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Introduction

Safety is a priority in everything we do in the Civil Air Patrol.
Whether ground or flying safety, each individual has a responsibility
to ensure they minimize risk to people and assets under their
control. Safety cannot simply be a buzzword and something we only
pay lip service to. It must be ingrained in our culture, our procedures
and our everyday life. This lesson, while concentrating on flight
safety, addresses safety issues that are applicable to both ground
and flying safety. Crew Resource Management, while designed
primarily for the flight deck, has at its core, basic principles
that can be practiced in any environment. Operational Risk Management
is essentially a ground based planning process that minimizes
airborne risk, but again, is applicable to everything we do –
on the ground or in the air. In other words, safety needs the
same commitment whether you’re on the ground or slipping the surly
bonds.
Crew Resource Management – A Safety Tool
Crew Resource Management (CRM) became one of the
two hot safety and flight training topics of the 90’s. As aircraft
maintenance has reached new levels of reliability, aircrew errors
have become the predominant factor in aircraft accidents. The US
Air Force estimates that upwards of 80% of all mishaps are the result
of human factors/errors. As aviation has progressed, hardware has
become more reliable and the environment more demanding. These higher
demands require better decision making by pilots, and better management
of the available resources. Therefore, the greatest investment aviators
can make to minimize the possibility of an accident is to maximize
the use of all available assets during flying operations.
But, first,
lets review a few basics. What exactly do we mean by CRM? We mean
the efficient and proper utilization of every available resource
within and without the cockpit. Simply put, the effective management
of a pilot’s available resources. Why do we stress CRM as a safety
tool? There are five main reasons: 1) Complacency – flying is dangerous.
When you stop respecting the environment you’re in and the inherent
risk, you stop paying attention and start making mistakes. 2) Communication
– flying operations demand not just clear, but effective communication.
You may know what your intentions are, but if you don’t communicate
them effectively, your crew or outside agencies, may not. This could
lead to an unsafe situation because people will not be working as
a team to accomplish the mission. 3) Equipment malfunctions – people
tend to think, "that will never happen to me". But any
emergency can, and will, and when you east expect it. Be prepared
and have a plan when it does. 4) "That’s not in the manual".
Many emergency situations simply are not in the flight manual. When
that happens, a good pilot will seek input from every available
source including other crewmembers, pilots in their and other aircraft,
air traffic control agencies and even phone patches to the aircraft
manufacturer. 5) Adverse weather – as good as we get at weather
prediction, there is never a 100% certainty that what you see is
what you get. This is the perfect reason to get weather updates
enroute and solicit pilot reports when available. These solutions
may sound simply like good piloting, which is exactly what CRM is.
There are many ways to practice CRM and put your training to use.
"Hangar Flying" sessions are a great way to practice "what
if" scenarios and can be a great way to test your flight decision
making and flying operations knowledge with other pilots. The integration
of CRM principles into flight planning and post mission debriefs
is critical to CRM success. Distribution and discussion of CRM newsletters
and "read files" can be a great stimulant to new CRM techniques
and ideas. And, finally, honestly relating personal experiences
to other aviators can be the greatest learning tool and reinforce
the lessons of experience. The bottom line is CRM must be more than
just training, it must be an inherent part of aircrew discipline.
Now that we’ve covered what CRM is and its impact on flight safety,
lets look at some technique that can enhance CRM in your cockpit.
First, maintain a consistent set of rules. Understanding FAA regulations,
flight manual procedures and personal minimums is the foundation
for safe aviation. Second, develop and practice good habit patterns.
Good habits will keep you safe and prevent mistakes such as skipping
checklist items when the stresses of an emergency situation start
piling up. Third, use a total cockpit approach. Organize your cockpit
before flight, including folding required maps, setting the radios,
opening and having available all checklists and keeping all emergency
tools, like flashlights, within easy reach. This will prevent confusion
and minimize "fumbling around in the dark" when, and if,
they are required. Fourth, establish a system for managing your
fuel. Every airplane has at least one thing in common: no fuel,
no fly. There are numerous cases of pilots concentrating on minor
cockpit malfunctions, forgetting the fuel gauge, and crashing on
empty tanks. Fifth, you can’t manage the weather, but you can manage
your flight through it. Get every bit of information you can from
television, weather reports, pilot reports and flight service. Then
use it to make a smart decision, even if it means canceling the
flight. Finally, be prepared for whatever happens. During every
phase of flight, expect the worst possible thing to happen and have
a plan in case it does. These are some suggestions and techniques
to enhance CRM in your cockpit. But nothing substitutes knowing
your own personal strengths and weaknesses, and exercising good
leadership to overcome the deficiencies.
There is one other memory aid that can help you during an emergency
situation. It is the word DECIDE, and each letter stands for a different
act. The D is "detect the need to make a decision". The
E, "evaluate your options, considering the goals of your flight.
The C stands for "choosing the options that best meet your
goals’. The I is critical, "implement that choice". The
second D is also for detect, "detect the changes that result
from your decision". Finally, the last E, "evaluate the
result and your need to make further decisions". This moniker
is fairly simple, but in the "heat of battle" simple is
what you need and what may save your life.
Effective CRM
can literally make the difference between life and death. Informed
decision making is relatively easy. The more information you have
to work with in the cockpit, the more intelligent (and safe) will
be the choice you make. We’ve all heard the adage "prior planning
prevents poor performance". This is especially true in aviation.
However, sometimes the unexpected happens and the ability to coordinate
all available resources into an effective solution, the use of CRM,
can be the key to success.
Operational Risk Management
Operational Risk Management (ORM), is not a new concept put forth
by desk bound theorists as a way to reduce accident statistics.
It is simply a method to formulize the risk assessment that we do
everyday. In other words, it’s common sense set into a structured
process that clearly establishes the relationship between the inherent
risk and the associated benefits. The number of high risk situations
is infinite, but some examples are taking off with a known problem,
flying in a high density area, low level flight operations, unfamiliar
airfields, deviations from standard operating procedures, unexpected
or hazardous weather and, the biggest risk factor of all, complacency.
Major Sandy
Kriegel of the US Air Force HQ AMC Flight Safety describes it best
when he writes, "Risk Management is a common sense way of accomplishing
the mission with the least possible risk. It’s a method of getting
the job done by identifying the areas that present the highest risk,
then taking action to eliminate, reduce, or control that risk. Risk
Management can be extremely flexible and can range from a process
taking only a few moments to a more expanded one lasting several
hours or days. Whenever possible, Risk Management should be fully
integrated into mission planning and execution. It is a tool used
to help make sound, informed decisions and gives you the opportunity
to step back and evaluate risks before you place people and resources
in an unsafe situation".
Operational Risk Management can be depicted as a formalized 6-step
process. First, identify all the hazards and potential sources of
danger you could encounter. Second, assess the risk associated with
the hazard and the effect on the mission. Experience and judgement
will play an important role in determining what the hazards are.
For example, night flying would pose little risk for an aviator
who has logged over 1,000 hours at night. However, for an aviator
who just received night/instrument certification, the hazard of
flying at night is greatly increased. Third, analyze risk control
measures. Risk can be accepted, reduced, avoided, distributed, and/or
transferred, and each option should be considered for each hazard.
Fourth, make control decisions. This is the most crucial part of
ORM. You must weigh the risk against the benefit and decide if the
mission is warranted. Just who makes this decision? The decision
should be made at the level corresponding to the degree of risk.
In other words, if you’re the one flying, you make the final determination
if it is worth the risk. Fifth, implement risk controls. It does
no good to identify the hazards and methods to minimize risk if
you don’t implement these measures. Finally, supervise and review
your missions and decisions and those of your subordinates. This
ensures that the appropriate hazards and risks were identified and
any changes implemented. This is also where "lessons learned"
are incorporated into future mission planning. See Pocket
Guide to USAF Operational Risk Management
In the end, ORM cannot be mandated; it must become part of the
CAP culture. To be a permanent part of our culture, it must be embraced
in everything we do. Risk is always present, but it is our responsibility
to reduce the risk as much as possible so as to avoid taking unnecessary
risk. Take active steps to reduce the risk to the least possible
and accept risk where the benefits outweigh the cost. Each of us
practices risk assessment in our daily lives on a "feel"
or subconscious level. With ORM, we are simply formalizing the process
to reduce the possibility that we are accepting a risk that is more
than we think it is, and prevent risks that we are unaware of from
becoming serious consequences. Once this process becomes part of
our daily mission planning, we will maximize our capability and
ensure mission success. In the end, we must ask ourselves: "what
is the difference between a known, evaluated and accepted risk and
a gamble?" The answer is information and the process that takes
that information and transforms it into the right decision – ORM.
Don’t become an accident looking for one!
See Introduction
to CAP Operational Risk Management (ORM)
The Essential Elements of the CAP Flight Safety Program
Safety is a priority in the Civil Air Patrol. Flight safety, while
no more important than ground safety, is perhaps, less forgiving.
It is therefore prudent to establish a dynamic safety program that
enforces safety guidelines and yet encourages people to disclose
lessons learned from personal experience. It must be flexible enough
to enable full-time and part-time aviators to gain the same insights
and practice the same procedures. To that end, there are some basic
elements that are critical to a successful safety program. It is
important to remember that safety responsibilities cannot be delegated,
and remain the providence of the commander. The commander will appoint
a safety officer to assist and advise the commander in the management
of the overall accident prevention program. These responsibilities
include:
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1. Planning safety training programs to include guest speakers
to aquaint all personnel with their responsibility for applying
safe practices
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2. Directing accident investigations and preparing safety reports
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3. Performing safety surveys both annually and at other times
when hazards or hazardous operations so warrant.
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4. Conducting staff visits to subordinate units to assist them
in identifying and solving safety problems.
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5. Reviewing and analyzing findings of accident reports to
determine trends and methods for preventing future accidents.
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6. Arranging for publicity of safety programs through such
media as bulletin boards, newspapers, etc.
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7. Establish a safety hazard-reporting program.
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8. Insure unit compliance with CAPR 62-1 and CAPR 62-2
These are the basic essential elements of a CAP flight safety program.
However, no safety program is complete without the utmost dedication
of each member of the CAP team. Safety needs to be a major concern;
both for ourselves and the people we help.
National, Region and Wing Accident Reporting Procedures and Requirements
The overall purpose of mishap reporting and investigation is mishap
prevention. Prompt notification and reporting of all CAP mishaps
to the appropriate officials is mandatory. When serious injury or
death is involved, there will be no formal or informal investigation
conducted by CAP unless directed by NHQ CAP.
Before we begin, we need to clarify some definitions. First, a
mishap is an unplanned or unsought event, or series of events that
result in death, injury, or damage to equipment or property. Bodily
injuries are personal injury mishaps resulting from aircraft or
vehicle accidents or incidents. Bodily injuries sustained in an
aircraft should be reported as part of that mishap. Nontraumatic
illnesses that occur as a result of CAP activities will be reported
as bodily injuries. Property damage to aircraft is classified as
"flight" or "ground". For flight classification,
mishaps involve the operation of corporate or member-furnished aircraft
during CAP activities, which takes place between the time any person
boards the aircraft with the intention of flight, until such time
as all persons have disembarked. These mishaps are classified as
accidents or incidents, depending on the severity. Accidents are
defined as an occurrence associated with the operation of an aircraft
which takes place between the time any person boards the aircraft
with the intention of flight and all such persons have disembarked,
and in which any person suffers death or serious injury, or in which
the aircraft receives substantial damage. A fatal injury means any
injury which results in death within 30 days of the accident. An
incident means an occurrence other than an accident associated with
the operation of an aircraft, which could affect the safety of operations.
Mishap reporting procedures are very specific and are spelled out
in CAPR 62-2. We will cover the highlights below, but it is important
to remember that every mishap should be reported because it is the
only way to prevent them from happening again. First, the unit or
activity commander will immediately notify the wing commander and
wing safety officer when any mishap occurs during a CAP activity.
Wing commanders or their designees will immediately notify NHQ CAP
of all accidents involving substantial damage, serious injury, or
death. In addition, the wing will also immediately notify their
liaison office, and the region commander or his/her designee, of
all aircraft accidents or incidents, and all other mishaps involving
death and/or serious injury. Lastly, unit or activity commanders
are responsible for completing and submitting CAPF 78, Mishap Report
Form, within 48 hours of the mishap.
Suffice to say, mishap reporting is serious business. Safety is
a commander’s program and the commander is responsible for the safe
conduct of all unit operations. Correct documentation and reporting
of mishaps is critical in preventing their reoccurrence and becomes
the foundation for our "lessons learned" program. It is
up to each of us to operate safely at all times, whether on the
ground or in the air, and make accidents a thing of the past.
Good News: Civil
Air Patrol logs safest year in history
(2000)
Conclusion
Safety is everyone’s responsibility. Crew Resource Management and Operational Risk Management can significantly reduce the number
of flying related accidents. Effective use of all available resources
and thorough pre-flight planning can minimize the chance that the
unexpected will happen. But, the best pilots are always prepared
with backup plans and alternative solutions. Practicing good CRM
and ORM techniques and procedures can ensure your flights are mishap
free.
For additional information see the CAP
Safety Program Web Page
OPR: CAP NHQ/ETP
Last Revised 02/07/2003
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