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A Small Point about the NTSB and Investigations

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    Regarding Boeings New Generation Take on Old (Persistent?) Problems. Maybe. Maybe not.

    George’s Point of View

    The 787: Dreamliner test flight suffered from extensive smoke, fire and structural damage originating in the P100′ electrical panel, a key component that distributes power from the left generator to power vital systems

    The 777: United electrical panel set the nearby insulation blankets on fire. This was initially reported as smoke. Thus no reason for the FAA to go there. And the full narrative said only “electrical fire” but did not elucidate beyond “electrical fire” to explain the electrical panel set the nearby insulation blankets on fire.

    The AAIB conclusions 4,5, and 6, were:

    • “The RGCB and Right Bus Tie Breaker (RBTB) suffered from severe internal arcing and short circuits which generated temperatures in excess of 1,000°C, and resulted in uncontained failures. The RGCB was probably the first to fail.”
    • “ Molten copper and silver droplets from the failed contactors dropped down through the open base of the P200 panel and ignited the insulation blankets below.”
    • “The insulation blanket fire spread underneath a floor panel to the opposite P205 power panel, causing heat and fire damage to structure, cooling ducts and wiring.”

    The three requirements for a fire: oxygen, ignition source and fuel.

    From 2000 to 2008, over 22 ADs are directed at insulation blankets that burn. Before that, from 1988 to 2010, 8 FAA Tech Center reports and 2 FAA Safety Conference Papers are directed at electrical induced fires or the insulation blankets that give fuel to the fire.

    When was the latest AD ?
    2008-23-09. REMOVE PET (AN-26). Boeing Model 727-200s, 737-200s, 737-300s, and 737-400, 747s, 757s, 767s Series Airplanes.from the fuselage. Such insulation blankets could ignite and propagate a fire that is the result of electrical arcing or sparking.
    DATES; Issued Oct 24, 2008 -effective Dec 15, 2008 – Comply by
    2014. If you read the AD, you can note that the compliance date is actually set beyond the affected planes anticipated passenger service-life. Compliance is put off until the planes will likely be converted from passenger to cargo.

    2002 FAA ASTRAC Conference Conclusions

    • In-flight Fires In Hidden Areas are a risk to aviation safety.
    • Most hidden fires are caused by electrical problems.
    • Non-compliance with Safety Regulations have been uncovered.
    • Fire Safety Problems and Improvements are in various stages of correction and study.
    • It is impossible to predict the relative risk of serious fires occurring in Hidden Areas or Locations.

    Without being too critical or belaboring the obvious, I do have to say that the 2002 conclusions are overly obvious and simplistic. These same points will probably be as true in 2002 and 2011 as in 3011. Point by point? Consider this:

    • In-flight fires are a risk to safety, whether they’re hidden or not. Certainly if one doesn’t know where they are, they have more time to be destructive before they are found. And as for being predictable-there probably is a random statistical probability that can come pretty close; but translating theory back to real life situations perfectly only happens on tv.
    • Electrical problems are certainly a broad umbrella-one might even say the current problems with rogue batteries to be a form of electrical problem.
    • Non compliance regarding safety is hardly an issue when a plane is in the testing phase; in fact, that is when the manufacturer is are troubleshooting to get rid of potential safety issues. The 777 electrical panel issue may or may not have a common cause; and if it does have a common cause, then, isn’t that splendid for Boeing? The detective job (i.e. finding the cause) is half of the problem already solved. What luck! But in real life, are the causes that easy to find? And in practice, how many times are non-compliance with Safety Regulations due to poor operator maintenance versus to unsafe parts?
    • Fire Safety Improvements are an ongoing process. It’s the nature of the beast.

    So here is the problem as it should possibly be stated:

    -We need compliance now because people are on these planes now, not at some random future date. Pushing back solutions puts more people are at risk. We need feasible compliance that doesn’t put good companies out of business but still maintains the highest possible safety standards NOT the lowest possible cost. Putting off compliance over a combustible insulation blanket until 2014? Really? How is this safe?

    -The lowest common denominator should not be lowest possible cost-to-the- industry. It should be the highest possible safety for the passenger. These things are not always mutually exclusive.

    -If the root problem is less than ideal materials used across many manufacturer and model applications, then quit pussyfooting around.
    If the boy is going to cry wolf, let it be for a real wolf. If the wolf is real, then act. If inadequate materials, composites, etc are the problem, then don’t point the finger and do nothing. Questionable materials have no place in an industry that lives under guidelines advocating and promoting safety over all.

    Like Yoda said, “Do or do not. There is no try.”

    Raise the standards.

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    Safety First: Aviation Lessons Learned

    We at Air Flight Disaster are always trying to learn from our mistakes, and your mistakes and everyone’s mistakes. Which is why we would applaud the following Helicopter Expo event “Lessons Learned from Helicopter Accident Investigations” even if Air Safety wasn’t our business.

    Pilots and interested parties wanting to learn lessons from recent helicopter accidents should pay attention to the following event:

    2014 HAI Rotor Safety Challenge

    Event: Lessons Learned from Helicopter Accident Investigations

    Date/Time: Monday, February 24, 8:00 am to 12:00 p.m. (PST)

    Location: Anaheim Convention Center (Ballroom C, Level 3), 800 W Katella Ave, Anaheim, CA 92802

    Participants: Vice Chairman Christopher Hart and NTSB senior air safety investigators

    Senior investigators from the National Transportation Safety Board will hold a training session about the lessons that have been learned from several recent helicopter accident investigations at the 2014 Helicopter Association International’s Heli-Expo in Anaheim, Calif., next week.
    Investigators will present case studies that emphasize NTSB safety recommendations related to helicopter maintenance, flight simulators, and flight recorders. The case studies will be followed by industry-led panel discussions on best practices in the industry. NTSB Vice Chairman Christopher Hart will provide opening remarks for the session.

    The preliminary schedule is posted below:

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    NTSB To Meet over Jackson Hole Airport Incident

    WASHINGTON, D.C. – The National Transportation Safety Board (NTSB) will hold a meeting to determine the probable cause and consider safety recommendations for a highway collision and an aviation incident.
    The first item the Board will discuss will be the March 12, 2011, crash in New York City of a World Wide Tours-operated motorcoach. Fifteen passengers died in the collision.
    The second item is a December 29, 2010, incident in which an American Airlines B-757 ran off the departure end of the runway into deep snow after landing at Wyoming’s Jackson Hole Airport. None of the 185 passengers and crew onboard were injured; the aircraft sustained minor damage.
    Event: Board Meeting
    Date/Time: Tuesday, June 5, 9:30 a.m. (ET)
    Location: NTSB Board Room and Conference Center, 429 L’Enfant Plaza SW, Washington, DC
    Participants: NTSB Board Members

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    Stolen Cessna Smashed up in Fresno

    What: Cessna 172N Skyhawk en route from Buchannan Field Airport
    Where: Fresno California
    When: Feb 5 2012
    Who: 1 fatality
    Why: Apparently Ray Pirro who was not a pilot snuck into Buchanan Field and stole the Cessna Skyhawk that took his life. Pirro had no pilots license, was covered in tattoos, was recently released from prison, and apparently just took the plane to take a joy ride. He flew into power lines and smashed up by Barstow Avenue. Owner Felix J Boston is a retired lieutenant colonel. He had left the plane in Buchanan Field Airport and was surprised to find someone had taken it. He called the plane “his baby” and regrets its loss.

    The thief had covered the plane’s registration numbers and stopped off at a Stockton Walmart for junk food. (The crash site was strewn with Cheese whiz.) There was still gas in the plane, so it did not run out of gas, but striking the power lines may have been Pirro’s downfall.


    IDENTIFICATION
    Regis#: 7582D Make/Model: C172 Description: 172, P172, R172, Skyhawk, Hawk XP, Cutla
    Date: 02/06/2012 Time: 0006
    Event Type: Accident Highest Injury: Fatal Mid Air: N Missing: N
    Damage: Substantial
    LOCATION
    City: FRESNO State: CA Country: US
    DESCRIPTION
    AIRCRAFT STRUCK POWERLINES AND CRASHED INTO A FIELD, THE 1 PERSON ON BOARD
    WAS FATALLY INJURED, 12 MILES FROM FRESNO, CA
    INJURY DATA Total Fatal: 1
    # Crew: 1 Fat: 1 Ser: 0 Min: 0 Unk:
    # Pass: 0 Fat: 0 Ser: 0 Min: 0 Unk:
    # Grnd: Fat: 0 Ser: 0 Min: 0 Unk:
    OTHER DATA
    Activity: Unknown Phase: Unknown Operation: OTHER
    FAA FSDO: FRESNO, CA (WP17) Entry date: 02/06/2012

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  • Safe But Not Safe Enough: Helicopter Crash Reduction

    International Helicopter Safety Team is a task force composed of American and European government agencies–an international safety team–forecasts to reduce the rate of helicopter crashes 80 percent within eight years, no doubt a good idea as helicopters crash three times more frequently than commercial airliners

    Seventy percent of helicopter crashes are determined to be the result of human error (training, overwork or poor design)

    Partial list of Fatal crashes in 2008
    Date ——– Location ——– Craft ——–#

    12/27/2008 Honiara, PO HUGHES 369 N104BN Fatal(1)
    12/11/2008 Sabine Pass, TX BELL 206 N180AL Fatal(5)
    11/16/2008 Lingen, Germany Rotorway PH-NTL Fatal(1)
    11/16/2008 Quitman, AR BELL OH-58C N153GF Fatal(1)
    11/2/2008 Gallatin, TN Robinson R-44 N300FX Fatal(1)
    10/16/2008 Dryden, NY Robinson R22 N943MH Fatal(1)
    10/15/2008 Aurora, IL BELL 222 N992AA Fatal(4)
    10/13/2008 Conroe, TX BELL 206 N6ZV Fatal(2)
    10/13/2008 Sedona, AZ BELL 407 N42AZ Fatal(1)
    9/27/2008 Forestville, MD AEROSPATIALE AS365 N92MD Fatal(4) 0
    9/21/2008 Kenosha, WI Robinson R44 II N999ZD Fatal(2)
    9/6/2008 Muzino Village, Russia Robinson R-44 RA-04180 Fatal(2)
    9/3/2008 Persian Gulf, United Arab Emirates Bell 212 A6-AVL Fatal(7)
    8/31/2008 Greensburg, IN Bell 206L-1 N37AE Fatal(3)
    8/29/2008 Ridgedale, MO Robinson R44 II N41411 Fatal(2)
    8/17/2008 Olalla, WA Robinson R-22 N301MA Fatal(1)
    8/6/2008 Alice Arm, Canada Hughes 369D C-GZIO Fatal(3)
    8/5/2008 Weaverville, CA Sikorsky S-61N N612AZ Fatal(9)
    7/19/2008 Price, UT Hughes 369D N400BE Fatal(3)
    7/15/2008 Salesville, AR Hughes 269B N469E Fatal(2)
    7/4/2008 Sunol, CA Schweizer 269 C-1 N2011A Fatal(2)
    6/29/2008 Flagstaff, AZ Bell 407 N407GA Fatal(7)
    6/29/2008 Flagstaff, AZ Bell 407 N407MJ Fatal(7)
    6/8/2008 Huntsville, TX Bell 407 N416PH Fatal(4)
    5/29/2008 Panama City, Panama Bell UH-1N SAN-100 Fatal(11)
    5/25/2008 Sunrise Beach, MO McDonnell Douglas 500-E N686F Fatal(1)
    5/24/2008 Avalon, CA Aerospatiale AS-350-D N67GE Fatal(3)
    5/16/2008 Comstock, MI Fairchild Hiller FH-1100 N5049F Fatal(1)
    5/10/2008 La Crosse, WI Eurocopter Deutschland EC 135 T2+ N135UW Fatal(3)
    5/9/2008 Muanda, Congo Bell 206 L-1 N5014V Fatal(1)
    4/30/2008 Paraty, Brazil Agusta/Westland A109S PR-IPO Fatal(2)
    4/28/2008 Bartlett, TX Robinson R44 N477SH Fatal(1)
    4/15/2008 Chickaloon, AK Eurocopter France AS350B2 N213EH Fatal(4)
    3/13/2008 Wilmington, NC Robinson R22 Beta II N2215R Fatal(1)
    3/11/2008 Santa Cruz, Peru Bell 412EP N417EV Fatal(10)
    3/2/2008 Nizhnevartovsk, Russia Robinson R-44 II RA-04223 Fatal(2)
    2/13/2008 Gascoyne Junc, Australia Robinson R44 VH-ZDP Fatal(2)
    2/8/2008 Totes Gebirge, Austria Bell 206B OE-XRH Fatal(2)
    2/5/2008 S. Padre Island, TX Eurocopter France AS350B2 N911VA Fatal(3)
    1/25/2008 Los Angeles, CA Robinson R22 N705JJ Fatal(1)
    1/22/2008 Ochopee, FL Robinson R44 N18HB Fatal(2)
    1/11/2008 Puebla, Mexico Bell 412HP XC-JCD Fatal(8)
    1/7/2008 Zuzenhausen, Germany Bell 206B D-HJET Fatal(1)

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    Former MD, NTSB Criticizes Malaysia’s Handling of Airplane Disappearance Crisis

    According to Peter Goelz ,former managing director of the United States National Transportation Safety Board (NTSB), Malaysia has not abided by the protocols of the Convention on International Air Transportation, in handling the Malaysia Airlines’ (MAS) MH370 disappearance crisis.

    In a recent interview, he regarded Malaysia’s conduct in this case as ‘the worst he has ever seen’.

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