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Commercial Aviation Safety Team (CAST) Process Overview Commercial Aviation Safety Team (CAST) Process Overview.

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Presentation on theme: "Commercial Aviation Safety Team (CAST) Process Overview Commercial Aviation Safety Team (CAST) Process Overview."— Presentation transcript:

1 Commercial Aviation Safety Team (CAST) Process Overview Commercial Aviation Safety Team (CAST) Process Overview

2 In the U.S., our focus is set by the White House Commission on Aviation Safety 1.1 Government and industry should establish a national goal to reduce the aviation fatal accident rate by a factor of five within ten years and conduct safety research to support that goal. 1.2The FAA should develop standards for continuous safety improvement, and should target its regulatory resources based on performance against those standards 5.3-2

3 The National Civil Aviation Review Commission (NCARC) on Aviation Safety Provided Additional Direction FAA and the aviation industry must develop a strategic plan to improve safety, with specific priorities based on objective, quantitative analysis of safety information and data. Government should expand on their programs to improve aviation safety in other parts of the world

4 In Response Ongoing Industry and FAA Safer Skies Initiatives were Combined into CAST Data-Driven, Consensus-Based, Integrated Strategic Safety Plan Developed In place and fully supported by Government and Industry with Worldwide Recognition - CAST

5 We Need to Continuously Improve Aviation Safety Year Hull loss accident rate

6 We Need to Continuously Improve Aviation Safety Year Hull loss accident rate Millions of departures Airplanes in service 28, , Boeing 11,300

7 We Need to Continuously Improve Aviation Safety Year Hull loss accidents per year Hull loss accident rate Airplanes in service 28, Millions of departures Business as usual Our goal 15, Boeing 11, ,595

8 Regional Perspective Accident Rates Vary by Region of the World Western-built transport hull loss accidents, by airline domicile, 1992 through 2001 Accidents per million departures 1 Insufficient fleet experience to generate reliable rate. United States and Canada 0.4 Latin America and Caribbean 3.1 Europe 0.9 China 1.1 Middle East 3.4 Africa 12.4 Asia 2.6 World 1.3 Oceania 0.0 (Excluding China) JAA Non JAA – 3.0 C.I.S. 1 3/19/02 REG-053a

9 Safety Responsibilities Are Shared Air Safety Manufacturers Government Operators Safe Airplane + Safe Operation + Safe Infrastructure = Safe Air Travel

10 NTSB Accident Incident Reports 21.3 Reports Airclaims data Historical Data Pareto Plots JSAT NASDAC data Safety Analysis Process Industry FOQA data JSAT

11 NTSB Accident Incident Reports 21.3 Reports Airclaims data Historical Data Pareto Plots JSAT NASDAC data Causal Analysis Combined Threat Cause Accident Safety Analysis Process Industry FOQA data JSAT Intervention Strategy

12 NTSB Accident Incident Reports 21.3 Reports Airclaims data Implementation Strategy JSIT Historical Data Pareto Plots JSAT NASDAC data Causal Analysis Combined Threat Cause Accident Safety Analysis Process Industry FOQA data JSAT Intervention Strategy Coordinated Plan Measuring Progress to Goal Industry Government Safer Skies AvSP

13 NTSB Accident Incident Reports 21.3 Reports Airclaims data Implementation Strategy JSIT Historical Data Pareto Plots JSAT NASDAC data Causal Analysis Combined Threat Cause Accident Safety Analysis Process Industry FOQA data JSAT Intervention Strategy Coordinated Plan Measuring Progress to Goal Industry Government Safer Skies AvSP

14 Excluding all security events

15 HUMAN FACTORS IN OPERATIONS & MAINTENANCE Carry-on Baggage Child Restraint Passenger Interference CABIN SAFETY IMPROVED DATA & ANALYSIS GENERAL AVIATION Loss of Control Weather Survivability Aeronautical Decisionmaking Controlled Flight Into Terrain Approach and Landing COMMERCIAL AVIATION Controlled Flight Into Terrain Loss of Control Weather Uncontained Engine Failures Runway Incursion Passenger Seat Belt Use Runway Incursions Safer Skies Turbulence

16 Industry Commercial Aviation Safety Team (CAST) Government *Representing GE and RR DOD FAA Aircraft Certification Flight Standards System Safety Air Traffic Operations Research NASA ICAO JAA TCC NATCA AIA Airbus ALPA APA ATA NACA Boeing P&W* RAA FSF IATA AAPA ATAC APFA Commercial Aviation Safety Team (CAST)

17 CAST Goals l Reduce the U.S. commercial aviation fatal accident rate by 80% by 2007 l Work together with airlines, JAA, ICAO, IATA, FSF, IFALPA, other international organizations and appropriate regulatory/ government authorities to reduce worldwide commercial aviation fatal accident rate

18 Safety enhancement development Master safety plan Enhancement effectiveness Future areas of study CAST Data analysis Joint Safety Analysis Teams (JSAT) Joint Safety Implementation Teams (JSIT) Joint Implementation Measurement Data Analysis Team (JIMDAT) Commercial Aviation Safety Team (CAST)

19 CAST A Three-Stage Process Influence Safety Enhancements - Worldwide Data Analysis Set Safety Priorities Achieve consensus on priorities Integrate into existing work and distribute Implement Safety Enhancements - U.S. Agree on problems and interventions

20 Joint Safety Analysis Team (JSAT) Process

21 Typical JSAT Membership n ALPA/APA n FAA (AIR, AFS, ASY, AAI) n Airbus n JAA n ATA n Transport Canada n NASA n Engine companies – (PW, GE, RR-Allison) n Boeing n RAA n Air Traffic Services n NATCA

22 JSAT Process Charter Development Establish Team Select Data Set Review Data Identify Intervention Strategies Assign Standard Problem Statements Record Characteristics/ Indicators Develop Event Sequence Evaluate Intervention Effectiveness Prioritize Interventions Technical Review & Report Results Identify Problems (what/why) Global Review of Characteristics/ Indicators Evaluate Problem Importance

23 Developed Event Sequence Facts and data – pilot - controller voice events – missed calls – events that occurred or should have Time coded each event

24 Develop Problem Statements Problem statements –What went wrong –Deficiency definition –Potential reason –Something which happened or didnt happen

25 Sample Standard Problem Statements 10 FLIGHTCREW – Failure of flight crew to follow established procedures (SOP) 39 AIRCRAFT EQUIPMENT – DESIGN NOT ERROR TOLERANT System design does not provide adequate redundancy to counteract errors or alerting of the effects of errors. 44 FLIGHTCREW – Flight crew failure to recognize and correct unstable approach. 100 REGULATORS – INSUFFICIENT AIR CARRIER OVERSIGHT. Insufficient regulatory oversight of air carrier operations including management and training practices.

26 Scoring - Problem Importance POWER – P1 – Importance of the problem or contributing factor in the cause of the accident FUTURE GLOBAL APPLICABILITY – Frequency of the problem or contributing factor (to this accident type) in future operations on a worldwide basis

27 RATING SCALES – Problem Statements POWER – P1 This scale is to be used to judge the importance of a specific specific problem or contributing factor in the cause of the accident. Little Importance Slightly important Moderately important Quite important Highly important No importance Completely important FUTURE GLOBAL APPLICABILITY This scale is to be used to estimate the frequency of the problem or contributing factor in future operations on a worldwide basis (for example: how often the situation occurs in accident scenarios; its impact is on present and future operations (equippage, traffic, regulatory differences); and whether it is applicable across airlines/airplanes/regions. Hardly any applicable Slightly applicable Moderately applicable Quite applicable Highly applicable Not at all applicable Completely applicable

28 Identify Intervention Strategies Intervention strategies –Suggested solutions –Things to do to prevent or mitigate the problem –Etc.

29 Scoring - Intervention Effectiveness POWER – P2 – Ability of the intervention to mitigate the problem or contributing factor (in a Perfect World) CONFIDENCE – Confidence that the intervention will have the desired effect

30 RATING SCALES – Interventions POWER – P2 This scale is to be used to judge the effectiveness of a specific intervention in reducing the likelihood that a specific accident would have occurred had the intervention been in place and operating as intended. (perfect world) Hardly any effect Slightly effective Moderately effective Quite effective Highly effective Not at all effective Completely effective This scale is to be used to define the level of confidence that you have that this specific intervention will have the desired effect. Hardly any confidence Slightly confident Moderately confident Quite confident Highly confident Not at all confident Completely confident CONFIDENCE

31 JSAT Reports Standard Problem Statements Interventions Prioritized Recommendations

32 Safety enhancement development Master safety plan Enhancement effectiveness Future areas of study CAST Data analysis Joint Safety Analysis Teams (JSAT) Joint Safety Implementation Teams (JSIT) Joint Implementation Measurement Data Analysis Team (JIMDAT) Commercial Aviation Safety Team (CAST)

33 JSIT Feasibility Scales Technical Financial Operational Schedule Regulatory Sociological

34 JSIT Safety Enhancements Develop Safety Enhancements from Interventions Collect detailed resource information Prepare Detailed Implementation Plans (DIPs)

35 Safety enhancement development Master safety plan Enhancement effectiveness Future areas of study CAST Data analysis Joint Safety Analysis Teams (JSAT) Joint Safety Implementation Teams (JSIT) Joint Implementation Measurement Data Analysis Team (JIMDAT) Commercial Aviation Safety Team (CAST)

36 Joint Implementation Measurement Data Analysis Team (JIMDAT) Process

37 Developed a Prioritization Methodology (JIMDAT) Identified the most effective solutions derived from all accident categories Considered effectiveness vs. resources Tested solutions against all fatal and hull loss accidents, U.S. domestic Part 121 Operations, Created draft Master strategic safety plan Identified areas for future study/mitigation

38 JIMDAT Process Provides consistent estimates of the accident prevention potential of safety enhancements –Accounts for the benefit of a single intervention or a combined group of interventions –Addresses overlap with other interventions/technologies –Preserves analysis criteria and results

39 Using JIMDAT for CAST Plan Development Risk reduction is primary measure Identified effectiveness and associated resource requirements for each enhancement Used for initial differentiation (2007 and 2020)

40 Integrated Strategic Safety Plan Contains 46 safety enhancements optimized to include those actions with the best effectiveness vs. resource relationships 22 complete/24 committed and underway Initially combines short-term liveware-based enhancements with transition to design change enhancements long term Projected 73% risk reduction by 2007 Foundation for U.S.-driven continuous improvements in worldwide aviation safety

41 Sharpening Our Focus All safety enhancements are valuable Some safety enhancements are more effective than others across the various accident categories Implementation reality demands better prioritization

42 Output Evaluation Spreadsheet Example

43 Score Combined Score Combined SOPs Example Scatter Chart Dollars In Millions 2007 Implementation & Resources

44 Resource Cost vs. Risk Reduction APPROVED PLAN Completed + Plan (2007 Implementation Level) Completed + Plan (2020 Implementation Level) All JSIT Proposed Enhancements (2020 Implementation Level) Resource Cost ($ Millions) Risk Reduction Total Cost in $ (Millions) % 25% 50% 75% 100% Risk Eliminated by Safety Enhancements Completed

45 Safety Plan Benefits Prediction of a 73% risk reduction that also results in approximately $620 million annual savings to the industry – Current accident cost per flight is approximately $76 cycle – Implementation of the 46 selected safety enhancements reduces this cost by $56 per flight cycle Safety is morally required and is also good for business

46 Dollars/Flt. Cyc Part 121 Aviation Industry Cost Due to Fatal/Hull Loss Accidents Historical cost of accidents per flight cycle 73% Risk reduction Savings ~ $56/Flight Cycle Or ~ $620 Million Dollars/Year Cost of accident fatalities following implementation of the CAST 2007 levels Cost Savings

47 U.S. Hull Loss & Fatal Accidents Portion of Total Fatality Risk Mitigated by the CAST Plan (2007 Implementation Values) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Total LOC Flt CFIT Fire/Explosion Runway Collision LOC GND Midair Crew Inc Eng-UCEF Sys-Comp Turbulence Evac Portion of Risk Risk Eliminated Risk Remaining CAST Fatal/Hull Loss Database – Security events excluded

48 All Regions Combined Worldwide Hull Loss & Fatal World Wide Accidents Portion of Fatality Risk Mitigated If CAST Plan is Adopted Worldwide (2007 Implementation Values) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% TotalCFIT LOC-I SCF-PP SCF-NP ICE Midair FIRE-NI FUEL RI ARC RE USOS WSTRW ADRM OTHER-BIRD Portion of Risk Risk Eliminated Risk Remaining Accident Classes Defined by CAST/ICAO Common Taxonomy

49 CAST A Three-Stage Process Influence Safety Enhancements - Worldwide Data Analysis Set Safety Priorities Achieve consensus on priorities Integrate into existing work and distribute Implement Safety Enhancements - U.S. Agree on problems and interventions

50 Joint Implementation Measurement Team (JIMT) Process

51 Reporting Standards Progressing on plan Plan developed but not progressing - may not make plan or no plan exists Late or critically off plan On plan but effected by late or critically off plan Output in plan completed Status of non-aligned carriers (color same as above) CAST-3-05

52 12/31/99 3/31/00 3/31/013/31/03 Retrofit program complete - all Part 121 aircraft have TAWS 3/31/04TAWS (Potential US Accident Rate Reduction ~5%) TAWS TSO Issues TAWS Part 23 AC released 3/31/05 ATA TAWS Final Rule AFS- 200 ACE- 100 TAWS AC OPS guidance AFS- 200 TAWS HBAT OPS guidance FAA All aircraft manufactured for use under Part 121 delivered with TAWS AIRFAA TAWS AFM requirement for newly manufactured airplanes AIR Part 25 TAWS AC released ANM /31/02 ops guidance not asked for no problems reported, moved to 3/31/03 (1.)

53 Carriers Implement training 6/30/00 7/31/00 9/30/004/30/01 12/31/00 Precision-Like Approaches (Potential US Accident Rate Reduction ~7%) AFS-200 Revise FAA order Plan to include angles Plan for public use (5) Issue AC A Plan for each runway end FAA Standards for new training and procedures Update pilot and ATIS information 1. AC A in final coordination (9) 2. Non-Alliance To Report (11) & (6) 3. Needs AC A Issues (6) Transition to RNAV/RNP (25a) (23) POIs policies to authorize GPS procedures as RNAV (19) Update RNP policy & criteria RNP procedures operational processes Plan for 3d NAV procedures (17) (24) (27) ICAO SARPs S&GAS (28a) (4) (7) (8) (9) (3) Plan to install DMEs (12) AFS-400 AVN ATA AFS- 400 AVN ATA AFS- 400 AFS- 200 (11,15,16,20,24,2 5A,26,27,29) (11) (11,21,6,20) (24,27) (9,24, 27) (11) (22) AFS- 400 (20) Plan for implementation of multiple "minima" Plan for operational approval of VNAV & RNAV Plan for education of inspectors, Check airmen & examiners (21) AFS- 200 (7) (24,25a) (24,27) (22,25a) (2.) (11) Crew procedures for stabilized approach (2.) (1.) (3.)

54 Global Aviation Safety Global Aviation Safety

55 ICAO IFALPA IATA FSF Global Aviation Safety Programs JSSI Concept Working togetherWorking together Common Strategy for Accident PreventionCommon Strategy for Accident Prevention Data AnalysisData Analysis Data Driven PlanData Driven Plan FAA CAST SARAST SEARAST Etc. Opportunities PAAST

56 CAST Links to International Safety Activities Asia/Pacific –ICAO COSCAP (Cooperative Development of Operational Safety and Continuing Airworthiness) –NARAST, SARAST, SEARAST –Association of Asia Pacific Airlines Europe –JSSI: JAA Safety Strategy Initiative Central / South America –PAAST: Pan American Aviation Safety Team East Africa –African Airlines Safety Council, AFRASCO West Africa –ASECNA (Agence pour la Securite de la Navigation Aerienne en Afrique et a Madagascar) Flight Safety Foundation –CAAG (CFIT & Approach and Landing Action Group) ICAO –Global Aviation Safety Plan (GASP)

57 JAA Joint Safety Strategy Initiative (JSSI) Process

58 Verify Validity JSSI Top Level Methodology - CAST Issue (ex. CFIT) JSSI-004 Data Choose Focus Area Other Considerations Do We Participate? Others Analyzing Focus Area? Interventions & Problems defined by others ? Verification of Validity of Results Required ? Data Yes No Yes No Create Analysis Team Define Problem Statements, Interventions, Effectiveness Determine European Feasibility Yes Data Intervention Under JAA Purview? Yes No Yes Develop Action Plan Recommend- ation Data Monitor Results Execute Plan Develop Detailed Plan JSSI STG Approval ? No 1 Yes Recommend Action to Appropriate Organization Yes CAST Implementation Plan Data No

59 Verify Validity JSSI Top Level Methodology - JSSI Issue (ex. Design Related) JSSI-003 Data Choose Focus Area Other Considerations Do We Participate? Others Analyzing Focus Area? Interventions & Problems defined by others ? Verification of Validity of Results Required ? Data Yes No Yes No Create Analysis Team Define Problem Statements, Interventions, Effectiveness Determine European Feasibility Yes Data Intervention Under JAA Purview? Yes No Yes Develop Action Plan Recommend- ation Data Monitor Results Execute Plan Develop Detailed Plan JSSI STG Approval ? No 1 Yes Recommend Action to Appropriate Organization Yes CAST Implementation Plan Data No

60 Pan American Aviation Safety Team (PAAST) Pan American Aviation Safety Team (PAAST)

61 Pan American Aviation Safety Team - PAAST Covers all of America south of the U.S. Well developed and organized Three Co-Chairs – Al Castan, IATA - Miami – Capt Rocky Marco Rocha, TAM Airlines - Brazil – Capt Luis Garcia, IFALPA - Mexico Active Action Teams / Volunteers Active ICAO participation PAAST

62 ICAO FSF IATA AITAL IFALPA AIRBUS BOEING EMBRAER Airline Management Airline Safety Departments States and Regulators IFATCA CAST (US), JSSI (Europe) & Other Regional Teams IBAC PAAST Pilots & Controllers Integration and Consolidation of safety efforts PAAST

63 CAST Links with ICAO

64 Working with ICAO CAST - ICAO Common Taxonomy Team ICAO Safety Indicators Study Group COSCAP (Cooperative Development of Operational Safety and Continuing Airworthiness) – South Asia Regional Aviation Safety Team – South East Asia Regional Aviation Safety Team Flight Safety Foundation CFIT/ALAR Action Group (CAAG)

65 Summary

66 NTSB Accident Incident Reports 21.3 Reports Airclaims data Implementation Strategy JSIT Historical Data Pareto Plots JSAT NASDAC data Causal Analysis Combined Threat Cause Accident Safety Analysis Process Industry FOQA data JSAT Intervention Strategy Coordinated Plan Measuring Progress to Goal Industry Government Safer Skies AvSP

67 Future Vision Execute the CAST-approved Safety Plan Measure Plan effectiveness and modify Plan based on metrics and results Continue the development of a proactive incident- based risk mitigation methodology Improve the CAST process Expand CAST influence on worldwide safety programs Integrate safety program with R & D initiatives Catalog the many on-going safety initiatives that dilute limited resources and identify opportunities for program integration and efficiency improvements

68 Safety Plan Development Accident JSATs Accident JSITs Safety Enhancements CAST Plan Incident Analysis Process Metrics JIMDAT Process Emerging Risk Changing Risk Safety Enhancements Aviation System Changes Present In Master Factors Yes No Demographic Changes Identify Hazards Identify Factors Develop Contributing Factors (new or emerging) Safety Enhancements Identify Hazards Identify Factors Master Contributing Factors CAST-051 CAST Plan Rev. FAST Hazards Metrics

69 Our Challenge: Stay Focused Work together internationally Coordinate strategy Target our resources Focus on prevention Communicate industry and government safety processes and initiatives Share results

70 CAST Process Data-Driven Industry/Regulatory Collaboration

71


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