Analysis of Pilot Transfer Accidents

Considering the lack of studies in the international academic literature on pilot transfer operations, my doctoral thesis advisor, Assoc. Dr. Our article titled "Dynamic Analysis of Pilot Transfer Accidents", which we prepared together with Cenk Şakar, was published in the journal "Ocean Engineering" in September, 2023. On the occasion of this article, I would like to summarize the results of the article and share them with you.

A pilot is a person who specializes in a particular region and guides ship captains on safe navigation. The pilot transfer operation, which includes the process of the pilot joining and leaving the ship, is a very risky operation in which fatal accidents may occur. Due to the nature of transfer operations, pilots move between two boats on the sea that move relative to each other, exposed to different weather conditions, throughout the day and night.

Considering the lack of studies in the international academic literature on pilot transfer operations, my doctoral thesis advisor, Assoc. Dr. Our article titled "Dynamic Analysis of Pilot Transfer Accidents", which we prepared together with Cenk Şakar, was published in the journal "Ocean Engineering" in September, 2023. On the occasion of this article, I would like to summarize the results of the article and share them with you.

While pilots ensure that ships maneuver safely by combining their knowledge and experience, they also play an important role in protecting the public interest in protecting port facilities and maintaining uninterrupted trade. Pilots, who ensure that port operations continue uninterrupted by minimizing the chances of accidents, are the unsung heroes of port supply chain operations.

The process of the pilot joining and leaving the ship, known as the pilot transfer operation, is an important operation that must be managed carefully and safely. Different arrangements are used for pilot transfer, such as pilot ladder, combination gear, trapdoor rig or beach plowing and gangplanks. Pilot ladder, also known as rope ladder, is used when the ship's freeboard distance is less than 9 meters; Combined equipment, in which a side ladder is used together with a pilot ladder, is used when the ship's freeboard distance is 9 meters or more. In addition, even if the ship's freeboard distance is below 9 meters, the pilot may request that combined equipment be prepared for safe transfer. The mentioned transfer mechanisms continue to be the safest transfer systems today, except for cases where the helicopter can be used as an alternative. In accordance with SOLAS rules, ships transferring pilots must have transfer equipment that complies with international rules and allows pilots to join and leave the ship safely.

The transition from pilot boat to pilot boat or from ladder to pilot boat is the most risky and most likely accident-prone process of the pilot transfer process. Since the pilot boat and the serviced ship move relative to each other in the dynamic working environment, fall arrest equipment known as fall arresters, such as those used by climbers, cannot be used safely in pilot transfer operations. All stakeholders, including the administration, shipowner, ship personnel, pilotage organizations and employees, have the responsibility to ensure that pilot transfer operations are carried out safely. Even though these stakeholders are doing their best to prevent accidents, pilot transfer accidents still occur today. Pilots' lives are in the hands of other parties who do not use the transfer equipment, and pilots must trust these parties and assume that the transfer equipment they use is safe.

The International Maritime Organization (IMO) addresses the necessary regulations on pilot transfer safety in SOLAS Annex 5 Rule 23 and directive A.1045 (27). Additionally, there are different industry recommendations and industry standards. SOLAS includes requirements for safe pilot transfer mechanisms, ship personnel's responsibilities regarding transfer, rules regarding the transfer equipment used, and rules regarding appropriate lighting. In IMO directive A.1045 (27), minimum standards and requirements for structural elements regarding pilot ladder and side scaffolds are specified. International Standards for Pilotage Organizations (ISPO) is a code of best practices to improve the quality and safety of pilots and pilotage organisations. The International Maritime Pilot's Association (IMPA) represents the international pilot community and promotes professional and safe pilotage operations. The safety campaigns organized annually by IMPA are a unique data analysis reported by pilots on pilot transfer equipment. In the last campaign in 2022, 17.26% of pilot ladders and 17.40% of combined equipment were reported as inappropriate. The most frequently reported nonconformities are; It was observed that the transfer equipment was not properly fastened and secured, improperly equipped retrieval line, inappropriate deck handles (handholds) and pilot  ladder steps were not horizontal. The safety campaign for 2023 was carried out between 01-15 October and the results have not been published yet. The "pilot ladder poster", published by IMPA and hung in places such as the bridge and pilot cabin on ships, constitutes an important visual resource showing the standard features of pilot transfer equipment.

Although the concept of "remote (or land) pilotage" (remote pilotage or shore based pilotage), which does not require a pilot transfer operation, seems to be a popular topic on which discussions will increase in the near future, with the increasing integration of technology into the maritime industry and especially with the research conducted during the pandemic period, its applicability is great. It is a question mark and there is a long way to go on the subject.

Although there are studies on pilotage operations in the literature, there are a limited number of analysis studies on pilot transfer accidents. Academic research on pilotage is mostly about pilots' workload and fatigue management and the comparison of different pilotage organization models. There are also studies conducted in the simulator environment and on the examination of bridge team management practices, including communication between the pilot and ship personnel.

After the literature study carried out within the scope of the research, the opinions of pilots were consulted and the root causes of pilot transfer accidents were revealed. In this process, some interrelated deficiencies were gathered under a single root cause. For example; Deficiencies such as damaged stair treads, dirty stair treads and unsuitable side ladder handles were evaluated under the root cause of "side ladder in poor condition". Similarly; Pilot ladder ropes in poor condition, cracked ladder steps, dirty ladder steps, ladder ropes of not suitable thickness, steps not being horizontal, steps not placed at appropriate intervals, unsuitable step connection amulets and marsepets, ladder steps not made of suitable material and inappropriate step sizes. The deficiencies were evaluated under the root cause of “pilot ladder in poor condition”. The root cause of "pilot ladder that is not securely fastened" includes sharp deck sheet metal edges that may damage the ladder ropes and fixing the pilot ladder to the deck with improper methods such as locks and bar anchors. Due to the large analysis network structure created, this research focuses on the deficiencies caused by the ship side and the transfer equipment itself; Pilot captain, pilot boat personnel and pilotage organization errors are not included in the study. It is planned to examine the errors specific to the pilot and his crew in future studies under a separate network structure.

The ranking of the root causes that cause pilot transfer accidents, obtained by blending fuzzy logic and fault tree analysis and Bayesian network analysis methods of the data collected by consulting the pilot captain's opinions, according to their weight ratio, is as follows:

As can be seen from the table above, the most important reasons causing pilot transfer accidents are respectively "poor condition pilot ladder", "lack of safety culture", "high seas or dead waves", "pilot ladder that is not securely fastened on the ship deck" and "missing or unsuitable identified as “deck handles”. It was determined that the share of reasons such as "limited visibility", "high ship speed for pilot transfer", "heavy rain", "side ladder angle more than 45 degrees" and "incorrect rigging of the anchor suspension rope" in pilot transfer accidents was relatively lower. has been made.

While it may be sufficient to have a single root cause listed above for an accident to occur, when looking at past accident reports, it is often seen that more than one of these reasons exists together.

In order to eliminate the above-listed risks of pilot transfer accidents, the standards determined by SOLAS and IMO must be followed. In order to prevent accidents, it is very important to conduct comprehensive risk analyzes and offer solutions to eliminate dangers. Wear and tear on the pilot ladder ropes, the fixing amulets of the steps, cracked or damaged steps should be checked regularly and during the preparation of the equipment, damaged ladders should be repaired or replaced with a new one. Transfer devices should be stored appropriately when not in use, protected from external factors such as sunlight and sea water, or kept in stores. The pilot ladder  and gangway steps must be clean and unpainted from slippery contaminants such as oil or grease. Ship personnel must securely tie the pilot ladder to be equipped to a solid point on the deck by tying it with ropes over the side ropes. It is also important not to transfer weight onto the steps when rigging the ladder because the steps of the ladder are not designed for this operation. In cases of adverse weather and sea conditions, additional safety precautions should be followed when performing a pilot transfer operation.

Following the safe management system plan and checklists of the ship personnel, covering all processes of the pilot transfer operation, will increase safety and ensure that malfunctions that may be overlooked are detected.

Considering that there are limited studies on pilot transfer accidents in the academic literature, I believe that there should be more similar studies that examine the literature from a broad perspective and contribute by offering a dynamic approach.

RESOURCES

-       Dynamic analysis of pilot transfer accidents. Ocean Engineering, 287, 115823 / Cenk Sakar and Mustafa Sökükcü.