Lack of CO2 Systems Risk Awareness Resulted In Crew’s Death

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In a recent, accident investigation report, the Bahamas Maritime showed how an engine room fire resulted in the death of an Able Body Seaman. Here’s the detailed report as published on their website.

Incident Summary

  • On 9 August 2014, the Pine Galaxy departed Los Angeles, the USA for a scheduled voyage to Yeosu, Korea carrying a multi-grade cargo of Tetramar, Canola Oil and several grades of Neutral Oil comprising 12,949.326 MT.
  • On 13 August 2014, the Second Assistant Engineer started the No.3 generator to complete further test runs. The thermometer on the lube oil system was damaged during routine maintenance on the generator.
  • The duty engineer decided to replace the thermometer and in doing so, removed the complete pocket assembly instead of only the thermometer causing lube oil to spray vertically at approximately 4.5 bar pressure. The lube oil came into direct contact with the exhaust manifold which had an operating temperature of approximately 320° Celsius.
  • A fire started immediately at the deckhead area above the generator and passed along the cable run towards the engine room workshop. The No. 3 generator tripped, causing a blackout.
  • Subsequently, the emergency generator came online. After some attempts to extinguish the fire it was decided to activate the CO2 system. A fire team was formed 25 minutes after the CO2 system was activated, consisting of the AB and Oiler who were instructed to enter the engine room to monitor the situation and report back.
  • During this operation, the AB was unable to return back and was subsequently evacuated by the search and rescue team but was unable to survive from the injuries sustained.
  • Subsequently, the emergency generator failed and could not be restarted. An attempt was then made to start the No. 1 generator locally, which resulted in another fire due to electrical shorting of cable wires. The generator was immediately stopped and the fire was extinguished.
  • The vessel was taken under tow and was towed to the port of San Francisco. The extent of damage sustained resulted in the vessel remaining without power for 14 days.

Details of vessel

  • The Pine Galaxy is a chemical/products tanker built in the Shin Kurushima Dockyard, Japan and registered in the port of Nassau, Bahamas.
  • The vessel was powered by a Kobe Diesel main engine, producing 8471 KW to drive a single fixed blade propeller. Additionally, the vessel had three Yanmar 6N18AL-UV generators with a capacity of 625 KVA each.
  • The cargo was carried in a total of twenty-two (22) cargo tanks that were arranged as 1 – 10 port and starboard with two slop tanks located aft of the cargo tanks. The vessel was fitted with a nitrogen generating system.

Casualties

  • The AB was part of the fire team, which was sent to sight and report any continued fire was the only casualty. The fire team consisting of an Oiler and AB was sent to engine room 25 minutes after the activation of the CO2 system.
  • However, the AB did not return and was subsequently found unconscious during the search and rescue effort. CPR was maintained for an extended period of time proved unsuccessful and the AB was pronounced dead on 13 August 2014.

Structural Damages

  • There was minimal structural damage overall and localized deck plating damage in the vicinity of the fire.
  • The cabling from the generators to the main switchboard located in the engine control room was heavily damaged.
  • Generator No. 1 had some oil residue on its surface but sustained negligible heat or direct fire damage. Generator No. 2 had a significant amount of oil on it, especially on the side facing generator No. 3.
  • The workshop area was subject to heavy fire and smoke damage.
  • The reason for the failure of the emergency generator was later determined to be a faulty voltage regulator.

Recommendations

  • It is recommended to review and improve familiarization training onboard for all emergency systems and initiate a safety campaign to ensure all crew members are educated on the importance of following established procedures in emergency response activities.
  • It is recommended to revise the safety management system to set clear training requirements for the operation of CO2 systems and to ensure these requirements are verified during internal management audits.
  • It is recommended to initiate a safety campaign to ensure all staff is aware of the hazards of running diesel engines with critical safety features removed.
  • Consider a review of the work planning procedures and risk assessments to be implemented for unplanned maintenance following any major overhaul operation.
  • It is recommended to review the competence and experience requirements of Officers onboard with responsibilities of designated equipment.
  • Consider clearly marking CO2 system pilot bottles to differentiate them from normal bottles.
  • Consider additional emergency lighting within the CO2 room to ensure space is properly illuminated.
  • Consider making a modification for hyper mist pumps to be connected to the emergency switchboard.

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Source: BahamasMaritime