NTSB -- NTSB CHAIRMAN ISASI SPEECH

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NTSB PRESS RELEASE

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National Transportation Safety Board

Washington, DC 20594

FOR IMMEDIATE RELEASE: April 29, 2010

SB-10-14

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NTSB CHAIRMAN DISCUSSES ADVANTAGES - AND LIMITATIONS - OF

USING DATA-DRIVEN SYSTEMS TO IMPROVE AVIATION SAFETY

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National Transportation Safety Board Chairman Deborah A.P.

Hersman said today that the use of data to manage and

improve safety in the aviation industry has had a positive

effect on the world's improving aviation safety record but

she cautioned against over-reliance on these systems to the

neglect of forensic investigation.

Addressing a conference of the International Society of Air

Safety Investigators in Chantilly, Virginia, Hersman noted

that "we have reached an era when aviation accidents are

extremely rare..." One reason is the use of data -

particularly, but not exclusively, Safety Management Systems

(SMS) - in accident prevention and investigation.

The Board has been advocating the use of SMS for a decade,

having issued 17 recommendations in favor of implementing

SMS in the aviation industry. When implemented correctly,

Hersman said, "SMS holds real promise in a variety of

scenarios." She noted several instances where SMS helped

eliminate potential unsafe conditions, notably a corporate

flight operation that used flight data to determine that

high bank angles occurred on repositioning flights, and a

review of commercial aircraft approach data that indicated a

high rate of TCAS (Traffic Alert and Collision Avoidance

System) warnings at a particular airport. In these

instances, she said, "data management adeptly identified a

clearly measurable set of information and allowed for a

relatively simple and effective solution."

However, Hersman noted, SMS works well for companies that

are already "getting it right," but may provide little more

than false confidence for companies with less than robust

safety cultures.

Also, there are accidents caused by a combination of factors

that SMS cannot possibly detect. As an example, Hersman

mentioned the British Airways Boeing 777 crash at Heathrow

Airport two years ago involving a dual engine failure on

approach. It was not data analysis that solved the mystery,

but detailed forensic analysis; the circumstances were so

unusual that a data analysis system would not pick them up.

Hersman said she hoped that with all the focus SMS will

place on data collection and analysis, "let's not lose focus

on outcomes. The success of SMS won't be measured by how

much data we collect, but by how many lives we save."

"I will enthusiastically support any approach that will make

our nation safer," she said. "But I think we need a

measured approach - one that acknowledges the potential

benefits and limitations of SMS, and further, doesn't

discount tried and true methods for identifying

vulnerabilities, such as accident investigations."

The text of Chairman Hersman's speech may be found at

http://www.ntsb.gov/speeches/hersman/daph100429.html.

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NTSB Media Contact: Ted Lopatkiewicz

(202) 314-6100

lopatt@xxxxxxxx

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