E R I K A O c c u p a t i o n a l A c c i d e n t F a l l O v e r b o a r d 2 7 F e b r u a r y

Transcription

1 MARINE ACCIDENT REPORT Danish Maritime Accident Investigation Board E R I K A O c c u p a t i o n a l A c c i d e n t F a l l O v e r b o a r d 2 7 F e b r u a r y Page 1 of 19

2 Danish Maritime Accident Investigation Board, Vermundsgade 38 A, DK-2100 Copenhagen Ø. Tel.: , CVR no.: The casualty report has been issued on: 7 November 2011 Case: The casualty report is available from the webpage of the Danish Maritime Accident Investigation Board Division for Investigation of Maritime Accidents/Danish Maritime Accident Investigation Board The Division for Investigation of Maritime Accidents investigated maritime accidents and serious occupational accidents on Danish merchant and fishing vessels. The Division also investigated maritime accidents in Danish waters involving foreign ships. On 15 June 2011, the Division for Investigation of Maritime Accidents was discontinued and its tasks were taken over by the Danish Maritime Accident Investigation Board. This report has been finalised by the Danish Maritime Accident Investigation Board in agreement with the Danish Maritime Authority in accordance with the guidelines that applied to the Division for Investigation of Maritime Accidents of the Danish Maritime Authority. Purpose The purpose of the investigation of the Division for Investigation of Maritime Accidents and the Danish Maritime Accident Investigation Board is to procure information about the actual circumstances of the accident and to clarify the reasons and the sequence of events leading to the accident for preventive purposes. The aim of the investigation is not to establish criminal or economic liability. Contact the Danish Maritime Accident Investigation Board Telephone: dmaib@dmaib.dk Outside office hours, you can contact the Danish Maritime Accident Investigation Board by telephone Page 2 of 19

3 Contents 1 Summary Conclusions Safety initiatives and recommendations The investigation Factual information Accident data Navigation data Ship data Weather data The crew Narrative Stowing the seine The crew The fisherman Qualification and training Equipment on board The fisherman s equipment Regulations for protective measures Treatment on board Training on board Risk assessment and action plan reducing risks Fisherman falling overboard from Greenlandic trawler MARKUS in May Analysis Immediate causes Contributory causes Page 3 of 19

4 1 Summary On 27 February 2011, the seiner ERIKA was fishing for capelin on the fishing grounds west of Iceland. At LT, while securing the third throw of the seine for the day, one fisherman fell overboard. The remaining crew were able to recover the fisherman, but he was unconscious, and it was not possible to resuscitate him. A doctor was hoisted on board ERIKA from a rescue helicopter, and the doctor declared the fisherman dead. 2 Conclusions Immediate causes (6.1) Unsafe actions The Division for Investigation of Maritime Accidents concludes that the change made to the sea rail made it possible to fall overboard between the gunwale and the sea rail. Unsafe surroundings It is the assessment of the Division for Investigation of Maritime Accidents that the vessel s movement in the sea was the cause of the seine starting to slide. The position of the fisherman working in the seine bin was normally considered safe, but the vessel s movements made the position exposed to the sliding seine. Contributory causes (6.2) The safety system The Division for Investigation of Maritime Accidents concludes that not all crewmembers had the mandatory training for commencing service on board a Greenland registered vessel. The deceased crewmember did not have any prior experience at sea and no maritime training before commencing his service on board ERIKA. It is the assessment of the Division for Investigation of Maritime Accidents that the completion of a maritime safety course introducing basic knowledge about the service at sea could possibly have increased the deceased crewmember s awareness about the possible risks during a potentially dangerous operation. The Division for Investigation of Maritime Accidents concludes that the fisherman was conscious when falling in the water and during the initial phases in the water. The Division for Investigation of Maritime Accidents notes that the fisherman would have been able to release a manually operated inflatable lifejacket immediately after having fallen into the water. It is the assessment of the Division for Investigation of Maritime Accidents that the use of a suitable lifejacket would probably have saved the fisherman s life as it would have kept his head above the water surface even if unconscious. It is the assessment of the Division for Investigation of Maritime Accidents that the rescue operation in very adverse conditions was conducted professionally Page 4 of 19

5 and that a faster recovery could not have been expected. The Division for Investigation of Maritime Accidents notes the efforts made by the trawlboss by entering the water and thereby being instrumental in recovering his unconscious colleague. It is the assessment of the Division for Investigation of Maritime Accidents that, when attempting to resuscitate their colleague, the crew used all available resources and did everything possible to revive their colleague. 3 Safety initiatives and recommendations Safety initiatives Sea rail Following the accident, the ship owner immediately installed a temporary net as a sea rail along the seine bin. This net was subsequently replaced by a permanent installation alongside the bin (see Figure 1). This sea rail is raised when shooting the seine and subsequently closed, thereby preventing crewmembers from falling overboard when working in the seine bin. Figure 1: Permanent sea rail along the seine bin installed following the accident (Photo: The ship owner) Safety training Following the accident, the ship owner has arranged for all members of the deck crew to complete a maritime safety course in Iceland. This course fulfils the relevant STCW regulations. Page 5 of 19

6 Surveys, Safety and Working Environment on Board Greenlandic Fishing Vessels. As a consequence of recommendations given by the Division for Investigation of Maritime Accidents following an accident on board a Greenlandic fishing vessel in 2010 the Danish Maritime Authority has initiated preparing an action plan for Greenlandic fishing vessels. The action plan focuses on the working environment on board the fishing vessels, and is prepared in cooperation with the Government of Greenland, the Greenland Employers Organisation, the Organisation for Greenlandic Fishermen, Sealers and Hunters (KNAPK) and the Danish Fishermen s Occupational Services Furthermore in 2010 and 2011 the Danish Maritime Authority has carried out several unannounced surveys on board Greenlandic fishing vessels with special focus on safety and the on board working environment. Recommendations The Division for Investigation of Maritime Accidents recommends that the shipowner: - considers ways to ensure that a suitable work lifejacket is available for crewmembers when working on deck in areas presenting an increased risk of falling overboard. 4 The investigation Following the accident, the Division for Investigation of Maritime Accidents was on board the vessel in Iceland on 1 March 2011 for interviews with crewmembers and data gathering. During the investigation, the Division for Investigation of Maritime Accidents has received information from the Icelandic Police, the ship owner, the Danish Maritime Authority and the Centre for Maritime Health Services. 5 Factual information 5.1 Accident data Type of accident (the incident in details) Falling overboard Time and date of the accident 27 February 2011 at LT Position of the accident N / W Area of accident North Atlantic IMO casualty class Very serious 5.2 Navigation data Stage of navigation Port of departure Securing gear after fishing Neskaupstadur, Iceland Page 6 of 19

7 5.3 Ship data Name ERIKA Home port Tasiilaq Call sign OWHM Vessel IMO no Ship owner East Greenland Codfish A/S Shipowner s IMO no: Register Greenland Flag State Denmark Construction year 1987 Type of ship Purse seiner Tonnage 1236 GT 5.4 Weather data Wind Sea state Water temperature Southwesterly m/s Approximately 8-9 metres 6.6 degrees C 5.5 The crew Number of crewmembers 13 Occupation on board the ship at the time of the accident (crewmembers relevant to the accident) Master Chief Officer Bosun and trawlboss Fisherman (deceased) 28 years old. Certificate as master on vessels of up to 3000 GT and certificate as medical care officer on board Danish vessels. Serving on board ERIKA since Has served in all deck positions on board. Serving as master since summer of years old. Certificate as master on board fishing vessels and certificate as medical care officer on board Danish vessels. Serving in the company since 2000 and on board ERIKA for the last 1½ years. 31 years old. Certificate for attended course in maritime safety and survival (STCW95 A-VI/1-1, 1-2, 1-3, 1-4). Serving on board ERIKA since years old. No maritime education. No previous experience at sea. Signed on the vessel for the first time on 2 February Page 7 of 19

8 5.6 Narrative Neuskaupstadur (Last port of call) MOB position Helguvik (planned next port of call for discharge) Figure 2: Iceland, MOB position, last port of call and planned next port of call. Photo: Google Earth ERIKA departed the port of Neskaupstadur, where the previous catch had been discharged, at LT on 25 February 2011, bound for the capelin fishing grounds off the west coast of Iceland. There were approximately 30 hours voyage from Neskaupstadur to the fishing grounds, and ERIKA commenced fishing at noon on Sunday 27 February During this Sunday, ERIKA threw the seine three times. After having shooted the seine three times, ERIKA was fully loaded and prepared to depart the fishing grounds for Helguvik on the west coast of Iceland in order to discharge the catch. While securing the seine in the bin after the last shoot, two crewmembers were working in the bin storing the lead weights in the forward part of the bin. The positions of the individual crewmembers were as indicated in Figure 3. Positions A and B are the two crewmembers working in the bin, and position D is the trawlboss operating the crane. Position A is the crewmember who later fell overboard. Page 8 of 19

9 Crane with roller for stowing the seine in the bin (seine crane) D : Position of the crane driver operating the seine crane Tube the seine travels through on its way to the crane and seine bin A: Position of the later deceased crewmember B: Position of the crewmember stowing the lead weights on the forepart of the seine bin Figure 3: Crewmember s position on deck. Photo: Icelandic Police. When the last part of the seine fell from the seine crane, it fell as expected in a pile vertically below the outer end of the crane. Due to the vessel s movement in the heavy swell, the pile started to skid towards crewmember A, who was standing close to the open railing on top of the already stowed part of the seine (see Figure 3). Witnesses have explained that, when the pile started skidding, the seine hit crewmember A and pushed him overboard passing under the open railing. As normal when preparing and securing the seine before and after fishing, the trawlboss operated the crane. The trawlboss therefore saw what happened and immediately called Man over board and shouted for a lifebuoy to be thrown in the water. A lifebuoy was thrown in the water, and it landed approximately 2-3 metres from the crewmember in the water. The crewmember in the water was observed swimming towards the buoy. He was not observed reaching the lifebuoy. The trawlboss ran to the wheelhouse just forward of the crane and took a survival suit, which he donned. He then ran to the main deck starboard side, where he met two other crewmembers just forward of the accommodation. When the crewmember fell overboard, the master was in the wheelhouse conning the vessel from the starboard manoeuvring position, turning the vessel into the wind to make work on deck easier for the deck crew. When he heard the Man over board call, he looked aft and immediately saw the crewmember in the water. He increased the Page 9 of 19

10 rate-of-turn to maximum using the thrusters and, while the vessel was turning, released the Man-Over-Board buoy and smoke marker from the starboard side bridge wing. 0,9 meter Approximate position of crewmember A Figure 4: The open railing alongside the seine bin. Photo: DMAIB When the trawlboss arrived on the main deck, he could still see the crewmember in the water. The man in the water was approximately 10 metres from the vessel, and the trawlboss observed that his head was bent forward and the face pointing down towards the water. There was no movement and the crewmember seemed unconscious. On his own initiative, the trawlboss donned a so-called BJOGVINSBELTI (a lifebelt with a line attached to the vessel). He then jumped overboard and swam towards the crewmember in the water. When the trawlboss arrived at the unconscious crewmember in the water, the crewmember was starting to sink below the surface of the water. The trawlboss took hold of the crewmember and lifted him out of the water, while shouting to the crew on board ERIKA to pull them in. The unconscious crewmember and the trawlboss were pulled close to ERIKA s side. The unconscious crewmember was hauled on board assisted by a wave pushing him, and attempts to resuscitate him using CPR, oxygen and automated external defibrillators (AED) were started immediately on deck by the chief officer and 3rd officer. It was estimated that approximately 10 minutes passed from the crewmember fell overboard until he had been recovered back on board ERIKA. Page 10 of 19

11 As soon as the trawlboss and the crewmember were back on board, and the master therefore did not have to concentrate as much about manoeuvring the vessel, he called the Icelandic coastguard, informed them of the accident and requested a doctor to be put on board by helicopter. The coastguard confirmed that a helicopter could be on the position within minutes. The resuscitation attempts were initiated immediately on deck by the chief officer and the 3rd officer. Because of the waves breaking and water coming on deck, the unconscious crewmember was shortly after moved inside the accommodation and the resuscitation attempts were resumed. The crewmember remained unconscious and did not seem to react to the treatment. The master was in constant contact with the Icelandic coastguard, and they confirmed that the CPR, oxygen and use of the AED was the correct treatment and should be continued. The master was not in contact with the Danish Radio Medical service. After a short while, a small helicopter arrived at the position. This helicopter had been on an exercise in the area and had been scrambled by the Icelandic coastguard following the first radio call from ERIKA. This helicopter did not have a doctor or a medic on board and therefore could not offer any medical assistance. Approximately 30 minutes after the first call to the coastguard, an Icelandic rescue helicopter arrived at the position, and a doctor was hoisted on board ERIKA. When the doctor arrived on board, he first gave the crewmember an adrenalin injection. He then had to wait for a heart monitor to be hoisted down from the helicopter. While waiting for the heart monitor, the attempts to resuscitate the crewmember continued. When the heart monitor was received and connected to the crewmember after approximately 15 minutes, the doctor observed no reactions to the treatment. He therefore stopped further treatment and declared the crewmember dead. At no time during the treatment did the crewmember regain consciousness. 5.7 Stowing the seine When securing the seine after fishing, the seine was taken through the tube just aft of the wheelhouse starboard side. From the aft end of the tube the seine went to the roller on the seine crane and from there vertically down to the stowed position in the seine bin. In the bin, the fisherman was assisting another crewmember who was stowing the lead weights used for weighing down the lower part of the seine when shooting it. The procedure used on the day of the accident was the standard procedure, and the fisherman stood in a position that was normally considered safe. However, the vessel was rolling heavily in the sea, and these movements made the pile of the seine below the seine crane slide towards the ship s side, hitting and thereby pushing the fisherman overboard. Page 11 of 19

12 5.8 The crew The crew consisted of 13 crewmembers. Until September 2009, the vessel had been on the Icelandic Register, but in September 2009 the vessel was transferred to the Greenland flag. Following the change of flag, the master and the deck and engine officers six in total all remained Icelandic. The cook, the bosun/trawlboss and the deck crew were all from Greenland. 5.9 The fisherman The fisherman signed on ERIKA on 2 February It was his first contract and he did not have any maritime training or any prior experience at sea. His contact to the ship owner and signing on the vessel was established via some of the other crewmembers who lived in the same Greenland settlement 5.10 Qualification and training According to the Danish Maritime Authority, the Danish rules and regulations regarding the qualification and training of crewmembers apply to Greenland registered vessels. The Danish rules and regulations stipulate that no one must serve on fishing vessels including Greenland registered vessels without having completed either a basic course for ship s assistants or a safety course for fishermen approved by the Danish Maritime Authority. Crewmembers with a minimum of two years service on board vessels before 1 September 1996 were exempted from this rule. The deceased fisherman had not completed any of the courses mentioned and did not have any experience at sea before 1 September According to the Danish Maritime Authority, control of qualifications and training on board Greenland registered vessels is under the jurisdiction of the Government of Greenland. The ship owner has informed the Investigation Division that it is their intention that all crewmembers on board their vessels should complete an approved maritime safety course. On board ERIKA the bosun/trawlboss had completed an Icelandic maritime safety course in March This course complied with STCW95 A-VI/1-1, 1-2, 1-3 and Equipment on board Sea rail Previously the sea railing along the seine bin had been as shown below in figure 5. Compared to the new sea rail in figure 4, the previous sea rail offered better protection against falling overboard. However, when shooting the seine, the seine was often caught in the sea rail, thereby making it more difficult to launch the seine. Therefore, in connection with a visit to a shipyard, the vessel s sea rail was changed to the design shown in figure 4. The ship owner has informed the DMAIB that, as a consequence of the accident, the sea rail on all the owner s vessels will be changed to a hydraulic system which can be Page 12 of 19

13 raised when shooting the seine. When this new system is in the down position, it will be much like the old system, thereby preventing crewmembers from falling overboard between the rails. This new system is shown in figure 1 as installed on ERIKA following the accident. Figure 5: The previous sea rail before being modified. Photo: Ship owner Immersion suits, lifejackets and lifelines ERIKA had on board survival suits for all crewmembers. These were only intended to improve the chances of survival in case the crew had to abandon the vessel. The suits were of a type not suitable for use when working on deck. There were self-inflatable lifejackets for all crewmembers. The crew had previously tried using these lifejackets when working on deck. Due to the amount of water on deck, the lifejackets often self-inflated during work on deck, and the use of these lifejackets had therefore been abandoned. The vessel was equipped with personal lifelines for the crewmembers. According to the crew, it was not practically possible to work on deck setting or recovering the seine using these lifelines. Page 13 of 19

14 Rescue belt (Bjorgvinsbelti) ERIKA had previously been on the Icelandic Register, and the BJOGVINSBELTI is mandatory on board Icelandic vessels (see figure 6 for a picture of the rescue belt). As described earlier, the trawlboss was wearing the rescue belt when he jumped into the water to rescue the unconscious crewmember, and this made it significantly easier for the other crewmembers to recover the two crewmembers in the water. Figure 6: The rescue belt (Bjorgvinsbelti) as used on board. Photo: DMAIB Helmet As is routine on most seine vessels when setting and recovering the seine, all crewmembers were routinely wearing helmets The fisherman s equipment When falling overboard, the later deceased crewmember was wearing a full set of raingear, sea boots and a helmet. Under the raingear, he wore normal warm clothes. He did not wear a lifejacket. On board ERIKA, there were no fixed rules regarding the equipment and personal protective equipment to be used when working on deck. The equipment used by the deceased crewmember was typical of the equipment used by the deck crew when working on deck Regulations for protective measures When crewmembers are working in areas presenting an increased danger of falling overboard, the relevant regulations from the Danish Maritime Authority must be met (Notice E, chapter VI, regulation 5 Technical Regulation on the Construction and Equipment etc. of Fishing Vessels ), stipulating that sufficient measures to prevent falling overboard must be taken. This includes using lifejackets, lifelines and/or other suitable equipment. Page 14 of 19

15 5.14 Treatment on board When the crewmember was brought back on board, he was unconscious and showed no vital signs of life. Resuscitation attempts were started using CPR, oxygen and the on-board automated external defibrillators (AED). When starting the treatment, it was observed that an apparently large amount of water came from the crewmember s lungs when the treatment began. Due to the amounts of water on deck, the unconscious crewmember was soon brought inside the accommodation and the treatment continued there. The master remained in the wheelhouse and was in constant contact with the Icelandic coastguard while waiting for the requested helicopter. The coastguard confirmed that the treatment given was correct and should be continued until the helicopter with the requested doctor arrived. The on-board treatment was conducted by the chief officer and 3rd officer. The master and the chief officer had completed the mandatory training for acting as medical care officers on board Danish registered vessels. When the doctor arrived on board after approximately minutes, he gave the crewmember an adrenalin injection, but this had no apparent effect. The doctor and crew had to wait for 15 minutes before a heart monitor arrived from the helicopter. While waiting for the heart monitor, the resuscitation attempts were continued. When the heart monitor was connected to the crewmember, it confirmed that the treatment had had no effect, and the doctor consequently declared the crewmember deceased. Although both the master and the chief officer had completed the Danish medical care training, the Danish Radio Medical service was not contacted Training on board When new crewmembers signed on board the vessel, they were given a familiarization tour of the vessel and their work on board. No familiarization form was used documenting the familiarization, but the tour followed a comprehensive checklist prepared by the chief officer and consisted of safety items, work related items and items related to life on board. When the later deceased crewmember signed on board ERIKA, he was given the familiarization tour after approximately two weeks on board. His familiarization was given by the chief officer. It was explained to the Division for Investigation of Maritime Accidents that, as ERIKA was the first service at sea for the later deceased crewmember, the ship management wanted to give him time to settle in and get used to life on board before giving him the familiarization tour. It was believed that the tour consisted of too much specific maritime knowledge to be comprehended by a crewmember without prior experience at sea. Training in specific tasks for new crewmembers was given as on-the-job training. New crewmembers worked closely together with an experienced colleague and were not given any independent responsibility before it was being considered safe to do so. Page 15 of 19

16 5.16 Risk assessment and action plan reducing risks On board ERIKA, a completed system of risk assessments covering the functions on board had been prepared. This system was written in Icelandic and had been used when the vessel was in the Icelandic Register. Due to the transfer to the Greenland Register in September 2009, a Danish system identifying the risks involved in the vessel s operations was being prepared, but had not yet been completed. As part of the new system a risk assessment regarding the risks involved when recovering the seine had been prepared. This risk assessment identified some areas of recovering the seine involving a special risk. For operations where special risks had been identified, an action plan for preventive measures reducing the risks should be prepared and implemented. On board ERIKA, this action plan regarding the risks when recovering the seine had not yet been initiated Fisherman falling overboard from Greenlandic trawler MARKUS in May In May 2010, a fisherman fell overboard from the Greenland registered trawler MAR- KUS when the vessel was shooting the trawl. The fisherman died and was never recovered. Following the accident, the Division for Investigation of Maritime Accidents published a report in Danish containing the recommendation below to the Danish Maritime Authority: Recommendation to the Danish Maritime Authority in the MARKUS report published on 21 September 2010: It is the assessment that, as regards Greenland fishing vessels, there is not the same possibility of being advised about occupational health as is the case in connection with fishing vessels registered in Denmark. An important element of this difference is the fact that, since 1993, the two sides of the fishing industry have had the possibility of being assisted and guided by the safety work of the Danish Fishermen's Occupational Health Service. A similar organization is not found in Greenland. - The Division for Investigation of Maritime Accidents recommends that the Danish Maritime Authority carries out an analysis of the occupational health conditions on Greenland fishing vessels and, on the basis of this and in co-operation with the relevant bodies, assesses what measures should be taken to improve the occupational health conditions on Greenland fishing vessels. Since the publication of the MARKUS-report the Danish Maritime Authority has initiated preparing an action plan for Greenlandic fishing vessels. The action plan focuses on the working environment on board the fishing vessels, and is prepared in cooperationwith the Greenland government, the Greenland Employers Organisation, the Organisation for Greenlandic Fishermen, Sealers and Hunters (KNAPK) and the Danish Fishermen s Occupational Services. The work is still in progress but three main areas has been identified as important for the overall result: - An improved sharing of knowledge between Greenland and Denmark, - A strengthened level of information regarding working environment in the larger fishing ports and as part of the maritime fishing educations. Page 16 of 19

17 - During surveys on board the vessels a increased focus will be on working environment on board. It is also proposed to establish a safety network divided in a team placed centrally and a team of safety representatives working locally out of the main Greenlandic fishing ports. If established this safety network will monitor the development in the occupational accidents on board Greenlandic fishing vessels and continually evaluate the possibilities of improving the safety on board the vessels. 6 Analysis 6.1 Immediate causes Unsafe actions Modification to existing sea rail. In order to ease the setting of the seine, the ship owner decided to change the design of the sea rail. The solution chosen introduced an approximately 90 centimetre wide gap between the gunwale and the sea rail. The Division for Investigation of Maritime Accidents concludes that the change made to the sea rail made it possible to fall overboard between the gunwale and the sea rail. Unsafe surroundings Sea state and vessel movement The master of ERIKA estimated the sea to be approximately 8-9 metres high. When preparing to recover the seine from the water, the vessel was lying with the sea abeam, making ERIKA roll heavily. When it was possible, the master started to swing ERIKA into the sea using his thrusters in order to minimise the vessel s movements and thereby making the work on deck easier. When the pile of the seine below the seine crane started to slide, hitting and pushing the crewmember overboard, the master was still in the process of turning the vessel into the waves, and ERIKA was still rolling severely. It is the assessment of the Danish Division for Investigation of Maritime Accidents that the vessel s movement in the sea was the cause of the seine starting to slide. The position of the fisherman in the seine bin was normally considered safe, but the vessel s movements made the position exposed to the sliding seine. Page 17 of 19

18 6.2 Contributory causes The safety system Qualifications and training For Greenland registered vessels, the Danish rules and regulations on the qualification and training of crewmembers applies. Apart from the officers, only one of the crewmembers had the mandatory course in maritime safety for fishermen. None of the remaining deck crew had the documented experience at sea before September 1996 to be exempted from the requirement to complete an approved maritime safety course. According to the Danish Maritime Authority, control of qualifications and training on board Greenland registered vessels is under the jurisdiction of the Government of Greenland. The Division for Investigation of Maritime Accidents concludes that not all crewmembers had the mandatory training for commencing service on board a Greenland registered vessel. The deceased crewmember did not have any prior experience at sea and no maritime training before commencing his service on board ERIKA. It is the assessment of the Division for Investigation of Maritime Accidents that the completion of a maritime safety course introducing basic knowledge about the service at sea could possibly have increased the deceased crewmember s awareness about the possible risks during a potentially dangerous operation. The use of life-saving equipment When the fisherman fell overboard, he was not wearing a lifejacket. Lifejackets had previously been used when working on deck, but because the lifejackets repeatedly inflated themselves due to water on deck, the use of these lifejackets had been abandoned. When the fisherman fell overboard, a lifebuoy was thrown in the water within seconds. The lifebuoy landed a few metres from the fisherman in the water, and he was observed swimming towards it. From the moment when the fisherman fell overboard until he was recovered back on board by the crew approximately 10 minutes passed, and it was established that the fisherman died from drowning. The Division for Investigation of Maritime Accidents concludes that the fisherman was conscious when falling in the water and during the initial phases in the water. The Division for Investigation of Maritime Accidents notes that the fisherman would have been able to manually release a manually operated inflatable lifejacket. It is the assessment of the Division for Investigation of Maritime Accidents that the use of a suitable lifejacket would probably have saved the fisherman s life as it would have kept his head above the water surface even if unconscious. The rescue operation When the crewmember fell overboard, the remaining crew on board reacted immediately. Approximately 10 minutes after having fallen overboard, the later deceased crewmember was recovered on board, and attempts to resuscitate him were initiated. Page 18 of 19

19 It is the assessment of the Division for Investigation of Maritime Accidents that the rescue operation in very adverse conditions was conducted professionally and that faster recovery could not have been expected. The Division for Investigation of Maritime Accidents notes the efforts made by the trawlboss by entering the water and thereby being instrumental in recovering his unconscious colleague. The treatment on board When the unconscious crewmember was recovered, attempts to resuscitate him started immediately using CPR, oxygen and on-board automated external defibrillators (AED). After minutes, a helicopter arrived at the scene hoisting a doctor to the vessel. The doctor administered adrenalin in a last attempt to obtain a heart rhythm. All attempts were unsuccessful, and the crewmember did at no time regain consciousness. During the treatment, the master was in constant contact with the Icelandic coastguard which followed the treatment. Because the master was already in contact with the coastguard, the Danish Radio Medical service was not contacted. The Division for Investigation of Maritime Accidents has been in contact with the Centre for Maritime Health Services for an assessment of the treatment given by the crew on board. The Centre for Maritime Health Services confirms that the treatment given was correct and all that could be done with the resources available. The Centre for Maritime Health Services finds it unlikely that contacting the Danish Radio Medical Service would have resulted in instructions about a different treatment. It is the assessment of the Danish Maritime Accident Investigation Board concludes that, when attempting to resuscitate their colleague, the crew used all available resources and did everything possible to revive their colleague. Page 19 of 19