The Transportation Safety Board of Canada (TSB) has released its investigation report into the fire and flooding on board the Holiday Island ferry near Wood Islands, Prince Edward Island.
As a result of the investigation, the TSB is issuing a recommendation to Transport Canada. It is also launching a national safety issue investigation into vessel fires and emergency response across Canada’s marine sector.
What happened on board the Holiday Island ferry
The ferry Holiday Island operated on a 75-minute route that crosses the Northumberland Strait between Caribou, Nova Scotia, and Wood Islands, Prince Edward Island (PEI). On 22 July 2022, the vessel departed for Wood Islands on the 2nd voyage of the day. As the vessel approached Wood Islands, the fire alarm sounded in response to an engine room fire. The engines were shut down immediately and the fuel supply valves were closed shortly afterward. The master purposely beached the vessel on a sandbar to the west of the channel, outside the entrance to the Wood Islands terminal, and both anchors were dropped. The crew attempted to fight the fire locally but were unable to do so successfully. In part because of the smoke and heat, the air intake vents on the housetop deck were not closed. A remote release of the carbon dioxide (CO2) fixed fire suppression system was unsuccessful. When the crew noticed this, the system was activated with a manual release and was partially successful. The vessel’s fire team began boundary cooling.
Preparations for evacuating passengers and non-essential crew members began while the fire teams were responding to the fire. Crew members assisted passengers down both marine evacuation system slides and into the life rafts. The crews of nearby vessels evacuated passengers and non-essential crew from the life rafts and took them to the reception point at the Wood Islands dock. Approximately 1.5 hours after the fire alarm first sounded, all passengers and crew members who were not part of the fire response had left the vessel.
As shore-based firefighters boarded the vessel to assist, boundary cooling was expanded to the housetop deck and to the funnel deck and the firefighters began to monitor temperatures. At this time, a significant amount of smoke was coming out of the air intake and exhaust vents for the engine room.
Close to high tide, at 1850, the stern of the Holiday Island floated free. The Holiday Island had been listing approximately 2° to 3° to port since the early afternoon. By 2017, the list had increased to approximately 5° and by 2044, it was listing approximately 10° to port.
At 2148, out of concern for their safety, persons still on board (approximately 40) were evacuated. The fire continued to burn, and smoke from the engine room vents and stack continued to be visible until mid-afternoon on 23 July. On the morning of 24 July, the Holiday Island was towed to the Wood Islands terminal and the on-board vehicles were unloaded later that day. The vessel was later declared a constructive total loss.
In the course of the occurrence, different numbers of passengers and crew were recorded. The master initially reported a passenger count of 182 and a crew count of 23 (a total of 205). In total, 236 passengers were counted at the reception point.
The investigation found that a series of temporary repairs to a leaking fuel rail had been made over a period of approximately 1 month before the occurrence using non-standard materials and methods, while the vessel remained in service. When the final temporary repair to the leaking fuel rail failed, fuel sprayed onto the hot engine components and ignited.
The investigation also found the following:
- At the beginning of the firefighting response, water from a fire hose likely spread the burning engine fuel around the engine room and contributed to the spread of the fire.
- An unlubricated component of the fuel valve assembly prevented the fuel valve from closing fully, allowing the contents of the day tank to drain through the damaged fuel rail and fuel the fire in the engine room.
- The crew believed they had activated the CO2 fire suppression system, because the resistance felt when the CO2 release mechanism cable was pulled provided a false indication of success.
- The guidance posted was not explicit. Consequently, the CO2 release was delayed, allowing the fire to grow. When the CO2 was released, the engine room space was not completely sealed. Air continued to enter the space through open vents, likely displacing the released CO2 and also adding oxygen to the fire. Consequently, the fire continued to burn.
- The flexible connection between the cooling system and the forward main engine was not protected against heat and fire. When the flexible connection was damaged by the fire, seawater from the vessel’s cooling system entered and began flooding the closed engine room.
- The investigation identified safety deficiencies related to policies and procedures for emergency responses and communication on the part of the crew, the vessel operator, and first responders. Specifically, the investigation also identified safety deficiencies related to accounting for passengers in case of an emergency. Lastly, the investigation identified safety deficiencies related to oversight by the authorized representative (AR) or their delegate, leading the Board to issue a recommendation.
Role and responsibilities of authorized representatives:
Under the Canada Shipping Act, 2001, an AR, typically the vessel’s owner, is the person who is responsible for acting with respect to all matters relating to the vessel that are not otherwise assigned to another person. The AR must keep up with changes in safety knowledge, standards, and regulations. Where matters are assigned by regulation to another role, such as the master, the AR remains responsible for oversight of those matters. In addition to ensuring regulatory compliance, the AR or the AR’s delegate plays a proactive role in ensuring safety. Given the scope of the AR’s responsibilities, the relationship between the master and AR is critical and collaboration is essential for the continued safe operation of a vessel. For example, this collaboration requires ongoing assessment by both the master and the AR to ensure that procedures are understood, followed, and accurately represent all operations and that they also comply with regulations.
One of the key issues uncovered in the investigation was the confusion surrounding the role of the authorized representative, the person legally responsible for a vessel’s safety. In this case, the Minister of Transport held this role, with operational responsibilities shared between Transport Canada and Northumberland Ferries Limited through a charter agreement. However, the investigation found that many staff at both organizations were unsure of what the role entailed and who was ultimately responsible for carrying out those obligations. The lack of clarity extended into critical areas such as operations, emergency repairs, and oversight. This investigation, along with others before it, has identified a lack of understanding and awareness of the roles and responsibilities of authorized representatives in the industry.
Recommendation:
“The Transportation Safety Board of Canada recommends that the Department of Transport provide comprehensive guidance for authorized representatives, outlining the full scope of their responsibilities. This guidance should support authorized representatives in understanding and complying with applicable regulations, thereby reducing the risk of vessels and crews operating without the minimum safety defences afforded by regulatory compliance.”
TSB Recommendation M25-01
Marine safety issue investigation: Vessel fires and emergency response:
The TSB has also launched a national safety issue investigation, M24A0348, into shipboard fires on commercial vessels and the effectiveness of emergency response in Canada.
Unlike individual occurrence investigations, an SII is broad in scope, involving an in-depth review of multiple occurrences and consulations with key industry stakeholders.
In the past decade, nearly 400 fires on commercial vessels have been reported to the TSB, with 10% resulting in total vessel loss.
Despite the nine safety concerns and 10 recommendations issued by the TSB in the last 35 years, vessel fires continue to endanger crews, disrupt operations, and threaten safety in Canadianwaters.
This investigation will explore what crew members and responders understand about fire response, how they handle these events, and Canada’s overall preparedness to respond to them. Given international concern over vessel fire safety, the TSB may also share its findings with the International Maritime Organization, and other global partners.
Areas of focus:
The SII will investigate safety issues that have been identified in previous TSB investigations including seafarer knowledge of fixed-fire suppression systems, training in vessel-based fires for shore-based firefighting personnel, and the capacity to fight shipboard fires in Canadian waters.
A survey will be made available to marine operators, firefighting services, ports and harbours, and other key industry stakeholders. The results will be compiled and analyzed along with other data gathered by the investigation to identify recurring gaps and trends.
Download the report: TSB Holiday Island report
