Inquest Into Sea Cadet's Death off Gosport
A jury's returned a verdict of death by misadventure at the inquest of a 14-year-old Sea Cadet who fell from the rigging of a training ship after he unclipped his harness to go to the assistance of a colleague.
Jonathan Martin, of Shadoxhurst, Ashford, Kent, fell from the sailing vessel TS Royalist in Stokes Bay, off Gosport on May 2, 2010.
He was recovered by the ship's seaboat and taken by helicopter to Queen Alexandra Hospital, Portsmouth, where he was pronounced dead.
Portsmouth deputy coroner Robert Stone said: ''There is some talk of the young cadets feeling responsible for what happened, while I understand their feelings, they cannot be held in any way responsible.''
Jonathan was one of 19 Sea Cadets on board Royalist, which had been taking part in celebrations to mark the 150th anniversary of the movement just hours before.
The inquest at Portsmouth heard that the ship had anchored at Stokes Bay at about 8pm and Jonathan and a number of cadets had volunteered to go up the mast to bring the sails in.
Jonathan, who had been a cadet for at least two years and who was described as ''very confident'' working at heights, had first of all brought in the port-side topsail.
But he then went down to the fore course yard, the lowest of the yards, when he realised that a female cadet at the end was having difficulties.
Detective Sergeant Nigel Lee, who investigated the death for Hampshire police, said that Jonathan had unclipped his harness from the line to first go round a cadet close to the mast and then again to pass a female cadet to reach the furthest girl who was having problems.
It was at this point that Jonathan lost his footing and fell to the deck and then into the sea.
The other cadets were said to be ''hysterical'' as they witnessed his fall, the inquest heard.
Jonathan's father, Andrew Martin, described his son as being ''very confident'' having previously been on several Sea Cadet voyages including once before on the Royalist.
He described how he had discussed safety with his son when he had shown him photos of the ship.
Mr Martin said: ''I said that looked a bit dangerous, he said 'Don't worry, we are all clipped on with our harnesses'.''
Describing his son, he added: ''He was a very out-going boy, sporty, he played for the school rugby team and all other types of sport at school.''
The inquest heard that the correct procedure advised to the cadets for helping someone is for the other cadets to come to a platform on the mast and then for the helper to go out.
This prevented the need for the helper to unclip themselves from the safety line to go round someone.
Howard Flegg, marine accident investigator for the Marine Accident Investigation Branch (MAIB), said: ''He fell to the deck because he unclipped his belt harness contrary to his training and onboard procedures for work at that position.''
He said that the MAIB had recommended that the Marine Society & Sea Cadets (MSSC) charity which operates the Royalist use full body harnesses with two lanyard rather than the single-lanyard belt in use at the time as well as to increase supervision of the cadets.
The inquest heard that the MSSC had adopted these new procedures.
The coroner said: ''In my opinion the actions of the MAIB and MSSC as a result of the accident mean that there is no-one to whom we need to report.
''Steps have been taken to make right something which had gone wrong.
''Whatever safety procedures are in place, accidents can happen.''
Mr Martin said: ''I would like to say thank you to everyone on board who tried to help Jonathan.
''I know it was very traumatic for all those involved.
''I would also like to say what an excellent organisation the Sea Cadets is, I think it's a great tradition.
''I am also pleased to see the matters the MAIB report highlighted have hopefully been acted upon in particular the use of the double harness which are now used and the adult supervision.''
Jonathan's family said in a statement released after his death: ''Jonathan was a wonderful son and grandson who tragically died whilst doing something that he loved.
''He was a popular young man who will be greatly missed by all who knew him.''
The 2010 Sea Cadet Festival, which was held over the weekend when Jonathan died, saw the youngsters put on displays and demonstrations at Gunwharf Quays in Portsmouth harbour while a marching band paraded through the marina.
During the celebrations, cadets climbed the rigging of TS Royalist for a formal salute and dressed the ship with flags and bunting.
The accident was the first death the ship had experienced since it was commissioned in 1971.
The ship is the Sea Cadets' flagship training vessel and has taken 30,000 cadets to sea with the capacity to take up to 24 at a time.
It has a permanent crew of six, plus up to three additional staff.
The voluntary youth organisation is open to young people aged 12 to 18 but members must be at least 13 and a half to go to sea.
The Sea Cadets have 14,000 members at 400 units around the UK.
Martin Coles, CEO of MSSC, said after the inquest:
"Jonathan's loss continues to be felt deeply by the charity and our sympathy remains with his parents.
''The safety of our staff, volunteers and cadets is paramount to the charity as demonstrated by 30,000 cadets having sailed on TS Royalist over the last 39 years without similar incident.
''We help young people develop valuable life skills through a range of adventurous activities, including on board TS Royalist, and focus on continual improvement in safety.
''A thorough review of our fleet safety management system started before the incident and we have incorporated actions arising from this into a full implementation of the recommendations of the MAIB's report.
''We have been supported in this by external experts and the Royal Navy.''