The Nautical Institute discusses a crew member dying after getting stuck between a pontoon and a bulkhead in a recent Mars Report. According to the Institute, the operation lacked good communication, co-ordination, and control.
The Nautical Institute gathers reports of maritime accidents and near-misses. It then publishes these so-called Mars Reports (anonymously) to prevent other accidents from happening. A summary of this incident:
A vessel in port was being discharged. Once the cargo above the tween deck had been offloaded, the deck crew needed to shift the pontoons with the vessel’s crane to facilitate discharging cargoes below.
Pontoons 6 and 7 were shifted and stacked at the planned positions. Two rigging crew moved from the aft access space and re-entered the cargo hold to unhook the lifting wire slings for pontoon 7. Then pontoon 8 was lifted and slowly swung towards the aft bulkhead where it was to be stowed. The same two crew had returned to the protected area in the aft access space and were waiting to unhook the lifting wire slings from pontoon 8.
When pontoon 8 was about 4 metres away from the aft bulkhead and being gently moved into position, one of the hold crew asked the crane operator via the VHF radio to stop the movement of the pontoon so that he could climb out of the aft access space, walk over pontoon 7 and climb onto pontoon 8. Once the momentum of pontoon 8 had stopped (now about 3 metres away from the aft bulkhead), the crew member climbed onto it. Standing on the pontoon, he signalled to the crane operator to continue moving the pontoon towards the aft bulkhead. At the same time, he shouted across to the other crew in the aft access space to stay within the protected area.
When the pontoon was about 1 metre away from the aft bulkhead, the other crew member suddenly exited from the aft access space, raising one leg to climb on to pontoon 8, which was now moving again.
The crane operator saw the danger, but could not stop the pontoon’s movement in time. The crew member’s chest was crushed between the edge of pontoon 8 and the aft bulkhead. The pontoon was cleared, and the victim attended to, but on the way to the hospital he succumbed to his injuries.
The official investigation found that, among others:
- The first crew member opted to enter the cargo hold before the pontoon was stacked in its final position.
- Despite being part of the same team to unhook the wire slings from the pontoon, there appeared to be a lack of co-ordination and communication between the two crew members.
- Being new to the company, the victim probably followed the actions of the first crew member by instinct.
- Although a risk assessment was carried out in line with the company’s SMS procedures, it did not cover the proper positioning of personnel during pontoon shifting operations, especially in situations where the access openings may be blocked by stacked pontoons.
The crew member’s chest was crushed between the edge of pontoon 8 and the aft bulkhead.
Advice from The Nautical Institute
- Working in a hold where heavy lifts are taking place needs excellent communication, co-ordination, and control.
- Standing on a lifted and moving pontoon is not good practice.
- Rigging crew should be in a protected area until the load is in position and stable and the weight is off the hook.
This accident was covered in the Mars Reports, originally published as Mars 202050, that are part of Report Number 335. A selection of this Report has also been published in SWZ|Maritime’s October 2020 issue. The Nautical Institute compiles these reports to help prevent maritime accidents. That is why they are also published on SWZ|Maritime’s website.
More reports are needed to keep the scheme interesting and informative. All reports are read only by the Mars coordinator and are treated in the strictest confidence. To submit a report, please use the Mars report form.