Flight Safety Information December 2, 2014 - No. 244 In This Issue Air-Safety Board Cites Failures Before Dreamliner's Battery Fire Indonesia will raise aviation safety standards Pilot killed when U.S. jet crashes in Jordan Cockpit Automation Can Cause Pilots to Lose Critical Thinking Skills DGCA grounds 71 pilots for violation on various counts (india) LIAT Fires Two Pilots Uzbekistan Bans Drone Aircraft PRISM TO HELP PREPARE FOR E-IOSA AIRCON3 - Pre-Conference Workshop THE AVIATION INVESTIGATION BUREAU OF THE KINGDOM OF SAUDI ARABIA TO SPONSOR A SAFETY MANAGEMENT SYSTEM COURSE GRADUATE RESEARCH SURVEY Pilot Health Survey Upcoming Events Air-Safety Board Cites Failures Before Dreamliner's Battery Fire FAA, Boeing and Yuasa All Faulted Over Fire That Led to Fleet's Grounding By JON OSTROWER and ANDY PASZTOR An investigator last year pored over a damaged lithium-ion battery in a lab as part of NTSB's review. A series of failures by the Federal Aviation Administration, Boeing Co. and its supplier of lithium ion batteries contributed to the fire that led to the grounding of the global 787 jet fleet last year, according to a report Monday from the U.S. aviation safety watchdog. The National Transportation Safety Board stopped short of identifying a definitive cause of the short circuit that triggered a battery fire aboard a Japan Airlines Co. 787 Dreamliner at Boston's Logan International Airport in January 2013, but said design, manufacturing and regulatory deficiencies contributed to the incident. The agency's experts ruled out overcharging, environmental and other issues as probable factors, leaving some type of contamination or a manufacturing defect as the most likely cause. The board said Japanese battery maker GS Yuasa Corp. 's "manufacturing process allowed defects" that could cause internal short circuiting of the battery's internal cells. Following a second incident with an overheating battery days later on another Dreamliner operated by ANA Holdings Inc. 's All Nippon Airways in Japan, U.S. aviation authorities ordered all 50 long-range 787s grounded. Other regulators around the world followed, and the fleet was grounded for 3½ months. In the months that followed, Boeing designed and tested new measures for the advanced jets to reduce the risk of a battery fire, including a containment and venting system that would flush any smoke or fumes overboard in the event of a failure. The 787 Dreamliner fleet returned to service in April 2013. In a statement, Boeing agreed with the report's finding that a short circuit inside one of the battery's six cells propagated and caused the battery failure, adding that it remains "confident in the comprehensive improvements made to the 787 battery system following this event, and in the overall performance of the battery system and the safety of the airplane." Attorney Kenneth Quinn, a U.S. spokesman for GS Yuasa, said in a statement Monday that "we appreciate and respect the NTSB's final report, although the root cause of this internal short circuit remains elusive." Mr. Quinn, a partner in the Washington, D.C., office of Pillsbury Winthrop Shaw Pittman LLP also said the company remains confident "in the quality and safety of our batteries, our state-of-the-art manufacturing processes and our highly skilled and trained employees," but plans to study the safety board's conclusions and recommendations. In an effort to reduce and share the cost to develop the 787 from 2002 to 2011, Boeing significantly reshaped its design and production methods to share responsibility with suppliers who, in turn, outsourced component design and testing to their own suppliers. Reflecting on the Jan. 7, 2013 incident which occurred following a flight from Tokyo to Boston, the safety board made repeated recommendations that emphasized tighter oversight by regulators, aircraft makers and their suppliers during the design and certification of advanced technologies like those on the 787. That lack of oversight from the FAA fell short in its role as chief monitor of Boeing's heavily outsourced business model for the Dreamliner, rippling down through to the battery manufacturer, it concluded. "FAA's oversight of Boeing, Boeing's oversight of Thales [SA]," which was responsible for the battery system electronics "and Thales' oversight of GS Yuasa did not ensure that the [battery] cell manufacturing process was consistent with established industry practices," the safety board wrote. Reflecting the overall thrust of the report, the NTSB called on Boeing to enhance "processes to establish more effective oversight of your suppliers." Some of the recommendations also highlighted broader issues of industry and government expertise, extending beyond the 787's specific battery problems. The report also, determined that Yuasa tested a battery "different than the final battery design" that was certified for use on the Dreamliner. As a result, the board found the testing wasn't "relevant or sufficient for making assumptions" about how the lithium cells would behave in actual service. In addition, the NTSB emphasized "the need for outside technical knowledge and expertise to help the FAA ensure the safe introduction of new technology into aircraft designs." A Boeing spokeswoman declined to say if it agreed with the NTSB's assertion that its own failure contributed to the incident, but defended the original battery design process that "used industry standard tests at the time." As a result of the investigation, she said "we now have a deeper understanding of the in-service environment, potential causes of faults in the battery" and tests and designs that reflect its real-world experience. In urging the FAA to seek help from independent technical experts, the board urged the agency to establish panels "as early as possible in the certification program." The goal, according to the report, should be "to ensure that the most current research and information" are available to regulators before they approve new technology. http://online.wsj.com/articles/faa-boeing-and-gs-yuasa-all-faulted-over-dreamliner-battery-fire-ntsb-says- 1417465012 Back to Top Indonesia will raise aviation safety standards Jakarta (ANTARA News) - The government, through the transportation ministry, will raise its aviation safety standards from category II to category I based on the guidelines set by the Federal Aviation Administration (FAA). "Safety must be guaranteed, and therefore, the implementation of safety programs will be tightened. Maintaining safety is important for our business. It is better that one does not fly rather than never land," Transportation Minister Ignatius Jonan noted in his speech during the opening of the general meeting of the members of the Indonesian National Air Carriers Association (INACA) 2014 here on Thursday. Jonan remarked that efforts to improve the safety standards had been started gradually. In addition, he noted that the determination of flight safety regulations not only applied to the airlines but also on the airports. "There are a lot of things that should be repaired, and the stakeholders should also be involved," Jonan affirmed. Improving the safety standards was also a major expectation of INACA from the government as it could help to lower the safety risk and aircraft insurance cost. Moreover, INACA Chairman Arif Wibowo stated that the improvement of safety standards should be conducted by the government, considering the competition at the regional and global levels that necessitated the implementation of international standards. He pointed out that Indonesia was the only country in the ASEAN region that ranked the lowest in terms of aviation safety. "In the ASEAN, only Indonesia and the Philippines had gone up from category two to one," he stated. In Asia, the safety standards of India declined from category one to category two. Arif urged the government to improve its infrastructure, supervision, and the implementation of on-field regulations. "This is to ensure that there were no presence of dangerous goods, animals, and kites at the airport. It requires the efforts of all stakeholders such as the operator and regulator," he added.(*) http://www.antaranews.com/en/news/96521/indonesia-will-raise-aviation-safety-standards Back to Top Pilot killed when U.S. jet crashes in Jordan (CNN) -- A U.S. Air Force pilot was killed when the F-16 Fighting Falcon he was flying crashed in an noncombat incident in Jordan, officials said. The crash happened at about 11 p.m. ET Sunday, U.S. Central Command said in a statement Monday. The jet was returning to its base shortly after takeoff, the statement said. It did not give a location, other than to say the crash was not in Syria or Iraq. A U.S. official told CNN the crash happened in Jordan. Pentagon spokesman Col. Steve Warren said the plane suffered maintenance problems after takeoff and then crashed as it attempted to return. Although it was a noncombat incident, the jet was headed to a combat mission, Warren said. Per military policy, the pilot's name was not immediately released. The crash remains under investigation. Air Force pilot's remains found in Gulf of Mexico after F-16 crash http://www.cnn.com/2014/12/01/world/meast/us-fighter-jet-crashes/ Back to Top Cockpit Automation Can Cause Pilots to Lose Critical Thinking Skills In the wake of recent airline crashes, major news networks have aired concerns about pilots' ability to accurately fly "by hand" when the airplane's cockpit automation systems fail. Although many of these concerns have centered on manual skills such as operating the airplane's controls, new human factors/ergonomics research suggests that pilots' thinking skills, such as navigating, remaining aware of the status of the flight, and diagnosing troublesome situations, are most vulnerable in today's automated cockpits. In a new study published in Human Factors, researchers studied how the prolonged use of cockpit automation negatively impacts pilots' ability to remember how to perform these key tasks. "There is widespread concern among pilots and air carriers that as the presence of automation increases in the airline cockpit, pilots are losing the skills they still need to fly the airplane the 'old-fashioned way' when the computers crash," said Steve Casner, coauthor of "The Retention of Manual Flying Skills in the Automated Cockpit" and research psychologist at NASA's Ames Research Center. Casner and coauthors Richard Geven, Matthias Recker, and Jonathan Schooler studied 16 experienced pilots as they flew routine and nonroutine flight scenarios in a Boeing 747-100 simulator. Levels of automation available to the pilots were varied as the researchers graded pilots' performance. The pilots also reported what they were thinking about as they flew. Results indicated that pilots' instrument-scanning and "stick-and-rudder" skills remained reasonably intact despite prolonged periods of disuse. More significantly, however, the study found that pilots often struggled with maintaining awareness of the airplane's position when the GPS and map display were disabled, or with troubleshooting problems when the automated systems were not available to provide hints. Furthermore, pilots who relied more heavily on the computers to handle these tasks and who allowed their thoughts to drift during flight were more likely to suffer the effects of rusty cognitive skills. "Our results suggest that we might be a bit less concerned about things that pilots do 'by hand' in the cockpit and a bit more concerned about those things that they do 'by mind,'" said Casner. "Pilots' ability to remain mindful and engaged as they now watch computers do most of the flying may be a key challenge to keeping their cognitive skills fresh." http://www.pddnet.com/news/2014/12/cockpit-automation-can-cause-pilots-lose-critical-thinking-skills Back to Top DGCA grounds 71 pilots for violation on various counts (india) NEW DELHI: At least 71 pilots were grounded this year for various reasons, including being found tipsy, with about half of them belonging to no-frill carriers SpiceJet and IndiGo, Rajya Sabha was informed on Tuesday. 19 pilots of SpiceJet and 16 of IndiGo were grounded by aviation regulator DGCA on two counts - testing positive in pre-flight breathalyser tests and being responsible for some incidents involving flight operation. The grounded pilot count for other airlines due to the same reasons was 11 each for Air India and Jet Airways, two each for Air India Charters and Alliance Air and one each for GoAir and JetLite. Of the total 71 pilots grounded, a total of 24 were punished for being found positive for breathalyser tests, 39 for incidents and eight for lapsed pilot licence, according to the data given by civil aviation minister Ashok Gajapathi Raju in reply to a written question. http://timesofindia.indiatimes.com/india/DGCA-grounds-71-pilots-for-violation-on-various- counts/articleshow/45349120.cms Back to Top LIAT Fires Two Pilots Caribbean air carrier LIAT has fired two pilots who "blatantly" disregarded flight instructions, the company said. In a statement released Monday morning, the company's CEO, David Evans, confirmed that LIAT had terminated its employment relationship with both pilots. LIAT said the pilots had been "charged with blatantly disregarding instructions from the company's Flight Operations Department and flying an aircraft to VC Bird International Airport just hours before the recent passage of Tropical Storm Gonzalo." "This decision to terminate followed a full internal investigation of the incident during which the pilots were represented," Evans said. LIAT said the Leeward Islands Airline Pilots Association had repeatedly called for the company to take action against indiscipline "and we are doing just that." "The company is committed to improving its service delivery to the public and will continue to take appropriate action as required from time to time," it said. http://www.caribjournal.com/2014/12/01/liat-fires-two-pilots/ Back to Top Uzbekistan Bans Drone Aircraft Uzbekistan has banned the import, sale and use of pilotless drone aircraft, citing air safety and security concerns. Media reports in the tightly controlled Central Asian nation say that Prime Minister Shavkat Mirziyaev signed an order on December 1 and that the ban comes into force on January 1, 2015. The order reportedly says its purpose is to secure flight safety and prevent the unsanctioned use of Uzbekistan's air space. The order will be enforced by Uzbekistan's Interior Ministry, the State Border Guard Committee, the State Tax Committee and the State Customs Committee. State-controlled media outlets and officials have been told to inform citizens "about accountability and possible legal consequences" of the use of drones, but it was not immediately clear what the consequences might be. http://www.rferl.org/content/uzbekistan-bans-drones-aircraft/26720863.html Back to Top Back to Top Pre-Conference Workshop: Thursday, January 15th: Investigations in support of Safety Management Systems (SMS): The International Civil Aviation Organization (ICAO) defines SMS as "A systematic approach to managing safety, including the necessary organizational structures, accountabilities, policies and procedures." Most Civil Aviation Authorities support the implementation of SMS in aviation training organizations and service providers. Many also include the provisions for a Safety Manager within those safety programs. This workshop will investigate the attributes of a supportive Safety Culture along with the competencies and skill-sets required of the Safety Manager to appropriately collect, analyze and take actions on safety information. The outcomes of this workshop will be assembled and distributed to participants in order for their consideration for inclusion into existing and future aviation programs and curricula. Workshop Leaders: Stewart Schreckengast, PhD, Senior Lecturer, Aviation Department, University of South Australia & Douglas Drury, PhD, Senior Lecturer, Aviation Department, University of South Australia are hosting. Free conference add on- but space is limited. Sponsored by the Robertson Safety Institute Registration Back to Top THE AVIATION INVESTIGATION BUREAU OF THE KINGDOM OF SAUDI ARABIA TO SPONSOR A SAFETY MANAGEMENT SYSTEM COURSE FOR INVESTIGATORS From 14 to 18 December 2014, the Aviation Investigation Bureau of the Kingdom of Saudi Arabia will sponsor a course titled "Safety Management Systems (SMS) for investigators". This course will be attended by its investigators, safety analysts and aircraft accident prevention specialists as well as other aviation safety professionals from within the Kingdom of Saudi Arabia. The course is part of an ongoing strategy in continual employee development in aviation safety practices, which includes a focus on approaches to safety utilizing proactive and predictive methods rather than traditional reactive methods. Captain Ibrahim S Al Koshy, the Director General of the Aviation Investigation Bureau of the Kingdom of Saudi Arabia stated that: "SMS is defined as a systematic approach to managing safety including the necessary organizational structures, accountabilities, policies and procedures. Throughout aviation: world airlines, regulators, operators, airports, maintenance providers and air traffic control are all working toward implementing SMS. This course is designed to provide our investigators and aviation professionals with the knowledge and skill to approach an investigation with the understanding of the SMS components". The list of invitees will include the General Authority of Civil Aviation, the Royal Saudi Air Force, Saudi Arabian Airlines, NAS, and senior management personnel from the major airports within the Kingdom of Saudi Arabia. Back to Top GRADUATE RESEARCH SURVEY Dear fellow pilots: By way of introduction, my name is Adrian Aliyuddin and I am currently pursuing my Masters of Science in Management from Embry-Riddle Aeronautical University and as part of my final assignment I need to conduct a research paper. I have chosen the topic of the interaction between airline pilots and ground- based operational control personnel from the airline, commonly known by several different titles such as, Operations Controller, Flight Dispatchers, Network Controllers or Duty Controllers. These personnel have the capability of sending messages to aircraft in flight and having pilots react to them. The topic of interest is the influence these ground-based personnel have on the decision-making of the pilots. In order to gather the data on this topic, I have set up a short survey in order to solicit feedback from the target audience. The survey should not take much more than 10 minutes to complete and only requires the participant to answer a number of questions in the survey. None of the survey questions are framed in a manner that could identify the participant and the data from this survey will be kept confidentially. There is also no obligation for you to complete this survey. The target audience is airline pilots who work in organizations that have the capability for messages from their ground-based personnel to reach the aircraft while in flight. If you meet the criteria of the target audience, you can access the survey using this link: https://www.surveymonkey.com/s/6CTH5WN I would like to thank you in advance for taking the time out to fill up this survey. Back to Top Pilot Health Survey Harvard School of Public Health/Department of Environmental Health Survey: Pilots are exposed to a multitude of occupational health hazards, including fatigue, respiratory symptoms, radiation exposure, and much more, on a daily basis. Noise exposure has been associated with increased fatigue, cardiovascular effects, adverse cognitive functioning, increased stress, and hearing loss. Crewmembers could have significant exposure during flights, leading to an increase in these effects and health issues. The impact of environmental noise, such as aircraft noise, where exposures are sustained over the entire flight has not been studied for airline pilots. Harvard School of Public Health has conducted a large survey of over 4000 flight attendants, and found higher rates of fatigue, headaches, and cardiovascular and other chronic diseases, compared to the general population, which may be due to exposure to noise and other environmental factors on the aircraft. Occupational noise in the aircraft is not regulated. As a result, exposure monitoring is rare and pilots are not aware of the increased fatigue and additional health issues related to noise exposure, especially over a given duration. This also includes exposure from preflight to all phases of flight. As such, airline pilots represent a potential high risk exposure group with respect to occupational noise during flight. U.S. airline pilots are also an aging population, with the mandatory retirement age now being increased from 60 years old to 65 years old. Age is a risk factor for hearing loss, as well as fatigue and other chronic conditions that are associated to noise exposure and age. Longer flight and duty times, also increase the fatigue and also additional chronic conditions associated with noise exposure. This survey would be the first conducted for airline pilots, and would evaluate noise health related effects, such as fatigue and additional chronic conditions. It would also be used to compare pilots against flight attendants and a greater male population versus female population, of flight attendants. The results of this survey would be of value in advancing the level of understanding of the impact of noise exposures in airline pilots, especially fatigue and the effects. The flight attendant survey was conducted in conjunction with the Association of Flight Attendants, the FAA sponsored National Air Transportation Center for Excellence in the Intermodal Transport Environment (RITE) and the Flight Attendant Medical Research Institute. The Harvard School of Public Health sponsored the survey and analyzed the data. The questionnaires include detailed inquires relating to the crewmember's personal characteristics, work history, and health status. The potential association of noise exposure with fatigue and hearing loss, could have significant implications for the safety of air travel and crewmembers. Please find the website for the flight attendant survey: www.FAhealth.org. A similar website would be created and administered by Harvard for the pilot group. The survey takes approximately 15 minutes to complete. This survey would be administered electronically, at no cost , by Harvard School of Public Health. The data would be analyzed and each response is anonymous and the airline would also be de-identified for Harvard data. This important data can be used to address the issue of fatigue and the working environment. Key points: -This would be the first group of airline pilots participating in this Harvard survey and/or data collection - This survey and data collection can also be offered to other industry pilot groups. -This data will be of exceptional use to the pilot group. -You would be at the forefront of this industry research and could also lead to new developments . -There is no cost and workload is minimal (sending an email with survey/follow up communications). -Please contact Deborah Donnelly-McLay (UPS pilot/Harvard Faculty Research Assistant) for more information at ddonnelly@ipapilot.org or 561-537-0046 Back to Top Upcoming Events: ERAU UAS FUNDAMENTALS COURSE December 9 - 11, 2014 ERAU Daytona Beach Campus, FL www.daytonabeach.erau.edu/uas Event: "The Future of Regulation of SMS and QA" Symposium. Keynote: Mr. Martin Eley, Director General Transport Canada. Location: Coronado Resort Hotel @ Disney World, Orlando Florida. Date: Jan 4-6, 2015 info: http://www.dtiatlanta.com/symposium.html A3IR CON 2015 January 16-17, 2015 Phoenix, AZ http://commons.erau.edu/aircon/2015/ Air Charter Safety Foundation (ACSF) NTSB Training Center, Ashburn, VA March 10-11, 2015 www.acsf.aero/symposium FAA Helicopter Safety Effort three-day safety forum April 21-23, 2015 Hurst, Texas eugene.trainor@faa.gov www.faahelisafety.org IS-BAO Workshop Information and Registration 2 - 3 Dec. 2014 Orlando, FL USA 6 - 7 Dec. 2014 Dubai, UAE 13 - 14 Jan. 2015 Baltimore, MD USA https://www.regonline.com/CalendarNET/EventCalendar.aspx?EventID=1592658&view=Month Curt Lewis