[Peetwo]

ATSB World Class? - My ASS: Version III  



Via LMH: 

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ATSB reinforces Recommendation in Letter to Angel Flight
7 November 2019
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The Australian Transport Safety Bureau (ATSB) has urged Angel Flight to reconsider its response to their recommendation to place passengers on airlines rather than private flights.

The recommendation was contained in the investigation report into the fatal accident of VH-YTM at Mount Gambier in 2017, but Angel Flight rejected the recommendation, preferring to stay with private flights as the primary service.
In a letter to Angel Flight CEO Marjorie Pagani dated 4 November, ATSB Chief Commissioner Greg Hood said he would give Angel Flight another chance to reconsider their position before posting the response on the ATSB website.
"The reasons outlined for the decision by Angel Flight to maintain its current policy of giving priority to private flights where possible do not address the evidence on which the recommendation was made," Hood states in the letter.
"As outlined in the final investigation report, that evidence centred on that commercial passenger flights have an established lower safety risk for passengers than private operations. The reasons stated in your response only addressed your disagreement with other evidence in the ATSB final report concerning the relative safety of Angel Flights and other private operations.
"The ATSB Commission believes that Angel Flight should firstly consider the safety of Angel Flight passengers. Regional and rural people should not be exposed to unnecessary levels of risk as a passenger on a private community service flight, and as such, Angel Flight should consider the safer option as the primary option, where available, before considering private operations.

"The ATSB Commission is therefore asking you to reconsider your response to the safety recommendation."
Pagani told Australian Flying that the ATSB seemed out of touch with what it meant for Angel Flight to put passengers on RPT flights.

"They completely overlook the very personal nature of the service; the difficulties with families and elderly people navigating major city airports to find the pick-up spots and of course the drivers themselves, who prefer not to have to negotiate those airports. 

"You would be surprised at the high number of people we have who strenuously object to having to use RPT – they don’t like the waiting, the queuing, the big arrival airports and the lack of personal contact.

"We even have abusive responses at times when we want to move passengers to RPT."

It is believed that Angel Flight will not be reconsidering their position.

Read more at http://www.australianflying.com.au/lates...vm9VPw3.99

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Hmm...sounds like the Hooded Canary is a bit miffed that Angel Flight is basically up yours to the bollocks safety recommendation his top cover organisation issued...  

I also wonder why it took him so long to respond remembering that AF issued their response (post [b]#282[/b] ) and made public on the Angel Flight Senate Inquiry web page over a month ago?? Probably wanted to keep it all hush...hush until  the bollocks Safeskies etc talk fests were over...

I also note a passing strange parallel disconnection when yesterday the ATSB issued the following media release in conjunction with the issuing of two preliminary investigation reports...

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Weather a focus of fatal accident investigations


Following the release of two preliminary investigation reports into multiple fatality accidents where the aircraft involved were operating under visual flight rules (VFR), the Australian Transport Safety Bureau (ATSB) is again highlighting to pilots the actions they can take to avoid a weather or low-visibility related accident.

Today, the ATSB has released the preliminary* reports for the collision with water of Bell UH-1H ‘Huey’ helicopter VH-UVC, and the collision with terrain of Mooney M20J VH-DJU.

Five people were killed in the accident involving VH-UVC, which impacted the ocean after last light at a time of reported severe weather near Anna Bay, NSW, on 6 September 2019. Then on 20 September 2019, a father and son died when VH-DJU collided with heavily-wooded terrain in the Dorrigo National Park near Coffs Harbour, NSW, in forecast weather conditions of low broken cloud.

Both accidents are unrelated, but in both instances the flights were operating under visual flight rules, and neither pilot had qualifications to operate in instrument meteorological conditions (IMC) or at night, the preliminary reports establish. Further, both investigations will continue to look at the weather and environmental conditions at the time of the accidents, among a number of other factors.

“It is important to stress that both investigations are still in their early stages, and the ATSB will not publish its findings until the final investigation reports are released,” said ATSB Executive Director Transport Safety Nat Nagy.

“But the ATSB notes that weather and environmental conditions are a focus for both investigations, and weather-related general aviation accidents remain one of the ATSB’s most significant causes for concern in aviation safety.

Pilots without a current instrument rating should always be prepared to amend and delay plans to fly due to poor or deteriorating weather conditions, and not to push on.

“Weather and low visibility-related accidents often have fatal outcomes, which is all the more tragic because they are almost always avoidable.”

To remind VFR pilots of the dangers of flying into IMC, and to highlight the actions they can take to avoid a weather-related accident, the ATSB is currently running a safety promotion campaign titled ‘Don’t push it, DON'T GO – Know your limits before flight’.

“‘Don’t push it, DON'T GO’ highlights three key messages: the importance of thorough pre-flight planning and having alternate plans, that pressing on where there is the possibility of entering IMC carries a significant risk of spatial disorientation, and the value of using a ‘personal minimums’ checklist to help manage flight risks,” Mr Nagy said.

“Pilots without a current instrument rating should always be prepared to amend and delay plans to fly due to poor or deteriorating weather and environmental conditions, and not to push on,” he said.

“Have alternate plans in case of unexpected changes in weather, and make timely decisions to turn back, divert or hold in an area of good weather.

“Finally, setting expectations for your passengers beforehand can take the pressure off continuing with the flight if the conditions exceed your personal minimums.”


Source: ATSB
A total of 101 occurrences of VFR pilots inadvertently flying into IMC in Australian airspace were reported to the ATSB in the decade from 1 July 2009 to 30 June 2019. Of those occurrences, nine were accidents resulting in 21 deaths.

Findings from ATSB previous investigations into aircraft accidents where a VFR pilot flew into IMC makes for sobering reading. A selection of those findings are published in the ATSB’s recently updated Accidents involving pilots in Instrument Meteorological Conditions publication.

“The ATSB encourages VFR pilots to learn from the experiences of others, to help build a robust understanding of the risks of flying into IMC and just how rapidly such accidents can happen,” Mr Nagy said.

‘Don’t push it, DON'T GO’ follows on from a similar campaign the ATSB launched in 2018, titled ‘Don’t push it, LAND IT’, which was directed at helicopter pilots.

‘Don’t push it, LAND IT’ encouraged pilots to use their helicopter’s unique ability to make precautionary landings almost anywhere if faced with flying into IMC, fading day light or if something concerns them with their aircraft.

 “Know your limits before flight,” Mr Nagy said. “If you’re faced with deteriorating weather or if something just doesn’t feel right, don’t push it, make a precautionary landing. If you do decide to push on, it could be the beginning of an accident sequence.”

*Preliminary reports outline basic factual information established in the early phase of an investigation. They do not contain findings, identify contributing factors or outline safety issues and actions, which will be detailed in an investigation’s final report.

[b]Read the preliminary report AO-2019-050: Collision with water involving Bell UH-1H helicopter VH-UVC, 5 km south-west of Anna Bay, NSW, on 6 September 2019[/b]
[b]Read the preliminary report AO-2019-052: Collision with terrain involving Mooney M20J, VH-DJU, 26 km west of Coffs Harbour Airport, NSW, on 20 September 2019[/b]

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Funny thing about that MR is when you delve into the helpful Hooded Canary links you come across some even more bizarre passing strange dichotomies...

Exhibit 1 link:  Accidents involving pilots in Instrument Meteorological Conditions

In the decade from 1 July 2009 to 30 June 2019, 101 VFR into IMC occurrences in Australian airspace were reported to the ATSB. Of those, nine were accidents resulting in 21 fatalities. That is, about one in 10 VFR into IMC events result in a fatal outcome.

Exhibit 2 link: https://www.atsb.gov.au/publications/200...e_weather/

The work of this study is based on a set of 491 aviation accident and incident reports drawn from the Australian Transport Safety Bureau (ATSB) occurrence database. The study compares three groups of pilots who differed in their response to adverse weather conditions encountered during their flight...

Now refer to the PDF link provided - HERE - and go to the reference pages (57-58). All that decades of factual evidence, statistics and repeated findings and yet the Mount Gambier accident final report slates the blame on Angel Flight? - Yeah right...   

MTF...P2