Spike in aircraft crashes sparks Navy concerns

By Dianna Cahn
The Virginian-Pilot

NORFOLK

A year after two Navy aircraft crashes in the same week off the coast of Virginia Beach – one killing three sailors – a look at the 2014 data shows a sharp spike in the number of the most serious flight accidents.

The Navy suffered 14 manned “Class A” mishaps – those involving loss of life, permanent disability, destroyed aircraft or at least $2 million in damage – in the 2014 fiscal year, which ended in September. It was the highest number since 2008 and marked a big jump from just four Class A mishaps in the prior year, according to the Naval Safety Center.

But Navy officials say that numbers alone don’t tell the whole story and that a year with an increase in severe mishaps, while cause for concern, does not mark a trend.

The data aside, the Navy is looking for a better approach, said Capt. Brendan Murphy, the fleet’s top safety officer. Murphy is working with Pacific Fleet and the Naval Safety Center on a new campaign that will focus on training, lessons learned and prevention.

“We think we can do better,” Murphy said. “The statistics are there. There’s not a single one that’s acceptable.”

In the past decade, the Navy reached a high of 14 Class A flight mishaps three times: in 2006, 2008 and 2014. But since 2008, the numbers had been going down, with 11 in 2009, seven in 2010, and nine in 2011 and 2012. The drop to four in 2013 was encouraging and made last year’s surge all the more striking.

The difference in accidents was also measured against flight hours. In 2013, the Class A flight mishap rate was 0.48 per 100,000 flight hours. The rate more than tripled in 2014 to 1.69 mishaps per 100,000 flight hours. The rates changed when ground and unmanned aircraft mishaps were included, adding three Class A mishaps to 2014 and seven mishaps to 2013, according to the data.

Class A mishaps on shore also rose last year, from two to four, while mishaps at sea dropped from 10 to six.

Every loss is personal, said Murphy, an aviator, particularly in a community as tight-knit as aviation. “In the grand scheme of things, we all know people who were part of mishaps, and we know their families,” he said.

The one universal among mishaps – from air to sea to shore – was that more than 80 percent could be traced to human error, Murphy said.

That raises the importance of creating a program in which information gleaned from accidents is shared across the fleet and ingraining sailors with the ability to assess risk from the start of their careers.

Experience, or “salt,” needs to be intentionally instilled, whether through hands-on training or education, Murphy said.

“What we are looking to do overall is increase our risk intelligence,” he said. “It’s how we stay ahead of dangerous situations every day.”

Murphy said improvement requires organization along several lines. Each command needs to have a chain of safety officers to monitor the command’s safety and to ensure that training and implementation are occurring.

Mechanisms must be in place to ensure that lessons are shared. For example: the time a mishap occurred in a rare circumstance and alerted investigators that two bolts securing the navigator’s seat on the KA-6 tanker were not interchangeable.

That lesson can serve as a cautionary tale for mechanics across a variety of fields, Murphy said.

Part of the effort, he said, is to expand the database of hazards. That requires a culture in which errors, concerns and cautions are shared – even if it means you have to “tell on yourself.”

Also, each command might have a different style of handling problems, and some might do things better than others. There should be a way to ensure they can share and learn from each other, he said.

Another challenge: teaching risk management to a young workforce. Murphy noted research showing that the human brain does not fully develop the ability to analyze risk until the age of 26. It’s a challenge to try to explain risk assessment to people who can’t yet fully see it.

“That’s complicated,” he said. “The way you compensate for that part of the brain that doesn’t know how to assess risk is to have them experience it.”

And when a correction is needed, everyone involved in making that correction – from creating a new widget to changing training or methodology – has to be kept informed.

Finally, safety should be viewed as an integral part of any mission, not as an afterthought or a hoop to jump through.

“It becomes part of the natural approach,” he said, “part of the inoculation.”