MAIB Report - Brixham fatality

[lakelandterrier]

The MAIB report on the tragic incident at Brixham at Easter has been released Makes interesting reading with a number of factors contributing to the sad fatality.

I know it was meant to be a short trip, but it drives home to me the need to always carry safety kit including HH VHF and correctly fitting lifejackets / PFDs and may be most importantly why one should have a good knife on your person whilst on the water at all times.

[ShinyShoe]

I think they missed a trick in the review. Is there a fundamental design flaw in certain PFDs that means all those straps are just asking to get entrapped on something? Yes her PFD was not tight enough, but I couldn't see how being tighter would have meant she couldn't get snagged? It may have made the belts harder to snag but Belt loops etc snag things. I've caught belt loops on trousers on door handles in the house - pretty much the same issue with cleats under a boat swimming out.

Noticeable that lots of the big sailors in PFDs have their rash vest over the top meaning there are no places to get caught?

Knife - interestingly also not mentioned by MAIB!

Radio - yip although probably made no difference in this case as 999 call from shore very soon after. Although 999 call to request to RNLI launch was maybe not as quick as a Mayday from a VHF with a clear location and incident. I suspect thats a case of someone on shore takes a lot more explaining where the incident is and what they've seen. CG want to be sure they are not getting a report of a sailing boat capsizing that will self recover in 20 seconds time etc.

I think there was also a lack of understanding of the conditions they were going out into (sheltered launch location). Almost a case of some training might be worse than no training. Its surprising that you can learn to water ski drive in a day yet PB2 takes 2 days and I didn't need to worry about towing people behind me etc...

[markmullen]

One of the reasons all our rescue boat crew carry a knife, in case of entrapment, either of ourselves, or of a casualty, whether it be by a PFD strap, or something else, shoe laces etc.

[Portholme]

I used to sail high performance skiffs with either a crew of two or three. On the 18 footers buoyancy aids were NOT allowed except on inland waters where the water authorities law took precedent.

The reason is that if you get caught under the boat, or worse a sail you can dive down and get out. In big crashes the first thing you do is check where your team mates are.

When we had to wear BAs we would wear a rash vest over to stop them getting snagged. The dressing order was wetsuit, trapeze harness, BA, rash vest so you can get the BA off relatively easily.

Of course this is a deeply sad thread and my commiserations to those involved but we all go to sea for sport or recreation understanding the risks and making novice crews aware of the risks.

[Mollers]

Woulda, shoulda, coulda.

With more safety kit than a well stocked chandlery onboard, shit still happens. It's a sad fact.

The people involved will never get over this, nuff said.

[ShinyShoe]

Originally Posted by Mollers

Woulda, shoulda, coulda.

With more safety kit than a well stocked chandlery onboard, shit still happens. It's a sad fact.

The people involved will never get over this, nuff said.

Completely agree Mollers. And the aim would presumably be:

1. avoiding flipping the boat in the first place
2. avoiding your own safety kit trapping you
3. being able to sort your self out if you do get trapped
4. being able to get help as quickly a possible if you need it

...In that order of priority

If I'm ever in the unlucky situation that something did go wrong I'd want to at least be able to assure myself that I'd done all I could to prevent it.

[Mollers]

Originally Posted by ShinyShoe

Completely agree Mollers. And the aim would presumably be:

1. avoiding flipping the boat in the first place
2. avoiding your own safety kit trapping you
3. being able to sort your self out if you do get trapped
4. being able to get help as quickly a possible if you need it

...In that order of priority

If I'm ever in the unlucky situation that something did go wrong I'd want to at least be able to assure myself that I'd done all I could to prevent it.

You or I probably wouldn't have gotton ourselves in to such a situation. If we had, maybe we could've sorted it. That doesn't mean that a whole different scenario wouldn't catch us out.

In truth, these guys shouldn't have set out that day. The conditions were too much for the boat etc, etc.

I see scary stuff on the water on most busy summer days, owners oblivious to the fact that their one bad landing from killing one of their kids.

[Poly]

Originally Posted by ShinyShoe

If I'm ever in the unlucky situation that something did go wrong I'd want to at least be able to assure myself that I'd done all I could to prevent it.

You'd probably better stay locked in the house and die from depression or couch potato driven heart disease then!

Mollers I agree, I think the missed lesson was not vhf, or knives, or kill cords, or rcd compliance, or even life jacket fitting...

...It is looking at how we train people to understand the limits of their craft, and themselves. Possibly using ribs for powerboat training doesn't help that?

[ShinyShoe]

Originally Posted by Mollers

You or I probably wouldn't have gotton ourselves in to such a situation.

Clearly you've never seen me behind the wheel of a boat!

If we had, maybe we could've sorted it. That doesn't mean that a whole different scenario wouldn't catch us out.

Oh I know. But I'd still like to think we can all at least learn from other people's mis-fortune and apply it to our own situation to see if we can reduce risks. So if we have buoyancy aids with bits that can get caught on things and bits on boats that can catch things is there something we can do about it to reduce the risk (Rash vest, spray top, change the cleat to a ring?)

I see scary stuff on the water on most busy summer days, owners oblivious to the fact that their one bad landing from killing one of their kids.

And we see it on roads and elsewhere too! Yesterday I saw a guy in a 'jeep' nearly side swipe a car he'd just undertaken as he pulled into the outside lane of the motorway at 70MPH (how they didn't make contact I still don't know - I think I closed my eyes!), then tail gate the car in-front of that with genuinely less than 12inches gap before trying to undertake him when a gap on the inside opened up. It was like watching one of those stolen cars on police camera action but with no police car chasing him. As there was no accident on the road I assume he got away with it all the way home and so will drive the same next time he's out. Its the same with boaters. They take risks and chances and get away with it so carry on in future. I've driven a car pretty stupidly at times in the past (although not as stupid as that guy I don't think!) and got away with it. I've learned as I matured and have seen some messy crashes etc. (Oh and having lined the police/courts/government pockets once or twice!) But even though I think I'm a better driver these days the things that I think will make a difference to me not dying if I crash are far more likely to be improvements in car safety design (airbags, impact protection, crumple zones etc).

[mick]

[QUOTE=ShinyShoe;696709]Clearly you've never seen me behind the wheel of a boat!





No we ain't AV you got one

[Mollers]

Originally Posted by Poly

...It is looking at how we train people to understand the limits of their craft, and themselves. Possibly using ribs for powerboat training doesn't help that?

In a nutshell 'experience', you can't buy it.

20 yrs of skiing on lakes taught him little when it came to leaving the harbour walls.

However, those of us here who think that we have salt water running through our veins, hopefully know who the boss is.

[ShinyShoe]

Originally Posted by Poly

You'd probably better stay locked in the house and die from depression or couch potato driven heart disease then!

No - I didn't say I can't balance risk and so can't leave the house, as you point out even that carries a risk. I said I'd want to know I'd done everything I could. Perhaps I should have caveated that with "reasonably" could.

...It is looking at how we train people to understand the limits of their craft, and themselves.

BUT that is WAY harder than it sounds. For numerous reasons:

• Craft abilities change in different conditions. Are you going to make people train in F1 - F8 winds?
• People abilities change with time and other factors (health, fatigue, drink & drugs). You can teach that abilities change but we've seen with car drivers that as people become older some will deny loosing those abilities. Plenty think alcohol/drugs doesn't affect them. Loads of new drivers think they should be allowed to drive a 3litre turbo on the day they pass their test - its only years later that many realise they didn't really have the skills to drive a 1 litre!
• A weather forecast today for F4-5 might actually only turn out to be F3 just touching F4, so if I cope in that next time its 4-5 I know I will cope fine... ...until it turns out to be F5-6 touching 7. Again you can teach what that means in a classroom - but you learn the realities on the water over time.
• Peer pressure. Possibly one of the real biggies and really hard to address. So you have got the whole family together, friend has brought her mate along for the weekend. Before you set off the weather looks OK. You drive for 3 hours to do your thing. Forecast has deteriorated, but it still looks OK at the moment. Having the 'balls' to say "sorry guys - we aren't going out" is REALLY tough. (God some people don't some to be able to tell their kids no more Coke or Sweets!) - I'm really not sure thats something that can be taught? Its something you learn...

Unfortunately unless you control the learning environment sometimes things will go tragically wrong while people are learning. (And we are all, always learning all the time).

Gonna be controversial and say maybe we should design out some of the risks. Is there a justifiable reason that a ski boat couldn't be built that could handle the sea conditions the accident happened in? Likewise is there a justifiable reason a bouyancy aid needs to have loops that can get caught on things. Is there a justifiable reason the cleat needs to be able to catch things? You wouldn't expect to buy a car that couldn't drive at 70MPH on UK roads. Why do we accept buying boats that can't handle fairly normal UK sea states?

You wouldn't accept a safety feature like an airbag that inflated and then stopped you getting out the car if it was on-fire. Or a car door that was likely to automatically lock its self if you crashed...

Possibly using ribs for powerboat training doesn't help that?

I'd bet these guys didn't train in a RIB.

Not many driving schools are teaching people in BMWs or Transit Vans... yet your licence lets you drive them.

[mick]

Originally Posted by Mollers

In a nutshell 'experience', you can't buy it.



20 yrs of skiing on lakes taught him little when it came to leaving the harbour walls.



However, those of us here who think that we have salt water running through our veins, hopefully know who the boss is.

Yup Mother Nature

[Mollers]

Anyway boys, off to the Fal Oyster Fest now to try to induce my shellfish allergy with many molluscs, washed down with a good glug of local ale.

Have a good afternoon.

Falmouth Oyster Festival | A celebration of Cornish Seafood

[lakelandterrier]

I'm sure most of us have ventured out at one time or another only to find conditions are worse than we'd estimated.

Brixham is one of those places where an initial look from above the breakwater can be deceptive, and the harbour is so sheltered you don't see the sea state until you clear the harbour wall. I've stuck my nose out from Brixham once or twice to very quickly decide discretion is the better part of valour!

The onshore alarm was raised just c.4 minutes after the event, but without a radio it took 14 minutes for those involved to alert the authorities, by one of the jetskis returning to the slip. Had any of the 3 craft party had a handheld VHF help could have been summoned by them sooner - without one of the party leaving the scene.

Had any of the party been carrying a knife they just may have been able to cut the PFD strap free - they might not due to cold water shock, sea state etc but there would have been more of a chance.

The key thing after this type of event is surely for us to take on board the learnings so that we
a) don't get in the situation in the first place and /or
b) if we do we, we have the equipment to minimise the risks, and the ability to help ourselves and our crews as much as possible

As Mollers has said, the burden this incident will be with the families for ever. we surely want to make sure this does not happen to us or anyone else by learning from it.

[Fenlander]

I see this story and the parents campaign to "licence" boat use is currently the Daily Mail's header story...

Parents of Emily Gardner seek to bring about change in the law | Daily Mail Online

MAIB report here...

https://assets.publishing.service.go...ort21_2015.pdf

[breezeblock]

sad to see this happen and its a remember to me why i bought a rib as they are pretty safe, stay safe chaps

[Fenlander]

Yes the even flotation of RIBS and SIBS spread along their length would prevent exactly the same accident. Seems that Fletcher only had the flotation of trapped air in its pointy bow.

[Poly]

Originally Posted by breezeblock

sad to see this happen and its a remember to me why i bought a rib as they are pretty safe, stay safe chaps

Originally Posted by Fenlander

Yes the even flotation of RIBS and SIBS spread along their length would prevent exactly the same accident. Seems that Fletcher only had the flotation of trapped air in its pointy bow.

I think we are being complacent if we believe that similar circumstances could not befall a RIB/SIB. The boat was capsized by a large wave from its starboard side - where it floated in a horizontal aspect before starting to sink at the stern. It might be less likely for a RIB to capsize in the first place, and it may be less likely to sink stern first BUT then a modern RCD compliant ski boat should float horizontally when flooded too. The reality is RIBs/SIBs DO capsize. If you want to avoid being a victim to something similar I'd make sure you understand how to helm the boat to minimise the risk of capsize, and reduce the number of "hooks" and "dangly bits" that people might get entangled. Sadly, no matter how much it might help Emily's parents' to cope with their loss, no licensing regime or lifejacket laws will prevent recurrence.

[Fenlander]

Yes agreed Poly never say never... but I did carefully choose the phrase "would prevent exactly the same accident"... with "exactly being the important word.

I hate seeing folks at the slip launching a "bargain" old speedboat with little or no built in flotation and a monster 1970s outboard. Sadly it often goes hand in hand with other basic errors in equipment or use that are obvious to the enlightened.

In truth I was thinking of our SIB which would float as level upside down as the right way up with any potential unexpected snag point hardly holding a person under water at all.... that poor girl was probably about 3m down at the snag point which would have been a hard ask for those that apparently tried to swim down and save her given the inevitable confusion and panic.