Welcome to SFTY 330

Aircraft Accident Investigation

Ed Shea

B.A. Russian University of Pittsburgh USMC Pilot (UH-1N, AH-1W, C-12)

Quantico, VA (The Basic School) Pensacola, FL (T-34, TH-57, Commercial Pilot) Camp Pendleton, CA (HMLA-267) Okinawa, Japan (HMM-365) 29 Palms, CA (3rd Battalion, 7th Marine Regiment)

Finished MAS

Norfolk, VA (Naval Safety Center)

Ed Shea

Real Estate Sales Dominion Enterprises (Director of Outside Sales for East Coast) Finished MBA Futron Corporation (NASA, DoD, FAA) Certified Safety Professional (CSP) Project Management Professional (PMP) 4th ANGLICO USMC Reserves

Your Background Name / Hometown What is your current position? What do you want to do with degree? What are you expectations?

Class Rules

What to expect of me

Be on time and prepared for class All PPT charts will be posted online by Friday following class All graded documents will be scanned into PDF format emailed to you You will know grading criteria for every assignment I will be available for questions and answer on email within one day

What I expect of you

Be on time and prepared for class if you need to miss a class, you will call me ahead and make up the work NOTE: New GI Bill Rules miss 2 classes I must notify ERAU Assignments will be your original work copying text on the internet is unacceptable You will make all deadlines for assignments 10 points per week will be deducted if not (must still notify me). If no notification, 10 points per day, unless otherwise noted Everyone will start the class with an A, it is your work or lack there of that will determine your grade

Syllabus

Grading

Standard ERAU Criteria

90 100 PTS 80 89 PTS 70 79 PTS 60 69 PTS Below 60 PTS

A (Superior) 90-100 % B (Above Average) 80-89 % C (Average) 70-79 % D (Below Average) 60-69 % F (Failure) 59 and below%

Class Participation 10%

Your participation is particularly important in this course, since each class constitutes a significant percentage of the total course. All absences, regardless of reason, require a make-up assignment, mutually arranged between the instructor and the student. If an absence is anticipated, the student should notify the instructor, preferably in advance. The students grade will be based on quality of input to class discussion.

Case Analysis 10%

Sign up next week one per student Look at accidents in text Provide summary of the accident and findings and Additionally, one important accident related topic (technology, physiology, etc.) Presented Weeks 4-7 as assigned.

If you sign up for the week, you need to present on that week in class.

Midterm 15%

Week 5 Open book, notes, PPTs

Paper Presentation 20%

Week 8 (8) Week 9 (Remainder) Content over style Presentation Criteria

Final Paper 25%

Due Week 8 Late is 0. Content over style This is a technical paper be careful to avoid plagiarism. Compiling articles with no analysis and your thoughts, whether cited or not is unacceptable! If you have any questions, please ask! Refer to rubric

Final Exam 20%

Week 9 In class Covers everything after Midterm Mix of fill-in, multiple choice, T/F

Plagiarism

Plagiarism: Presenting as ones own the ideas, words, or products of another. Plagiarism includes use of any source to complete academic assignments without proper acknowledgement of the source. Cite everything?

Important Dates

Week 2 Select accident for Case Analysis Weeks 4-7 Case Analysis Presentations Week 5 Midterm Week 8 Paper Due Week 8 - Presentation of papers (12) Week 9 Presentation of papers (remainder) Week 9 Final (in class)

Questions?

Chapter 1
Intro to Aircraft Accident Investigation

From 1903

To

2012

From Here

To HereIn 50 Years

Definitions

Aircraft accident

Some degree of damage or injury associated with the operation of an aircraft (different for military and government aircraft)

ICAO (International Civil Aviation Organization)

Intention of flight AND

A person is fatally or seriously injured as a result of

Being in the aircraft, direct contact with any part of the aircraft, or direct exposure to jet blast

Definitions

ICAO Accident - continued

Except:
Injures are from natural causes Self inflicted or inflicted by others on aircraft Stowaways Engine failure or damage, when limited to the engine or engine areas (accessories, cowlings, etc.)

Definitions

ICAO - Serious Injury

Hospitalization of 48 hours or more (starting within 7 days of incident) Results in any fracture of a bone Lacerations which cause severe hemorrhage Injury to any internal organs Second or third degree burns Verified exposure to infectious substances or injurious radiation

Definitions

US Substantial Damage

Damage or failure which adversely affects the structural strength, performance, or flight characteristics of the aircraft and which would normally require major repair or replacement of the affected component Developed by Department of Labor under Occupational Safety and Health Administration (OSHA) Act

US Military

Definitions

US Civil Aircraft
Aircraft other than public aircraft Commercial Airlines and General aviation (GA)

US Public Aircraft

Whether aircraft was involved in governmental functions national defense, intelligence, search and rescue, law enforcement, etc.

According to its charter, National Transportation Safety Board (NTSB) only investigates Civil Aircraft Accidents

Findings, Causes, and Recommendations

Findings
Not defined by ICAO International Society of Air Safety Investigators

All significant conditions and events, causal and noncausal, found in the investigation.

Turn to Figure 1-1

Findings, Causes, and Recommendations

Causes
Investigation bodies are charged with determining cause(s) of the accident ICAO definition

Actions, omissions, events, conditions, or a combinations thereof, which led to the accident or incident.

Findings, Causes, and Recommendations

Types of Causes

Descriptive
What happened The sequence of conditions and events which, singly or in combination, led to the accident; listed in chronological order

Explanatory
Why the accident happened Predisposing events and conditions which explain why the descriptive causes existed or occurred. Form the basis for recommendations

Findings, Causes, and Recommendations

General conclusions about causes

No such thing as a single cause aircraft accident All causes should be identified and listed chronologically (no priority) Arguments about whether a particular finding is or is not a cause are generally a waste of time.

Findings, Causes, and Recommendations

Recommendations
Most important aspect of the investigation Do something to prevent the accident from happening again and correct deficiencies identified in the process

Some issues
Investigators may not be best group to decide what is to be done (economic tradeoffs) Recommendations become permanent part of accident, regardless if not correct or exact

Findings, Causes, and Recommendations

Recommendations - continued

Keys to good ones

Remember they are suggestions on how to correct the issue if there is a better way to get there go! Non specific to method and specific to objective (eliminate the possibility for rudder jam situations vs reengineer the shear bolt so rudder jam situations are eliminated). Have a technical review prior to report being released

Key Personnel / Organizations in the Investigation

ICAO ground rules Investigator-In-Charge (IIC) person / group responsible for investigation NTSB Investigates all civil aircraft accidents in US Federal Aviation Administration (FAA) agency responsible for safety; will assist NTSB Local Law Enforcement usually have jurisdiction and will be present

Key Personnel / Organizations in the Investigation

Local Fire Department in charge while people are still being rescued or fire is still burning Coroners and Medical Examiners authority over any human remains (identification, determining cause of death, issuing death certificates) Military complete jurisdiction over accidents involving military aircraft or on military property

Key Personnel / Organizations in the Investigation

Insurance Carriers owner of the wreckage (after NTSB is complete with it) Property Owner retains all rights to damages Aircraft Owner / Operator Until transferred to insurance company, they own the wreckage OSHA if injury is workplace-related (aircraft collides with vehicle) may fall under their jurisdiction

Key Personnel / Organizations in the Investigation

Environmental Protection Agency (EPA) will get involved if damage to environment Federal Bureau of Investigation (FBI) will get involved if sabotage to aircraft, hijacking, bomb threats, or criminal acts involving commercial aircraft US Customs Service will get involved if smuggling is suspected or if flight originated outside US News Media ALWAYS!

End of Chapter 1