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Lack of Bridge Resource Management Training Contributed to Collision

Maritime Activity Reports, Inc.

March 23, 2023

Source: ATSB

Source: ATSB

The Australian Transport Safety Bureau (ATSB) has released its investigation report into a bulk carrier’s collision with two tugs in Tasmania last year highlighting the importance of bridge resource management (BRM) and the design of bridge systems to reduce the risks of human error.

On January 28, 2022, the Australian-flagged bulk carrier Goliath was turning in the swing basin to berth at the Port of Devonport, Tasmania, when it collided with two moored tugs, which subsequently sunk. There were no personnel on board the tugs at the time.

Goliath’s master had moved from the wheelhouse to the port bridge wing conning station to complete the turn. During this transfer of maneuvering controls, the correct steering mode was not selected. Subsequently, the master’s maneuvering orders, issued in the belief the ship was in joystick steering mode, had the unintended effect of increasing the ship’s speed as it closed on the tugs.

The ATSB found that neither the master nor the second mate on Goliath had undertaken the required BRM training and effective BRM was not evident during the incident.

“The various concepts, techniques, and attitudes that together comprise BRM remain among the most effective measures available to identify and eliminate, or rectify, human error,” said ATSB Chief Commissioner Angus Mitchell.

Since the incident, operator CSL Australia arranged for all deck officers serving on board Goliath to attend BRM training ashore and has added BRM training to its fleet crew training schedule. Additionally, the operator had modified Goliath’s joystick panels to incorporate a positive visual indication that joystick steering mode was selected.

The ATSB observed that, while the TasPorts risk assessment for Devonport had considered the potential for collisions between ships maneuvering in the swing basin and smaller vessels in the vicinity, the risk of injury to personnel on board those smaller vessels was not specifically considered. On this occasion, it was largely fortuitous that there were no personnel on board the tugs at the time of the collision.

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