Safety Enhancement in Helicopter Operations
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Transcript of Safety Enhancement in Helicopter Operations
Safety Enhancement in Helicopter Operations
IHST Latin American Regional Conference
Sao Paulo , Brazil
Somen ChowdhuryExecutive Committee Member, IHST
VP Internationl, AHS
Contents
• Why IHST : Background• Objectives, Goals & Implementation• Safety : in Design, manufacturing &
operations - Every Step of the Way• IHSS 2005 Montreal Conference • IHST Regional Cooperation• IHSS 2007• Conclusions
Background: Current State of Affairs
Too many Accidents ~ 565/year worldwide Lives lost Poor Public imageBusiness loss Injuries Too expensive
UNACCEPTABLE
PumaCrash.wmv
24,294 Worldwide Civil Helicopters
Worldwide distribution by country
India (140)0.53%
South Africa (563)2.14%
Germany (698)2.65%France (796)
3.03%England (1080)
4.11% Canada (1801)6.85%
Brazil (435)1.65%
Australia (1215)4.62%
Others (4386)16.67%
New Zealand (642)2.44%
Mexico (368)1.40%
Japan (799)3.04%
Italy (642)2.44%
United States (12743)48.44%
Six Years Data2000- 2005
• Civil & Military uses
– 3049 accidents– 2643 fatalities– 1027 serious injuries– 5439 minor/ no injuries
Worldwide Helicopter Accidents/ year1980-2005
Worldwide Helicopter Accidents/Year1980 - 2005
0
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Acc
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US Civil Registry Non-US Civil & Military US Military & USCG (ABC)
Source : Roy Fox Bell Helicopter
Accidents rates per 100,000 hr
• As per AUA ( Mike Kriebel):– 2,225,000 total helicopter hours in USA in
2004– Accident rate per 100,000 flight hours : 8.09– Fatal rate 1.48– Turbine civil accident rate : 5.11– By contrast : U.S. Air carrier rate : 0.159
• US data shows no change in rate over 24 years
Need to bring down helicopter accident rates
Bell civil turbine accident causes worldwide (1994-2003)
Airworthiness14%
Non-AW (human, etc.)74%
Unknown12%
Source : Roy Fox, Bell Helicopter Textron
Causes of Accidents
• Bell Civil turbine accident causes world wide (Pie chart)
– Non Air worthiness ( Human) 74%– Unknown 12%– Airworthiness 14%
Accident status in SAM countries
• SAM: covers South, Central and Carribean countries
• Reference ICAO report 297- AN/171presented in ICAO conference RAAC/9 , Santiago Chile 2005
• Data primarily discusses large transport aircraft accidents
• Conclusions of report generally valid for helicopter operations
SAM countries ( contd)
• 1992 – 2001 ( 10 year period) Transport A/c accident dataAsia-Australia 26.8% of all accidents Europe 21% of accdnts 29% of oprnsN.America 20.5% of accdnts 42% of opnsCentral &S. America 16.8 % vs 9%Africa 14.5%
ICAO Conclusion : accidents 3.8 times more likely in Latin American countries than in
USA & Canada
SAM countries (contd)
• ICAO statistics (297 AN/171 ADREP) mentions hull losses in the region is 2 to 3 times world average (from 1993 to 2002)
• Flight Safety Foundation suggests a risk multiplier of 5 be considered for CFIT for Central & S American airspace compared to Australia /N Zland /US & Canada
ICAO report conclusions• Air cargo operations hull losses have tripled from 1993
to 2002 world wide : accidents 22 times more frequent than passenger operations
• Cause : Less attention paid; operational hours are different; older fleet
• Helicopter accidents are frequent ( do not have separate numbers)
• Main causes: Human Factors, maintenance, operational issues, situational awareness, training
• Helicopter accidents globally about 50 times more than passenger transport aircraft
Less attention and lack of enforcement of safety practices seem to be the primary cause of increased accidents
The Real Challenge Iceberg Theory
Hidden or Unseen Conditions are Below The Surface
The BIG Picture
1
300
1200
10
Heinrich Ratio
Serious Incidents
Accidents
Incidents
Near Misses
The ‘Swiss Cheese’ Model
Some holes dueto active failures(present in use)
Other holes due tolatent conditions
(present, not visible)
Successive layers of defenses, barriers, & safeguards
Hazards
ACCIDENT
Barriers areSafety Nets
When barriers fail
The Danger…- is all around us!!!
Goals & ImplementationNeed to Act
• Can the industry do better ?
• How ?
• Need a mitigation Strategy
Need to Act
• Helicopter operations are essential• There is a need to have a
comprehensive hard look as to how we operate and do business
• There is an absence of any concerted plan so far
• IHSS 2005 was held in Montreal to kick – off the accident reduction process
CAST (commercial aviation safety team) was considered a good model to follow
IHSS 2005 Montreal Conference
• Four day program– Training Sessions
• Management• Military• Maintenance
– Invited Speakers– Paper sessions
• Military & Civil missions• Human Performance &
Training• Design & Maintenance• Accidents & Regulation• Management & Economics
– Discussion panels – Plenary session
• Results–Attendance ~250–International
• 13 countries • 5 continents
–Industry wide• Government
•Regulatory•Accident Investigators
• OEMs• Mission groups• Operators•Pilots•Maintainers•Aviation PressIHST set up
IHSTMission
To provide government, industry and operator leadership to develop and focus implementation of an integrated, data-driven strategy to improve helicopter aviation safety worldwide, both military and civil.
VisionTo achieve the highest levels of safety in the international helicopter communities by focusing on appropriate initiatives prioritized to result in the greatest improvement in helicopter aviation safety. Goal
To reduce helicopter accidents by 80%By 2016
Executive Committee
IHSTIHST
JHSATJHSAT JHSITJHSIT
Subcommittees Subcommittees
Secretariat
IHSTOrganisation
JHSAT - Joint Helicopter Safety Advisory TeamJHSIT - Joint Helicopter Safety Implementation Team
Implementation:Process
Influence Safety Enhancements -
Worldwide
DataAnalysis
Set SafetyPriorities
Achieve consensus onpriorities
Integrate into existing work and distribute
Implement Safety Enhancements - U.S.
Agree onproblems and interventions
Charters Joint Helicopter Safety Analysis Team (JHSAT) Charter:
Conduct, review and analyse accident report and identify causal factors;
Investigate and recommend improvements and develop mitigation strategies to meet 80% goal ; periodic status measurements;
Draft action plans to determine intervention strategies and milestones for IHST approval.
Joint Helicopter Safety Implementation Team (JHSIT) Charter: Develop and prioritize implementation plan; Carry out rigorous cost-benefit analysis for implementation strategies to
achieve IHST goals; Develop action plans; Coordinate implementation of IHST-approved strategies; Develop and track performance; Determine progress in meeting major milestones and effectiveness of
interventions.
Buy-in Worldwide: Government, Military & Civil Groups, OEMs
• USA– AHS - American Helicopter Society
International– AAMS - Association of Air Medical Services– FAA - Federal Aviation Administration – FSF - Flight Safety Foundation Inc.– HAI - Helicopter Association International– NAVAIR - U.S. Navy - Naval Safety Center– NTSB - National Transportation Safety Board– U.S. Army Combat Readiness Center
• Europe– BEA - Bureau d'Enquêtes et d'Analyses pour
la Sécurité de l'Aviation Civile– EHA - European Helicopter Association
• Canada– TCCA - Transport Canada Civil Aviation– TSB - Transportation Safety Board of
Canada• India, Australia & now Brazil & Latin
America (ABRAPHE, CENIPA)
USABellBoeingSikorskyRRPratt & WhitneyHoneywell
EuropeEurocopterAugusta-WestandTurbomeca
CanadaCHC Helicopters
Brazil : Petrobras,Lider
Need all operators to buy-in
D(OEM)
Original Equipment
Manufacturer
OEM
OEM
OEM
Approach
• How do we achieve the best decisions?
• Regulatory obligations
• Voluntary Actions
Regulation
Regulation = An enforced rule of conduct
• Tells industry: What to do / What not to do• Outlines legal Obligations & authorities• Assumes the industry will by default not comply• Directed towards meeting public expectations• Elements of posturing
• New Approach : sharing of responsibilities
Voluntary Compliance In the interest of one’s business, lives and efficiency of operations
• Develop a voluntary code of conduct : reflects maturity of the industry
The Safety management system
• Need to Outline a plan• Will be a proactive system• Will be documented• Will have a safety oversight system• Training• Quality Assurance• Emergency preparedness• A closed loop corrective system
Product Life CycleDesign
Manufacture
Operations
Maintenance
Modifications & Repairs
ContinuingAirworthiness
Design FieldOperation
Airworthy
Product
S M S S M S S M S
3 years 20-30 years
SafetyFailure Prevention
technologies
Reliability-anti corrosion
-- reduce vibration
Survivabilitytechnology-ext. airbag
-Crash worthy seats& fuel tanks
-- floatation gear-- egress
Quality Assurance- No Flaw
Operational regulations Maintenance
Human Factors-Training of all parties
--Pilot aids-Mission comprehension
Manufacturing
Safety: Every Step of the Way
IHST StrategyContinuing Airworthiness
Short term
Action
Design• Failure Prevention Technologies
– Fail safe design vs safe life design/ CPR for evolutionary design– Composite structures : prevents catastrophic failures– HUMS : DPHM; embedded sensors
• Reliability– Corrosion control– No single point failure for critical components : 10-9
probability– FMEA
• Survivability– Energy absorbing seats– Crash worthy fuel tanks– Energy absorbing structures– egress
RETURN
DESIGN
ENGINEERING MAINTENANCE
SYSTEMS STRUCTURES SYSTEMS STRUCTURES
STRUCTURALMAINTENANCE
REQUIREMENTS- Damage Tolerance Insp.
- Safe Life ComponentRetirements
SYSTEMS/POWERPLANTSMAINTENANCE
REQUIREMENTS- Maintenance Significant Items
(MSIs)
STRUCTURALMAINTENANCE
REQUIREMENTS- Structure Significant Items
(SSIs)
MANUFACTURER- Servicing
- Maintenance Tasks- Repair Instructions
- Components Manuals- Inspection Techniques
- Troubleshooting- Tooling
- Etc.
ICAs
MAINTENANCEREVIEW BOARD
REPORT
Functional HazardsAnalysis (FHA)
Systems Safety Analysis (SSA)
- Candidate CertificationMaintenance Requirements (CCMRs)
- Major Futur Consequences
Certification MaintenanceRequirements (CMRs)
AIRWORTHINESSLIMITATIONS
Probability and Severity Relationships
EFF
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NA
IRC
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FT A
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OC
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Normal Nuisance Operatinglimitations;emergencyprocedures
Significant reductionin safety margins;difficult for crew tocope with adverseconditions:passenger injuries
Large reductio insafety maragins; crewextended because ofwork load or environ-mental conditions,serious injury ordeath of small num-ber of occupants
Multipledeaths,usually withloss ofaircraft
FAR
25
PR
OB
AB
ILIT
Y(R
EF.
ON
LY)
PROBABLEEXTREMELY
IMPROBABLE
JAR
25
PR
OB
AB
ILIT
Y
PROBABLE
REASONABLYPROBABLE
EXTREMELY
IMPROBABLE
CA
TEG
OR
YO
FE
FFE
CT
MINOR MAJOR HAZARDOUSCATA-
STROPHE
IMPROBABLE
IMPROBABLE
FREQUENT REMOTEEXTREMELY
REMOTE
100 10-1 10-2 10-3 10-4 10-5 10-6 10-7 10-8 10-9
Failure risk mitigation strategy
HAZARD SEVERITY
HAZARDPROBABILITY
Catastrophic
Level 1
CriticalLevel 2
Significant
Level 3
Negligible
Level 4
Frequent – Level A 1A = EXTREMELY HIGH
2A = EXTREMELY HIGH
3A = HIGH 4A = MEDIUM
Probable – Level B 1B = EXTREMELY HIGH
2B = HIGH 3B = MEDIUM
4B = LOW
Occasional – Level C
1C = HIGH 2C = HIGH 3C = MEDIUM
4C = LOW
Remote/Seldom - Level D
1D = MEDIUM 2D = MEDIUM 3D = MEDIUM
4D = LOW
Improbable/Unlikely - Level E
1E = LOW 2E = LOW 3E = LOW 4E = LOW
Manufacturing
• Flawless manufacturing– Reduce MDRs– Improved inspection technologies– Reduced variability
RETURN
Monitoring of Fielded Systems
• Service Difficulty Reporting System (SDRS)
• Computerized Airworthiness Information System (CAIS)
• Civil Aviation Daily Occurrence Reporting Systems (CADORS)
Murphy’s Law No. 3If anything can possibly go wrong, it will!
MAMA
MIA !
Murphy’s Law No. 8
By making something perfectly clear, someone will be totally confused!
???
Field & Flight OperationsHuman Factors
RETURN
The door opened in flight!
Human Factors is cause of 75% accidents
It is critical to enhanced safety
Need to integrate HF in maintenance
Provide smarter maintenance aids
Provide increased situational awareness inputs to pilots
IHST Regional CooperationInternational Cooperation is essential
– Regulators– Operators– OEMS
In all regions of the world.
We started with S Asia, Australia then BrazilGo to: S.Africa, Middle East, JapanRussia
We are all in it together
IHSS 2007• Montreal• Dates –September 19 to 21, 2007• Action Plan from JHSAT, JHSIT • Report on worldwide participation
Pictures from www.tourisme-montreal.org
Conclusions
• Need to act urgently in improving the safety of helicopter operations
• Important area of focus is human factors and situational awareness
• Get involved in the IHST process• Accidents can be avoided : need to set up
the right process• The present accident rates in the
helicopter industry are unacceptable
Questions?Please check out the IHST website:
www.ihst.org
Thank you