PB83-916408

NATIONAL
TRANSPORTATION
SAFiTT
BOARD

WASHINGTON, D.C. 20594

MARINE ACCIDENT REPORT

RAMMING OF THE
BAYOU STEEL COMPANY PIER FACILITY
TWO MILES SOUTH OF LaPLACE, LOUISIANA
BYTHE DUTCH BULK CARRIER M / V AMSTELVOORN
SEPTEMBER 26, 1982

NTSB/MAR-83/08

UNITED STATES GOVERNMENT

 TECHNICAL REPORT DOCUMENTATION PAGE
1
1. Report No. 2.Government Accession No. 3.Recipient s Catalog N o .
NTSB/M AR-83/08 PB83-916408
h. Title and Subtitle Marine Accident Report—Ramming 5 . R e p o r t Date
of t h e Bayou Steel Company Pie]r Facility, Two Miles South October 6, 1983
of LaPlace, Louisiana, by the Du tch Bulk Carrier 6.Performing Organization
M/V AMSTELVOORN, Septembe r 26, 1982 Code
7 . Author(s) 8.Performing Organization
Report N o .

9. Performing Organization Name and Address 10.Work Unit No.

3804
National Transportation Safety Board ll.Contract or Grant N o .
Bureau of Accident Investigation
Washington, D.C. 20594 13-Type of Report and
Period Covered
12.SponsorÌng Agency Name and Address Marine Aecident Report
September 26, 1982
NATIONAL TRANSPORTATION SAFETY BOARD
Washington, D. C. 20594 1b.Sponsoring Agency Code

15.Supplementary Notes

16.Abstract
About 0410 on September 26, 1982, the outbound Duteh bulk carrier M/V
AMSTELVOORN experienced a steering gear malfunction and rammed the pier facility of t h e
Bayou Steel Company, located 2 miles south of LaPlace, Louisiana, on the l e f t descending bank
of the Lower Mississippi River at mile 132.4 above Head of Passes (A.H.P.). The ramming
severely damaged the 961-foot pier and destroyed the 275-foot T-wharf and associated cargo
handling equipment. Hie AMSTELVOORN sustained moderate ab ove-water line damage to t h e
bow. There were no d e a t h s or injuries, but property damage was estimated at over $8 million.

Hie National Transportation Safety Board determines that the probable cause of t h e
accident was a steering gear failure on the M/V AMSTELVOORN due to the contamination of a
solenoid-actuated hydraulic control valve with foreign partie les which had passed through
improperly sized oil strainers resulting in the spring-centered spool piece in the control valve
sticking and creating a system hydraulic lock t h a t held the rudder in the full l e f t rudder
position. Contributing to the accident was the f a c t t h a t the steering gear room was not
manned by a qualified person in communication with t h e bridge.

17.Key Words 18.Distribution Statement

Solenoid control valve; steering gear This document is available
failure; hydraulic control system; bulk c a r r i e r ; lower to the public through the
Mississippi River; confined; congested or restricted w a t e r s ; National Technical Information
steering system; hydraulic rudder lock; contamination; Service
foreign p a r t i e les; non-magne tic partie les; magne tic partie les; Springfield, Virginia 22161
hydraulic fluid.
lS.Security Classification 20.Security Classification 21.No. of Pages 22.Pri ce
(of this report) (of this page)
UNCLASSIFIED UNCLASSIFIED 34
NTSB F o r m 1765.2 (Rev. 9/74)
 CONTENTS

INTRODUCTION 1

SYNOPSIS 1

INVESTIGATION 2
The Accident 2
Injuries to Per sons 5
Damage to Vessel 5
Damage to Pier Facility 5
Crew Information 5
Vessel Information 5
Steering System 5
Steering Operation 7
Steering System History 10
Waterway Information 11
Tests and Research 11
Other Information 13

ANALYSIS 14
Steering System Failure 14
Crew Response 15

CONCLUSIONS 17
Findings 17
Probable Cause 18

RECOMMENDATION 18

APPENDIXES 21
Appendix A—Piston Steering Gear Operating Manual; Technical Data,
New Operating Instruction 21
Appendix B—Crew Information 25
Appendix C~ Lloydfe Register of Shipping Rules and Régulations
for the Construction and Classification of Steel Ships, 1976 26
Appendix D—International Convention for the Safety of Life at Sea,
1974, Régulations 29
Appendix E—Protocol of 1978 Relating to the International Convention
for the Safety at Sea, 1974 31

ii
 NATIONAL TRANSPORTATION SAFETY BOARD
WASHINGTON, D.C. 20594

MARINE ACCIDENT REPORT

Adopted: Oc tob er 6, 1983

RAMMING OF THE
BAY OU STEEL COMPANY PIER FACILI TY
TW O MILES SOUTH OF LaPLACE, LOUISIANA
BY THE DUTCH BULK CARRIER M/V AMSTELVOORN
SEPTEMBER 26, 1982

INTRODUCTION

This accident was investigated by both the National Transportation Safety Board and
the U.S. Coast Guard. Although no public hearing was convened, the Safety Board
conducted an on-scene investigation between September 27 and October 8, 1982. This
report is based upon the evidence developed by the investigation and analyses made by the
Safety Board. The Safety Board has considered all facts in the investigative record t h a t
are pertinent to its statutory responsibility to determine the cause or probable cause of
the accident and to make recommendations.

The Safety Board's analyses and recommendations are made independently of the
Coast Guard. To inform the public of all Safety Board recommendations and the
responses thereto, all recommendations and responses to recommendations are published
in the Federal Register.

SYNOPSIS

About 0410 on September 26, 1982, the outbound Duteh bulk carrier
M/V AMSTELVOORN, owned by Nedlloyd Bulk Shipping of Rotterdam, Holland,
experienced a steering gear malfunction and rammed the pier facility of the Bay ou Steel
Company, located 2 miles south of LaPlace, Louisiana, on the left descending bank of the
Lo wer Mississippi River at mile 132.4 ab ove Head of Passes (A.H.P.). The ramming
severely damaged the 961-foot pier used for vehicular t r a f f i c and destroyed the 275-foot
T-wharf and associated cargo handling equipment. Hie AMSTELVOORN sustained
moderate above-waterline damage to the bow. There were no deaths or injuries, but
property damage was estimated at over $8 million.

The National Transportation Safety Board determines that the probable cause of the
accident was a steering gear failure on the M/V AMSTELVOORN due to the contamination
of a solenoid-actuated hydraulic control valve with foreign particles which had passed
through improperly sized oil strainers resulting in the spring-centered spool piece in the
control valve sticking and creating a system hydraulic lock that held the rudder in the full
left rudder position. Contribuíing to the accident was the fact that the steering gear
roo m was not manned by a qualified person in communication with the bridge.
 -2-

INVESTIGATION

The Accident

Shortly before 0200 c.d.t., 1J on September 26, 1982, loading was completed of
about 31,500 metric tons of No. 2 yellow corn aboard the Dutch bulk c a r r i e r
M/V AMSTELVOORN, which was moored at the Peavy Grain Dock at St. Elmo, Louisiana,
about 40 miles north of New Orleans. The ship's crew conducted predeparture testing of
the engìnes and navigation equipment, including the steering gear system. According to
the master, the steering system tests involved operating t h e rudder from full port to full
starboard from the bridge steering station and using t h e starboard main steering gear
pump, then the port main steering gear pump, and then both main pumps s i multane ou s ly in
the hand-electric (follow-tip) mode and in the pushbutton (non-follow-up) mode. The
manual opération of the steering system was tested by depressing the solenoids in t h e
steering gear compartment. Ali components of the steering gear operated satisfactorily
during the predeparture testing.

As was the customary mode of opération, the m a s t e r ordered t h a t both the port and
starboard steering system main pumps be o p e r a t e d si multane ously when t h e
AMSTELVOORN got underway. This procedure provided rapid response of the rudder to
heim signais. (See appendix A.)

Shortly a f t e r the predeparture testing, a New Orleans/Baton Rouge pilot boarded

the ship. About 0300, the ship departed the grain dock and proceeded down the lower
Mississippi River, en route to Taiwan, Republic of China. The navigation watch on t h e
ship's bridge consisted of the pilot, the master, the chief mate, and the helmsman. A
lookout was posted on the port bridge wing. The chief engineer and the third and fourth
assistant engineers were on watch in the engineroom and in the engine control room. At
the time, the weather was clear and the visibility was unlimited. The ship's main engine
was driving the propeller at 95 rpm, yielding a ship speed of 15 mph through the w a t e r .
The following river c u r r e n t was 1.7 mph, giving the vessel a speed of about 16.7 mph over
the botto m. Waterborn traf fie in the immediate area was light.

As the ship proceeded downriver, the pilot issued rudder commands directly to t h e
helmsman. At 0355, when an 0400 to 0800 helmsman relieved a 2400 to 0400 helmsman at
the steering control stand, the ship was being steered by the hand-electric (foHow-up)
mode with both steering system main pumps operating proper ly.

As the ship entered the bend at Bonnet Carre Point, about 34 Statute miles above
New Orleans, the pilot issued a "starboard 20" command to begin the right turn. (See
figure 1.) The helmsman repeated the command, as he did all heim commands, and then
executed it. The rudder r e a c t e d quickly to the controls, and the ship began turning to
starboard. About 0410, as the ship was completing the starboard turn, the pilot issued a
"steady" 2 / c o m m a n d to the helmsman. To carry out the command, the helmsman applied
hard port rudder to a r r e s t t h e starboard swing of the ship. The ship's turn to starboard
slowed and stopped, and then the ship began to turn to p o r t . The helmsman a t t e m p t e d to
position the rudder amidship, but the rudder remained at the full port position. He t h e n
positioned the T-handle for 10° starboard rudder, then 20° starboard, and then hard
starboard, but the ship continued turning to port. The helmsman then reported t h e
steering system malfunction to the chief mate.

1/ Ali t i m e s are c e n t r a i day light t i m e based on a 24-hour clock.

2/ An order to the helmsman to keep the ship's head in the direction the vessel is on, at
the moment the order is given. Also "steady-as-you-go."
 -3-

.Woodland
Light

Left Descending Bank

Bayou Steel C o m p a n y &

Pier Facility

(Not to Scale)

Mississippi River

Figure 1.— Approximate trackline of vessel to pier.

 -4-

The master and the pilot overheard the helmsman report the malfunction to the
chief mate and, from their respective locations on t h e bridge, saw the rudder angle
indicators which showed the full port rudder position. About 0411, the pilot issued "stop"
and "full astern" commands to the chief mate, who im mediately signaled the engineroom
via the engine-order-telegraph. Meanwhile, the master called the engine control room on
the two-way page system 3/ and informed the third assistant engineer that the steering
system had malfunctioned. The master then ordered t h e chief mate and the lookout to
leave the bridge and to go for ward to the forecastle to drop the anchor.

The third assistant engineer responded to the p i l o f s order on the engine-order-

telegraph by reversing the main engine. He then responded to the master's call over the
two-way page system and proceeded to the steering gear compari ment. At the time, the
fourth assistant engineer was at the engine controis, and the main motor was moving in
the astern direction. About the sa me time, the chief engineer entered the engine control
room through another door. As the chief engineer approached the throttles, the master
signaled for "emergency full astern" on the engine-order-telegraph. About 0411 1/2, the
chief engineer executed the order.

As the third assistant engineer entered the steering gear compartment, he checked
for obvious signs of trouble, such as sparks, smoke, or heavy oil leakage, but he found
none. He then checked the port and starboard main steering pump motor ammeters and
the level indicators of the hydraulic oil tanks. All readings were satisfactory. The third
assistant engineer switched on the steering engineroom two-way page system to
communicate with the bridge, and then he proceeded to the starboard side of the steering
gear to check for leaks and to test the control solenoids. While he was looking under the
steering gear, the starboard main hydraulic ram moved out about 2 centimeters (about
0.8 inch) and then stopped. There was no evidence of a leak. The third assistant engineer
attempted to cause rudder movement by depressing the starboard forward solenoid button,
which normally causes rudder movement to port; however, the rudder did not move. He
then depressed the starboard a f t solenoid button, which normally causes rudder movement
to starboard, and the rudder immediately began moving to starboard.

Meanwhile, the ship had proceeded across the river toward the left descending bank
and the pier facility of the Bayou Steel Company and had slowed to about 9.2 mph. On
the bridge, the helmsman had kept the heim control T-handle at hard starboard while the
ship had continued turning to port. The pilot sounded the danger signal with the ship's
whistle. When the helmsman noticed that the rudder had started to swing to starboard, he
shouted, "the rudder is coming back." About 0415, the ship struck the T-wharf and pier.
Two men working on the pier jumped into the river to avoid dangerj both men swam
ashore uninjured. A crâne on the T-wharf fell onto moored freight barges alongside the
wharf. The ship's port anchor dropped from its position in the hawse pipe. The chief m a t e
applied the brake of the anchor windlass to secure the port anchor chain as the ship moved
astern, away from the pier. At 0423, the starboard anchor was lowered.

Immediately a f t e r the accident, the steering gear was operated from the bridge
steering stand while the ship lay at anchor near the Bayou Steel Company pier. The
steering machinery operated properly in the hand-electric (follow-up) mode and the
pushbutton (non-follow-up) mode with first the starboard main pump in opération, then
the port main pump, and then with both main pumps simultaneously. The ship, with two
tugs standing by, then proceeded under its own power and control, to a shipyard at New
Orleans for a damage survey and repairs. The steering gear did not malfunction en route

3/ A two-way page system provided voice communication over a loud speaker system to
the bow, stern, engine control room, and steering engineroom among other specific
locations.
 -5-

to the shipyard. At the shipyard, the ship was surveyed to assess the damage and
coordinate repairs. The U.S. Coast Guard (USCG) Captain of the Port (COTP) of New
Orleans, prohibited the ship from sailing until it had been inspeeted and had been issued a
Seaworthiness Certificate by the Coast Guard.

Injuries to Per sons

There were no personal injuries.

Damage to Vessel

The impact of the ramming of the AMSTELVOORN into the concrete T-wharf and
pier of the Bayou Steel Company caused above-waterline damage to the steel hull and
decks from the stem back to the forecastle's a f t e r bulkhead. Temporary repairs costing
about $61,500 were made to the ship at New Orleans. On October 5, 1982, the
M/V AMSTELVOORN was released by the authorities and allowed to résumé the voyage to
Taiwan, Republic of China. Permanent repairs to the ship, estimated at about $750,000,
were completed at a repair facility in the Far East a f t e r discharge of the cargo.

Damage to Pier Facility

The Bayou Steel Company pier and wharf facility were damaged extensively. A
16-foot-wide, 961-foot-long, elevated, concrete pier provided access for vehicular traffic
to the T-wharf from an asphalt ramp up the levee. The pier was connected in a "T"
fashion to a 275-foot-long, 52-foot wide concrete wharf (see figure 2), which was
supported by pipe pilings driven into the river bed through a concrete revetment. A
gantry crâne with a capacity of 22,000 pounds was mounted on the wharf and used for
loading and discharging ship cargo. The T-wharf and appurtenances were destroyed, and
damage to the wharf and pier facility was estimated at $7,400,000.

Crew hi formation

The M/V AMSTELVOORN was manned by a Dutch crew of 29 persons. Ail were
properly licensed or documented as required under Dutch law. (See appendix B.)

Vessel information

The AMSTELVOORN was a Dutch bulk carrier, owned and operated by the Nedlloyd
Bulk Shipping Company (Nedlloyd). The ship, which was constructed of welded steel, was
built by G. Dimitrov Shipyard at Varna, Bulgaria, and was launched on March 23, 1981. It
was 661 feet long, 91 feet wide, and 51 feet deep with a gross tonnage of 22,973 tons.
The ship was classed by Lloyd's Register of Shipping. The superstructure, the bridge, and
the engineering spaces were located a f t , and the seven cargo holds were located forward
of the superstructure. The ship was propelled by a single propeller, driven by a 13,700-hp
diesel engine, and it was equipped with a gyrocompass, two radars, a fathometer, a course
recorder, a Loran-receiver, and a VH F rad io téléphoné.

Steering System

The AMSTELVOORN was equipped with a Hydroster model MS-800-TE-1 dual

electro-hydraulic steering system, which incorporated considérable redundancy. The
steering gear was installed in accordanee with Lloyd's Register of Shipping "Rules and
 I
Oì
I

Figure 2.— Bayou Steel Company Pier and T-wharf facility.

 -7-

Regulations for the Construction and Classification of Steel Ships, 1976," the
International Maritime Organization's "Regulations for Machinery and Electrical
Installations in Passenger and Cargo Ships, 1975" and the "International Convention for
the Safety of Life at Sea, 1974." (See appendixes C through E.) However, the
AMSTELVOORN was not in conformance with the 1978 Protocol (TSPP) amendments to
SOLAS '74 which took e f f e c t May 1, 1981, and which require block diagrams both on the
bridge and in the steering gear room and emergency steering drills once ever 3 months.
The investigation did not determine if, at the time of the accident, the Netherlands
Government had incorporated these requirements in its domestic regulations.

The steering system's principal parts consisted of a rudder stock and tiller which was
turned by two main hydraulic rams. The main hydraulic rams were actuated by hydraulic
pressure from either one or both of the main electric-motor-driven hydraulic steering
gear pumps.

Steering Operation

Depressing either the l e f t - or right-hand pushbutton (non-follow-up mode) (see

figure 3) or moving the T-bar control handle (follow-up mode) on the steering control
stand transmits an electric signal to the appropriate steering gear solenoid-actuated
control valve (see figure 4) in the steering gear compartment. The energized solenoid
moves the spring-centered spool piece of the control valve to the forward position for
starboard rudder movement or the a f t position for port rudder movement in response to
the respective signal from the bridge. The movement of the spool piece opens internal
valve ports which direct the flow of hydraulic oil from the auxiliary pump through the
solenoid-control valve to the control cylinders, causing movement of the control pistons
either in the l e f t - or right-hand direction. The ends of the control piston rods are
mechanically connected together and also are connected near the mid-point to a floating
bar linkage, which is connected to the stroking linkage of both main hydraulic pumps at
the a f t end of the bar and connected to the tiller at the bar's forward end. When the
floating bar is moved by the control piston rods to the right or to the l e f t , the forward end
of the bar on the tiller remains momentarily stationary while the a f t end of the bar is
moved through the stroking linkage, which puts the on-line main pump or both main pumps
on stroke 4/ to produce a fluid discharge. The hydraulic discharge of the main pump(s) is
directed to the main hydraulic cylinders, and the main hydraulic rams move the tiller and
rudder to the port or starboard in response to the signaL The movement of the rudder and
tiller displaces the forward end of the floating bar as the rudder moves toward the
ordered rudder angle position. In the follow-up mode, when the rudder reaches the
ordered position, the movement of the floating bar linkage at the a f t end places the
pump(s) in the neutral, or no-stroke, position where oil flow and rudder movement are
stopped.

The main hydraulic components of the AMSTELVOORN's steering system, the

bridge-mounted electric steering control console, and the main and emergency pump
motor controllers were manufactured by the Hydroster Company of Gdansk, Poland. The
main steering gear machinery was equipped with four strainers. Two strainers were
located in the hydraulic pipelines of the discharge of the auxiliary pumps, and two were
located in the return pipe to the hydraulic oil recirculation tanks. The strainers consisted
of a doughnut-shaped magnet which retained magnetic particles and a surrounding screen
of 25-micron mesh. 5/

4/ On stroke—to change the discharge of a variable displacement pump from the neutral
(no-discharge) to a positive pump discharge.
5/ Micron—a metric unit of measurement of one-millionth of a meter, or 39 millionths of
an inch (0.000039).
 -8-

1. 'T Bar Control Handle (Handling Tiller)

2. Control Mode Selector Switch
(Follow-Up/Non-Follow-Up)
3. Push-Buttons of Non-Follow-Up Steering
4. Lamps Signalling Non-Follow-Up* Steering ON
5. Rudder Deflection Dial
6. Gyrocompass Repeater Cards
7. This Lamp Has Three Functions:
— It Informs That Autopilot Is Switched On, Burning
With White Light;
— Burning With Red Light It W a m s That Follow-Up
Steering Motor Is Overheated or Follow-Up
Steering Supply Is Cut-Off;
— It Is Illumination Dimmer Knob as Well.
8. The Non-Follow-Up Supply Cut-Off Warning Lamp
9. " C O U R S E TO S T E E R " Knobs

Front View

Figure 3.—Navigation bridge steering control stand.

 -9-

Rudder Stock

Tiller Connection of Port and

Starboard Control Piston
Rods to Floating Bar
Main Hydraulic Rams

Floating Bar

Control Cylinder

Auxiliary Pump

Main Ram
Shut-Off Valve

Main Hydraulic Pump

Solenoid Control Valve Floating Bar Control

Linkage to Put Main Pump
Main Pump Motor " O N or OFF" Stroke

Main Hydraulic Cylinder

Starboard

Top View
Type
MS-800-TE 1

Mechanical Connection-
From Floating Bar to Port
and Starboard Main Pumps

Figure 4.—Dual electro-hydraulic main steering gear

manufactured by Hydroster of Gdansk, Poland.
 -10-

The solenoid-actuated hydraulic control valves were manufactured by the Rexroth

Company of West Germany. Each valve was equipped with a spool piece which had an
operating clearance of 4 microns. Hydroster supplied operating instructions and manuals
relating to the steering system in Polish, English, and Bulgarian.

Steering System History

The AMSTELVOORN had a history of steering gear operational and control

malfunctions and failures beginning on the day a f t e r delivery of the vessel to the owrter
and continuing to the date of this accident.

The M/V AMSTELVOORN was delivered to Nedlloyd on July 23, 1981. On the
following day, hydraulic piping on the starboard steering engine f r a c t u r e d . Temporary
repairs were made at sea by the ship te crew. A few days la ter at Pireaus, Greece, a
marine repair firm fabricated and installed new pipe lines and delivered a set of spare
pipe lines to the chief engineer.

Two weeks later, while the ship was navigating in the Mississippi River, the steering
system malfunctioned while in the hand-electric (follow-up) mode. The master stopped
the vessel without incident, and the crew searched for the cause of the malfunction, but
without success. The vessel resumed its trip up the river; however, a few hours later the
steering system malfunctioned again while in the hand-electric (follow-up) mode. The
master switched the steering system control mode to pushbutton (non-follow-up), and
continued up the river to the New Orleans anchorage, where the crew searched for the
source of the steering problem, but was not success fui in locating it. The next day, during
shifting of the vessel from the anchorage to a cargo pier, a t h e r m a l protection relay
failed on the starboard steering motor. Temporary repairs were made, and a relay
replacement was ordered. On September 24, 1981, the failed t h e r m a l protection relay
was replaced, and 200 liters (about 52 gallons) of hydraulic oil was added to the steering
system to replace oil losses caused by system leaks and pipe and flange fractures.

During periods when the AMSTELVOORN was sailing in the open sea, the master
attempted to navigate the vessel with the autopilot (automatic steering control mode).
When the steering control system was in the autopilot mode, the ship was unable to
maintain a steady course. TÎne control unit (manufactured by C. Plath) gave too much
correction, both to port and to starboard, causing a condition of oversteering or hunting of
the autopilot control unit. On August 21, 1981, while the ship was moored in New
Orleans, a C. Plath service représentative examined the bridge-mounted autopilot
steering control system, but could not find the cause of the oversteering.

On November 8, 1981, while the AMSTELVOORN was moored in New York, two
guarantee engineers representing the shipbuilder examined the steering system's
hand-electric (follow-up) control, but they were not ab le to de termine the cause of its
malfunction. A C. Plath service représentative also examined the autopilot steering
control system for the cause of the oversteering problems in January 1982 when the ship
was moored in Singapore, and again in January, when the AMSTELVOORN was in Jebel
Ali, United Arab Emira tes. However, the examinations did not disclose the source of the
problems.

On February 3, 1982, the port steering motor overload alarm activated. The vessel
was stopped at sea, and the condition was corrected.
 -11-

In a letter, dated Mareh 5, 1982, to the Nedlloyd Fleet Technical Department, the
AMSTELVOORN's chief engineer stated that he had repaired many hydraulic oil leaks, but
that the steering system leaks persisted. He stated that the hydraulic oil that leaked out
of the steering system was collected, filtered twice, and returned to the hydraulic system,
and that, in his opinion, the leaks were mainly caused by vibrations.

On June 7, 1982, while the ship was at sea, a hydraulic pipe line of the starboard
steering engine fractured. The crew made temporary repairs, and the ship proceeded to
Syros, Greece, where permanent repairs were made.

Waterway Information

Océan-going vessels of various nations transit the lower Mississippi River to and
from New Orleans and Bâton Rouge. The river is measured northward in Statute miles
above a point in the Mississippi River Delta at the junction of the various Channels leading
to the Gulf of Mexico which is called Head of Passes.

Heading downbound from St. Elmo, Louisiana, the Mississippi River is relatively
straight for about 6 miles before it enters a 90° right turn at Bonnet Carre Point (mile
133.5 above head of Passes (A.H.P.)). A-light at Bonnet Carre Point marks the right
descending bank, and a light at Woodland marks the left descending bank for navigation
around the bend at Bonnet Carre Point. (See figure 1.) The river then flows straight for
about 3 miles downstream from Bonnet Carre Point to a 90° left turn at Thirty-Five Mile
Point (at mile 130 A.H.P.). (See figure 2.) The Bayou Steel Company's pier facility is
located along this 3-mile stretch of river on the left descending bank at mile 132.4.

Depending on the time of the year and the amount of water runoff upstream, the
river current varies between 1 and 5 mph. At the time of the accident, the current at
Bonnet Carre Point was about 1.7 mph.

Tests and Research

On October 2, 1982, an electrical engineer and a hydraulic engineer representing the

ship's owners conducted dockside inspections and tests of the AMSTELVOORN's steering
system in the presence of a Safety Board investigator, a U.S. Coast Guard représentative,
a marine engineer surveyor representing Bayou Steel Company, and the AMSTELVOORN's
master, chief engineer, and second and third assistant engineers.

A visual inspection of the system revealed that ali control valves were in their
proper position, that the oil levels in the main steering system hydraulic oil recirculating
tank and in the emergency steering system oil tank were at the proper levels, and that the
mechanical rudder angle indicator correctly indicated the position of the rudder. No
scoring or heavy wear marks were found on the main hydraulic rams, and the floating bar
control linkage showed no excessive movement. There was no evidence of excessive leaks
or corrosion of the structural members of the gear. Ail parts appeared to have been
lubricated adequately. Two magnetic particle strainers, one on each of the discharge
pipes of the auxiliary pumps, and the two magnetic particle strainers in the return lines to
the main hydraulic oil recirculating tank, were opened; the magnets were coated slightly
with a fine magnetic Sludge. Disassembly and inspection of the port and starboard
solenoid control valves revealed that ail springs and spools were intact. Shallow slide
marks were found on the spools, but there was no evidence of heavy grooving.
 -12-

An inspection and test of the electrical components was conducted. The power and
the control relays for both pump units were tested, and they functioned properly. The
control voltage in both the follow-up and non-follow-up modes and the résistance in ail
four solenoid coils (two in each solenoid-actuated control valve) were measured and found
to be satisfactory. The opération of the lirrìit switches in t h e follow-up and non-follow-up
modes was checked and determined to be proper. The motor controllers were checked for
broken or loose wires and electrical contacts; no discrepancies were found. One fuse in
the starboard solenoid control circuit was found to be shimmed with two washers to
maintain a snug fit. Although this is not a proper method of insuring a sound electrical
connection, the starboard solenoid control circuit functioned satisfactorily, and there was
no sign of arc ing.

The components of the amplifier box, located on the navigation bridge, and the
system interface box, located in the converter room, were inspected and tested; no
malfunctions were found. The steering column components and the steering gear alarm
system, located in the wheel house, were examined and were found to be operating
properly. No signs, instructions, charts, or block diagrams were posted on the bridge or in
the steering gear compartment concerning procédures to follow in the use of the main
steering system or of the emergency steering system to c o r r e c t a steering failure.

At the conclusion of the electrical tests on October 3, 1982, a sériés of operational

tests was developed while the vessel was stili moored at the shipyard. With the steering
system in the hand-electric control (follow-up) mode with only the port main pump in
opération, the rudder was moved from full port to full starboard in 23 seconds without
incident. The same évolution was conducted with only the starboard main pump in
opération with identical results. With both main pumps operating in the hand-electric
mode, the rudder was moved from full starboard to full port in 12 seconds. The system
was then put in the pushbutton (non-follow-up) mode, and the rudder was operated from
full port to full starboard with the port main pump first, then the starboard main pump,
and finally with both main pumps operating. The resulting times were the same as the
times measured in the follow-up mode. The emergency steering system was operated
satisfactorily from the controls in the steering gear compartment.

The steering system was put in the hand-electric control (follow-up) mode with both
main pumps operating and with one solenoid control valve manually actuated for port
rudder move ment while the other solenoid control valve was manually actuated for
starboard rudder movement. With the solenoid control valves in these positions, the
rudder did not move because equal hydraulic forces were acting in opposition to each
other.

With the steering system in the hand-electric control mode (follow-up) and both
main pumps in opération and with the starboard solenoid control valve at rest in the
neutral (spring-centered) position. The port solenoid control valve was manually actuated
from the steering gear compartment to e f f e c t rudder movement in each rudder direction
The rudder response varied: several times it responded properly, and at other times, it
responded in a sluggish manner, the first indication of an improper rudder response in the
course of the test.

The steering system was operated with the port main pump running and with t h e
starboard main pump on electrical standby. When the power supply to the port main pump
was interrupted, the starboard unit instantaneously came on the line and continued moving
the rudder with only a momentary hésitation. The same resuit was achieved with the
starboard main pump running and with the port main pump on electrical standby.
 -13-

At the conclusion of the dockside operational tests, the electrical engineer sailed
with the ship from New Orleans to Panama and performed a sériés of operational tests
while the ship was underway at sea. The electrical engineer was successful in recreating
the rudder hydraulic lock condition in any rudder angle position by electrically disabling
any one of the four solenoids on either of the two hydraulic control valves while both main
pumps were operating together.

Other Information

Late in October 1982, the electrical engineer and the hydraulic engineers
representing the ship's owner traveled to Nedlloyd's offices in Rotterdam, Holland. They
presented their inspection, test results, findings, and theories of the steering system
malfunction. The engineers concluded that foreign particle contamination of the
hydraulic oil caused the spool piece of the solenoid control valve to stick and to hold the
rudder in a hydraulic lock. After examining and analyzing the engineers' data, the
technical and engineering staff of Nedlloyd agreed with the findings and theories of the
electrical and hydraulic engineers. On October 26, 1982, a meeting was held at Nedlloyd
House, Rotterdam with représentatives of Hydroster, the steering gear manufacturer.
The following excerpts are taken from the minutes of that meeting:

According to Mr. Dubicki [representing Hydroster], the steering gear

equipment as installed on M/V AMSTELVOORN is of a standard design.

He [ Mr. Dubicki] pointed out that during installation of steering gear,

nobody from Hydroster supervised installation.

Mr. Dubicki agreed t h a t it is common practice to run on one steering

engine at sea and on two engines in confined water s. This is in
accordance with Nedlloyd instructions. He confirmed [ Nedlloyd] our
opinion that, when running on two steering engines, a failed solenoid (or
remote control of solenoid) will resuit in a frozen rudder.

The meeting between the Nedlloyd and the Hydroster représentatives resulted in the
issuance and distribution of additional service information for operating the steering gear
system. (See appendix A). Hydroster stated t h a t :

Extensive research shows that when steered with the Polish steering
column in the followup mode and two steering gears in service, and the
functioning of one of the directional [solenoid control] valves fails, we
face a blocking of the actuator [control piston] cylinder. In this case
the ship becomes completely rudderless and the rudder will be blocked in
the last position.

Why one of the directional valves fails is not clear yet. This failure
could have been electrical as well as hydraulic by means of particles in
the oil vent blocked the spool [of] the solenoid valve. We understand
that when one of the directional valves fail, we have a dangerous
situation. The experts who did the research work advised us to use one
steering gear under ail circumstances, which has been discussed with the
nautical départ ment and they agree with it.
 -14-

The use of one steering gear under a l l circumstances has the

disadvantage of slow reaction of the rudder, but in this installation
sailing on one steering gear is a lot safer t h a n with two steering gears.
The rudder movement is fast enough with one steering gear and within
the maximum allowable time of 28 seconds when moving from hard port
to hard starboard.

Following the meeting, Nedlloyd issued a telex message which outlined changes in
the operating instructions to the AMSTERVOORN and its sisterships, the AMSTELVAART
and the AMSTELVLIET. The message stated, ". . .under all circumstances . . .sail with
one steering gear running and the other in electrical standby."

A November 12, 1982, telex message from Nedlloyd's office in Rotterdam to the
AMSTELVOORN, the AMSTELVLIET, and the AMSTELVAART stated:

In the case of a steering malfunction, immediately switch over to the

push-button system. If the malfunction still exists then switch over
steering gear operation to run one main steering gear pump and switch
off the other main steering gear pump that was on the line. In this way
the other directional solenoid [control] valve can be used and a new
choice of push-button or hand-electric control mode can be made. In
relation to above, please instruct people on t h e bridge in the operation
and control of the steering gear and post written instructions on the
bridge.

ANALYSIS

Steering System Failure

The steering gear system installed on the M/V AMSTELVOORN had been in service
14 months. The system was a modern design which incorporated redundancy to provide
two separate electrohydraulic steering systems and conformed with Lloyd's Register of
Shipping Rules and Regulations and international standards. However, the system had
experienced a history of problems and malfunctions from the day following its delivery to
the owners to the day of this accident.

The steering system failure on September 26, 1982, probably was caused by the
sticking of the spring-centered spool piece in the starboard solenoid-actuated hydraulic
control valve. The control valve was located on the starboard side of the steering gear
machinery mounted outboard of the starboard main steering motor-pump coupling. The
malfunction occurred while the port and starboard main steering pumps were both
operating in the follow-up control mode. Sticking of the spool piece in the a f t position
opened ports within the control valve which allowed hydraulic oil pressure to hold the
rudder in the port position. When the helmsman moved the T-bar handle to starboard, to
bring the rudder to midship, only the port side solenoid-actuated hydraulic control valve
positioned its spool piece for starboard rudder movement. Consequently, one-half of t h e
hydraulic control system was positioned for a port rudder movement and the other half of
the control system was positioned for a starboard rudder movement. The existence of this
condition prevented rudder movement because equal hydraulic forces were acting in
direct opposition to each other, thereby creating a hydraulic lock.

' The final series of operational tests conducted a f t e r the accident demonstrated t h a t
disabling any one solenoid electrically simulated a condition of a stuck spool piece of the
solenoid-actuated hydraulic control valve. With the steering gear hydraulically locked
 -15-

and both main pumps on the line, rudder control could be regained by shutting down one of
the two operating main pumps. This opération deactivates one side of the control system,
either port or starboard, preventing one from opposing the other, and releases the
hydraulic lock.

The sticking of the spool piece may have been caused by foreign particle
contamination of the hydraulic fluid. The main steering gear system is equipped with four
strainers. Each strainer consists of a doughnut shaped magnet, surrounded by a shaped
screen of 25-micron mesh. The port and starboard solenoid-actuated hydraulic control
valves have operating clearances of 4 microns, so nonmagnetic particles passing through
the strainer could cause sticking of the control valve spool piece. A letter to the
Nedlloyd Fleet Technical Department from AMSTELVOORN's chief engineer stated, that
a f t e r a pipe rupture or a f r a c t u r e sometime before the accident, the leaked hydraulic
fluid was collected, filtered twice, and returned to the steering system. Foreign,
nonmagnetic particles probably were entrained in the reclaimed hydraulic fluid and were
introduced to the hydraulic system. In addition, the repeated repairs to the hydraulic oil
side of the system, the pipe and flange fractures, and the removal and replacement of
pipe created conditions which favored the introduction of foreign particles into the
hydraulic oil system.

Following the accident, Nedlloyd issued instructions for the AMSTELVOORN and its
sisterships, the AMSTELVAART and the AMSTELVLIET, to prohibit the opération of the
steering system with both main pumps running. Hydroster, the manufacturer of the
steering gear, developed modifications to the steering gear system to permit simultaneous
opération of the pumps. Nedlloyd has not found these modifications satisfactory, and
until an acceptable modification is done on the AMSTELVOORN and its sisterships, the
ships will use only one main steering gear pump and will maintain the other main steering
pump in electrical standby.

Crew Response

When the steering gear failed, no steering system alarm was activated to indicate
the source or type of failure. About 0411, the steering malfunction became apparent to
the navigation watch on the bridge, and about 0415, the AMSTELVOORN struck the pier
facility. Düring the intervening 4-minute period, however, the bridge navigation watch
failed to make any a t t e m p t to switch to an alternate mode of control or opération in an
e f f o r t to regain rudder control.

Although switching control modes from hand-electric to pushbutton may not have
released the stuck spool piece or cleared the hydraulic lock condition, it should have been
the first step in a logicai sequence of available alternatives in an a t t e m p t to bypass or
correct the steering malfunction. Switching the operational mode from the port and
starboard main steering pumps to only the port main steering pump could have allowed the
spring-centered spool piece in the deenergized starboard unit to reposition itself and
return rudder control to the bridge. The bridge watch had a 50 percent chance of initially
selecting the correct pump to deenergize. In order to react quickly and correctly to a
steering emergency, the crew must be thoroughly trained and familiar with the steering
machinery, its opération, and its control. In this case, some indoctrination and drills in
actually changing over steering systems and control modes would have been invaluable.
The Safety Board believes that, in light of the history of steering failures aboard the ship,
Nedlloyd should have provided the crew with training in the opération and control of the
steering system.
 -16-

Further, the AMSTELVOORN's crew was handicapped in coping with a steering

system malfunction onboard the AMSTELVOORN because no instructions, signs, charts, or
block diagrams were posted, either on the bridge or in the steering gear space, to indicate
the procedures to follow to make use of the available redundancy to correct a steering
failure. Such block diagrams are now required on all vessels, e f f e c t i v e May 1, 1981, as a
result of the Protocol of 1978 relating to the International Convention for the Safety of
Life at Sea 1974. This requirement has not been domestically implemented in the U.S.
Code of Federal Regulations/U.S. Coast Guard Regulations except for tank vessels over
10,000 gross tons.

As a result of a steering gear failure onboard the Spanish freighter M/V POLA DE
LENA on February 9, 1979, the Safety Board recommended that the U.S. Coast Guard:

Require each self-propelled vessel of 1,600 gross tons or greater

navigating in confined or congested waters of t h e United States to have
operating instructions and a block diagram t h a t clearly and simply
explain the changeover procedures for the r e m o t e steering gear control
systems and steering gear power units on the vessel. The instructions
and block diagrams should be permanently displayed both on the
navigation bridge and in the steering engineroom. (M-80-42)

In a letter dated August 28, 1980, the U.S. Coast Guard responded that it concurred
in the recommendation and had included it in its proposed rulemaking. As a result, the
Safety Board on October 27, 1980, classified recommendation M-80-42 as
"Open—Acceptable Action." However, in 1981 the proposed rulemaking was cancelled.

The manufacturer's operating instruction manuals and all data relating to the
steering system were written in Polish, English, and Bulgarian but were not written in
Dutch, which was the native language of the crew. The Safety Board believes that it is
imperative that instructions for vital ship systems be printed in a language t h a t the crew
understands. As a result of its investigation of a f i r e onboard the PROTECTOR
ALPHA, 6/ the Safety Board recommended that the Coast Guard:

Propose adoption of a resolution by the International Maritime

Organization to the e f f e c t that operating instructions for vital
emergency equipment and vital ship data, such as stability information,
be printed in a language which is readily understood by the ship's
officers. (M-83-3)

The Coast Guard responded that it concurs in the intent of the recommendation and t h a t
the content of the recommendation will be appropriately raised at the International
Maritime Organization's (IMO) Subcommittee on Slip Design and Equipment.

In a number of investigations, the Safety Board has had occasion to consider the
need for and the adequacy of redundancy in steering systems to allow personnel on the
navigation bridge to shift to alternate means of steering in the event of a failure. Hie
failure of the steering gear system on the AMSTELVOORN demonstrated that redundancy
alone in a system^ design is not enough to prevent accidents unless personnel a r e
adequately trained to make full use of the alternate steering systems and control modes.
The mechanical malfunction of the steering gear which precipitated this accident might

6/ Marine Accident Report — "Fire Onboard the Cypriot Bulk Carrier PROTECTOR
ALPHA, Columbia River, Near Kalama, Washington, February 14, 1982"
(NTSB/M AR- 83/1).
 -17-

have been corrected had the crew been properly trained and drilled in the use of all
available operating procedures.

The Safety Board also has investigated other steering accidents which support its
position that steering gear rooms on oceangoing vessels should be manned by qualified
personnel when vessels are operating in restricted or confined waters. As a result of its
investigation of the collision and fire on the SS CV SEA WITCH and the S.S. ESSO
BRUSSELS 7/ on June 2, 1973, in New York Harbor, the Safety Board recommended that
the Coast Guard:

Establish a requirement for oceangoing vessels in designated restricted

waters such as New York harbor to have the emergency steering station
manned. This should also apply to foreign vessels. (M-76-2)

The U.S. Coast Guard responded that Safety Recommendation M-76-2 was included in a
Notice of Proposed Rule Making (NPRM), dated May 6, 1976. As a result of comments
received by the Coast Guard, the recommendation was dropped from the final rulemaking
of January 31, 1977. On February 3, 1979, 8/ the Safety Board reiterated Safety
Recommendation M-76-2 as a result of its investigation of the steering failure on the
M/V POLA DE LENA. . In a letter dated February 11, 1981, the Coast Guard responded
that it continues to not concur with this recommendation because "the number of serious
incidents which result from steering gear failures which could have been prevented or
mitigated by manning the emergency steering station is insignificant." The Safety Board
continues to believe, however, that steering compartments should be manned by a
competent and trained person when the ship is navigating in narrow rivers, channels, and
harbors of the United States. Had the AMSTELVOORN's third engineer (or another
qualified person) been on station in the steering gear room, his action to press the solenoid
button, which released the stuck spool piece of the control valve, could have been taken
earlier and might have restored rudder control in time to avoid the collision with the pier.
As a result of its investigation of this accident, the Safety Board r e i t e r a t e s safety
recommendations M-80-42 and M-83-3.

CONCLUSIONS

Findings

1. The AMSTELVOORN experienced a malfunction of the steering gear system on

September 26, 1982.

2. Full steering control could have been regained by switching off the starboard
main steering engine to regain rudder control with power from the port main
steering engine.

3. A hydraulic lock condition was created in the AMSTELVOORN's steering

system when a spool piece in the starboard solenoid-actuated hydraulic control
valve stuck, thereby preventing the rudder from moving from the full port
position.

7/ Marine Accident Report-"S.S. C.V. SEA WITCH—S.S. ESSO BRUSSELS (Belgium);

Collision and Fire, New York Harbor, on June 2, 1973, with Loss of Life"
(USCG/NTSB-MAR-75-6).
8/ Marine Accident Report—"Collision of Spanish Freighter M/V POLA DE LENA with
two Mississippi River Ferry Boats and the Gretna Ferry Landing, February 3, 1979"
( NTSB-M AR- 8 0 -10 ).
 -18-

4. The steering gear system's hydraulic oil s t r a i n e r s were not properly sized to
protect the hydraulic control valve from contaminant with foreign p a r t i c l e s
flowing through the strainer which would cause the control valve spool piece
to stick.

5. Serious vibration problems, the fractures of pipe and flange fittings, and
extensive hydraulic oil leakage indicate a need for a design change to the
steering system.

6. No written instructions, signs, charts, or block diagrams were posted on the

bridge or in the steering gear room to indicate the steps to be followed in the
event of a steering system emergency.

7. The instructions and engineering drawings in the operating instructions and

manuals for the ship were written in a language which the crew of the
AMSTELVOORN did not understand; t h e r e f o r e , the crew was unable to read
the instructions and engineering drawings for the opération and control of the
ship's vital systems.

8. The crew lacked proper training in the opération of the shipfe steering gear
system.

9. The collision might have been avoided if t h e steering gear room had been
manned by a qualified person in communication with the bridge.

Probable Cause

The National Transportation Safety Board determines that the probable cause of t h e
accident was a steering gear failure on the M/V AMSTELVOORN due to the contamination
of a solenoid-actuated hydraulic control valve with foreign particles, which had passed
through improperly sized oil strainers, resulting in the spring-centered spool piece in the
control valve sticking and creating a system hydraulic lock that held the rudder in the full
left rudder position. Contributing to the accident was the f a c t that the steering gear
room was not manned by a qualified person in communication with the bridge.

RECOMMENDATIONS

As a resuit of its investigation of this accident, the Safety Board reiterated t h e

following recommendations to the Coast Guard:

Require each self-propelled vessel of 1,600 gross tons or greater

navigating in confined or congested waters of the United States to have
operating instructions and a block diagra m that clearly and simply
explain the changeover procédures for the remote steering gear control
systems and steering gear power units on the vessel. The instructions
and block diagrams should be permanently displayed both on the
navigation bridge and in the steering engineroom. (M-80-42)

Propose adoption of a re solution by the International Maritime

Organization to the e f f e c t that operating instructions for vital
emergency equipment and vital ship data, such as stabiìity information,
be printed in a language which is readily understood by the ship's
officers. (M-83-3)
 -19-

In addition, the Safety Board made the following recommendations:

—to the U.S. Coast Guard

Establish a requirement that self-propelled vesseis of 1,600 gross tons or

greater navigating in narrow rivers, Channels, and harbors of the United
States have the steering gear compartment manned by a competent
person trained to switch the steering gear to ali alternate modes of
control and opération. (Class H, Priority Action) (M-83-82)

Require that ail vesseis over 1,600 gross tons navigating in U.S. waters
have written emergency steering procédures and that they conduct and
enter in the ship's log regulärly scheduled drills involving the loss of
steering gear control. (Class H, Priority Action) (M-83-83)

—to the Nedlloyd Bulk Shipping Company:

Take all necessary action to correct conditions of excessive vibrations,

mechanical failure of pipelines and flange fittings, and hydraulic system
leaks to improve the reliability of the Hydroster model ME-800-TE-1
steering gear system in ail modes of system opération. (Class II, Priority
Action) (M-83-84)

Establish written emergency steering procédures for use onboard ail

Nedlloyd fleet vesseis of 1,600 gross tons or greater, and conduct
regularly scheduled emergency drills for the loss of steering gear
control. (Class II, Priority Action) (M-83-85)

—to Hydroster/Slip Machinery Works:

Contact ship own ers/opera tors of ail vesseis that are outfitted with the
Hydroster model MS-800-TE-1 steering gear and inform them of the
hazards involved in simultaneous opération of both main steering pumps.
(Class II, Priority Action) (M-83-86)

Provide revised operating instructions for simultaneous pump opération

of both pumps on the Hydroster Model MS-800-TE-1 steering gear to ail
vesseis that are outfitted with this type of steering gear. (Class H,
Priority Action) (M-83-87)

Review the steering gear system design of the Hydroster model MS-800-
TE-1 and design an effective alarm which will activate when the system
fails due to hydraulic lock. (Class n, Priority Action) (M-83-88)

—to the International Association of Classification Societies:

Advise member societies of the circumstances of the accident involving

the Dutch bulk carrier M/V AMSTELVOORN on September 26, 1982, and
encourage them to take ail necessary action to require that ail
conditions of excessive vibrations, mechanical failure of pipelines and
fittings, and hydraulic system leaks are corrected on vesseis which they
have classed to improve the reliability of installed Hydroster model
MS-800-TE 1 steering gear systems in ail modes of system opération.
(Class H, Priority Action) (M-83-89)
 -20-

Encourage member societies to contact ship owners/operators of vesseis

which they have classed that are outfitted with the Hydroster model
MS-800-TE-1 steering gear to inform them of the hazards involved in
simultaneous opération of both main steering pumps. (Class II, Priority
Action) (M-83-90)

Encourage member societies to require t h a t vesseis which they have

classed which have the Hydroster model MS-800-TE-1 steering gear
installed operate the system using only one pump until revised operating
instructions for simultaneous opération of b o t h pumps are received from
the manufacturer. (Class H, Priority Action) (M-83-91)

Encourage member societies to require an e f f e c t i v e alarm on vesseis on

which the Hydroster model MS-8Û0-TE 1 steering gear system is installed
which will activate when the system fails due to hydraulic lock.
(Class H, Priority Action) (M-83-92)

BY THE NATIONAL TRANSPORTATION SAFETY BOARD

/s/ JIM BURNETT

Chair man

/s/ PATRICIA A. GOLDMAN

Vice Chair man

/s/ FRANCIS H. Me ADAMS

Me mber

/s/ G.H. PATRICK BURSLEY

Member

/s/ DONALD D. ENGEN

Member

October 6, 1983
 -21-

APPENDIX C

APPENDIX A

PISTON STEERING GEAR OPERATING MANUAL

î'V\
NE- 1 H
Piston steering gear 1011 .000
Operating manual
Page 2/ß

Preface

This manual describes in very simple manner the

operatine of steering gears equipped with electric >

¡
control systems, so called telemanipulators /steering |

control/.

Details data conceming of operatine of above gears I

is given in manual of steering engines which are

included in the steering gear set.

2. Working capabilities of'steering engine

2.1. Main_/principal/_duty

In r u d d e r d e f l e c t i o n a n g l e r a n g e aC = - 35° steering

engine to be operated in main working system /ali

cylinders/ v/hen one main pump unit operating.

2.2. Additional dutv

In very heavv navigation duty, when rapid r u d d e r nove- I

meñts are neccessary, it is p e r m ^ s i b ^ to operate

with ali cylindcrs and twojTun^^jnvy^m

within rudder deflection range aC= - 35°.

.3.
Steering engine can operate in auxiliary working sys-

ton /half quantity of cylinders/-when cne punp unit is

operatine? at the half of maximum ship's speee.

r.EfV^K:
Operation of tv;o punp units with half quantity of

cylinders is not permitted.

APPENDIX D -22-

1
1 T e c h n i c a l d o t ' of ;.I3300rj:i
i J . ». O
! s t e e r i n g engixie
rssier 2aechanicsl and h y d r a u l i c p a r t
. 4/7
i

tor quo ün= 0 , 3 Àioaz.

2.7.1. Y/hcn C l a s s i f i c a t i o n S o c i e t y Iîulea recommcnd the other
r e l a t i o n of maximum torque to n o m i n a l torc.ue the par-»
mis3ible servies load shoald be adequate reduccd.
2.8. E l e c t r i c motor power
i n pumpieg s e t P n a c 330V, 50:-Io
• Pn = 3 3 k ' J 3 t 440V, oO.ia
2.9. Supply v o l t a g e - - o f e l c c t r i c motor» .
- baaic 3x330V, 50Hs
s t e e r i n g engine may be adopted
to supply 3x220V, 50Hs
e i t h e r 3-440V, 50Mz
or 3--44OV, 6Olia
Supply v o l t a g e f o r v.'hich the s t e e r i n g en - i n e i o
adapted i 3 g i v e n i n Technical d a t a o f s t 2 e r i n g g o a r .
2.10. Steering enfine control
r
P o l l o w i n g c o n t r o l p o o s i b i l i t i o s a r e proviàad:
- remote - by meano of c l c c t r i c c o n t r o l system
- l o c a i , cisnual - by meana of push-but tons o.i e l e c t r o -
* magnetic v o l v e which c n t a r s i n t o composition of
3teering engine.
Remote c o n t r o l p o s s i b i l i t i e s e r e d e t e r m i n a v i by type
o f e l e c t r i c c o n t r o l system which i o u s e d i n s ü e e r i n g
gcar.
5teering'~engiho con cooperato v . i t h the o l o c t r i c cor.-ro!
system of f o l l o w i n g f i r m o : P2L iVarszewa, AIC-, A^ochUts
I Ar'.ias-Dccco , P i a t h , 3 p e r r y .
3. S en t rry c lì? \-n et. c r i c t i c

3.1. ..lar.imum vor'.iir.g prosauro of

cr.-'ir.c
/ s a f o t y v a l v e s o pce l a g praaauec./
/1..5 ;
 -23- APPENDIX A

Technical data of I£3300'iii1 , - i

s t e e r i n g engine
: c; r o s i c r ilcchanical and h y d r a u l i c part pogc 5 / 7

3.2. Nominal working p r e s s u r e or engine

Pn= 16 J.IPa
/ISO kC-/cm2/
3.3. Nominal working p r e s s u r e of o v e r f l o w
v a l v e i n the h y d r a u l i c c o n t r o l
system -0,1 l
Pss .\t= 1 , 7 /,
/ 1 7 " 1 kG/cm 2 / I
3.4. Nominal working p r e s s u r e of S 2 f e t y
v a l v e i n f i l l i n g u p system o f
engine c a i n hydraulic system
¿0 1
p ,a = 1 , 0 ;i?s
¿1 ?
/ 1 0 1 IcG/cm /
3.5. Switches and l i m i t i e r s o f engine d e f l e c t i o n
3 . 5 . 1 . Z l e . c t r i c s w i t c h e s of remote c o n t r o l system
in the engine are s e t on d e f l e c t i o n c/~= - 3 5 ° |
3.5.2. ì i e c h a n i c a l l i m i t i e r s of c o n t r o l system
are s e t on d e f l e c t i o n 0 £ = ±35° ì
if there io no e l e c t r i c sv.it che a
and on d e f l e c t i o n = ¿33° ^ }
if e l e c t r i c remote c o n t r o l system ha3 tha e l j c t r i c 0
s w i t c h e s which are s e t on d e f l e c t i o n o£ = - 3 5 0 :
3.6. Oil vaiarne which is n e c c s o o r y f o r
eng i n e r e v e r o i n g f r o m c*f=Q° to c*f = 20°
V
0-20 D= 22i
~'':
3.7. Capocity of engine h y d r a u l i c system
/•without c i r o u l a t i n g and re serve t a n k s /
V=
c 60 dm-5 i
Opero t i n p o s s i b i l i t i e s of s t e e r i n g eng ino ir. the
ma in hydraulic system
- anyone of tv:o pumping s e t drivaa tv;a h y i r a u l i c
c y l i n d o r s ol pov.cr u n i t - b a s i c oeovatior..
- rnyor.e of tv.o preoi:;g s e t d r l v o s ona of ó.. a
hydraulic c y l i s à a r s - ras:rvo o^arstian
- o a t a pur. p va 3 s a t o d r i v ; cylm'ior J
3.0 Tha a i o c r i n g Ina can bo Criva.i b v-a i.......
APPENDIX D -24-

XJ V
Additional Servicing Information
on MS 600 TE1 Steering Ccar

The steering gear does not respond to a set control

signal.
Reason: Supply circuit of a solenoid of one of solenoid
valves is defected or there is no pressure in one
of the hydraulic control systems.
* ~ V/hen one pumping unit works.
The pumping,units to be svitched ovcr.
II - When tv/o pumping units work.
One of pumping units being -in opération tc
be switchcd off. If the steering gear
still does not respond to tho set control
signal the pumping units ,to be svdtchcd
over.
 -25-

APPENDIX B

CREW INFORMATION

Master

The master had been aboard the AMSTELVOORN from November 9, 1981 to
February 9, 1982, and again from June 15, 1982, to the date of the accident. He was a
1948 graduate of the Nautical College of Amsterdam.

Chief Mate

The Chief mate was assigned and reported onboard the AMSTELVOORN on June 14,
1982. He had been working as a chief mate since 1962.

Helms m an

The helmsman reported onboard the AMSTELVOORN in June 1982. This was his
first time on board and his first time steering the ship down the Mississippi River.

Chief Engineer

The chief engineer had been sailing as a chief engineer since 1972. He reported
onboard the AMSTELVOORN as chief engineer on August 23, 1982, 34 days before the
accident. He had not sailed on ships with a similar steering gear arrangement and had no
special training for the type of steering gear installed on the AMSTELVOORN.

Third Engineer

The third engineer was a graduate of the Netherlands Merchant Marine Academy
and had reported onboard the AMSTELVOORN on June 15, 1982. He had not sailed on
ships with a similar steering gear arrangement and had no special training for this type of
steering gear.

Fourth Engineer

The fourth engineer had reported on board the AMSTELVOORN on September 15,
1982.
 -26-

APPENDIX C

LLOYD'S REGISTER OF SHIPPING

RULES AND REGULATIONS FOR THE
CONSTRUCTION AND CLASSIFICATION OF STEEL SHIPS, 1976

Chapter D HULL CONSTRUCTION

Section 23

STEERING GEAR
Symbob 2306 In passenger ships, the auxiliary gear is to be
23Ù1 power operated if the Rule diameter of rudder stock at the
d, = diameter of rudder stock, in mm, at tie tiller exceeds 230 mm. When main steering gear pcy er
tiller head, as obtained from D 2203, units and their connections are fitted in duplicate and each
» rr- ^ïB^finr-p from the point of application of the power unit separately is capable of satisfying the require-
load on the tiller to the centre of the rudder ments of 2303, an auxiliary gear will not be required.
otock, in mm,
2307 In passenger ships, where the Rule diameter of
b s= distance between the section of the tiller
the rudder stock at the tiller exceeds 230 mm, an alter-
arm under consideration and the centre of native steering position remote from the main steering
the rudder stock, in mm. position is to be provided. The steering control systems
NOTE, a and b are to be measured with rero from the main and alternative steering stations are to be
rudder angle, arranged so that failure of either system would not result
n = total number of bolts in the tiller coupling. in inability to steer the ship by means of the other syBtem.
NOTE. n in general is not to be taken Means are to be provided to enable orders to be trans-
greater than six. mitted from the bridge to the alternative steering station.
Y minirrmm yield Btress or 0,5 per cent proof
stress of the tiller bolt material, in N/mmJ 2308 The exact position of the rudder, if power
(kgf/mm1). operated, shall be indicated at the main steering station.

2309 The after steering wheel and gear in ocean-

General
going ships are to be adequately protected or situated in
2302 All ships are to be provided with two indepen- such a position that protection can be dispensed with.
dent means of moving the rudder. In passenger ships and in
cargo ßhips of 500 tons gross and above, one of the gears is 2310 The steering gear is to be secured to the seating
to be operated by power. All gears sre to be fitted and by fitted bolts and suitable chocking arrangements are to
tested under working conditions to the satisfaction of the be provided.
Surveyors.
2303 The power operated main steering gear is to be Tillers and Quadrants
capable of putting the rudder over from 35 degrees on one 2311 Tillers and quadrants are to be shrunk on,
side to 35 degrees on the other side with the ship running hydraulically assembled or bolted to the rudder stock. The
ahead at maximum service speed. The time taken to put shrinkage allowance is to be between 1/550 and 1/700 of the
the rudder over from 35 degrees on either aide to 30 degrees diameter of the rudder stock in way, except when a key is
on the other side is not to exceed ££ seconds at maximum fitted in which case the allowance should not exceed 1/1100.
service speed. Where hydraulic methods are used for assembly, the
interference fit between the tiller and the rudder stock is to
The gear is also to be designed in relation to the be as for the shrinkage allowanoe indicated above. The
maximum astern speed Sec D 2203. rudder stock is to have a taper not exceeding 1:12 on the
2i<04 The auxiliary gear is to be of adequate strength diameter for dry fits and not exceeding 1:15 on the diameter
and sufficient to steer the ship at navigable speed and is to when oil injection methods are used
be capable of being brought speedily into action in an Where the tiller and quadrant are bolted, a shim is to
emergency. be fitted between the two halves of the tiller prior to its
being machined to take the rudder stock, and removed prior
2305 Id cargo ships, a power operated auxiliary gear
to fitting to rudder stock. The thickness of the «bim is to be
is to be fitted where the Rule diameter of the rudder stock
not less than :—
at the tiller, corresponding to a speed of 10 knot«, is 250 mm
and above. Where main steering gear power unite and their (a) i f n = 4, 1/700 of the diameter of the rudder
connections are fitted in duplicate and the duplicate unite stock in way,
acting together satisfy the requirements of 2303, and each
(b) if n = 6, 1/830 of the diameter of the rudder
power unit separately satisfies the requirements of 2304, an
stock in way.
auxiliary gear will not be required.
 -27- APPENDIX C

Chapter D H U L L CONSTRUCTION

2316 With bolted tillers the distance from the oentre

Where the tiller and quadrant are bolted, or where a
of the rudder stock to the oentre of the boita should generally
shrinkage or interference fit lesa than given above is used,
a key having an effective sectional area in sbear not less be equal to d8 ( 1,0 + —5= ) mm
than 0,25 d 8 J mm2 is to be fitted. The thicknesa of the key \ vn /
should not be lese than — mm. 2317 The thickness of the flange in each half of the
6 0,66 d 0
The keyways ahould eitend over the full depth of the bolted tiller should not be leas than
tiller and are to have rounded ends. Vn ,
Loeking or Brake Gear
2312 The section modulus of the tiller arm at any
point within ita length taken about a vertical axis is not to 2318 An efficient loeking or brake arrangement is to
be lesa than the gres ter of the following:— be fitted to ail gears to keep the rudder steady when
necessary.
For a single arm táller
In bow ruddere where a vertical loeking pin is opera te d
I 0,150,' (a-b) cm from the deck above, positive means are to be provided to
(a) - =
y 1000a ensure that the pin can be lowered only when the rudder is
1 exactly central. In addition, an indicator is to be fitted at
(b) -I = O.Oed,5 ( a - 0 ,'—_
9d.)
cm , the deck to show when the rudder is exactly central.
y 1000a
Where more than one arm is fitted, the combined modulus Rudder Siops
of the arma is not to be less than as reguired above.
2319 Suitable stopping aro gemente are to be
For solid tillers the breadth to depth ratio ia not to be provided for the rudder. Cut-oute on the steering engine
more than 2. are to be arranged to operate at a smaller angle of heim than
those for the rudder.
2313 The depth of the boss is not to be lésa than the
diameter of the rudder stock d g . The thicknesa of the boas
in way of the tiller is not to be less than 0,4d r

2314 The diameter of boita in bolted tillers or quad-

rants is not to be less than :—
0,60d,
db = — j = ~ 111111
yn

2315 Where the diameter of the rudder stock is greater

than 400 mm, higher tensile ateel boita Eue to be used
for bolted tillers. A predetermined setting up load équiva-
lent to a stress of approximately 0,7Y ahould be applied to
each boit when the tiller is assembled.

The yield and ultimate tensile stress of the boit material

are to be stated on plans submitted for approval, together
with füll détails of the methods to be adopted to obtain the
required stress. Where patent nute or systems are used, the
manufacturera' instructions for assembly ahould be adhered
to.
Alternatively, a lower stress in the bolts may be accep-
te cï providing two keys are fitted each having dimensions as
Bpecified in 2311.
APPENDIX D -28-

ELECTRICA! EQUIPMENT
Chapter M

Stooring Goar
§06 (a) Only short-circuit protection and overload
alarm are to be provided in steering gear circuita.
(b) Indicatore for running indication of ateering gear
motori are to be instaüed.
The exact position of the rudder, if power opera tod, ia
to be indicated at the principal steering station.

(c) In all paasenger ohipa and in oargo shipe of 6000T

gross tonnage and upwards electric and electro-hydraulic
steering gear is to be served by two circuits fed from the
main switchboard. One of the circuits may pass through
the emergency switchboard. Each circuit is to have adequate
capacity for supplying all the motore which are normally
connected to it and which operate simultaneoualy.
If transfer arrangements are fitted in the steering gear
room to permit either circuit to supply sny xnotor or
combina ti on of motore, the capacity of each circuit is to be
adeguate for the most severe load conditions.
The circuits are to be separated throughout their
length as widely as is practicable.
(à) In cargo ships of less than 5000T gross tonnage
^here'electric power is the sole source of power foi both
main and suxiliary steering gear the supply arrangements
are to comply with (c) above.
If the auxiliary steering gear is powered by a motor
primaril? in tend ed for other services alternative protective
arrangements to that required by sub-para. (o) will be
specially considered.
(e) Where electric control of the steering system is fitted
an alternative control system is to be installed. This may
be a duplicate electrica! oontrol system or oontrol by other
means.
 -29-

APPENDIX E

INTERNATIONAL CONVENTION FOR THE SAFETY

OF LIFE AT SEA, 1974, REGULAHONS

Regulation 29
Steering Gear*

(a) Passenger Ships and Cargo Ships

(i) Ships shall be provided with a main steering gear and an auxiliary
steering gear to the satisfaction of the Administration.
(ii) The main steering gear shall be of adequate strength and sufficient
to steer the ship at maximum service speed. The main steering gear
and rudder stock shall be so designed that they are not damaged at
maximum astern speed.
(iii) The auxiliary steering gear shall be of adequate strength and
sufficient to steer the ship at navigable speed and capable of being
brought speedily into action in an emergency.
(iv) The exact position of the rudder, if power operated, shall be indicated
at the principal steering station.
(b) Passenger Ships only
(i) The main steering gear shall be capable of putting the rudder over
from 35 degrees on one side to 35 degrees on the other side with the
ship running ahead at maximum service speed. The rudder shall be
capable of being put over from 35 degrees on either side to 30 degrees
on the other side in 28 seconds at maximum service speed.

(ii) The auxiliary steering gear shall be operated by power in any case
in which the Administration would require a rudder stock of over
228.6 millimetres (9 inches) diameter in way of the tiller.
(iii) Where main steering gear power units and their connexions are
fitted in duplicate to the satisfaction of the Administration, and each
power unit enables the steering gear to meet the requirements of
sub-paragraph (i) of this paragraph, no auxiliary steering gear need
be required.
(iv) Where the Administration would require a rudder stock with a
diameter in way of the tiller exceeding 228.6 millimetres (9 inches)
there shall be provided an alternative steering station located to the
satisfaction of the Administration. The remote steering control
systems from the principal and alternative steering stations shall be so
arranged to the satisfaction of the Administration that failure of
either system would not result in inability to steer the ship by means
of the other system.
(v) Means satisfactory to the Administration shall be provided to enable
orders to be transmitted from the bridge to the alternative steering
station.

(c) Cargo Ships only

(i) The auxiliary steering gear shall be operated by power in any case in
which the Administration would require a rudder stock of over
355.6 millimetres (14 inches) diameter in way of the tiller.
(ii) Where power-operated steering gear units and connexions are fitted
in duplicate to the satisfaction of the Administration, and each unit
complies with sub-paragraph (iii) of paragraph (a) of this Regulation,
no auxiliary steering gear need be required, provided that the
duplicate units and connexions operating together comply with sub-
paragraph (ii) of paragraph (a) of this Regulation.
APPENDIX D -30-

Regulatioo 30
Electric and Electrohydraulic Steering Gear*

(a) Passenger Ships and Cargo Ships

Indicators for running indication of the motors of electric and electro-
hydraulic steering gear shall be installed in a suitable location to the satisfaction
of the Administration.

(b) All Passenger Ships (irrespective of tonnage) and Cargo Ships of5,000 Tons
Gross Tonnage and upwards
(i) Electric and electrohydraulic steering gear shall be served by two
circuits fed from the main switchboard. One of the circuits may pass
through the emergency switchboard, if provided. Each circuit shall
have adequate capacity for supplying all the motors which are
normally connected to it and which operate simultaneously. If
transfer arrangements are provided in the steering gear room to
permit either circuit to supply any motor or combination of motors,
the capacity of each circuit shall be adequate for the most severe load
condition. The circuits shall be separated throughout their length as
widely as is practicable.

(ii) Short circuit protection only shall be provided for these circuits and
motors.

(c) Cargo Ships of less than 5,000 Tons Gross Tonnage

(i) Cargo ships in which electrical power is the sole source of power
for both main and auxiliary steering gear shall comply with sub-
paragraphs (i) and (ii) of paragraph (b) of this Regulation, except that
if the auxiliary steering gear is powered by a motor primarily intended
for other services, paragraph (b)(ii) may be waived, provided that the
Administration is satisfied with the protection arrangements.

(ii) Short circuit protection only shall be provided for motors and power
circuits of electrically or electrohydraulically operated main steering
gear.
 -31-

APPENDIX E
PROTOCOL OF 1978 RELATING TO THE INTERNATIONAL
CONVENTION FOR THE SAFETY OF LIFE AT SEA, 1974

CHAPTER V

SAFETY O F NAVIGATION

Regulation 1
Application
This Chapter, unless otherwise expressly provided in this Chapter, applies
to ail ships on ail voyages, except ships of war and ships solely navigating the
Great Lakes of North America and their connecting and tributary waters as far
east as the lower exit of the St. Lambert Lock at Montreal in the Province of
Quebec, Canada.

B a g o l a t i « 19-2

tKeering Qear - S a t i n a and U r l i l i

(a) With in 12 boura befbre departure, t h e «bip* s otoerinß gear s h a l l
be checked ond tootod by t h e ahip'a erev. She t e s t procedure o h a l l
i n c l u d e , ubare applicable, the opération pf the fOlloving:

(i) t h e aain atee r i n g gear;

(ii) the atodliary s t e e r i n g ( p a r ;

(iii) t h e raaote otoering gear control oytrtenc;

(ir) t h e a t a e r i n g position« loco,teû on the narigating bridge;

(r) the aaergenqr paver otçjply;

(-vi) the rudder angle indicatore in r e l a t i o n to the actual position

of t h e rudder;
(vii) thé reaote ateering gear ccn-uroi nyotcn pov<*r f a i l u r e a l a r n s ;
end

(riii) t h e ateering gear power m i t f a i l u r e alarne.

(b) Sie che eia and t e s t a a h a l l include:

(i) t h e f u l l eoveeent of the rudder according to the requirefi

eapabilitioD of "le (.Bering gear;

(ii) a v i s u a l inspection of t h e ateering gear and i t s connecting

linkAge; end

(iii) the opération of the —ans of cosami cation betveen the

n a r i g a t i n g bridge and a t e e r i n g gear coapartsent.
APPENDIX D -32-

(e) (i) Binple ope r a t i n g i n s t r u c t i o n s v i t h a b l o c k di agra» ohaving the

change-over procedure« I b r reaote a t e e r i n g gear c o n t r o l ayateae and
a t e e r i n g gear power unito e h a l l be peraanently displayed on t h e
n a r i g a t i n g bridge and ¿n t h e a t e e r i n g gear c o a p a r t a e n t .

(ii) Ali o f f i c e r à concernei v i t h t h e o p é r a t i o n and/or aaintenance

of a t e e r i n g gear a h a l l be f a v i l l a r v i t h t h e opération of t h e a t e e r i n g
a y s t e w f i t t e d on t h e ahip and v i t h t h e procédures f b r changing fresa one
ey»tea to anothér.

(d) In addition to the routine check« and t e s t a preaeribed in

paragraphe (a) and (b) of t h i s Régulation, eaergency s t e e r i n g d r i l l e
a h a l l take place at l e a s t once overy t h r e e aontha in order to p r a c t i a e
.ecergency otoering procedurea. S>eoe d r i l l o a h a l l inelude d i r e c t
control from v i t h i n t h e a t e e r i n g gear c o a p a r t a e n t , t h e c o r i cations
procedure v i t h t h e n a r i g a t i n g bridge and, vbere a p p l i c a b l e , t h e
opération of a l t e r n a t i v e power oupplioo.

(e) The Adadnistration aay vai re the requireaent to carzy out the
checks and t e s t s prescribed in paragraphe (a) and (b) of t h i s Régulation
f b r ships vhich r e g u l a r l y ply on voyagea of a h o r t durât ion. Sueb ships
a h a l l c a r j y out these checks and tea ta at l e a s t enee evazy v a e k .

(f) B» date vpon vhich the ehecka and t e s t s preaeribed in

paragraphe (a) and (b) of t h i s Begulation are c a r r i ed out and t h e dat.
and d é t a i l s of eaergency s t e e r i n g d r i l l a c a r r i ed out m d e r paragraph (d)
of t h i s Begulation, a h a l l be recorded in t h e l o g book aa aay be
prescribed by the A d v i n i s t r a t i a n .
I