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Asian Institute of Maritime Studies
Pasay City, Philippines

INTERNATIONAL SHIP AND PORT FACILITY SECURTIY CODE

In partial fulfillment of the Case Study and presentation for:
Issues and problems in the Maritime Industry being addressed by ISPS
Sunken Ships

Submitted to:
ENS. GRACIANO C. CONSORIO PCG (Ret)
Instructor
Submitted by: Group Number 2 I. Introduction
The sea is a large body of salt water that is surrounded in whole or in part by land. More broadly, the sea is the interconnected system of Earth's salty, oceanic waters—considered as one global ocean or as several principal oceanic divisions. Moreover, it has served as a home for marine and aquatic environment and also as defined roads for marine transportation in the conduct of trade and civilization. In spite of the glorious facts accounted, the sea was also the venue and sole witness of such tragedies, catastrophes known as maritime incidents.
By definition, maritime incident means any occurrence, other than an accident, that is associated with the operation of a ship and effects or could affect the safety of operation. From the initiation of transport at sea up to the present, tremendous accounts of maritime incidents can be noted and such incidents lead to countless loss of lives, property, and the environment. With these adverse effects at hand, major approaches can further explain the importance of such incidents.
From a historical approach, the first transport at sea was accounted as trade using small wooden boats which later grew to ships and other vessels. Constructively, wood and other low grade materials were used to build such ships and vessels which traveled beyond the defined borders of the world. Due to lack of further studies, analyses, and technology, such materials grew old faster with time and lead to such unfortunate mishaps into maritime incidents recorded such as the Galleon Trade and the Titanic which took large numbers of innocent lives.
From a theoretical approach, maritime incidents and other catastrophes at sea conceived the various technological innovations, conventions, regulations, and rules which govern the maritime world today. Relatively, the hostile existences resulted to optimistic and regulative approaches to preserve the safety of life, property and environment. In the present, all efforts have been continually made to propagate such innovations, regulations, codes, and rules which constitute as pillars of the maritime industry. Hence, maritime incidents gave birth to numerous conventions, codes, and regulations such as SOLAS 1974, STCW 1978, and MLC 2006 among many others and also to the innovation of navigational and mechanical equipment.
Conclusively, maritime incidents may account to equilibrium between principles of thoughts. Through these inimical cases recorded the human element learned, conceived, and implemented different resolutions to accommodate various kinds. For this reason, safety of life, property, and environment is continually molded and ensured as the maritime industry continue to learn from mistakes and promulgate that history itself shall not be repeated but therefore enhanced as nothing in this world is infallible.

II. Scope of Research and Presentation A. Background of the Study Maritime incidents come in various forms depending on the nature of distress encountered by the ship at sea itself. It includes piracy, bombing, smuggling, stowaway, oil spill, collision, and fire onboard, aground, and sunken, capsize, abandon ship, steering casualty and many others. But among all of those mentioned above, sunken ships are the most striking as they leave definite evidences on how intense the distress they have run into leaving the premise of once seaworthy vessels into a wreck lying beneath the seabed. According to research and records, more than 16.5 sunken ship incidents occur each year on the average from year 2000 to 2014. Distinctively, these incidents of vessels lying on the seabed accounted to countless losses in life, property, and the environment. With the adverse effects already taken into account, the causes of such definite distress still lies in the elements involved in the conduct of maritime transportation and operation. From a natural standpoint, the hostile nature of the marine environment can be opted out as a major cause to most of sunken ship cases. Unlikely, adverse weather brought by storms and other calamities at sea devours ships and vessels along its wake. Remarkably, such losses and damages from this clause are said to be force majeure or an act of God that there is nothing man can do to avoid such events. As a saying of mariners goes, “A smooth sea never made a skilled sailor.” From an instrumental standpoint, nothing in this world is made perfect or infallible. Maritime operations and routines are highly dependent on vital equipment on both deck and engine to perform their vigorous functions. Relatively, the ship itself is an instrument for the maritime profession and industry and is subject to errors and failures. Reasonably, some sunken ship incidents can be accounted to equipment failure which leads to enormous, adverse effects in all aspects known to man. Evidently, the human element has contributed the largest percentage to most sunken ship cases. By definition human error means that something has been done that was "not intended by the actor; not desired by a set of rules or an external observer; or that led the task or system outside its acceptable limits". In short, it is a deviation from intention, expectation or desirability. Despite the efforts made to minimize human error among the maritime profession and industry, such efforts that were even turned to regulations such as Standard Marine Communication Phrases in the STCW Code and many others were easily violated by negligence among ignorant crew and personnel leading to occurrence of such maritime incidents especially sunken ships.
Convincingly maritime incidents, especially sunken ships, are accounted to the elements and components acting as prerequisites to the maritime operation. Among these elements, root causes can be easily opted, analyzed, and therefore resolved to minimize the frequency, avoid such incidents, and promulgate the safety of life, property, and the environment as to be preserved in their natural order.
B. Objectives This study focuses sunken ships as maritime incidents which have been a real culprit of damages and calamities that cost countless losses in life, property, and of the marine environment. Basically, the basis of this study are the maritime incidents which account from year 2000 to 2014 which were gathered and further analyzed for the purpose of this study. Furthermore, the said study will be greatly in accordance in obtaining the following objectives: a. To gain knowledge about maritime incidents which are present risks related with the maritime profession and industry. b. To gather sufficient relevant data from the year 2000 to 2014 to serve as basis for the said study. c. To opt out causes through vigorous analysis of the said data and raise awareness from the detrimental effects from the incidents. d. To conduct discussions on why the occurrence of incidents become high and low in the inclusive span of time. e. To identify and point out the root cause of all such incidents within the inclusive years; and f. To draw inferences and recommend measures that will help resolve such incidents by identification, prevention, and further analysis on the causes of such incidents.

C. Maritime Incident with Photographs of such Incidents
Ship sunk year 2000
6 June ( Mexican Navy): The Minesweeper was sunk off the island of Cozumel for use as an artificial reef. The Auk class displaced 890 tons on average, and had an approximate length of 220-225 feet. They could reach a maximum speed of about 18.1 knots (33.5 km/h). Auks were equipped with a single 3 inch gun, two 40 mm Bofors guns, and eight20 mm Oerlikon guns.
Thirty-two minesweepers were ordered by the US (as BAM-1 to -32), intending them to be supplied to the Royal Navy under Lend; 12 were retained for USN use and given names and the "AM" hull classification prefix. Those transferred to the RN were named as the Catherine class receiving "J" pennant number prefixes.
Eleven minesweepers of the Auk class were lost in World War II, six to direct enemy action including USS Skill, torpedoed byU-593.

Ship sunk year 2002
26 September * Le Joola ( Senegal): The passenger ferry capsized and sank in the Atlantic Ocean off the coast of Gambia with the loss of at least 1,863 of the over 2,000 people on board. 64 survivors. It is thought to be the second-worst non-military disaster in maritime history. * The ship was plying the route from Ziguinchor in the Casamance region to the Senegalese capital, Dakar, when it ran into a violent storm, farther out to sea than it was licensed to sail. The estimated 2000 passengers on-board amounted to at least three times as many as the ship was designed to hold, and only about half of them had tickets. The large numbers sleeping on deck added further instability. Rescue operations did not start for several hours. *

Ship sunk year 2003
31 May * Fu Shan Hai ( China): The bulk carrier collided with Gdynia ( Cyprus) off Bornholm, Denmark and sank. Fu Shan Hai was a Chinese bulk carrier which on 31 May 2003 was involved in a collision with the Polish container ship Gdynia north-west of the Danish island of Bornholm in the Baltic Sea. Later the same day Fu Shan Haisank in 69 metres (226 ft) of water. At that moment, she was the biggest ship to be sunk in the Baltic Sea.

Ship sunk year 2004
27 March * HMS Scylla ( Royal Navy): She came into to the public limelight in 1973 when she collided with the Torpoint ferry in fog during her very first movement * HMS Scylla was a Leander-class frigate of the Royal Navy. She was built at Devonport Royal Dockyard and was the last RN frigate to be built at the Dockyard so far. Scylla was launched in August 1968 and commissioned in 1970. It was the start of a long and eventful career that ended with her sinking as an artificial reef in 2004.

Ship sunk year 2006
23 March
Pong Su ( Tuvalu): The Pong Su incident began in April 2003 when Australian military personnel from Special Operations Command intercepted the Pong Su, a North Korean ocean freighter in Australian territorial waters. The ship was suspected of being involved in smuggling almost 150 kg (330 pounds) of heroin into Australia.
The Pong Su was a 349-foot (106 m), 3,743-tonne ocean freighter registered in Tuvalu and North Korean owned. The ship was flying the flag of Tuvalu, a flag of convenience. Four men arrested on shore were convicted of importing heroin, the crew were all acquitted and deported, and the ship was destroyed in 2006. *

Ship sunk year 2007
23 November * Explorer ( Canada): The cruise ship struck an iceberg and sank close to the South Shetland Islands in the Antarctic Ocean. One hundred passengers and fifty-four crew were evacuated from the ship and took to the liferafts. (The two people that remained and attempted to stabilize the ship gave up and evacuated as well). The Antarctic Dream was reported to be assisting in the rescue.

Ship sunk year 2008
21 June

Princess of the Stars ( Philippines) was a ferry owned by Filipino shipping company Sulpicio Lines. It capsized on June 21, 2008, off the coast of San Fernando, Romblon, at the height of Typhoon Fengshen (PAGASA name: Frank), which passed directly over Romblon as a Category 2 storm.
Built in 1984 by Ishikawajima-Harima Heavy Industries Co., Ltd. Aio, Japan, the 23,824-ton ferry MV Princess of the Stars, formerly MV Ferry Lilac of Shin Nihonkai Ferry, had a total passenger capacity of 1,992 people.

Ship sunk year 2010
22 April * Oil rig Deepwater Horizon ( Marshall Islands) Deepwater Horizon was an ultra-deep water, dynamically positioned, semi-submersible offshore oil drilling rig owned by Transocean. Built in 2001 in South Korea by Hyundai Heavy Industries,] the rig was commissioned by R&B Falcon, which later became part of Transocean, registered in Majuro, Marshall Islands, and leased to BP from 2001 until September 2013. In September 2009, the rig drilled the deepest oil well in history at a vertical depth of 35,050 ft (10,683 m) and measured depth of 35,055 ft (10,685 m) in the Tiber Oil Field at Keathley Canyon block 102, approximately 250 miles (400 km) southeast of Houston, in 4,132 feet (1,259 m) of water. On 20 April 2010, while drilling at the Macondo Prospect, an explosion on the rig caused by a blowout killed 11 crewmen and ignited a fireball visible from 40 miles (64 km) away. The resulting fire could not be extinguished and, on 22 April 2010, Deepwater Horizon sank, leaving the well gushing at the seabed and causing the largest oil spill in U.S. waters.

D. Chart of said Maritime Incidents from 2000 - 2014

E. Discussion
According to the data gathered for the purpose of this study, sunken ship incidents rose from a minimal average of 10.33 incidents from year 2000 – 2008 to a towering average of 34.5 from year 2009 – 2015. From this statistical observation, the minimal average is still not negligible due to the reason that it causes such detrimental effects to life, property, and the environment. Adversely, such losses due to the larger incidental average from the year 2009 – 2015, induced much destruction to all such accounted deleterious effects.
Nominally, the number of incidents grew to almost triple the number throughout the span of time recorded for this study. With this observation, it can be noted that the inclusive years where the number of incidents piled up to be tripled, were the years were further technological developments were implemented on the maritime industry. With such developments that took place in the industry, various innovative techniques and equipment were implemented thru regulations and amendments to incumbent laws governing the maritime sector. Positively as a result of such valuable innovations, the enhancement for the safety of the maritime industry, particularly shipping, became the valiant objective. Distinctively, the safety of navigation was further improved with the addition and operation of high technology equipment came to force. Due to this reason, bridge and engine operations, functions, and routines came to be at ease.

On the other hand, the negative effects still struck the maritime industry and thus far were never eliminated. From the valuable enhancements and ratifications for innovations which subject ship operations, functions, and routines to a lighter load, came a relaxed state on the human element which can be opted out as the sole clause for human error. Specifically, this sole clause accounted for 52.05%, the largest percentage among principal causes of sunken ship incidents recorded. Mathematically, it accounted more than half of the percentage taken by the other principal causes such as equipment error (27.40%) and Force Majeure (20.55%).
Therefore, based on the data gathered for this study, the incident became higher due to innovations to the maritime sector which objectives were for the enhancement of the safety of life at sea. Distinctively, these innovations took place on the inclusive years where the incidents rose from minimal to more than thrice the number. Reasonably, all such things introduce positive and negative effects to all such prerequisites. As for the maritime industry, particularly shipping, it induced valuable enhancements but also the clause of human error, which accounted considerable amounts for a principal cause for maritime incidents.

F. Root Cause
For the purpose of this study which is based on record of the International Maritime Organization, sunken ship incidents which causes tremendous countless losses in life, property, and the environment are due to three principal causes. These three principal causes are identified for the purpose of this study only and are not limited to Human Error, Equipment Error, and Force Majeure.
Furthermore, the root cause of sunken ship incidents is therefore identified as human error which accounted to 52.05% of all such incidents. Human error, as a reasonable cause for sunken ship incidents, implies more than half in number compared to other principal causes such as force majeure which accounted only 20.55% and equipment error with 27.40%.
By definition, human error means that something has been done that was "not intended by the actor; not desired by a set of rules or an external observer; or that led the task or system outside its acceptable limits". In short, it is a deviation from intention, expectation or desirability. It is inscribed and originated solely to the human element depending on the physical, physiological, and psychological factors within.
As the root cause of the majority of sunken ship incidents, human error can thus be related and compared to the other principal causes for further distinction. In comparison to the equipment failure and force majeure, human error is the only principal cause that can be corrected. Convincingly, force majeure as natural phenomena, area undesirable, unintentional, and unknown. It comes when it is least expected as it is an act of God. In addition to, equipment error cannot also be corrected as all such equipment and instruments are subjected to such errors and malfunctions. Relatively, only such care and safety procedures can be applied to equipment to rectify avoid such turmoil.
Conclusively, human error is the root cause of such maritime incidents not only limited to sunken ships but also to others such known incidents. In comparison with the other such principal causes, it is the only cause where correction can be applied for it is dependent on the human element. Relatively, physical, physiological, and psychological factors shall be taken into reckon for the human element subjected to human error as the radical reason.

III. RECOMMENDATION
Based on the research we made, the following recommendations are offered for consideration. The Coast Guard has already made progress toward implementing them.
Human error
The most frequently identified human errors across all vessel and casualty types Inadequate Communications, Inadequate General Technical Knowledge, Inadequate Knowledge of Own Ship Systems, and Poor Design of Automation and poor decision making of the Master and Officer. As a result of information received from research it was possible to determine how these errors were addressed. Data provided was part of a safety management system (SMS), where “lessons learned”. Managers used the lessons learned to refine policies and procedures in order to reduce human errors in their operations. This systematic, high-level approach to process improvement clearly contributed to the dramatic reduction of sunken of ships. Given the success within the shipping industry, it is recommended that the SMS provisions of the recently published proposed rule for inspection of vessels emphasize SMS implementation to the fullest extent possible.
We have seen that human error (and usually multiple errors made by multiple people) contributes to the vast majority (52%) of marine casualties, making the prevention of human error of paramount importance if we wish to reduce the number and severity of maritime accidents. Many types of human errors were described, the majority of which were shown not to be the “fault” of the human operator.
Material Failures or Equipment Error
While the focus of this study was human factors, the data show that more than (27%) of accident were the result of material failure. Vessel casualty graph have shown that the combination of material failure and loss of vessel control led to some of the largest sunken of ships from 2000 through 2013. Material failure was identified as a significant factor for propulsion and steering problems. When such failures occur on large vessels, such as tank ships and freight ships, the potential for damage due to allision, collision, or grounding is significant. According to industry feedback, material failures were also a significant factor in near-miss incidents. It is recommended that the Coast Guard continues to study incidents that result in loss of vessel control and modify the vessel inspection procedures for large U.S- and foreign-flag vessels marine casualties.
Rather, most of these errors tend to occur as a result of technologies, work environments, and organizational factors which do not sufficiently consider the abilities and limitations of the people who must interact with them, thus “setting up” the human operator for failure. Human errors can be reduced significantly. Other industries have shown that human error can be controlled through human-centered design. By keeping the human operator uppermost in our minds, we can design technologies, work environments, and organizations which support the human operator and foster improved performance and fewer accidents.
Force majeure
Based on the study we have conducted perils of the sea are an act of God that is unpredictable, dangerous and one of the factors that cause major sunken of the ships in maritime industry. As recommendation about the study, seaworthiness is needed to less the tragedy that might happen.
The term 'seaworthiness' refers not to a fixed standard, but to a relative standard which varies according to the ship and the exigencies of the voyage. A seaworthy vessel must have a competent master and a sufficient number of competent crew members.
In general conclusion about the force majeure, it is better to be ready in case of such unpredictable situation that might happen, also being updated always on the news and importantly becoming a faithful seafarer that always seek help to our God. Keeping always on track and course was the mission of every vessel but in case of unpredictable act that might encounter it’s better to alter course and be on a safe way to save the life, vessel, and environment.

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...friendly and helpful * Good product range to satisfy what people want most, the necessities * As many strategically sited stores as possible, with a good expansion programme * Heavy advertising of their price philosophy and convenience * Clean stores, comprehensive range, good and clothes, good prices. Products: Asda offers services such as CD’s, DVD’s, Groceries, Games, Electrical, Flowers, Furniture, Local Gifts, Mobile phones, Opticians, Pharmacy, Photo, Travel, Petrol and Oil, Delivery and Insurance. It is believed that the new phrase ‘more for you for less’ will emphasise the quality and freshness of its food and drink products as the low price angle was not working as well as it used to with consumers. Asda’s aim is to produce good quality products at low prices. Main Marketing Objectives are to increase market share and compete Tesco. Target Audience The potential customers of Asda are people with low and medium income, as well as students, younger housewives, disabled and retired. Their requirements of those groups are more promotions and low prices. Proposed Marketing Strategies In order to compete Tesco successfully, Asda needs to increase its market share. So the project is to increase the customer coverage, improve the product position in the market and increase overseas sales. A new group of customers should be targeted – people with higher income. In order to do this, new products should be introduced. To identify exactly which products, a......

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...Walking the Talk: an Article for Critical Eye Archie Norman, the former CEO and Chair of the supermarket chain ASDA, left a haunting image when he spoke at a conference last week. He compared the store visits he engineered with those of ASDA's previous CEO. In the latter, a fleet of large cars would arrive at the Supermarket door and out would step 5, 6 or more senior executives. The store manager would be waiting patiently at the door. Hands would be shaken and the entourage would sweep down the aisles of the store. 'Hi, what do you do? You enjoy working here?' and then off to the next visit with a passing: 'tidy up that main display' to the manager on the way out. By contrast, Archie would go alone, park in the far corner of the car park, leaving the near spaces to shoppers who were spending money. He left his jacket in the car and walked unannounced into the store. He'd chat to customers: 'what do you like?', 'what could we do better?', 'thanks for shopping here' and to the staff: 'What's the best thing about working here? And the worst?' and finally he would talk to the manager, maybe over a coffee in the canteen. 'What can I do to make your life easier?' 'How's business?' A final walk round the store, maybe with the manger, then off to the car park to write any action notes to himself before setting off for the next visit. The point was not about the need to 'press the flesh' or be visible: it was how you got a realistic picture of what was going on and actually do...

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...motivation did Archie Norman discover at ASDA? ASDA was one of the most successful retail businesses in the United Kingdom. It had a competitive advantage due to its unique superstore structure and its low price leadership in the market. Everything changed all of a sudden as ASDA found itself with demoralized employees, slow growth in sales, and declining profits in 1991 due to many years of lack of interest from previous managers. It had been a 1 billion pounds cash surplus supermarket chain in 1987, and by 1991 it had a debt of over 1 billion pounds. This was the situation that Archie Norman encountered at ASDA when appointed Chief Executive Officer (CEO). The main reasons of the problems that ASDA and Archie Norman had to face were due to complex organizational inefficiencies. The employees had lost the ability to act independently and got used to be told what to do after many years of controlling management. ASDA had become a bureaucratic and hierarchical institution and as a direct result of this rigid functioning structure in the company any kind of innovation was stopped from being encouraged or implemented. Without any innovation ASDA was unable to keep its competitive advantages in the retail market in the United Kingdom. So ASDA and Archie Norman had to face the challenge of transforming the superstore in relation to its management style of doing things as well as implementing a sense of culture based on the core values of ASDA. Management and leadership had to......

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...ASDA Case Stephany Mejia 1. What problems of motivation did Archie Norman discover at ASDA? Archie discovered that beyond the immediate financial crisis ASDA had organizational and cultural issues. These issues created a problem of motivation. ASDA’s top executives had offices in a separate part of the headquarters and were isolated from the rest of the company, one manager explained that executives seemed more interested in “hunting and partying” than in addressing serious issues faced by the company. ASDA had become more bureaucratic and hierarchical. The bureaucracy had reached a point that made it difficult to get anything done. With the financial crisis people feared losing their jobs, so they didn’t want any attention to themselves and this stopped any innovation. There was little integration or interaction between the classes. Executives came mostly from the upper class while lower level employees came from working class. There was clearly a communication issue and subordinates were intimidated by their superiors and thus afraid to tell them anything other than what they wanted to hear. There was also an issue of communication between different departments such as buying, marketing and finance and this made coordinating activities particularly difficult. Since employees were not allowed to do anything and were so afraid this caused them to lack motivation for ASDA. 2. What do you think Archie Norman should have done on his first day on the job? ...

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