Baton Rouge Image courtesy of Burgess

The tragic death of a chief engineer aboard the Isle of Man-flagged Baton Rouge has highlighted critical safety lapses in enclosed space procedures and electrical maintenance protocols, according to the UK Marine Accident Investigation Branch (MAIB).

MAIB, investigating the incident on behalf of the ship’s Registry, has published its findings. They reveal systemic failures in risk assessment and safety management that contributed to the fatal accident. This tragedy was preventable, so what urgent measures can be taken to prevent future incidents?

On 23 February 2024, the chief engineer was electrocuted while replacing a damper actuator in the yacht’s engine room ventilation system. He had not isolated the 230V electrical circuit or obtained a permit to work (PTW) for the task.

Working alone in high temperatures (50-55°C) within the vessel’s ventilation overpressure duct compartment, the chief engineer suffered a fatal cardiac arrest when he came into contact with live electrical conductors.

The report points to a series of safety procedure failures, the most critical being the decision to work on a live circuit, which should have been undertaken only with appropriate safeguards. The absence of a permit to work also indicates that there was no formal assessment or structured safety measures to mitigate the dangers.

The compartment itself met industry definitions of an enclosed space due to its limited access and high temperatures, but the yacht’s Safety Management System did not classify it appropriately and the safety procedures for the enclosed space were not adhered to. Without a proper rescue plan in place, the crew then struggled to extract the chief engineer, delaying emergency response efforts.

In response to the findings, MAIB advises that electrical work should always be approached with extreme caution and that circuits must be isolated before maintenance begins. If working on live equipment is unavoidable, it must be done with extreme care, using protective equipment and under extra supervision.

Enforcing permit-to-work systems is another fundamental measure, ensuring that tasks are properly assessed before work begins. The definition of enclosed spaces must also be fully understood by all parties and correctly applied, with high-risk areas treated as such and entry procedures followed to the letter.

Burgess, the yacht’s management company, has revised its safety procedures since the accident. This includes aligning enclosed space definitions with industry best practices, strengthening permit-to-work requirements and implementing additional safety training for crew members.

Fleet-wide guidance has also been issued to reinforce risk management and emergency preparedness. The MAIB has not issued formal recommendations, as these actions have already been taken, but the report serves as a clear reminder to the wider industry of the importance of safety on board, as complacency, even in routine tasks, can have fatal consequences.

To read the full report, click here.

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