The UK registered container ship CMA CGM Centaurus, 131,322gt, crashed into the quay at the United Arab port of Jebel Ali because she was unable to “attain a sufficiently high rate of turn into a basin in preparation for berthing,” according to the report on the incident by the Marine Accident Investigation Branch (MAIB), in London.
The CMA CGM Centaurus, of 11.400 teu, was arriving at the DP World port on May 4, 2017, and had a pilot on board.
The MAIB said the accident resulted in a shore crane collapsing and 10 of the shore personnel being injured, one of them seriously. Giving the reasons for the accident, the MAIB report said the pilot was unaware of the ship’s speed, and the ship’s bridge team was uncertain of the maximum speed required to complete the turn safely.
“There was no agreed plan for the intended manoeuvre, and therefore no shared mental model between the bridge team and the pilot,” said the report. “Consequently, the pilot was operating in isolation without the support of he bridge team, allowing the pilot’s decision-making to become a single system point of failure.
“The pilot’s performance was focused on efficiency, which influenced his decision to turn the ship into the basin without ensuring that the manoeuvre was conducted at a sufficiently slow speed to enable its safe completion. “The Master/pilot exchange carried out on the ship lacked structure and detail and there was little further detail as the approached proceeded.
“By not actively engaging with the bridge team, the pilot effectively signalled that he did not need their assistance.” The MAIB report said that by not requiring its newly recruited pilots to undertake Bridge Resource Management (BRM)-Pilot training, the Jebel Ali port authority missed the opportunity to both emphasize its commitment to the effective integration of its pilots with bridge teams, and ensure its pilots were trained/ refreshed in the principles of BRM.
“Despite extensive industry guidance, there continues to be a reluctance by Masters and pilots to work together in accordance with the principles of BRM,” said the MAIB report.