The Australian Maritime Safety Authority had not adequately managed the National Plan and annual exercises required to prepare for such incidents had not been conducted for 4 years before the incident. This probably resulted in the ineffective implementation of its Maritime Assistance Services procedures, the inefficient process for issuing directions and inadequate coordination of the incident with state authorities.
To be advised
Response by Australian Maritime Safety Authority
The Australian Maritime Safety Authority (AMSA) advised the ATSB that it did not agree with the finding that the National Plan had not been adequately managed.
However, AMSA advised that a range of national capability programs have been delivered under the oversight of the National Plan Strategic Coordination Committee (NPSCC), including:
ATSB comment
The ATSB welcomes the safety action taken by AMSA which, in conjunction and consistent with action to address the 3 other safety issues addressed to AMSA, could adequately address this safety issue. The ATSB also notes the recommendations from the review of the National Plan, which require further reviews of its key elements. Therefore, the ATSB will monitor the safety issue and action and has issued the following safety recommendation to AMSA.
The Australian Maritime Safety Authority (AMSA) advised the ATSB that it did not agree with the finding that the National Plan had not been adequately managed.
However, AMSA advised that a range of national capability programs have been delivered under the oversight of the National Plan Strategic Coordination Committee (NPSCC), including:
The ATSB is concerned that AMSA does not agree with the investigation’s finding that it had not effectively managed the National Plan. However, the ATSB welcomes the safety action that it has taken, which could adequately address the safety issue when implemented in conjunction with action to address the 3 other safety issues addressed to AMSA. In this regard, the ATSB notes the recommendations of the National Plan review, which require further reviews of its key elements. Therefore, the ATSB will monitor the safety issue and action and has issued the following safety recommendation to AMSA.
The Australian Transport Safety Bureau recommends that the Australian Maritime Safety Authority (AMSA) progresses safety action to address this safety issue in conjunction with action to address the other safety issues addressed to AMSA in this report.
On 13 August 2025, the Australian Maritime Safety Authority (AMSA) advised that it accepted the ATSB’s recommendation in relation to this safety issue. However, AMSA also noted that its response to the ATSB draft investigation report had affirmed that the National Plan for Maritime Environmental Emergencies (National Plan) had been adequately managed prior to the incident and acknowledged the role of the National Plan Strategic Coordination Committee (NPSCC) in overseeing the implementation of the plan and ensuring its effectiveness.
In terms of safety action to address the safety issue, AMSA advised that this covered areas related to interagency coordination, exercising the National Plan and a related learning and development programs.
Safety action for interagency coordination includes further steps to improve collaboration and communication with response partners. Monthly meetings are held between AMSA and states, the Northern Territory and the Australian Marine Oil Spill Centre, to discuss implementation and review of the National Plan, exercises, learning and development and recent response activities. The outcomes from these meetings include:
In addition, AMSA facilitates National Plan coordination workshops, the most recent of which (Marine Pollution Controller workshop, June 2025) targeted senior managers responsible for interagency coordination with a focus on coordination across jurisdictional boundaries.
Action has also been proposed to enhance National Plan exercises. In June 2025, the NPSCC agreed that future exercises include more focussed exercising of a maritime casualty, including the use of Maritime Assistance Services (MAS) procedures, issuing of directions (intervention) and coordination with state and Northern Territory authorities. An AMSA proposal outlining the approach to include MAS procedures in future exercises is to be presented for consideration by the NPSCC in November 2025.
Finally, the National Plan learning and development programs aim to strengthen capability to uphold the plan’s objectives and ensure that AMSA staff and jurisdictional partners acquire the comprehensive theoretical knowledge and hands-on skills crucial for leading and coordinating effective incident management and pollution response efforts. Several of the training programs are designed for incident controllers and incident management teams and numerous courses across a range of related fields have been delivered to several hundred participants since the incident. Participant feedback indicates that this training greatly enhances their preparedness to respond confidently and efficiently to real events in real time and highlighted the benefits of integrating theoretical learning with practical scenarios, the expertise of seasoned trainers, and the opportunity to exchange real-world experiences with peers across jurisdictions.
The ATSB welcomes AMSA’s acceptance of the recommendation to address this safety issue. However, the ATSB notes AMSA’s comments that the National Plan had been adequately managed before the incident and the NPSCC’s role in overseeing the implementation of the plan and ensuring its effectiveness, which suggests that it does not consider that the safety issue existed. Nevertheless, AMSA is taking safety action as described above with some key initiatives underway.
Therefore, the ATSB will monitor the issue and seek an update from AMSA in January 2026 on the progress of these initiatives and other related safety action.
