Costa Concordia – The 3 Most Fatal Mistakes

John Konrad
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January 20, 2012

gcaptainWhat Really Killed Costa Concordia’s Passengers?

Captain Schettino has received a lot of criticism in the mainstream press and, possibly, even more from industry insiders including gCaptain for abandoning ship before the last passenger was safe. An important question is not being asked however… would his presence on the bridge have saved lives?

The answer is likely no.

Abandoning ship may have been unconscionable but it was certainly not a lethal decision. This post hopes to identify those mistakes made which directly resulted in loss of life, but also come to the defense of the Captain by identifying what actions did, in fact, save human lives.

Of note, the following comments are made with input from ship captains and maritime experts based on the evidence now available. But its not until the “black box” is analysed and the investigation complete that we can determine the true causes of this disaster. What you are about to read are the best guesses of ship experts.

The First Fatal Mistake

Accidents are a result of many small events which latch together to form an incident chain. Taken separately, each mistake is minor but when strung together, they lead to disaster. Remove one link, one minor mistake along the timeline, and the chain is destroyed… disaster is avoided. It is beyond the scope of this article to reach back and uncover each mistake that was made, mistakes that reach back well before the vessel was even designed. I only mention this because the first major failing may sound small to some, but it’s critically important to the safe operation of ship.

The first fatal mistake was likely in the training of the bridge crew. The job of the captain is to give orders and the crew must accept even foolish ones, but it’s the understanding and execution of these orders which is most important.

When Captain Schettino ordered a “flyby” of the local port, it was the mate on watch’s responsibility to lay the course line down on the chart, check for hazards and advise the captain of obvious dangers. Once underway, it’s the mate’s job to follow the planned route and monitor any identified hazards.

“Flyby’s” or “showboating” maneuvers are in-fact dangerous, but are preformed every single day by countless ships around the world. So why did this one run aground?

The most likely answer is the mate on watch got distracted and missed the turn. This is easy to do with today’s reliance on a myriad of electronic navigation devices and the distraction that comes from phone calls to the bridge, logbook entries and, yes, sometimes the call of Facebook updates streaming into a cell phone.

We do not know why the mate on watch missed the pre-assigned turn, maybe it wasn’t laid out on the chart in the first place or maybe the Captain ignored the course line, we don’t know, but the turn was missed.

A classic failure of bridge resource management and crew training.

The Second Fatal Mistake

Slow down!

We hear those words everyday, but in our cars and at work, may of us ignore them. Moving fast is ok most of the time, but not when you’re in trouble. Once the turn was missed the ship should have slowed down. This is not a simple task on a 114,147 ton moving object, it requires backing down on engines and can result in uncomfortable motions that would disturb the passengers.

But it’s essential.

Once the turn was made the ship should have slowed down. But it didn’t.

The Middle

Many mistakes were made during the next few minutes but none of them fatal. Cruise ships run into rocks and reefs on a semi-frequent basis (it happened just last week here in the US) and most people survive. Even aboard the Titanic, there was enough time to save most lives if enough lifeboats had been available. Mistakes happen. The captain could have sent out a distress signal, he could have loaded all the lifeboats and taken a number of other positive actions, but I believe those actions would not likely have saved many lives..

The most critical factor in disasters is time. Time slows down in the mind of those witnessing disaster, but the real clock, the one on the wall, keeps ticking. Only so much can be done and the captain himself can give nothing but orders.

The Third Fatal Mistake

One hour and twenty five minutes after the point when the Costa Concordia missed that first critical turn she ran aground on the beach of Giglio island and, in doing so, the third – and possibly most fatal – mistake was made.

A slowly sinking ship that’s relatively stable and close to shore is not intrinsically dangerous. Yes, you want to get the passengers off before she sinks but you still have time to preform the rescue. What is dangerous is a listing ship!

When a ship lists past 5 degrees she becomes exceedingly dangerous (check out this video). The smooth steel decks turn into slides that propel equipment and people down it at a high rate of speed. It’s common practice to beach a sinking ship for two reasons. First, it brings the ship closer to shore allowing people to swim to safety (which they in fact did in this case) and limits the time of those who jump overboard from being in the cold water. Second, grounding the ship prevents her from sinking which can allow you more time to rescue those stuck inside her damaged hull.

Some even praise Captain Schettino for running the Costa Concordia aground, but this decision was flawed.

When a ship is grounded to prevent her from sinking, the typical maneuver is to point her bow toward a sandy point on the charge and drive her ahead. This was not possible here because the ship had lost propulsion. Instead the ship was driven by thrusters (or current, the facts remain unclear) sideways toward the beach. When the keel hit bottom her 114,147 tons of steel continued to have momentum but, because she was moving sideways (all sway with very little surge or yaw), the momentum didn’t propel her further onto the beach, rather it seems to have caused her top-heavy build to “trip over itself”.

The ship’s stability was already reduced by the free communication of water into the ship at the area of damage. Grounding reduced the stability further. When the keel touched bottom the center of gravity moved from inside the ship down to the keel. Just watch a toy ship in the bath as you let out the water… once the toy ship’s keel touches the bottom of the tub the ship tilts over.

Why does a ship list to starboard when all her damage is on the port side? This could have been caused by emergency ballasting procedures (pumping water into the starboard side to compensate for the water entering to port) but the more likely answer is that by grounding her starboard-side-to the beach the ship’s momentum pulled her over to starboard.

This was the most critical mistake!

Cougar Ace
Listing Car Carrier Cougar Ace

In 2006 the massive car carrier Cougar Ace experienced ballast problems and listed heavily in a remote section of Alaska. The damage was extensive but all crew members were able to escape to safety. A fatality did happen, as Joshua Davis so eloquently discovered in his article about the disaster, but not for days after the incident. The death did not occur in the storm or escape from the ship, it happened in calm seas when a salvage expert accidentally skid down her heavily listed decks.

Heavy lists aboard ships are dangerous and, in this case, could likely have been avoided if, rather than beaching the ship, Captain Schettino had anchored her in close proximity to the shore.

In Schettino’s Defense

Be sure to read Part 2 of this editorial on the Costa Concordia disaster titled “In Defense of Captain Schettino“.

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