Free SMS Training By Aviation Safety Management Society of India for all the Stakeholders in Aviation

Greetings from Aviation Safety Management Society of India (ASMSI).

Aviation Safety Management Society of India (ASMSI) is an all India Registered “Not for Profit” Society, dedicated to the promotion of Aviation and Aviation Safety in the country, through spread of knowledge and awareness.

ASMSI is fortunate to have large number of highly accomplished and reputed Aviation Professionals (Former Secretary/Additional Secretary, Members of Parliament, Air Marshals, Generals, Admirals, President ICAO (ANS) Senior  Officials from DGCA, AAI, Industrialist,Doctors,Pilots,Engineers,Air Craft ,Helicopter Operators and MRO,s etc.), both from Civil and Military Aviation, as its Esteemed Members and associates. These professionals are working with zeal to share their knowledge and expertise, selflessly, in the field of Aviation, for the benefit of all the stakeholders in Aviation.

Since it is learnt that the implementation of SMS by the Operators has been found to be lacking, ASMSI has taken a conscious decision to work towards effective implementation of Safety Management System.

It is well known that Safety Management System is a very effective and proven management system to identify hazards in a proactive manner and to ensure that hazards do not turn into accidents, incidents, through timely elimination of hazards.

SMS was introduced in India for the first time on 20 Jul 10 by DGCA through the issue of a CAR. Since then DGCA has been making concerted efforts to ensure that the SMS is implemented in letter and spirit. However, in some recent audits by DGCA, it was observed that the implementation of SMS is lacking on many fronts and obviously it is not being taken seriously by most of the Operators. The lack of effective implementation of SMS was also highlighted by the Honorable Minister of Civil Aviation during his briefing to the lawmakers in Parliament.

The Scope of SMS includes all the personnel of the Operator, right from the CEO downwards to lowest level, including employees from Finance, HR, Admin and Marketing etc., since they also have a role to play in maintaining safe Operation and maintenance environments in the Company. Hence, it is essential that every employee of the Company should be sensitized to the concept of Safety Management System, depending on their role and responsibilities.

Most of the Operators get only those employees i.e. Pilots, Cabin Crew, Accountable Executives/Managers, Chief, Deputy Chief of Flight Safety and Safety Manager etc. trained which are required to be trained as mandated by DGCA. In the absence of SMS training, the other employees of the Company, obviously, remain ignorant about the SMS. Even the employees who have been trained do not take SMS seriously, possibly, due to lack of supervision, monitoring and involvement of the Management.

The Management of the Aviation organisations should appreciate that SMS is a very useful system to promote safety, efficiency of their Operations and prevention of accidents. It needs to be remembered that Accidents are bad for business, reputation and can impact very heavily on the finances and survivability of a Company.

Keeping in mind the importance of SMS towards better  safety  standards and the reluctance of the Operators to get the SMS training done for all their personnel due to financial considerations/constraints, ASMSI has taken the initiative to offer the services of its SMS experts to conduct Online  SMS training of all the personnel of a Company, free of cost.

We have requested all the Operators to make use of the opportunity of the offer of ASMSI to get all their personnel trained on SMS, without incurring any expenditure. Training of all the personnel on SMS will go a long way in enhancing safety of the operations and promoting Safety Culture in the organisation.

We are aware of the fact that most of the Officials from DGCA are quite learned and expert in their field of Work/Operations. Hence, the professionals from ASMSI would be keen to interact with the Officials from DGCA to learn from their vast knowledge and field experience, to enable them to share the knowledge gained through such interaction, with the other stakeholders in Aviation.

ASMSI takes great pleasure in extending an open invitation to Officials from DGCA to join SMS training sessions Online as and when they can spare some time from their busy schedule, to refresh their knowledge about Safety Management System and provide guidance to us in enhancing quality of training and safety standards.

Kindly email to aviationsafetyindia@gmail.com whenever you wish to join the training in groups or individuals and we will be prompt in  giving you date and time of training Online.

Our Mission is to assist DGCA in effective implementation of Safety Management System among all the Stakeholders, to create safe flying environments in the country.  We are quite hopeful of receiving the guidance, support and cooperation from the learned Aviation Professionals from DGCA.

Knowledge and Awareness are Key to Achieve and Maintain High Standards of Safety.

Many Many Happy Landings

COVID19 has the potential to damage the lungs & heart. Pilots may survive a COVID19 infection but may not fly again. There is a need to ask some direct questions to the authorities and airlines. “I am risking the rest of my career but I may not have a job too” my thoughts at the moment. (Walter Rego has explained the financial impact in detail)

ICAO, IFALPA and others need to address the crew medical recovery procedure at the earliest. So far, the ICAO aviation medicine requirement is that the pilot needs to be disease-free. The secondary impact of the disease will have greater repercussions.

PPE saves lives?

False sense of safety is what PPE’s give. It is highly unsafe for a pilot to be wearing the full PPE with a mask and hood. What is there is a need to don the emergency oxygen? Regulations require the O2 mask to be donned in 5 seconds using one hand and without affecting the eye glasses. Its just not possible.

The world is reeling under the stress of COVID19 virus pandemic. The mortality rate stands low and those with pre-existing illnesses, getting on with the years are at greater risk.

Clinical Classifications:

Mild Cases: The clinical symptoms are mild and no pneumonia manifestations can be found in imaging.

Moderate Cases: Patients have symptoms such as fever and respiratory tract symptoms, etc. and pneumonia manifestations can be seen in imaging.

Severe Cases: Adults who meet any of the following criteria: respiratory rate >30 breaths/min; oxygen saturations <93% at a rest state; arterial partial pressure of oxygen (PaO,)/oxygen concentration (FiO,) s; <=300 mm Hg. Patients with> 50% lesions progression within 24 to 48 hours in lung imaging should be treated as severe cases.

Critical Cases: Meeting any of the following criteria: occurrence of respiratory failure requiring mechanical ventilation; the presence of shock; other organ failures that require monitoring and treatment in the ICU.

How can a respiratory illness like COVID-19 damage the heart?

Can COVID-19 damage the heart? Yes: Although COVID-19 — the disease caused by the coronavirus that’s led to the global pandemic — is primarily a respiratory or lung disease, the heart can also suffer.

Early reports coming out of China and Italy, two areas where COVID-19 took hold earlier in the pandemic, show that up to 1 in 5 patients with the illness end up with heart damage. Heart failure has been the cause of death in COVID-19 patients, even those without severe breathing problems such as acute respiratory distress syndrome, or ARDS.

Not all heart problems related to this coronavirus — officially called SARS-CoV-2—are alike, however. Cardiologist Erin Michos, M.D., M.H.S., explains the different ways the virus — and the body’s response to it — can cause heart damage.

“There are multiple mechanisms for heart damage in COVID-19, and not everyone is the same,” Michos says. Temporary or lasting damage to heart tissue can be due to several factors:

• Lack of oxygen.
• Myocarditis: inflammation of the heart.
• Stress cardiomyopathy.

Financial grounding (written by Walter Rego)

I am thankful to Walter Rego for this contribution and helping putting forth the inevitable.

“After considering the risk, signing a new contract makes no sense.  In normal times with no risk (of disease), we get a take-home of ‘X’ amount – lowest being 70lakhs/per annum(USD93,000)  – ours is a rare skill involving so many licenses + a VALID medical– so in abnormal times they should pay us, even more, to come out and fly.

– The pandemic is ‘still on’ it’s not over, and the chances of getting infected are very high especially since the virus is so contagious.
Let’s say you contract the virus and fall sick (several pilots in the high-risk category) if u recover from the disease there is a good chance that u may be PMU – as it attacks ur heart tissue and lung tissue and you may have permanent damage.
Its gonna be a statistical occurrence…let’s say of 5% of the pilots. 
It is also highly possible that you make take the disease home and give it to a family member.  Also due to reduced revenue the hotels the transportation everything is gonna be substandard, and out of your control.
If they propose the pay cut after the pandemic over and it’s all safe then considering a pay cut due to a recession may make sense, but right now for the risk- I would actually ask for even more money or choose to sit at home.

Also, remember the treatment for COVID in a good hospital is almost 7 lakhs – they will quarantine everyone living in your home in a substandard facility and flight crew will have mandatory testing.  The disease being super highly infectious, let’s say 2 people from your family are affected- u lose 14 lakh or even the family member.

With the pay cuts/altered hourly flying based salary being announced (illegally) by airlines, pilots (Capt’s in some airlines) would almost take home 25 lakhs(USD33,000) max this year.
Even if the Pilot is 40 years of age he has another 25 years to go contracting the virus and going to a hospital and then running the risk of being PMU it makes absolutely no sense to go to work but to wait it out till the pandemic is over and then start flying. “

Pharma drugs & organs

Chloroquine phosphate: dizziness, headache, nausea, vomit, diarrhoea, different kinds of skin rash. The most severe adverse reaction is cardiac arrest. The main adverse reaction is ocular toxicity.

Combination of drugs also cause fatal arrhythmia, severe coma.

The psychological stress and symptoms of COVID-19 patients

Confirmed COVID-19 patients often have symptoms such as regret and resentment, loneliness and helplessness, depression, anxiety and phobia, irritation and sleep deprivation. Some patients may have panic attacks.

Psychological evaluations in the isolated wards demonstrated that about 48% of confirmed COVID-19 patients manifested psychological stress during early admission, most of which were from their emotional response to stress. The percentage of delirium is high among critically ill patients.

There is even a report of encephalitis induced by the SARS-CoV-2 leading to psychological symptoms such as unconsciousness and irritability.

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A Boeing engineer who last year lodged an internal ethics complaint alleging serious shortcomings in development of the 737 MAX has written to a U.S. Senate committee asserting that systemic problems with the jet’s design “must be fixed before the 737 MAX is allowed to return to service.”

The letter to the Senate, a copy of which was obtained by The Seattle Times, was written by engineer Curtis Ewbank, a 34-year-old specialist in flight-deck systems whose job when the MAX was in early stages of development involved studying past crashes and using that information to make new planes safer.

His letter, sent earlier this month, argues that it’s not enough for Boeing to fix the flawed Maneuvering Characteristics Augmentation System (MCAS) that’s known to have brought down the aircraft in two crashes in Indonesia and Ethiopia.

“I have no doubt the FAA and lawmakers are under considerable pressure to allow the 737 MAX to return to service as quickly as possible and as soon as the public MCAS flaw is fixed,” Ewbank told the Senate.  “However, given the numerous other known flaws in the airframe, it will be just a matter of time before another flight crew is overwhelmed by a design flaw known to Boeing and further lives are senselessly lost.”

He goes on to suggest similar shortcomings in the flight-control systems may affect the safety of Boeing’s forthcoming 777X widebody jet.

Ewbank’s letter also reveals that he has been interviewed about his concerns by the FBI, which suggests his allegations have at least been considered as part of the Justice Department’s probe into what went wrong on the 737 MAX and whether the actions of anyone at Boeing were criminal.

He mentions he has also delivered details of his allegations to the lead investigator on the U.S. House Committee on Transportation, chaired by Rep. Peter DeFazio, D-Ore.

In 2014, during early work on the MAX’s development, Ewbank worked unsuccessfully to have Boeing upgrade the MAX’s flight-control systems by adding a new data measurement system called Synthetic Airspeed that would have served as a check on multiple sensors. If it had been implemented, he believes it might have prevented the fatal crashes.

Ewbank’s original internal ethics complaint, first reported last October by The Seattle Times, alleged that Boeing rejected his safety upgrades because of management’s focus on schedule and cost considerations and the insistence that anything that might require more pilot training would not be considered.

He also alleged that Boeing pushed regulators at the Federal Aviation Administration (FAA) to relax certification requirements for the airplane, particularly in regard to the cockpit systems for alerting pilots that something is wrong inflight.

Those systems on the MAX have been under scrutiny because during the two fatal MAX crashes that killed 346 people, pilots struggled to understand the cascade of warnings in their cockpits.

‘Hand-waving and deception’

Ewbank’s letter to the Senate Committee on Commerce, Science, and Transportation was sent June 5, ahead of a public hearing Wednesday that featured scathing criticism of FAA Administrator Stephen Dickson for his agency’s lack of progress in addressing the lapses of oversight in certifying the MAX.

Ewbank criticizes not only Boeing for its design of the MAX but also the FAA for approving the design without proper oversight.

“The 737 MAX’s original certification was accomplished with hand-waving and deception to hide the numerous ways the 1960s-era design of the 737 does not meet current regulatory standards,” he wrote.

And he hit out at a recent Department of Transportation (DOT) advisory panel report on the MAX crashes that recommended only minor changes to the way airplanes are certified, preserving Boeing’s central role in that process. Ewbank called the report “a serious threat to aviation safety and the flying public.”

“If the FAA was truly regulating in the public interest, it would take action against Boeing for its continued deception and gross errors in the design and production of the 737 MAX by withdrawing Boeing’s production certificate,” he concluded.

Ansley Lacitis, deputy chief of staff for Democratic Sen. Maria Cantwell of Washington, said her office “was made aware of the letter right before the hearing” on Wednesday.

“The first step of a whistleblower investigation is to make contact with the whistleblower and we have done that,” Lacitis said. “We take these and other allegations seriously and continue to investigate them.”

In a statement, Boeing said company officials have not seen the letter.

“Boeing offers its employees a number of channels for raising concerns and complaints and has rigorous processes in place that ensure complaints receive thorough consideration and protect employee confidentiality,” the statement said. “Boeing does not comment on the substance or existence of such internal complaints.”

Boeing’s statement adds that “when the MAX returns to service, it will be one of the most thoroughly scrutinized aircraft in history, and we have full confidence in its safety.”

Ewbank could not be reached for comment.

After the Seattle Times made public his internal ethics complaint, Boeing placed Ewbank on leave. “We can confirm that Mr. Ewbank remains an employee in good standing,” company spokesman Bernard Choi said this week.

Flawed flight-deck systems

One conclusion of the DOT report on the MAX crashes was that if the 737 MAX had been certified as an all-new jet instead of as a derivative of the earlier model, it “would not have produced more rigorous scrutiny … and would not have produced a safer airplane.”

Ewbank calls this “utterly incorrect.”

He cites specific regulations for which Boeing, because the MAX was considered a derivative model, didn’t have to meet the latest safety standards. And he points to how these shortcomings could have affected the pilots in the two crashes.

NEW DELHI: The Directorate General of Civil Aviation (DGCA) has launched a probe into AirAsia India after a pilot levelled allegations of safety breaches by the airline on social media.
The pilot, who airline officials say has been suspended pending inquiry into disciplinary charges, had levelled charges in a video that went viral on Monday.

Taking cognisance of that, the DGCA tweeted: “DGCA has taken note of the concerns raised by some stakeholders against a particular airline and its approach to safety. DGCA has already started an investigation into the issues flagged and shall take appropriate action based on the outcome of the said investigation.”

In a statement, AirAsia India said that it “stands firmly on its value of ‘safety always’. The safety of our guests is of paramount importance in every aspect of our operations. AirAsia India is cognisant of the matter in regard to a social media post put up by one of its employees. We are cooperating with the DGCA on this matter. As a policy, AirAsia India does not comment on matters pertaining to its business or employees.”

Charges by the Pilot:-

The fear of taking a sick leave.

In the YouTube video where Taneja details the circumstances around his suspension, the AirAsia India pilot talks about an environment that discouraged pilots from taking a sick leave despite being unwell. This is a job that is responsible for about 200 people’s lives and needs a high level of physical and mental fitness.

Pilots from other airlines agreed with Taneja. “Pilots do fear asking for a sick leave, as it may lead to punitive action,” a pilot with over 20 years of flying experience, told Moneycontrol. The punitive action may be in the form of a lower bonus, at the end of the year.

“On any other job, one could go to work despite feeling a bit under the weather. As a pilot, I can’t afford to do that,” says the pilot cited above.

At the same time, added another aviator, the management also takes notice if a pilot is repeatedly taking sick leave or takes off on festivals despite being rostered to fly.

One does not know the factors around Taneja’s allegations, and only the investigation by DGCA can throw light.

SOPs not being followed

Taneja alleges that the airline was not strictly adhering to the SoPs issued by the government, on flying amidst COVID-19 times.

Though the pilot doesn’t get into the details on which SoPs were not being followed, one gathers he was talking about the procedures to be followed within the aircraft. Taneja alleges that he was forced to delay a flight by 40 minutes because SoPs were not being followed.

Is it the responsibility of the pilot-in-command (PIC) to ensure SoPs are followed in the flight, or should he just leave it to the ground handling team?

It’s a topic that seems to have different views.

“Pilot becomes responsible for the aircraft only once the doors are closed. Otherwise, he should let the ground handling team manage it,” says a senior executive from the industry.

Country’s largest airline IndiGo, another senior executive pointed out, details in its manual that the PIC assumes command of the flight the moment he signs the aircraft acceptance, and he is responsible “for the safe execution of the flight and for the safety of the occupants…and orderly conduct of the flight..”

The ‘flight’ is the key word here. The manual defines ‘flight’ to represent the period between ‘doors closed’ and ‘doors open.’

Amit Singh, an industry veteran and Fellow of London’s Royal Aeronautical Society, points to the Civil Aviation Regulations – which advises airlines on several aviation aspects. “The pilot-in-command shall be responsible for the safety of all crew members, passengers and cargo on board when the doors are closed,” says the CAR.

So going by the CAR, is Taneja technically responsible for the SoPs that are to be done before the doors close?

A senior pilot agreed with the CAR guidelines, but added that when it comes to the COVID-19 SoPs, the policy may differ from airline to airline.

On Taneja’s concerns, one will have to wait for the investigations to reveal if he was following the protocol laid down by the company, or not.

Flap 3 or Flap 4

Taneja’s third and final point was on Flap 3 and Flap 4.

Flaps are installed on an aircraft’s wings and are mainly used to create a drag in the speed of the plane while landing or taking off. This in turn can reduce the distance required for landing and take-off.

Flap 3 saves fuel – about 8kg – a reason why nearly all airlines advise their pilots to use this mode, rather than Flap 4.

But in the case of AirAsia India, alleges Taneja, the airline had made it mandatory for its pilots to use Flap 3, for 98 percent of their landings. In one particular month, Taneja says, he had done 10 landings, out of which seven were done using Flap 3, thus making it only 70 percent.

Two of the landings, says Taneja, were in Imphal where landing is complicated and thus he used Flap 4. Should he have compromised on passenger safety to save fuel, he asks.

Again, industry has differing views on this. “AirAsia India isn’t wrong in asking him to do a F3 landing to conserve fuel. It’s done the world over,” says a senior pilot with a private airline.

At the same time, pilots point out that few airlines put a target to using Flap3. “It’s an advisory. There are better ways to save fuel. In fact, if you plan your descent properly, a pilot can save more than 100 kg of fuel,” says a senior pilot.

Amit Singh says the solution may lie in wording the advisory. “If the airline wants its pilots to consistently perform FLAP 3 landings instead of Flap Full, then what should the policy read? As per my understanding, the policy should be:

“Normal flaps for landing is Flap 3 but, at the discretion of the pilot in command, up-to a maximum of 2 percent landings can be performed with Flap Full.

“People tend to avoid risk when a positive frame is presented but seek risks when a negative frame is presented,” Singh says in his blog Mindfly.

One can’t say if a different framing of the advisory would have prompted Taneja to react differently. At the same time, it’s an interesting thought. Can policymakers bring in more positivity to their regulations?

The style

While the three issues raised by Taneja have set off a debate in the industry, executives have also discussed the method the senior pilot has used to air his grievances.

Few employees take to social media to raise allegations against their employer. And that, say experts, may not be the ideal way.

“Talking about it is publicly about an organisation, there is a reputational risk of the company. From an HR point of view, it is not at all advisable to go immediately on social media and share details. Maybe one can speak about any concern about an organisation one he/she has left the company and also preferably without naming the firm,” says Aditya Narayan Mishra, CEO, CIEL HR Services.

He adds that talking about confidential information that one is privy to at the workplace, on social media, is not just contractually disallowed but is also ‘morally incorrect.’

For sure, the suspension of Gaurav Taneja has raised many an issue and may set a precedent in the industry.

Looking London Landing Tokyo, the wrong runway at Haneda:mindFly

Synopsis

On Thursday, December 22, 2016, an Airbus A320-214, registered JA811P, operated by PeachAviation Co., Ltd, as the scheduled Flight 1028 of the company, while approaching runway 16L of Tokyo International Airport, mistakenly tried to approach for runway 23 which was closed at 00:39 JST. An air traffic controller in the control tower noticed the situation and instructed it to go around at the position of about 5 miles east of the airport. Afterwards, the aircraft landed on runway 16L at 00:55 JST via visual approach following radar-vectored.

JTSB Full investigation report

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Probable cause, JTSB report

It is probable that the serious incident occurred because aircraft, conducting VOR-A approach to land on runway 16L of Tokyo International Airport, mistakenly tried to approach for runway 23 which was closed.

It is probable that the aircraft mistakenly tried to approach for runway 23 which was closed because advance preparations for VOR A approach by the captain and the first officer were not sufficient, and they could not recognize the runway change instruction to land as a threat and then they failed to manage workloads, properly monitor and advise.

MindFly Human Factor analysis

Tokyo Approach instructed that the Aircraft would be set to land on runway 34R. Later, Tokyo Approach reported that he expected to change landing runway to runway 16L. As per the investigation report, the Captain was amazed because he did not expect any possibilities of landing runway change at all and he had no idea about the reason for this change, but he thought that he could manage to address this situation because it was good weather around the Airport. He asked the FO to set up MCDU15, but later he noticed that the FO looked confused.

Expectation Bias 

Purdue University carried out a study of accidents incidents of landing on wrong runways and wrong airports. One of the reasons for landing at the wrong surface is that flight crew have a mental picture of the airport and orientation of the runways, this is compared with what the pilot see outside. The pilots misjudge the time, speed, distance and; finally, misidentify the landing surface through the distortion of facts of the facts of reality (Antuano & Mohler, 1989). The pilots are thus, disoriented and are inadequately informed by the external visual environment. This is more so when transiting from instrument conditions to visual conditions.

Visual cognition is limited by the number of computations it can perform, because the brain can process only a fraction of the visual faculties in detail, and by the inherent ambiguity of the information entering the visual system (Christopher, 2011). The brain prioritizes the information to reduce the burden. Attention prioritizes stimulus processing on the basis of motivational relevance, and expectations constrain visual interpretation on the basis of prior likelihood.

The expectation is the state of the brain that reflects prior information about what is possible or probable in the forthcoming sensory environment. Expectation leads to faster acquisition and interpretation of the visual input.

Conclusion

The crew had prepared and briefed for an ILS approach for runway 34R. The position of the runway from the arrival route would have been turning left after crossing point ‘KAIHO’ and the runway would have been straight ahead.

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The Captain had this mental image in mind when he prepared and briefed for the approach. The last minute change of runway to use runway 16L did not reprocess the mental image. The Captain flew the arrival route and the moment he saw a runway on his left, he turned and aligned with the runway. This is what he was expecting to see visually. The mental image matched with the visual image and expectation bias over ruled all visual indications of a wrong runway and that too a closed runway.

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It is imperative not only to reprogram the FMS for a correct visual representation of the runway on the navigation display but also to reprogram the mental image. The supporting crew plays an important role in this situation but is also challenged due to suddenly increased workload. The importance of briefing is exemplified here. We all carry out normal briefings but the SOP must also include strategies for handling change and that too last minute change. Unless there is a plan B ready and you are convinced and reprogrammed mentally, do not proceed.

My paper on “Inattentional blindness during visual approach”. This could have been the worlds worst air disaster.