Tuesday, April 22, 2014




EDITORIAL NOTE: This post follows up on our post of Monday April 21, 2014 where we first examined what we know of this accident and reprinted an article clarifying the master's responsibilities in an accident. To read our original post . To follow our analysis as it unfolds we suggest starting at the beginning with our original post. Our analysis is very different from the official S. Korean government pronouncements put out so far and very different from the media opinions thinly disguised in the reporting so far. We suggest our analysis only to those who can handle fact based maritime forensics if you are simply looking for a scape goat and are willing to allow  everyone else in the "causation matrix" a free ride then stick with the general media. But our analysis concerns itself with the proximate cause and all contributing factors and the responsible parties for both the proximate cause and all contributing factors. 

We believe the above image to be a South Korean Coast Guard photo of S Korean Coast Guard helicopters working the rescue attempt of the capsized ferry SEWOL. It is similar to a number of AP photos which may be viewed at : https://www.google.com/search?q=Korean+Ferry+SEWOL,+photos+official+company&tbm=isch&tbo=u&source=univ&sa=X&ei=tdJWU5nsH-KV8gH1q4DoDg&ved=0CDoQsAQ&biw=1304&bih=707#imgdii=_  you will also find photos from other sources there as well. We have at least studied the photos posted at the above linked site and can find no evidence of inflatable life rafts or rigid life boats. Look carefully at the top most deck , in this photo turned on its port side. The top deck is the typical storage spot for automatically released inflatable life rafts, often the back up system for large cruise ships. We also looked carefully along the sides of the ship in photos taken of it during normal service and could see no evidence of rigid life boats or inflatable evacuation rafts. 

 Yet this ship was operating along an open ocean route in a cold water region. If we are correct in assuming that the ship had no way of evacuating passengers except to put them in life jackets and in the water, the reported repeated discussions between the ship's deck officers and the Korean Coast Guard Vessel Traffic Center about how soon could the ship expect help to arrive makes an awful lot of sense. As we speculated in yesterday's post, the deck officers and the Master were possibly facing a Hobson's Choice expose their passengers to death by hypothermia while awaiting rescue or delay evacuation until rescue was at hand. The warmest we would have expected the water temperature to be at that location, and this is highly optimistic on the side of warmth, would be 55 degrees F or 12.78 degrees C. In water temperatures between 40 and 60 degrees F survival times vary with age, and physical condition and what a person is dressed in when they enter the water but the range is 1 to 6 hours with 1 to 3 hours being more likely, and time to becoming unconscious can be as short as thirty minutes. The colder you are when you enter the water, the shorter the survival time. So standing around on a cold deck a long time waiting to enter the water may extend your over all survival time but not your survival time in the water.

 Now assuming, remember we are just speculating based on photographs; that the ferry did not have life boats or inflatable evacuation rafts so that there was no way to get the passengers off dry shod. Now doesn't the radio transcript between the ferry and the S. Korean Coast Guard Vessel Traffic Center (VTC) make sense? The ferry officers keep asking when they may expect help because they are trying to extend survival times. The VTC never gives them an answer because frankly while the VTC probably knows exactly how long it will take to get the first coast guard helicopters on scene they also know the small number of helicopters they can send won't be able to carry but a handful of people at a time. Behind the scenes the VTC personnel are working with their Search and Rescue counter parts to see what kind of surface vessel response they can put together from both S. Korean Coast Guard assets and "Good Samaritan" commercial vessels". At the moment the VTC is talking with the ferry, the total vessel response possible is not known yet, the transit time of the first vessels to the scene is not known, and their carrying capacity for survivors is not known. This is all "Ops normal" in most any coast guard around the world under similar circumstances. No country has instant rescue resources for hundreds of off shore passengers always ready at hand for immediate deployment. The first asset on scene will likely be a helicopter and it won't be able to carry many people.Put people in the water too soon and when the surface rescue fleet arrives, much like in the Titanic case , they are just collecting bodies floating in life jackets.

 The S. Korean Vessel Traffic Center (VTC)  repeatedly urged the ship's officers to get the passengers dressed as warmly as possible and into "life rings". The ferry replied that their public address system no longer worked . The VTC urged the ferry to send crew members below and to start getting the passengers ready for evacuation even though they could not yet give a time on scene for rescue. If you read the stories of crew heroism linked to at the start of the article you will note that it contains stories of crew members below decks and in interior public spaces doing just that, in some cases giving away their own personal flotation device (life jacket) to passengers when there were more passengers in a space than there were life jackets in storage. Again this would be a normal situation, there must be one personal flotation device per person carried aboard but no maritime nation requires a ship to carry 100% of the requirement in each and every public space aboard. Typically ethical companies carry more than one per person, but storage is always some what spread out. NOW WE HAVE TO ASK AT THIS POINT  IF THE FERRY, IN FACT, AND WE NOW THINK IT MORE PROBABLE THAN NOT ; DID NOT HAVE LIFE BOATS OR EVACUATION INFLATABLE RAFTS WHY NOT?

 We don't know S. Korean passenger vessel safety law but we know the basic trend in such regulations in a lot of nations. We think it more probable than not that the ferry was not required to carry either life boats or inflatable evacuation rafts. The National Transportation Safety Board NTSB in the United States has had a recommendation pending for about a decade for the U.S. Coast Guard to require dry shod evacuation on all passenger carrying vessels. To this date the U.S. Coast Guard has not acted on the recommendation. The U.S. , nearly a century after Titanic , has many exceptions to the life boat rule of one seat per person duplicated on each side of the vessel for some fairly large passenger excursion boats, crew boats and ferries in the warmer climate zones of the U.S. Yet as the NTSB points out despite fairly mild winter air temperatures the water temperatures in winter over most of the United States inland and coastal waters will induce hypothermia in very little time. After a small charter fishing boat with no inflatable raft put its passengers and crew in life jackets into the water and ended up losing most to hypothermia before rescue, the NTSB recommended that there be no exceptions to carrying some form of dry shod evacuation flotation for any passenger carrying vessels. Owners of such vessels on "short route services" ( variously described by different industry interests ) have fought vigorously to avoid the carriage of this type of life saving equipment calling it an unnecessary expense. The U.S. Coast Guard has yet to respond to the NTSB. Usually the U.S. has the highest life safety requirements of any maritime nation, the reason most often cited by owners for registering their vessels outside of the U.S.  So if South Korea had no life boat rule for such a ferry, not only was it's running without life boats or inflatable evacuation rafts technically legal, it was well within discernible international norms. The problem is the international norm is immoral and irresponsible in light of what is known today about hypothermia.

 Now do you begin to see that the Captain's decisions involving delay of getting every one on deck were far from "murderous" but in fact due to circumstances beyond his control including the possible facts that by law and corporate greed he could not get evacuation rafts for his ship if they were not required by regulation and management viewed them thus "an unnecessary expense'? 
Add to that the unforeseen loss of the public address system and a picture emerges when combined with stories of heroic crew members below decks passing out life jackets of a ship trying to comply with the VTC's recommendations, but also trying to guess against a host of unknowns the best moment to put everyone on deck and when to commit the people to the water where upon the slow and varied by individual death process by hypothermia begins. "Murderous decisions", or difficult and dangerous ones with circumstances setting up the potential for disaster far beyond the control of the Captain, or any of the crew. This is what we mean by contributing factors. Who was responsible for the contributing factor of no evacuation rafts and all of the complications that beset the crew with in terms of abandonment timing?  The government failed to pass the necessary law. Out of a lack of foresight, or based on lobbying by the ferry owners?  The owners who are not obligated to run their vessel safety programs on minimal regulatory compliance standards, had the choice of only carrying the minimum the government required or properly equipping their vessels per modern best recommended practices. The Captain may have made the final decisions but his choices were limited by government and management years before the incident happened. Who really showed the callous disregard for human lives the Captain, the government, or the owners. In hind sight the Captain's decisions were not the best. But the decisions by government and the ferry owners managers were made in the cold light of day without the decks listing and the hull flooding and doomed children screaming. The apparent, and again we stress the word apparent; we aren't official investigators, and don't have access to direct evidence; lack of evacuation rafts is, if a fact, a major contributing factor in the death count. The Captain and none of the deck officers were responsible for the lack of of such life saving equipment.

 In America there are big excursion boat companies that have been exempted from a variety of safety regulations including inflatable evacuation rafts by operation of regulations. Yet in some markets you can observe more than one excursion vessel operator; often most are operating on minimal regulatory compliance. But occasionally one will be operating on best recommended practices. Observe the steamboat NATCHEZ in New Orleans

Photo by Infrogmation , licensed:  GNU Free Documentation License
 This large passenger day excursion boat operates in a busy river harbor carrying no over night passengers. Potential assist tugs and other potentially helpful craft are always in sight. The banks of the river are only a stone's throw away. They operate in a climate as near to tropical as you can get and still be in a technically temperate latitude.  Because of these conditions their Coast Guard Certificate of Inspection does not require them to employ watchmen ( a sort of junior unlicensed mate), but they do, in fact enough to keep all passenger decks under watchful surveillance when underway. They also aren't required to employ a non navigating mate, a requirement in the over night service, but they do. If ever an argument could be made that people in life jackets wouldn't wait long for rescue their route would qualify for that argument, but the Natchez carries inflatable evacuation rafts. If the company was run by the typical bean counters their safety program would be gutted as over kill. In fact it is simply a program based on best recommended practices, by ethical management and skilled boat officers. Operating on the assumption that putting passengers in the water would be the routine response in an emergency never crossed the New Orleans Steamboat Company's corporate mind. Revenue/ Profit wise they do just fine despite the extra passenger safety overhead. Safety is just as much a mark of quality in the cruise / excursion/ ferry industries as good food and general cleanliness. It is not a money loser except to short sighted management. 

 So as to the contributing factor of a lack of dry shod evacuation equipment, who should the Korean public hold responsible / liable, the Captain and the one mate who has been charged and described as "murderous and negligent", or the government and the owners? The government chose to not update the safety regulations to reflect modern knowledge of in water survival times. The owners chose not to set up their safety and survival equipment in accordance with best recommended practices and instead chose minimal regulatory compliance as their standard. Again this assumes that in fact the ship did not carry such equipment. If it did then the question should revolve around why the equipment was not deployed.

Finally as we noted in yesterday's post, the proximate cause of the loss of life is the capsize.
It would be difficult for a Captain to cause that by his sole error. We note that the S. Korean Coast Guard has detained the Chief Engineer. But that doesn't mean that he is responsible either. There are dozens of potential reasons that could cause sudden flooding and the resultant threats to stability. Some of these conceivably could be caused by manufacture's defect. Some failures may be of equipment subject to third party inspection and certification, classification society surveyors,  or SK Coast Guard inspectors or others may have failed to detect a critical defect, even then failure to detect a defect may not be evidence of negligence.
Our advice to the South Korean public is to with hold judgement until the information starts coming from reliable sources like the RK Coast Guard and any relevant marine transportation investigative body.  

 Generally, you may pretty well accurately presume that anything coming out of the mouths of elected officials or corporate officials right now is self serving and done in anticipation of deflecting liability for contributing factors. By arresting and criminally charging specific persons and attempting to vilify them in the media a defensive legal barrier is now erected around the accused and it becomes unlikely that any useful information that could be used to prevent this sort of thing in the future will  be forth coming as it would be if this thing was being examined in a neutral and forensic manner with judgement being reserved until all of the facts were in. Declarations of murderous intent by the President not with standing, you can bet that there is such an examination starting up within the SK Coast Guard system and that you won't hear much until they have some real verifiable facts available. 

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