The Black Box

Bella Dinh-Zarr, PhD, MPH, Vice Chairman

The famous “black box.”

Mosaic image of data recorders for the Most Wanted List issue are Expand Recorder Use to Enhance SafetyReporters always ask us about it during high-profile aviation and rail investigations. After the sinking of the El Faro cargo ship during Hurricane Joaquin, the news media closely followed the recovery of the voyage data recorder, which was located in about 15,000 feet of water.

The black box, which is usually orange with reflective tape to make it easier to locate in wreckage, can be critical to our investigations at the NTSB. These devices can withstand enormous impact forces, intense temperatures, and the extreme pressures of ocean depths. Recorders capture a range of useful data, from crewmembers’ actions and conversations to vehicle parameters. We use these data to help identify the cause of an accident and to make recommendations to prevent such accidents from happening in the future. Industry can also use this information to make transportation safer.

We analyze recorder information in all modes of transportation. We transcribe audio from cockpit voice recorders and extract information from flight data recorders on aircraft. We review voyage data recorders that provide ship data, bridge audio, and radar images on vessels. We assess information from event recorders and forward- and inward-facing video recorders on trains. We analyze a variety of recorders and cameras that provide performance information on highway vehicles. No matter what type of recorder we encounter, we are required by law to protect the information obtained for our investigations.

Although the NTSB uses recorders to learn from one tragedy to prevent future ones, industry and operators can install recorders and develop programs to learn lessons from normal operations.

The NTSB urges the transportation industry to install recorders in their vehicles, vessels, trains, and aircraft, and to assess the data collected from them to prevent accidents and assess operator performance. Industry can use information from data, audio, and video recorders to identify issues of operational weakness or noncompliance with procedures. Airlines use the data they gather in everyday line operations through flight operational quality assurance (FOQA) programs to prevent accidents from occurring in the first place. Although most large aircraft are already required to have flight data and cockpit voice recorders, we have also recommended that they have cockpit video recording systems, and we have recommended that certain small aircraft that are not required to have recorders be required to carry recording devices that capture data. For smaller aircraft, recorders can provide crucial accident data, and they can also be a vital part of flight data management programs.

We appreciate the special value of data from video recorders, and that’s why many of our recent recommendations to regulators and operators propose that video recorders be installed to capture operator and crew behavior. Currently, investigators have no access to the visual information from an accident sequence. Although we can piece together key events in an airplane accident from cockpit audio and flight data, with video we have access to nonverbal communications and cockpit instrument manipulation. In fact, our NTSB scientists have even written software that reads needle positions and creates valuable data tables based on cockpit images! Reconstructing the accident sequence without video evidence requires additional time and effort—possibly delaying critical safety improvements.

What can be learned when inward-facing video is available? The answer is apparent from our 2014 investigation of the mid-air breakup of SpaceShipTwo during a test flight. SpaceShipTwo was equipped with data recorders, including video recorders to document the flight test. Because of those video images, the NTSB was able to identify quickly (by the second day of the on-scene investigation) that the co-pilot moved a lever at an inappropriate time, which ultimately resulted in the crash.

It is indisputable that we can make transportation safer by using information obtained from recorders. That’s why “Expand Recorder Use to Enhance Safety” is on the NTSB’s Most Wanted List of transportation safety improvements. And that’s why we urge transportation operators to install this important safety technology as soon as possible.

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