Investigation report highlights why TSB is conducting national investigation into marine fires
A newly released Transportation Safety Board (TSB) investigation into a 2023 engine room fire aboard the bulk carrier Cuyahoga near Pelee Island, Ontario, is highlighting persistent, systemic safety issues in Canada’s marine sector—issues already under national scrutiny by the TSB’s ongoing safety issue investigation into vessel fire preparedness.
A preventable fire on Lake Erie
On May 23, 2023, the Cuyahoga was carrying crushed stone from Marblehead, Ohio, to Kingsville, Ontario, when a fire broke out in the engine room. The crew acted quickly, shutting off the main engine’s fuel supply and attempting to activate the vessel’s CO₂ fire suppression system—first remotely, then manually. Both attempts failed, and the fire was ultimately extinguished only after the engine stopped due to fuel starvation.
The TSB found the root cause to be a maintenance lapse: “The fire was caused by fuel spraying from a disconnected injection line onto exposed hot surfaces.” The report notes that after an earlier repair, “retaining clamps were not reinstalled,” making the lines vulnerable to loosening from vibration. Recurring leaks were treated as routine, “without investigating the underlying cause.” The crew “lacked regular access to updated maintenance and torque specifications.”
Fire suppression system: Multiple failures
The vessel’s CO₂ fire suppression system failed at every turn. The TSB states, “The remote release cables had been routed through the engine room and were damaged by the fire.” When the crew tried a manual release, “the system discharged CO₂ into the cylinder room instead of the engine room, due to incorrect activation instructions and loose or missing components.”
Systemic issues: Not an isolated case
The Cuyahoga incident is emblematic of broader, long-standing safety gaps. The TSB emphasized, “the issues raised in this investigation... are not unique and affect the safety of marine transportation across the country. They reflect long-standing, systemic safety issues.”
Recognizing these persistent risks, the TSB launched a national safety issue investigation in July 2025, before the Cuyahoga report, “to build a clearer understanding of how vessel fires are currently managed and identify the gaps in Canada’s preparedness for marine emergencies.”
Lessons for health and safety leaders
The TSB’s findings are a call to action for health and safety professionals:
- Maintenance and documentation: The Cuyahoga’s crew treated recurring leaks as routine, without investigating root causes. The TSB warns, “If vessel maintenance and machinery monitoring do not ensure that propulsion machinery remains reliable, there is a risk of damage... and of injuries to personnel.”
- Training and emergency readiness: Crew lacked access to up-to-date manufacturer specifications and proper training on emergency systems. “If training, instructions, and emergency drills... are inadequate or missing, there is a risk that the crew will be unable to respond effectively.”
- Equipment and structural integrity: The fire suppression system’s failure was compounded by poor cable routing and unclear instructions. “If the integrity of structural fire protection is compromised and emergency equipment does not operate reliably... fire prevention, control, and extinguishing efforts will be hindered.”
- Shore-based support: The TSB highlighted gaps in shore-based firefighting capabilities, noting that many municipal fire departments lack the training and equipment to respond to shipboard fires, putting “crew, the general public, property, and the environment at risk.”
The Cuyahoga investigation underscores the urgent need for a proactive safety culture, robust maintenance protocols, comprehensive training, and clear emergency procedures. As the TSB concludes, “Safety management will remain on the Watchlist... until: Transport Canada implements regulations requiring all commercial operators to have formal safety management processes; and transportation operators... demonstrate to TC that it is working—that hazards are being identified, and effective risk-mitigation measures are being implemented.”
