A backlogged safety recommendation is less likely to be resolved satisfactorily than one that is settled routinely, according to an ASW analysis of about three dozen cases in which National Transportation Safety Board (NTSB) officials met with the Federal Aviation Administration (FAA) counterparts to resolve their differences.
The meetings were convened under the aegis of the NTSB’s SWAT program, an acronym that stands for “Safety With A Team.” The SWAT moniker is suggestive of police SWAT (special weapons and tactics) teams, whose unique skills are often called upon to resolve high-threat situations. Thus, the SWAT effort as it applies to the NTSB is intended to represent the intense focus needed to resolve a situation. It was launched at the initiative of NTSB Chairman Ellen Engleman-Connors as part of her publicly stated determination to resolve, one way or the other, a list of NTSB recommendations that have languished for years in the twilight zone of “open” recommendations that have not been finally resolved.
The FAA ultimately accepts more than 90 percent of the NTSB’s aviation safety recommendations. However, of 37 “open” cases resolved over the past year and half by NTSB and FAA negotiators, the acceptance rate was distinctly lower – about 85 percent. Thirty-two of those 37 cases were closed with what the NTSB categorized as “acceptable action.”
These 37 cases represent those for which action has been completed, one way or the other. Other unresolved recommendations – to be resolved by SWAT in future negotiations – are not included.
The recommendations were sorted into three major categories of NTSB actions called for: a regulatory action response (i.e., a required action), an advisory response (e.g., informational material to the industry), or a catch-all labeled “Other,” in which recommendations calling for evaluations, studies, reviews and so forth were aggregated.
The 37 previously open recommendations fell into two major groups: “Open – acceptable response” but pending final action, or “Open – unacceptable response,” pending resolution of what was a clear disagreement between the NTSB and the FAA.
We focus here on those recommendations that were in the latter category. Of the 12 cases in an “Open – unacceptable action” status, seven were closed with an “acceptable action” or an “acceptable alternate action.” That’s a 60 percent acceptance rate for this subset of 12 openly contentious cases. The five remaining cases (“Closed – unacceptable action”) accounted for the other 40 percent.
Of greatest interest, in those cases where the NTSB called for required action, its success rate was markedly lower. Thirteen of the 37 cases in an “Open – acceptable” or “Open – unacceptable” status called for required action. Of these, the FAA responded with required action in only four cases, issuing advisory material in seven cases and taking other action in the remaining two.
Sharpening the focus, nine of these 13 cases were in an “Open – unacceptable action” status and called for required action. The FAA required action to resolve only two of these cases. Advisory action was taken in response to two others, which the NTSB accepted. In the remaining cases, the FAA disagreed with the need to take action.
Thus, the acceptance rate was about 22 percent in those cases where the NTSB had classified the case as open, the interim response was deemed unacceptable, and the recommendation urged required action.
In other words, the more disputatious the recommendation and the more stern the action called for, the less likely it was resolved satisfactorily. The table at p. 3 provides a sampling, illustrating the range of safety recommendations involved, as well as some of the nuance and clear disagreements involved in these cases. The proverbial bottom line on these lingering cases is that where the NTSB called for required action, the response rate hovers closer to 50 percent than 90 percent. And if the NTSB called for required action and the FAA flat-out disagreed, the acceptance rate was zero.
Nonetheless, favorably clearing 32 of 37 cases illustrates the aphorism that where the spirit is willing, progress is possible.
Sampling of SWAT
Extracts from 14 of 37 Safety With a Team (SWAT) recommendations resolved – not always to the NTSB’s satisfaction. Note the cases where the NTSB sought required action and the FAA issued advisory, not regulatory material.
| Recommendation number, date issued, summary and pre-existing status | Date of SWAT meeting, action taken and resulting status | Nature of action |
|---|---|---|
| A-00-014 Jan. 27, 2000 Require w/in 10 years that all nonprecision approaches approved for air carrier use incorporate a constant angle of descent with vertical guidance from on-board systems. Open – acceptable action. | Dec. 12, 2003 Descent angles have been published for 89.6% of airports’ nonprecision approaches. The task is being done at a programmed rate for completion by Sept. 2007. Closed – acceptable action. | Other |
| A-00-015 Jan. 27, 2000 Include in nonprecision approach info tabular info allowing pilots to follow a constant angle of descent by cross- referencing the distance from the airport and the barometric altitude. Open – acceptable response. | Dec. 12, 2003 FAA opposes recommendation, concerned that the added information would crowd charts, making them more difficult to read in a high workload situation. Closed – reconsidered. | No action |
| A-00-016 Jan. 27, 2000 Evaluate the benefits of depicting terrain and obstacles along a specific approach path in the profile view of approach charts. Open – acceptable response. | Dec. 12, 2003 Opposed due to concerns about human factors issues such as chart clutter. Since the KAL 801 accident [at Guam], a requirement has been implemented to depict colored terrain in the plan view (top down) on approach charts. Closed – acceptable action. | Other |
| A-00-017 Jan 27, 2000 Provide user groups with draft plan and profile views to assist in evaluating proposed instrument procedures. Open – acceptable response. | Dec. 12, 2003 Plan and profile views are now available regarding draft instrument procedures on the FAA’s Web site. Closed – acceptable action. | Other |
| A-00-039 June 16, 2000 Require ATC facilities to retain recorded voice communications and radar data for 45 days. Open – unacceptable action. | July 31, 2003 FAA issued changes to Order 7210.3T revising data retention requirements to 45 days. Closed – acceptable action. | Regulatory |
| A-00-072 July 14, 2000 Require all new airliners to meet evacuation demonstration requirements regardless of the number of passenger seats. Open – unacceptable response. | Oct. 3, 2003. FAA disagrees with need. Closed – unacceptable action. | No action |
| A-00-079 July 14, 2000 Determine if a means of assistance is needed for evacuation exits higher than 6 feet. Open – unacceptable response. | Oct. 3, 2003. FAA reviewed action in safety board’s report and determined that no changes are needed. Closed – acceptable action. | No action |
| A-00-087 July 14, 2000 Require minimum comprehension testing for safety briefing cards. Open – unacceptable response. | Oct 3, 2003 FAA does not have any plans to mandate comprehension testing for passenger safety briefing cards. Closed – unacceptable response. | No action |
| A-00-090 July 14, 2000 Require independently powered evacuation alarm systems operable from each crewmember station. Open – unacceptable status. | Oct. 3, 2000 FAA believes already-required public address (PA) and interphone systems meet the same level of performance as the recommended system. Closed – unacceptable response. | No action |
| A-00-099 Aug. 25, 2000 Require DC-10 and MD-11 operators to provide pilots with info and training regarding ground spoiler knockdown feature and its effects on landing characteristics. Open – acceptable response. | Dec. 12, 2003 FAA issued FSAT (Flight Standards Information Bulletin for Air Transportation) 01-12, specifically mentioning changes to the flight crew operating manual. (ASW note: an FSAT is advisory; the NTSB was seeking a “required” action). Closed – acceptable response. (Cont’d on p. 4) | Advisory |
| A-00-115 Dec. 20, 2000 Issue an airworthiness directive (AD) requiring modification of the oxygen bottle shutoff valve assembly so that the position of the valve (open/closed) can be clearly and accurately verified during preflight inspections. Open – acceptable response. | Feb. 3, 2004 Lear issued Service Bulletin 35/36-35-4 on Feb. 27. On May 6, the FAA issued SAIB (Special Airworthiness Information Bulletin) CE-04- 67. (ASW: an SAIB is advisory, an AD is required). Closed – acceptable alternate. (See ASW, May 31, p. 1) | Advisory |
| A-01-054 Dec. 10, 2001 Require the use of automatic brakes for landings on wet, slippery or high crosswind conditions. Open – unacceptable response. | Dec. 12, 2003 FAA issued Notice N8400.68, “Use of Autobrakes for Landing in Adverse Conditions,” which recommends the use of autobrakes. Closed – acceptable alternate. | Advisory |
| A-01-083 Jan. 4, 2002 Issue an advisory circular (AC) describing the need for flight crews to take immediate and aggressive action in response to signs of an in-flight fire. Open – acceptable response. | Oct. 3, 2003 FAA issued AC 120-80, “In-Flight Fires.” Closed – acceptable response. | Advisory |
| A-96-016 May 31, 1996 Require that the crew alerting system on the B757/767 be modified to include a “caution” alert when an erroneous airspeed indication is detected. Open – acceptable response. | Feb. 3, 2004 FAA issued AD 2004-10-05, effective June 2004, requiring the modification. Closed – acceptable action. | Regulatory |
| A-96-149 Dec. 20, 1996 Evaluate the necessary functions of the aircraft crash ax. Open – acceptable response. | Oct. 3, 2003 SAE (Society of Automotive Engineers) developed an Aerospace Standard for aircraft crash axes. Closed – acceptable alternate. | Advisory |
| Key: Regulatory: denotes required action with teeth (e.g., an AD). Advisory: denotes advisory action to inform the industry. Other: denotes a different kind of work in response to the NTSB recommendation, work in progress or work completed (e.g., audits, reviews, evaluations, etc.). Source: NTSB, symbols ASW | ||