4.6 - Lab Activity: Witness Interviews

ASCI 615

Aviation/Aerospace Accident

Investigation and Analysis

Data Collection Part II

Overview

• Records Review • Electronic Evidence

 CVR  FDR  ATC data  Weather  Aircraft Records  Crew Records

• Accident Photography • Witness Interviews

Records Review

• Records are not as glamorous as wreckage, but may tell a large part of the story. Personnel training and qualification, aircraft maintenance and modification, and company policies and procedures all help build a picture of the operation prior to the accident

• Operations Specialist –  Gather personnel, medical, and training records of aircrew

involved.  Get copies of operating procedures, flying schedules, and

training procedures from the owner/operator.

Records Review (Cont.)

• Maintenance Specialists –  Gather aircraft, engine, appliance, maintenance, servicing, and overhaul

records.  Gather personnel and training records for maintainers involved with the

accident aircraft.  Gather records on maintenance procedures, policies, and training.  Gather the same records for any organization that did outsourced

maintenance. • Air Traffic Control Specialist –

 Gather copies of all ATC voice and radar tapes.  Gather copies of local ATC policies and procedures.  Gather personnel and training records of local ATC personnel if

involvement in the accident is suspected.

Records Review (Cont.)

• Human Factors Specialist –  Gather and analyze crew issues including medical records,

schedule, crew rest, off-duty activities, nutrition, hydration, etc.

 May involve interviews with family members to establish activities leading up to the aircraft.

 Research previous work done on human-machine interface and ergonomics in the aircraft.

• Weather Specialist – FAA requires special weather observation to be taken at the time of the accident. Gather this as well as weather forecast provided to the aircrew.

Records Review (Cont.)

• Survival Specialist –  Gather information from first responders and rescue

personnel on condition and location of survivors, condition and location of casualties, and type and severity of injuries.

 Gather emergency response procedures and established plans (E.g., Airport Emergency Plan)

 Gather data “CREEP” data (covered in a later module)  Gather information from operator on assigned seat location

for each individual on the aircraft, both crew and passengers.

Records Analysis • Personnel records (crew and maintenance) –

 Look for the obvious first: medical problems, training deficiencies, qualification issues, personal problems.

 Analyze training received and adequacy of training for the job  Analyze currency of training  Make sure the people involved were trained, qualified, and

current to be doing the job they were doing for both crew and maintenance

 Make sure the people involved were capable of doing what was demanded of them

 In some cases a psychological autopsy may be needed. Get trained aviation psychologist to do it

Records Analysis (Cont.)

• Operations and maintenance records –  Look for glaring deficiencies in the operation first: training

programs, procedures, policies, compliance issues  Look at the adequacy of policies and procedures involved in

operations and maintenance  Look at organization culture  Look at inspections from outside agencies such as the FAA or

OSHA and their findings  Look at accident and incident history for this company  Look at accident and incident history for this type aircraft

Records Analysis (Cont.)

• Maintenance records –  Look at maintenance history on the accident aircraft to

ensure adequacy of maintenance and compliance with FAA and company procedures

 Look at overall maintenance operation through inspection reports

 Look at any outsourced maintenance procedures and the records of the outside agency

 Look at maintenance history of the organization

Records Analysis (Cont.) • Reviewing records is tedious, but it is essential. • They paint a picture of conditions of man, machine,

and environment prior to the accident. • Records are rarely pure.

 They may be incomplete or inaccurate.  Accuracy is totally dependent on the quality of the records-

keeping system.  Cover-ups are usually evident.

• Do not be afraid to ask for anything you think is missing.

• Keep track of what you have read so when it becomes important you can find it.

Electronic Evidence Basics

• Most widely known are Cockpit Voice Recorder and Flight Data Recorder

• “Black Boxes” are really orange • Computerization of aircraft has opened new sources

of data • Flight director computers, flight control computers,

maintenance recorders, and others with non-volatile memory may contain useful information

Electronic Evidence Basics (Cont.)

• Collect any computer cards, protect them from the elements and from magnets, and send them to be read at the laboratory

• Never open a CVR or FDR in the field. If submerged in water, place in a water-tight container filled with the same water.

• The NTSB labs can resurrect data from burned tape and computer memory. Never throw out a computer component or audio/video tape because it’s damaged.

Flight Data Recorders • Early recorders only tracked five

parameters. Used steel or aluminum tape. Poor recording quality and readout

• Digital Flight Data Recorders (DFDR) track up to 300+ parameters. Newest technology records with digital and microchip technology. More accurate data collection. Data points recorded more frequently. Improved recording quality and readout.

Flight Data Recorders (Cont.)

• Newer FDRs are tied into the Flight Management System (FMS). They record up to 25 hours of data on non-volatile memory. New construction methods make them lighter and stronger.

• DFDR information can be used to create a computer generated flight recreation and in advanced simulation

TWA 800 FDR Printout

Cockpit Voice Recorders

• Older recorders recorded on mylar tape – 30 minute loop then overwrote itself

• Cockpit area microphone picks up all conversations and aircraft noises in the cockpit

• Each crew position has a separate channel that records all radio/intercom transmissions.

Cockpit Voice Recorders (Cont.)

• Newer, solid state recorders will record up to two hours of audio data before it writes over the communications. In development are solid state recorders that also have video storage capability.

• Restrictions on release – may not be used in legal or certificate actions. Transcripts not released until 90 days after the accident or public hearing, whichever is first.

Cockpit Voice Recorders (Cont.)

• Cockpit cameras –  Recommended by the NTSB to assist in accident

investigation.  Opposed by airline pilots because of fear the companies

would use them for disciplinary action rather than just for accident investigation.

 Debate continues.

Air Traffic Control Recorders

• All air traffic control facilities record all radio transmissions on audio recorders

• Radar facilities record radar data from both primary and secondary radars as well as audio

• Radio communications and time signals on the tapes allow synchronization between ATC tapes and other recorded media

• Following an accident, ATC facilities change tapes to preserve audio and radar information

• Important for the investigator to get copies of tapes along with transcripts of audio

Air Traffic Control Recorders

• ATC tapes can confirm aircraft flight path, verify communications recorded by the CVR, indicate erratic flying, show converging aircraft or flight path conflicts, or show when/where an aircraft disappeared from radar.

• ATC tapes, along with Flight Data Recorders may be used to reconstruct aircraft flight path

• Limitations: primary radar affected by terrain and weather. Slow sweep rates by older radars may limit effectiveness of recording.

Uses of Electronic Evidence

• Just as computers are playing a larger part in aircraft construction, they are also playing a greater role in accident investigation.

• FDR data can be input to create a computer model of aircraft flight leading up to and during an accident.

• Non-volatile memory cards from other computer systems such as FMS can be used to verify the computer model.

• CVR data can assist in analyzing crew actions and though processes.

Other Records

• ATC Records • Aircraft Records

 Maintenance  Company and Manufacturer records

• Crew Records  Training/experience  Medical

• Weather

Accident Photography

• Photography is a necessary and important tool in accident investigation.

• Photography records facts:  What something is  Where it was  How big it is

• Photography will jog your memory

• Photography is used in the courtroom

Accident Photography Basics (Cont.)

• Photographs are not a substitute for a well written report.

• Good photographs enhance the story that is told in the report.

• Bad photographs confuse the story.

• Photographs used in the report must be well planned.

• Think about hiring a professional photographer, this is not the time for amateur hour

Accident Photography Basics (Cont.) Photographic tendencies:

• Don’t take enough pictures – miss the key piece of the puzzle

• Don’t have a plan – photos taken at random or poorly documented

• No frame of reference in the pictures – don’t know the size of what you’ve shot

• Enclose too many pictures in report – try to use photos without any explanation

Photographic Equipment Digital versus film

• Digital is cheap and can be inserted into the report easier. It can also be manipulated easily.

• Film is more expensive and requires more work to insert into the report. Film is more difficult to “doctor” and is more evident when it has been doctored.

• Probably wise to use both. Shoot digital pictures and backup anything that might be important with 35 mm film. That way you have negatives to use in court to backup your testimony.

Famous fake digital photo. Portion of photo of 747 used in test of explosion in baggage compartment added to photo of landing 747. Circulated through the Internet as original photo. Done by someone well versed in photo manipulation.

Photographic Equipment (Cont.)

Color versus black and white • Cost difference between the

two no longer a factor. • Color should be used where

required to show paint transfer, fluid colors, burn patterns, paint discolorations, medical evidence, color coded instruments, etc.

• Black and white can be used to document contrasts.

Color shows burn pattern

B&W shows contrast

Photographic Equipment (Cont.)

• Video versus still - Video cannot be put into a printed report, but it can be used effectively to show the overall wreckage distribution. Overhead video can be used to distinguish between aircraft path and rescue vehicle path.

• Make sure you understand your equipment before you need it. You usually only get one opportunity to photograph things. That’s not the time to be learning to use your camera.

• Keep a log of every picture you take.

Photographic Equipment (Cont.)

• Camera:  35 mm single lens reflex  50 mm lens (15 inches)  Macro lens (9 inches) probably several lens

• Tripod – Effective for photos in low light and for photos where the investigator must hold up a part or hold up a reference marker.

• Flash attachment – For low light conditions and to fill in shadows in daylight.

Accident Photography

• Arrive at scene as soon as possible – the sooner you’re there, the less the scene will be contaminated

• Determine specific sequence to shoot – have a plan and shoot your plan

• Start from big to small  Tourist technique: make sure you get overviews of the

scene to give perspective to the accident  Photos can show terrain gradient  Aerial photos can assist in creating wreckage diagram  Medium distance shots connect overviews and close ups

Accident Photography

• Record position of wreck before it’s moved – need close-ups to document damage, but longer range shots to show wreckage position

• Record position of switches and flight controls and instrument readings before they are moved

• Distinguish between accident damage and rescue/firefighting damage

• Photograph scrapes, ground impact marks, paint transfers, and fire/soot marks

• Document every photo taken, where it was taken, and what the object of the photo was

Accident Photography (Cont.)

Other sources of photographs: • Press – the media will arrive on scene quickly, with cameras

rolling. They can document rescue/ firefighting efforts and damage. Usually are willing to cooperate with investigators

• Emergency teams – often they document their efforts with onboard video cameras in fire trucks and police cars

• Passengers – digital cameras on cell phones and passengers on vacation with cameras can yield photos of conditions prior to the accident

• Witnesses – noise, smoke, lights, etc. attract attention and availability of cameras makes accident photos likely

Let the pictures tell their story

Witness Rules of Thumb

• Witnesses may help or hinder • Eye witnesses may offer conflicting testimony • Some witnesses say what they think they’re expected to

say • If witnesses get the chance to discuss their separate

stories, they may include what others saw into what they saw

• The longer it’s been since the accident, the less the witnesses remember

• Plan your interview so you know what you expect to obtain from each witness

Types of Witnesses

• Participants – aircrew, passengers, maintainers – May be in shock initially. Some are reluctant to talk. Some want to tell everything they know. Trauma can lead to repressed memory.

• Eye witnesses – People who saw something or think they did.

• Experienced witnesses – People with a technical knowledge of what they saw. Often will provide analysis in addition to information.

• Technical witnesses – People with technical knowledge of the aircraft involved.

• Legal expert witnesses – Hired guns used in court to validate data.

Locating Witnesses

• Airline personnel – dispatcher, aircrew, cargo handlers, anyone who may have been able to see

• Rescuers – fire, medical, HAZMAT • Law enforcement – can collect names and addresses of

witnesses at the scene • News media – video footage of the scene can be used to

spot witnesses, but they must be identified • Spectators – not most reliable witnesses, may not have

seen anything, but want to tell what they’ve heard • Advertising – least reliable way to locate witnesses

Witness Interview Techniques

• Plan a location for the interview where the witness will be comfortable. The location can be a major factor in the witness’ attitude.

• Introduce yourself to the witness, tell him/her your mission and who you work for

• Bring a list of questions to ask, note pad, pencils, maps, tape recorder, and model of the aircraft

• Get permission from the witness to use the tape recorder before you start recording and again on tape

Witness Interview Techniques (Cont.)

• Put the witness at ease and if possible remove all distractions

• Establish where the witness was in relation to the crash in order to establish the witness’ perspective in relation to the accident

• Establish witness’ background to establish witness knowledge of aviation and credibility

• Be patient with the witness and do not argue. If you contradict the witness, he/she may change testimony to fit what they think you want to hear

Witness Interview Techniques (Cont.)

• First question: “What did you see?” Allows the witness to lead the interview rather than being led

• Let the witness tell the story without interrupting. Shows the witness you want to listen

• Let witness hold the aircraft model and move it to simulate what was seen

• Only make notes if absolutely necessary. Note taking may make witness think what was just said was important and may try to embellish it

Witness Interview Techniques (Cont.)

• After witness tells the story, play back tape and ask questions for clarification of individual points

• Go through witness statement again • Give witness a point of contact for contacting you later if

more is remembered • Thank the witness

Witnesses

• Witness testimony is not evidence. • Use the testimony to corroborate what the evidence tells

you. If they disagree, believe the evidence • What we observe we try to fit into our personal frame of

reference, to make it make sense to us • Not all witnesses can put what they saw into words due to

experience, intelligence, or physical limitations

Summary

• Records collection and analysis is a tedious process, but if done properly can build a picture of an individual, aircraft, and organization and the corporate culture prior to the accident

• Electronic evidence is providing more information to investigators than ever before

• You can never have too many photographs. • Witnesses can be your best friend or worst enemy in an

investigation. Use them to back up physical evidence. If they disagree, believe the evidence