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posted by hubie on Monday December 01, @09:26PM   Printer-friendly
from the details-matter-even-really-little-details dept.

The root cause of the collapse of Baltimore's Francis Scott Key Bridge when hit by container ship Dali has been identified. It was the wrong placement, by a few millimeters, of the label on one wire. As usual, the National Transportation Safety Board has taken their time and done a detailed investigation--summarized in this short video
      https://www.youtube.com/watch?app=desktop&v=bu7PJoxaMZg

tl;dr - the wire was not completely inserted into a terminal block, due to the wire label wrapped over the ferrule. Over time the connection became intermittent and eventually shut off power on the ship...after which it drifted into the bridge. Of course there were additional contributing problems as well.

The YT video comments include some more interesting details.

[Ed. note: For those not inclined to watch the YouTube video, the narrative summary of the video is listed in the spoiler below.]

1. The Dali electrical system distributes power and control signals throughout the vessel.
2. The control circuits contain hundreds of terminal blocks that organize thousands of wires.
3. The wires on the Dali were terminated with metal sleeves called ferrules that allowed for easier assembly into the terminal blocks.
4. Each wire was identified with a labeling band.
5. This image shows several terminal blocks on the Dali with wires connected.
6. To assemble a wire into a terminal block, a tool inserted into a side port opens a spring clamp, which allows the wire's ferrule to slide into place.
7. Removing the tool closes the spring clamp, securing the ferrule firmly against the terminal block's internal conductor bar.
8. Labeling bands identify wires and are typically positioned on the wire insulation.
9. However, many labeling bands on the Dali wires were placed partially on the ferrules, which increased the ferrules' overall circumference.
10. As a result, during vessel construction, some of the ferrules could not be fully inserted in the terminal blocks, including the ferrule on wire 1 from Terminal Block 381.
11. On that wire, the labeling band prevented full insertion of the ferrule, so the spring clamp gripped only the ferrule's tip, resulting in an inadequate connection.
12. Due to this unstable connection, over time the ferrule on wire 1 slipped out of the spring clamp to rest atop the spring clamp face, resulting in a precarious electrical connection.
13. When a gap occurred between the ferrule and the spring clamp face, the electrical circuit was interrupted, leading to a blackout on the Dali.

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  • (Score: 2) by JoeMerchant on Tuesday December 02, @08:04PM (2 children)

    by JoeMerchant (3937) on Tuesday December 02, @08:04PM (#1425621)

    >They were running the generators fuel supply using a maintenance cleaning pump instead of the main and backup fuel pumps (why?)

    That's the ingenuity the owners pay them for. Can you make it through next year before submitting any new parts orders? If you do there's a 5% bonus in your paycheck!

    > I guess if you have a triply redundant system some dumbass will try to run everything off the third backup until it fails too.

    This is why aircraft get annual inspections. Ships above a certain size should, also, but do not AFAIK. Were I harbormaster somewhere with a big fancy commuter bridge over the channel, I do believe I would require safety inspections before letting those scows in my harbor, but then they'd probably replace me with a more "business friendly" harbor master pretty quick.

    > they'd occasionally burn out engines but at least they'd have power.

    At least until the engine burns out. That one I get. What I don't get is allowing these things entry to ports with no seaworthiness checks whatsoever. The Dali can displace 149,000 tons (according to some sources) and cruise at 22 knots, that's 9.5x10^9 Joules of kinetic energy. If a Kh-47M2 Kinzhal 4300kg hypersonic missile manages to strike at Mach 10 (as I understand things they don't always hit at maximum speed), that's only 2.3x10^10 Joules of kinetic energy - equivalent to 5 tons of TNT - so the ship ramming out of control is only equivalent to 2 tons of TNT so it's "safe enough?"

    >If they didn't have triple redundant fuel systems they wouldn't do something dumbass like not maintain it at all until all three failed at once.

    As captain of a vessel with more destructive potential than a Mach 6 hypersonic missile, I wouldn't be leaving port without redundant fuel systems operational. That's like driving your car down the freeway with no brakes and a steering linkage that can let go at any moment.

    >If they didn't have a backup generator that worried too much about stuck cooling damper doors, they'd have power.

    By the time you've MacGyver'ed it that far, you already should be stopped waiting for proper repairs.

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  • (Score: 2) by VLM on Tuesday December 02, @08:38PM (1 child)

    by VLM (445) Subscriber Badge on Tuesday December 02, @08:38PM (#1425628)

    At least until the engine burns out. That one I get.

    I was thinking about that while eating lunch and I bet steering works at idle. Sure it'll burn out / boil over / warp the heads at full throttle but dropping to idle instead of shutting off altogether might be a safer response to overheating.

    Might be a situation where the engine manufacturers guarantee is at financial risk unless the electronics shuts down the engine, vs the risk of knocking over a $5B bridge taking 6 years to replace.

    That is also an amazing part of the story, inflation adjusted they built the first bridge for $0.5B equivalent half a century ago, and the replacement is supposed to cost $5B inflation adjusted now. Ten times the cost. Well maybe it'll be ten times as strong, who knows.

    • (Score: 2) by JoeMerchant on Tuesday December 02, @08:59PM

      by JoeMerchant (3937) on Tuesday December 02, @08:59PM (#1425629)

      > Ten times the cost. Well maybe it'll be ten times as strong, who knows.

      It'll probably have more effective bumpers against future accidents. That's one thing they did for the Sunshine Skyway after it got clipped.

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