Letter to NTSB concerning early access to factual data - Pull early, pull often! - Safety and Training Programs - Cirrus Owners and Pilots Association

Letter to NTSB concerning early access to factual data

Today, I was invited to submit comments on a form used by NTSB investigators to prepare for press briefings after an aviation accident. This outreach to GA type clubs was part of the NTSB focus on GA safety seeking ways that can the NTSB help us by providing more factual information immediately after an accident. "Improving General Aviation Safety" was added to the NTSB Most Wanted List this year. After giving my comments, I took advantage of the dialog to make a point about early release of factual data. 

 

Email to NTSB Staff

Some additional background, since you invited a response! Wink

COPA has been acknowledged by knowledgable people as one of the leading aviation safety organizations for the quality of our accident discussions, for the extensive safety programs we created and operate, and for the results of our safety initiatives. COPA members show up in fatal accident reports about 1/2 of the rate you would expect compared to non-members if the attention to safety were uniformly distributed. And among active COPA members, meaning those who attend our recurrent training program or post on the discussion forum frequently, they show up about 1/4 of the expected rate.

As well, the COPA community routinely discusses accidents in the Cirrus fleet with expertise provided for weather factors, flight path analysis and visualization, LiveATC recording analysis, preflight and inflight decision making, regulations, mechanical issues, and lots of training and human factors issues. Fortunately, the number of Cirrus accidents has dropped precipitously in the past 6 months -- one fatal in Brazil in February, then one fatal in October -- in a fleet of 5000+ airplanes, that's dropped our fatal accident rate to 1.44 per 100,000 hours compared to the 2.38 of GA personal & business flying.

Consequently, COPA accident discussions have swerved towards discussing other notable GA accidents, most recently the Columbia 350 that crashed Sunday near Winston-Salem. The interest in safety seems insatiable among our community members.

In June, I attended the NTSB GA Safety Forum and spoke with several NTSB staff about exactly this issue -- how to keep pilots more engaged in safety discussions. 

In August, I provided the attached email message to Avidyne who met with the NTSB Board and discussed ways to make additional factual data available to the GA community.

Subject: COPA posts by date for most active accident discussion

Can you guess when the NTSB reports were issued?

Accident date -- Nov 26
Preliminary report -- Dec 7
Factual report -- April 27
Probable cause -- May 16

There were a total of 665 posts and 29,404 views. (Sorry, but charting views by date is not feasible.)

My point with this slide was the great and timely activity soon after the accident is a teachable moment. We have the attention of a large audience, perhaps 1000+ pilots who read these COPA accident discussion threads. We have little factual information at that time. You see the small bump in activity after the Preliminary Report -- and then nothing until the Factual Report and Probable Cause reports come out in record time, just 6-7 months. BTW, the oldest Cirrus fatal accident still without a Factual Report occurred 32 months ago (WPR10FA383 at Phoenix, AZ) and there are 14 fatal accidents without Factual Reports.

There are two items of factual data that would be of timely interest to the COPA community: 1) the flight path data recorded by the airplane and 2) the experience and recent training history of the pilot.  

I realize that the Cockpit Displays Analysis Report would need to be sequestered until the Factual Report, since that contributes to the investigation process. However, the factual data of the flight path would help clarify what the airplane was doing during the accident chain so that the teachable moment can focus on what actually happened rather than wild speculation of what someone imagines could have happened.

The interest in the facts about the pilot's recent training history reflects both a timely desire to encourage better and more effective training among the COPA Pilot community as well as encourage the NTSB to place greater emphasis on human factors in their investigation process. Major accident investigation reports include a section entitled Human Factors, but most GA accidents do not. Yet, pilots are known to be determined as the cause of a huge percentage of GA accidents. BTW, a recent count of Cirrus fatal accidents revealed that 25 of 26 NTSB probable causes were attributable to pilot actions -- that's 96%!

We have a teachable moment right after the accident during the intense discussion. The NTSB could help our community by sharing factual data as soon as it is available.

This is a change in the lengthy investigation timeline, for which I appreciate the important reasons for due deliberation by the investigation team. But what's being done now is not working, so something like this needs to be considered for change.

 

Have fun!

 

Cheers
Rick

 

Comments
  • I just read about the failed deployment of a repack chute in Texas.  Our plane was repacked last year.  What do we do now that we question the viability of the new rocket motor.  Can they be checked to confirm their use ability, or are we stuck waiting to see if another fails?

    I bow down to the pilot in the Texas accident for his skill and luck.  We owners need fast investigation of this by Cirrus, and the rocket motor manufacturer. Any owner wishing to talk about this can reach me at davepechan@yahoo.com

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