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Welcome to a chapter of the e-book Disaster Investigation.

1.27 No Safety Instructions - censored

The Final report (5) has no information about the personal safety systems aboard, e.g. how passengers and cargo were checked before the voyage. Personal safety in Estonia proper 1994 was low and you had to protect yourself. Gun control did not exist. If guns or weapons were carried on board has not been investigated.

The Final report states that there was a personal safety system aboard, i.e. in an emergency the 2 000 passengers were supposed to be alerted by the various alarms (bells and public address) and to collect their life jackets and gather at certain mustering points. Crewmembers were supposed to assist, e.g. ensure that all passengers in cabins had left the cabin and reached the mustering points. However, this system was never practiced, as the voyage was just 12 hours, even if it would have taken only 15 minutes to execute. No safety information was given to the passengers on departure. It was the Swedish partner of Estline Appendix 7, which had the overall responsibility of the safety to be executed by the crew of the Estonian partner on board.

But neither party was responsible for ensuring that the system actually worked.

They believed that the safety equipment and safety system was in order, as the ship was duly certified, but had nobody verified, if the system worked?

Why had they not trained the abandonment of the vessel and then noticed that it was impossible to evacuate 2.166 persons in a dry condition?

The Final report does not analyse the situation. A small Estonian crew shall escort 2 000 passengers to the lifeboats and life rafts. The voyages always take place at night - from 07.00 pm to 09.00 am. About 1 000 passengers must be supposed to sleep in their cabins, so the crew should have been trained to visit all 400-500 cabins on four different decks in an emergency to ensure that the passengers were awake and had started to evacuate after an alarm was given.

However - the sad fact is that, even if the Estonian speaking crew could have escorted the 2 000 passengers - a majority non-Estonian speaking - to the embarkation stations for lifeboats and life rafts, there weren't seats for all passengers 1.33 in the boats/rafts - the ship was not seaworthy!

And the Swedish NMA knew about it and had done absolutely nothing.

Because the fact is that more than 50% of the persons aboard were assumed to jump into the sea from deck 7 about 19 meters above the waterline at this stage of abandoning the ship and to swim to the life rafts that were supposed to be thrown into the sea from deck 8 1.34.

Nobody at Estline had considered how 2 000 passengers would abandon the ship. The whole crew lived well and safely up on decks 8 and 9 and had no problems to reach the lifeboats (for 692 persons). But who in the crew was instructed to run down to deck 1 and escort about 400 passengers there to safety? The reason why proportionally more crew than passengers survived is that the crew lived in safer cabins on deck 8 and had never been trained to save the passengers on deck 1!

Lack of proper safety instructions and crew training of evacuation contributed to the accident. The 'Estonia' was not equipped to evacuate its passengers and was unseaworthy all the time!


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