200640 Pyrotechnics incident

09 Feb 2006 MARS
With the recent spate of attacks on merchant ships, and also on a yacht in the Gulf of Aden, from fast-moving boats, we held a special anti-piracy drill prior to entering the 'danger zone'. The contingency plan on board for this type of emergency had obviously drawn inspiration from more proactive seafarers' reports in IMB bulletins and other reports, where the use of pyrotechnics to repel attackers was advocated.

The master failed to interpret the operating instructions on the canister correctly due to ambiguous words and illustrations that seemed to match the firing system of a different make of pyrotechnic that he had seen being demonstrated at a shore-based survival refresher course.

Conducting the demonstration on the bridge wing, with the canister pointing outboard and downwards, clear of all persons and obstructions, he pulled out the firing ring but stopped short of proceeding to the next step in the firing sequence. However, when he attempted to push the ring back to its 'safe' position, the rocket flare was ejected into the sea. Subsequently, it was realised that the sliding back of the ring into the body itself was indeed the designed method of firing the flare. It was also realised that once the ring is pulled out, resetting the spring-loaded firing pin was impossible.

Fortunately, no injury or damage was sustained and no vessel was within sight or seen on radar on a 12-mile range.

 

200640

 

Root cause/contributory factors

  1. Failure to interpret the operating instructions correctly, due to ambiguous text and illustrations;
  2. Confusion between two different makes of pyrotechnics, each with similar but different firing mechanisms;
  3. Contingency plan advocating the use of pyrotechnics against attackers without considering the accompanying hazards to ship and crew;
  4. No warning on canister to say that once the ring is pulled out, 'resetting' of the firing mechanism or cancelling its operation was impossible.

Corrective actions

  • A 'near-miss' report was sent to the company and the used canister was subsequently used for more effective training on the operation of this type of pyrotechnic.
  • The reference to the use of pyrotechnics against attackers was deleted from the contingency plan.

Other valuable lessons

  • It is unlikely that every seafarer will get the chance to activate a pyrotechnic during his career. His or her experience may be restricted to witnessing a demonstration during shore-based training or seeing one in training videos. This can increase the risk of wrong operation in emergency.
  • Use of pyrotechnics other than as intended for indicating distress must be discouraged.
  • Training on pyrotechnics handling and operation must be done at every emergency drill with particular caution.
  • Manufacturers should be urged to convey operating instructions in clear, unambiguous text and diagrams, not only on the canister, but also in the form of a booklet, poster, demonstration video etc.
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