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Report into Kilkee Coast Guard boat tragedy published

Serious concerns have been expressed about aspects of the MCIB’s investigation and report.

An investigation into the tragedy in Kilkee that claimed that life of Irish Coast Guard volunteer Caitríona Lucas has found that the boat was launched in conditions which were outside the operations limits of the vessel.

41-year-old mother-of-two Ms Lucas, who was a member of the Doolin unit of the Irish Coast Guard, died on September 12th 2016 when the rigid inflatable boat (RIB) on which she was operating with two colleagues from Kilkee, capsized after being struck by a wave.

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The three volunteers were taking part in a search for man reported missing three days earlier. Ms Lucas was pronounced dead in hospital after being airlifted from the scene. Her colleagues James Lucey and Jenny Carway were rescued during an extensive multi-agency operation.

The Marine Casualty Investigation Board (MCIB) has published its report into the tragedy.

The report, comprising two parts, also states that insufficient consideration was given to the necessity and effectiveness of a boat operation.

The investigation concluded that the Irish National Search and Rescue Framework does not provide adequate clarity in relation to search and recovery operations as to when a search and rescue operation becomes a search and recovery operation or at any of the intermediate stages.

The report further concludes, the criteria for determining the response to recovery operations as opposed to search and rescue and the appropriate responses were not clearly defined.

Another conclusion was that the use of new technologies or alternative means of carrying out search and recovery operations was not adequately considered.

“The criteria for oversight at Kilkee station to ensure that it met pre-determined operational readiness were not established. There was not evidence of any effective management system in place with associated oversight to ensure that it met these criteria before the operation was tasked,” the report states.

The probe also concluded that: “The ’Triple Lock System’ to decide on launching a boat was not adequately set out. Neither the roles and responsibilities, nor the acceptance criteria for launching before each launch were adequately documented.”

Issues regarding the Delta RIB have also been highlighted which, according to the report, was not licensed or certified in accordance with the statutory requirements for the activities in which it was engaged.

A second section of the report details concerns raised by some parties involved about the draft report they received from the MCIB earlier this year. Correspondence from several parties including the Irish Coast Guard, raised serious concerns about many of the MCIB’s findings.

See full report here.

Meanwhile, Minister for Transport Shane Ross has welcomed recommendations in MCIB report and accelerates  advances in the Coast Guard Safety Management Systems

Minister Ross said: “I wish to again express my deepest condolences to the family and loved ones of Caitríona, who lost her life so tragically, doing the volunteer work she loved. Caitríona was a talented, hardworking and deeply committed member of the Doolin Coast Guard Unit. She was a selfless member of a unique group of people, those men and women who dedicate themselves to the protection of others at great risk to themselves. Caitriona made the ultimate sacrifice and her loss has been enormous. Coast Guard volunteers, in particular the direct colleagues of Caitríona in the Units at Doolin and Kilkee, were devastated at the tragic events that unfolded on that day.”

Minister Ross welcomes the report’s recommendations in full and will be ensuring that they are all implemented. These are clearly aimed at minimising the potential risks involved in SAR boat operations into the future.

The Minister also notes that as there is a separate on-going investigation being carried out by the Health and Safety Authority that it would not be appropriate for him to comment on the detail cited in the report.

The late Caitríona Lucas with colleagues during an operation in 2012 – Photo: © Pat Flynn 2016

Minister Ross said: “As an immediate response to this report, I have taken the following steps:

I have broadened the national SAR Framework review already underway as a response to the recent AQE Report on SAR aviation. It will now encompass the relevant recommendations arising from the MCIB report. The Review Group itself met formally on Wednesday 5 December under the independent chairmanship of Sir Alan Massey, former CEO of the Maritime and Coastguard Agency in the UK.

I have instructed the IRCG to accelerate its work in developing an independently accredited ISO safety management system that will be robust and fit for purpose. This work is already underway and significant effort and investment has taken place over the last two years.

That said, I am requiring the IRCG and the Marine Survey Office to take the necessary and pragmatic steps to ensure that any issues which could impact on vessel or crew safety are addressed as a matter of urgency.”

Minister Ross concluded: “Caitríona Lucas was an extraordinary woman – brave, committed, supremely generous – and her death was an appalling tragedy. Her life will be remembered by the actions of all those involved in Search and Rescue activities. I know the Irish Coast Guard including its 900 volunteers are committed to honouring her memory. We will ensure volunteer safety remains at the heart of Search and Rescue operations”.

 

 

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