TSB featured article
Black boxes essential for transportation safety
By Wendy Tadros, Transportation Safety Board of Canada
Published in The Hill Times on Monday, 09 April 2012.
Gatineau, Quebec—When tragedy strikes and a transportation accident occurs, investigators from the Transportation Safety Board of Canada (TSB) are called to the scene. It is their job, in what is often a race against time, to sift through wreckage and start unravelling a deadly puzzle before valuable clues are lost. Few items are more sought-after than the on-board recorders—the "black boxes" that store navigation details, engine and equipment settings, and the voice recordings that can tell the most important story of all.
The men and women who work at the TSB are among the very best at what they do, with an impressive track record of getting to the bottom of things—literally. For more than two decades, they've made our organization a world leader in accident investigation: pioneering techniques that recovered the hard drive from a sunken ferry off the coast of British Columbia, or before that, dredging the bottom of the ocean off Peggy's Cove to reconstruct the millions of fragments from Swissair Flight 111. Despite their accomplishments, however, every single investigator knows that the absence of black box data makes the work that much harder–like handing someone a broken magnifying glass and then turning out the lights. That doesn't mean you can never find what you're looking for, but it will take a whole lot longer.
Six weeks ago, three people died and dozens were injured when Via Rail train 92 left the tracks near Burlington, Ontario. Within hours, TSB investigators knew from the black box that the train had been travelling far too fast over 100 km/h in a zone marked for just 24 km/h—but that was merely the first step. However, because these black boxes are not required to record voices, the key question–why–may prove unanswerable.
In the summer of 2010, in our fragile Arctic, the TSB was again called upon to investigate when the passenger vessel Clipper Adventurer ran aground in Coronation Gulf, Nunavut. Investigators arrived on scene to find steps had not been taken to save the ship's on-board recorded data, in particular the bridge audio recordings. And while none of the nearly 200 people on board were injured, determining the details of exactly what happened–and again, why–will be a lot more difficult.
The good news is there are some fields where data capture is done well. Canadian aviation, for example, has enjoyed the benefits of voice and data recordings for approximately 50 years. The benefits of this technology were evident once again last August, when a Boeing 737 slammed into a hill barely a mile from the airport at Resolute Bay, Nunavut, killing 12 of the 15 people on board. By sheer coincidence, TSB personnel were already en route, taking part in a nearby military training exercise aimed at demonstrating Canada's capabilities in the north. This meant search–and–rescue resources were on scene within minutes, and that our investigators had a tremendous level of cooperation from the RCMP, Environment Canada, and DND. The recorders–both data and voice–that were on board the plane contained information that will prove invaluable over the coming months as we complete our analysis, and when we release our investigation report Canadians will be the beneficiaries of what we learned.
Despite those clear benefits, voice recorders continue to follow a
“hit and miss” course. A case in point is Canadian railways where, sadly, those who should be leaders are sticking to entrenched positions: The companies will only agree to recorders if they can use them for compliance monitoring and discipline; the unions, in turn, fear retribution if what happens in locomotive cabs is recorded. And yet the fact is, the sole purpose of voice recordings is for safety. This information is protected by law, and cannot be used to discipline or prosecute individuals.
Clearly, it is time to move beyond historical positions and to do what is best for safety. The final results of the Burlington investigation won't be known for some time, but already the minister of Transport has referred the issue of voice recorders to the Advisory Council on Railway Safety. This is a good first step, but it is absolutely crucial that we move beyond consultation. Now is the time for leaders to lead, because when it comes to making Canada's transportation system safer, it's progress–not promises–that will count.
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