‘Death Watch’ Collisions and the ‘Human Element’

Human beings were never built to work at night. Our primeval body clock says it’s time to sleep and rest for the next dangerous day as a hunter gatherer. In short, our brains have not yet evolved to deal with the 24/7 business of shipping or a world that now operates in the same way. Nor are human brains going to able to do this for a very long time. This short article will explore the impacts of what is now formally recognised as ‘the human element’ in relation to ship safety. It will also consider the urgent need to build and develop better training and competence barriers to protect ourselves and those around us from the often disastrous effects of human error.

The recent collision between the naval vessel USS Fitzgerald and the containership ACX Crystal, resulting in the tragic loss of seven US Navy lives, provides an unfortunate but graphic illustration of the ‘human element’ problem. These two vessels collided with each other in clear weather while navigating in an area south of Tokyo Bay at about 01:30 am on 17 June 2017. Bearing in mind the fact that the two vessels were both fitted with anti-collision equipment including automatic radar plotting (ARPA), automatic identification systems (AIS) and VHF radio and were both manned by navigating personnel certified as being competent, how could such a thing have happened?

Multiple investigations are now underway. There is little doubt that these investigations will be very thorough and that at least some of the results will ultimately be published. There is also little doubt that the underlying cause will not be found to have been due to any failure in the equipment fitted on board either vessel. In fact, long experience, statistical evidence and the circumstances of the incident as currently known make this a virtual certainty. So what probably went wrong?

The course (080º T) and speed (18.5 knots) of the ACX Crystal was being transmitted by her GPS linked AIS unit. These signals are received by shore stations and can quickly be converted to provide a video image of the ACX movements and speed. However, no such AIS data appears to be available for the USS Fitzgerald as naval vessels will usually not transmit their AIS presence for security reasons. This being the case, there is currently no comparative match available between the courses of the two ships up to the point of impact.

So what analysis can be made? The post incident photographs of the two ships and the extent and locations of the physical damage they both suffered can tell us a lot; especially when combined with a basic knowledge of the International Collision Regulations (COLREGS). This investigative technique, known as ‘Speed and Angle of Blow Analysis’, is based on proven scientific principles and it pre-dates AIS and all other forms of independent ship tracking.

Visible damage to the ACX Crystal can be seen as an indentation of the upper bulwarks of her port bow flare area. Visible damage to the USS Fitzgerald can be seen as heavy indentation and crushing to her starboard side superstructure. It is also reported that the USS Fitzgerald was holed below the water line and that flooding was the cause of the deaths that occurred.

The nature and position of the damage to both vessels suggests that initially both vessels were under way and heading in the same easterly direction, with the USS Fitzgerald situated to port and north of the ACX Crystal. The question then must be as to what the relative angle of approach was between the two vessels? Were they crossing vessels governed by COLREGS Rule 15 such that the USS Fitzgerald was obligated to alter course to starboard so as to pass clear and astern of the ACX Crystal? Or, more likely, were they on converging courses, with one of the two vessels overtaking the other, such that the overtaking vessel was bound by Rule 13 to keep clear of the overtaken vessel? A definitive answer will not become available until the speed and course data, as recorded on the VDR (black box) units of both vessels, has been analysed.

Meantime, it may be useful to consider that the confusion surrounding Rule 13, the overtaking rule, may well have contributed to the collision. Rule 13 provides that a vessel shall be considered to be an overtaking vessel if it approaches another vessel from more than 112.5º aft of that vessel’s heading. As such, the overtaking vessel must keep clear. However, if the approach is from less than 112.5º, then Rule 15 applies such that the two vessels are deemed to be crossing vessels. Further, that the vessel that has the other vessel on her own starboard side must keep clear.

In the aforementioned circumstances, it only requires a tiny one degree difference in the angle of approach to reverse the COLREGS burdens of both of the vessels involved. The result of the Rule 13 and Rule 15 conundrum is that an officer of the watch (OOW) will often be unsure whether they are an overtaking vessel that must keep clear or a crossing vessel that has the right of way and must stand on. This situation has been experienced many times before. Indeed, for maritime lawyers and investigators, it has become a classic 00:00 – 04:00 hrs (12 a.m.- 4 a.m.) ‘death watch’ collision scenario.

The solutions are in fact all contained within the COLEGS, despite the fact that they were created decades before electronic aids such as ARPA, AIS, ECDIS, VDR and VHF were ever invented. Rule 13 for example provides that if the OOW is not sure whether they are a crossing vessel or an overtaking vessel, they must assume they are an overtaking vessel and keep clear. However, at 1:30 a.m. when the OOW’s tired brain is not happy with a darkened bridge environment and is also fighting with the anxiety of whether to call the Master for assistance, the cards are stacked against the exercise of logic. Instead, the choice is often to attempt to communicate by VHF with the other vessel while in a close quarters situation that is getting closer and exponentially more dangerous with each passing second.

Whatever was reportedly communicated between the ACX Crystal and the USS Fitzgerald, it obviously did not assist. Collision ensued, seven lives were lost and others were injured, huge financial losses will be suffered and careers will be ruined. For insurance purposes, causation will be deemed to be a ‘peril of the seas’. Both vessels will ultimately be found to blame. The only remaining question will be as to the apportionment of fault so as to be able to settle the legal liabilities and the insurance claims. Despite all this, it will almost certainly be the ‘human element’ that has once again punched a huge hole in the multiple safety barriers provided by the COLREGS, STCW Convention prescribed Certificates of Competence and all of the very expensive anti-collision devices that the IMO now obligates sea-going ships to be equipped with.

SeaProf believes that one of the answers lies with more intense ‘hands on’ training followed by the rigorous testing of competence in realistic high stress scenarios. The airlines figured this out decades ago when they created and engaged with the flight simulator training concept. It took the shipping industry a very long time to catch up and even longer to apply as an integral part of the test of competence for ship’s navigating officers. The upside is that the number of ship collisions has been reduced significantly during the past 10 years as simulator training becomes more available and more realistic. However, the very clear message from the Fitzgerald/ACX Crystal collision is that a great deal more still needs to be done to eliminate ‘human element’ induced tragedies and loss in the shipping industry.

One of the new topics on the Key Elements of Shipping course, scheduled for 10-12 October 2017 in Singapore, will be a visit to the Kongsberg Ship Simulator Centre. Course participants will learn about the role of ship simulator training in overcoming the ‘human element’. Participants will also experience a ‘hands on’ opportunity to navigate a large vessel under the watchful eye of Mr Wong Kok Fai, a former Singapore Navy commanding officer and now the Simulator Training Manager for Kongsberg.

For more information about the Key Elements of Shipping Course, please go to our website to check out the details and the generous fee support available. We hope you will be interested to join us and we will be pleased to welcome you to the Kongsberg ship’s bridge to engage in a unique and challenging learning experience.



Leave a Reply

Your email address will not be published. Required fields are marked *