RAA Incident & Accident Reports - Board Topic for February

[Guest davidh10]

There has been significant discussion on the lack of information published about RAA incidents and accidents which aren't investigated by ATSB, and thus the missed opportunities for learning that such feedback to the flying community provides. Of the posts I can recall, everyone felt that we, as pilots and aircrew were deprived of information that should be provided under a comprehensive SMS (Safety Management System).

 

It is now the ideal time to lobby your RAA Board Member and explain the benefits that would flow from publication of incident and accident reports for RAA aircraft. Further, that you support the premise outlined below, as a way forward to investigate a means of working in collaboration with ATSB to accomplish this objective in a feasible manner.

 

While there have been various suggestions about RAA releasing information, most are problematic due to legal and indemnity issues.

 

ATSB (Australian Transport Safety Board), was created under the Transport Safety Investigation Act 2003 which also provides a privileged status as an independent investigative agency whose sole objective is to improve transport safety in all its forms. That privileged status is unique and means that the reports published by ATSB cannot be used to prosecute or sue anyone. Any evidence needed to support a legal case needs to be obtained by the legal bodies, and ATSB provide for law enforcement agencies to observe their examination of accident artifacts for that purpose. The benefits this brings are the fact that in ATSB mostly produce:-

 

1. A preliminary report after 30 days.
    
    
   
2. A final report within 12 months, or if the investigation is on-going, interim reports.
    
    
   

 

 

The problem RAA faces is that for any investigation where ATSB decides not to investigate, the responsibility falls to the state police force. While the police may request RAA assistance in the investigation, as a law enforcement agency, the police hold onto evidence and reports for use by themselves and the Coroner. While RAA may possess some of the information, they are at risk of being sued if they release information that is perceived to be libellous, deleterious to someone's legal defence or the basis of a prosecution. It may not just be RAA that gets sued directly. It could also be that one party to an accident sues another party to the accident, based on information published by RAA. In that case the second party may sue RAA for providing the basis of the legal case against them. For these reasons, direct publication by RAA is mostly not possible.

 

While there has been a suggestion that the Government could legislate to give RAA special status like ATSB, the reality is that will not happen.

 

The potentially feasible route would be for RAA to create a joint working agreement under which ATSB would hold the responsibility for the investigation, but subcontract investigative resources from RAA. The evidence and findings would go back to ATSB, who could then publish the reports. Such an arrangement should be attractive to ATSB, as they have finite resources and one of the reasons they don't investigate most RAA accidents is by reason of resource prioritisation. If the investigative resouces are provided to ATSB, by RAA, then it expands their capability to investigate more accidents and to benefit directly from the analysis.

 

A proposal along these lines has been put on the RAA Board Agenda for February by John McKeown (Sth Qld). If you are in favour of RAA investigating whether something along these lines could be achieved, now is the time to communicate that support to your Board Representative.

 

* Edit: Attributing the proposal to John McKeown, as he has now given me explicit permission to disclose that fact.

 

 

[David Isaac]

Excellent concept David and worthy of support.

 

My personal view is we should all get behind this and contact our various State representatives to have this discussed as an agenda item at the February Board meeting.

 

These are the kind of issues that would make a real difference in RAA and are much more important than Magazine issues.

 

More importantly I would argue that Police involvement in RAA accidents prevents the RA Aus from executing an effective safety management policy which should be part of the RA Aus Safety management Plan.

 

 

[ave8rr]

Just what I have wanted to see for along time David. Lets push this one and see if we can get some action along the lines suggested.

 

Cheers Mike Kununurra WA

 

 

[Guest Clansman]

Sounds like a very good idea so I'll be contacting my SA board rep to discuss it. Anything that keeps us safer sooner by alerting pilots to things that go wrong the better. The caveat is, of course, sensitivity to family bereaved if a worst case outcome. At the lower end of seriousness, it's usually no worse than the dented pride of the pilot involved in something which could have been easily avoided. But there's no place for pride when others may learn something from someone else's mistake, and actually avoid serious injury.....etc. By committing aviation we need to understand we open our actions to scrutiny at the minutest level for good reason. Understanding cause and effect is so darned important, whether systems driven or human factor.

 

Achieving something like the proposal being put could actually reduce resources needed by streamlining/dovetailing with ATSB. As always it's resources, time, money, common sense and goodwill which are needed to make things like an SMS work well, otherwise it becomes a bureaucratic millstone driving up costs for little or no return.

 

If the fear of legal recriminations are removed by pursuing the idea, it would seem to me that we will all benefit from a more robust and more timely investigative outcome. I wish the RAAus board well in their deliberations.