Originally Posted by
nonsense
I don't see mis-fueling as the root cause of this incident. That's not going deep enough.
That is exactly the point I was trying to make, the cause of the misfuelling activity itself must be subject to root cause investigation.
As a result of such investigations then procedures are refined to the point where a robust fuelling procedure is in place, which "
providing" it is followed will control the risk. However, as you point out, an administrative control is still open to poor human performance and that is the limiting factor in controlling misfuels.
I agree that mechanical/engineering controls are the only way to give the guaranteed performance we are looking for. For whatever reason the ongoing nature of this problem (even with continuing loss of life) does not seem to provide the industry/manufacturers/regulators with the incentive to get on do something about it.
My comments reflect my involvement in fuelling operations where we have to work with what we are given, which is a global fleet of aircraft requiring overwing/open line/gravity (or whatever anyone wants to call it) fuelling, without the necessary standardization in fuelling equipment.
There are many proactive folks in the fuelling industry who have tried hard to make it as fool proof as possible. Having worked in locations around the world I am not naive and I realize that in some places the rigor applied to fuelling operations is not be ideal and therefore problems will occur.
In too many places fuelling is seen as an inconvenience, something that everyone knows has to be done but sometimes its just not taken seriously enough. With such attitudes and a reliance on procedure to prevent misfuelling then it's almost a given that it will happen.
I'd like to see the engineering route to a solution explored, in truth I don't think it'll ever happen.