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  1. The Golden Thirteen    




    Discuss and analyze the movie:    The Golden Thirteen    



Subject Literature Pages 3 Style APA


Coast Guard Station Quillayute River Small Boat Mishap

                The Coast Guard’s unofficial moto is “You have to go out, but you don’t have to come back” (Wells, 2006).  Senior enlisted leaders need to remember the lessons from the Quillayute River motor lifeboat mishap so they will not repeat the mistakes of the past.  This paper will provide a background of the Quillayute River mishap, present the findings of the investigation, and show the resulting changes to Coast Guard search and rescue stations.


                Station Quillayute River, one of the most remotely located search and rescue stations, is located on the Quileute Native American reservation in La Push, Washington at the mouth of the Quillayute River.  One of only 20 designated surf stations; the 26 members assigned are highly trained in operating 44-foot steel hulled, motor lifeboats.  In service since the early 1960s 44-foot motor lifeboats known for their incredible strength and stability, are designed to be self-righting and self-bailing.  A 44-footer can negotiate waves up to 30ft, and maneuver in breaking surf up to 20ft.  Operating within 50 nautical miles of the coast, 44-foot motor lifeboats require a crew of four: a coxswain (member in charge), a boat engineer, and two crewmembers.  Since surf stations experience extreme sea conditions, they have an additional requirement to have a qualified surfman onboard while operating in breaking seas.  A surfman takes the place of the coxswain and is required to be on-duty at the unit if weather conditions exceed the established limits set by headquarters.

                On the night of February 12, 1997, the station received a radio call from a sailing vessel reporting they were encountering heavy rain, wind, and seas.  They wanted to enter port to avoid the forecasted gale.  Unit personnel noticed the wind had increased significantly, more than forecasted, and the entrance of the river or the bar was most likely impassible due to heavy seas and breaking waves.  Before the station could collect further information, the sailing vessel called MAYDAY and reported they were taking on water and drifting towards shore.  Since the weather report did not forecast breaking seas, a qualified surfman was not on duty at the station.  The station sounded the alarm and launched motor lifeboat CG44363.  As CG44363 approached the river entrance, the Station Officer in Charge ordered the crew to “check out the bar to see if they could cross” (Nobel, 2002, p. 88).  The Coxswain soon reported they had crossed the bar, but were encountering 16-18 foot seas.  Moments later the unit heard a faint radio call reporting they had rolled.  CG44363 re-righted, but as the seas continued to build, it rolled two more times throwing three of the crewmembers into the water.  As the breaking waves continued to push CG44363, the fourth crewmember remained tethered to the boat, safely making it ashore.  Searching throughout the night, two Coast Guard helicopters and the second 44-footer, with a surfman onboard, eventually located and recovered the bodies of the three missing crewmembers.  With the background provided, this paper will now present the findings of the investigation.

Findings of the Investigation

                The investigation of this mishap looked at a number of areas, including; crew training, environment, and human error.  Ultimately, the reported leading cause was:

                a series of human errors.…a combined disregard of risk assessment by elements of the                Search and Response system…evidenced by the lack of adequate briefings to evaluate        the nature of the distress, the on-scene weather, and the capabilities of the potential     response platform prior to launching (Nobel, 2002, p. 172). 

Investigators determined, if the unit was fully aware of the weather conditions and conducted a proper risk assessment they would have ensured a surfman was onboard the lifeboat.  Also considered a contributing factor was the coxswain’s sense of urgency to respond.  The crew not wearing helmets and not properly tethered to the boat, is indicative of their desire to respond as quickly as possible.  The final contributing factor stated, “he failed to recognize his own limitations regarding his qualifications and experience handling the boat in these conditions and therefore did not demonstrate the standard of care of a reasonably prudent…Coxswain” (Nobel, 2002, p. 169).  Of additionally note, in previous studies the U.S. Department of Transportation (2001) reported consistent understaffing at search and rescue stations.  At the time of the mishap, the station had one surfman position unfilled.  With the findings of the investigation presented, this paper will show the resulting changes to Coast Guard search and rescue stations  


The findings of the investigation led to many changes.  An increase in tour lengths to improve local knowledge and experience, establishment of a prospective surfman program to identify and train members desiring to qualify as surfman, and changes to “sea duty” advancement requirements to keep highly trained members in the surf community.  Crew protective equipment upgrades included; requirements for dry-suits, helmets, and a redesign of harnesses used to tether the crew during a rollover.  Headquarters now requires all members to receive training in risk assessment and Team Coordination Training, “to teach members how to analyze potentially hazardous situations while working together as a team.…curriculum focuses on knowing one’s limitations before taking actions” (Pollinger, 2007).

                This paper provided the background of the Quillayute mishap, presented the findings of the investigation, and showed the resulting changes to Coast Guard search and rescue stations.  Coast Guard senior enlisted leaders need to remember the lessons learned from the Quillayute mishap so they will not repeat the mistakes from the past.  The 1934 Instructions for United States Coast Guard Stations (Gibbons, 1934) included, “The statement of the keeper that he did not try to use the boat because the sea or surf was too heavy will not be accepted unless attempts to launch it were actually made and failed” (p. 4).  Coast Guard rescue crews operate in extreme conditions and make difficult decisions every day, but sometimes the hardest decision they can make is when not to go.



Gibbons, S. B. (1934). 1934 Instructions for United States Coast Guard Stations. Washington,      DC: Assistant Treasury Secretary. Retrieved from           https://www.uscg.mil/history/docs/1934InstructionsCoastGuardStations.pdf 

Noble, D. L. (2002). The rescue of the gale runner. Gainesville, FL: University Press of Florida.

Pollinger, J. (2007, March 23). Past tragedy leads to safer future. Coast Guard News. Retrieved from http://coastguardnews.com/past-trgedy-leads-to-safer-future/2007/03/23

U.S. Department of Transportation, Office of Inspector General for Auditing. (2001). Audit of     the Small Boat Station Search and Rescue Program United States Coast Guard. (MH-   2001-094). Retrieved from https://www.oig.dot.gov/sites/default/files/mh2001094.pdf

Wells, W. R., II. (2006). Semper paratus: the meaning. Retrieved from                 https://www.uscg.mil/history/articles/SemperParatusTheMeaning.pdf




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