NTSB: Critical Maintenance Error Leads to Engine Room Fire That Claimed Two Lives

A fatal engine room fire aboard the cargo vessel Stride, which claimed two lives and resulted in $12 million in total losses, was caused by the installation of an incorrect valve during routine maintenance, according to a National Transportation Safety Board (NTSB) report released today.

The incident occurred on January 8, 2024, during bunkering operations at the Barbours Cut Marine Terminal in LaPorte, Texas. One additional crew member was seriously injured in the fire, which eventually self-extinguished after the crew shut down engine room ventilation.

NTSB investigators determined that the root cause of the accident stemmed from the installation of an angle stop check valve instead of the specified angle stop valve in the vessel’s port double bottom diesel oil (DBDO) tank. This critical error occurred approximately six weeks before the incident.

The incorrect valve installation created a cascade of events during bunkering operations. When one tank reached capacity, diesel oil was redirected through a common vent line instead of flowing into the intended DBDO tank. The fuel then escaped through a previously sealed cut-out section in the vent pipe, where temporary sealing and tape failed to contain the flow. The escaped diesel oil cascaded onto operating machinery in the engine room, igniting the fatal fire.

“This tragic incident highlights the critical importance of proper component selection in marine systems,” said the NTSB in their report. The agency emphasized that vessel drawings and diagrams must be carefully consulted when ordering replacement parts to ensure system functionality is maintained.

The investigation also revealed several procedural violations that contributed to the accident. The vessel’s crew failed to adequately monitor tank levels during the bunkering operation, violating the company’s safety management system requirements. Additionally, the operation was understaffed, with only three engineering crew members present instead of the required minimum of four.

In their recommendations, the NTSB stressed the importance of maintaining proper staffing levels during bunkering operations and ensuring frequent tank soundings are taken to prevent overflow situations.

This incident serves as a stark reminder of how seemingly minor maintenance decisions, combined with procedural oversights, can lead to catastrophic consequences in maritime operations.

The loss of the Stride, valued at $12 million, represents one of the most significant marine casualties resulting from an incorrect valve installation in recent years.

The full NTSB report can be found here.

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