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A study on navigation safety of gravel ships in Taiwan.
|Authors: ||Tsai, Li-ming|
gravel ships;navigation safety;seaworthiness;Swiss Cheese Model
|Issue Date: ||2018-08-08T03:41:05Z
|Abstract: ||臺灣位處歐亞大陸板塊與太平洋板塊的交會處，氣候受到季風與地形的影響甚大，尤以東北部海域因為洋流與潮流的匯集作用，容易造成不穩定的海象。根據勞氏協會評估海事頻率、船流複雜度、天候海象等因素，於「海難回顧（Casualty Return）」資料中，將臺灣海域列為中度海上風險環境。觀諸歷年紀錄資料，近年來臺灣散裝貨輪海難事件有不減反增的趨勢，基於船舶安全、船上人命、財產及貨物安全，海難風險議題不容人們忽視。 臺灣砂石業自1970年代以後一直十分興盛，但在過去幾年以來，受到中國砂石限運的影響，以及砂石船業景氣之沒落，砂石船的經營環境雖隨著時空與產業的變化而有所改變，目前臺灣地區砂石運輸幾乎以東砂北運為主。研究者鑑於近十年來臺灣地區船難事件頻繁，加上過去學界大多著重在砂石船的產業環境與經營模式之探討，缺乏對砂石船船難原因的分析，因此借助瑞士起司理論（Swiss cheese model）的觀點，從天候與海象因素，船舶適航性以及人員的人為因素等層面，來逐一探討影響臺灣砂石船航行安全的主要肇因。瑞士起司理論乃由James Reason所提出，主要解釋偶然意外的發生是由於微小錯誤所累積，在一個臨界點小錯誤醞釀為大錯誤，造成意外結果；若按照瑞士起司理論的原理應用在海難事故的分析上，我們可推斷，很多海難事故的發生並非單一錯誤所造成，很可能是一連串之未注意事件所導致。 本研究試著從天候與海象因素、船舶適航性因素以及人員的人為因素的分析中，找出並鎖定某個問題加以解決問題，以有效防堵或降低船難事故發生的可能。研究者以2000年到2012年臺灣海域12年來散裝砂石船之船難事故為案例，並以二位學者、三位港務人員與三位船員為對象，使用研究者自編之半結構式訪談大綱作為資料蒐集的工具。研究者透過訪談方式並輔以航海紀錄、相關會議文件與研究札記進行分析，根據所得結果作成以下研究結論： 一、天候與海象因素並非絕對是砂石船船難的肇因。 二、船舶的適航性不足是導致砂石船船難發生的主要因素。 三、人員的配置不當與人為的疏失是導致砂石船船難發生的主要因素。 四、相關單位如能明確立法並據以執法，將可能遏止砂石船的船難發生。|
Taiwan Island is located at region between the Eurasian Plate and Pacific Plate, the extreme weather conditions are always affected heavily by monsoon and topography, especially the intersection of ocean current and sea tides as a on sequence in unstable sea state at north-east region. As per assessment of Lloyd's Register of Shipping, they defines the Taiwan Island Sea as the more dangerous maritime surroundings above average according to “Casualty Return” evaluated with wreck occurrence, ship flow complex rate and the weather and sea state. Bulk carrier wrecks are more than more in recent years in terms of event records over the years, the shipwreck issues should not be dismissed in view of ship safety, human life, property and safety cargos transportation. Gravel businesses in Taiwan developed prosperously after 1970s, but gravel ships businesses circumstance had varied with the changes on space-time conditions and industry in the past several years which are affected by mainland China’s policy on gravel transportation restraint and gravel ships businesses recession, and now gravel transportation in Taiwan almost mainly continues on the pattern of “to-North and from-East” direction. The researcher explored the main causes from the weather and sea state, ships seaworthiness and human errors effected on navigation safety for gravel ships as Swiss Cheese Model was applied on this study in consideration of ships wrecks high frequency occurrence in recently ten years and people’s ignorance on exploring gravel ships wreck causes, on the contrary focus on gravel ships industry circumstance and business practice. Swiss Cheese Model was pointed out by James Reason, it exposed that the accident often fermented from cumulative little faults and happened on the tipping point as these little faults evolved in heavy faults. Thus, we could deduce that many ships wrecks conceived in a chain of event factors were neglected, but not a single event if we used Swiss Cheese Model theory to analyze wreck causes. The researcher tried to find out the critical causes and lock on the most crucial factor to overcome it by event tracing from the weather and sea state, ships seaworthiness and human errors in order to decrease and block the occurrences in ships wrecks. This study is to collect and adopt seven gravel ship wrecks cases from 2000 to 2012 as samples and associate the interview with two scholars, three harbor officers and three Seafarers for further investigation. Meanwhile, semi-structured interviews were also adopted for use of empirical research. Including the interviewing with the people at the field and adopted the ships navigational records, committee papers and study notes for analyzing. Finally, the conclusion was made according to the findings at the field as the followings: (1) The weather and sea state should not be deemed as the inevitable major factors and cause the capsizing of the ravel ship. (2) The insufficient seaworthiness should not be deemed as certain major factors to lead the gravel ship wrecks. (3) The impropriate manning arrangement and human errors should be the major elements to cause the capsizing tragedy. (4) If the relevant government institutions could make concrete legislations and enforce the laws, gravel ship wrecks might be decreased.
|Appears in Collections:||[商船學系] 博碩士論文|
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