Report on fatal carbon monoxide poisoning aboard motor cruiser Diversion published by MAIB

Report on fatal carbon monoxide poisoning aboard motor cruiser Diversion published by MAIB
Report on fatal carbon monoxide poisoning aboard motor cruiser Diversion published by MAIB

The MAIB has released a report on fatal carbon monoxide poisoning aboard the motor cruiser Diversion. At about 2000 on 4 December 2019, the bodies of two men were discovered in the cabin of the privately owned motor cruiser Diversion, which was moored to a quay in the centre of York, England. The bodies were those of the boat owner and his friend, who had spent the previous evening in the city centre socialising with former work colleagues and were spending the night on board.

Both men had died as a result of carbon monoxide poisoning. The carbon monoxide had leaked into the cabin from the boat’s diesel-fuelled cabin heater exhaust.

Safety Issues
– the cabin heater’s exhaust silencer was not designed for marine use: its connection to the exhaust pipe system was not gas tight, the installation had not been checked by a professional heater installer, and it had not been serviced;

– the cabin ventilation system did not meet the requirements of the Boat Safety Scheme and this might have increased the rate at which the carbon monoxide accumulated in the boat’s cabin space;

– the owner and his friend were not alerted to the danger because a carbon monoxide alarm had not been fitted.

As a result of the investigation’s initial findings the MAIB issued a safety bulletin, which has since been referenced in Boat Safety Scheme publications and has been featured in the 2020 Carbon Monoxide awareness week. As a result of these actions, no recommendations have been made in the report.

Read the safety bulletin: 2020 SB2 Diversion

Statement from the Chief Inspector of Marine Accidents:
“The MAIB investigation into this tragic loss of lives once again highlights the importance of installing carbon monoxide alarms on boats with enclosed accommodation spaces. This is the fifth fatal marine accident investigated since 2014, where a functioning carbon monoxide alarm could have saved lives. Carbon monoxide alarms suitable for the marine environment are readily available, inexpensive and simple to fit, and I urge boat owners to invest in one as soon as possible.

It is commonplace for marine engines, generators, cookers and heaters to produce carbon monoxide during normal operation; amateur installation and un-serviced appliances can introduce the risk of boat users inhaling lethal levels of this toxic gas. The importance of checking the installation and routine servicing of all such devices by a professional cannot be overstated.”

Statement from the IIMS Chief Executive Officer:
“I agree entirely with the comments made by the Chief Inspector of Marine Accidents. Too often we have seen carbon monoxide as the cause of deaths onboard boats. Such incidents are avoidable and the installation of an inexpensive carbon monoxide alarm would most likely save lives.

I urge marine surveyors the world over to implement a duty of care and if, when surveying a vessel and no carbon monoxide alarm is installed, they make a recommendation to the owner to fit one as a matter of urgency.”

Download the full report: 2021 03 Diversion Report

Read another MAIB related article: Downloadable MAIB Spring 2021 Safety Digest of accident reports published

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