Can Commercial Airlines Can Commercial Airlines Achieve “One Level of Safety” Achieve “One Level of Safety” By Embarking on a Program of By Embarking on a Program of

“One Level of Training” ?“One Level of Training” ?What is the relationship between What is the relationship between

Training and Safety in Commercial Training and Safety in Commercial Air Operations?Air Operations?

Can Commercial Airlines Achieve “One Can Commercial Airlines Achieve “One Level of Safety” By Embarking on a Program Level of Safety” By Embarking on a Program

of “One Level of Training” ?of “One Level of Training” ?

What is the relationship What is the relationship between Training and between Training and

Safety in Commercial Air Safety in Commercial Air Operations?Operations?

Washington, DC B-737Washington, DC B-737July 1981July 1981

Washington, DC B-737Washington, DC B-737Jan 1982Jan 1982

Roselawn , IN ATR-72 Roselawn , IN ATR-72 Oct 1994Oct 1994

Roselawn, IN ATR-72Roselawn, IN ATR-72Oct 1994Oct 1994

Monroe, MI Embraer 120Monroe, MI Embraer 120January 1997January 1997

Monroe, MI Embraer 120Monroe, MI Embraer 120Jan 1997Jan 1997

Toronto Canada DHC-8/Q400Toronto Canada DHC-8/Q400Feb 2009Feb 2009

Buffalo, NY DHC-8/Q400Buffalo, NY DHC-8/Q400Feb 2009Feb 2009

Buffalo, NY DHC-8/Q400Buffalo, NY DHC-8/Q400Feb 2009Feb 2009

Into the UnknownInto the UnknownThe crews that crashed at:The crews that crashed at:

Washington D.C. B-737 1982Washington D.C. B-737 1982

Roselawn, IN ATR-72 1984Roselawn, IN ATR-72 1984

Monroe, MI EMB-120 1997Monroe, MI EMB-120 1997

Buffalo, NY DHC-8/Q400 2009Buffalo, NY DHC-8/Q400 2009

Did not knowDid not know• Indications of ice buildup on acftIndications of ice buildup on acft• Aerodynamic effects of icing on acftAerodynamic effects of icing on acft• Safest procedures in icingSafest procedures in icing• What to do if in troubleWhat to do if in trouble• How to recover from upsetHow to recover from upset

On The Day of the AccidentOn The Day of the Accident

Flight Crew was:Flight Crew was:• TrainedTrained• QualifiedQualified• CertifiedCertified• Company and FAA monitorCompany and FAA monitor

The crews that crashed atThe crews that crashed at

• Gitmo, CubaGitmo, Cuba DC-8F DC-8F 19XX 19XX• Kuala Lumpor B-747 1989Kuala Lumpor B-747 1989• Agana, Guam B-747Agana, Guam B-747 1997 1997• Little Rock, AR MD-80Little Rock, AR MD-80 1999 1999

FLYING TIGERSFLYING TIGERSFebruary 19, 1989 in PUCHONG MALAYSI, MalaysiaFebruary 19, 1989 in PUCHONG MALAYSI, Malaysia

Aircraft: BOEING 747-200, registration: N807FTAircraft: BOEING 747-200, registration: N807FTInjuries: 4 Fatal.Injuries: 4 Fatal.

Korean B747Korean B747

Agana GuamAgana GuamAugust 1997August 1997

AA B737 Little Rock, ARAA B737 Little Rock, ARJune 1999June 1999

Did not knowDid not know

How fatigue degrades:How fatigue degrades:• PerformancePerformance• Visual PerceptionVisual Perception• Crew Resource ManagementCrew Resource Management• Decision makingDecision making

Chicago, IL SWA B-737Chicago, IL SWA B-737December 2005December 2005

AF AB 340 Toronto, CanadaAF AB 340 Toronto, CanadaAugust 2005August 2005

Kingston, JamaicaKingston, JamaicaDEC 2009 AA B737DEC 2009 AA B737

The crews that crashed atThe crews that crashed at

• Chicago Midway Chicago Midway B-737B-737 20052005• Toronto, CanadaToronto, Canada AB-340AB-340 20052005• Kingston, JamaicaKingston, Jamaica B-737B-737 20092009

Did not knowDid not know

Cumulative Negative Effects:Cumulative Negative Effects:• TailwindTailwind• Heavy weightHeavy weight• Decreased braking actionDecreased braking action• Non-grooved runwayNon-grooved runway• Extra speed on finalExtra speed on final

Threat and Error ManagementThreat and Error Management

Their training did not adequately Their training did not adequately prepare them for their real prepare them for their real operating environmentoperating environment

Aircraft AccidentsAircraft AccidentsPast and Future (?)Past and Future (?)

Why are we not learning our Why are we not learning our lessons?lessons?

Why does each airline have to have Why does each airline have to have the same mishap to learn the the same mishap to learn the lesson?lesson?

How do we Get There From How do we Get There From Here?Here?

How do we achieve a higher level of safety?

We believe that an accident indicates a training shortfall.