BSAFE Onboard Safety

BSAFE INCIDENT CASE STUDY 21: MISMANAGEMENT OF MEDICAL CONDITION ON BOARD

Published: 23 November 2023

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A TRAGIC INCIDENT UNFOLDED ON BOARD A BULK CARRIER, CLAIMING THE LIFE OF A CADET WHO HAD SPENT THREE MONTHS ON BOARD. THE 34-YEAR-OLD TRAGICALLY LOST HIS LIFE AFTER INHALING HYDROCARBON FUMES EMITTED FROM A BUNKER TANK VENT WHILE THE TANKS WERE BEING HEATED. THE SHIP’S MANAGEMENT TEAM INITIALLY MISJUDGED THE SEVERITY OF THE CADET’S ILLNESS, LEADING TO A CRITICAL DELAY IN PROVIDING THE NECESSARY MEDICAL TREATMENT AND ADVICE.

WHAT HAPPENED

On 12 November 2022, aboard a bulk carrier off the western coast of Africa, a sequence of events unfolded that tragically led to the death of the deck cadet (DC). At the time of the incident, the ship was carrying approximately 46,000 MT of Nickel Ore, with the no. 5 cargo hold loaded to an estimated 47%. The ship had several Heavy Fuel Oil (HFO) tanks, including the no. 2 HFO tank (port), which emitted vapours from vents with approximately 170 MT low Sulphur fuel (0.49% of Sulphur content). The ship’s chief officer (CO) tasked the fitter with conducting repairs in the no. 5 cargo hold, and both began preparations around 0800 hours. They noticed a strong smell of fumes emanating from a vent associated with the no. 2 HFO tank port.

The fitter assured the DC that the repair wouldn’t take long, and the work began once the bosun opened the hatch cover, taking approximately 15 to 20 minutes. The DC assisted the fitter by passing equipment into the cargo hold while standing near the HFO tank vent on the main deck. Both exited the cargo hold around 1115 hours, with the DC expressing discomfort.

The following day, the DC reported feeling unwell to the CO, mentioning a headache and attributing it to inhaling fumes from the HFO tank vent the previous day. The CO advised rest and informed the ship’s master. The DC’s condition gradually worsened over the next few days, marked by reduced food consumption and diarrhoea.

Efforts were made to provide medical advice through communication with the crewing manager and a medical professional. The advice was to place the DC on a light diet. On 20 November, while the ship was sailing near the Cape of Good Hope, the master advised the DC to remain in his cabin due to choppy seas.

On 24 November 2022, citing that the DC had been experiencing dizziness, vomiting and diarrhoea, the master contacted the crewing manager to discuss the possibility of signing off the DC at Mauritius (ETA – 28 November 2022). It was decided that the second officer should accompany the DC’s sign-off, while the company-initiated plans for the DC to seek medical attention in Mauritius. Attempts were made to encourage the DC to consume food and receive medical advice, but his condition continued to deteriorate.

On 25 November, the DC’s condition deteriorated significantly, and he was found unresponsive by another deck cadet (DC 2) tasked with monitoring his condition every two hours. CPR was initiated, but the DC did not show any vital signs, and he was declared deceased.

Figure 1 VIEW OF THE FORWARD VENT FOR NO.2 HFO TANK (PORT)
Source MARINE SAFETY INVESTIGATION REPORT – TSIB – MOT – SINGAPORE

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