NTSB Most Wanted List 2015

If the NTSB puts out a “Most Wanted List” in reference to aviation problems, chances are they’re probably significant problems because these problems frequently aid in accidents. For general aviation, I feel that because there are more accidents in this area than in commercial, and a big issue seems to be not noticing the warning signs of a stall/spin, it would have to be a significant issue. In my opinion, the greatest factor negatively impacting safety for the general aviation would be situational awareness, in general, during heavy workload areas during flight. For instance, the Prevent Loss of Control in Flight in General Aviation article has three different instances where the planes would enter inadvertent aerodynamic stall and spin coincidentally. This is not to say that this is perhaps a major issue in itself, but rather some pilots being distracted with other maneuvers, or not recognizing the warning signs of a stall (2015). “The reason we still see these kinds of events is that we don’t really train to avoid stalls and spins. Most of the training is to show you how to get into a stall; and recover to satisfy your checkride – no spins. The spin becomes the boogie man because we don’t expose primary students to it. (We barely expose instructors to spins). This creates unnecessary anxiety that can turn up when you find yourself inadvertently in a spin – read panic. Also, we don’t teach you what it will look like when you get into an unintentional stall; safe to say that it won’t be straight and level flight or a mild 20 degree bank” (Owens, 2012).

As for commercial aviation, this article emphasizes ways to strengthen procedural compliance, and company compliance. In particular, the lack of callouts (or CRM in general) can cause or increase confusion on the procedures that have or have not already been accomplished (Strengthen Procedural Compliance, 2015). CRM alerted the aviation industry to the human interactions that are an integral part of any team performance. This training has the potential to save lives and money, as well as prevent accidents and lawsuits. While no one can assess how many lives have been saved or crashes averted as a result of CRM training, the impact has been significant. LOSA data demonstrate that 98 percent of all flights face one or more threats, with an average of four threats per flight. Errors have also been observed on 82 percent of all flights with an average of 2.8 per flight. Flawed group dynamics were evident when an Air Florida plane lifted off from Washington's National Airport on a winter day in 1982. Ice in a sensor caused the speed indicators to read too high, leading the captain to apply too little power as the plane ascended:

First Officer: Ah, that's not right.   Captain: Yes, it is, there's 80 [referring to speed].   First Officer: Nah, I don't think it's right. Ah, maybe it is.   Captain: Hundred and twenty.   First Officer: I don't know.
It wasn't right, and the first officer's muting his concerns led to the plane's stalling and crashing into a Potomac River bridge, killing all but five people on board (Making Air Travel Safer, 2015).

The NTSB list of recommendations for general aviation and commercial aviation for each of these topics do seem overall reasonable. For commercial aviation, the recommendations given to the FAA and the industry include 1) requiring pilots to conduct landing distance assessments, revising the procedures for handling thrust reverser lockout after landing, and discontinuing dive-and-drive approaches in non-precision approaches. They also emphasize requirement of pilot training programs for monitoring skills and workload management (Strengthen Procedural Compliance, 2015).

“In 2001, the FAA announced that the industry should discontinue the use of a ‘dive and drive’ process on non-precision approach procedures, since they contribute to controlled flight into terrain (CFIT) accidents, the leading cause of fatal commercial air accidents worldwide. Instead, the FAA advocates the use of procedures and training for a stabilized continuous descent on non-precision approaches. Some airlines have gone so far as to implement procedures that require pilots to immediately initiate a missed approach if they don’t see the airport when they reach the MDA; they are not permitted to continue ‘driving’ to the MAP” (Trescott, 2013).
As for general aviation, the recommendations given include pilots needing to avoid conditions that can lead to aerodynamic stalls and situations approaching wing critical AOA and decrease of airspeed (Prevent Loss of Control, 2015).

I feel as though the FAA and the airline companies, for the most part, already have their own implementations of these recommended procedures. For commercial aviation in terms of the thrust reverser lockout and landing distance assessment, put slightly more concentration on those subjects during simulator training. As for the CRM issue, it’s just a matter of awareness, and it is one of the largest areas covered in systems safety. Pilots know about the sterile cockpit, they know about callouts, and they know about situational awareness. The industry can continue to promote CRM positively, as they have been doing. I am not necessarily saying lack of CRM is not an issue, but it somehow always seems to pop back up in a major aviation NTSB report.

References

Making Air Travel Safer Through Crew Resource Management. (2014, February 1). Retrieved February 8, 2015, from http://www.apa.org/research/action/crew.aspx

Owens, B. (2012, September 21). Stall Spin Awareness: What Your Instructor Should Be Telling You. Retrieved February 8, 2015, from http://iflyblog.com/stall-spin-awareness-what-your-instructor-should-be-telling-you/

Prevent Loss of Control of Flight in General Aviation. (2015, January 1). Retrieved February 8, 2015, from http://www.ntsb.gov/safety/mwl/Documents/MWL_2015_Factsheet_07.pdf

Sterile Flight Deck (OGHFA BN). (2010, October 26). Retrieved February 8, 2015, from http://www.skybrary.aero/index.php/Sterile_Flight_Deck_(OGHFA_BN)

Trescott, M. (2013, August 20). No more ‘dive and drive’ instrument approaches. Retrieved February 8, 2015, from http://blog.aopa.org/opinionleaders/2013/08/20/no-more-dive-and-drive-instrument-approaches/

 Strengthen Procedural Compliance. (2015, January 1). Retrieved February 8, 2015, from http://www.ntsb.gov/safety/mwl/Pages/mwl10_2015.aspx