Fatal accident during mooring operation
Official report: (Edited from Statens haverikommission (SHK) Swedish Accident Investigation Authority – Report S-95/11)
A general cargo ship arrived with an import cargo that was stacked high on the hatch covers, exposing a large lateral wind area. A strong offshore wind was blowing during the final approach to the berth (starboard side to) with a pilot on board, but it had been already decided that the docking could be safely completed without tug assistance.
The forward mooring team on the forecastle consisted of the C/O, Bosun and an able seaman (AB). The vessel was fitted with a large wavebreaker right forward, which meant that the forecastle deck had very little clear area. Standing on a small bulwark platform on the starboard side, the C/O was leading the team and also operating the mooring winches remote control levers located close by. The bridge team had no view of the forward mooring station due to the tallwavebreaker and high deck cargo.
The ship approached the berth at an angle of about 30 degrees and, with her bow close to the jetty, the forward spring line was sent ashore and belayed on a bollard. In order to bring the stern closer to the quay the pilot requested slow ahead on the engine and full port rudder. In addition, the bow thruster was activated to port so as to align the ship parallel with the wharf.
Before undertaking this manoeuvre, the Master warned the foredeck team on the portable VHF radio that the engine would be working ahead and that all personnel should stand clear of the taut backspring. This was acknowledged by the C/O, but for unknown reasons, he remained at his position. The engine and rudder movement was performed but had to be repeated within minutes as the stern did not move sufficiently towards the quay. Again, before the engine movement, the Master called out a warning to the foredeck team and got confirmation from the C/O but he remained at his location near the winch remote control unit. This time, the engine order lasted longer, and probably due to the bow moving ahead and away from the shore, the backspring came under very high tension and suddenly parted. The broken rope end snapped back violently and hit the C/O on the head and neck, who was felled and lay motionless. Unfortunately, despite all efforts by crew and paramedics, the ambulance doctor declared the C/O dead soon after.
Investigation of the accident
1 The spring line had only been in use for a month and appeared to be in good condition;
2 The method used to berth a high-sided vessel without tug assistance in the prevailing conditions by working engine, rudder and bow thruster against a single backspring constituted a high risk maneuver;
3 The C/O failed to move away from snap back zone even after being warned by Master;
4 Poor design - Confined/restricted area on the forecastle deck and improper location of winch remote control unit
5 The company had no specific guidelines for mooring and the company management had not identified mooring to be a hazardous operation.
Editor’s Note: Although the report does not specify the actual point of failure of the hawser, it is likely that the newly inducted line parted at a stress point or nip that would have developed at the multi-angle fairlead when the vessel was moved with a prolonged ahead engine kick. This incident clearly illustrates how the sudden linear contraction of a synthetic fibre rope parting under excessive tension can cause injury/damage at a considerable distance from the point of failure.
（译文参考：船舶管理部 傅恒星编译）
锚泊操作时致命事故
官方报告：（由瑞典SHK事故调查当局编写-Report S-95/11）一艘货舱甲板上高高的堆着进口货物的杂货船，形成较大的侧面受风面。船舶引水在船并接近码头的最后阶段一股强劲的离岸风自右舷吹来，但此时已经决定在不需拖轮协助情况下独立靠泊。
在船首甲板执行系泊作业的人员组成包括，大副、水手长和一名一等水手，该轮在首甲板正前方设有巨大的防浪墙，这就意味着在艏甲板仅存一片很小的开敞空间。大副站在设在右舷舷墙上的一个小的作业平台上指挥船首作业人员，同时操纵身边的系泊缆车的遥控杆。由于堆起的高高的货物和高大的放浪舷墙的存在，驾驶台人员无法观察到首系泊站及作业人员。
船舶已30°夹角接近码头，并且船首靠近码头，首倒缆被送到码头并系到缆桩上，为了让船尾靠近泊位引水要了“Slow Ahead”和左满舵，为了让船舶与码头平行，引水员还启动了首侧推使船头左移。
执行该机动操车前，船长通过VHF警告船首系泊人员，船舶将用进车，人员应远离倒缆可能反弹的区域，大副确认明白指令，但不知何故他仍然站在原来的位置没动，在几分钟内车、舵多次同时作用，但船尾向码头靠近的效果不明显。再次动车前，船长又警告船头系泊人员远离危险区域。和上次一样，大副答应后仍然呆在缆车控制单元附近没动，这一次，主机用车时间比前几次都长，在车、舵的作用下，可能由于船首向前并远离码头运动的缘故，倒缆越绷越紧并且突然断裂，断缆末端迅猛回弹并击中大副的脖子和后背，被击中的大副躺倒后一动不动。不幸的是，尽管船员和医护人员付出各种努力，急救医生依然在不久后宣布大副已经死亡。
事故调查
1 该倒缆一个月前刚投入使用，状况良好；
2 在没有拖轮协助并在当时风、流条件下仅仅通过动车、舵、首侧推的配合来操纵一条高舷墙的船舶在倒缆束缚下机动用车，本身就是一个高风险策略。
3 尽管船长一再警告，大副始终未能离开缆绳可能的反弹区域
4 设计的缺陷-狭小/受限的首甲板空间，和不恰当的缆车控制单元位置的布置。
5 公司没有专门的系泊作业的操作指南，并且在公司的管理体系里没有将系泊作业界定为危险作业。
编者按：虽然报告没详细指出该系船缆断裂的确切位置，有可能新投入使用的缆绳，在通过导缆孔时出现受力方向/角度多次改变，在主机持续作用下船舶前进，缆绳提供反作用，缆绳在应力点或剪切点处断裂。 该事故清楚的表明，线性收缩的合成纤维绳在受到过度张紧情况下故障点的突然断裂会导致一定范围内的人员受伤/损坏。
