De: Curt Lewis & Associates, LLC de la part de Curt Lewis & Associates, LLC Envoyé: lundi 4 mars 2013 13:43 À: fgae@club-internet.fr Objet: Flight Safety Information [March 4, 2013] [No. 048] Flight Safety Information Flight Safety Information March 4, 2013 - No. 048 In This Issue ASIA-PACIFIC SAFETY RECORD SLIPS Qantas Flight Cabin Temp Soars, Forced to Land Two planes emergency landings at Dutch airport Finally, PH passes aviation safety audit (Philippines) 4 Die in Small Plane Crash in Northern New Mexico Sacramento Woman Arrested For Assaulting JetBlue Flight Attendant PROS IOSA Audit Experts China's first jumbo jet to debut in 2014 Review: Air Safety Lessons Could Save Lives in Hospitals Airbus Military's A400M aircraft is poised to take off FSI on TWITTER CL&A Expert Services ASIA-PACIFIC SAFETY RECORD SLIPS; Airline accident rate lowest in 2012, says IATA The IATA says runway excursions, in which an aircraft, such as the one in photo, careens off a runway during landing or takeoff, were the most common type of accident in 2012, accounting for 28 percent of total accidents. MONTREAL -- The global accident rate for Western-built jets in 2012 was the lowest in aviation history at 0.20, the equivalent of one accident every 5 million flights, with the Asia Pacific's safety performance suffering a decline, according to a report by the International Air Transport Association (IATA). The global accident rate, measured in hull losses per million flights of Western-built jets, was a 46 percent improvement over 2011, when the accident rate was 0.37, or one accident for every 2.7 million flights, IATA said. The report shows that by region, the Asia Pacific's safety performance fell to 0.48 in 2012 from 0.25 in 2011, second only to Africa, which worsened to 3.71 from 3.27. Europe was in third place, declining from 0.0 to 0.15. Runway excursions, in which an aircraft careens off a runway during landing or takeoff, were the most common type of accident in 2012, accounting for 28 percent of total accidents, the IATA said. Most or 82 percent of runway excursions occur after a stable approach where the aircraft floated beyond the normal touchdown point, or braking devices did not activate in a timely manner, or because directional control was not maintained after landing. This type of accident continues to present challenges for the industry, the IATA said. IATA's 240-plus member airlines recorded no Western-built jet hull losses in 2012, the association said. "The industry's 2012 record safety performance was the best in history. Each day approximately 100,000 flights arrive safely at their destination," said Tony Tyler, director general and CEO of IATA. Tyler credited the "dedication and cooperation" of airlines, airports, air navigation service providers, manufacturers and safety regulators for working together to ensure that every flight "is as safe as possible". "Nevertheless, there is still work to do. Every accident is one too many and each fatality is a human tragedy," Tyler said. He said since the first commercial flight took off on January 1, 1914, the airline industry has made continuous improvements in safety its top priority, he said. The IATA highlighted the following industry data: Close to 3 billion people flew safely on 37.5 million flights (29.8 million by jet, 7.7 million by turboprop) 75 accidents (all aircraft types, Eastern and Western-built), down from 92 in 2011 15 fatal accidents (all aircraft types) versus 22 in 2011 6 hull loss accidents involving Western-built jets compared with 11 in 2011 3 fatal hull loss accidents involving Western-built jets, down from 5 in 2011 414 fatalities compared with 486 in 2011 Fatality rate slightly increased to 0.08 per million passengers from 0.07 in 2011 based on Western-built jet operations IATA member airlines bested the industry average, keeping down accidents of all aircraft types to 0.71 accident per million flights compared with 2.01 for the whole industry, or 13 of the 75 accidents. The IATA said airlines on its Operational Safety Audit Registry (IOSA) experienced no Western-built jet hull loss accidents. The total accident rate (all aircraft types) for IOSA registered carriers was 4.3 times better than the rate for non-IOSA carriers (0.96 vs. 4.11). Today, 381 airlines are on the IOSA registry (www.iata.org/registry). For IATA's 240- plus airlines, registering with the IOSA is a requirement for membership in the association. That some 140 non-member airlines are on the registry clear indicates that IOSA has become the global benchmark for airline operational safety management, the IATA said. "IOSA once again demonstrated its positive impact on aviation safety. Carriers on the IOSA registry recorded an accident rate that was more than four times better than their non-registered counterparts. Not only did IOSA-registered carriers have a lower accident rate but the accidents were less severe in terms of fatalities and damage to aircraft," said Tyler. http://www.malaya.com.ph/index.php/business/shipping-and-transportation/25502- asia-pacific-safety-record-slips-airline-accident-rate-lowest-in-2012-says-iata Back to Top Qantas Flight Cabin Temp Soars, Forced to Land MELBOURNE: At least 50 passengers and crew were treated for heat stress when a domestic flight of the Australian carrier Qantas made an emergency landing at the Sydney Airport after its undercarriage overheated. QantasLink QF2260, was travelling from Sydney to Lord Howe Island, when it was forced to return to Sydney "due to a technical issue with the air-conditioning system", a spokeswoman for the airline told a local newspaper. The plane landed at 1.47pm local time and ambulance crews assessed about 50 passengers for dehydration. A New South Wales Ambulance spokesman said two female passengers were treated at the scene for dehydration and transferred to hospital, both in a stable condition, Sydney Morning Herald reported. He was unable to confirm how high the temperatures were or how long the passengers were exposed to the heat. Reports said that the cabin temperature climbed to almost 40 degrees Celsius onboard the Dash-8 aircraft. QantasLink operates flights to more than 50 city and regional destinations across Australia and Papua New Guinea. http://www.indiatimes.com/news/rest-of-the-world/qantas-flight-cabin-temp-soars- forced-to-land-64283.html Back to Top Two planes emergency landings at Dutch airport (CNN) -- Two planes made emergency landings at Amsterdam Schiphol Airport at almost the same time Monday, the Dutch airport said. The first plane was a KLM flight departing en route to Milan, Italy. The flight reported a possible technical problem and asked to return. The plane was inspected by engineers, and passengers were waiting to depart, the airport said. The second emergency landing involved a Delta Air Lines plane. It was not immediately clear what prompted that plane to land. Initially, the airport said a fire caused the landing. But a military police official described the issue as one of "technical difficulties." Delta would only say the plane, from Amsterdam to Mumbai, made the landing for "precautionary measures." "The aircraft landed without incident, and passengers deplaned normally," the airline said in a statement. It was "nothing big," Robert Van Kappel of Schipol Military Police of the incident. Schiphol is one of Europe's busiest transit sites. Back to Top Finally, PH passes aviation safety audit (Philippines) MANILA, Philippines - After 5 years, the Philippines passed the global safety audit of a United Nations aviation body, marking the first step in the process toward the lifting of restrictions against Philippine carriers. The International Civil Aviation Organization (ICAO) has lifted the "significant safety concerns," or audit findings, on the ability of Civil Aviation Authority of the Philippines (CAAP) to meet global aviation standards, CAAP said in a statement on Monday, March 4. The audit results of ICAO -- a United Nations agency that oversees international civil aviation -- are the basis of the US Federal Aviation Administration (FAA) in ruling to keep or lift the Category 2 status it imposed on its counterpart in the Philippines, the CAAP. A favorable ICAO audit and a positive FAA review have long been awaited especially by local airlines and tourism officials that would like to bring more foreign visitors from the huge markets of the US and EU. The European Union may also follow the FAA's move after it blacklisted the Philippines in 2010. Official notice The head office of ICAO in Montreal, Canada relayed to CAAP the official audit results and recommendation of the team based on their February visit, said CAAP director general William K. Hotchkiss III. The official ICAO advice noted that the Philippines has made "corrective actions" that have "successfully addressed and resolved the 'significant safety concerns' identified by the ICAO," CAAP said. CAAP cited Mohamed Elamiri, ICAO Deputy Director for safety management and monitoring, for "the active commitment by the Philippines towards resolving the deficiencies identified through the Universal Safety Oversight Audit Programme." Following the ICAO audit team's visit in February, Transportation Secretary Joseph Emilio Abaya had expressed optimism that the Philippines has passed the aviation safety audit and that a recommendation to lift all safety issues is at hand. Early in 2012, the government admitted that the country's aviation safey status is dragging the potential growth of tourism behind. The ICAO had raised concerns over the safety and oversight structure and the revalidation of airline carriers, among others, by Air Transportation Office (ATO), the CAAP predecessor. The Philippine government has since spun off the regulatory function of the aviation body into CAAP and has set aside budget for the training of aviation inspectors and information technology assets. Local players Philippine Airlines (PAL) and Cebu Pacific have been keen on the lifting of these bans, and have separately made orders for new planes they can deploy to profitable routes in the west. - Rappler.com Back to Top 4 Die in Small Plane Crash in Northern New Mexico ANGEL FIRE, N.M. March 4, 2013 (AP) Four people died at the airport in the northern New Mexico community of Angel Fire after the single-engine plane they were traveling in crashed as it was taking off. Federal Aviation Administration spokesman Lynn Lunsford says the cause of the crash was unknown, but noted that the area was experiencing heavy winds at the time of the crash Sunday afternoon. The plane's destination wasn't immediately known. No information was available about the two adults and two children aboard the single- engine Mooney plane. State police say there were no survivors in the crash. Investigators from the National Transportation Safety Board and FAA are on their way to the site. Angel Fire is located 150 miles northeast of Albuquerque. The plane was owned by a company in Scottsville, Texas. ************* Date: 03-MAR-2013 Time: Afternoon Type: Mooney M20E Super 21 Operator: Verhalen Flyers LLC Registration: N3484X C/n / msn: 1156 Fatalities: Fatalities: 4 / Occupants: 4 Other fatalities: 0 Airplane damage: Written off (damaged beyond repair) Location: Angel Fire Airport - KAXX, Angel Fire, NM - United States of America Phase: Take off Nature: Private Departure airport: KAXX Destination airport: Narrative: The aircraft, a Mooney M20E Super 21, N3484X, impacted terrain during an attempted takeoff around 1pm local in high wind conditions (gusting over 48 knots) at Angel Fire Airport - KAXX, Angel Fire, New Mexico. The aircraft was destroyed by impact and the four passengers onboard received fatal injuries. www.aviation-safety.net Back to Top Sacramento Woman Arrested For Assaulting JetBlue Flight Attendant SACRAMENTO (CBS13) - A woman was arrested at the Sacramento International Airport for allegedly assaulting a crew member aboard a JetBlue flight on Saturday morning Sacramento County Sheriff's Department spokesperson Sgt. Jason Ramos said 37-year- old Yevelina Rakhuba of Sacramento had to be restrained on an inbound flight after an "episode" in which a crew member was assaulted and suffered minor injuries. Rakhuba also broke a male flight attendant's wristwatch during the scuffle. She was cited an released for misdemeanor assault and battery charges. http://sacramento.cbslocal.com/2013/03/02/sherriff-sacramento-woman-arrested-after- altercation-on-jetblue-flight/ Back to Top Back to Top China's first jumbo jet to debut in 2014 BEIJING, March 4 (Xinhua) -- China's first jumbo jet, the C919, is expected to make its maiden flight in 2014 as planned, its chief designer told Xinhua on Monday. The design of C919's airframe has been completed and the ground tests of the jet's major equipment will start in 2013, said Wu Guanghui, the jumbo jet's chief designer and vice general manager of the Commercial Aircraft Corporation of China (COMAC), the aircraft's manufacturer. The company had overcome a lot of difficulties, including insufficient experiences and technological reserves, weak industrial foundation and fierce competition, and had made new progresses in 2012, he said. The COMAC will complete a series of technical review work and conduct over 40 wind tunnel tests in 2013, said Wu, who is in Beijing to attend the first session of the 12th National Committee of the Chinese People's Political Consultative Conference. Back to Top Review: Air Safety Lessons Could Save Lives in Hospitals Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety Suzanne Gordon, Patrick Mendenhall, and Bonnie Blair O'Connor, authors of Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety (ILR Press, 2013), argue the workplace democracy lessons of aviation's "Crew Resource Management" safety program can reduce medical errors. The book includes a foreword by famed Captain "Sully" Sullenberger, hero of a near-crash. Beyond the Checklist opens with a horrifying story of a very close brush with death, due to preventable medical errors. In a recent New York Times op-ed, a physician described how, due to inadequate coordination and communication among staff during his hospital stay, he lost a leg. These cases are all too typical. A landmark 1999 Institute of Medicine study found that almost 100,000 patients each year die from avoidable medical harm. Such failures result in large part from the rigid, traditional hierarchies that separate health care workers from one another. Hierarchies with deadly consequences were once a feature of the airline industry, too-until high-fatality accidents prompted a radical overhaul of industry processes, beginning in the eighties. Book: Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety, by Suzanne Gordon, Patrick Mendenhall, and Bonnie Blair O'Connor, ILR Press, 2013. In recent years, health care providers have been trying to apply lessons from that overhaul. The most commonly known are checklists: just as pilots and maintenance crews run through a list of tasks to make sure the craft is ready for flight, doctors-and sometimes also nurses-go through their own checklists before and after surgery. But checklists are only the simplest element. At the heart of the success in aviation has been the introduction of teamwork. Regular readers of Labor Notes may cringe, justifiably asking, "How do I know this 'teamwork' is not another management scheme to eliminate craft lines, combine jobs, and justify slashing wages and benefits?" Fortunately, safety teamwork is not about speed-up and cost-cutting-at least not in its origins. But this is not to say that managers won't try to twist safety teamwork projects to those ends, just as they have done in some institutions when new health care technologies were introduced. As Charley Richardson warned Labor Notes readers in 2010, technologies like electronic medical records and tracking devices can be used to hurt workers and "tip power toward management." Richardson urged health care workers to educate themselves about such changes and organize to prevent technology misuse and abuse. Beyond the Checklist examines the new safety initiatives in the same spirit. Dysfunctional Culture It has been more than ten years since the Institute of Medicine published its shocking findings, but despite hundreds of millions spent on new patient safety efforts, hospital harm is still common. The authors of Beyond the Checklist explain: Many well-intentioned safety efforts have fallen short because doctors, administrators, and other staff resist necessary changes in the hierarchical and often dysfunctional culture of hospital work. Patients get hurt or become even sicker when doctors, nurses, and other hospital staff fail to share information, don't work effectively in teams, or ignore mechanisms-like hand-washing to prevent infection-designed to minimize human error. They compare these failures to the safety success story of Crew Resource Management protocols in aviation. CRM requires everyone with any role in a flight-whether in cockpit or passenger areas, on the runway, hangar, or in air traffic control-to solicit information and acknowledge that information has been heard. It also mandates new, safer processes for every step from preparation through to post-flight checks. Those implementing CRM had to overcome resistance from captains who were used to having the last word-often the only word-in decisions, and from pilots who were uncomfortable with the "the 'soft skills' of better communication and respectful interaction with co-workers." As in health care, there were obvious gender roles at play. Yet by now, the authors report, the consensus among airline workers "is that our cockpit management decisions are far better when we have regular input and information from all members of our aviation team, in the air and on the ground." Unfortunately, this is not yet the case in health care. Few hospitals have created an environment where staff members feel free to challenge a physician or complain to an administrator. In medical schools and on the job, doctors are not encouraged, much less required, to consult with skilled and experienced members of their health care team, who may have life-saving input. Doctors, nurses, transporters, and other staff must share crucial information about the patient and feel free to challenge each other if a mistake appears imminent. This requires parallel training on "codes of mutual respect"-to be blunt, doctors must learn to listen to, and not insult or demean, nurses, med students, or anyone else who red-flags a potential misstep. Spotty Success Several chapters in Beyond the Checklist detail the application of CRM to health care: how various hospitals implemented it, the resistance they overcame, and the impact on patient outcomes. Above all, the authors argue, changes must be continuous and self-reinforcing. In some hospitals, managers used one-off CRM pilot projects to win bragging rights, but didn't sustain the necessary follow-up-whether because of inertia, competing priorities, or insufficient buy-in from leaders and staff. The authors recommend collective training, rather than training specific to medical specialties. They further recommend taking safety training beyond hospital walls, into schools for health care workers. In my hospital and others, staff members are also trained to encourage patients and their families to ask questions of their physicians and nurses. Inadequate staffing, the authors note, can be another barrier to team-based safety. Co- author Suzanne Gordon, who has written and edited numerous books about nurses and nursing, is a well-known advocate of improved nurse/patient ratios. She and her co- authors describe how overwork produces stress, which in turn affects learning and performance. "One wonders," they write, "how anyone can talk about effective teamwork in health care without dealing with the kinds of workloads and schedules that keep people from getting enough sleep"-or even from having time to eat, in shifts of eight, 12, or more hours. The authors also note how a market-based health care "industry" creates its own barriers. For instance, one hospital CEO was afraid safety process changes would cause his physicians to take their income-generating cases to another hospital. The authors view this as a reason government regulators should make such changes mandatory. Even in aviation, workers worry that the pursuit of profit is hurting safety efforts. Famed pilot Chesley "Sully" Sullenberger (hero of a near-crash and author of the book's foreword) has warned of job outsourcing and a growing "culture of intimidation and pressure." The authors write: Work intensification-the attempt to get more out of personnel with reduced resources-is a major trend that threatens both quality and safety... Regardless of their place in the hierarchy, people are pushed to attain an increasing variety of productivity measures... their work is subject to more and more distracting interruptions, and they are given less time for rest and respite. Such economic pressures are only going to increase in health care, as politicians of both parties continue their attacks on Medicare and Medicaid, slashing hospital reimbursement while providing ever-greater subsidies to the makers of high-tech medical devices and patient records software. Yet government funding can also be a positive force. Beyond the Checklist gives a telling example: A government-funded teamwork program, called TeamSTEPPS, focuses on leadership, situation monitoring, mutual support, and communications. Because it's a government program, hospitals wanting to adopt the program receive free materials and training. My own favorite example is the VistA software used throughout the Veterans' Affairs hospital system: a free, adaptable, cooperatively-developed and -improved program. It stands in stark contrast to the huge number of proprietary, for-profit systems peddled by competing vendors-which can make teamwork harder, and cross-institution information- sharing damned near impossible, as we saw during Superstorm Sandy. Working to implement the cross-occupation, cross-institution safety practices recommended in Beyond the Checklist can be a small but important step to better equip workers for the bigger battles we need to tackle in the fallout of the economic crisis. A workforce more conscious of-and empowered to do something about-life-saving changes at work is a workforce poised to take on these bigger issues, such as government funding and policies. Those Labor Notes readers who want additional context can't do better than the recent volume co-edited by Suzanne Gordon, First Do Less Harm, which describes workplace and industry-wide barriers to pro-safety, pro-worker change. And don't miss her previous books on nursing! Andrew Pollack is a senior data and health policy analyst at Maimonides Medical Center. http://www.labornotes.org/blogs/2013/03/review-air-safety-lessons-could-save-lives- hospitals Back to Top Airbus Military's A400M aircraft is poised to take off After a decade in the making, cost over-runs to the tune of billions of euros, and delays of more than three years, the next generation of European military transport aircraft is finally poised for entry into service. Airbus Military will deliver the first A400M to the French Air Force within the next few weeks. In just a few weeks, the French air force will take delivery of the very first operational A400M from Airbus Military's final assembly line in the Spanish city of Seville. Not only will it mark a key milestone for the €20bn-plus (£17bn) programme, but it will also have major significance for Britain, both for the military and for industry through manufacturing and exports. It comes at a time when Western military budgets are shrinking and the British Ministry of Defence is battling to protect itself against further cuts. A tough fiscal backdrop, combined with the fact that brand new programmes come around just every 20 to 25 years, makes it all the more significant for the RAF. Britain is one of seven partner nations behind the A400M, alongside France, Belgium, Germany, Spain, Turkey and Luxembourg. A total of 174 aircraft have been ordered by those countries, with 22 heading Britain's way. Cedric Gautier, head of the A400M programme at Airbus, insists its problems are in the past and says his teams are "working like hell" at the final assembly line in Seville to get the aircraft in shape for deliveries. "Yes, we had some issues which caused delays ... [but] this aircraft is ready." RAF Brize Norton is scheduled to receive its first one in September 2014, with the final one scheduled for delivery in 2018 in what will amount to a £3.26bn programme for the MoD to replace the current fleet of C-130 Hercules, of which the final one will be retired in 2022. Philip Dunne, the minister for defence equipment, support and technology, says the A400M will become the "workhorse" of the RAF's lift capability, transforming how it does business. Speaking on one of the first flights of a sample A400M at Brize Norton, he said: "It has much greater lift capacity than the Hercules it will be replacing and much greater range, so that we will either be able to lift twice as much for the same distance, or travel twice as far with the same amount of kit." As Britain reduces its military presence in Afghanistan, the A400M is unlikely to be used in service there, but it will be ready for action wherever required, whether at war, on peacekeeping missions or on humanitarian missions to provide disaster relief. The A400M will be able to travel at speeds of up to Mach 0.72 (around 460mph), and is designed to be much quieter and more comfortable than its predecessor the Hercules, delivering troops in better condition to deal with whatever mission faces them. It is able to carry 116 military personnel and vehicles and helicopters that are too large or too heavy for previous generation airlifters, including a CH-47 Chinook helicopter. While the RAF will have to wait until next year to receive its first A400M, preparations are already well under way at Brize Norton, and the work on building Britain's aircraft has already begun at Airbus facilities. Not only will it transform the RAF's military capability, it will also provide a boost to British industry. While aircraft will be delivered from Airbus Military's final assembly line in Seville, around 14pc of every aircraft is British made, largely because part of the wings are made and assembled by Airbus at Filton, Bristol. The programme overall sustains around 8,000 jobs in the UK, according to Airbus. Meanwhile the MoD reveals today that it is investing a further £306m into the A400M programme in Britain. It is funding a £226m training centre at Brize Norton, which will house two full flight simulators to train RAF pilots, as well as provide training for engineers and all those who will operate, support and maintain the MoD's fleet of A400Ms. The national training centre will support around 300 long-term jobs. The MoD is investing a further £80m in additional technology for the 22-strong fleet. Mr Dunne says the MoD is seeking in all its procurement programmes to be clear about what it will fund to provide certainty for its contractors. As for the A400M, it is hoped that there will be considerable potential for exporting the transport aircraft. That is something Britain as a partner nation stands to benefit from, at a time when the Government is pushing the message that the UK economy needs to be rebalanced away from the debt-fuelled spending of the pre-crisis years and towards more manufacturing and exports. "This is a government that is not embarrassed about defence exports. We think that defence has an important role to play in the growth economy," says Mr Dunne. "This aircraft we have flown today is a really good example of a world-class aircraft that has enormous export potential. Once it is in service with some of the original partner nations we think the potential for demonstrating it to other nations is huge. And there will be substantial export sales." Airbus has already booked its first export customer in Malaysia, and speaking at the final assembly line in Seville, Mr Gautier said there was potential to sell hundreds more, with a focus on the Gulf and Asia as a priority. "We went to Asia with success and this year we intend to increase the marketing campaign when the flight tests are done," he said. For the time being, the US is not a target market for the European programme, but Mr Gautier has not ruled it out beyond 2020, if America has not launched development plans for a new programme to replace old fleets by that time. "The US market is an opportunity, but we're not in a hurry to target that market. We are not yet there." For Britain, as for the other partner nations, the once troubled programme has been a long time coming, but with four deliveries of the A400M scheduled for this year, it should finally be about to take off. http://www.telegraph.co.uk/finance/newsbysector/industry/defence/9906144/Airbus- Militarys-A400M-aircraft-is-poised-to-take-off.html Back to Top TWITTER For late breaking aviation news, follow us on Twitter @ curtllewis01 Back to Top Back to Top Quick Links Products Services Training Contact us... Contact Information "Flight Safety Information" is a free service of: Curt Lewis, P.E., CSP, FRAeS, FISASI CURT LEWIS & ASSOCIATES, LLC (Targeting Safety & Risk Management) curt@curt-lewis.com www.curt-lewis.com www.fsinfo.org PH: 817-303-9096 Cell: 817-845-3983 Fax: 682-292-0835 Curt Lewis & Associates, LLC is an international, multi-discipline technical and scientific consulting firm specializing in aviation and industrial safety. Our specialties are aviation litigation support, aviation/airport safety programs, accident investigation, safety & quality assessments/audits, system safety (PRA), human factors, Safety Management Systems (SMS) assessment/implementation & training, safety/quality training & risk management, aviation manual development, IS-BAO Auditing, airfield/heliport lighting products and Technical Support. 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