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Report: False alarm triggered grounding off Kahnawake

The Transportation Safety Board of Canada (TSB), has pblished its report into the grounding of the 'Heemskerkgracht' on Aug 22, 2024, in the South Shore Canal of the St. Lawrence Seaway off Kahnawake, Quebec, after a sudden loss of propulsion. According to the Transportation Safety Board of Canada, the main engine shut down due to the activation of a false alarm on the oil mist detector (OMD). The vessel was anchored while awaiting assistance and was later refloated and towed to the Port of Côte-Sainte-Catherine. The vessel sustained minor hull damage. Oil mist detectors are designed to prevent catastrophic engine failures by shutting down the engine if oil mist is detected. However, these detectors cannot differentiate between oil mist, water vapour, or smoke, which can trigger false alarms. In this case, a maintenance oversight played a key role. During a scheduled maintenance, the OMD measuring head was replaced with a different model that required an external power source for its heater, unlike the original, which was self-powered. As a result, the heater was left unpowered, leaving the measuring head vulnerable to false alarms caused by water vapour. The investigation found that water vapour buildup triggered the false alarm, causing the automatic engine shutdown and subsequent grounding. Actionable insights for safety leaders The TSB report underscored that following the occurrence, the vessel operator replaced the OMD measuring head with a unit matching the original model. The new head was installed according to the manufacturer’s instructions and was properly calibrated and tested. Thecase demonstrates the need for rigorous oversight of equipment changes, thorough documentation, and regular verification that safety systems are fully functional. The TSB’s investigation serves as a reminder: even well-intentioned safety devices can introduce new risks if not properly managed.

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