Flight Safety Information July 18, 2013 - No. 148 In This Issue Asiana Flight 214 pilots hospitalized, AP reports Pilots challenged by monitoring automated systems Asiana to pay $15K to store burned jet South Korea asked Asiana to review safety before crash Full Sized Jet Fighter Drone, QF-4, Crashes Along Florida Highway FAA Warns Pilots About Medication Use Indonesia needs to do more to improve aviation safety Air India Suspends 2 Pilots for Allowing Actress into Cockpit 2013 Aviation Human Factors and SMS Seminar - Dallas, July 23-24, 2013 Think ARGUS PROS FAA Data: Aircraft Near-Misses Up 600 Air Canada flight diverts on water-throwing flier Asiana Flight 214 pilots hospitalized, AP reports The Asiana Airlines pilots involved in the crash landing of Flight 214 earlier this month have been hospitalized in South Korea "for psychological trauma and injuries caused by the incident," The Associated Press reports. The news agency cited officials who "spoke on condition of anonymity." Those officials, from South Korea's Land, Infrastructure and Transport Ministry, said Wednesday that the pilots' hospitalization follows medical checkups they received on returning to South Korea this past the weekend. The pilots were questioned by a U.S. and South Korean joint investigation team while in the USA. A separate session with South Korean officials also looms for the pilots. The Land, Infrastructure and Transport Ministry officials say that interview could come as soon as Friday, depending on doctors' recommendations. The Associated Press adds South Korean officials gave no further details and spoke on condition of anonymity citing department rules. Asiana Flight 214 crash landed at San Francisco International Airport on July 6, resulting in three deaths and dozens of injuries. Against the news of the pilot's apparent hospitalization, The Wall Street Journal reports that they "fear they will face criminal prosecution in (Asiana's) home country of South Korea, said people familiar with their thinking ... ." The Journal adds that "prospect ... alarms U.S. pilot-union leaders and air-safety experts." http://www.usatoday.com/story/todayinthesky/2013/07/17/asiana-flight-214-pilots- hospitalized-ap-reports/2524031/ Back to Top Pilots challenged by monitoring automated systems National Transportation Safety Board member Robert L. Sumwalt said Wednesday at a pilots' conference that an NTSB report finds lapsed monitoring factored in 94 percent of aviation mishaps. He spoke in the wake of the July 6 Asiana Airlines crash in San Francisco. By JOAN LOWY WASHINGTON (AP) - Airline pilots spend nearly all their time monitoring automated cockpit systems rather than ''hand-flying'' planes, but their brains aren't wired to continually pay close attention to instruments that rarely fail or show discrepancies. As a result, pilots may see but not register signs of trouble, a problem that is showing up repeatedly in accidents and may have been a factor in the recent crash landing of a South Korean airliner in San Francisco, industry and government experts say. Teaching pilots how to effectively monitor instruments has become as important as teaching them basic ''stick-and-rudder'' flying skills, a panel of experts told an annual safety conference of the Air Line Pilots Association, the world's largest pilots union, on Wednesday. ''The human brain just isn't very well designed to monitor for an event that very rarely happens,'' said Key Dismukes, a top NASA human factors scientist. While people ''do very well'' at actively controlling a plane, ''we're not well designed to monitor for a little alphanumeric (a combination of alphabet letters and numbers) on the panel even if that alphanumeric tells us something important,'' he said. ''We can't just sit there and stare at the instruments.'' The ''sheer volume of monitoring required even on the most routine flights and the diversity'' of systems that must be monitored has increased, he said. Concern about the problem is great enough that government, union and industry safety officials formed a working group last fall to come up with a blueprint for teaching pilots techniques for how to overcome the brain's natural tendency to sometimes see but disregard important information. For example, if pilots see airspeed indicators showing appropriate speeds landing after landing, their brains may filter out an unexpected low or high speed, they said. ''The human brain filters out information it considers unchanging,'' said Helena Reidemar, an airline pilot and the pilots union's director of human factors. Asiana Flight 214 crashed short of a runway at San Francisco International Airport on July 6 after a nearly 11-hour flight from Seoul, South Korea. Of the 307 people on board, three have died and dozens of others were injured. One of the issues that have emerged in the National Transportation Safety Board's investigation of the accident is whether the pilots, who were supposed to be watching airspeed indicators, were aware the plane was traveling at speeds so dangerously slow that it was at risk of losing lift and stalling. The flight's pilots set a target airspeed of 137 knots for crossing the runway's threshold. The plane reached speeds as low as 103 knots just before its landing gear and then its tail collided with a rocky seawall at the end of the runway, shearing off the tail, dumping three flight attendants onto the tarmac and sending the rest of the plane spinning and sliding. Dismukes cautioned that it's too soon to reach conclusions about whether the three Asiana pilots who were in the Boeing 777's highly-automated cockpit were closely monitoring the plane's airspeed, ''but what was going on there in terms of monitoring systems obviously is going to be a crucial issue.'' Robert Sumwalt, an NTSB board member, said: ''The question is, did the pilots recognize they were slow? And if not, why not?'' The board's investigation hasn't turned up any mechanical or computer problems with the plane, NTSB chairman Deborah Hersman said at briefing last week. The board has repeatedly investigated accidents in which pilots' failure to closely monitor key systems contributed to the crash, Sumwalt said. In 2007, after an investigation of a fatal business jet accident in Pueblo, Colo., the board recommended that the Federal Aviation Administration require that pilot training programs be modified to contain segments that teach and emphasize monitoring skills and how to manage multiple tasks, Sumwalt said. Since then, the board has twice repeated the recommendation in response to other accidents, he said. The FAA, however, hasn't required airlines to change their training programs, Sumwalt said. Instead, the agency suggested airlines revise their procedures to ''promote effective monitoring'' if pilots are found to be inconsistent in their monitoring techniques, he said. The board doesn't believe the advice goes far enough, and has categorized FAA's response as ''unsatisfactory,'' Sumwalt said. One of the accidents that led NTSB to renew its recommendation was the February 2009 crash of a regional airliner near Buffalo, N.Y. In that case, the two Colgan Air pilots weren't closely monitoring the Bombardier Q-400's airspeed and so failed to notice that the plane's speed had rapidly dropped about 50 knots, Sumwalt said. The startled captain responded incorrectly to an automated warning of an impending stall, sending the plane plunging into a house below. Fifty people, including a man on the ground, were killed.Continued... ''This is an area that is really ripe for improving safety,'' he said. ''It's time for a paradigm shift. ... It used to be pilots were judged on their stick-and-rudder skills. They also should have to have good monitoring skills.'' Some airlines are incorporating those techniques for improving monitoring skills in their training, experts said. ''We understand there is a threat. We understand there is a need to do things better,'' said Christopher Reed, a JetBlue Airways captain and pilot training manager who was a member of the panel. JetBlue is trying to give pilots more time flying planes without relying on automated systems in part ''because the mental habit patterns you are following by practicing those skills can help you be a better monitor,'' he said. Several panel members emphasized the importance of ''actively monitoring'' versus ''passively monitoring'' cockpit systems. Pilots who are flying without automated systems are mentally engaged in flying, and they need to bring that same awareness to monitoring, experts said. ___ Follow Joan Lowy on Twitter at http://www.twitter.com/AP_Joan_Lowy Back to Top Asiana to pay $15K to store burned jet In this July 6, 2013, file photo, firefighters, lower center, stand by a tarpaulin sheet covering the body of a Chinese teen struck by a fire truck during the emergency response to the crash of Asiana Flight 214 at the San Francisco International Airport in San Francisco. Renting in San Francisco is a costly affair, even if you're just leasing space to store your charred airplane. Asiana Airlines is being charged $15,000 by San Francisco International Airport to keep the wreckage from the fatal July 6 crash at the hub for two weeks, said SFO spokesman Doug Yakel. Asiana has been given until July 26 to remove the wreckage. Yakel said SFO does not plan to extend that deadline. The husk of the Boeing 777 was moved early Friday to a remote stretch of airport land that cannot be seen by passengers in the terminals. SFO and other entities also have initiated the process of recovering from the South Korea-based airline costs incurred following the crash, which killed three people and injured dozens more. Those costs include cleanup of spilled jet fuel and other materials emanating from the downed jetliner, along with man-hours for airport personnel and police and fire crews working overtime. United Airlines contracted with an airline salvage company to move the remains. Yakel said United runs a large maintenance operation at SFO and "had a ready, established contract at the airport for recovery." It's also an Asiana marketing partner. http://www.sfexaminer.com/sanfrancisco/asiana-to-pay-15k-to-store-burned- jet/Content?oid=2514287 Back to Top South Korea asked Asiana to review safety before crash (AP)South Korea's transport ministry said Thursday it asked Asiana Airlines Inc. to review safety measures two months before an Asiana flight crash-landed in San Francisco. Kwon Yong Bok, director general of aviation safety policy at the transport ministry, said the government informed Asiana on April 30 it should hire more pilots, engineers and cabin crew as the airline planned to increase its fleet of airplanes by 20 percent by 2017. It currently has 80 planes. "We asked the company to review its safety policies once again," Kwon said by phone. He said the ministry also recommended that Asiana centralize its safety management system and set up an oversight team for aircraft maintenance. The recommendations were made as part of a safety consulting program that the ministry set up for the airline industry to minimize the risk of accidents. Asiana Flight 214 crash-landed at San Francisco's international airport on July 6, killing three people and injuring dozens. Twelve people are still hospitalized including five cabin crew, South Korea's transport ministry said Monday. The crash of the Boeing 777 was Asiana's first accident since a cargo plane landed in waters near South Korea's Jeju island in 2011, killing two pilots. Its deadliest plane accident was in 1993 when a domestic flight crashed south of Seoul, killing 66 people. The cause of the San Francisco accident is still being probed but investigators have so far found no evidence of mechanical problems with the plane. Back to Top Full Sized Jet Fighter Drone, QF-4, Crashes Along Florida Highway A full sized jet fighter, modified into an unmanned target drone, spun out of control Wednesday morning and crashed along U.S. Route 98, a highway near Tyndall Air Force Base in Florida. No injuries have been reported. This is the second time in a week, according to WJHG's report (via Gizmodo), that a drone has gone down at Tyndall Air Force Base, located near Panama City, Florida. According to Tyndall Air Force Base's statement, the drone was a QF-4 - a modified F-4 Phantom, a full-sized jet fighter-bomber which was primarily used by the Air Force during the Vietnam War era. The drones are used as a realistic full-scale target for air- to-air weapons system tests. Eyewitnesses said that the large drone came in "hard and fast," according to WJHG's report, and then exploded, sending up a huge black cloud of smoke. Last Wednesday morning, Tyndall Air Force Base destroyed a QF-4 drone over the Gulf of Mexico for "safety considerations during its return to base following a routine operation," according to the Air Force's statement. The drone can be flown remotely, and according to the Air Force's fact sheet, an explosive device is placed in the QF-4 to destroy the aircraft remotely if it should become uncontrollable and pose a danger to those on the ground. As of yet, it's unclear whether this fail-safe worked, though a picture from the highway nearby, US 98, shows smoke billowing up from the ground. The drone was assigned to the 53rd Weapons Evaluation Group and crashed during take- off at 8:25 Wednesday morning. Authorities have closed the highway near the crash site. The road may be closed for up to 24 hours, and Panama City drivers headed to Mexico Beach are encouraged to use Highway 22 east to Highway 71 south as a detour. A statement has been released by Tyndall Air Force Base on the incident: "An unmanned Air Force QF-4 drone, assigned here to the 53rd Weapons Evaluation Group, crashed on the drone runway during take-off at 8:25 a.m. today. No personnel were injured during the incident. Base and local police and safety officials have closed Highway 98 and are anticipating that it will remain closed for up to 24 hours. This closure is being done strictly as a precautionary measure due to fires resulting from the crash and a small self-destruct charge carried on board the drone. The status of this device is unknown however, it is powered by a short-life battery which will be fully depleted in 24 hours. The charge is used to destroy the drone if it leaves its pre-approved flight plan. Motorist traveling from Panama City to Mexico Beach, should use Hwy. 22 east to Hwy. 71 south, and from Mexico Beach to Panama City Hwy. 71 north to Hwy. 22 west. http://www.latinospost.com/articles/23795/20130717/full-sized-jet-fighter-drone-qf-4- crashes-along-florida.htm Back to Top FAA Warns Pilots About Medication Use Medications played a role in 12 percent of fatal general aviation crashes in the past decade, according to the study. They may seem like harmless over-the-counter medications, but everyday drugs like pain relievers or cough suppressants can impair a pilot's ability to safely fly a plane or helicopter, according to a new study by the Federal Aviation Administration and the general aviation industry. According to the study, medications played a role in 12 percent of fatal general aviation crashes in the past decade. Concerned, the industry and government today sent out an alert to the nation's estimated 450,000 general aviation pilots to warn them to pay careful attention to any medications they may be taking. The letter points out that "pilots might not be aware of the ubiquitous presence of sedating antihistamines in many over-the-counter treatments for common allergies, coughs, colds and sleep aids." It urges pilots to pay careful attention to side-effects of any medication, and recommends that pilots wait as long as five times past the dosing interval before climbing into a cockpit. "So if it was an eight-hour medication, you might go as long as 40 hours before you get into an aircraft," said Bruce Landsberg, president of the Aircraft Owners and Pilots Association (AOPA) Foundation. "It's important for pilots to understand that any medication that they take may have some kind of effect," he said. One accident cited in the letter to pilots killed a 3- and 6-year-old girls and their grandparents. The grandfather was at the controls when the small plane went down short of the runway in Visalia, Calif., in 2006. The National Transportation Safety Board found one of the causes of the crash was a build-up of sedating medication -- an over- the-counter sleep aid -- in the man's system. Commercial pilots are subject to random drug and alcohol testing. There's no such requirement for general aviation pilots. In a statement, the FAA said it "believes education pilots to make themselves aware of the potential detrimental effects of medications is the most effective way to address this issue." In an FAA brochure entitled "Medications and Flying," the FAA tells pilots they should not fly while using any medication whose side effects include "lightheadedness, dizziness, drowsiness or visual disturbance." Of course, any warning against "operating motor vehicles or machinery" while on the medication is also a red flag. The FAA's own study of fatal accidents between 2004 and 2005 found that drugs and medications were found in 42 percent of pilots who died in plane crashes. That report did not indicate whether the substances contributed to the accidents, but did underscore the widespread the use of medications. Non-commercial pilots are basically on the honor system. Landsberg insists it's a system that by and large works. "We're very concerned about safety, because it's our own safety that's at stake and those of our passengers, business associates and loved ones," he said. Still, a little education never hurts. So in addition to the alert that went out today, industry groups plan articles in trade publications, on-line education and other efforts to stress to pilots that medications and flying doesn't mix. http://abcnews.go.com/US/faa-alerts-general-aviation-pilots- medication/story?id=19684010#.UefhEo2sh8E Back to Top Indonesia needs to do more to improve aviation safety, say experts Indonesia's air safety record improved last year, reversing the upward trend -- this is despite the number of flights doubling in 2012. Still, experts said Indonesia needs to do more to reach international aviation safety standards. JAKARTA: In the history of Indonesia's aviation industry, Jakarta has never developed its own capability to fully investigate air accidents on its territory. However, that changed three years ago with a modest laboratory. Indonesia took a major step in air accident investigation by setting up its own flight recorder laboratory. It now has the capabilities to retrieve, read and analyse flight data from what is commonly known as the "black box". The Indonesian National Transportation Safety Committee (KNKT) sent a handful of technicians overseas for training. Now, it has the expertise to retrieve flight data from all types of aircraft operating in Indonesia. Andreas RH, a flight recorder technician, said: "We can now handle data from all types of aircraft operating in Indonesia. There's no need to send information overseas like before." Fortunately though, Andreas has fewer black boxes to analyse this year, compared to last year. In 2011, there were 32 air accidents. In 2012, that figure fell to 27. It is a significant improvement, especially since the number of flights jumped last year. The rate of aviation accidents now stands at 1.43 per 100,000 flight hours. Tatang Kurniadi, chairman of Indonesia's National Transportation Safety Committee, said: "For example, in 2007, our total flight time nationally was around 500,000 hours. Now it is more than 1.8 million hours. So if we compare the rate of accidents, it has dropped dramatically." Still, Mr Tatang points out that the number of accidents remains at an average of 23 annually. He attributes this to a combination of factors. He said: "It's a combination of new airports, new aircraft and new pilots flying the routes. These need attention." Chappy Hakim, a former air marshall who chaired the special task force in 2007 on Indonesia's aviation safety, said business interests are compromising safety standards. Mr Chappy said: "There are runways with restrictions. There are numerous reasons why a Boeing 737 cannot be fully-loaded or carry full capacity. It means there are restrictions. You can operate but with restrictions. But who are monitoring the restrictions?" Indonesia has made tangible progress in the last five years to improve the standards of its aviation industry. That has led the European Union to lift its ban on a number of Indonesian airlines, including the national carrier Garuda. However, there is still a lot of work to be done before Indonesia can reach international standards of safety. Mr Chappy added: "We have progressed in many aspects but we have not yet improved on all the findings that ICAO reported in 2007. Up until this year, I don't think we will be able to move up from category two to category one." Indonesia will need to hurry to get its aviation sector ready to meet the challenges of 2015 -- that is when the ASEAN open skies agreement will be implemented, which will see even more flights in and out of the country. http://www.channelnewsasia.com/news/asiapacific/indonesia-needs-to-do/748318.html Back to Top Air India Suspends 2 Pilots for Allowing Actress into Cockpit NEW DELHI, India - Two Air India pilots have been suspended after they allowed a South Indian actress to sit inside the cockpit mid-air on a Bangalore-Hyderabad flight in flagrant violation of safety norms. "Both pilots have been suspended and taken off the roster. An inquiry is going on," airline officials said, adding that the matter came to light after a passenger lodged a complaint with the airline. The pilots have been identified as Jagan M. Reddy and S. Kiran. Aviation regulator DGCA has taken a serious view of the incident that took place last month, official sources said. While both the pilots were suspended by the national carrier pending an internal inquiry, the Directorate General of Civil Aviation is conducting a probe into the "flagrant violation of passenger safety norms," they said. In his complaint, the passenger said the actress was allowed into the cockpit when the plane was mid-air. She occupied the observer's seat during the flight, which is reserved for examiners and observers authorized by the DGCA. With quite a few such incidents coming to fore in the past months, the DGCA is considering amending its rules to impose harsher penalties on the cockpit crew, the sources said, adding that cockpit entry by a passenger is completely prohibited since the 9/11 terror strike. In May, the pilot of an Air India flight from Delhi to Bangalore got locked out of the cockpit as the door got jammed, resulting in the co-pilot making an emergency landing in Bhopal. In April, two stewardesses were inside the cockpit for nearly 45 minutes as one of the two pilots took a long break. http://www.indiawest.com/news/12213-air-india-suspends-2-pilots-for-allowing-actress- into-cockpit.html Back to Top 2013 Aviation Human Factors and SMS Seminar - Dallas, July 23-24, 2013 Just under a month until the 2013 Aviation Human Factors and SMS Seminar in Dallas, July 23-24 at the Frontiers of Flight Museum, from 8-5 each day. The seminar fee is $100. Please RSVP if you plan to attend. We have a great speaker lineup, entertaining venue and a chance to share best practices with your fellow professionals. FMI: http://www.signalcharlie.net/Seminar+2013 Registration: http://www.signalcharlie.net/Seminar+Registration+2013 Kent B. Lewis (850) 449-4841 www.signalcharlie.net Back to Top Back to Top FAA Data: Aircraft Near-Misses Up 600 Near misses between aircraft have shot up an alarming 600 percent over the last four years, according to the Federal Aviation Administration, the Washington Times reported. The "serious errors" are caused by air-traffic controllers who leave too little distance between aircraft, Jeffrey Guzzetti, the U.S. Transportation Department assistant inspector general, told Congress earlier this year. There were 37 reported near-collisions in 2009. By 2012, that number jumped to an estimated 275, investigators said. Reports of planes that get too close, but are not in serious danger of colliding, also are on the rise, The Washington Times reported. Those lesser errors remained relatively flat from 2006 to 2009, but rose from 1,200 to 1,900 in less than two years afterward. The inspector general's office estimated that the number will rise again sharply, to 2,500, when the data for fiscal 2012 is compiled. But the inspector general warned that an exact count of incidents in which aircraft come too close is impossible to accurately nail down - and could be even higher - because the FAA's collection of that information is incomplete. During a February investigation, FAA officials suggested that the increase in near- collisions was because of more thorough reporting of such incidents. The IG agreed reporting was improving, but insisted that errors and mistakes still are on the rise. Airline safety has come front and center July 6 after an Asiana Airlines Boeing 777 jetliner crashed at San Francisco airport, killing three. Staffing shortages could be at the root of the agency's inability to thoroughly investigate near-collisions, the inspector general fears. At the start of 2012, the agency had 300 people assigned to conduct investigations. By February, there were only 16, with the FAA insisting it planned to hire more. A spokesman for Republican Rep. Frank A. LoBiondo of New Jersey, chairman of the House Transportation subcommittee, told the Washington Times that Congress is monitoring FAA efforts to stop near-collisions and that the safety of the "flying public is the first and foremost concern." But, the IG said, manpower needed to track near-collisions isn't the only area where the FAA is woefully understaffed. Over the past three years, the FAA has reported six times that it did had too few aircraft-safety officers. http://www.newsmax.com/US/aircraft-near-misses-rising/2013/07/16/id/515332 Back to Top Air Canada flight diverts on water-throwing flier A London-bound Air Canada flight from Vancouver diverted to Nova Scotia on Monday after a passenger became unruly and started throwing water at the crew and other fliers about 6 hours into the flight. Authorities tell the CBC that the problem passenger was a 51-year-old Vancouver man. In addition to dousing people with water, the man acted "strangely" and began making threats toward the crew when attendants tried to calm him, Cpl. Scott MacRae of the Halifax Royal Canadian Mounted Police says to the CBC. Air Canada Flight 854 had just cleared the Labrador coastline and was heading out over the Atlantic when the Boeing 777 diverted to Halifax, according to FlightAware.com. MacRae says authorities received a call about the unruly flier at around 4:20 a.m. local time and then removed the passenger from the plane when it landed at around 5:10 a.m. local time. The man was taken to a local hospital for a mental evaluation, The Canadian Press reports. "It's not common, but it's certainly not uncommon," MacRae tells the CBC about the diversion to Halifax. "When this happens, it causes a lot of inconvenience for passengers, costs are incurred by airlines, and (there's) a disruption, of course, at our airports." Flight 854 spent about an hour at Halifax before continuing on to London, where it landed about five hours later than scheduled. As of Tuesday afternoon, police were still considering whether to bring charges against the man, The Chronicle-Herald of Halifax reports. http://www.usatoday.com/story/todayinthesky/2013/07/16/air-canada-flight-diverts-on- water-throwing-unruly-flier/2522055/ Curt Lewis