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Strengths and weaknesses in assessing human factors in maritime risk assessments
1. Strengths and weaknesses in risk assessments Presentation at Transportforum Linköping, Sweden, 2010-01-14 Markus Lundkvist, Risk analyst Swedish Maritime Administration
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3. SMA tasks and and budgeted costs 2009 Pilotage 47 M⏠Maritime Traffic Information 6 M⏠Fairways and Aids to Navigation 30 M⏠Icebreaking 25 M⏠Cartography 7 M⏠Search and Rescue 27 M⏠Transport policy and regulations 10 M⏠Administration 25 M⏠----------------- Appr 177 MâŹ
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6. Definition of Risk Assessment in this presentation Step 1 Hazard indentification Step 2 Risk assessment Step 3 Risk control options Step 4 Cost benefit assessment Step 5 Decision making recommendations Decision makers
7. Strategic and operational risk assessment - VTS Risk Control Measures / Options Formal Safety Assessment (FSA) Regulation of VTS area and service (Swedish Transport Agency) IMO - Formal Safety Assessment Guidelines Goal Maritime safety VTS provides valuable services to mariners (Swedish Maritime Administration) Collisions, groundings and contacts are avoided Strategic risk assessment Operational risk assessment
12. HazID Farled/ Hamn OmrĂ„de i farled/hamn Riktning Olyckstyp Bakomliggande orsaker Fartyg som ffa kan vara inblandade (typ, storlek, lots ombord etc) PĂ„ vad baseras bedömningen (intrĂ€ffad hĂ€ndelse eller identifierat möjligt scenario) 1 Yttre omrĂ„det VĂ€st/syd pĂ„ Trubaduren In / ut Kollision / nĂ€rsituation OsĂ€kerhet vilken bordningsposition som skall anvĂ€ndas. Samtliga ftg som Ă€r pĂ„ vĂ€g till och frĂ„n Göteborg eller yttre ankarrutor IntrĂ€ffad hĂ€ndelse. UtgĂ„ende ftg kan vara ovetande om inkommande fartygs intentioner. Och/eller anta att ftg Ă€r pĂ„ vĂ€g till annan bordningsposition Ă€n vad som Ă€r tĂ€nkt. 2 Yttre omrĂ„det VĂ€st/syd pĂ„ Trubaduren In / ut Kollision / nĂ€rsituation Manövrering vid embarkering / debarkering av Lots. Ftg kan göra ovĂ€ntade manövrar för övrig trafik, nedsaktningar / ovĂ€ntade girar. Pga. att fokus flyttas frĂ„n sjövĂ€gsreglerna till att ta ombord lots. Samtliga ftg som Ă€r pĂ„ vĂ€g till och frĂ„n Göteborg eller yttre ankarrutor IntrĂ€ffad hĂ€ndelse. Upphinnande ftg som Ă€r under omkörning av lotspliktigt ftg (som hĂ€r skyldigt att hĂ„lla kurs och fart) kan plötsligt göra ovĂ€ntade manövrar. Dessa situationer uppstĂ„r Ă€ven för utgĂ„ende trafik, men dock ej lika frekvent. Ăven lĂ€mnandet av lots anses "lindrigare".
14. Defective radio watch Too late radio call Pomerania Rio Grande Poor cooperation Fear for engine alarm? Too late speed reduction Acceptance of a too narrow margin in distance Causes/factors Neglecting the ABÂŽs warnings Too vague change of course All steering gears were not running Concentration on telephone call Limited experience? High confidence in the radar COLLISION Vessel on starboard? Limited education? Nonchalance? Wrong radio channel ? Nonchalance? ? Too much respect Too much respect Routine/ Obligation? ? ? ? Poor cooperation Neglecting the ABÂŽs warnings ? Act/Event Act/Event Causes/factors
15. 1. Anomaly in ship position, draught, course, speed, (or in waterway) 2. Anomaly becomes observable for VTSO 3. VTSO becomes aware of the situation 4. VTSO calls ship to inform or to ask about intention 5. Bridge team understands the question/information 6. Bridge team undertakes appropriate measures 7. Anomaly is corrected with sufficient marginal to avoid accident 2. Slight delay in radar, AIS, information from mariners 3. Workload, experience, operational procedures 4. Communication means 5. Workload, status 6. Situational awareness and correct action 7. Ship manoeuvrability , fairway size and configuration
16. Event tree 1. Anomaly in ship position, draught, course, speed, (or in waterway) 2. Anomaly becomes observable for VTSO 3. VTSO becomes aware of the situation 4. VTSO calls ship to inform or to ask about intention 5. Bridge team understands the question/information 6. Bridge team undertakes appropriate measures 7. Anomaly is corrected with sufficient marginal to avoid accident Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? Yes p=? No p=? Yes p=? Yes p=? Yes p=? Yes p=? No p=? Yes p=? Yes p=? Yes p=? No p=? Yes p=? Yes p=? No p=? Yes p=? No p=? No p=?
18. Claims data 2000-2009 H&M, LoH Swedish Club Probability: 1 SAFEDOR (2007) Swedish data Probability: Sw. Accident dbase ASEK 4 (SIKA, 2009) Probability: 1 Assumption of average delay ASEK 4 (SIKA, 2009) FSA Guidelines Probability: Sw. Accident dbase Claims data 2000-2009 (contact, P&I) Swedish Club Probability: 1 (contact) Negligible in most cases . Estimation approach CASUALTYID SUBCLASS CATEGORY DATEOFLOSS TOTAL _100_USD MAINDEDUCT_USD CLAIMDETAILS VESSELTYPE 20000001 Hull and Machinery Insurance Collision 01-jan-00 75265 41088 C/W BERGEN ARROW AT DURBAN ROAD Container 20000004 Hull and Machinery Insurance Collision 04-jan-00 2526 100000 COLLISION WITH PORT ARTHUR AT NEW ORLEANS Bulker 20000005 Hull and Machinery Insurance Collision 07-jan-00 2332 75000 C/W NEW HAI HUNG AT HONG KONG Bulker 20000008 Hull and Machinery Insurance Collision 11-jan-00 2474 100000 COLLISION WITH ATLAS AT CADIZ Dry Cargo 20000009 Hull and Machinery Insurance Collision 12-jan-00 326009 35000 C/W PASADENA UNIVERSAL Bulker 20000013 Hull and Machinery Insurance Collision 20-jan-00 266221 70000 ENTANGLED PROPELLER AND C/W VENTO DE MELTIMI AT ALEXANDRIA Dry Cargo 20000046 Hull and Machinery Insurance Collision 21-feb-00 4262 67500 STRUCK BULKWAYU AT MARACAIBO Dry Cargo 20000062 Hull and Machinery Insurance Collision 09-feb-00 60397 45000 C/W TUG PIONEER AND BARGE AT SEMARANG Container 20000108 Hull and Machinery Insurance Collision 16-mar-00 493 39807 COLLISION WITH MAERSK CASTRIES AT FREEPORT BAHAMAS Container
20. Human factor in risk assessment Strategic risk assessment Operational risk assessment
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22. Frequency assessment - models? RCMs impact on: Lateral distribution Grounding candidates Causation factor
23. Frequency assessment â Reported accidents involving Swedish and foreign ships per port call in Sweden Sources: Swedish Maritime Safety Inspectorate, 2002 /Swedish Transport Agency, 2008: Sjöolyckor i svenska farvatten. Swedish Maritime Administration, 2008: Sektorrapport.Sjöfartens utveckling 2008.
24. Consequence assessment - Source : ITOPF, 2009: Oil tanker spill statistics 2008. Spills over 700 tonnes. Oil transported and number of oil spills > 7 tonnes.
25. Some strengths and weaknesses in FSA FSA step Strengths Weaknesses Hazard identification Widened knowledge of accident scenarios Structured identification Limited insight Simplification of causal chains Risk Assessment (Frequency, probability) Estimation of probability â good decision Changing system (rules, technology, traffic regime) Geographically (and poor) statistics Risk assessment (Consequences) Impact distribution on different values Monetary value Limit of accident impact Risk Control Options Limited Limited insight in combinations Limited number of RCMs evaluated Limited insight in effect Cost-Benefit Assessment Effectiveness approach Rough costs, poor data, sensitive to state of market
26. Final questions When are collisions and groundings predictable? For whom are they predictable? When is the accident probability 1? Differences - operational and strategic risk assessments? What strengths and weaknesses in risk assessments have You identified? What are the similarities and differences compared to medievial risk assessment?