Finding into death of Allan Russell McFarlane
Deceased
Allan Russell McFarlane
Demographics
71y, male
Date of death
2019-01-11
Finding date
2021-01-14
Cause of death
cardiac arrest secondary to near drowning
AI-generated summary
A 71-year-old experienced boatman died from cardiac arrest following near drowning when a borrowed boat capsized in Port Phillip Bay. The vessel (MA827) had multiple design and maintenance issues: low freeboard unsuitable for bay conditions, water ingress through an unprotected engine cable hole, missing internal bung plugs in bulkheads, and an unlabelled bilge pump the operator was unaware of. Moderate winds and commercial shipping wakes contributed to water accumulation. The boat owner and primary operator had minimal familiarity with the vessel. Critical gaps existed: no automated bilge pump activation, no bilge alarm, no vessel inspection requirements at registration/transfer, and poor handover of safety-critical information between sellers and buyers. Prompt bystander CPR and emergency response could not overcome the near-drowning injury.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Drugs involved
Clinical conditions
Procedures
Contributing factors
- vessel capsized due to water ingress through engine cable hole in transom
- low freeboard of vessel unsuitable for bay conditions with moderate winds and shipping wakes
- missing internal bung plugs in port and starboard bulkheads allowed water to flood multiple compartments
- operator unfamiliar with vessel after minimal prior use
- unlabelled bilge pump - operator unaware of its existence
- no automated bilge pump activation system or bilge alarm
- absence of vessel inspection requirements at registration or transfer of ownership
- poor handover of safety-critical vessel information between seller and new owner
- vessel designed for water skiing with continuous forward momentum, unsuitable for stationary fishing
- moderate winds (18-28 km/h) and commercial shipping traffic causing wave action into transom area
Coroner's recommendations
- Transport Safety Victoria should consider requiring all boats to be fitted with manual or electrical pumping mechanisms to all bilge areas
- All boats fitted with electrical bilge pumps in enclosed bilge areas should have automated switches, floats, or alarms if manual bilge exists
- Transport Safety Victoria should implement a system of vessel inspections at registration and acquisition or transfer of vessel ownership, akin to roadworthy inspections for vehicles
- As part of seaworthy inspections, builder's plates should be retrospectively attached determining the number of people, conditions the vessel is suited for, and maximum engine capacity
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