Category Archives: Events

When an Aircraft Goes Missing

By Mike Hodges, Air Safety Investigator, NTSB Office of Aviation Safety

On August 9, 2008, a privately-owned Cessna 182E airplane was reported overdue near Juneau, Alaska. The NTSB immediately started monitoring search efforts being conducted by the US Coast Guard, the Alaska State Troopers, the Civil Air Patrol, and a host of good Samaritans. The search area was expansive and included remote inland fjords, coastal waterways, and steep mountainous terrain. In an effort to start gathering information that was potentially relevant to the accident, we interviewed other pilots flying in the area, as well as Federal Aviation Administration (FAA) Flight Service Station personnel to better understand weather conditions at the time the airplane disappeared. After an extensive but unsuccessful search, search-and-rescue activities were suspended on August 20, 2008.

For all aviation accidents such as this one, when initial search-and-rescue activities are suspended and no wreckage is found, the NTSB issues a preliminary report, available to the public in an aviation accident database that can be accessed through our website. If the wreckage is not located within 180 days from the initial date of disappearance, we complete a final report with a probable cause statement of “undetermined.” The final report includes all pertinent information that was initially gathered at the time the aircraft was reported missing. If the wreckage is eventually located after the initial 180 days, we reopen and complete the investigation.

On October 25, 2017, I was the on-call air safety investigator for the NTSB Alaska Regional Office. Alaska State Troopers notified me that a deer hunter had discovered airplane wreckage on Admiralty Island, about 15 miles south of Juneau, Alaska. We eventually determined that it was the missing Cessna 182E. So, 9 years after the airplane went missing, we reopened the case.

In Juneau, I met with an aviation safety inspector from the FAA, an Alaska State Trooper, and members of Juneau Mountain Rescue. As with most remote aircraft accidents in Alaska, traveling to the scene requires an airplane or helicopter because there are no roads. The NTSB chartered a commercial, float-equipped Cessna 206 airplane, and we flew to Young Lake on Admiralty Island in the Tongass National Forest—the largest intact temperate rainforest in the world.

Flying to Young Lake near the accident site
Flying to Young Lake near the accident site

As an air safety investigator working in Alaska, I often face unique challenges, whether it’s a hike to a remote area to reach an accident site or a wildlife encounter. In this case, after arriving at the northern end of Young Lake, we hiked nearly 2 miles to the accident site, each of us carrying either firearms or bear spray because of the large population of brown bears on the island. We also carried satellite phones because there’s no cell phone reception in the area. The wreckage was in densely‑forested, steep mountainous terrain a little over a mile northwest of the north end of Young Lake, at an elevation of about 1,075 ft. mean sea level. The average tree height at the accident site was about 100 ft.

Landing on Young Lake
Landing on Young Lake

When we arrived at the site, the FAA aviation safety inspector and I documented and examined the wreckage. The cockpit and fuselage were destroyed by a postimpact fire. The wreckage of the missing airplane was confirmed via the serial number located on the airframe data plate. Time and nature had taken their toll—the heavily corroded wreckage was covered with dirt, fungus, leaves, and branches. The Alaska State Trooper recovered the remains of the two occupants.

View of the wreckage
View of the wreckage

Once the investigative and recovery activities were completed, we hiked back to Young Lake, contacted the commercial aviation operator for pickup, and returned to Juneau. Because the location was so remote, the wreckage was not recovered.

NTSB Air Safety Investigator Mike Hodges
Mike Hodges using a satellite phone at Young Lake to provide an update to NTSB leadership

On-scene activity is just one part of our investigative process. In each investigation, we look at the roles of the human, the machine, and the environment. By learning about the factors that cause an accident, we can make recommendations to prevent similar accidents in the future. In this investigation, I reviewed the airplane’s maintenance records, considered the pilot’s aviation training and medical records, and examined meteorological and topographical data for the accident area. As a result of the investigation, the NTSB determined that the probable cause of the accident was the pilot’s decision to continue visual flight into an area of instrument meteorological conditions, which resulted in the pilot experiencing a loss of visual reference and subsequent controlled flight into terrain. The pilot’s self‑induced pressure to complete the flight also contributed to the crash. The final accident report can be viewed here.

If you ever happen to come across aircraft wreckage—or what you think is aircraft wreckage—no matter how old it appears to be, please notify local law enforcement and the NTSB Response Operations Center in Washington, DC. If you’re able, please provide latitude and longitude coordinates of the wreckage location, along with photographs of what you found. The NTSB can then continue investigating what happened, which can help prevent future accidents from occurring. Also, importantly, family and friends of those who died in the accident may be interested in the new information. If you ever have the chance to visit the NTSB Training Center in Ashburn, Virginia, you will see an etched window on the front of the building that states the building is dedicated to the victims of transportation accidents and their families. The display also summarizes the NTSB’s crucial work of improving transportation safety for our great nation: “from tragedy we draw knowledge to improve the safety of us all.”

NTSB Training Center display

Remember Bellingham

By Member Jennifer Homendy

Today marks the 20th anniversary of the Olympic Pipe Line rupture in Bellingham, Washington, which resulted in the release of about 237,000 gallons of gasoline into a creek that flowed through Whatcom Falls Park. Sometime after the rupture, the gasoline ignited and burned about 1.5 miles along the creek. Two 10-year-old boys and an 18-year-old young man named Liam Wood died; 8 others were injured.

Bellingham, WA
Postaccident aerial view of portion of Whatcom Creek showing fire damage.

Liam had just graduated from high school and was fly fishing when he was overcome with fumes from the rupture. Years later, I met Liam’s stepfather, Bruce Brabec, as a staffer on Capitol Hill. Since Liam’s death, Bruce has been a tireless advocate for closing gaping holes in pipeline safety regulations, many of which have been revealed as a result of our pipeline accident investigations.

This past fall, I saw Bruce at a pipeline safety conference. The discussions over the days that followed left me wondering how much we’ve accomplished over the last 20 years. Is our pipeline system truly safer?

From a numbers standpoint, it’s good news and bad news. According to the Pipeline and Hazardous Materials Safety Administration (PHMSA), there were 275 significant gas and hazardous liquid pipeline incidents in 1999, resulting in 22 fatalities and 208 injuries. Since that time, the number of significant incidents has fluctuated as PHMSA adopted new reporting criteria, with 288 significant incidents occurring in 2018.

Fatalities and injuries have decreased since 1999 to 7 fatalities and 92 injuries in 2018, but that provides no comfort for victims, their families, or their loved ones. The fact is, although pipelines are one of the safest ways to transport hazardous material, the impact of just one incident can be devastating. And although the number of accidents is low compared to other modes like highway and rail, there is much more that pipeline operators and federal regulators can do to get to zero incidents, zero fatalities, and zero injuries on our nation’s pipeline system.

Our recommendation for operators to install automatic or remote-control shut-off valves in high‑consequence areas is a perfect example. In 1994, we investigated a natural gas transmission pipeline rupture in Edison, New Jersey, which resulted in a fire that injured 112 people and destroyed 8 buildings. Pipeline operators were unable to shut down the gas flow to the rupture for 2½ hours. Our report on the accident recommended that the Research and Special Programs Administration (RSPA), PHMSA’s predecessor, expedite requirements that automatic- or remote‑operated mainline valves be installed on high-pressure pipelines in urban and environmentally sensitive areas so that failed pipeline segments can be rapidly shut down. We have been recommending valve installation in some form on pipelines since 1971.

In response, RSPA issued a regulation requiring operators to install a valve only if the operator determines it will efficiently protect a high-consequence area in the event of a gas release.

Fast forward to September 9, 2010, when an intrastate natural gas transmission pipeline owned and operated by the Pacific Gas and Electric Company ruptured in a residential area in San Bruno, California. The rupture produced a crater about 72 feet long by 26 feet wide. The section of pipe that ruptured was found 100 feet south of the crater. The released natural gas ignited, resulting in a fire that destroyed 38 homes and damaged 70. Eight people were killed, many were injured, and many more were evacuated from the area.

In our report on the accident, we once again recommended that PHMSA expedite the installation of automatic shutoff valves and remote-control valves on transmission lines in populated areas, drinking water sources, and unusually sensitive ecological resources. Congress then required PHMSA to implement the recommendation in the Pipeline Safety, Regulatory Certainty, and Job Creation Act of 2011 (PL 112-90).

It’s been a decade since San Bruno, and PHMSA is nowhere near issuing a final rule to implement our recommendation. This issue is highlighted on our 2019–2020 Most Wanted List of transportation safety improvements (Ensure the Safe Shipment of Hazardous Materials).

MWL03s_HazMat

It’s my hope that over the next few years, we’ll see some real improvements in pipeline safety and avoid tragedies like the ones in Bellingham and San Bruno. With the technology we have readily available today, there’s absolutely no reason for any parent to have to face the loss of a child because of a pipeline accident. I hope that the next time I see Bruce Brabec, we’ll finally have the regulations in place that he’s worked so hard for on Liam’s behalf.

 

 

 

 

Eliminate Distractions

By Vice Chairman Bruce Landsberg

The NTSB has investigated distraction-linked crashes in all modes of transportation. Our 2017 distracted driving roundtable, “Act to End Deadly Distraction,” made one thing very clear:

We don’t feel these losses in a statistical table. We feel them at the dinner table. We also don’t call them “accidents” because they are totally predictable.

More than 100 people die every day on our roads and highways, nine or ten of them per day in distraction-involved crashes alone. More than 1,000 people per day—391,000 in one year—are injured in distraction-involved crashes. And it’s certain that this number is greatly under-counted. Many of these injuries are life-altering, disfiguring and permanently crippling. My apologies for being graphic – but ask anyone who’s been involved whether the distraction that caused the crash was worth it.

Listen to stories told in our 2017 roundtable by survivor advocates. Or, simply ask around. It won’t take long to find someone with a story of a friend, business colleague or loved one lost to a distracted driver.

What too many of these crashes have in common is a portable electronic device – the universal cell phone. When the NTSB made its first recommendation about driver distraction by “wireless telephone” in 2003, cell phones were primarily just that: tools for making voice calls. Although some cell phones had keypads, the word “texting” does not appear in that early report.

In 2011, the NTSB recommended that the states ban non-emergency driver use of all portable electronic devices that did not support the driving task. To date, no state’s laws have gone that far. Why?

And since drivers look to the law for guidance, no state’s drivers have gone so far as to voluntarily stop driving while visually, manually, and/or cognitively distracted. Why?

Now, a second 2011 NTSB safety recommendation is becoming steadily more feasible: Safety Recommendation H-11-47. We recommended that CTIA—the wireless association, and the Consumer Electronics Association, encourage the development of technology that can disable portable electronic devices within reach of the driver when a vehicle is in motion (with the ability to permit emergency use of the device while the vehicle is in motion, and the capability of identifying occupant seating position so that passengers can use their devices).

Unfortunately, the recommendation has not been adopted, despite smartphones and apps that will allow the driver to opt out of calls and texts while driving. So, why hasn’t there been more action on this recommendation?

The best safety solution is always to design out the problem. Rather than just encourage people to do the right thing, don’t give them the opportunity to do the wrong thing… and possibly take a life or maim someone.

Don’t misunderstand, we endorse a solid tech solution, but such a solution won’t work in every situation. It must be a belt-and-suspenders effort, together with the familiar three-legged stool of highway safety (awareness, tough laws, and high-visibility enforcement).

This year many more loved ones will be lost to distraction, but surveys tell us that most people think distracted driving is a bad idea. Until, that is, we have to put our own phone down. Hypocritical? It couldn’t possibly happen to me – I’m too good a driver! The numbers prove otherwise.

Time, tide and tech wait for no man or woman, to coin a phrase. By the end of today a thousand more families will be dealing with tremendous loss and pain.

This month, the NTSB will host its third Roundtable on Distracted Driving: Perspectives from the Trucking Industry. During the roundtable, members of the trucking community, victim advocacy groups, the business community and legislators will come together to discuss the problem of distracted driving and potential countermeasures. We also hope to hear about new efforts to close Safety Recommendation H-11-47.

To kickoff Distracted Driving Awareness Month, on April 3, we will also host, with Impact Teen Drivers and the California Highway Patrol, the Western States Teen Safe Driving Roundtable to talk about the state of teen driving and the proven strategies for preventing teen-driving related crashes.  Now, what are you going to do about it?

Another Step Toward Safer Skies in Africa

By Dennis Jones, NTSB Managing Director

In my recent blog post, I talked about the NTSB’s visit to South Africa as part of the US Department of Transportation’s Safe Skies for Africa (SSFA) program. Last week, the NTSB team returned to Africa—this time, to the east African nation of Kenya—in continued support of the SSFA program, the aviation safety capacity-building initiative that includes collaboration between African countries and several US government agencies. In Kenya, as in South Africa, we once again shared investigative lessons learned with more than 150 air safety investigators, aviation trainers and operators, government officials, and safety advocates from Kenya and countries in the surrounding region.

Blog Image 1

I was particularly excited about this trip because I first traveled to Kenya for accident investigation purposes 20 years ago, and later, based in the capital city of Nairobi, I worked to implement the NTSB’s SSFA program responsibilities. The goal of the SSFA program in Kenya was to help the country achieve FAA Category 1 status and pave the way for direct scheduled commercial air service between the United States and Kenya. The NTSB’s contribution toward this goal was to help Kenya’s accident investigation program meet international standards in accordance with the provisions of the International Civil Aviation Organization’s (ICAO’s) Annex 13. Our activities included working with the Air Accident Investigation Division of Kenya (AAID) to develop its program, which included on-the-job investigator training; establishing policy, procedures, and practices for the organization; and producing memoranda of understanding between AAID and other domestic government agencies. The NTSB partnered with ICAO as part of the SSFA program to conduct aircraft accident investigation workshops throughout Africa; the first such event was held in Nairobi in 2007.

It took some time but, thanks to Kenya’s painstaking and diligent efforts, and the assistance provided by the SSFA program, Kenya achieved an FAA Category 1 rating in February 2017. Consequently, US and Kenya air carriers can now, with the approval of their respective regulatory agencies, travel between the two countries. Kenya Airways, Kenya’s national carrier, will launch its inaugural flight to the United States, destined to JFK International Airport in New York, in October 2018.

Although Kenya’s government is focused on improving aviation safety, the country—and, more broadly, the continent—still faces challenges that the region’s stakeholders are dedicated to overcoming. General aviation (GA) safety issues have been formidable in the region, just as they are in the United States, and we sought to share some of our experience addressing this issue. Further, through the SSFA initiative, NTSB representatives have recognized other modal transportation safety issues and safety advocacy opportunities for future consideration as the agency formulates its international scope of activities.

After accompanying the NTSB team to South Africa last month, I was fully confident in its ability to conduct the workshop in Nairobi. The team was composed of professionals representative of the superb workforce at the NTSB, and they delivered powerful presentations sharing lessons learned.

Shamicka Fulson, a program manager in the Office of the Managing Director, coordinated the development of the workshops in South Africa and Kenya. She delivered opening remarks and provided an overview of the agency and the SSFA program to begin the workshop in Nairobi.

Clint Crookshanks, an aerospace engineer in the Office of Aviation Safety, facilitated a workshop related to identifying common aviation safety lexicon. He reviewed different accident case studies with the audience and discussed ways to interpret the generalized and vague definitions often found in aviation investigations, such as “substantial damage to aircraft,” or the distinction between an “accident” and an “incident.”

Luke Schiada, Deputy Chief of Aviation Safety for the Eastern Region, presented accident case studies that highlighted international cooperation. Luke told the audience that he believed “international cooperation is, in large part, about building relationships and trust.” He stressed the importance of interacting with and learning from the collective knowledge and experiences of participants in settings like the SSFA workshops. I can’t agree more; after all, we can’t improve within unless we are willing and able to learn from without. Even sharing enables learning and growth.

Dennis Hogenson, Deputy Regional Chief of Aviation Safety for the Western Pacific Region, focused on GA safety improvements. He pointed out that, like Africa, the United States is seeing a high incidence of GA crashes. He told his audience that, while airline accidents have become rare, GA accidents account for most aviation fatalities. In many of our GA accident investigations, we’ve discovered that pilots didn’t have the adequate knowledge, skills, or recurrent training to fly safely. Dennis encouraged his African counterparts to initiate more training and increase awareness of technology that can help prevent these tragedies; this is something we continue to strive to do in the United States via our Most Wanted List issue addressing loss-of-control in flight.

Nicholas Worrell, Chief of the Safety Advocacy Division in the Office of Safety Blog Image 2.jpgRecommendations and Communications, urged attendees—most of whom were investigators—to go beyond investigations to see real improvements in safety. The work doesn’t end with the report findings issued after the investigation; the work to improve safety just begins, he said. African safety organizations need to develop advocacy efforts and strategies to ensure their safety recommendations are implemented. Nick encouraged the audience to look to some of Kenya’s most notable leaders, like Jomo Kenyatta, political activist and Kenya’s first president, and Wangari Maathai, Nobel Peace Prize winner, both of whom saw a need for and executed effective advocacy to improve laws, policies, and practices.

The goal of our visit to Kenya was to continue fostering the development of a safer aviation transportation system in East Africa. It is integral to our mission at the NTSB to share globally what we have learned from 51 years of safety investigations. As the NTSB team supporting the SSFA program has shown, improving transportation safety is a collaborative process that doesn’t end at our borders.

Pedestrian Safety: An NTSB Special Investigation Report

By Member T. Bella Dinh-Zarr, PhD, MPH

 5,987. That’s the number of pedestrians who died on our roadways in 2016. That’s 16 people every day across our country. But because these tragedies happen one by one, pedestrian deaths often fail to receive national attention. But as an agency dedicated to preventing transportation deaths and injuries, we know that must change.

In 2016, we held a public forum to address pedestrian safety. Experts from around the country discussed the data we need to better understand the risks, technology that could prevent vehicles from hitting people, and highway designs that offer safer roads or paths for pedestrians. Since that initial public meeting, we have conducted more than a dozen investigations into pedestrian deaths in order to gain insight into how we can prevent these deaths from happening.

Although the pedestrian crashes we investigated were not meant to be representative of nationwide data, the circumstances around the crashes were not unique—a child walking to school, an older man taking an evening walk around his neighborhood at dusk, a man walking his dog after lunch, a woman crossing a crowded city street, another leaving a bar at night. In most of the cases, the pedestrians were in crosswalks at intersections, and many occurred where speed limits were posted for 25­–30 mph.

Historically, the NTSB has focused highway investigations on vehicle-to-vehicle collisions. But, having watched the trendline of pedestrian fatalities increasing steadily over the past 10 years, we are now calling attention to the problem of pedestrian safety. After all, although we may not all be drivers, we are all pedestrians. As communities embrace the goal of eliminating highway fatalities, preventing pedestrian crashes must be a top priority.

Tomorrow, September 25, 2018, the NTSB will examine the issue of pedestrian safety during a public Board meeting, beginning at 9:00 am. NTSB staff will present recommendations intended to improve pedestrian safety, and afterward, we will release the investigations, the special report, a supplemental data analysis report, and directions to a website that will allow people to examine the history of pedestrian fatalities in their own communities. In addition to being open to the public, the meeting will be webcast for interested parties who cannot attend in person.

Details of the investigations conducted in support of our pedestrian special investigation report will be available after the Board meeting on our NEW Pedestrian Safety page at the NTSB website: www.ntsb.gov/pedestrians.

Ten Years Later: Remembering Chatsworth With Action

By  Member Jennifer Homendy

Ten years ago today, September 12, 2008, a Metrolink commuter train filled with passengers in Chatsworth, California, collided head-on with a Union Pacific freight train. The collision took the lives of 25 people and injured 102 others. The cause: A texting engineer. A human operator making a human error.

On this 10th anniversary, we offer our condolences to all those who lost loved ones or were injured in the Chatsworth tragedy.

 

Photo of the Collision of Metrolink Train 111 With
Union Pacific

Although I was not a Member of the National Transportation Safety Board at that time, I was working tirelessly as the Staff Director of the Subcommittee on Railroads, Pipelines, and Hazardous Materials in the U.S. House of Representatives to mandate implementation of technology, called positive train control (PTC), which could have prevented the Chatsworth accident from occurring.

PTC is designed to automatically stop a train when a human operator fails to. Human error is the leading cause of all train accidents. Frustratingly, the NTSB has been recommending that railroads implement PTC to address human error-caused accidents for nearly 50 years.

In the wake of the Chatsworth collision and a number of others investigated by the NTSB, Congress passed the Rail Safety Improvement Act of 2008, which required freight, intercity passenger, and commuter railroads to implement PTC by the end of 2015. As the deadline approached, Congress extended it to 2018, with the possibility of further extensions until 2020. Now, as the new deadline approaches, PTC is still not fully implemented.

We know from railroad reports to the Federal Railroad Administration, the agency charged with regulating the railroads, that PTC is operational on only a small fraction of the railroad network.

Accidents, however, continue to occur. Since 2008, the NTSB has investigated 22 accidents that could have been prevented by PTC. Together, these accidents have resulted in 29 deaths, more than 500 injuries, and more than $190 million in property damage.

Tomorrow, Chairman Sumwalt will testify on Capitol Hill regarding the need to finish the job without further delay. Regrettably, nothing that the NTSB does can turn back the clock and change a tragic outcome; we can only urge that others be spared such an outcome in the future.

As the newest Member of the NTSB, I will continue to advocate for full implementation of PTC and for the safety recommendations we made as a result of the Chatsworth crash so that a similar tragedy is prevented in the future.

In the meantime, there is something you can do as we remember Chatsworth: eliminate distractions while operating a vehicle. Distraction continues to play a significant role in accidents.

Distracted driving kills thousands and injures hundreds of thousands every year. On the railroads, PTC is an effective backstop in case an operator is distracted, fatigued, impaired, or otherwise unable to take the right action. But operators must still adhere to strict procedures to minimize the chance of an accident.

On the highways, collision avoidance systems—forward collision warning systems and automatic emergency braking—are beginning to play a similar role to PTC. We think that these systems should be on every car, and we are working toward that outcome. But even without a collision avoidance system, you can take control by doing the right thing. Don’t send a text, make a call, or update your social media while driving. Strict laws aimed at preventing the use of portable electronic devices while driving and high-visibility enforcement can help, but ultimately, it’s up to each driver to drive attentively.

As we mark the 10th anniversary of the Chatsworth collision, we still have a long way to go to ensure the same kind of accident doesn’t happen again. But there are things we can do. We can insist railroads complete PTC implementation on all their tracks. We can choose vehicles with collision avoidance systems, and we can refuse to drive distracted.

Fatal collisions don’t end on impact; they echo through communities for years after the moment of a crash. But there can be hope as well as mourning in the echoes—hope for change that will prevent future tragedies. It will take all of us in transportation—professionals and the general public—to ensure the lessons learned from the Chatsworth tragedy result in that change.

 

The Value of Video

By Jennifer Morrison, NTSB Investigator-in-Charge, Office of Highway Safety

 On January 19, 2016, a Greyhound bus with 22 people on board was traveling on a California interstate in the dark in moderate-to-heavy wind and rain. The driver intended to take the left exit, en route to the next stop in San Jose, but instead crashed the bus head-on into the end of a concrete barrier. The bus jumped the barrier and rotated onto its side. Two passengers were ejected and died; the driver and 13 passengers were injured.

The crash occurred at 6:37 in the morning, after the driver had been on duty, commuting to his route and driving the bus, for about 12 hours. Tempting as it was to assume this crash resulted from driver fatigue, our investigation soon revealed that other factors were at play.

HWY16MH005_prelim[1]
Final rest position of bus and remains of REACT 350 crash attenuator base
When I arrived on scene with the rest of the “go team,” we discovered that the highway interchange where the crash occurred had four through lanes, two right exit lanes, and a single left exit lane. When the driver moved the bus left to what he thought was the left exit lane, he instead unintentionally entered a 990-foot-long unmarked gore area that separated the through lanes from the left exit lane. The gore area ended at the concrete barrier where the crash occurred. The crash attenuator at the end of the barrier likely absorbed some crash energy, but it was not designed to redirect a large commercial vehicle like a Greyhound bus.

What was interesting about the crash attenuator was that it had been hit before; our investigation found that damage from the previous impact had ripped the reflective sheeting off its face. Records showed that the California Department of Transportation had placed temporary barricades but had never finished the repair.

Fortunately for our investigation, the bus, like most of Greyhound’s buses now, was equipped with a video camera system. Video recovered from the bus showed that the temporary barricades had blown over, possibly in the wind and rain that morning. As we watched the forward-facing and inward-facing videos, the scene became clear: the driver was attentive as he signaled and moved into the gore area, interpreting it to be a travel lane. At 1 second before impact, a dark black barrel (the first part of the crash attenuator) appeared in the middle of the “lane” (see Figure 1). There was no reflective sheeting on its face, and there were no temporary barricades set up to identify the hazard.

Without the video camera system onboard the bus, it would’ve been impossible to know that the barricades had blown over prior to the crash, rather than simply been displaced by the event. Without the video evidence, it would have been easy to assume that the driver was just too tired or otherwise distracted by fatigue to see the warning. But the video showed clearly and indisputably the events leading up to the crash.

greyhound video
Still image of onboard video at 1 second prior to impact.

Onboard video systems provide investigators and fleet owners with the invaluable, unbiased evidence to interpret—and work to prevent—crashes like this one. That’s why we’ve strongly recommended they be installed on all highway vehicles for decades. We even emphasize the importance of these systems on our Most Wanted List of transportation safety improvements. This crash illustrates why this technology is important, and we continue to urge operators to install it across their fleets.

NTSB Most Wanted List of Transportation Safety Improvements 2017-2018

To learn more about this issue, join us Thursday, September 13 at 2 PM EST, for our “Reducing CMV Crashes Through the Use of Video Recorders webinar.” In our 1-hr webinar, NTSB Member Bella Dinh-Zarr, investigators and recorder analysts from the Office of Highway Safety and Office of Research and Engineering, along with commercial fleet owners representing the truck and bus industries, will discuss why and how their organizations use video recorders to improve safety. NTSB investigators will provide an in-depth discussion into the Greyhound crash discussed in this blog and will also highlight a truck case study. For more details or to register, visit this link.