Record of Investigation Into Death
Coroners Act 1995
Coroners Rules 2006
Rule 11
I, Christopher Webster, Coroner, having investigated the death of
Shane Allan Ransley
WITHOUT HOLDING AN INQUEST
Find :
(a) Shane Allan Ransley (Mr Ransley) died on 4 January 2011 on the East Derwent Highway at Risdon Vale, Tasmania, aged 49 years.
(b) Mr Ransley was born in New Norfolk, Tasmania on 12 June 1961. He was a single man employed by HighRig Crane Hire, Tasmania, as a rigger.
(c) Mr Ransley died as a consequence of blunt trauma of the head sustained during a motor vehicle crash.
Background:
Mr Ransley had been employed as a rigger by HighRig Crane Hire in 2008. HighRig Crane Hire is a part of the National Crane Hire group, and is located at Scotts Road, Risdon Vale. Mr Ransley had expressed an interest in becoming a qualified crane driver, and subsequently was provided training by his employer to enable him to gain both a heavy rigid truck driver licence and crane driver ticket. He initially obtained a 20 tonne ticket, which was upgraded to a 60 tonne ticket, and was certified by Peter Martin Industrial Licencing Solutions as a crane driver in November 2008.
Mr Ransley was considered by his employer to be the second most experienced 20 tonne Franna crane operator in the business, in terms of amount of time spent using that particular crane. Mr Ransley primarily drove cranes for jobs contracted to the company at the zinc works, Nystar, in Lutana. The 20 tonne Franna crane had been transported to Tasmania by the company specifically for the work involved in the contract with the zinc works.
Circumstances :
About 7:30am on 4 January 2011, Mr Ransley began work after the Christmas and New Year break. About 9:30 or 10:00am the manager received a call requesting a crane at the ADARDS Nursing Home construction work site on Bounty Street, Warrane. Mr Ransley took the job and drove the 20 tonne Franna articulated crane to the site. Mr Ransley drove from the Scotts Road depot in Risdon Vale, to the worksite in Warrane, where he remained for a couple of hours before returning to the depot.
About 12:30pm on 4 January 2011, Mr Ransley was driving the 20 tonne Franna crane along the East Derwent Highway at Risdon Vale as he was returning from Warrane to the depot. It appears Mr Ransley has lost control of the crane as he proceeded down the hill on his approach to the Risdon Vale roundabout on the East Derwent Highway, causing the vehicle to swerve and then rollover at least three times before coming to rest on the centre verge outside the driveway to the Risdon Prison complex.
As the vehicle rolled, Mr Ransley has been thrown from the cab through the driver’s window, which was at least partially open at the time of the crash, and was crushed when the crane has come to rest on him, causing immediate fatal injuries.
According to legislative requirements the vehicle did comply with seatbelt requirements and was fitted with a lap belt. Unfortunately on this occasion Mr Ransley was not wearing the seatbelt. The cab of the crane is reinforced and built to provide protection from crushing of any occupants, providing they were contained in the cab in the event of a crash. An examination of the cab after the crash revealed the drivers window had been down.
Further investigation conducted on behalf of the Coroner has revealed several witnesses to the manner of Mr Ransley’s driving both to and from the Addards worksite.
According to a witness, Mr Cleeland, who had been travelling behind the crane on it’s journey from the HighRig Crane depot at Risdon Vale, "…as the crane was travelling past the jail it did a sudden maneouvre. It veered quickly to the left and the passenger side tyres connected with the gravel side of the roadway before correcting back onto the roadway. I was still travelling behind the crane at this time, travelling at around 75kph, and did not need to brake to avoid the crane at any point." Further, according to Mr Cleeland, as the crane travelled along the East Derwent Highway towards Warrane, "the crane appeared to be driving fine and was not exceeding the speed limit at any time. I passed the crane as we entered the 100kph zone".
Another witness, Mr Seaberg, described the crane as it travelled in the opposite direction to him on Grass Tree Hill Road near the prison at about 10:00am that day, "…my attenton was drawn to a crane travelling towards me. The crane was wobbling, almost fishtailing, as it came towards me. At first it was in its own lane but as it got within about ten car lengths of my vehicle the crane moved over into my lane and at one point the passenger side of the crane appeared to tilt so much that the tyres left the roadway and then hit back down, it looked as though the crane was going to tip." According to Mr Seaberg, the crane did not appear to be travelling in excess of the speed limit.
A further witness, Ms Chambers, stated she had been travelling home to Lindisfarne from Cambridge Park along the Tasman and East Derwent Highways when she observed a crane travelling in the right lane in front of her vehicle. As both vehicles approached the slip lane from the Tasman Highway to the East Derwent Highway, Ms Chambers saw the crane appear to ‘wobble’ from side to side and move into the left lane and back again to the right lane. As the crane took the slip lane to Lindisfarne, "the crane came dangerously close the the concrete pylon that supports the overpass and nearly drove into the hill side. As the crane came to the give way line that merges onto the East Derwent Highway the crane didn’t even appear to slow as it drove onto the highway and crossed straight to the far left lane." Ms Chambers remained in the right lane to pass the crane, and then moved to the left lane. She stopped for a red light at the intersection with Ronnie Street, Lindisfarne, and was concerned about the crane being able to stop behind her. She moved her car forward and slightly into the intersection to allow the crane more room to stop, and recalls the boom arm of the crane over hanging the top of her car. After the ligths changed to green, Ms Chambers drove off and did not see any further driving of the crane.
Mr Elwell was travelling in his vehicle behind Mr Ransley’s crane vehicle at the time of the crash. Between the vehicles was a flatbed truck, and according to Mr Elwell all three vehicles were travelling at a speed not more than 85 kph as they travelled down the hill towards the Risdon Vale roundabout. As the crane passed the 70kph sign it appeared to swerve left and then right, "like he (the driver) was trying to regain control. When it came back to the right it hit the concrete curb on the right and the crane tipped over and rolled approximately three times down the grass centre divide. I stopped and attempted to assist with first aid but there was nothing I could do as the driver was pinned under the cab…"
According to Mr Craig Ackerly, a friend and workmate of Mr Ransley, as the 20 tonne Franna crane was an articulated vehicle it required a lot of attention when being driven as well as smooth steering control. Mr Ackerly had also often worked with Mr Ransley, and, particularly in the beginning of career with the company, Mr Ransley would often drive whichever crane they were using to and from the job worksite. Mr Ackerly, who has at least 10 years experience as a crane operator, made the following observation in his statement to the Coroner,
"In my opinion and based on what I have been told about the accident I believe that for some reason Shane may have pulled too hard on the steering and it has caused the articulation of the crane to cause the flicking motion, which would have then caused him to try to correct the steering when in fact in an articulated vehicle it is often better to allow the vehicle to steer through the movement rather than attempt to jerk back on the steering to stop the flicking".
The Franna crane was examined in situ by Mr Mark Kramer, a Transport Inspector with the Department of Infrastructure Energy and resources, and further examined at the compound. He noted the crane was in relatively well maintained condition, and although non-compliant due to two worn front suspension radius arm bushes he determined these would not have contributed to the incident. He further noted that inspection of the vehicle revealed the driver seat belt, which was unworn at the time of the crash, "had the male belt portion wrapped under the seat base and covered with grit and grime".
The crash scene was examined soon after the crash by the Officer in Charge of Accident Investigation Services, Eastern and Southern Police Districts, Sergeant Rodney Carrick. Sergeant Carrick noted the top drivers side window to the cabin was down 240mm, and although the glass had been smashed there was fragmented glass still adhering to the side window grooves. In his affidavit Sergeant Carrick made the following comments,
"The speed limit on East Derwent Highway approximately 150 metres south of the crash is 100km/h. It then reduces to 70 km/h. Scene examination did not reveal any evidence from which a speed determination or analysis could be properly made. Evidence from a witness indicates the crane was travelling at a speed under 85km/h as it approached the 70km/h speed restriction sign. Scene examination does not put into dispute the evidence of this witness in relation to speed.
The crane by definition is a heavy vehicle and therefore it has an overall speed restriction of 100km/h. There is certainly no evidence to suggest the crane was traveling at a speed which was in excess of this statutory limit.
The tyre scuff marks on the road clearly indicate there has been the application of a significant left hand steering lock followed immediately by a counter steer (right hand steering lock). There is no evidence of maximum braking. The tyre marks were made by rotating and side slipping tyres. The marks were certainly suggestive of the driver initially loosing control and then attempting to regain control by the counter steer without maximum brake effect.
During the course of the clockwise rotation the crane has struck the curb and median strip on the eastern side of the road. This has caused the crane to flip (trip) and become airborne. The crane has completed three (3) lateral rotations before coming to rest on its drivers side. Having regard to the deceased’s position in relation to the cabin of the crane I believe he was ejected immediately prior to the vehicle coming to rest.
Flips occur when vehicles are moving sideways and the resistance at the tyres is sufficient to cause the vehicle to rise and move through the air. This motion is typically caused by the wheels hitting a curb or furrowing in loose material. That is, a ‘tripping’ of the vehicle occurs with a fairly large horizontal movement through the air.
It was noted the integrity of the crane cabin had not been compromised apart from a crack in the forward windscreen and the breaking of the glass of the top driver’s side window. In my view had the deceased been wearing his seat belt and had his window up the likelihood of being ejected from the vehicle would be greatly reduced."
The cabin of the crane withstood any impact caused by the rollover of the vehicle. The windscreen sustained one crack, and it appears the driver window has smashed as a result of decreased strength due to it being partially wound down at the time of the incident.
An investigation was also conducted by Mr Paul Mackin, an inspector employed by Department of Justice, Division of Workplace Standards Tasmania. As a result of his investigation, Mr Mackin noted the operator’s manual for the Franna Crane AT20, held by HighRig Crane Hire, instructed the operator to "proceed to drive as a normal heavy vehicle" when driving the crane on the open road. He stated that since the incident involving Mr Ransley, National Crane Hire Pty Ltd have imposed a speed limit of 75 kms per hour on all crane operators employed by the company while driving on the open road.
A post-mortem examination was conducted by Forensic Pathologist, Dr Donald Ritchey. He determined the cause of Mr Ransley’s death was blunt trauma of the head sustained during a motor vehicle crash, and would have been near instantaneous.
Toxicology of a post-mortem blood sample revealed the presence of THC and THC-COOH, indicating the use of cannabis by Mr Ransley at some time prior to his death, however due to the breakdown of these chemicals a timeframe of when this use occurred is unable to be determined. There is no indication from witnesses that Mr Ransley appeared under the influence of an illicit drug on the morning of the accident.
Mr Ransley died immediately as a result of the blunt trauma he received following the rollover of the articulated 20 tonne Franna crane he had been driving on the East Derwent Highway, Risdon Vale, on 4 January 2011.
Findings & Comments :
The evidence does not suggest that the crane had any fault or problem which may have contributed to the death of Mr Ransley.
Mr Ransley was a qualified driver of types of cranes that he was driving at the time of his death but had not had any experience of driving cranes of that tonnage on the open road previously, and the evidence of other motorists indicate that he was having difficulty driving that crane prior to the over-turning of that crane.
The overturning of the crane was probably caused by the vehicle travelling too fast in light of Mr Ransley’s lack of previous experience with the crane, and driving at a speed near the imposed speed limit for normal motor traffic. The safe traveling speed for a crane (and indeed any heavy vehicle) is less than that of a normal motor vehicle being driven in the same circumstances. All vehicles should be driven at a speed and manner appropriate to the circumstances. Just because the statutory speed limit is set at a particular speed does not mean that it is safe to drive a vehicle at that speed. This is particularly true for large vehicles which must be driven according to the circumstances.
His impairment may have been affected by the presence of drugs in his system but this is not possible to state categorically.Mr. Ransley failed to wear a seat belt and left the window completely open allowing him to be thrown from the vehicle. If he had not been thrown from the vehicle he was unlikely to have died in the manner he did.
It should be emphasised by trainers and employers of crane drivers that seat belts should be worn at all times on open roads, and that safe traveling speeds for cranes (and indeed any heavy vehicle) is less than that of a normal motor vehicle.
I conclude this matter by conveying my sincere condolences to Mr Ransley’s family.
DATED : Thursday 21 July 2011 at Hobart in Tasmania.