Safety investigators from around the world will converge in Canberra this month to take part in the ATSB’s Human Factors for Transport Safety Investigators course.

Participants from Indonesia, Finland, New Zealand, Taiwan, Bangladesh, Singapore, Nauru and Vietnam will join Australians for an overview of human factors in safety-critical systems in the aviation, marine and rail industries.

ATSB Manager International Richard Batt says demand for the course, run twice per year, is always high.

“The ATSB is a leader in the application of human factors to transport safety investigations and is well placed to share its extensive knowledge,” Dr Batt said.

“The course was originally designed for ATSB staff but we recognise our commitment to improving safety investigations internationally in aviation, marine and rail industries.”

Dr Batt said human factors comprise the effects of physical, psychological and environmental factors on human performance in different task environments.

“This is a multi-disciplinary science that applies knowledge about the capabilities and limitations of human performance to all aspects of the design, manufacture, operation and maintenance of products and systems.

“After any accident or incident, a thorough operational and technical investigation is essential to determine what happened. Often it is only by investigating humans factors at both the operational and organisational level that it can be determined how and why events occurred.

“I should reiterate that in any ATSB investigation, we do not seek to lay blame or apportion liability. We incorporate this important philosophy throughout all aspect of the course.”

The course will cover issues such as perception, memory, attention, situational awareness, decision making, fatigue, stress, workload, ergonomics, safety culture as well as aviation, marine and rail case studies.

Presenters at the course come from the ATSB, the Australian Maritime Safety Authority, Macquarie University as well as private organisations Humanology, Flight Medicine Systems, Convergent Safety and Westwood-Thomas Associates.

ATSB senior research analyst Dave Wilson is working on a research investigation that will raise awareness of potential weather-related risks among pilots and also examine the effectiveness of rules that have been in place for more than 30 years.

Weather planning rules in Australia are unique compared to countries in Europe and North America. Because weather in Australia is generally good, risks are very low. But when weather is unsuitable for landing, these differences can have a real-world effect on aircraft operations. It is these effects that Dave’s research aims to quantify.

A number of unforecast weather episodes relating to flights into major Australian airports have led to unforeseen diversions, holding and, in some cases, landing below published safe limits. Dave’s research is seeking to understand how the reliability of weather forecasts affects the ability of flight crew to conduct safe landings.

“I want to help decrease the likelihood of pilots being exposed to unexpected and unsuitable conditions for landing,” Dave said. “The likelihood of an accident happening because of conditions unsuitable for landing is low. But in making it even lower, the probability of a major accident happening reduces considerably.

“Initially I’m looking at Mildura and Adelaide airports. At Mildura, 99 per cent of the time, the weather is suitable to land a large aircraft. But based on the data I’ve looked at, there is still a remote possibility you may have an unreliable forecast. With the volume of air traffic, this could affect up to four aircraft per year.

“If you look at Adelaide, the chances of a single flight crew being exposed to an unreliable forecast are lower. However, when you take into account fluctuations in weather reliability, and the aircraft traffic arrival patterns (around 50,000 per year), the potential to result in a catastrophic accident increases. That’s what we want to avoid.

“If you’re in the air and you get to the point of last safe diversion—where you’ll be committed to landing at the planned destination—if the current forecast predicts marginal conditions, questions are raised as to whether continuing to the planned destination or diverting to an alternate destination should be required. This scenario has been a particular focus of this research.”

Dave has a vested interest in his research. Several actually. He’s a pilot who first flew solo when he was a 15-year-old student at Caringbah High in Sydney—well before he could legally drive. The opportunity of subsidised flying with the Australian Air Force Cadets was too good to knock back. He has since flown aerobatics out of Bankstown Airport but has undertaken little flying over past two years while pursuing this research.

Dave also has degrees in Aeronautical Engineering and Physics from Sydney University. It was there he attended a guest lecture by Pierre Blais from the Directorate of Defence Aviation and Air Force Safety (DDAAFS(Opens in a new tab/window)), which set him on a path to the ATSB.

“It was then that I thought investigating aviation safety would provide the ultimate career path for me. I find it both meaningful and challenging,” Dave said.

The research was initially going to secure Dave a Master’s degree. But he is now upping the ante and aiming to pursue a Doctorate. A stumbling block is finding reviewers with sufficient expertise in a related field. When you’re breaking new ground, this is often the case.

After first working at the Department of Infrastructure as a vehicle compliance engineer, Dave came to the ATSB to embrace his love of aircraft, engineering and how things work. Now with six years under his belt, Dave is also considering his future. “I’m happy as long as I’m being challenged,” he said. “But after this research is completed, I wouldn’t mind also undertaking a broader range of transport safety investigations.”

Research on Adelaide and Mildura aerodromes is expected to be published by the end of 2016. Progressive reports for each major aerodrome in Australia and four of our remote island aerodromes (Norfolk, Cocos, Christmas and Lord Howe) will be progressively released over the next year or two.

If you hold a current Australian ATPL and CPL licence and have worked as an Australian charter or airline pilot in the past 12 months, we would like to hear from you.

The online survey will take around 15 minutes to complete. The results will establish a benchmark for the state of aviation safety in Australia. Responses will assist the ATSB to identify areas in Australian aviation safety that can be targeted for development.

All responses will be anonymous. We’ll publish our analysis of the responses in aggregated form on the ATSB website.

Complete the online survey.(Opens in a new tab/window)

The Australian Transport Safety Bureau (ATSB) is concentrating on the risk of wildlife strike during the 2016 Airport Safety Week.

Airport Safety Week, from 17–21 October, is a safety campaign that is specifically tailored to engage with employees and contractors working on an aerodrome.

ATSB Chief Commissioner Greg Hood says wildlife strike statistics provide a reminder to aircraft and aerodrome operators to be aware of the hazards posed to aircraft by birds and non-flying animals.

“Occurrences involving aircraft striking wildlife remain the most common aviation occurrence reported to the ATSB,” Mr Hood said. “Strikes with birds continue to be a significant economic risk for aerodrome and airline operators and a potential safety risk for pilots.”

Last year, 1775 wildlife strikes were reported to the ATSB, 97 per cent involving birds.

“The growth of reporting wildlife strike since the Transport Safety Investigation Act was introduced in 2003 has especially helped the ATSB to better understand the nature of birdstrikes, what the major safety risks are and where they lie,” Mr Hood said. “This has helped everyone in the aviation industry to better manage their safety risk.”

Larger bird species and flocking birds have the potential to do the most damage to aircraft. Compared to birdstrikes, animal strikes are relatively rare. The most common animals involved are hares and rabbits, kangaroos, dogs/foxes and wallabies.

There are a range of activities that can be undertaken to reduce the risk of wildlife strike.

Wildlife hazards should be assessed as part of serviceability inspections, wildlife patrols, runway inspections, and wildlife counts. Where a hazard is identified, it should be addressed through active management or by communicating the hazard to ATC or pilots.

It may be necessary to use the ATIS, a NOTAM, a note in Enroute Supplement Australia (ERSA) or a Birdwatch Condition Report to adequately communicate the hazard.

If a wildlife strike occurs, a strike report form should be completed and sent to the ATSB within 72 hours, including as much detail as possible.

Early morning, late afternoon, and after rainfall are key times for removing potential wildlife. Prioritising areas requiring dispersal should be based on airport operations, aircraft movement activity, and the distribution of high and moderate risk species.

Position of a wildlife controller should in most circumstances ensure that the wildlife are encouraged to fly or move away from aircraft movement areas and not across them.

There should be a focus on manoeuvring areas, and a variety of tools and techniques should be used to prevent habituation.

Australian Transport Safety Bureau (ATSB) Chief Commissioner Greg Hood today welcomed international visitors to the 19th Marine Accident Investigators Forum in Asia (MAIFA) conference in Canberra.

MAIFA is a non-profit organisation dedicated to promoting safety at sea and preventing marine pollution through the exchange of ideas, experiences and information acquired in marine accident investigations.

“I’m delighted to welcome participants to Canberra and I look forward to a fruitful exchange of ideas,” Mr Hood said.

“Australia’s reputation for high quality and rigorous investigations makes it uniquely placed to assist with transport safety in the Asia Pacific region.

“The ATSB has an active program of regional engagement with other transport safety agencies, over and above that required by our international obligations.”

As well as investigating marine accidents and incidents in Australia, the ATSB provides technical assistance to a range of countries in our region.

Nation’s participating in the MAIFA conference are Cambodia, the People’s Republic of China, Hong Kong, Japan, the Republic of Korea, Malaysia, New Zealand, Singapore, Thailand and Vietnam.

Australian Transport Safety Bureau communications manager Carl Fellows has put his demons to bed after finishing the famous Hawaii Ironman on his third attempt.

The Ironman World Championship at Kona on Hawaii’s big Island is billed as the toughest one-day, multi-sport endurance event in the world.

Few athletes know the truth of this like Carl.

The Ironman comprises a 3.8km ocean swim, a 180km ride through Kona’s lava fields and a 42.2km marathon. It’s hot, humid and windy.

After twice not finishing the event, in 2004 and 2009, Carl completed 2016 Hawaii Ironman in 13hrs 1min, after struggling with stomach issues for much of the run.

“I really thought I had the gut issues sorted this time,” Carl said. “I had a great swim, was conservative on the bike but struggled right from the start of the run.

“I used a different electrolyte drink from my two previous attempts and spent time acclimatising in the University of Canberra’s environment chamber. I’d done the training and was confident I had covered all bases.”

After a 1hr 2min swim and 5hr 22min ride, the run turned ugly. Instead of a 3hr 30min marathon, the course proved character-revealing with Carl battling on for a 6hrs 25min marathon.

“I had issues as soon as I started running,” Carl said. “If my heart rate went over 90bpm, I’d start throwing up. So it was lots of walking and stopping. I also had back spasms which I think were triggered from the vomiting.”

Carl is a talented athlete who qualified for Hawaii after finishing third in his age group in 9hrs 37min at Port Macquarie’s Ironman Australia in May, including a 3hr 23min marathon. A time in the low 10 hours was a reasonable expectation at Hawaii.

But Hawaii is famous for chewing up even the best professional athletes.

“I think somehow I’ve upset the big island,” Carl said. “It doesn’t like me. This was personal. I finished, but I don’t think I’ll be back.”

As the national transport safety investigator, the Australian Transport Safety Bureau deals with reports of many different types of events—some of these involve self-harm.

Many of these result in loss of life, with a tragic ripple effect among family, friends and colleagues. That ripple can also extend to people who become involved inadvertently, such as train drivers or air traffic controllers.

World Suicide Prevention Day, on 10 September, is an opportunity to connect, communicate and care—three words at the heart of suicide prevention.

So how do we do this? There are six key steps.

1. Reach out. Ask them directly if they are thinking about suicide. This shows you care and they’re not alone.
2. Listen to them. Let them talk. They will often feel a great sense of relief that someone wants to talk to them about their darkest feelings.
3. Check their safety. Stay with them, if you can. And remove the means of suicide.
4. Decide what to do and take action. Talk about what you can do together to keep them safe. And don’t agree to keep it a secret.
5. Ask for a promise. Thoughts of suicide may return, so ask them to promise to reach out and tell someone.
6. Get help. This may be through a GP or a counsellor, psychologist or social worker. It could be through a school counsellor. And there’s always 000. Community health centres may be able to help, as could crisis supports services such as Lifeline and Kids helpline. See support from family and friends, youth group leaders, a sports coach, a priest, minister of religious leader.

We also need to reconnect with those who we’ve lost contact with. Today—and everyday—is R U O K Day. So check in with friends, loved ones, mates and colleagues and ask the question: Are you okay?

For more information, visit Lifeline Australia(Opens in a new tab/window) or R U O K(Opens in a new tab/window).

The ATSB says pilots continue to collide with known wires in aerial application, including agricultural spraying, spreading and firefighting.

The Australian Transport Safety Bureau says pilots continue to collide with known wires in aerial application, including agricultural spraying, spreading and firefighting.

The ATSB’s Aerial application safety 2015–2016 year in review found wirestrike was the most common cause of accident and serious incidents in aerial application between May 2015 and April 2016.

Wirestrikes (where an aircraft hits a wire such as a powerline) caused 11 accidents and serious incidents in the 12-month period. Other types of accidents and serious incidents were engine failure or malfunction (6), collision with terrain (3), controlled flight into terrain (2) and runway excursion (2).

Most wirestrikes involve wires that the pilot was already aware of. Often, they involve wires which the pilot has flown several times before that day.

With their flying operations very close to the ground, aerial application pilots are well aware of the dangers of wires. The ATSB says pilots need to know the location of wires in the area to be sprayed through maps, talking with landowners and locals, and through aerial reconnaissance before operations commence.

Spraying patterns need to be organised with the wire locations in mind, and pilots need to maintain focus during their flying task, and use continuous reminders of the presence of wires. When plans change or the spray pattern differs such as for clean-up runs, pilots need to redo their aerial reconnaissance of wires.

Although there has been a slight growth in the number of accidents over the past three years, there were considerably fewer accidents each year in the past decade than in the previous 25 years.

Aerial agriculture has the second highest accident rate per million hours flown across the operation types, behind non-VH-registered recreational aeroplanes.

Aerial application operations are inherently risky, involving low-level flying, high workloads and obstacles such as power lines and uneven terrain.

Read the ATSB research report (AR-2016-022) Aerial application safety 2015-2016 year in review

A hard landing of a Maule MT-7-235 aircraft at Greenfields airstrip near Noosa in Queensland on 16 May 2016 highlights why it’s important for pilots to conduct a go-around when in doubt.

A hard landing of a Maule MT-7-235 aircraft at Greenfields airstrip near Noosa in Queensland on 16 May 2016 highlights why it’s important for pilots to conduct a go-around when in doubt.

The requirement for three take-offs and three landings in the last 90 days is a regulatory requirement for pilot currency, but this does not guarantee pilot proficiency. Pilots need to be ‘go-around prepared’ because the execution of a go-around is an infrequent manoeuvre.

The pilot had flown about five flights, totalling about 20 hours in the previous 12 months and the pilot’s last flight was about four-to-five weeks prior to the accident flight.

When flying infrequently, proficiency in take-offs and landings can be improved by dedicating a portion of the flight to practicing circuits, including go-arounds. The United States Federal Aviation Administration describes this as ‘imbuing the quantity of flying, however limited, with quality.’

The Maule pilot conducted a private flight from Greenfields with two passengers on board. After a trip that included a re-fuel at Gympie, the flight headed north towards Maryborough before returning to Greenfields along a coastal route.

On final approach to Greenfields, the pilot noticed they were getting low. At about 500 ft, they increased the power to regain their approach path. The pilot subsequently assessed that the aircraft was too high and lowered the nose to re-intercept the approach path.

The pilot flared the aircraft for landing, the aircraft landed heavily and bounced into the air. As the aircraft landed again, the nose wheel touched down first (before the main landing gear) with sufficient force that the nose wheel strut fractured.

The nose landing gear and propeller then dug into the ground and the aircraft rotated over its nose and slid a short distance inverted before coming to rest. The pilot and one passenger were uninjured, another passenger sustained minor injuries, and the aircraft sustained substantial damage.

The pilot had not operated the Maule aircraft with more than one passenger on board prior to the accident flight and felt that the higher all-up-weight of the aircraft with an extra passenger on board may have contributed to a higher sink rate on final approach.

The pilot later formed a view that a go-around, rather than continuing with the landing manoeuvre, would have been a better option.

Take-off and landing phases of flight are critical, since the aircraft is operating closer to the stall speed and with less height to recover from a control problem, relative to cruise flight.

A go-around could have prevented an unstable approach and initial bounce from escalating to an accident.

Read the final report: Hard landing involving Maule MT-7, VH-DRS, near Noosa, Queensland, on 16 May 2016

Enhanced safety actions will help reduce risks for aircraft and ambulance operators at Blackall Airport in Queensland.

Enhanced safety actions will help reduce risks for aircraft and ambulance operators at Blackall Airport in Queensland.

This follows a runway incursion involving an aeromedical Hawker Beechcraft B200 aircraft and an ambulance on the night of 28 February 2016.

At about 2.30 am the plane was descending to Blackall Airport with a pilot, a doctor and a nurse on board.

Earlier, at about 2.20 am, an ambulance driver was dispatched to Blackall Airport by the ambulance coordination centre to meet the aircraft for patient transportation. The ambulance driver was the only occupant of the vehicle.

A series of events involving missed communication and sighting between the ambulance and the aircraft resulted in the Beechcraft B200 initiating a missed approach.

The pilot climbed and entered a hold pattern about 5,000ft above the airport before descending and landing without incident.

As a result of this occurrence, the aircraft and ambulance operators have advised the Australian Transport Safety Bureau (ATSB) of a range of safety actions to be implemented.

For the aircraft operator, runway strip inspections will continue for night operations at all aerodromes with known or suspected animal hazards and where appropriate ground personnel can safely conduct inspections.

Formal procedures will be developed in conjunction with the ambulance operator detailing safety procedures for those rural/regional stations where a request for a runway inspection is likely.

Appropriate procedures will be developed for requesting airstrip inspections for incorporation in the airstrip data manual.

And there will be closer safety liaison between the respective ambulance and operator safety departments.

The ambulance operator has advised the ATSB that staff working at Blackall Airport will attend the airport operator induction program.

Consultative arrangements with occur with key stakeholders and there will be a review of local UHF/VHF radio communications procedures between the operation centre, aircraft operator, airport operator, and ambulance attending the airport.

In addition, there will be a review of induction programs for staff in consultation with the aircraft operator and the airport. All new and existing staff will participate in a revised induction program. Induction workbooks will be reviewed and all new and existing staff will be provided with a copy of the workbook.

A review of the Blackall standard operating procedures will be conducted to ensure that procedures cover all aviation safety requirements.

The International Civil Aviation Organization (ICAO) has identified runway safety as one of its priorities and has been working with countries and aviation organisations globally to reduce runway safety accidents. ICAO has a runway safety website and has published a Manual on the prevention of runway incursions (Doc 9870 AN/463), available on the website.

Additional information on runway safety is available from Airservices Australia, including The airside drivers guide to runway safety.

Read the final report: Runway incursion involving a Hawker Beechcraft Corporation B200, VH-FDG, at Blackall Airport, Queensland, on 28 February 2016