Saturday, July 1, 2006
One Way to Break the Chain
Certain she had not exceeded engine or gearbox torque limits, the young flight officer was still concerned she had "pulled too much power" on the heavy, twin helicopter on takeoff from an oil-rig helideck.
At home base, she removed the the quick access recorder's memory card, proceeded directly to the Helicopter Operations Monitoring Program (HOMP) manager and asked him to upload and help her analyze that takeoff. Within minutes, the data confirmed she had not exceeded the limits. With the HOMP manager's assistance, she better understood the event and circumstances leading up to it. Clearly, this pilot's ability to immediately review data about an event with a trusted, highly experienced senior pilot is an important tool to improve her piloting skills.
HOMP fills a historical gap in trust and knowledge that left aviation reactively seeking evidence from "smoking holes" to identify its biggest mistakes rather than pro-actively learning from non-accident events and preventing mistakes and the accidents they caused.
In the early 1970s, British Airways began monitoring and analyzing data from all flights to pro-actively identify unsafe acts or trends and prevent accidents. The first widely used flight data monitoring system, the British Airways Safety Information System, is the parent of HOMP and Flight Operations Quality Assurance (FOQA), both of which provide hard data needed to drive safety improvements. In an industry that simply does not change without facts that strongly indicate improvement, HOMP and FOQA complement other valuable human-factors programs like crew resource management and line-oriented flight training, addressing the most common causal factor in accidents--human error.
A HOMP trial by the U.K. CAA, with Bristow Helicopters, British Airways, Smiths Aerospace, BAE Systems and Shell Aircraft, showed how flight data can be routinely downloaded from every flight, analyzed for parameters outside established "normal" limits, and turned into useful information for improving flight performance and safety. In the two-year operational period covering 11,500 flight hours, the HOMP manager, the operator or its customers identified, analyzed and resolved numerous events and incidents. Based on this first formal demonstration of flight data monitoring for helicopters, Bristow and other helicopter operators have committed to fully implementing HOMP without waiting for a CAA mandate.
HOMP addresses how the aircraft is operated. Its sister program, Health Usage Monitoring System (HUMS), primarily addresses mechanical components and procedures like rotor track and balance. Together, they make a powerful team of hard data-based safety information producing systems that can drive down the accident rate wherever they are in use. Pilots engaged in a HOMP understand that information from this system allows them improve their own performance by eliminating errors. (The "golden key" to HOMP's value is absolute trust that individual identities will not be revealed beyond the "gatekeeper"--the HOMP manager--lest some disciplinary action result from a simple human error.) HOMP is not limited to identifying human error. It also helps identify hazardous circumstances and procedural and organizational issues.
Rapid extraction of basic flight information from a flight data recorder through a quick access recorder, and analysis of it by computer, is quite easy to do on all-digital aircraft. But it is possible on any aircraft with a flight management system or computer. Older helicopters, especially single-engine, single-pilot types that comprise most of the working fleet today, can have a "semi-HOMP" by implementing innovative concepts like GPS-based flight tracking and selectively recording various accelerations and parameters.
Improving safety by pro-actively dealing with precursor events that are normally unreportable and have not resulted in damage or injury is the way ahead. Events like these, linked together, constitute the chain of underlying factors that can cause an accident. HOMP is one way to break the chain.
I first became aware of HOMP in 1999, when as the U.S. Navy Dept. director of safety and survivability, I visited U.K. offshore operators to learn about advancements in HUMS, which was first implemented in the North Sea in the early 1990s. Any HUMS-equipped aircraft has the basic components for HOMP, and it was an easy step up to pro-active prevention of accidents. Shell and other offshore customers are now requiring operators to have HOMP in their contracts, so it is certain to grow in use in offshore helicopter services. But HOMP's value and utility applies to all helicopter operations. I strongly advocate implementing HOMP as a major step toward achieving the International Helicopter Safety Team's goal of an 80-percent reduction in the accident rate by 2015. I believe HOMP will buy much of the desired improvement in fewer than five years if widely implemented.
A former presidential appointed member of the U.S. National Transportation Safety Board, Richard Healing is a professional engineer and senior partner in the Washington- based consulting firm R Cubed Consulting, LLC. Before joining the NTSB, Healing served as the U.S. Navy's first director of safety and survivability and was instrumental in adoption of the lifesaving Helicopter Emergency Egress Device, flight recorders and many other safety improvements on combat aircraft.