The european helicopter safety team (ehest): 2008/2009 achievements





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EHSAT co-Chairs, 2 Safety Analysts

Abstract

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1. EHEST: THE EUROPEAN COMPONENT OF THE INTERNATIONAL HELICOPTER SAFETY

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2. EHEST: THE HELICOPTER COMPONENT OF THE EUROPEAN STRATEGIC SAFETY

INITIATIVE (ESSI)

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Figure 1 - EHEST participating countries



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Figure 2 - Example of a three level Standard Problem Statement coding



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Figure 5 - Examples of Intervention Recommendations

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4. PRELIMINARY EHSAT RESULTS

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4.1. General data

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Figure 6 - Number of accidents per type of operation in the analysed dataset

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Figure 7 - Distribution of accidents over the phase of flight

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Figure 8 - Pilot-in-command Flight Experience on all Helicopter types (data from 155 accidents)

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Figure 9 - Pilot-in-command Flight Experience on the Accident Helicopter Type in hours (data from 155 accidents)



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Figure 10 - Pilot experience per type of operation for all types and for the accident helicopter type 4.2. Analysis of the accident factors using Standard Problem Statements (SPS)

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S P S C a tego ry - le vel 1 Percentage % 

Figure 11 - Standard Problem Statement results on highest level in percentage of accidents in dataset



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Pivot chart of general info sheet

       0 - 1000 1001 - 2000 2001 - 3000 3001 - 4000 4001 - 5000 > 5000 Num b e r of Ac c ide nt s

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Pivot chart of general info sheet

         0 - 1000 1001 -2000 2001 -3000 3001 -4000 4001 -5000 5001 -6000 6001 -7000 7001 -8000 8001 -9000 90001 -10000 Num be r of A c c ide nt s

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Figure 12 - EHSAT results on 1st level SPS in percentage of accidents

Figure 12. SPS Level 1: EHSAT results compared with US JHSAT results Percent of Accidents in which Top 5 SPS category (level 1)

was identified at least once

EHEST data versus US JHSAT data

         Ground Duties Data issues Pilot situation awareness Safety Culture/Management

Pilot judgment & actions SPS C a te g o ry - l evel 1 Percentage % 86-+6$7GDWD (+(67GDWD &RUUHODWLRQLV

Percent of Accidents in which SPS category (level 2) was identified at least once

15 16 16 18 19 20 20 25 29 31 0 5 10 15 20 25 30 35

Human Factors - Other Visibility/Weather Procedure Implementation Mission Risk - Terrain/Obstacles Inadequate Pilot Experience Landing Procedures Flight Profile unsafe External Environment Awareness Mission Planning Human Factors - Pilot's Decision

S P S ca te g o ry - l e ve l 2 Percentage %

Figure 13 - Top 10 Standard Problem Statement results on 2nd level SPS

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4.3. Analysis of the accident factors using HFACS

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Unsafe Supervision

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Organisational Influences

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Figure 14 - Percentage of Accidents where HFACS level was identified at least once

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4.4. Analysis per type of operation

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“Once the patient was boarded the helicopter took off despite the degraded weather condition because an ambulance was waiting to bring the patient to the hospital. The helicopter hit the ground (snowed surface)

with the right skid and nosed over just after take off in poor visibility due to falling and blowing snow”.



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Top issues – Commercial Air Transport

Top issues Standard Problem

Statements Top issues HFACS

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Table 1 - Top issues for Helicopter Commercial Air Transport operations (Excluding factors related to Data Issues)

/HW XV QRZ FRQVLGHU D W\SLFDO H[DPSOH RI DQ $HULDO :RUN DFFLGHQW “During vertical take off with external

cargo from a confined landing area in the forest, the helicopter started to rotate to the left after having

cleared the tree tops. The helicopter lost altitude, contacted the surrounding trees and crashed”. 



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Top issues – Aerial Work

Top issues Standard Problem Statements Top issues HFACS

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Table 2 - Top issues for Helicopter Aerial Work operations (Excluding factors related to Data Issues)



(YHQWXDOO\OHWXVKDYHDORRNDWDW\SLFDO*HQHUDO$YLDWLRQDFFLGHQW“The helicopter was on a Visual Flight

Rules flight. En route, it entered an area of rising terrain and low cloud base. Radar tracking indicates that the helicopter slowed down, and then made a sharp turn before disappearing off the screen. The helicopter then suffered an in-flight collision with terrain directly after the loss of radar contact”.



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Top issues – General Aviation

Top issues Standard Problem Statements Top issues HFACS

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Table 3 - Top issues for Helicopter General Aviation operations (Excluding factors related to Data Issues)



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4.5. Intervention recommendations

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Figure 15 - Distribution of Intervention Recommendation categories for all analysed accidents



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5. WAY FORWARD

5.1 Handover of intervention recommendations to the EHSIT

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Pivot chart of Analysis sheet - IR

4 11 15 19 40 58 70 169 252 307        

Infrastructure (aerodrome, heliport, ATC, ...) Research Manufacturing Aircraft Design Aircraft System/Equipment Design Maintenance Data/Information Issues Regulatory Operations Training/Instructional Number of IR categories

Intervention Recommendation Categories – All Accidents

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5.2. Continuation of EHSAT work

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5.3. Communication Sub-Group

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6. CONCLUDING REMARKS

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Acknowledgements



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References

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