Alexandria, Va. – I would be willing to bet money that after reading the average accident report, you ask yourself, “What were they thinking?” Not in a negative or derogatory manner, but in real puzzlement. How could the pilot, operator, or maintenance tech have made such poor choices — choices that resulted in their own deaths or those of their co-workers or customers?
This is a natural reaction. Most accidents involve good people trying to do their best. And we know from the resulting investigations that most accidents, unfortunately, involve these same people making poor decisions and taking unacceptable risks.
I acknowledge that, when we review accidents, we are normally sitting in the comfort of our office or home, after the fact, with all the wisdom of an armchair quarterback. Even so, most accident reports leave us stunned at the flawed decision making and risk assessment involved. Most of the time, we find no rational justification for the actions of those responsible, whether they are operators or members of the flight or maintenance crews.
No one intends to kill themselves and others via the operation of an aircraft. But I have to admit it sure seems that way sometimes. Just consider some scenarios present in numerous accidents:
• A helicopter is en route, and it is uncertain if there is sufficient fuel to reach the destination or a refueling point. Not a tough decision you would think, especially in a helicopter: land now! But instead, the flight continues, the engine fails, and there is an unsuccessful autorotation. All aboard are killed. This type of accident has repeatedly occurred in personal, private, and commercial flights.
• Some pilots, both general aviation and commercial, decide they will conduct low-level nap of the earth flights or demonstrate their nonexistent aerobatic skills. No surprise: they hit obstacles, mostly wires, or cause in-flight breakup of the aircraft. Again the result is injuries and fatalities.
• Pilots who are not rated to fly instrument flight rules (or, if rated, are not current or proficient) fly a visual flight rules aircraft into instrument meteorological weather conditions, either day or night. Do I need to tell you the rest? Most helicopter pilots who inadvertently enter instrument meteorological weather or lose ground reference last an average of 20 to 45 seconds before they lose complete control of the aircraft, causing an in flight breakup of the helicopter or uncontrolled descent to the ground or water. That is, if they have not already flown into terrain, water, wires, towers, or a building.
• Another accident report indicates a utility worker was suspended below a helicopter to perform maintenance work on electrical lines. During the operation the engine failed, and in the ensuing emergency landing, the worker was killed. Initial indications are that the engine failure was caused by fuel exhaustion.
I don’t think rational people who are honest with themselves can read about these incidents and not ask, “What were they thinking?”
These problems are not new. I know of another disturbing incident involving a helicopter pilot in Vietnam who responded to a medical evacuation request while on another mission. Adequate fuel was a real concern, but because of medical urgency, the decision was made to conduct the evacuation.
The wounded were picked up and delivered to a field hospital, and everyone thought the pilot was a great guy. The aircraft was then directed to an adjacent fueling point.
As the pilot was sighing a breath of relief and the aircraft was on the fuel pad, the engine quit from fuel exhaustion. Through the grace of God and sheer luck, no accident occurred. But you still have to ask, “What was that pilot thinking?”
Since I was that pilot, I can tell you: I was thinking all the wrong things that day. In doing so, I risked my life, as well as the lives of the wounded and my crew. When that engine quit, my heart stopped. I told myself, “You idiot, what the hell were you thinking? Never again.”
Remember, safety isn’t a one-time act. It is a discipline of always doing the right thing for the right reasons. When you hear of an accident, don’t ask, “What were they thinking?” Focus on what you can do to ensure this same accident never happens to you.
What are your thoughts? Let me know via e-mail: firstname.lastname@example.org.
As always, have a safe flight and fly neighborly.
Matt Zuccaro is president of HAI.