~ Practical Lessons From Major Accidents ~
IRC Risk and Safety
Protecting life by shaping the design and operation of hazardous facilities

March 2009
 
Greetings!

The feedback we received from last month’s bulletin really confirmed the value of what we are doing.

This practical lessons bulletin covers the misadventures of Sir Ernest Shackleton's 1914-17 Imperial Trans-Antarctic Expedition. It is a great story of unbelievable hardship, incredible leadership, and obvious mistakes. Although it happened nearly a hundred years ago, the lessons are equally applicable today. Take a look at the short video via the link on the right.

IRC’s mission is to provide readily usable solutions to help prevent accidents at hazardous facilities—learning from mistakes is a valuable aid.

The Shackleton expedition can be analyzed using the bow-tie diagram—a powerful risk assessment technique. For people not familiar with bow-tie diagrams, IRC Risk and Safety will host a free, one-hour breakfast seminar May 7 in Houston covering the theory and benefit of bow-tie diagrams. We will use Shackleton, and others, as case studies at the seminar. A key benefit of bow-ties is that they can be used quickly and easily to perform robust and useful risk assessments, hence their rapidly increasing popularity in hazardous industries. We have only 50 places, so you will need to be quick—sign up for the seminar by email (see link on the right), and we will reply with additional details.

bowtie diagram

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MEB

Morris Burch, CEO

+1 713 647 7929
Sir Ernest Shackleton's
Imperial Trans-Antarctic Expedition
Endurance sinking and timeline
Two Years of Suffering from Hunger and Frostbite

The Job Advertisement

“Men wanted for hazardous journey. Small wages. Bitter cold. Long months of complete darkness. Constant danger. Safe return doubtful. Honor and recognition in case of success.”

Nearly 5,000 men applied for the job.

The Mission

To be the first person to cross Antarctica on skis and with dog sleds.

Brilliance or Destined for Failure?

The story of Sir Ernest Shackleton’s failed Antarctic expedition is often held up as a tale of unbridled determination and legendary leadership. A man so selflessly devoted to the welfare and morale of his men, he was willing to put himself through unimaginable agonies to ensure their survival. An alternate view is that he was a man with a large ego on a mission doomed for failure from the beginning.

It is fair to say, however, that he should be applauded for repeatedly getting his men out of dire situations.

Evidence suggests that, fundamental to his undoing were inadequate planning, poor preparation, lack of team member skills, and a mistaken belief that strength of character and determination were enough to overcome whatever challenges might arise.

The mission failed. The crew never set foot on Antarctica.

Preparation or Lack Thereof

By June of 1914, Shackleton had raised only half of the £70,000 (more than £1,500,000 today) needed for the expedition. With the threat of World War I looming and the window of opportunity closing to catch the Antarctic summer, his chances of leaving for the South Pole looked unlikely. However, after receiving a last-minute donation of £24,000 (more than £514,000 today), Shackleton and his crew of 27 set out from England in early August in a 144-foot long, 300-ton wooden ship christened Endurance. The ship was built by a master shipwright in Norway and supposedly was equipped to withstand ice.

Despite the plan to use skis and dog sleds, no one in the party knew how to train or drive a team of dogs, and only one knew how to ski. One reason for this was that Shackleton's recruitment criteria were weighted as: first, optimism; second, patience; third, physical endurance; fourth, idealism; fifth and last, courage.

Ignored Warnings

The whalers on South Georgia Island told Shackleton that the ice conditions were the worst they had ever seen. Ignoring their advice of the severity of the hazard Shackleton and his men headed south in early December. Meanwhile, a supply ship, the Aurora, sailed from New Zealand to the Ross Sea to rendezous with the Endurance expedition crew.

Just off the Antarctic continent, the Endurance encountered the first ice pack and, after weaving through loose ice floes, entered thick pack ice in mid January 1915. Within one day the ship was frozen fast in the ice. While stranded, they endured months (April through August) of darkness—the sun never rose.
Endurance map of planned route
Endurance map legend

The Endurance Sinks

The crew used the ship as shelter until spring in September. But the spring thaw did not free the Endurance. Rather the loosened plates of ice crushed the ship. It began taking on water in October and sank in late November of 1915. The future continually looked dire. Supplies were low, supplemented by an occasional meal of seal or penguin meat. The sled dogs began to die. Extreme cold, biting winds, and miserable outlook were ever present. Shackleton maintained moral by assigning each man duties and ensuring regular exercise, combined with games and songs.

Escape and Rescue

During March 1916, the crew tried several times to move the camp on foot. But the loaded lifeboats weighed a ton and were difficult for men to drag, even over the ice. The ocean’s swells could be felt under the thinning ice and some of the crew began to get seasick. In early April 1916, they set out in the lifeboats for Elephant Island, about 100 miles to the north. Then, April 24, a few days after arriving at Elephant Island, Shackleton set out with five of his best men in his best lifeboat with minimal supplies to try to reach the whaling community on South Georgia more than 700 miles away.

“We gave them three hearty cheers and watched the boat getting smaller and smaller in the distance. Then seeing some of the party in tears, I immediately set them all to work,” reads a journal entry by second in command James "Frank" Wild. Ill, frostbitten, and close to starvation, they waited for rescue, with blubber lamps for light and subsisting on seal and penguin meat, which was scarce.

After 16 days navigating rough seas and hurricane-force winds, Shackleton's rescue expedition landed on South Georgia, but some 30 miles from the nearest settlement. In an amazing feat of physical achievement, in 36 hours they walked the distance over icy, mountainous, unmapped terrain. After four more months and three attempts, Shackleton succeeded in rescuing the rest of his crew from Elephant Island at the end of August 1916.

The Aurora crew also suffered hardships. Having made the trip from New Zealand to Ross Island, the ship was trapped in ice and finally was carried out to sea as the crew set up the supply depots. The crew was incommunicado and without orders or knowledge of the fate of Endeavor. Three Aurora crewmen died before the survivors were rescued that August.

The Accident: Causes and Contributors

  • Focus was on fund-raising rather than on preparation and planning; last-minute funds made them rush and contributed to the late sailing
  • Hazards were not properly identified; therefore, no plans were in place to manage those hazards
  • No search-and-rescue (emergency response) was available so they could not expect to be rescued because World War I was consuming resources
  • Ignored advise from knowledgeable experts (the whalers) about the severity of the hazard
  • Recruitment was not competency based but focused upon attitude for the job, the hardship, and the struggle; crew lacked critical skills

Practical Lessons

  • On the positive side, Shackleton's selection criteria for men (attitude-based) had a positive outcome in terms of getting his men back alive

    Consider a candidate's attitude toward safety as a selection criterion.

  • Planning, preparation, and resources

    Conduct thorough hazard identification involving knowledgeable people and develop realistic plans to manage the hazards.

  • Be prepared for emergencies

    Provide necessary resources and test regularly, including external, third-party support.

  • Shackelton’s reckless actions put rescuers and the supply boat crew at risk, ultimately ending in tragedy.

    Consider not just your own people, but the wider community, when making key decisions.

  • Hope is not preparation, nor is it a strategy

    Ultimately Shackleton was lucky. Poor preparation resulted in insufficient barriers to them becoming stranded, but thankfully the limited recovery measures available to them worked. When managing major hazards, ensure a diversity of independent barriers and recovery measures.

References

  1. The Antarctic Circle. $100 Contest! Online at http://arctic-circle.org/advert.htm. Accessed 3 March 2009.
  2. The Endurance. (N.D.) Antarctic Connection. Online at http://www.antarcticconnection.com/antarctic/shackleton. Accessed 2 March 2009.
  3. Ernest Shackleton (modified 2 March 2009). Wikipedia, the free encyclopedia. Online at http://en.wikipedia.org/wiki/Ernest_Shackleton. Accessed 2 March 2009.
  4. James Caird Society Shackleton News. The Story of Shackleton's "Aurora" and Its Long-suffering Crew - By an Eye-witness. Online at http://www.jamescairdsociety.com/shackleton-news.php?id=103858 Accessed 24 March 2009.
  5. Nova. (Feb 2002) Tending Sir Ernest’s Legacy: an Interview with Alexandra Shackleton. Nova Online. Online at http://www.pbs.org/wgbh/mpvashackleton/1914/alexandra.html. Accessed 2 March 2009.
  6. Chappel, C. (N.D.) Shackleton’s Leadership of the Endurance Expedition. Netherlands: Direction Europe BV. Online at http://www.leiderschapontwikkelen.nl/uploads/Ernest_Shackleton.pdf . Accessed 2 March 2009.

Image Credits

  1. Royal Geographic Society. File:Endurance Final Sinking.jpg (photo, Nov 1915) Endurance final sinking in Antarctica. Wikipedia. Online at http://en.wikipedia.org/wiki/File:Endurance_Final_Sinking.jpg. Accessed 2 March 2009.
  2. Ernest Shackleton, Wikipedia, the free encyclopedia. (map and legend). Online at http://en.wikipedia.org/wiki/Ernest_Shackleton.
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