North American 5Year Safety Plan and Workgroup Report

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North American 5-Year Safety Plan and Workgroup
Report
Ixtapa, Zihuatanejo January 24-28, 2005
Prepared by the Trinational Safety Work
Group December 1, 2004
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2004 ParticipantsSafety Workgroup

Ron McGarry Fred Dryden Roger Moore William
Wallace
Mauro Gomez Peralta Jorge Romero Garcia Ted
Bruner Jorge Garcia Gallegos Carlos Cruz Garcia
Shelley Chambers Jean Soucy Mike Laughlin Wayne
Harper Joyce Lee
Workgroup Leader
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• Summary of North American 5-year Strategic Safety
  Plan
• 2000-2005

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Mission Statement

• In partnership with NAFTA aviation authorities of
  Canada, Mexico, and the United States, reduce
  fatal aviation accidents by 2005 from the 2000
  levels as follows
•   Air Carrier fatal accident rate by 40
•  
• General Aviation total accidents by 20
•  

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Trinational Fatal Air Carrier Accident Rate per
100,000 Flight Hours
0.010
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Trinational General Aviation Accidents
1827
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Overview of Objectives

• Implement Intervention Safety Strategies for Air
  Carrier, Helicopters and General Aviation
  Airplanes
• Conduct International Aviation Seminars
• Implement NAFTA Specialty Air Services
• Developed Trinational Accident Reporting System

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Objectives

• 1. Air Carrier, Helicopter and General Aviation
  Airplanes
•      
• Through the use of the Trinational Accident
  Reporting System, determine leading and root
  causes, and contributing factors of accidents
  among the three countries for air carriers,
  helicopters and general aviation airplanes.
• Through analysis, develop and implement
  trinational accident intervention strategies.
• Evaluate the effectiveness of the implemented
  strategies.

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Objectives (Continued)

• 2. International Aviation Seminars
• (Referred to as Amigos de La Aviacion
  meetings)
• Designed to provide aviation information for
  airmen operating between the countries of Mexico
  and the United States.
• Aircraft operating rules, policy and flight plan
  information
• Aircraft airworthiness requirements
• Customs and immigration requirements
• Annually, focal points from each country
  coordinate the latest operational safety
  information and present it to meeting attendees.

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Objectives (Continued)

• 3. NAFTA - Specialty Air Services
• The North American Free Trade Agreement (NAFTA)
  identifies 14 Specialty Air Services (SAS) that
  are authorized to operate across trinational
  borders provided certain requirements are met.
  The 14 Services are

• Aerial Advertising
• Aerial Construction
• Aerial Inspection or Surveillance
• Aerial Mapping
• Aerial Photography
• Aerial Sightseeing
• Aerial Spraying

• Aerial Surveying
• Firefighting
• Flight Training
• Forest Fire Management
• Glider Towing
• Heli Logging
• Parachute Jumping

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Objectives (Continued)

• 4. Trinational Accident Reporting System
• Develop a web-based trinational accident
  reporting system.
• Use the system for trinational accident analysis
  to determine leading causes, root causes and
  contributing factors for air carrier, helicopter
  and general aviation airplane accidents in North
  America.

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Trinational Accident Reporting System Overview

• Web-based technology.
• Each CAA reviews its countrys final accident
  reports.
• Each country feeds accident information into the
  main server via the internet using a trinational
  format.
• The system can automatically query and sort
  reports and report elements.
• The system has tri-lingual capability in English,
  Spanish, and French.
• The Safety Workgroup (SWG) reaches a consensus on
  the leading and root cause(s) and contributing
  factors for each accident report.
• Based on the SWG analysis, trinational accident
  prevention strategies are recommended for
  implementation and evaluation.

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2004 Safety Workgroup Report
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Workgroup ReportContents

• International Aviation Safety Seminars
• Specialty Air Services
• Sub-Workgroups
• Air Carrier
• Helicopter
• General Aviation Airplanes

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International Aviation Safety Seminars

• The Trinational International Aviation Safety
  Seminars (Amigos de La Aviación) airmen education
  meetings have been held since 1984.
• Seminars were held in Saltillo, Mexico, March
  26-27 2004, and San Diego, California, August
  20-21, 2004.
• The next seminar is planned for Guadalajara,
  Mexico in March, 2005.

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Specialty Air Services

• The Workgroup recommendations were accepted by
  the NAFTA Steering Committee and amended advisory
  material has been processed.
• The NAFTA Advisory Workgroup will meet in Mexico
  City in July, 2005.
• They will evaluate the Trinational Specialty Air
  Services Advisory Material and make
  recommendations to update it.

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Air CarrierSub-Workgroup
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2004 Goals Air Carrier Sub-Workgroup

• March 2003 through 2005
• Implement one or more common safety
  intervention strategy(s) at each Trinational CAA
  . 

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Air Carrier Accomplishments

• The Workgroup reviewed the top eight root causes
  for air carrier accidents in North America.
• Not following procedures-Operations
• Failure of Equipment/Component
• Poor Judgment-Operations
• Aircraft Handling
• Lack of Crew Coordination
• Not following Proper Procedures-Maintenance
• Diminished Situational Awareness
• Communication Clarity

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Air Carrier Accomplishments (Cont.)

• Each Trinational country reviewed its own
  internal aviation safety strategies to see which
  ones could best counter the eight trinational
  root causes.
• The workgroup reviewed each CAAs proposals and
  recommended the following joint safety
  strategies
• Confidential Safety Reporting Programs for
  Airlines and their Employees
• Re-Examination of Airmen
• CAA ISO (or equivalent) Process Evaluation
• Quality Assurance Programs
• Communication Clarity
• Line Operations Safety Audits (LOSA)

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Air Carrier Accomplishments (Cont.)

• Confidential Safety Reporting Programs for
  Airlines and their Employees
• These programs permit the identification and
  disclosure of inadvertent mistakes by airlines
  and or their employees so the safety issues can
  be identified, analyzed and corrected without
  fear of reprisal from either the company or the
  CAA.
• Re-Examination of Airmen
• This policy gives the CAA the ability to
  re-examine a certificated airmen whose safety
  performance is marginal. This could be done by
  the CAA itself or delegated to industry such as
  an airline pilot check airman. Depending on the
  CAA, it could be done at anytime or during airmen
  testing and proficiency events.

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Air Carrier Accomplishments (Cont.)

• CAA ISO Process (or Equivalent) Evaluation
• This safety strategy requires development,
  documentation
• and registration of an internal quality
  management system
• (QMS) such as the ISO 9001-2000 standard or
  equivalent.
• The results of successful development and
  documentation of
• CAA effective processes will enable each CAA to
  more
• effectively meet the needs of its customers and
  improve the
• consistency of CAA services, measure its output
  and ability to
• meet its core mission and objectives, and bolster
  its credibility
• within the aviation environment, regarding the
  services it
• provides.

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Air Carrier Accomplishments (Cont.)

• Quality Assurance Programs
• These programs are designed to improve the
  quality of regulatory oversight by each CAA and
  improve the level of operational safety provided
  by the air carriers themselves.
• The specific programs are identified by
  different names such as Systems Safety, Air
  Transportation Oversight System, Safety
  Management System or Quality Assurance.

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Air Carrier Accomplishments (Cont.)

• Communication Clarity
• Each CAA agreed to comply with ICAO Annexes 1, 6,
  10 and 11 that establish language proficiency
  requirements for pilots and controllers. This
  strategy will require, as a standard, either the
  use of English or the language spoken on the
  ground. All international pilots and controllers
  must demonstrate proficient English language
  capability to the ICAO Operational Level 4
  standards, by 2008 when the testing requirements
  take effect. 
• Line Operations Safety Audit (LOSA)
• Each CAA would support the use of LOSA by air
  carriers through a regulation or policy.
•  

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2006-2010 Goals Air Carrier

• Phase into the new 5-Year Strategic Safety Plan
• Continue to Implement Strategies
• 2006-2010 Measure the effectiveness of the
  programs
• 2006-2010 Make adjustments as necessary

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HelicopterSub-Workgroup

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Helicopter2004 Goals

• March 2003 through 2005
• Implement one or more common safety
  intervention strategy(s) at each Trinational CAA
   
•  

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HelicopterAccomplishments

• July 2000 Established Trinational Work Group
• January 2002 Analyzed reporting system data
  and identify leading causes of accidents
• October 2002 Identified root causes
• October 2003 Recommend and implement safety
  intervention strategies

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HelicopterTrinational Root Causes

• The Work Group reviewed the top ten root causes
  for helicopter accidents in North America.
• Aircraft Handling
• Improper Airspeed
• Poor Judgment-Operations
• Not following procedures-Operations
• Failure of Equipment/Component
• Not following Proper Procedures-Maintenance
• Complacency
• Operating Environment
• Diminished Situational Awareness
• Fatigue

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HelicopterTrinational Intervention Strategies

• Each Trinational country reviewed its own
  internal aviation safety strategies to see which
  ones could best counter the ten trinational root
  causes.
• The Workgroup reviewed each CAAs proposals and
  recommended the following joint safety
  strategies
• Voluntary Disclosure Programs
• Environmental Operations Training
• Improve Helicopter Flight Training Programs
• Flight and Duty Time Limits
• CAA Risk Based Oversight
• Establish A Safety Culture
• Encourage Development and Dissemination of
  Aviation Safety Information Tri-Laterally

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HelicopterTrinational Intervention
Strategies(Continued)

• Voluntary Disclosure Programs
• These programs allow disclosure of inadvertent
  mistakes by air operators and their safety
  employees without fear of substantial penalty
  from either the company or the CAA.
• The reports are analyzed and corrective action is
  taken to fix the identified problem(s).
• Environmental Operations Training
• Each CAA agreed to comply with the 2008 ICAO
  English language proficiency requirements for
  pilots and controllers.
• Ensure SAS operator training programs include
  additional training unique to the operations
  being conducted.

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HelicopterTrinational Intervention Strategies
(Continued)

• Improve Helicopter Flight Training Programs
• This strategy stresses the importance of sound
  initial training practices in the areas of pilot
  judgment and basic flying skills. Many of the
  accidents reviewed indicated a lack of judgment
  and poor basic flying skills.
• Flight and Duty Time Limits
• Require specific flight and duty time limits for
  certain commercial flight crewmembers and
  maintenance personnel.

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HelicopterTrinational Intervention
Strategies(Continued)

• CAA Risk Based Oversight
• Establish risk based oversight allowing each CAA
  to allocate resources effectively.
• The specific programs are identified by different
  names such as Systems Safety, Air Transportation
  Oversight System, Safety Management System or
  Quality Assurance.
• Establish/Improve the Safety Culture
• Establish/improve the safety culture within
  each CAA and air operator.

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HelicopterTrinational Intervention
Strategies(Continued)

• Encourage the Development and Dissemination of
  Aviation Safety Information Trilaterally
• Allocate resources to facilitate the
  dissemination of aviation safety information
  trilaterally. This will help to ensure the
  success of the Helicopter intervention
  strategies.

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2004 Accomplishments Helicopter

• Implemented several strategies trinationally
• Suspected Unapproved Parts Safety Program 
• Safety Culture programs ALAR, CFIT, FOQA, and
  Safety Seminars
• Web Based Safety Information through Worldwide
  Web access

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2006 - 2010 Goals Helicopter

• Continue to Implement Strategies
• 2006 - 2010 Measure the effectiveness of the
  programs.
• 2006 - 2010 Make adjustments as necessary

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General Aviation Airplane Sub-Workgroup
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General Aviation Airplane Accomplishments

• October 2002 Agreed to add general aviation
  accidents to the reporting system
• 2003 - Established workgroup to identify leading
  causes of accidents
• July 2004 - Initiated root cause identification

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General Aviation Airplane2005 Goals

• Recommend intervention strategies
• Establish workgroup to implement recommendations
• Implement recommendations

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General Aviation AirplaneTrinational Accident
Analysis

• The Workgroup will review general aviation
  airplane final accident reports from 1997 through
  2000.
• Canada 83
• Mexico 105
• U.S. 209 (Randomly Selected -- 6387 U.S.
  Reports)
• 397 Total Reports to Be Reviewed
• 238 of the 397 total reports have been analyzed

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General Aviation AirplaneNext Steps

• Complete analysis of general aviation accident
  reports and determine top Trinational root causes
  by May 2005
• Complete development of intervention strategy
  recommendations by September 2005

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General Aviation Airplane2006-2010 Goals

• Continue implementing the trinational airplane
  intervention strategies
• Continually evaluate the effectiveness of the
  trinational intervention strategies
• Make adjustments as necessary

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QUESTIONS?