- 期刊
從美國海軍「本田岬海難」探討航安風險管理
Innocent Tragedy-Lessons Learned from a Devastating Incident in the US Navy
摘要
一、在1923年9月7日夜間，採單縱隊20節航速（時速36公里）高速疾馳的14艘美軍最先進的戰艦，因為惡劣天候與一連串的人為疏失，導致7艘驅逐艦觸礁、擱淺翻覆，並成為美國海軍承平時期最慘痛的海事案，代價何其殘酷。二、本次任務，因為輕忽安全因素，導致7艘戰艦在美國加州聖塔芭芭拉郡近岸的本田岬海域發生船難，更造成23人死亡的重大傷損慘劇；經事發後的多方檢討，一致認為「人為因素」係本案肇事的主因，凸顯即使是先進艦船，若無法有效掌控危安風險因子，也會釀成巨禍。三、儘管國際海事界一直針對有效降低事故發生，不斷積極改善船體設計或提升航儀設備要求等方式，盡量補足「人」在這方面之缺漏與風險；但「人因」占海事事故肇生的比率始終偏高。故本文運用「人為因素分析與歸類系統」，深入探討人為疏失的肇因與預防，期從每一次重大海難中汲取教訓、深切省思與檢討，才能落實「航安」要求，確保戰力完整。
並列摘要
1.On the night of September 8, 1923, 14 warships were speeding in a single column at a speed of 20 knots (36 kilometers per hour). Due to bad weather and a series of human errors, 7 of the most advanced destroyers of the US military stranded, and became the most tragic maritime case of the U.S. Navy in peacetime, and the price was so huge. 2.In this mission, due to neglect of safety factors, seven warships were involved in a shipwreck in the Cape Honda waters off the coast of Santa Barbara County, California, USA, resulting in 23 fatalities and heavy injuries. After the incident, After multiple reviews, it was unanimously believed that "human factors" were the main cause of the accident, high-lighting that even advanced ships will cause huge disasters if they cannot effectively control safety risk factors. 3.Although the international maritime community has been aiming to effectively reduce the occurrence of accidents and has been actively improving hull design or upgrading navigation equipment requirements and other methods to try to make up for the deficiencies and risks of "human factors" in this regard; "human factors" account for the majority of maritime accidents. ratio is always on the high side. Therefore, this article uses the "Human Factors Analysis and Classification System" to deeply explore the causes and prevention of human errors. It is hoped that lessons can be learned from every major maritime disaster, and can be implemented to "safety" requirements.