Most Turbulence Recommendations Don’t Reduce Injuries

Investigation of the 20 July 2010 turbulence incident involving a United Airlines B777 over Missouri has just begun, but already a broader question arises: why haven’t all the National Transportation Safety Board (NTSB) recommendations to combat exposure to turbulence had an effect? People are still thrown about the cabin from turbulence, injured and occasionally even killed.

The latest incident involves a United B777 cruising at 34,000 feet, about 60 miles southeast of Kansas City, right into a wall of convective turbulence rising at 50-100 mph. The flight crew apparently made no evasive action (to be explored by NTSB investigators, for sure), and the airplane’s 265 passengers and crew were subjected to what one passenger described as “just a huge up and down.” Four flight attendants and about 20 passengers were injured to the extent that hospitalization was necessary. Fortunately, and unlike past turbulence encounters, there were no deaths. (See Aviation Safety Journal, ‘Turbulence During Flight Injures Scores; After Years of Such Events, Why Do They Continue?’)

The NTSB has been issuing recommendations to counter turbulence encounters and injuries since the early 1970s. Either the recommendations are not relevant to the real dynamics of the problem, the Federal Aviation Administration (FAA) has not responded effectively, or some combination of both factors must be at fault.

For in-flight turbulence, since 1972 the NTSB has issued 46 recommendations. A summary of each recommendation may be found at Aviation Safety Journal. (See ASJ; ‘Long History of Turbulence Recommendations; Most Miss the Target’)

From these nearly four dozen recommendations, a number of inferences can be made:

— Deaths seem to be a much greater stimulus for NTSB recommendations than injuries. The recommendations are the result predominantly of fatal crashes.

— Of the 46 turbulence-related recommendations issued, 19 (41%) deal with the cruise phase, where most injuries occur. If the number of deaths and injuries in cruise were considered, the order probably should be reversed, with 60% of the recommendations addressed to the cruise phase of flight.

— Of the two “OPEN” recommendations (e.g. awaiting final FAA corrective action), none deal with passenger or crew safety during turbulence.

— Of the 18 “CLOSED” recommendations concerning turbulence in cruise, some have been overtaken by events, others are airplane specific and only one (A-73-002) deals with interior design to reduce injuries.

— No NTSB recommendations deal with flimsy overhead bin latches coming open during turbulence and spilling their contents onto passengers sitting below.

— None of the NTSB recommendations address the chronic problem of standing flight attendants being injured or killed during turbulence.

— None of the NTSB recommendations address the continued failure of all passengers to remain buckled up while seated.

— None of the recommendations address galley carts in the aisles. One can envision a means to secure them: a track in the floor, and a foot-pedal operated upside-down “T” fitting on the bottom of the cart to anchor it when stationary. Coffee pots could be secured by straps (coffee pots have been known to fly about during turbulence, scalding passengers).

— None of the NTSB recommendations address the dangerous practice of “lap children,” despite the history of such children being hurled to their injury or death during in-flight turbulence.

 — None of the recommendations address cockpit-cabin crew coordination when turbulence is expected.

The NTSB claims it has a 90%-95% acceptance rate for its recommendations generally. In the area of turbulence, it has about an 80% acceptance rate, under the generous allowance that if the action was closed by the NTSB for even the flimsiest reasons advanced by the FAA, that recommendation counted towards the overall acceptance rate.

It is also evident, from the recent injuries on the United Airlines flight over Missouri that the successfully implemented NTSB recommendations have had nil effect over the past 30 years at reducing injuries during in-flight cruise.

The FAA has done the easy things that cost little, thereby garnering a high acceptance rate to the NTSB recommendations. The difficult efforts that require money tend to generate a huge amount of delaying correspondence and result in either a slow death to the recommendation or it being held in an “OPEN” status by the NTSB in the slim hope of implementation.

The NTSB may wish to reconsider the process of generating recommendations. It seems that many are “down in the weeds,” offering much in the way of detailed, tactical advice. Meanwhile, the major issues – such as aircraft certification (see A-94-056) – which seem straightforward, languish in a miasma of “do nothingness.”

Average time for recommendation on turbulence to be classified “CLOSED – Acceptable Action” is on the order of four years. The longest period to acceptance is 18 years. Given that most of the recommended actions in this category are simple, the time seems excessive and not behooving of a pro-active safety culture at the FAA. Then again, the sheer volume of NTSB recommendations has to be taken into account. Fewer, more strategic NTSB recommendations might reduce the workload at the FAA – at a “cost” to the NTSB of a lower percentage of “CLOSED – Acceptable Action” about which to crow.

And if nothing is changed, recommendations coming out of the NTSB’s investigation of the United turbulence event will take 4-18 years to resolve, and the method of FAA implementation may have marginal effect on staunching injuries.