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developed an informal list of accident causes, and for opera- made the same mistake if he was sober. What we really need tional reasons, prefers picking a probable cause from that list. to ? gure out is how the system failed, and here it becomes

Alcohol impairment is a prominent member of that list, and, more interesting. once NTSB completed its investigation, there was no doubt By nature, we have to assume that a certain percentage of that the Master was impaired. As a matter of fact, the report ship operating personnel have an alcohol problem, just like a provides an excellent discussion on alcohol impairment on certain number of voyages have storms. What we need to do is pages 7 and 8. recognize when this becomes a problem and how to prevent it

However, a closer reading of the sequence of event should from impacting ship operations. The prevention is related to show that alcohol impairment is not a particularly useful con- procedures and procedural failure will ask why a person with clusion to this investigation. Alcohol impairment in an in- an alcohol problem can rise to become a ship master. What dustrial setting is often related to alcoholism (it could also we also need to avoid is to miscast alcoholism as an easy be professional incompetence or dysfunctional corporate cul- probably cause. For example, when I worked on the Exxon ture). Alcohol impairment is a physical reality that can throw Valdez (for plaintiffs, no less) it very quickly became clear a wrench in the works at inopportune moments in ship opera- that Capt. Hazelwood’s drinking was highly unlikely to have tions just like storms can cause a problem in ship operations. been the probable cause of the incident. However, to this day,

We don’t like alcohol in a navigational setting, and we don’t everybody talks about Tanqueray on the Rocks, and nobody like storms at sea that much either, and we try to avoid both. talks about the wheelhouse screw-up on Capt. Hazelwood’s

If I were to conclude that a storm was the cause of the El clear and simple instruction, which really was the cause of

Faro sinking, I am sure there would be a collective “Duh” the grounding. groan. Alcohol impairment is no different, and actually fuzz- So, if we study the sequence in ? gure 1 more closely, we ier, because we do not know if the Master would also have can identify the lapses in the process shown in ? gure 2,

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