Sunday, February 8, 2015

The National Transportation Safety Board’s Most Wanted List: Improving Safety in Aviation

The National Transportation Safety Board’s Most Wanted List: Improving Safety in Aviation
            It is safer to fly today than at any other point in history.  A great deal of the increase in safety is a result of changing the ideology surrounding aviation safety. In a broad sense, the aviation industry has gone from a reactive approach to accidents that looks to single out lone causes, and transitioned into a culture that is proactive that analyzes the entire system in order to prevent future accidents.
            The National Transportation Safety Board (NTSB), in keeping with the proactive approach to preventing accidents, has created a most wanted list that singles out problematic areas in different modes of transportation. The link to this list is: http://www.ntsb.gov/safety/mwl/Pages/default.aspx. The two areas that I will be focusing on are “Prevent Loss of Control In Flight In General Aviation and Strengthen Procedural Compliance” (NTSB).
            There is indeed a problem with the loss of control in flight in general aviation, the first issue I will touch on. In fact, according to a fact sheet released by the Federal Aviation Administration (FAA), loss of control in flight was found to be the number one cause of fatal accidents in general aviation between the years 2001 and 2011 (FAA, para. 32). This statistic is even more unsettling considering that the rates of fatal accidents over the last decade in general aviation, “have remained relatively static” (FAA, para. 31).
            In my opinion the leading factor in these accidents is a lack of proficiency due to either a lack of, or improper, training. Because of the recent economic downturn less pilots are taking to the skies. This has also led to a lack of pilot proficiency resulting from the lack of flight time that pilots are registering. More and more pilots have found it difficult to keep up with rising costs in fuel and parts, consequently keeping them out of the cockpit. In the NTSB report on loss of control in general aviation it was pointed out that, “GA pilot proficiency requirements are much less rigorous than those of airline pilots. GA pilots are much more likely to have longer intervals between training sessions and longer intervals between flights” (para. 3).
            Further complicating matters is poor initial training methods. Rich Stowell, the first to be designated a Master Aerobatic Instructor, had this to say about training for loss of control in flights:
Take the typical stall training conducted to satisfy the FAA's Practical Test Standards, for instance. The emphasis is placed on detailed procedures used to configure for, perform and exit a couple of specific types of stalls. Treated as an independent maneuver unto itself, the whole ordeal is often enveloped in unnecessary melodrama as well. The actual lessons learned, however, are fear and a false association between the stall and slow airspeed.
Consequently, the student granted private pilot privileges might then adopt what seems to be a perfectly reasonable strategy: fly a little faster to have greater margin against those scary stalls. More instances of flat-spotted or blown tires and burned-up brakes result during landing, as do cases where airplanes overrun seemingly short runways. Yet the blame is pinned on the educationally deprived pilot's improper airspeed control and poor judgment. And rather than dealing with the underlying problem, some flight schools simply prohibit pilots from taking their high-performance rental airplanes to airports with runways shorter than 5000 feet (para. 7-8).
            The recommendations that the NTSB has put forth to combat this issue call for pilots to increase their individual efforts to stay proficient, know the limitations of their aircraft, and maintain training. These recommendations are common sense initiatives that every pilot should be doing on their own. The NTSB fails to attack the root causes of the issue, focusing on the pilot instead of looking at the systemic problems, i.e. improper initial training. Based on the research I have conducted I believe the NTSB needs to perform a broad review of training techniques and, based on their results, implement a nationwide program that seeks to correct improper training techniques. Additionally, The FAA should require higher standards of performance from general aviation pilots by revising the current testing standards pilots must pass in order to retain their certification.
            Of greater risk to the public is the issue of procedural non-compliance among commercial aviation. A study done by Boeing from 1982-1991 found that, “claimed that flight crew adherence to procedures could have prevented more than 50 percent of the 232 fatal hull losses” (Aviation Today, para. 5). Keep in mind that this number does not take into consideration nonfatal accidents.
            The cause of these breakdown in procedures is psychological, and differs from system to system. In an article done by Aviation Today, several theories are given as to why people break procedures:
Actually, there are a number of psychological factors hard-wired into humans that can predispose employees to PiNC. The Modified Situation Control Theory 7 indicates that given a reasonable benefit and reasonable chance that no one may detect the violation and the violator would not suffer adversely from their peer group — there is a far greater than even chance the person would violate. The debatable Risk Homeostasis Theory 8 as well as established social psychological thinking indicates that people are natural risk optimizers and generally tend to overestimate their abilities and to underestimate levels of risk (para. 21).
Although the cause of the non-compliance of procedures is situationally dependent and due to varying psychological factors, there is a way to prevent breakdowns in procedure.
            The NTSB has called for an increase in training for abnormal situations, along with the revision and exclusion of several standing procedures. The proposed changes by the NTSB would most assuredly have a positive impact on the industry as a whole, however I would take it a step further. Organizations within the aviation industry need to constantly review and revise procedures in order to eliminate unnecessary steps and add new ones which could lead to higher safety levels. In order to establish such an evolving system managers will need to be provided with continuous feedback from employees about where they see issues with procedural non-compliance, as well as how the employees feel the procedures can be improved. This is a proactive approach that can be used to enhance systems safety in any organization.
            In summary, the most wanted list put forth by the NTSB takes a positive proactive step towards increasing safety in general and commercial aviation. With that being said, the NTSB does not dig deep enough into the root causes of the issues they have focused upon. If there are changes to be made they must be on an industry level, accomplished through training and education of safe practices. Stephen Pope of Flying Mag gives us the bottom line saying, “U.S. airline operations were fatality free in 2011 and 2012, while on-demand Part 135 operations showed safety improvements across the board. That left general aviation as the lone segment where initiatives aimed at improving safety appear to be having little effect.”




Bibliography
Aviation Today. (2007, February 1). Aftermarket: Why good employees violate procedures — Is it inevitable. Retrieved February 8, 2015, from http://www.aviationtoday.com/am/categories/maintenance/Aftermarket-Why-Good-Employees-Violate-Procedures-Is-it-Inevitable_8188.html#.VNe8Y53F8TU
Federal Aviation Administration. (2014, July 30). Fact sheet – General aviation safety. Retrieved February 8, 2015, from http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=16774
National Transportation Safety Board. (2015). Strengthen procedural compliance. Retrieved February 8, 2015, from http://www.ntsb.gov/safety/mwl/Pages/mwl10_2015.aspx
National Transportation Safety Board. (2015). Prevent loss of control in flight in general aviation. Retrieved February 8, 2015, from http://www.ntsb.gov/safety/mwl/Pages/mwl7_2015.aspx
Pope, S. (2013, August 8). Why can't general aviation move the safety needle? Retrieved February 8, 2015, from http://www.flyingmag.com/technique/accidents/why-cant-general-aviation-move-safety-needle

Stowell, R. (n.d.). The problem with flight training. Retrieved February 8, 2015, from http://www.aviationsafetymagazine.com/airplane/Flight-Training-Mistakes.html

6 comments:

  1. You raise some good points. In each situation it is the pure mental state of each person that matters the most. If we could find a way to keep each and every pilot completely focused, we could end almost every human error made in the air.

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  2. That seems to be the challenge Anas. As I said in my blog I truly believe it is about developing a system that is continually evolving and learning in order to adapt and prevent accidents. The commercial industry in the United States has greatly improved in safety, but for some reason the GA industry has not been able to figure it out.

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  3. Joe, I recently took a look at the following link: (http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=16774) which outlines what the FAA plans to do in order to improve GA safety. It just so turns out that this link was also in your bibliography. The FAA brings up several examples of adding the Angle of Attack Indicators into aircraft, as well working with aircraft manufacturers designing stall resistance into air frames. Among these technological advancements, trained pilots STILL must consciously make the effort and use aeronautical decision making skills in any flight; whether it is commercial aviation or GA.

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    1. Yes, even as airplanes get safer and safer, that does not mean that training should get easier and that pilots can afford to become more complacent. As newer automation is added into aircraft cockpits it is important that pilots are not relying on it to heavily and also staying situationally aware by monitoring an cross checking information.

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    2. Both of your replies are well received. Shane and Tyler, like I mentioned in class my worry is that the addition of new technology may, as Shane mentioned as well, cause pilots to become over complacent.

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  4. I agree with you wholeheartedly that the NTSB is only looking at the symptoms of these types of accidents and not the root causes. It is akin to what the FAA did a few decades ago when most crashes were chalked up to pilot error and not the underlying factors such as fatigue or company culture. The CFI you quoted had a great point about how pilots are trained to fear stalls that only occur in a predicted way as opposed to scenario based training.

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