Category Archives: Marine Safety

Prioritizing Safety This Holiday Travel Season

By Stephanie Shaw, Acting Chief, NTSB Safety Advocacy Division

This week, families and friends will gather to celebrate the Thanksgiving holiday. According to estimates from AAA, nearly 55 million people will travel away from home this year, with about 49 million of them taking to the roads.

As we mark the beginning of the holiday travel season, we want to ensure that everyone arrives safely at their destinations. Unfortunately, travel on our roads can be the riskiest mode of travel during the holiday season.

NTSB investigations continue to highlight actions needed by regulators, legislators, and industry to ensure the safest transportation system for the traveling public. Our Most Wanted List (MWL) identifies specific transportation safety improvements needed across all modes. It includes five road safety improvements that address pervasive problems like speeding, alcohol and other drug impairment, and distraction. The MWL also calls for collision-avoidance and connected vehicle technologies and implementation of a Safe System Approach to better protect all road users.

At the NTSB, we believe that safety is a shared responsibility, so for the traveling public, we’ve highlighted some ways you can keep yourself and others safe, regardless of the travel mode you choose.

By Car

Impairment by alcohol and other drugs, unsafe speeds, fatigue, and distraction continue to play major roles in crashes. Here’s what you can do:

  • Designate a sober driver, or call a taxi, or ridesharing service if your holiday celebrations involve alcohol or other impairing drugs.
  • Follow safe speeds. In bad weather, safe speeds are often below the designated speed limit. Speeding increases the chance of being involved in a crash and intensifies the severity of crash injuries.
  • Make sure you’re well rested! A fatigued driver is just as dangerous as one impaired by alcohol or other drugs.
  • Avoid distractions. Don’t take or make calls or text while driving, even using a hands-free device. Set your navigation system before you start driving. If you’re traveling with others, ask them to navigate.
  • Make sure to use the correct safety restraint for child passengers, and be sure it’s installed correctly.
  • Ensure you and all your passengers are buckled up! In a crash, seat belts (and proper child restraints) are your best protection against death and serious injuries.

By Bus

The NTSB has made recommendations to improve motorcoach operations and vehicle crashworthiness, but travelers should know what to do in an emergency.

  • Pay attention to safety briefings and know where the nearest emergency exit is. If it’s a window or roof hatch, make sure you know how to use it.
  • Ask your driver to give you a safety briefing if you’re unsure of where the exits are or how to use them.
  • Use your seat belt when they’re available!

By Plane or Boat

These tips can help you and your loved ones in an emergency on planes or vessels.

  • Pay close attention to the safety briefing! Airline and marine accidents have become very rare, but you and your family can be safer by being prepared.
  • Know where to find the nearest emergency exit and flotation device whether you’re on an airplane or a boat.
  • Confirm that you and your traveling companions—even children under age 2—have your own seats and are buckled up when flying.
  • Don’t forget your child’s car seat. The label will usually tell you if your child car seat is certified for airplane use; the owner’s manual always has this information.
  • Call the airline and ask what the rules are for using a child’s car seat on your flight, if you don’t already know.
  • Follow crewmember instructions and remain calm in an emergency.

By Train

The NTSB has made recommendations to improve passenger rail operations and vehicle crashworthiness, but travelers should also follow these safety tips.

  • Stow carry-ons in the locations provided (overhead and racks). Don’t block aisles.
  • Review your trains safety information which may be provided as a safety card in your seat pocket or displayed in your railcar.
  • Follow crewmember instructions and remain calm in an emergency.

No matter how you travel, make a commitment to put safety first.

We wish everyone a safe and happy Thanksgiving.

Episode 51: Conception Investigation

In a new episode of our Behind-the-Scene @NTSB podcast, we talk with Morgan Turrell, Director, Office of Marine Safety about the lessons learned from the 2019 Conception disaster.

To learn more about the NTSB Conception investigation, and to access the full investigative report and docket, visit our investigation webpage.

For more information about the NTSB Most Wanted List “Improve Passenger and Fishing Vessel Safety” item visit our website.

The previously released podcast episode featuring Morgan Turrell is available on our website.

Subscribe to the podcast on Apple PodcastsGoogle PlayStitcher, or your favorite podcast platform.

And find more ways to listen here: https://www.blubrry.com/behind_the_scene_ntsb/

Time for Action: Passenger Vessel Safety Can’t Wait

By Chair Jennifer Homendy

Three years ago, I launched with the NTSB Go Team to Santa Barbara, California, to investigate the deadliest U.S. marine accident in decades.

On September 2, 2019, the Conception dive boat caught fire in the early morning hours, burned to the waterline, and sank less than 100 feet from shore. Tragically, the 34 people asleep below deck in the bunkroom — 33 passengers and one crewmember — were trapped. None of them survived. 

A plaque to honor the 34 victims of the Conception dive boat tragedy on September 2, 2019, sits in Santa Barbara Harbor. Photo by Rafael Maldonado, News-Press

The Conception tragedy was my first marine investigation as an NTSB Board member. As I have previously shared, I am forever changed by the time we spent on scene—especially my time speaking with the victims’ families.

Unfortunately, they are not alone. Including the Conception, the NTSB has investigated seven passenger vessel accidents since 1999 that have claimed a total of 86 lives.

Eighty-six lives lost unnecessarily. Eighty-six people who’ve left behind bereaved families and friends.

Enough is enough.

It’s time for meaningful action to improve passenger vessel safety — and it starts with the U.S. Coast Guard (USCG).

Our Marine Safety Partner

The USCG is NTSB’s closest marine safety partner. Our relationship is an outstanding example of government collaboration focused on saving lives and improving safety.

It is no exaggeration to say that we could not carry out our marine safety mandate without the USCG. Every accident we investigate is supported in a variety of ways by the dedicated men and women of the USCG, and my sincere thanks goes out to every one of them.

Many NTSB marine safety recommendations are directed to the USCG because, as the industry’s regulator, they are best positioned to improve safety.

Improving passenger and fishing vessel safety is on the NTSB’s Most Wanted List of Transportation Safety Improvements (MWL).

Lessons from Tragedy

There are currently 21 open NTSB recommendations to the USCG focused on improving passenger vessel safety. “Open” status means the recipient of our safety recommendation has not, in the Board’s estimation, sufficiently addressed the safety risk.

That’s 21 unacted-upon opportunities to prevent further passenger vessel tragedies, like the Conception

Every day that an NTSB recommendation lingers as “open” is unacceptable. But, sometimes, we must measure inaction on our recommendations not in days, weeks, months, or even years.  That’s the case with several NTSB recommendations to the USCG.

Here are some of the safety gaps the USCG needs to address — all of which are on the MWL.

Fire Safety

The Conception is a heartbreaking example of the need for rigorous fire safety standards for small passenger vessels.  

We determined the probable cause of the accident was the failure of the operator, Truth Aquatics, to provide effective oversight of its vessel and crewmember operations. The lack of both oversight and adherence to certain safety requirements allowed the fire to grow undetected.

We also found that the lack of a USCG regulatory requirement for smoke detection in all accommodation spaces and inadequate emergency escape arrangements from the vessel’s bunkroom contributed to the undetected growth of the fire and the high loss of life.

As a result of our investigation, we issued 7 new safety recommendations to the USCG and reiterated a prior recommendation calling on the USCG to require safety management systems (SMS) on U.S.‑flag passenger vessels.

The Conception disaster was so compelling that Congress felt our safety recommendations needed to be codified into law. Legislators mandated the USCG implement our recommendations in the Elijah E. Cummings Coast Guard Authorization Act of 2020 as part of the National Defense Authorization Act.

The USCG took an important step to carry out this congressional mandate by issuing an interim rule, most of which took effect in March of this year. We look forward to the final rule implementing our recommendations.

Until then, our recommendations from the Conception investigation remain open. 

Safety Management Systems

The second safety issue involves SMS: a comprehensive, documented system to enhance safety. They’re so effective that the NTSB has recommended SMSs in all modes of transportation.

For nearly two decades, we’ve called for SMS on passenger vessels. This call to action is on the MWL, which is our single most important tool to increase awareness of important needed safety improvements.

The first time we issued a marine SMS recommendation was due to the October 15, 2003, ferry accident involving the Andrew J. Barberi. The vessel struck a maintenance pier at the Staten Island Ferry terminal, killing 11 passengers and injuring 70 others. We issued a recommendation to the USCG to “seek legislative authority to require all U.S.-flag ferry operators to implement SMS.”

Congress granted the necessary authority in 2010 — but the Coast Guard still didn’t act.

We then investigated a second accident involving the Andrew J. Barberi. This time, the ferry struck the St. George terminal on May 8, 2010, resulting in three serious injuries and 47 minor injuries.

Between the 2003 and 2010 accidents, the New York City Department of Transportation Ferry Division had implemented an SMS. Based on differences between crew actions in the two accidents, we concluded that the SMS benefitted passenger safety.

But the USCG still didn’t act on our SMS recommendation.

Several more accidents followed — in all of these, we determined an SMS would have either prevented the accident or reduced the number of deaths and injuries:

  • In 2013, the Seastreak Wall Street hit a pier in Manhattan, seriously injuring four passengers; 75 passengers and one deckhand sustained minor injuries.
  • In 2018, a fire aboard the small passenger vessel Island Lady killed one passenger and injured 14 others.
  • In 2019, the Conception tragedy claimed 34 lives.

The USCG initiated steps in January 2021 to implement our SMS recommendation by publishing an Advanced Notice of Proposed Rulemaking (ANPRM). In the ANPRM, the Coast Guard discussed that the NTSB “has identified issues associated with failed safety management and oversight as the probable cause or a contributing factor in some of the most serious casualties involving U.S. passenger vessels.”

That was over 18 months ago. We’ve been calling for such a requirement for almost 20 years. We will persist for as long as it takes.

I look forward to working with Admiral Linda Fagan in her new role as Commandant and call on the USCG to prioritize the rulemaking in the weeks and months ahead.

The Work Ahead

When it comes to safety, time is of the essence. That’s why we fight so hard for NTSB recommendations: to improve passenger vessel safety and save lives.

On the third anniversary of the Conception disaster, I’m calling on the USCG to act on the 21 open NTSB passenger vessel recommendations.

Doing so can’t undo past tragedy — but it can prevent similar suffering for other families.

I can think of no better way to honor the memory of the 34 Conception victims, whose loved ones we hold in our hearts today.

Salute to the US Coast Guard’s Persistence in Improving Recreational Boating Safety

By Jeff Marcus, Chief, NTSB Safety Recommendations Division

In many states, when using motorized recreational vessels, or engaging in activities like canoeing, kayaking, and standup paddleboarding, operators are not required to attend a boating safety course, obtain a license or certificate, be familiar with the navigation rules (commonly called the “Rules of the Road”), or even demonstrate proficiency in watercraft operation.

In 2016, the NTSB sought to better understand the scope of the issue and determine the safety impact on the nation’s waterways following:

  • our investigation of a collision between eight kayakers and a New York Waterways ferry,
  • feedback we received from marine industry representatives, and
  • concerns about the increase in encounters between commercial and recreational vessels.

We took what we learned and began to develop a safety recommendation report.

In 2017, we published Shared Waterways: Safety of Recreational and Commercial Vessels in the Marine Transportation System, providing our findings as well as recommendations to improve shared waterway safety. We found there is an increased safety risk, especially where confined waterways limit the ability of vessels to maneuver. This is exacerbated not only by the diversity of waterway users but also by differences in their experience, marine knowledge, and boat-handling skills. Moreover, state requirements varied considerably. 

At the time of our report, the US Coast Guard estimated that in 2015 only 28 percent of motorized recreational vessel operators were required by state laws to complete a boating safety course or pass an examination of boating safety knowledge. Could you imagine if that were the case when it came to obtaining a private pilot’s license? Clearly, recreational vessel operators need a minimum level of boating safety knowledge to mitigate the various risks associated with the type of vessel being operated.

So, we issued Safety Recommendation M-17-2, which asked the Coast Guard to seek statutory authority to require recreational boat operators to complete a national boating safety course. When we issued this recommendation, we were aware that the Coast Guard had previously sought statutory authority to require recreational boat operators to complete a national standard minimum boating safety education course. As our Shared Waterways report pointed out, at that time, over 70 percent of motorized vessel operators and most nonmotorized vessel operators were still not required to demonstrate minimum boating safety knowledge.

Today, we commend the US Coast Guard for its determined and sustained role in promoting recreational boating safety. Although the Coast Guard has not been granted authority to implement a minimum national standard for boating safety as we’d hoped, it has developed an alternative approach that addresses the safety issue. Instead of saying there was nothing they could do because they didn’t have statutory authority, the Coast Guard developed a solution to address the safety problem. Consistent with congressional direction, the Coast Guard focused on supporting state-led initiatives to develop educational programs and requirements for recreational boaters. Working in partnership with the National Association of State Boating Law Administrators, the states, and various recreational boating stakeholders, the Coast Guard helped develop and update boating education standards. With the Coast Guard’s active support, recreational boating education has greatly improved nationwide. In its latest update to the NTSB, the Coast Guard reported that currently all but five states have mandatory boating safety education.

Safety is a journey, not a destination. Although there is always more to be done, the Coast Guard’s alternative action led to significant improvements in recreational boating safety across the nation and satisfied the intent of our recommendation.

We issue safety recommendations to other federal agencies and transportation stakeholders engaged in all modes: air, highway, rail, marine, and pipeline. Although we may recommend a particular action, there are often alternative solutions that are equally effective in addressing a safety problem that we identify through our investigations. Like sailing into the wind, sometimes a direct path isn’t possible; sometimes you must tack back and forth to make the mark. We encourage our safety recommendation recipients not to give up if our recommended action proves unattainable, and to pursue alternate actions to satisfy the intent of the recommendation. Our goal is to improve transportation safety in any way possible.

We ask all our recommendation recipients to share updates with us on relevant actions they’ve taken to address our concerns. Hearing from them helps us evaluate progress and properly classify the status of recommendations.

Stay safe on the water. Let’s work together as we navigate our way to zero transportation deaths and serious injuries, and safer transportation for all.

Improving Safety in the Second-Largest Continent

By Nicholas Worrell, Chief, NTSB Safety Advocacy Division

In August, 2019, I wrote that Safe Skies for Africa was ending, but that the safety journey would go on in Africa, the world’s second-largest and second-most-populous continent. Earlier this month, it was my pleasure to represent the NTSB in a presentation about best practices in safety advocacy at the Civil Aviation Operational Safety Workshop in Cape Verde.

The occasion was Aviation Safety Week, which gathered together transportation safety leaders from seven African nations, the EU, and the United States to share safety knowledge. Attendees were interested to learn from my presentation that in the United States, the accident investigator—the NTSB—has no power whatsoever to require change.

Enter Advocacy.

It’s been said that information + persuasion = advocacy. The idea is never to misrepresent; rather, it is to present information that makes the case most compellingly. If the case is compelling enough, your advocacy might inspire people to act. Then, they might influence others to act as well, creating a critical force multiplier. I spoke to my audience about advocacy methodology, messaging, and tools, and the absolute need for collaboration, working with and through others. I reminded my audience, though, that advocacy differs with the context and the organization. At the NTSB, for example, it’s the one way we can bring about change and encourage implementation of our recommendations. However, I urged safety leaders in Africa to be mindful that all advocacy is local. What might work in the United States might not necessarily work for all of Africa.

Ultimately, wherever it is done, advocacy done right moves the needle toward saving lives. As transportation safety leaders, I told my audience, we must communicate our work to gain the desired impact and outcomes. We must be proactive and go to our audience, not sit back waiting for them to come to us.

It was an honor addressing these passionate transportation safety leaders from the African region. We should always remember that our transportation safety work crosses air, land, and sea. When we share our lessons learned and best practices, and when others share theirs with us, we may save lives not just nationally, but globally, as well.