July 09 Safety Meeting Larry Brockshus

Overview Gen Courter guidance Annual ORM Review 2009 Aircraft incidents

Guidance from the CAP Nat. Commander Maj. Gen Amy Courter SUBJECT: Interim Change Letter-Increased Safety Requirements for Cadet Activities New requirements to increase safety at cadet events – Safety officer requirments – ORM training and worksheets – For flight activities Ground handling Aerodynamics training Wing walker training

Cadet activity requirements (cont.) NCSA Directors and Wing and Region Encampment Commanders will appoint a Safety Officer – Assist in accomplishing the requirements outlined below – Conduct daily safety briefings – Maintain pertinent training records ORM training requirements – Activity directors and staff to complete the Intermediate ORM course – Students to complete the Basic ORM course before attending the activity. – The on-line ORM Course is located at: – Students and staff can view the ORM worksheet at: Complete ORM Worksheet for activities. You can also use it to evaluate and document safety mishaps that occurred at your specific event last year, if that information is readily available.

Cadets at flying activities Students and staff will view the “Ground Handling” video before attending the activity. – The video is located at: turnUrl=%2fCAP.MultiMedia.Web%2fVideo.aspx. Students and staff will also complete "Essential Aerodynamics" an on-line course and test (with certificate) – Available from AOPA Air Safety Foundation located at: namics&project_code=& namics&project_code=& Glider activates : students and staff will complete the “Wing Runner Course” before attending that activity. – Available at:

Annual ORM Refresher

The Six Step path to ORM may seem long…

Six Steps Step One: Identify the Hazards Step Two: Assess Risks Step Three: Analyze Risk Control Measures Step Four: Make Risk Control Decisions Step Five: Implement Risk Controls Step Six: Supervise and Review

Step One: Identify the Hazards First analyze the mission List the possible hazards – Charts events chronologically or in order of importance to reduce the chances of forgetting any segment – Stay focused on the specific event under analysis and limit your list to the "big picture" – Choose the cause that is the first link in the chain of events

Step Two: Assess Risks Assess the risk for each hazard. – Probability of an event – Severity of the outcome PROBABILITY LikelyOccn’lSeldomUnlikelyOften Catastrophic Moderate Critical Negligible SEVERITY Extremely High High Medium Low

Step Three: Analyze Risk Control Measures Lower the probability of occurrence and/or decrease the severity : – Identify the control options available – Determine their effects on the risk level – Prioritize the control measures Once determined, rank them starting with the controls that have the greatest effect on severity and probability

Step Four: Make Risk Control Decisions Make decisions at the right time – Late as possible to allow more time for collecting info. – Wait too long, and decisions can't be effectively integrated Make risk control decisions at the right level. – Who can best judge the full range of issues involved. – Keep the person who takes the heat in the loop. The goal is not the least level of risk; it is the best level of risk for the total mission

Step Five: Implement Risk Controls Make an implementation plan. For each control: – Make implementation clear – Establish accountability – Provide support at all levels Seven most common reasons why implementation plans fail: – Wrong control for the problem – Disliked by the operators – Disliked by the leaders – Too costly – Overmatched by other priorities – Misunderstood – Not measured until it's too late

Step Six: Supervise and Review Determining the actual effectiveness of risk controls throughout the operation – Supervision of the implementation – Review of the cost/benefit balance – Feedback on the original plan

ORM Integration The integration of ORM is crucial because: – Maximize training realism by reducing unnecessary restrictions and limitations. – Expand operational capabilities in virtually all areas. – Enhance overall decision making. – Make ORM the leading edge of improved employee- management relations. – Cuts losses significantly.

An ORM Analogy Think of ORM as a battle where risk is the enemy – Step One: Where is the enemy – Step Two: Where is the enemy most dangerous – Step Three: What can we do to counter the enemy – Step Four: Make our Battle Plan – Step Five: Attack – Step Six: Battle Damage Assessment, plan next attack

ORM Application Can be used at different levels – Time Critical – Deliberate – Strategic Can be applied by everyone and applied to every situation – Even “on-the-run” crisis situations (the definition of Time Critical)

Four Principles of ORM Accept no unnecessary risk Make Risk decisions at the appropriate level Accept risk when benefits outweigh the cost Integrate ORM into CAP at all levels

Final Thought on ORM ORM does not eliminate risk, or try to create the least level of risk, but aims to have the best combination of acceptable risk and overall mission success.

2009 MN Aircraft Incidents

Incidents 19 Feb, #1218, Damage on horizontal stab 21 Mar, #1262, Hit tie down ring, Soft Field T.O. 17 Apr, #1303, Hit tie down ring, Student Solo 23 May, #1376, Bent Aileron 30 May, #1390, Scraped rear tail box 18 Jun, #1437, Wing leading edge dent 23 Jun, #1492, Scraped wing tip

Concerns 3 incidents of aircraft tail hitting to ground – Training – Technique 5 incidents had an unknown cause – Poor pre/post-flights – Integrity? All were preventable

Be Safe