on Marine Accidents, from media and from available court proceedings (available in English text), and from the captain, the Skagerrak Safety Foundation has made an ISM Code evaluation of the navigational aspect of the bridge team’s performance, which was leading to the very first collision with the reef of Giglio Island.
The preliminary conclusion is the stating of a gross negligence of the ISM Code and the STCW Convention with respect of the sharing of responsibility between the Company, the captain and the bridge team, with reference to the ISM Code, chapter 3, Company responsibilities and chapter 5, Masters responsibility, and indeed chapter 6.3 and 6.5, dealing with competence and training requirements for personnel. This analysis is available upon request.
The conclusion of the Skagerrak Foundation’s ISM Code evaluation of the Costa Concordia accident is that this accident is a typical “ECDIS serial accident”, with the preliminary conclusions as follows:
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“As a preliminary conclusion about the grounding accident of Costa Concordia at the coast of Italy the 12th January 2012, the accident seems to be caused by a serial category of accidents normally defined as an “organizational accident” or a “system failure”, where several of the management elements for ship operation seems to have been inappropriate to ensure a safe operation:
- Inappropriate international standards for ECDIS (electronic navigation) - Inappropriate generic, type specific and familiarization of ECDIS training of navigation officers- Inappropriate attention to language qualifications for bridge team members- Inappropriate BRM (Bridge Resource Management) training and drills- Inappropriate standard and procedures for the control of watertight doors- Inappropriate performance of Stability Computer (as lack of power and inappropriate level sensors)-“Organizational faults” or system faults require a revaluation of the total management concept. This revaluation may even go beyond the company’s responsibility, such as the considering of the suitability of international rules and regulations, national laws, industry standards, manning patterns, sailing waters restrictions, or even war and political issues.”
The use of ECDIS electronic navigation does have its advantages, but it may also have a strong negative impact if not used correctly, and the use of ECDIS is even known to be the causative factor in several major accidents such as collisions and groundings, commonly known as “ECDIS assisted groundings”.
In order to make a complete ISM Code analysis of the Costa Concordia accident, it is necessary to get access to the Company’s total SMS documentation, to get access to the retrospective investigation of the ECDIS equipment from the wreck, or a physical inspection of a similar bridge arrangements on sister ships, and to carry out interviews of relevant personnel, both from the crew and the company.By the first look, it seems like the most critical element in such a consecutive or serial action is the hiring and appointment of a helmsman who did not master the command language on the bridge. But this element was only the crucial part of the corrective action to avoid collision with the Giglio Island coast reef after the regular navigational procedures failed, and was consequently not the root cause of the accident.
The 2010 STCW Manila amendments recognized the need for navigational officers to undergo an ECDIS training even if electronic chart navigation is just being used only as an “aid to navigation”. This amendment entered into force on January 2012, which was 12 days before the Costa Concordia accident. The Manila amendments leave it to the various flag states to interpret the code, and define what kind of training and certification they wish to acquire.
Consequently, the 2010 Manila amendment left the shipping industry in a mess of confusion, misunderstanding and misinterpretations. If the Manila 2010’s amendment intention was to make a clarification of the training requirements for ECDIS, the result was quite the opposite; the various flagstates ended up with a diversity of training requirements, varying from an individually study by an “in-house” CBT (Computer-Based Training”), to the 5 days (40 hours) “generic IMO Model Course 1.27”, plus one-day specific/type training before the signing on, and finally the fully familiarization training onboard, before the navigator is taking charge of an navigational watch.
This problem is highlighted in several P&I Club’s bulletins and notations, which draw the member’s attention to IMO’s ISM Code’s requirement for crew training and certification, and to the IMO’s “Guidance for good practice”.
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Since 2011, the Nautical Institute has coordinated an ECDIS industry group, and produced a range of guidelines to clarify the requirements for competency and training requirements in relation to ECDIS (Guidelines: Industry Recommendation for ECDIS Familiarisation).
The analyzing of the Costa Concordia’s case reveals: According to the captain’s statement, the company’s training standard for ECDIS was based upon the use the ECDIS system as an “navigational aid” (not primary). In accordance with the STCW regulations prior to the amendment enforcement, the company set the training standard for the navigators to be the use of an “in-house“ CBT.
If that is correct, the Company’s training procedures was probably in compliance with the STCW up to the enforcement of the 2010 Manila amendment, which was the 1 January 2012 (13 days before the accident). Consequently, the navigational system of Costa Concordia was probably not in compliance with the IMO/STCW regulations at the time of the grounding. However, in accordance with the IMO practice, the Company is subject to the flagstate’s regulations.
The Italian Administration’s relation to the IMO’s STCW Training Convention is also a great concern of the European Shipsmaster’s Union CESMA, which published the following article from an IItalian captain member in their union magazine CESMA News 2015 (excerpt):
“We (Italy) are not yet able to fully accept the STCW Convention, so maritime training is not yet regulated by international provisions. The Italian rank, “capotano di lungo corso” (sea captain), which has been the pride of Italian masters for a century, no longer exists. All this taking place while maritime trade is in the midst of a revolutionary change and requires attention, intelligence and rapid and safe intervention. But this seems not to involve us, we’re not in line with the times.” Quoting of Article from CESMA News, November 2015
Based upon the very limited information about the bridge procedures which is available from the Accident Investigation Reports, the Skagerrak Safety Foundation has made an analysis of the situation on the bridge prior to the first collision with the reef of Giglio Island.
The conclusion of this analysis is that the situation on the bridge of Costa Concordia, with 4229 persons onboard, prior to the reef collision the 12th of January, 2012, at a speed of 16 knots with a distance of four ship-lengths from the shore, was in fact as follows:
In about a three minutes period prior to the collision with the reef, due to the language barriers between the helmsman and the bridge navigational team, the steering of the vessel was in reality under the sole control of a not competent helmsman.
See the attached figure 1, which illustrates the situation on the bridge prior to the reef collision,and figure 2, which shows a typical helmsman’s console on cruise ships.
Navigation, summing up:
The ECDIS training must be taught in the total context of the vessel’s navigation, rather than just covering the operation of the ECDIS system on the bridge. We understand that the IMO The ISM Code (Ch. 6.3 and 6.5) calls for a total assessment of the ECDIS’s operational aspects, the composition of the bridge team (with or without helmsman), the specific ship’s bridge procedures covering the regular and non-regular operational aspects, including programs for necessary drills and preparation of new staff members in the team.
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The Company’s bridge procedures should not be restricted to the need for training and certification of the bridge team’s navigators, but should also include the selected helmsmen, lookouts and possible training cadets, as they are important members of the bridge team. For cruise ships, with very few duties of practical operation as helmsman, special training facilities should be arranged.
The Skagerrak Safety Foundation fears that as the Costa Concordia navigational equipment and bridge procedures (manning of the helmsman’s console in critical navigational situations), is a rather common navigational practice for cruise ships operating with ECDIS, such critical situations is not restricted to the Costa Concordia case, but may also be relevant for a great number of cruise ships in service today.
2: Clarification of the command authority during the rescue operation, and the role of the Italian Coast Guard
As known, the rescue operation was coordinated by the Italian Guard’s MRSC center in Leghorn, by captain De Falco, which again appointed the head of the patrol boat G 104, belonging to Guardia Financa (custom authority), as the on-scene commander (OSC).
During the rescue work, after the tilting of the ship, captain De Falco established an audial communication with captain Schettino, which at that time was onboard Costa Concordia’s lifeboat, commanding the rescue operation. This conversation was immediately released to the press media.
However, most of the statements given in this press information are factually wrong, and should consequently be deleted or corrected by the Italian Coast Guard. The content of this audio conversation is shown in the attached Appendix 2 (Wikipedia quoting).
As captain De Falco was coordinating the rescue work from his office in Leghorn, 140 km away from the rescue scene, he was not able to observe the rescue operation directly. A possible inappropriate link of information between captain De Falco and the appointed on-scene commander (OSC) might explain why captain De Falco did not know that the ship already had rolled over, half sunk with the starboard side fully submerged, when he ordered captain Schettino to re-board the ship. The communication between captain De Falco and captain Schettino reveals:
The Coast Guard captain De Falco discharget Francesco Schettino as the captain of “Costa Concordia”, and put himself “in charge of the operation”.
The Coast Guard captain De Falco did not at all listen to captain Schettino, who tried to explain that the ship already had tilted, but was harassing him by saying he will “make him look very bad” and that he will “make him pay for this.”
Finally, the Coast Guard captain De Falco ordered captain Schettino to re-board the ship. If any such ladder climbing had been carried out at that time, in the opposite direction of the passengers escaping route, such a climbing would have been fatal to the passenger’s rescue operation. The factual information, with reference to the Accident Investigation Report and from the court proceedings, is shown in the attached figures 3 and 4. Figure 3 shows the development of ships heeling after the reef collision (factual information), added with the main rescue events, and figure 4 shows the situation on the top shipside when the Italian Coast Guard’s captain’s order to the captain to re-abandon the ship was given.
We fear that captain De Falco’s handling of the rescue operation and harassment of the ship’s represent a major violation of the IMO’s SAR regulations for rescue work at sea.
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Reference to the IMO SAR Convention, excerpt of chapter 4.7, “On-scene coordination”:
“4.7.1 The activities of search and rescue units and other facilities engaged in search and rescue operations shall be coordinated on-scene to ensure the most effective result.
4.7.2. When multiple facilities are about to engage in search and rescue operations, and the rescue co-ordination centre or rescue sub-centre considers it necessary, the most capable person should be designated as on-scene coordinator as early as practicable and preferably before the facilities arrive within the specified area of operation. Specific responsibilities shall be assigned to the on-scene coordinator, taking into account the apparent capabilities of the on-scene coordinator and operational requirements.
4.7.3. If there is no responsible rescue coordination centre or, for any reason, the responsible rescue coordination centre is unable to coordinate the search and rescue mission, the facilities involved should designate an on-scene coordinator by mutual agreement.”
We understand that the SAR Convention is in force for all administrations which have ratified the Convention, and that the Convention cannot be set aside or overruled by any national regulations.
The SAR Convention seems to be missing a clarification of the authority of the MRSC and the “On-Scene Coordinator” if the ship’s captain wants to retain in command to coordinate the rescue work by the ships lifeboats. This might cause a confusion about who is in command between the rescue parties involved, if not commonly agreed in advance, or clarified in the IMO regulations.
The above mentioned problems about the MRCC’s authority when dealing with the master in command of a distressed vessels could be avoided by a clarification of the code or by writing a guidance protocol in addition to the SAR Convention.
The IMO SAR convention, conclusions:
An effective and professional co-operation between the vessel in peril and the rescue team is of paramount importance to obtain the most effective results of the rescue work
We urge the IMO regime to add a clarification or a protocol to the SAR Convention, defining the authority between the MRCC and the master of the distressed vessel, in cases where the master wants to retain his command from the vessel or from the vessel’s lifeboats after having abandoned the vessel.
3: The Criminalisation of seafarers
“Member states should, in accordance with their national legislation, take into account the relevant provisions of the IMO guidelines on fair treatment of seafarers in the event of maritime accidents.
EU Directive 2009/18/EC, Preamble, item 9
The watershed in the modern maritime legal system for the treatment of seafarers was the instigation of the International Safety Management Code (The ISM Code) in the 1990’ties.This code is now ratified by all seafaring states, including Italy.
The Italian court’s savage sentence of 16 years in prison for captain Schettino is in great contrast to the ruling of British court, after the capsizing of the Passenger/Ro-Ro ferry Herald of Free Enterprise in
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the Belgian port of Zeebrugge in 1987, causing the loss of 190 lives.
The immediate cause of the accident was that the bow door remained wide open when the ship left the port, allowing an inrush of water as the vessel increased speed, while the person responsible for the closing of the bow door, lay asleep in his cabin. The accident inquiry identified errors by five of the ship’s crew, who were accused of gross negligence.
But the court, led by Justice Sheen, did not stop by identifying the shortcomings of the ship’s master and the crew. As the accident inquiry also revealed that the company’s shore management was blameworthy, Mr. Justice Sheen summarized the company’s attitude towards safety in the following statement: “From top to bottom, the body corporate was infected with the disease of sloppiness, and negligence of every level of the company’s hierarchy”. Consequently, he ruled that no members of the crew were sentenced to jail, and their verdict was limited to a time-limited ban from sailing.
As a consequence of The Herald of Free Enterprice case, IMO later on instigated the development of the ISM Code, which represented a shift from the traditional IMO prescriptive rules, which was based upon the captain’s responsibility, towards an enhanced Company management responsibility for the safety of the ship operation.
The ISM code is stating that it is the company’s responsibility to establish the safe operational procedures of ship operation, and to support the development of a safety culture. The ISM Code states (excerpt):
“The Company should clearly ensure that the SMS (Safety Management System) operating onboard the ship contains a clear statement emphasizing the Master’s authority.
The Company should establish in the SMS that the master has the overriding authority and the responsibility to make decisions with respect to safety and pollution prevention and to request the Company’s assistance as may be necessary.”
The ISM Code Chapter 5.2, The Master’s responsibility and authority The public opinion of the Costa Concordia case has from the start been dominated by the public statement made by the Italian Coast Guard’s captain De Falco, which is boiling down to a personal blaming and harassment of captain Schettino. This treatment of a victim of a ship’s accident is a disgrace of the proud history of rescue work at sea in all the seafaring countries all over the world.There is no doubt that this defamation of captain Schettino, presenting a lot of false statements and accusations, has dominated the later court proceedings of captain Schettino..
The Italian Court’s motivation for the verdict of the captain is not yet delivered, but we understand from Captain Schettino that his final decision to stranding the ship was based upon a prior consultation with the company’s emergency duty office, a decision which also was condoled by the Italian Coast Guard’s office in Leghorn MRCC (probably by the same captain de Falco).
During the rescue operation of Costa Concordia, the national coast guard rescue coordinator (MRCC) discharged the captain of the ship and, took over the command of the ship and rescue operation, and then performed a character assassination of the captain, which was immediately released to the press media.
The MRCC’s authority is not specified in the SAR operating procedures (Chapter 4). More specific, the MRCC’s authority should be clarified. Does the national coast guard captain (MRCS), in general, have the authority to perform a character assassination of the ship’s captain, released to the press media, which may have a detrimental effect upon a possible later court proceeding against the captain.
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The Skagerrak Foundation claims that the alleged blame of guilt and character assassination of the ship’s captain, as presented by the Italian Coast Guard’s captain De Falco during the rescue operation, is a breach of all IMO regulations and EU Directives for fair treatment of seafarers. This incident also reveals a need for guidance for public information to the press media in the IMO SAR Convention.
Criminalisation of the captain: Summing up
The Skagerrak Safety Foundation fears that without any public withdrawal or corrections of the Italian Coast Guard’s character assassination of the captain of Costa Concordia, the captain is deprived the possibility to get a fair treatment in any Italian Courtroom.
4: Stability Decision Support System
The Costa Concordia accident reveals a serious weakness or even defect in the installation and use of an integrated Stability Decision Support System of a flooding emergency for cruise ships, which should instigate an amendment in the IMO’s regulations for stability measurement.
At first, the “Stability Computer” should be connected to the bridge battery bank, and not to the emergency switchboard, as it did for Costa Concordia (As the emergency generator may fail in a flooding emergency).
The Costa Concordia had normal tank gauging system. This means that there was a pressure sensor in each tank intended for liquids (ballast, fuel, potable water, etc.). The pressure gauge data was transferred to the machinery automation system, which converted the data into volume using predetermined liquid density and sounding tables (calculated for even keel condition). This volume information should have been transferred to the NAPA stability computer from the machinery automation system. This location of the data processing is not acceptable, as the machinery automation system might be flooded in an emergency flooding situation.
There were no flooding sensors (or even detectors) in the big dry compartments like engine rooms.
In general, the following quotation seems to be commonly known and accepted from the literature discussing passenger ships stability:
“Fulfilling of the existing regulatory requirements alone does not offer the master of the ship a solid ground for decision making in distress situations. This is because some key factors, such as utilization of real time flooding level sensor and door status data (see below item 5), are currently not a requirement.”
“Integrated Decision Support System for passenger ships”, Pennanen, Ruponen & Ramm-Smith
Stabilty Computer (Decision support system:
The Skagerrak Safety Foundation recommends strongly that the specified key factors as the fitting of time flooding sensors and door status data should be made mandatory for all cruise ships, both for newbuildings and existing ships.
5: Confusion about requirements for closing of WT doors for cruise ships
From the report of The Italian Maritime Investigative Body of Marine Accidents investigation of Costa Concordia accident, it appears that the collision between the port side of the hull and the eastern
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reef of “Le Scole” punctured the ship in three continuous compartments (compartments 5, 6 and 7).
Furthermore, after some 10-15 minutes following the first impact, it was also observed water flow leaking out through the watertight door no. 24, flooding the compartment no. 4.
We understand from the Italian MAIB’s final conclusions that it is likely that Costa Concordia should be surviving the flooding of three the punctured compartment, and that the flooding of the fourth compartment, caused by the leaking of the watertight door (no 24) was crucial to the final capsizing of the ship.
Within the last years we have observed that an unacceptable great number of cruise ships have sunk of capsized, caused by the well-known operational procedure to keep the watertight doors open for the convenience of longitudinal passing or transportation.
SOLAS Ch. II-1, Reg. 22 requires all watertight doors to be kept closed at sea, with the following exception.
“To permit the passage of passengers and crew, or when work in the immediate vicinity of the door necessitates it being opened. The door must be immediately closed when the transit through the door or when the work is completed.
Flag administrations may also permit certain doors to remain open during navigation if considered absolutely necessary, determined essential to the safe and efficient operation of the ship’s machinery”
Quoting from GARD’s “dangers of power operated watertight doors. GARD conference May, 2013
As seen, this requirement may be overturned by the Flag Administrations, which seems to have a more relaxed position to this requirement, and may permit that certain doors may be remain open during navigation if considered absolutely necessary, determined essential to the safe and efficient operation of the ship’s machinery.
As the tragic examples of the consequences of keeping the WT doors open for cruise ship, we will mention some examples from the later years:
In 2000: With 534 people on board, the Greek passenger ferry Express Samina hit rocks and sank in 45 minutes. 85 people died. The ship had 11 WT doors in subdivision bulkheads, and 9 of which were open and could not close due to lack of power.
In 2007 the cruise vessel Sea Diamond ran aground on a volcanic reef near the Greek Island Santorini, with 1.195 passengers onboard. A father and a daughter did not survive. It was later disputed whether the watertight doors were closed, or at what time they were closed.
In 2011 the Norwegian passenger vessel Nordlys was taking in water after the puncturing of the hull at the location of the extracted stabilizer fin at the quay. One cargo hold was first penetrated, but the water leaked through a WT door to the next cargo hold, and the vessel was very close to capsizing
Furthermore, The IMO guidance for watertight doors in passenger ships (MSC.1/Circ. 1380) states that “the number of openings in watertight bulkheads on passenger ships is to be kept to a minimum in accordance with SOLAS regulation II-1/13.1”.
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In a Ship Safety Conference in May 2013, the P&I insurance company GARD’s representative Alf Martin Sandberg raised the following question:
“The number of WT doors reduced to a minimum?How is this requirement observed by ship designers and of those authorities approving the designs, when a vessel ends up with such high numbers of WT doors as 30 – 40, up to 74?”
Watertifght doors: Summary:
The Skagerrak Safety Foundation consider the alternative to keep the watertight doors open or closed under navigation is a conflict between operational efficiency and passenger safety, and should not be accepted for cruise- and passenger ships. This matter should be reconsidered by the IMO regime.
6: Court proceedings indicate lack of implementation of the ISM Code ratification in the Italian judicial system.
The public reference from the court proceedings against the captain gives the impression that the captain has the sole responsibility of the Costa Concordia accident. This is a breach of the ISM Code, as the intention of the ISM Code is that the Company should have the final responsibility for the safe operation of the ship
The ICS International Chamber of Shipping’s “Guidelines on the application of the SM Code” gives the following statement in the introduction of the ISM Code guidelines:
“The operation of merchant shipping is specialised and complex, governed by comprehensive rules and conventions developed by national and international authorities. Nevertheless, regulation of the technical aspects of shipping can only achieve part of the objective of safe operations.
In the final analysis, while the master is clearly responsible for the safety of the ship and her crew, the final responsibility for the administration and safe operation of each ship rest with the Company”
ICS “Guidelines on the application of the ISM Code”
The first available documentation from the Costa Concordia accident (as released by the Italian Coast Guard, see Appendix 2) and the court proceedings of the captain and other documentation from the company, available in English text, seems all to blame the captain for causing the accident.
This is in contrast to the very intention of the ISM Code, as clearly presented by the above quoted statement from ICS.
This sole blaming of the captain also seems to be a breach of the practical experience from other Flag States, is expressed by a sea captain, who has been studying the practices of the ISM Code in general. See the below excerpts from captain T. Mattsson’s doctoral thesis by The University in Lund, Sweden:
«The ISM Code has a mission to squeeze human error out of ship operations. To do this, it must bear down on the owner’s systems of operation. As a result, the owner’s wellestablished right to rely on the negligence of his crew in the event of an accident giving rise to a claim is challenged. The company now may not land all blame on the master.
The mere existence of a code which addresses safety management makes it clear that a significant amount of what passes for crew negligence will now be treated as management
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failure”.
“Excerpts from “Some consequences of the ISM Code”. Master thesis by Captain T. Matteson, University of Lund, Faculty of law
The ongoing trial of captain Schettino after the Costa Concordia accident indicate that in spite of the fact that the Italian Administration has ratified the ISM Code, the ISM Code has not been fully implemented in the Italian judicial system.
THE SKAGERRAK SAFETY FOUNDATION
Arne Sagen, MNIAccident Investigator (ILCI/USA) / ISM Controller (IACS) / Quality Assessor (ISO 9000)
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Figure 1:
“The situation on the bridge of Costa Concordia, with 4229 persons onboard, at a speed of 16 knots and with a distance of four ship-lengths away from shore in the three crucial minutes period, prior to the collision with the reef.
The steering of the vessel was in three minutes in reality under the sole control of an incompetent helmsman, due to the language barriers between the helmsman and the bridge team.
As many cruise ships have very similar navigational equipment, bridge procedures and manning policy, the Skagerrak Safety Foundation fairs that that this situation is not restricted to the Costa Concordia, but is also relevant for most of the large cruise ships in service today.”
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Fig 2. A typical helmsman’s console for a large cruise ship
Helm orders may differ from ship to ship and from flagstate to flagstate.
The Skagerrak Safety Foundation fears that the need for qualification and certification of the helmsman is commonly neglected.
(Alternatively manual steering on ECDIS could be a part of the navigator’s duty.)
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Figure 3. The central rescue activities in relation to CC gradually tilting in the rescue operation
The captain left the ship at 23:34 (UTC) after the last lifeboat had been launched, by falling/jump-ing on the top of a nearby lifeboat.
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Figure 4. The situation on the top shipside when the captain was ordered to re-board the ship. The only way to climb upwards was to use the adder, where the passengers were climbing down.
Any attempt to climb upwards could have fatal consequences to the passenger’s safety evacuation.
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APPENDIX 2
Quoting Wikipedia: Record of communication between Italian Coastguad and Costa Concordia 17.01.2012:
Coast Guard: «This is De Falco from Liverno, am I speaking to the captain ? Please tell me your name»Captain: «This is captain Schettino.»Coast Guard: «Schettino? Listen Schettino, there are people trapped on board. Now yoy need to go on your life boat, under the bow on the ship on the side. There is a ladder. You need to climb up the ladder at and board the ship. Get on board and report to me how many people there are. Is that clear?. I am recording this conversation, captain»Captain: «Captain, let me tell you one thing..»Coast Guard: «Speak up!»Captain: «The ship, at this moment ...»Coast Guard: «Captain, speak up. Shield the microphone with your hand and speak louder. Clear?Captain: «At this moment the ship is tilted.»Coast Guard: «I understand. Listen, there are people who are coming down the ladder on the bow. Go back in the opposite direction, get back to the ship, and tell me how many people there are and what they have onboard. Clear? Tell me if there are children, women and what kind of help they need. And you tell me the number of these categories. Is that clear. Look, Schettino, perhaps you have saved yourself from the sea but I will make you look very bad. I will make you pay for this. Dammit!»Captain: Captain, please...»Coast Guard: «There is no please about it. Go back on board. Assure me that you are going back on board!»Captain: I am in the life boat, under the ship. I haven't gone anywhere. I am here»Coast Guard: «What are you doing?Captain: «I am coordinating...»Coast guard: «What are you coordinating there? Gt back on your ship and coordinate the rescue on board. Are you refusing?Captain: «No, I am not refusing»Coast Guard: «Are you refusing to go on board. Tell me the reason why you are not going.»Captain: «I am not going because there is another life boat that has stopped.»Coast Guard: «You get on board. This is an order. You need to continue the rescue. You called the evacuation, now I am in charge. You need to go on board the ship, is that clear?»Captain: «Captain..»Coast guard: «Can you hear me?»Captain: «I am going..»Coast Guard: «Go. Call me when you are on board. My rescue team is there. He is at the bow. Get going. There are already corpses, Schettino: Move!»Captain: «How many dead are there?»Coast Guard: «I don't know. One I am aware of. You need to be telling me this. Christ!»Captain: «But you are aware it is dark and we can't see anything?»Coast Guard: «And what do you want? To what can be done, how many people there are and what you need. Now! Go home, Schettino. It is dark and you want to go back home?. Get on the bow of the ship and tell me what can be done, how many people there are and what they need. Now !»Captain: I am here with the second commander.»Coast Guard: «Excuse me?»Captain: «I am here with the second commander his name is ...»Coast Guard: «So both of you, get on board, both of you. What is the name of the second?»
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Captain: «Dimitry.»Coast Guard: «Dimitry who?»Captain: «Dimitry (unclear)»Coast Guard: «You and your second commander, go and get on board now. Is that clear?»Captain: «I want to get onboard the ship, but the other life boat has stopped its engine and is drifting and I called other rescuers.»Coast Guard: It's already one hour and you are telling me this. Now, get on board now. And you tell me Is that clear? How many people there are!»Captain: «Okay, captain.»Coast Guard: «Go right now!»
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SKAGERRAK SAFETY FOUNDATIONOFFICE: Gml. Drammens vei 227 ● Asker sentrum / POST: Postbox 23 ● 1371 Asker ● Norway
WEB: www.skagerrak.org new site under construction / EMAIL: [email protected] / [email protected].: Jan Harsem +47-95 77 11 99 / Arne Sagen + 47 67 54 17 10
