Dan wrote:
I really want to point out is that these investigative offices quite often miss the real cause
Peter wrote:
if an accident involves a high net worth individual, or a personal injury claim, and/or the airframe manufacturer is still active in the market and keen to defend the brand, […] the various parties’ lawyers get involved, and while the AAIB is supposedly not influenced by such, they cannot publish something which might blow back up at them. In addition, the report is more bland, and thus of lesser learning value, than might otherwise be the case
Well if you guys are trying to stir the pot on something you know I am sensitive to as a way to making me post, you made it!
Both @Mooneydriver and myself have posted before on specific cases with Swiss SUST and French BEA where legal proceedings interfered with the outcome of aircraft investigations.
Disclaimer: I am not a legal expert, (although married to one and working on aviation legal matters all of my life)
We are talking two different worlds with two different goals here:
-Aviation: aiming to ensure safe flying
-Law: aiming to ensure law is abided by through compensating damaged parties and penalising damaging parties.
When an aviation accident happens, the former should be about finding the truth and establishing what can be done to avoid a re-occurrence, the latter is about what can be proven in court using court-acceptable evidence, what they like to call the “legal” truth.
In my opinion, unless gross negligence or wilful misconduct is evident or clearly suspected, the legal world should stay at arms’ length well away from accident investigations. Once you involve legal proceedings, your chances of finding the truth about what happened are clearly diminished, since all parties involved will have a defensive/offensive goal different from truth-finding.
Unfortunately that is not the case. IN the old time, the legal system used to be more respectful of the aviation system. Conclusive evidence from the latter should never be used in the former, but obviously some of the evidence will be common.
However due to several high-profile accidents (like this) , where there was evidence that the aviation investigatory body may have been covering or facilitating the coverage of evidence in order to avoid certain conclusions, that respect is now lost.
The result is the situation described by you guys, resulting in truth-hiding.
Happy to stand corrected or commented by more legally oriented posters, or anyone, for that matter.
Going back to the SR22 discussion – yesterday, by coincidence, I flew one – first time in 20 years. It’s a very easy plane to fly. You get used to the side-stick in about 30 seconds. It’s true that the electric trim is very fast – to retrim when hand flying takes just the tiniest jab of the switch. But it was nowhere near as big a problem as I remembered.
I hand flew quite a bit and didn’t find it hard, though like any new type it takes a bit of getting used to. We showed 175 KTAS which was very pleasant – though at 17 GPH not especially economical. We flew from Cannes to Ajaccio in Corsica, with a couple of approaches to Calvi along the way.
This was a G2 with Avidyne and GNS430. I’m used to the GNS430 so that was no issue. The Avidyne does the job, not especially better or worse than the G500 in my plane.
Aveling wrote:
Long ago I stood with other pilots watching a tri-pacer or similar landing on a grass strip. The aeroplane went out of control and I, and others, stood rooted to the spot aghast. I turned to my friend standing beside me and only then realised that he was already half way across the field running toward the plane, which in the event recovered safely. Individual reactions may vary …
That’s for sure.
A couple of years ago I was walking from the hangar to the car at Enstone while a microlight was landing on the south side grass perhaps 300 yards away. Our paths were reciprocal and just before it passed out of my field of view I noticed it bounce, pitch forward, dig in and crash. From noticing that happening, my next explicit memory is thinking how I was quite out of breath and how running straight across the north side grass and hard runways without looking might have been a dumb thing to do.
Thankfully the only things damaged were the aircraft and his pride.
Peter wrote:
I used to hate T&Gs. They just make you sweat like a pig, you learn little because your brain is on overload… Doing them solo is also really bad because nobody is relaxed and watching you, so if you make a mistake you probably make a big one.
@Peter I don’t doubt that circuits at Shoreham wouldn’t be much fun…. ATC, lots of traffic, students flying big circuits.
When I was taught tailwheel at Enstone by the incomparable @RobertL18C, the first thing I did after he signed me off in the PA17 was fly a load of solo circuits, often an hour of them at a time, on summer evenings. Calm conditions, no one else around, nothing on the radio. It was a lot of fun and I felt myself improving enormously with every session – lots of go arounds, touch and goes, stop and goes, every permutation. After a while I made the circuits smaller and smaller, tiny military-style ovals and landing from a power-chop at late downwind. It was fun seeing just how precise you could be with it.
That was on the grass at Enstone, but I believe Oxfordshire Sport Flying (who operate the hard runway) offer all-you-can-eat circuits on a given day for £30 or so. They almost certainly wouldn’t mind if you wanted to do it in the evening, in fact you can pay them online and just get on with it – no need to even ask. Enstone has no such concept as open or closed. It has no lights, but that’s the only limitation.
Airborne_Again wrote:
Because it is not well defined what a “real” cause is?
Most TSB’s use the term “Most probable cause” unless they have a 100% proof case, which is rare. Some TSB’s use the MPC formula even then. I think this is a very good practice: You communicate the consensus you’ve reached without claiming to be infallible. Most accident investigators are far too good professionals to even consider such a claim.
Dan wrote:
What I really want to point out is that these investigative offices quite often miss the real cause, or do not point it out as such. Whatever the reasons were and are, I cannot say, but this is disappointing to say the least…
That is why most of them use the above term. And if new information turns up which suggest otherwise, most TSB are willing to listen. Not all though.
Dan wrote:
During all these years I also tried “to learn” and studied hundreds of accident reports… I’m still not sure we really learn thru them, but that would be another topic.
So did I and yes, I still think we can. But it requires an open mind and the willingness to read between lines sometimes. In quite a few cases, I felt I could learn a lot more from reading the factual descriptions and reconstructions rather than the actual conclusions. That happens quite often in recent years when a technically excellent report is followed by a CYA or politically motivated conclusion which in cases sais the opposite.
Dan wrote:
The local SUST has supreme authority around here, and this goes as far as screening which accident they deem worth investigating or not.
I think in many cases it’s a simply question of workload. If an accident is deemed such that not a lot can be learnt from it, not a lot has actually happened and it concerns “exotic” airplanes, they often go the way of either stopping the investigation or to go to an accident brief. Frankly, I’d prefer the latter as a minimum unless the reason itself for opening the investigation proves false.
Antonio wrote:
-Aviation: aiming to ensure safe flying
-Law: aiming to ensure law is abided by through compensating damaged parties and penalising damaging parties.
You forgot Nr 3: Politics. Quite often, politics also interfere into investigations, aiming to reach certain political objectives by (mis)using the accident as an example.
Annex 13 clearly states, and most TSB’s repeat that claim in their reports, that the object of this report is NOT to pass a legal judgement but to determine the most probable reason in order to learn from them and increase safety. Quite often, this is in diametric conflict of the objective of lawyers, state attornies and, the worst, politicians and lobbyists, who will use any suitable accident to support their own agendas.
Dan wrote:
The local SUST has supreme authority around here, and this goes as far as screening which accident they deem worth investigating or not.
The homebuilt world unfortunately suffered a couple of accidents in recent years, with associated casualties, and though the SUST were forced to do a preliminary investigation, the full investigations were then discontinued on the grounds that those aircraft are one-off and there is no benefit to be gained by going further…
That’s a pity for Swiss (and other) pilots, I can’t say about DGAC in France as their website is still showing a lot of opening cases for ULs.
I suppose that man power and associated budgets were just following the number of flight hours in certified GA, keeping UL world apart. Now a lot – if not most – certified aviation pilots are moving to UL because it’s cheaper, easier and less regulated, so their futur accidents could well be not investigated anymore. Hence the parachutes…
When I was taught tailwheel at Enstone
Teaching tailwheel in a 90 HP Super Cub is a great experience, thank you @Graham for flying with me.
@Dan as CRM evolves accident case studies continue to be part of the recurring training. Where CRM helps is adding the framework of the ICAO competencies in accident analysis. It certainly isn’t about monday morning quarter backing, as the Americans might say, or blaming the crew, but identifying how crew might ‘trap errors’ before they develop into an accident chain.
The Air Safety Foundation reviews are a good example of the accident case study in the context of CRM.
Thanks @RobertL18C. Yes, I know about that stuff some… had my share of it 🤓
And I still do read, and study some, accident reports. But one thing’s for sure differs from your CRM example, and that is it is not, through differing factors, applicable to the individual reading the report. There is a world of difference between only being a gawker, and taking something away, from said accident report. As much as there is a difference in its use and application in the pro or private aviation world.
