Fatal Collisions Part II: USS John S. McCain August 21 2017

August 20, 2017, day before USS McCain was scheduled to transit the Singapore Strait and enter Sembawang for a scheduled port visit, McCain held a navigation brief to prepare the crew. Sounds like a good idea, but it also sounds more formal than any such briefing I ever held. I would usually lay out the track on a chart and show it to the captain. Then I would brief the bearing takers.

The report of investigation into the next days' collision described the purpose of the brief as "designed to provide maximum awareness of the risks involved" in transiting the channel. At 0400 the following morning (August 21, 2017) as the darkened ship, showing only her navigation lights required by international rules, None of the principal watchstanders on the bridge, including the officer of the deck and the conning officer, had attended the previous day's brief.

By 0430, manned stations on the bridge included: the executive officer,  officer of the deck, conning officer, junior officer of the deck, commanding officer, quartermaster of the watch, navigator, shipping officer, helmsman, and boatswain's mate of the watch. Just outside, on the port wing of the bridge, a single lookout was stationed. The lee helm and helm safety officer positions were not manned.

The ship had not yet stationed the Sea and Anchor detail, consisting of crew members with specialized navigation and ship handling qualifications. This was not planned to be set until 0600. The ship had already entered the Singapore Strait Traffic Separation Scheme at 0520. Among crew members standing watch on McCain's bridge at the time were sailors temporarily assigned from USS Antietam (CG-54) which had run aground in January and was being repaired. Antietam's steering and thrust control system was considerably different from McCain's system. These watchstanders lacked a basic level of knowledge on the steering control system, especially how to transfer control of steering and thrust between stations.

At 0513, McCain was steering 226 degrees at 20 knots.  The captain noticed that the helmsman was having difficulty steering the ordered course while also controlling the thrust of the port and starboard engines. So at 0519, he ordered that steering be separated from thrust control and divided between two control consoles. It was a sensible thing to do.

Just giving a sensible order doesn't do any good unless the crew knows how to carry it out.

At 0521 the helmsman reported loss of steering. The ship was in a turn to port, crossing into an adjacent traffic separation lane in front of a large tanker. At 0524 McCain crossed in front of merchant ship Alnic's bow and was struck in berthing compartments three and five. Compartment five, normally fifteen feet wide, was compacted to five feet wide. Ten sailors were drowned.

The proximate cause of the collision is that the crew did not succeed in separating steering control from thrust control as the captain desired. As the ship attempted to steer within the traffic separation scheme, it came about that the starboard propeller provided thrust for 20 knots while the port shaft provided thrust for only 5 knots. This caused the ship to twist to port, which the helmsman was powerless to counteract by moving the rudder. In short, the helmsman and lee helmsman did not know how to do what the captain directed.

The investigative report explained: "The combination of the wrong rudder direction, and the two shafts working opposite to one another...in this fashion caused an un-commanded turn to the left into the heavily congested traffic area in close proximity tothree ships, including the Alnic."

The helmsman thought steering control had been lost when, in reality, it had been shifted to a different control station without the helmsman, the captain or anyone else on the bridge understanding what was happening. For about three minutes McCain sailed on a course to collide with Alnic without anyone being able to correct the situation. Watchstanders finally regained control by shifting to a third control station, but this was too late. The collision created a 28-foot diameter hole both above and below the waterline. Once again, a navy crew exerted heroic efforts to save their ship from sinking.

The report states that bridge personnel "lost situational awareness." In a more informative section, the report observes: Personnel assigned to ensure these watchstanders were trained had an insufficient level of knowledge to effectively maintain appropriate rigor in the qualification program. The senior most officer responsible for these training standards lacked a general understanding of the procedure for transferring steering control between consoles."

I don't know that I accept "loss of situational awareness" as the explanation. Although the focus since the collisions has been the Pacific Fleet, I suspect similar problems exist in the Atlantic.

What may have been missing was what an older generation of naval officers referred to as "forehandedness." That is, the practice of thinking ahead, planning ahead, preparing for every contingency and, in particular, organizing and training for every likely or even conceivable event.

I think Admiral Burke would be deeply concerned about what happened to his ships.

I know he would have put his shoulder to the wheel to fix the problem.

I suggest today's navy do the same.

Collisions of USS Fitzgerald and USS John S. McCain - Summary Report

Last Wednesday the US Navy released a summary report of investigations into the June 17 collision between USS Fitzgerald and a Philippine container ship and the August 21 collision between USS John S. McCain and a merchant tanker in the Strait of Malacca.

When I saw the first reports of the collisions, I didn't want to jump to conclusions. It appeared very much as though neither ship had been keeping a proper bridge watch.

It was worse than I imagined.

About 0100 June 17, 2017, USS Fitzgerald was operating in the vicinity of the island of O-Shima near the Izu Peninsula, within sight of the Japanese coast, at darken ship, with regular navigation lights showing. Fitzgerald was on a southerly heading under a clear, moonlit sky with light to moderate sea. According to the Navy's investigation, Fitzgerald's radar operators failed to tune and adjust radars to maintain an accurate picture of other ships in the area.

This kind of problem harkens back to the failure of USS Blue, a radar-equipped destroyer at the Battle of Savo Island (near Guadalcanal) to detect Japanese ships during a 1942 attack. The Japanese fleet on that long ago July 8th had no radar, but soundly trounced the radar-equipped US fleet. In the case of  USS Fitzgerald, weather and visibility conditions were such that competent, attentive seamen really needed no radar to keep track of ships in the vicinity. It could all have been taken care of visually.

There was a traffic separation scheme in the vicinity of O-Shima to enhance safety of shipping, but Fitzgerald did not follow it. Fitzgerald was, like all commercial ships, equipped with an Automated Identification System, to alert nearby ships of it position, but did not turn it on. Like other ships of the Arleigh Burke class, Fitzgerald's hull was designed to minimize its return of other ships radar, using stealth technology. In essence, Fitzgerald was operating at sea under a cloak of invisibility, concealing its own position from other ships. So Fitzgerald must be under a special obligation to avoid colliding with other ships. Perhaps an extra careful system of lookouts?

Because of international rules for maneuvering at sea, there must be special attention paid to ships on Fitzgerald's starboard side. Fitzgerald had NO lookouts stationed on the starboard side.

Fitzgerald's skipper had gone to sleep in his cabin, and the ship's second in command, the executive officer, was also not on the bridge. Normally, that is not a problem. The officer of the deck, the officer on watch in charge of the ship, follows the Captain's standing night orders. Those standing orders require the officer of the deck to notify the Captain whenever another vessel is predicted to come within 3 nautical miles of Fitzgerald.

The investigative report cites 13 instances when Fitzgerald came within 3 nautical miles of another ship and the officer of the deck did not alert the captain. About 0125, Fitzgerald encountered three merchant vessels approaching from the starboard side each of which posed a risk of collision, including the Phillipine container ship ACX Crystal. Apparently uncertain about collision risk, about 0129, the OOD ordered hard left rudder and increased speed. Shortly afterward, ACX Crystal slammed into Fitzgerald's starboard side, rupturing the hull both above and below the waterline, knocking sailors out of their bunks and initiating a heroic effort to save the ship.  Following the collision, thirty-six Fitzgerald sailors were recognized for their heroic efforts at damage control and rescue efforts.

Lookouts never saw the ACX Crystal coming.

INCONCEIVABLE!

If anything, events aboard USS John S. McCain on August 21 were even worse. I'll tackle that story tomorrow.