AVIATION SAFETY LESSONS FROM TENERIFE AIRPORT DISASTER

It is now approximately 46 years since the worst accident in aviation happened. The accident happened at Los Rodeos Airport, now known as Tenerife North Airport on 27th March, 1977. Two Boeing 747 pax jets collided on the runway leading to 583 fatalities making it the deadliest accident in the aviation history. This accident will forever remain in the aviation history books as one that triggered major safety improvements and advancements in the whole of aviation fraternity. The accident investigations process was a little bit more challenging because of its wide scope, that is: it involved two airlines, three major states of interest, several civil aviation authorities, aircraft manufacturer and they were dealing with hundreds of families who had lost their loved ones. This meant that coming to an agreement was nearly a close to impossible task because each entity involved is & wants to protect their integrity, brand, public image/trust, not forgetting that there were compensations that were to be made to the victims. However, aviation’s SMS improves through pro-active, reactive or predictive approaches which makes safety better in overall operations.

For this accident, the approach was reactive and hence there had to be findings and safety recommendations amidst the fracas and resistance amongst the involved parties on the areas they had gone wrong. This is for the purposes of ensuring necessary mitigation and prevention measures in the future for such happening once again. In my analysis of the accident report, I established that aviation’s industry safety standards have greatly improved which has also contributed to the safety state we are enjoying today in aviation. Find my analysis of the safety areas that I feel this accident impacted positively in relation to today’s levels of safety.

1.?????CREW RESOURCE MANAGEMENT (CRM)

From the accident report, there was a blame directly to the PIC of KLM’s aircraft. He violated very basic SOPs such as Take Off clearance from the ATC. He decided to initiate the take off roll in poor visibility conditions without clearance. The First Officer initially attempted to intercept the action but he later seemed intimidated out of the captain’s actions to insist on taking off. There was an additional flight engineer in KLM’s aircraft cockpit who most probably was also listening to ATC vs Crew conversations but interestingly did not challenge the captain’s decision.

Today, air operators have the safety mandate to take their crew through a CRM training which helps in ensuring that there is no single predominant character/person in the cockpit. This training helps in ensuring that every person in the cockpit can give their input and challenge their senior whenever they are about to make a safety critical mistake. The final decision about an issue ought to be collectively agreed by the cockpit crew rather than being a single individual input/decision. This improves greatly on safety because one crew member is checking on the other and overseeing their actions. CRM has since then been a way/tool that has reverted several possible accidents/incidents in the aviation industry.

2.?????ATC vs AIRCRAFT COMMUNICATION

There were several cases of ambiguity pointed out when the investigations team reviewed the CVR. Misunderstandings and lack of clear interpretations between the ATC and the flight crew were evident, which made pilots from both KLM and Pan Am aircraft to miss key/critical instructions.

Today, radio telephony communications have been standardized and CAAs require all pilots and traffic controllers to pass certain Radiotelephony examination before being approved to be involved in operations. This standardization has ensured that there is a common point of reference and hence there is no ambiguity when certain instructions are issued. Communication is important but ability to understand and successfully implement what has been communicated is far much important. Aviation safety has greatly improved from the fact that the individuals involved can commonly agree on what has been communicated.

3.?????ORGANIZATIONAL ISSUES/MATTERS & REQUIREMENTS

It was established that KLM’s PIC could have been in a hurry and was in some pressure to fly in order to save himself from probable warning letters, report writing and cost accountability and justification from the company. This hurry and pressure caused him to make mistakes which ended up catastrophic.

Today, organizations, airlines and aircraft operators are required to consider SAFETY as the key priority in their operations. Safety should not, ought not and can never be compromised for anything operational wise. All staff in the aviation industry should never compromise on safety, no matter the pressure they face in operations. All SARPs, SOPs and safety precautions have to be considered and taken before any other action.

SAFETY CARRIES THE DAY!