Todd Curtis and John Goglia analyze an accident that was investigated by the Australian Transportation Safety Bureau, Australia’s version of the NTSB. The ATSB report offers comprehensive aviation safety details and insight. John and Greg review the level of detail and compare it to what they find in NTSB reports from similar general aviation accidents.

The Australian accident involved a Cessna 172 aircraft that crashed due to pilot decision making. This was the pilot’s first solo flight using the autopilot system. His confusion led to the fatal plane crash.

John compares the pilot’s decisions in the Australian accident with those of the pilots in the 2000 crash of Alaska Airlines Flight 261. In that aviation disaster, the crew decided to keep flying rather than make a precautionary landing.
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Todd discusses the steps he takes to avoid making autopilot-related errors in flight. He uses both a laptop-based flight simulator at home and a more sophisticated fixed based simulator to complement his flight training.

Greg Feith and John Goglia review recent general aviation safety issues. Lack of operation discipline is leading to avoidable plane damage insurance claims. Because the claims increase insurance rates, all general aviation pilots are paying a price.

Multiple incidents are shared as examples: planes running over taxi lights, ground collisions with aircraft and other objects, engines started with tow bars attached. John and Greg see a lack operational discipline by general aviation and professional pilots as a root cause of these avoidable incidents.

The issues are not limited to smaller general aviation aircraft. John mentions 2014 fatal accident involving a Gulfstream aircraft where the aircraft operator exhibited operational discipline issues. John and Greg also use as an example the Piaggio elevator separation event mentioned in Episode 195.
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Aviation safety depends on pilots having a high level of operational discipline at all times when the plane is moving.

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Concorde Battery is pleased to announce that PAMA President John Goglia will present A Chat on the Back Porch during the Piston session of the Concorde Battery Virtual IA Renewal Series January 11 & 12. During his 50 minute presentation he delivers “observations from someone with 50 years in the business,” as he states.
 
Concorde Battery Corporation’s Virtual IA Renewal Series is a free online Maintenance Training Event.  Distinguished speakers teach one-hour courses on Piston (January 11-12), Turbine (January 17-18) and Rotorcraft (January 25-26) specific topics. The three series run for four hours daily over two days and are available in a morning (8 AM – 12 PM EST) and evening (5 PM – 9PM EST) session to accommodate worldwide audiences.  Each session is eligible for up to 8 hours of IA and FAA AMT credit.
 
 
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Pilot and maintenance failures combined to create a dramatic turboprop incident that became a criminal case. John Goglia and Greg Feith explore the incident with a Piaggio aircraft that lost an elevator on the first flight of the day and continued with operations.

The air taxi flight crew landed and flew to next airport without performing a preflight inspection. John and Greg talk about the indications the pilots could have detected to recognize problems even if they could not visually inspect the elevators.

John cites the NTSB investigation of the 2000 crash of an Emery Worldwide Airlines DC-8 as an example of how a pilot may be able to feel the difference in the control response when a flight control surface fails.

The investigation found that maintenance done in response to mandatory AD 28 days before this incident had not been done properly. The nuts holding the elevators in pace were not torqued properly. The plane flew 128 hours with loose hardware.
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Adding to this incident, the head of maintenance of the charter company operating the plane took steps to hide evidence from the NTSB and FAA. A criminal investigation led to a fine that put the company out of business and a conviction for the head of maintenance.

The 2019 Agusta AW139 helicopter crash at sea killed both pilots and all five passengers. While the crew had flown the route on at least 10 previous occasions, this was their first night flight.

Greg, Todd, and John raise many issues beyond the probable causes listed in the NTSB report:

• Inadequate flight planning
• Lack of a formal safety management system in the company that operated the helicopter
• The long duty day of the flight crew
• Focus on accomplishing the mission over operational discipline

“There were no mechanical issues. This is all about a lack of planning and poor decision making by the pilots,” John says.

The helicopter CVR does not indicate that the pilots did any of the proper checks for IFR at night. They also were not monitoring their gauges, and seemed to misread the instruments. Fatigue may have been a factor, since the pilots were awakened to make the 2AM flight.
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John ends the show by encouraging pilots and aircraft operators to use flight risk assessment tools (FRAT) from the FAA and the NBAA to help prevent accidents.