PPRuNe Forums - View Single Post - Two helicopters collide - Gold Coast, Queensland - Sea World 2/1/2023
Old 5th Jan 2023, 02:31
  #210 (permalink)  
fdr
 
Join Date: Jun 2001
Location: 3rd Rock, #29B
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Our ICAO 9859 SMS based regulatory structure, incorporating §100, §119 and other regulatory requirements have a cognitive dissonance with the real world. We end up managing by exception, which hardly helps and in this type of event, it is apparent that the term "system" "safety" and "management" are misplaced. IIRC, this is not the first event in recorded time that the number of aircraft involved in a bad day exceeded 1... so how is that going for us so far?

The world is messy, stochastic... yet SMS is a linear process, and is based on linear models of causation, that a number of us with interest in safety have discomfort with. It is not only aviation, it is reflected in all of our close coupled activities, the NPPs, transport, IT security, medical, defence etc... bandaids are not a best line of defence. Technology has potential to alter the risks in good and bad ways, but generally, the outcome tends towards goodness, our controls however act to deny ready access to better systems etc.

It is indeed fortunate that Wilbur and Orville did not have the regulatory bodies that exist today which seem to have an intent to be happier with a dismantlement of the infrastructure of aviation to ends that seem to be contrary to the employment needs for the regulator itself.

An iPad with a stratus 3 and Foreflight would have given a chance to avoid this event, at a grand total of about $2500, achieving a better outcome than the TCAS II ch 7.1 which of course was a 110 K USD update of faulty software that was certified to do a job, cost 150K to install and then we get billed for the "upgrade" to fix the defect that was inherent in the system. I have greater faith in my iPad than the TCAS II system, it also has a vastly better MTBF.

Assessment of the real world condition vs expectation is necessary to conduct THA, it is dynamic, but our setups tend to go unnoticed unless it is done. Normal operations do give insights into slips and potential threats but needs a mind set change, and a review of exactly how and why we have arrived with the system that we have, for frankly, I think the pony poop in the stable is not the desired outcome to avoid some of the bad days that occur.



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