On July 19, 2018, a band of destructive thunderstorms with a history of high winds plowed through portions of the nation’s heartland, prompting the National Weather Service to issue a severe thunderstorm warning for areas near Table Rock Lake in Branson, Mo.
Despite the urgent warning, the crew of a fully loaded “duck boat” steered the vehicle into the water for a tour of the scenic lake in the popular tourist destination in the Ozarks.
It was a decision that would cost 17 passengers and crew members their lives.
A National Transportation Safety Board report issued Tuesday faults the operator of the ill-fated boat, Branson Ride the Ducks, for failing to monitor and respond to the changing weather. The NTSB also criticized the U.S. Coast Guard, which investigators say failed to enact NTSB recommendations on duck boat safety dating back to a 1999 incident that could have prevented the 2018 tragedy.
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In its report, which was detailed in a virtual news conference on Tuesday, the NTSB focused heavily on the meteorological elements of the catastrophe, concluding that boats should not have been in the water at the time. While Branson Ride the Ducks management was found to be responsible for improper decision-making in the face of severe weather, the NTSB also felt that captains and mariners should be provided additional weather training.
“Clearly the entire reason we’re here today is to prevent further tragedies,” said Robert Sumwalt, chairman of the NTSB. The board has authority to issue recommendations, but implementing them is not mandatory.
A predictable storm
The tragedy occurred on an otherwise sunny summer day. Until late afternoon, there was no visual indication that severe weather would be a problem in southwestern Missouri. But as early as 11:20 a.m., the National Weather Service Storm Prediction Center had issued a severe thunderstorm watch, advertising the likelihood of damaging winds and large hail in the afternoon.
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Shortly after lunchtime, a curved band of thunderstorms known as a derecho began taking shape in northern Kansas, blasting southeast with widespread 60 to 75 mph straight-line winds. It had been raging for most of the day before arriving in Branson.
On its website, Branson Ride the Ducks claims the storm was “unprecedented.”
“The storm system that ultimately impacted Stretch Duck 7 first developed about seven and a half hours prior the accident time, about 400 miles from the accident location,” Michael Richards, chairman of the NTSB’s meteorology group, said on Tuesday.
Touring during a severe thunderstorm warning
At 6:28 p.m., passengers boarded the duck boat at the company’s base in Branson. Before departure, the manager on duty instructed the captain to take the water portion of the tour first, knowing a severe storm was en route.
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“Although investigators were unable to interview him, the manager on duty was aware of the threat of inclement weather as evidenced by his decision to have the captain of Stretch Duck 7 complete the water portion of the tour first,” said Marcel Muise of the NTSB.
A severe thunderstorm warning came at 6:32 p.m., urging those in the vicinity of Table Rock Lake to seek shelter. Despite this, Stretch Duck 7 entered the water at 6:55 p.m. — some 23 minutes after the warning was issued.
In a National Weather Service assessment report, the agency felt the warning provided more than adequate lead time; the NTSB also cited “accurate forecasts.” These findings contradict the tour boat operator’s claims that the storm was unprecedented and not anticipated.
“Despite the available information, Ride the Ducks allowed four of its vessels to enter the water in close proximity to the approaching weather,” Muise stated. “Staff believes that Ride the Ducks did not effectively use all available weather information to monitor the approaching severe weather, nor assess the risk posed to their waterborne operation.”
The boat should not have entered the water
According to the NTSB, Coast Guard restrictions on the vessel’s certificate of inspection prohibited Ride the Ducks’ amphibious vehicles from operating in winds exceeding 35 mph, or waves topping two feet. While winds and waves were calm when the duck boat entered the water, the 60 to 70 mph gusts warned on by the National Weather Service were already approaching the northern end of the lake at that time.
The NTSB made it clear that the duck boats should never have entered the water and that “Ride the Ducks should have suspended waterborne operation … in anticipation of the imminent severe weather.”
Company management failed to adequately monitor and respond to the weather
NTSB investigators confirmed that weather warnings were delivered to Ride the Ducks management; the company used a Web-based service known as Streamer RT to receive weather alerts. An email detailing the severe thunderstorm warning was delivered at 6:32 p.m., with a lightning alert at 6:49 p.m. — both well ahead of the storm’s arrival and the duck boat’s entry onto the lake. Investigators were unable to determine whether staff opened the emails at the time.
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Ordinarily, the company’s tour route would consist of vessels traveling about 1,000 feet offshore, passing around an island before heading back to shore. Investigators found that Stretch Duck 7 and neighboring vessel Stretch Duck 54 turned back for shore early at 7 p.m., as the winds and waves kicked up before reaching the landmark.
“Stretch Duck 7 was exposed for several minutes to three- to five-foot waves and winds over 70 mph, resulting in waves intermittently flooding through the bow hatch,” the NTSB’s Brian Young said.
It was at that moment that the captains of Stretch Duck 7 and Stretch Duck 54 lowered the vessels’ canopies over the windows; four minutes later, bilge alarms were heard in both boats, indicating water entering the hull. Simultaneously, a 73 mph wind gust was clocked nearby.
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The boat “rapidly” sank shortly thereafter. Stretch Duck 54 made it back to shore safely. The hull was recovered four days later at a depth of 85 feet.
According to Muise, “Company guidelines instructed captains not to enter the water when … severe weather was approaching.”
However, the NTSB indicated the captain probably believed he had time to safely perform the water portion of the tour based on information provided from dispatch and the on-duty manager. After Stretch Duck 7 left its facility, there was “no further communication” between management and the captain.
NTSB recommends additional weather training
The NTSB did not fault the boat’s captain, instead stating there was “no indication” to the captain that the tour should not go on as planned.
Muise said that the NTSB “believes additional weather-related training may be justified for operators and for deck officers” of commercial vessels including duck boats. “Mariners with rivers endorsements would benefit from a better understanding of weather products.”
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The NTSB faulted vagueness in company policy as a factor contributing to the disaster, noting that while “severe weather” was listed as being dangerous to operations, there were no strict definitions of severe weather — or how fast or close it was approaching. That, they say, helped lead to “subjective decisions” from management and captains.
“[The NTSB] believes Ride the Ducks should have had specific guidance for the operation team to determine when to suspend waterborne operations,” Muise said.
Among these “no-go” criteria may have been the issuance of a severe thunderstorm warning by the National Weather Service.
“Had Ride the Ducks employees taken more appropriate actions and made better decisions, it is likely the duck boat would not have sunk, because they would not have continued operations based on the weather forecast,” Sumwalt said.
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Ripley Entertainment, which owns Branson Ride the Ducks, said it “would be reviewing the National Transportation Safety Board’s report as soon as it is available.”
“Branson Ride the Ducks fully cooperated with the NTSB’s investigation into the accident that occurred in July of 2018. We remain dedicated to working with the community of Branson, and continuing our support of all those who were impacted by the accident,” Ripley spokeswoman Suzanne Smagala-Potts said.
Structural factors contributed to the disaster
It wasn’t only the weather that led to the disaster. The NTSB directly called out the Coast Guard for failing to implement NTSB recommendations first made nearly two decades earlier following a similar deadly accident.
Structurally, two weaknesses in the vessel’s design and operation contributed to the disaster. Namely, a lack of reserve buoyancy and compartmentalization.
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As waves built, they broke over the bow of Stretch Duck 7, entering an air intake/bow hatch near the engine. That caused the bow to pitch downward as it began to take on water.
If the hull of the boat was broken into compartments or subdivided, only the front compartment would have filled with water — allowing the rest of the boat’s buoyancy to keep it afloat.
Because there was no containment, any water that spilled into the bow was able to move throughout the hull, in turn letting a deluge of water to continue entering more quickly than the bilge pump could evacuate it. Before long, the passenger cabin was filling with water.
In 2000, in a report on a May 1, 1999, disaster involving a duck boat named Miss Majestic that killed 13 in Hot Springs, Ark., the NTSB cited a lack of “adequate reserve buoyancy” contributed to the sinking.
In that report, the NTSB specifically urged the Coast Guard to mandate “watertight compartmentalization, built-in flotation, or equivalent measures, so that the vehicles will remain afloat and upright in the event of flooding, even when carrying a full complement of passengers and crew.”
According to the NTSB, the Coast Guard did not implement these recommendations, increasing the likelihood of an event like the Branson disaster.
Coast Guard responds
In Tuesday’s news release, the NTSB stated that “contributing to the duck boat’s sinking was the Coast Guard’s failure to require sufficient reserve buoyancy in amphibious vessels.”
The NTSB also found that, in the Table Rock Lake disaster, the lowering of vessel canopies — coupled with the donning of life jackets inside the vessel — effectively trapped passengers and hampered escape, increasing loss of life.
It’s not a novel issue; during the 1999 sinking in Arkansas, the NTSB reported that “the canopy … was a major impediment to the survival of the passengers” and closing it was an “entrapment.”
During that incident, all but one surviving passenger stated that the canopy was a major obstacle preventing escape.
However, in the wake of the 1999 incident, the Coast Guard took the position that “even if the windshield and canopy were open, there still would have been a bottleneck of individuals trying to escape the vessel.”
In 2002, the NTSB again urged the Coast Guard to mandate the “removal of canopies for waterborne operations, or the installation of a Coast Guard-approved canopy that does not restrict either horizontal or vertical escape by passengers in the event of sinking.”
Brian Young of the NTSB did not mince words in criticizing the Coast Guard.
The NTSB “believes that, had the Coast Guard implemented the NTSB’s 2002 recommendation … the Stretch Duck 7 likely would not have sank.”
This time, however, it seems the Coast Guard is moving forward with new guidance. On April 22, the Coast Guard issued a bulletin recommending the removal of canopies from duck boats due to the risk they pose.
“The Coast Guard agrees with the NTSB that the canopy likely impeded passenger egress, and now we recommend all canopies be removed before … vessel operations,” Coast Guard spokesman Kurt Fredrickson said.
While the Coast Guard has not yet addressed the reserve buoyancy issue, the agency noted it is conducting “two separate investigations into the sinking of Stretch Duck 7” and will use the findings “to determine the need for any regulatory actions.”
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