Ameriflight PA-31 Accident - Arizona

[skatergeek]

Like I said before, sometimes even the most conservative pilots find themselves in a pickle; while some of the most cowboy ones never do; and vice versa. Mistakes happen on both ends of that spectrum, as well as best laid plans going to heck by factors outside one's control. It will be interesting what is found.

Exactly.

 

[Maurus]

A couple things come to mind.

First, it's extremely rare for the NTSB to come right out and cite a company for causing an accident. The accident report always faults the pilot, because...well...it WAS the pilot's fault. Thing is, there could have been factors behind the scenes, such as pressure from the company, pressure from coworkers, fatigue, etc.

Second, it seems as though you're talking out of two sides of your mouth. On one side you say AMF has no control over these accidents, then out of the other side you say things have improved because of new policies.

There's a novel idea...improve safety through better systemic processes. Kinda like how airlines have been doing it for years.



I see what you're saying, but my point all along is that this is a question of risk management. Every operation has certain risks involved and manages those risks to get as much productivity as possible while killing as few people as possible.

AMF very well might operate in a higher risk environment, but that means they need to take steps in other areas to mitigate the risks. The policies you stated above are examples of ways they're doing this.

How exactly can AMF control a pilot when they are single pilot? Should we start installing cameras in the aircraft?

My point is that AMF can make procedure changes that do help pilots that do as they are told as far as SOPs and what not, but some of those accidents involved pilots going against procedure in some way (FAA and/or company policy). The improvement that needs to be made is at a mental level with the pilots. Some think that they can get away with stuff since they are the only body in the aircraft. No way the company can stop that unless they outright catch the pilot being stupid. Having a second crew member (that speaks English) to hold the PIC accountable helps in those situations. Cape Air likely doesn't deal with this nearly as much since the cargo is passengers rather than someone's amazon package. That alone will change a pilot's mental state as they are now directly responsible for those passengers.

The NTSB does actually look into every aspect. They hammered Quest Diagnostics pretty hard when they had a Baron go down. All the NTSB cares about is the probable cause and other factors leading up to the crash (this includes looking at fatigue). They will make recommendations when deemed necessary as well.

When it comes to fatigue they can only get limited info. The pilot may have had enough time to get tons a sleep/rest, but what they decide to do instead could be unknown and again, something the company can not control.

Saying, "Eh, we can handle a few fatalities," is not acceptable risk management, in my opinion.

I don't see anyone saying this.

 

[DE727UPS]

Never forget pilot pushing. You can have procedures and policies that look pretty and all but you need to dig deeper to see the reality. For example, I know of a company that has a fatigue policy that makes the FAA happy. The ugly truth is you have to prove your fatigue was within the companies control to not get docked sick pay. In other words, the company can't control noise in the hotel, so they didn't cause the fatigue, so pilot loses sick pay, so pilot is less likely to call fatigue when not fit to fly because they get paid at the year for excess sick time. The system is set up to reward pilots who aren't fatigued/sick and that's a hard carrot to overcome. In the end, it's up to the PIC to do what's right for him in his situation come hell or high water. Does that really promote safety? Is safety really promoted by the company? I really think safety comes after profits but without planes falling from the sky, it's hard to make that point.

 

[jrh]

Again, no one is saying "we can handle a few fatalities".

Not directly, but that's essentially what's being said when pilots talk about what a high risk job it is, needing to bend either the company or FAA's rules to stay out of trouble regarding ice, oxygen, mountainous terrain at night, and so on--all things said earlier in this thread. I also interpret quotes like, "It was only a matter of time" coupled with the fact pilots keep showing up to work in that environment as "We can handle a few fatalities." Sometimes actions speak louder than words.

On one hand, you're saying to get most productivity as possible, while mitigating risks; then on the other hand you appear to be expecting near-100% safety.

Yes, that's exactly what I'm saying. Why is that so outrageous?

Plenty of other sectors of flying have figured out how to do it. Thirty or forty years ago fatal airline accidents were semi-commonplace. I bet if you'd talked to pilots in those days, they'd be making all the same arguments you are for why it can't be improved, yet look at us now. The airline industry is at an all time best regarding safety.

Here's a completely serious, non-hypothetical question: If every AMF plane were loaded up with the family of a management employee on every flight flown, would the operation be run the same way it is now? And I'm not talking about flying through turbulence or having beautiful interiors. I'm talking about the true core operation.

Would the avionics still be equipped the same?
Would the same types of airframes remain on their current routes?
Would inoperative equipment still be deferred as often?
Would the pilots be hired with the same qualifications, trained to the same standards, and paid the same?
Would dispatchers treat the pilots the same way?
Would pilots make the same go/no go decisions?
Would company policies regarding weather minimums, rest requirements, and so on remain the same?

If the answer is not "yes" to all of these questions, I think it begs the question of why one person's (management's) loved one is more important than another person's (pilot family's) loved one.

 

[ppragman]

You flew freight, you already know the answer to this question. Its the nature of the operations being wildly different from one another in many ways. You could conceiveably fly freight in day VFR only, but mission degradation would ensue, and you wouldn't be flying the freight for long.

You can aim for a zenith all you like, but you have to figure in mission realities. The Air Force could park all its planes and have a 100% safety record, but no missions would get accomplished.

The goal is maximum utility with minimum risk. These are curves that you could theoretically compute if you had enough flights to figure out the data. Realistically, it simply becomes a game of where you draw the line. At my outfit, we've got risk assessment forms as a way of quantifying risk, but the assessment of what is risky enough to warrant inclusion in our quantification is by and large dependent on the people who've been there before and made mistakes. Other operations have similar things. We put the line in the sand where we think the balance sits, and if that means we delay flights, then that's the standard we set and we delay. If the weather is too crummy, it's too crummy. You can't just go by your gut all the time when it comes to decision making, because invariably you'll make a stupid decision. You have to quantify the threats, then evaluate them. The adage I've always said is that you can have crappy equipment, heavy airplanes, or bad weather, but not anymore than one - and even that will kill you some times. That's a minimalist stance on risk assessment, but it stands as correct most of the time.

In the real world, using risk assessment strategies saves you or your customer money. We almost never go missed here. Why? Because we generally don't launch if we're not sure were going to make it in. In the freight world, going missed was much more common, because UPS had no problem shuffling us out the door as long as the visibility was good enough even though when it's VV001, and I had absolutely no problem going missed if I didn't see it at mins (other guys not so much). At 1800RVR and VV001, its a crap shoot if I see the lights to go lower and get in. As a result, I don't know how much fuel I wasted holding before going off to the alternate because getting in wasn't practical but the company wanted you to "try it." How much unnecessary work was created by trying to push it? How much additional unnecessary risk is created? And for what? So the packages can get there a little bit earlier? So that the passengers can arrive on time? Try to maximize your utility (how many on-time departures you have, how much you can carry), and try to minimize your risk (train your pilots properly, limit flights in icing and low visibility conditions, consider the ramifications of ceilings on the approach and not just visibility, try to keep your pilots from flying fatigued or sick) and you'll make money without it being sketchy as hell. You wreck one airplane for something stupid like flying in severe icing, or scud running into a crap-ass little airport and how many dollars does it take to make up for the loss of the airframe, the training loss, the cost of the increase in insurance premiums, and reputation? Not to even mention the human cost.

I look at this stuff as "smarter not harder." If something seems "hard" in the airplane, if I feel that "man I can make this work if I just..." then I drop back, think about what I'm doing, and try to justify it to myself rationally. If I can't justify it through the lens of "is this reasonable, legal, and safe" then I go somewhere else and hangout until the weather gets better. That said, I'm more risk averse in the airplane than I was before.

 

[Cal Goat]

I have known Dave for almost 6 years, he was not a "cowboy". AMF does have a lot of them, especially in PHX, but he was one of the more conservative pilots.

That makes it all the more painful then. As I've tried to emphasize here, I did not know him and I hope that the investigation shows that he made the right choices and just ended up in a bad situation beyond his control.

 

[z987k]

Would the avionics still be equipped the same?
Would the same types of airframes remain on their current routes?
Would inoperative equipment still be deferred as often?
Would the pilots be hired with the same qualifications, trained to the same standards, and paid the same?
Would dispatchers treat the pilots the same way?
Would pilots make the same go/no go decisions?
Would company policies regarding weather minimums, rest requirements, and so on remain the same?

If the answer is not "yes" to all of these questions, I think it begs the question of why one person's (management's) loved one is more important than another person's (pilot family's) loved one.

That is a no to each and every question.

 

[Boris Badenov]

Just let me poke my head in here and be the Devil's Advocate for a second. We have jobs because it's useful to get stuff from one place to another real fast. Whether that stuff be pax, freight, cameras, or med crew. Obviously our first responsability is Safety. Yes, absolutely, totally, etc. But if the stuff doesn't get where it's supposed to be in a semi-timely manner, it might as well just go on a truck. To my knowledge, I've never left the ground when it was foreseeably stupid or dangerous to do so (gotten close a few times). But here's the thing. Is there a Cowboy Culture in freight? Maybe, to some degree (not even remotely as much as there used to be, I feel pretty sure). But a pilot worthy of being called Captain presumably knows the word "no", and how to say it. How is this any different from any other job that involves stuff that could kill you? OF COURSE there will be a certain amount of pressure from the profit-motive. There is that sort of pressure in any job. PIC means Pilot In Command. Command isn't an award you get, or just a fourth stripe on your uniform, it's a huge responsability. You get to call the shots, but you also have to wear the brown helmet if you screw up. And if everyone turned down or refused to fly any time there was a .000001% chance something bad might happen, nothing would ever leave the ground. We get paid to mitigate risk, not to avoid it alltogether. I can conceive of a scenario in which the Amflight pilot did nothing wrong. He studied the weather, he considered the performance of his machine, and he made a rational, well-thought-out decision to go fly. And then his number came up. I'm not saying that's what happened, but I am saying that it's a possibility. Any of us could get hit crossing the street tomorrow or have a piece of satellite fall on our poor heads. The notion that "the most conservative decision wins every time, all the time", doesn't pay the bills. We get paid to move stuff, safely. Move Stuff. And Safely. Both matter.

 

[Inverted]

First death in six years is GOOD? Are you serious? By those standards, what would be considered a "bad" streak? The previous decade, when planes were going down every 2-4 years? Six years is not exactly something to brag about.

I'd be intrigued if you could find me an operator outside of the freight world that has fatal accidents every six years and everyone shrugs it off as normal.

As for the cause of this specific accident, I don't know. But any time a fatality is the result, again, I don't think anyone should be looking at it as par for the course. It means the pilot went deep, deep down the accident chain for one reason or another.

I take offense if you think loosing an ex co-worker who I was slated to train (but didn't) in an airplane I have a bunch of time in, doing the exact same thing has he was night in and night out. A fatality is NEVER good, it is NEVER acceptable and is NEVER easy. But it doesn't mean the safety record isn't good. Compare accidents/incidents per flight out from AMF to any other 135 operation freight or otherwise and you wouldn't be arguing. You are trying to find a reason to blame AMF for who knows why... Sometimes you can't help a lapse in judgement. You also can't help a freaking heart attack. Maybe David had a heart attack, we don't know and we may never know. But trying to use this specific situation to blame AMF in its policies is freaking insane. And I will be 100% honest, as I think I, Maurus, Cal Goat and others have been. Nobody is sugar coating anything, but we also know what this company does on a daily basis, and for that, I think the safety record is pretty good. Especially when you look at the probable, or actual causes of these accidents as Maurus pointed out. In the end you can't fix stupid, this is where there have been a few incidents. And in the end, you cant hold a pilots hand. We are talking single pilot operations in airplanes that other companies wouldn't even consider operating without two crews, and AMF does it well. But every once in a while things don't go so smooth.

 

[Inverted]

Here's a completely serious, non-hypothetical question: If every AMF plane were loaded up with the family of a management employee on every flight flown, would the operation be run the same way it is now? And I'm not talking about flying through turbulence or having beautiful interiors. I'm talking about the true core operation.

Would the avionics still be equipped the same?
Would the same types of airframes remain on their current routes?
Would inoperative equipment still be deferred as often?
Would the pilots be hired with the same qualifications, trained to the same standards, and paid the same?
Would dispatchers treat the pilots the same way?
Would pilots make the same go/no go decisions?
Would company policies regarding weather minimums, rest requirements, and so on remain the same?

If the answer is not "yes" to all of these questions, I think it begs the question of why one person's (management's) loved one is more important than another person's (pilot family's) loved one.

I am not really sure what your motive is here. Are you trying to bash a company that you have never worked for and are going off of heresy? You forget that the equipment AMF operates is no secret. You don't interview, go through indoc, go through training, take a checkride, and THEN find out what you will be flying. Are you telling me you have never flown an airplane you probably shouldn't have in order to gain hours, or further your career?

I think you are also looking at the pax/freight dynamic a little differently as well. My current company is much more conservative because we have passengers on board. The pilots are still capable of doing the exact same things as they would if there are boxes on board. But when the business is passenger comfort, and repeat business, it changes things a lot. There are several ex AMF employees that work with me and we are all fully capable of taking a plane to mins in icing at night yadda yadda yadda. We don't take the risks like we did flying freight because our paychecks are completely dependent on happy customers, in fact all flying is bases on this. Happy customers in freight is their packages getting to where they need to be all of the time. Happy customers in charter is getting there safely and timely. Trust me an angry passenger shuts up real quick when it is a safety issue.

 

[ppragman]

I am not really sure what your motive is here. Are you trying to bash a company that you have never worked for and are going off of heresy? You forget that the equipment AMF operates is no secret. You don't interview, go through indoc, go through training, take a checkride, and THEN find out what you will be flying. Are you telling me you have never flown an airplane you probably shouldn't have in order to gain hours, or further your career?

I think he's making the point that the company isn't doing enough to make sure the airplanes are capable enough for the kinds of things they're asking the pilots to do.

 

[Boris Badenov]

Compare accidents/incidents per flight out from AMF to any other 135 operation freight or otherwise and you wouldn't be arguing.

Eeeeehhhhh. I'll quibble with you there. To my knowledge, the fatal accident rate at RUF was zero. Nil. Nada. Not one, ever. They got close a few times, but no one ever died. And that's about 15 years of flying The World's Most Dangerous Airplane (tm) in every conceivable weather condition, and a large proportion of that ad-hoc which anyone who's flown freight knows is orders of magnitude scarier and more dangerous than a scheduled run. Now, obviously, it' s a MUCH smaller sample size of flight hours, but while I don't think Amflight is exactly the Abattoir of Doom, I don't think it's quite right to say that it's the Standard to which all other Freight operators ought to aspire, either. As I said above, it's all a calculation. *shrug*

 

[Inverted]

I think he's making the point that the company isn't doing enough to make sure the airplanes are capable enough for the kinds of things they're asking the pilots to do.

Well, I don't know what to say to that. /A has been just fine for thousands of pilots, for hundreds of thousands of hours, for decades. Would I have liked more equipment? Ya maybe. But did I have enough situation awareness to know exactly where I was at all times, and had enough equipment to legally and safely do what I was trying to do? YEP.

 

[ppragman]

Well, I don't know what to say to that. /A has been just fine for thousands of pilots, for hundreds of thousands of hours, for decades. Would I have liked more equipment? Ya maybe. But did I have enough situation awareness to know exactly where I was at all times, and had enough equipment to legally and safely do what I was trying to do? YEP.

This is a valid point, but the argument could be made that having airplanes that are strictly /A (or even EGADS /U or /X) could be an easily correctable contributing factor in a lot of accidents over the years. Especially when the technology exists to put better equipment in at reasonable prices but the choice hasn't been made to do this.

 

[Inverted]

Eeeeehhhhh. I'll quibble with you there. To my knowledge, the fatal accident rate at RUF was zero. Nil. Nada. Not one, ever. They got close a few times, but no one ever died. And that's about 15 years of flying The World's Most Dangerous Airplane (tm) in every conceivable weather condition, and a large proportion of that ad-hoc which anyone who's flown freight knows is orders of magnitude scarier and more dangerous than a scheduled run. Now, obviously, it' s a MUCH smaller sample size of flight hours, but while I don't think Amflight is exactly the Abattoir of Doom, I don't think it's quite right to say that it's the Standard to which all other Freight operators ought to aspire, either. As I said above, it's all a calculation. *shrug*

I am talking with regards to the type of operation. Accidents per hours flown. Of course there are tons of operations without a fatality. Hell my curent job is one of them. I can also tell you that we do 1/100th of the flying AMF does on a daily/weekly/monthly basis. And I would be the first person to to agree that it is NOT the standard to which other freight operators ought to aspire. But there is a reason why companies hire AMF guys, and know of AMF. The pilot training standard is what other companies aspire to. This is why AMF is known for a lot of things which may not be so rosie, but they are known for making great pilots.

 

[Boris Badenov]

I'm not a Amflight hater AT ALL. But I've read a few threads on Amflight in my time...you know what, forget about me. Let's ask mikecweb. mikecweb

 

[ppragman]

I am talking with regards to the type of operation. Accidents per hours flown. Of course there are tons of operations without a fatality. Hell my curent job is one of them. I can also tell you that we do 1/100th of the flying AMF does on a daily/weekly/monthly basis. And I would be the first person to to agree that it is NOT the standard to which other freight operators ought to aspire. But there is a reason why companies hire AMF guys, and know of AMF. The pilot training standard is what other companies aspire to. This is why AMF is known for a lot of things which may not be so rosie, but they are known for making great pilots.

Correlation, causation not is?

There are a f-ton of Amflight guys out there, because Amflight is a huge company.

 

[Inverted]

This is a valid point, but the argument could be made that having airplanes that are strictly /A (or even EGADS /U or /X) could be an easily correctable contributing factor in a lot of accidents over the years. Especially when the technology exists to put better equipment in at reasonable prices but the choice hasn't been made to do this.

The equipment isn't the issue. That is a bandaid for lackluster piloting. I would be shocked to see an NTSB report citing equipment or lack there of, being the contributing factor. I would be more willing to bet it would talk about the pilots inability, or the pilots failure to, or the pilots decision to.

Sure, would a moving map maybe helped the 99 pilot who forgot the course change in Montana? That is a definite yes, but do you think the NTSB said oh the plane wasn't /G? No it was the pilots failure change course at the FAF.

 

[Inverted]

Correlation, causation not is?

There are a f-ton of Amflight guys out there, because Amflight is a huge company.

There are hiring pools at a lot of companies. But I have seen 3 different companies call the dispatch number asking to hire AMF guys. That doesn't happen on accident.

 

[Roger Roger]

I'm a little confused as to why some of the same folks who have previously criticized their former employer for running busted ass ragged out equipment that needed to die ages ago (9DS anyone?) "VFR" operations that would make an Alaska pilot blush, and a training department characterized by arbitrary and illogical procedures are now rushing to defend the operation.