Category Archives: Transportation History

A Call to Action from Kennedy

By Chair Jennifer Homendy

This week, I visited NASA, Boeing, Blue Origin, and Space-X at Kennedy Space Center (KSC) in Florida. KSC has been a leader in space exploration for over 50 years. The Apollo, Skylab, and Space Shuttle programs took off from there, as did the Hubble Space Telescope, the Mars Rover project, and New Horizons, the first spacecraft to visit Pluto.

To visit Launch Complex 39A and stand where the Apollo and Space Shuttle astronauts once stood before they launched into space was humbling, and as I watched Space-X’s Transporter-5 launch and land from the balcony of Operation Support Building 2 and the return of Boeing’s Starliner Spacecraft virtually, I was reminded of how important it is that we learn from the past as we advance into our future.

Exactly sixty-one years earlier, to the day, on May 25, 1961, President Kennedy addressed a joint session of Congress and laid out a truly ambitious goal: landing a man on the Moon. Not just landing a man on the Moon but returning him safely to Earth. He called for national leadership and implored Congress and the country to take a firm and sustained commitment to a new course of action, “a clearly leading role in space achievement, which in many ways may hold the key to our future on earth.” And he demanded that the whole of government, working together as one, dedicate themselves to jumpstarting a future he knew was in the best interests of our country.

The vision that President Kennedy laid out 61 years ago continues to shape our nation and the world. Today, NASA is developing its deep space rocket, the most powerful rocket it has ever built, the Space Launch System (SLS), while commercial space companies transport cargo for the federal government and private businesses to space as well as to the International Space Station (ISS). These companies have also begun transporting passengers.

Commercial spaceflight is a rapidly evolving industry and shows tremendous promise. Over the last decade, Federal Aviation Administration (FAA)-licensed commercial launches and re-entries have grown tremendously, from 1 licensed launch and 0 licensed re-entries in 2011 to 54 licensed launches and 6 licensed re-entries in 2021. The federal government needs to be prepared for these exciting technological advances. For NTSB, that means ensuring we remain ready if an accident occurs. If the past has taught us anything, it’s not a matter of “if” an accident will occur, it’s a matter of when.

The NTSB has investigated accidents involving space vehicles for over 30 years. In 1986, we participated in the investigation in the Space Shuttle Challenger disaster; in 1993, we investigated the Orbital Sciences Pegasus accident; we again participated when the Space Shuttle Columbia disintegrated on reentry and 7 astronauts died, in 2003; and in 2004, we assisted NASA with the Genesis Sample-Return Capsule crash investigation. More recently, in 2014, we investigated the in-flight explosion of SpaceShip Two.

All this is to say, we aren’t new to commercial space. The fact is NTSB is world renowned for its reputation as the “gold standard” for thorough, fact-based, independent investigations of accidents in all modes of transportation, whether those accidents occur on our roads, railways, waterways, or in our skies. We have been at the forefront of safety and the advancement of new technologies and new ways of moving people and goods for decades. We’re used to new challenges, and we’re ready for them.

The key to our success is our independence. That independence is what sets us apart. We aren’t tasked with exploring space; that’s NASA’s mission. We aren’t tasked with promoting, licensing, or regulating the safety of the commercial space industry; that’s the job of the FAA. Our entire mission is focused on determining what happened when a tragedy occurs, why it happened, and issuing safety recommendations aimed at preventing it from happening again. In other words, our one and only goal is to save lives and prevent the reoccurrence of terrible tragedies.

These past few months, I’ve spent time with our safety partners at FAA and NASA in hopes of ensuring we’re all prepared should tragedy occur. I’ve done this because I believe that the disparate arms of the federal government must work together to ensure the safety and success of this burgeoning industry. The commercial space industry is American innovation at its finest. As a government, we don’t want to get in the way of awe-inspiring technological innovations we once thought unimaginable, but we want to provide guardrails and cooperation, guidance and protection of the public, and we all need to work together as one to make that happen.

Sixty-one years ago, President Kennedy called on us to work together for the best interests of our country. The need for all of us to work together resonates as much today. I call on our safety partners at NASA, at FAA, at the Departments of Commerce and Defense to work with us and the stakeholders who I visited this week, among others, to ensure that safety remains a top priority alongside commercial space innovation.

Reflections on International Women’s Day

By Chair Jennifer Homendy

Who will be speaking? The Chair? What’s his name?

That’s what I overheard a reporter asking an NTSB employee just a few weeks ago. We were in Pittsburgh, where I was on scene for the agency’s investigation into the collapse of the Fern Hollow Bridge.  

I couldn’t help myself and jumped in with: “He’s a she…and it’s me!”

The reporter was mortified and apologized profusely. We shared a laugh and went on to have a great press conference.

NTSB Chair Homendy at a press briefing on the NTSB investigation into the collapse of the Fern Hollow Bridge in Pittsburgh, Pennsylvania.

Even though I responded with humor, that exchange was just one example of an unconscious bias that women encounter every day. Of course, unconscious biases can reflect one or more “-isms:” racism, ableism, heterosexism, ageism, classism, etc. 

In all fairness to the reporter, he responded appropriately. By that I mean he acknowledged his mistake and apologized sincerely. He wasn’t defensive and he didn’t invalidate my reaction. His response showed real humility, which is why we were able to move on so quickly.  

What You Can Do

I offer two suggestions for small but powerful ways you can recognize International Women’s Day and #BreakTheBias.

First, accept that no one is free from unconscious bias. Work to become aware of the ways you may show your own “-isms” and do what the reporter did: own the error and offer a genuinely sincere apology. Fight the urge to say I didn’t mean it like that. The only way to ensure you do better next time is to respond with humility.

You can also be intentional about using words that communicate a sense of belonging. When backed up by action, the language we use can change the culture from one of exclusion to one of inclusion.

Women in Transportation

Increasing the representation of women in all transportation modes will go a long way toward combatting unconscious bias. Consider the following statistics:

  • Aviation: Women hold only 8.5% of FAA pilot certificates. Female flight engineers, 4.3%; mechanics, 2.6%; parachute riggers, 10.1%; ground instructors, 7.8%; air traffic controllers, 16.8%; dispatchers, 19.7%.
  • Highway: While 49% of all workers nationally are women, only 18% of infrastructure workers are women. Moreover, in 20 of the largest infrastructure occupations, less than 5% of workers are women. And 7.9% of truck drivers are women.
  • Marine: Women make up just 1.2% of the global seafarer workforce. While this represents a nearly 46% jump from 2015, it’s not nearly enough.
  • Railroad: Women hold less than 8% of rail transportation jobs and the latest Federal Railroad Administration report acknowledges that “recruiting and retaining a diverse representation of employees remains a persistent issue.”
  • Pipeline & Hazardous Materials: Over 80% of hazardous materials removal workers are male — and just 15% of civil engineers are women. As for pipeline, women make up 10.8% of the pipeline transportation workforce and 21.8% in natural gas distribution. Unfortunately, these numbers drop even lower when it comes to higher-paying technical jobs in the oil and gas industry.

We have work to do, including here at NTSB. Our latest state of the agency report showed that our female workforce is 7% below the civilian labor force — something I think about every day. I’m only the fourth woman to serve as Chair since the agency was created in 1966. This is a message I’ll be sharing at the upcoming International Women in Aviation Conference.

When I was appointed to lead the NTSB, I made the decision to be addressed as Chair Homendy. I didn’t make this out of personal preference, but for the next woman to serve in the role. Perhaps, if we de-gender the office, the fifth female Chair will have one less bias to break.  

Black History Month and Transportation Safety

By Nicholas Worrell, Chief, NTSB Safety Advocacy Division

Our stoplight system—red for stop, green for go, and yellow for caution—benefits every motorist in the nation. Yet, most people don’t realize that the system was invented by a Black man whose father was formerly enslaved: Garrett Morgan.

A largely self-taught inventor and a hard worker, Morgan was the first Black person in his city of Cleveland, Ohio, to own a car. In 1923, he realized the need for a yellow signal after seeing a crash at an intersection, and the rest is history. As a result, our roads are much safer today.

But they’re not equally safe for all communities. As Chair Jennifer Homendy has said, “Black road users are not as safe as their white counterparts—and these disparities are unacceptable.” For example:

  • Traffic fatalities among Black people increased by 23% between 2019 and 2020, compared to an overall increase of 7.2%. (NHTSA)
  • From 2010–2019, Black people were struck and killed by drivers at an 82% higher rate than white, non-Hispanic Americans. (Smart Growth America)
  • Drivers are less likely to yield to Black people walking and biking than white people doing those activities. Black pedestrians were passed by twice as many cars and experienced 32% longer wait times for cars to yield to them than white pedestrians. (National Institute for Transportation and Communities)

This month, we celebrate Garrett Morgan and all Black leaders who’ve worked to improve transportation safety. We should also take this time to examine the shameful statistics and work to address their root causes. We can’t address the problems different communities face in transportation until we recognize the diversity of the communities we serve and the disparities between them. These statistics beg the question: How much of the full transportation safety story are we overlooking?

Members of the transportation safety community must understand how—and who—transportation tragedies strike, and we must engage the communities we want to help in designing solutions. We need representatives of all colors, creeds, and perspectives to improve transportation for everyone, regardless of their race.

Garrett Morgan improved life for all in the U.S. Yet during his time, a time before civil rights, overt racism was so common that it was literally built into our transportation system’s asphalt and concrete bones. We owe it to Black pioneers like Garrett Morgan—and to all the traveling public—to make transportation safety more equitable.  

Recognizing a Quarter Century of 24/7 Response

By Chair Jennifer Homendy

Blue jackets. Devastating scenes. Calm in the wake of tragedy.

This is how many people describe their first impressions of NTSB. It’s not surprising given the international visibility of our on-scene work.

But today is all about who you don’t see: the folks who make the agency’s headline-grabbing work possible.

I’m talking about the incredible people of NTSB’s Response Operations Center, which is today celebrating 25 years of uninterrupted service to our nation.

What is the ROC?

It’s no exaggeration to say the Response Operations Center — or “ROC,” as we affectionally call it — is the agency’s central nervous system.

The ROC is staffed 24-hours-a-day, seven days a week by at least two watch officers. They work three or four consecutive, 12-hour shifts, for a total of about seven shifts over two weeks. 

The room looks as you would imagine: a dozen televisions line the wall in front of desks staffed by watch officers. Newscasters deliver the day’s stories from C-SPAN, the Weather Channel, CNN, MSNBC, Fox News, and various local stations.

NTSB’s Response Operations Center. The photo was taken before the pandemic required the use of masks in our office.

This is where the team takes in reports of transportation-related events around the clock. In addition to monitoring the news outlets, the team fields phone calls and emails from around the world, triages them, and rapidly pushes out the news to NTSB leadership and investigators who need to respond.

But most importantly, the ROC initiates the launch process by notifying the appropriate modal duty officers when an accident or crash occurs. 

As the investigation team members pack their gear, the ROC staff help prepare everything for the launch. This includes setting up conference calls, reserving hotel rooms, and booking rental cars. As for flights, many of the Washington, DC-based go-team members will expedite their travels to investigation destinations using one of the jets managed and operated by the Federal Aviation Administration (FAA).

The NTSB has access to two jets managed and operated by the Federal Aviation Administration.

Origin Story

The first NTSB communications center opened its doors on February 3, 1997, in a conference room at NTSB headquarters.

NTSB’s first communication center in 1997.

The idea to launch a command center came from former NTSB Chairman Jim Hall, who was on scene for the July 17, 1996, Trans World Airlines flight 800 explosion. It was the third-deadliest aviation tragedy in U.S. history.

Befitting its status as “central” to our mission, the agency relocated the ROC in 2014 to a room in the literal center of the building.

What It Takes to Operate for 9,125 Consecutive Days — and Counting

Once settled into its current location, the agency invested in everything needed to operate the ROC without interruption, no matter what.

Here are some examples of what it takes to keep the ROC ready for anything:

  • Computers specifically built to run nonstop, complete with special air filters to keep their internal systems clean.
  • A standalone HVAC system that runs independently from that of the building.
  • A full kitchen to ensure ROC staff can eat and prepare food even if local restaurants are closed.
  • Ever mindful of workplace safety, even the chairs in the ROC are ergonomically designed for continuous use.
  • Regular drills to ensure preparedness. 

The View from the ROC

For many working in the ROC, having a front seat to transportation tragedies can take an emotional toll.  

When asked how they cope, here’s what some team members had to share:

“For me, when these bad things happen, it is sort of like a wake-up call. It helps me appreciate life more.”

“The way I cope is by not following a crash after we play our role in the ROC. I don’t keep tabs on what is going on with them. I have to let go.”

The serious nature of the work may explain why the ROC team has named the electronic voice from its primary notification system.

Similar to the voice from your favorite smart speaker, “Helga” alerts ROC staff when notifications arrive from the FAA, Federal Railroad Administration, or the National Response Center. She’s been a constant in the ROC.

One team member shared that giving the system a persona is another coping mechanism, adding: “If it ever gets lonely in the ROC, there is always Helga to keep you company.”  

Celebrating 25 Years of 24/7 Response

Even as we celebrate the dedicated service of our ROC team, every NTSB employee is working to put ourselves out of a job by making transportation safer.

Until that day arrives, consider sending a mental “thank you” to the incredible professionals of the ROC the next time you’re enjoying the weekend, celebrating a holiday, or enjoying a quiet night at home.

The duty officers are always there, monitoring the safety of our transportation system.

Just as they have for the last 25 years.

Two-years Later: Conception Tragedy Still a Reminder that More Should Be Done to Improve Passenger Vessel Safety

By Chair Jennifer Homendy

Two years ago today, a preventable tragedy became one of the worst maritime events in US history.

At about 3:14 a.m. on September 2, 2019, the U.S. Coast Guard (USCG) received a distress call from the Conception, a 75-foot-long small passenger vessel operated by Truth Aquatics, Inc.

Preaccident photograph of the Conception (Source: http://www.seawaysboats.net)

The Labor Day fire began in the early morning hours, as five crewmembers slept in their upper-deck crew berthing. Two decks below, thirty-three passengers and one crewmember slept in the bunkroom. A crewmember on the upper deck, awakened by a noise, noticed a glow from the aft main deck and alerted the remaining four crewmembers that there was a fire on board. Then the captain radioed the 3:14 a.m. distress message to the USCG before evacuating the smoke-filled wheelhouse.

Crewmembers tried to get to the bunk room through the main deck salon but were blocked by fire and smoke. Unable to reach the bunkroom, they jumped overboard. Two of them re-boarded the vessel at its stern but were once again blocked by smoke and fire. Ultimately, the five crewmembers who had been sleeping on the upper deck survived. Two were treated for injuries. But tragically, the 33 passengers and one crewmember who had been asleep below deck in the bunkroom lost their lives in the fire.

Small passenger vessel Conception at sunrise prior to sinking (Source: VCFD)

Along with a multidisciplinary NTSB team, including marine safety investigators and specialists from the NTSB Transportation Disaster Assistance (TDA) and Media Relations divisions, I launched to my first maritime investigation as a Board Member. During my time on-scene, I met with the families of those on-board the vessel and gave them the only promise we at NTSB have to give, that we would find out what caused the fire aboard the Conception, in hopes of finding ways to prevent similar suffering for other families.

Our investigators, along with the USCG, the Federal Bureau of Investigation (FBI), and the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) were carefully recovering wreckage. They examined a similar vessel to help learn how it was built, and how escape might have been thwarted for so many. While we conducted our safety investigation, a parallel criminal investigation was underway.

Yet despite difficult circumstances and the limited evidence left after the fire, the NTSB was able to identify critical safety issues, determine the probable cause, and make important safety recommendations. If implemented, these recommendations will help prevent a similar tragedy from happening again.

NTSB investigators found that the Conception had no smoke detectors anywhere in the main deck salon where the fire likely started. But incredibly, there are no passenger vessel regulations requiring smoke detection in all accommodation spaces. The vessel was also required to have a roving patrol to guard against and raise alarm in case of a fire or other emergencies, but there was no evidence that such a safeguard was in place, and the USCG has difficulty enforcing such an important requirement aboard small passenger vessels.

Furthermore, small passenger vessel construction regulations for means of escape did not ensure that both escape paths from the sleeping compartment exited to different spaces. On the Conception, the only emergency routes from the passenger accommodations exited into the same space, which was fully engulfed in fire.

Finally, our investigation highlighted yet another company with ineffective safety oversight. When the Board met to deliberate the report on the tragedy on October 20, 2020, we determined that the probable cause of the fire on board the small passenger vessel Conception was the failure of Truth Aquatics, Inc., to provide effective oversight of its vessel and crewmember operations, including requirements to ensure that a roving patrol was maintained, which allowed a fire of unknown cause to grow, undetected, in the vicinity of the aft salon on the main deck. Contributing to the undetected growth of the fire was the lack of a USCG regulatory requirement for smoke detection in all accommodation spaces. Contributing to the high loss of life were the inadequate emergency escape arrangements from the vessel’s bunkroom, as both exited into a compartment that was engulfed in fire, thereby preventing escape.

The NTSB reiterated its Safety Recommendation (M-12-3) to the USCG to require all operators of U.S.-flag passenger vessels to implement safety management systems (SMS) considering the characteristics, methods of operation, and nature of service of these vessels, and, with respect to ferries, the sizes of the ferry systems within which the vessels operate. An SMS is an enormously powerful tool which helps a safety critical company identify hazards and mitigate risks.

Additionally, we issued seven new safety recommendations to the USCG to:

  • require new and existing small passenger vessels to be equipped with smoke detectors in all accommodation spaces, which are interconnected so that when one detector alarms, the remaining detectors also alarm.
  • develop and implement inspection procedures to ensure vessel operators are conducting roving patrols when required.
  • require a secondary means of escape into different exits from overnight accommodations that emerge into different spaces than the primary exit, and that those routes are not obstructed.

While these regulatory changes may take time, the NTSB also recommended that industry groups such as the Passenger Vessel Association act voluntarily to install smoke detectors and improve emergency egress routes. Finally, we recommended that the company that operated the Conception implement an SMS to improve safety practices and minimize risk.

The Conception investigation report is an excellent example of the NTSB’s ability to complete investigations in a timely manner, resulting in effective common-sense safety recommendations. It is now up to the USCG and industry to make these essential changes to improve safety and prevent the horrendous loss of life we saw two years ago on Labor Day weekend. The NTSB added Improve Passenger and Fishing Vessel Safety to its Most Wanted List in 2021 and will actively advocate to ensure these safety recommendations are implemented.