[Peetwo]

AMSA & OTSI disconnection on Transdev safety issue transgressions??

Ref: https://www.smh.com.au/national/nsw/high...5c35r.html

"..Internal figures seen by the Herald show the incident two weeks ago takes the number of steering failures involving the Fairlight to eight since late last year, while the Balmoral has had three and the Clontarf one...

"...The internal figures also show the six-strong fleet of older first-generation Emerald-class ferries, used mostly on inner-harbour routes, have suffered seven steering failures over the past two years..."

And from the OTSI SAN from the previous year: https://www.otsi.nsw.gov.au/sites/defaul...210831.pdf 

"..In 2021, a total of eight incidents relating to problems with DCV vessel steering systems have
been reported to OTSI with varying failure modes..."

And via the Oz Arab Media, May 26th 2022: https://ozarab.media/government-announce...6367187500

JO HAYLEN MP
SHADOW MINISTER FOR TRANSPORT
MEMBER FOR SUMMER HILL

The NSW Government has announced a major review of its defect ridden crisis prone overseas built Emerald Class Manly ferries just a day after NSW Premier Dominic Perrottet claimed there were no problems with the vessels.

Yesterday, on Wednesday, May 25, Mr Perrottet claimed the vessels were, “world class ferries that are much, much better and advanced than the ones they replaced.”

He went on to say that, “while there will always be difficulties, they aren’t substantive, they are minor.”

However, the overseas built Emerald Class ferries have been plagued by defects for months, with new defects being discovered on an increasingly regular basis.

In the last two weeks alone:

• The ‘Balmoral’ suffered a major steering failure.
  
• The ‘Clontarf’ was docked three times in a week after it’s lubricating oil system cracked and caused hot oil to spray around the engine room, triggering the vessel’s fire alarms. The vessel underwent repairs but a similar incident occurred the day after and then cracks were found in the vessel’s fuel tanks.
  
• The ‘Fairlight’ has been repeatedly docked because of multiple cracks found in the vessel’s fuel tanks.
  

Shadow Minister for Transport Jo Haylen said:

“What planet is the Premier on? These overseas built ferries are riddled with defects and new ones have been discovered just in the last fortnight. These ferries aren’t world class, they are junk and passengers are faced with cancellations and delays because they simply aren’t up to the job.

“These aren’t minor difficulties, they are clearly deep systemic issues, and they occurred on the Liberal party’s watch. The Premier clearly doesn’t understand how serious the problems with these ferries are, and he doesn’t get that his Government’s transport procurement policies have completely failed.

“Building transport infrastructure overseas means the taxpayer doesn’t get value for money, and that passengers get a bad product. It’s time we learnt the lessons from the Government’s failures and start building our trains, trams, buses and ferries in Australia again.”

Add to that the recent catastrophic engine failure on the Clontarf and several rumoured overload events, one of which involved a turn around with more than a 100 pax overload. Yet our Federal regulator AMSA and OTSI apparently do not have any concerns in regards to what appears to be a substantial systemic trail of operational safety issues and non-compliances??

In order to understand why it is the regulator and state safety investigator are seemingly disinterested in the above operator safety issue transgressions, I have began doing some research into other international jurisdiction, namely the USA, the UK and how they are harmonised and compliant with the IMO SARPs. 

Starting with investigation, which in the case of the USA is conducted by their Coastguard in conjunction with the NTSB.

Extract from the 'NTSB Office of Marine Safety':

Office of Marine Safety


Program Description

The Office of Marine Safety (OMS) investigates marine casualties to determine the probable cause of each casualty and identify safety recommendations that will prevent similar events in the future. Investigated casualties include those classified by the US Coast Guard as major marine casualties in US territorial waters or involving US flagged vessels worldwide, and casualties involving both US public (government) and nonpublic vessels. In addition, the office investigates select catastrophic marine casualties, as well as those of a recurring nature.

These responsibilities are specified in the Independent Safety Board Act and Title 49 Code of Federal Regulations Part 850. Major marine casualties may include any one of the following:

• the loss of six or more lives.
  
• the loss of a mechanically propelled vessel of 100 or more gross tons.
  
• property damage initially estimated to be $500,000 or more.
  
• a serious threat, as determined by the Commandant of the Coast Guard with the concurrence of the NTSB Chair, to life, property, or the environment by hazardous materials.
  

After investigating each major marine casualty, the OMS identifies safety issues and issues an investigation report, which may include safety recommendations to federal government agencies (such as the Coast Guard), state agencies, vessel owners and operators, vessel classification societies, or maritime industry organizations.

Under the International Maritime Organization’s (IMO) Casualty Investigation Code, the OMS also participates with the Coast Guard as a Substantially interested State in investigations of serious marine casualties involving foreign-flagged vessels in international waters. For example, the NTSB often participates in casualty investigations that involve foreign-flagged cruise ships with US citizens on board.

The OMS also actively participates in US-based and international groups to improve marine investigations and promote maritime safety. This includes—

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• reviewing US position papers related to marine casualty investigation.
  
• participation at IMO meetings.
  
• tracking developments in marine casualty investigation and prevention.
  
• cooperation with other marine casualty investigation organizations worldwide
  

Very different system, unlike AMSA Coast Guard is the SAR and safety authority but not the regulator.

The UK investigator is the MAIB: https://www.gov.uk/government/organisati...anch/about

Contents

1. Who we are
   
2. Our responsibilities
   
3. Our priorities
   

1. Regulations and guidance
   
2. Corporate information
   

Our job is to help prevent further avoidable accidents from occurring, not to establish blame or liability.
Marine Accident Investigation Branch receives between 1500 and 1800 reports of accidents of all types and severity each year. On average this leads to 30 separate investigations being launched.

Again a different system as the UK doesn't have individual State investigative bodies to have to deal with. The effectiveness of their system is very much apparent when you review some of their investigation accident and serious incident final reports etc. : https://www.gov.uk/government/publicatio...stigations

IMO one of the best indications of the effectiveness of the MAIB was in their safety digest publication...

Ref: https://www.gov.uk/government/publicatio...ests-20-24

In a passing strange coincidence there was this incident and lessons learnt in the latest safety digest (ref pg 7):

 

Some months later while on passage, a sudden and increasingly loud sound emanated from the main engine. The duty engineer recognised that something serious was occurring and took cover as the main engine
catastrophically failed. Major internal engine components were thrown out through the crankcase and a large fire engulfed the engine room (Figure 2). The duty engineer was fortunate to escape through the thick black smoke that enveloped the engine room as he struggled out of the compartment via the secondary escape route, without the use of an emergency escape breathing device (EEBD).

Once the vent flaps had been closed and the duty engineer accounted for, the engine room was flooded with carbon dioxide, which extinguished the fire. However, it was some days before the engine room could be re-entered as it was unclear whether all the carbon dioxide bottles assigned to the main engine room had been discharged...

The Lessons

1. Qualifed → It is not unusual for contractors to undertake major maintenance work on board a ship;
however, it is imperative that they can provide assurance that they have the skills and equipment to meet the original equipment manufacturer’s expectations of how it should be done. Operators and managers
must endeavour to maintain a level of oversight that ensures work is completed to a satisfactory standard.

2. Maintain → Whereas components were overengineered and could withstand poor treatment in the past, this is not always the case for modern, technically advanced machinery. Engine components, particularly on modern engines, are designed to maximise the power output while keeping component mass and size to a minimum. The components are thus highly stressed and their correct maintenance is critical. What may seem an innocuous cut or heat mark from using inappropriate tools can have serious consequences when the component is heavily loaded or operating at high revolutions. This type of damage affects the component metallurgy and introduces stress raisers, which can lead to fatigue failure.

3. Equipment → The duty engineer was lucky to escape from the smoke-filled engine room. While the
ship had the correct number of emergency escape breathing apparatus as required when the ship was
constructed, it did not have to comply with a 2003 International Maritime Organization (IMO) circular that required one EEBD to be positioned on each deck or platform level near the secondary means of escape. Ship managers and operators should consider increasing and improving EEBD distribution to maximise the likelihood of escape from a smoke-filled space.

4. Signage → The carbon dioxide fixed firefighting system was activated and successfully extinguished the fire. However, it was unclear in the bottle room which gas bottles discharged to which space and therefore impossible to confrm that all bottles had been discharged. This led to delays in gaining entry to the space, which in some circumstances could be critical. Such a problem can be avoided with clear labelling and a means of checking that the necessary bottles have been discharged, as outlined in MGN 389 (M+F), Operating Instructions and Signage for Fixed Gas Fire-Extinguishing Systems.

MTF...P2