Minnesota Wing Safety Meeting July 2010 Lt Col Larry Brockshus MN Wg/SE
Overview ORM review June Safety Beacon – Lessons learned from a mishap – Cadet injuries on the RISE – Tire Pressure
Civil Air Patrol ~ Air Force Auxiliary I n t e g r i t y - S e r v i c e - E x c e l l e n c e Lt Col Brillo Macklin CAP-USAF SWLR/DO 16 Oct 2003 Operational Risk Management
I n t e g r i t y - S e r v i c e - E x c e l l e n c e Poor Judgment... Leads to accidents What is ORM?
Natural Evolution From Traditional Risk Management Systematic Decision-Making Tool All Dimensions of Risk Considered I n t e g r i t y - S e r v i c e - E x c e l l e n c e “First reckon, then risk” Field Marshall Helmuth Von Moltke
Why ORM? I n t e g r i t y - S e r v i c e - E x c e l l e n c e Ensure Necessary Risks are Taken An Important Tool for Realistic Training Significant Potential to Expand Capabilities
4 Key Principles I n t e g r i t y - S e r v i c e - E x c e l l e n c e Accept No Unnecessary Risks Make Risk Decisions at Appropriate Level Accept Risks When Benefits Outweigh Costs Integrate ORM into Doctrine and Planning at all Levels
6 Step Process I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1. Identify the Hazards 2. Assess the Risks 3. Analyze Risk Control Measures 4. Make Control Decisions 5. Implement Risk Controls 6. Supervise and Review
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1. Identify the Hazards 2. Assess the Risks 3. Analyze Risk Control Measures 4. Make Control Decisions 5. Implement Risk Controls 6. Supervise and Review Step 1 Identify the Hazards Process: Emphasize hazard ID tools. Adds rigor and early detection Output: Significant improvement in the detection of hazards (50%+)
I n t e g r i t y - S e r v i c e - E x c e l l e n c e Process: All hazards evaluated for mission or activity impact. Root causes determined and risk levels assigned. Output: Personnel know the priority risk issues of the organization and of their function. 1. Identify the Hazards 4. Make Control Decisions 3. Analyze Risk Control Measures 5. Implement Risk Controls 6. Supervise and Review 2. Assess the Risks Step 2 Assess the Risks
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1. Identify the Hazards 2. Assess the Risks 3. Analyze Risk Control Measures 4. Make Control Decisions 5. Implement Risk Controls 6. Supervise and Review Step 3 Analyze Risk Control Measures Process: Comprehensive risk control options developed on a worst-first basis Output: A full range of cost effective, mission supportive, risk controls for the decision-maker
Process: Gets risk decisions to the right person, at the right time, with the right support. Output: Personnel know their decision- making authority and limitations. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1. Identify the Hazards 2. Assess the Risks 3. Analyze Risk Control Measures 4. Make Control Decisions 5. Implement Risk Controls 6. Supervise and Review Step 4 Make Control Decisions
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1. Identify the Hazards 2. Assess the Risks 3. Analyze Risk Control Measures 4. Make Control Decisions 6. Supervise and Review 5. Implement Risk Controls Step 5 Implement Risk Controls Process: Leaders lead, operators involved, accountability known Output: Controls approved by decision-maker are implemented
I n t e g r i t y - S e r v i c e - E x c e l l e n c e 1. Identify the Hazards 2. Assess the Risks 3. Analyze Risk Control Measures 4. Make Control Decisions 5. Implement Risk Controls 6. Supervise and Review Step 6 Supervise & Review Process: Measures mission effectiveness and direct indicators of risk. Output: Real time status. Proactive NOT reactive.
USAF APPROACH Top-Down Strong Senior Leader Backing Decentralized Implementation Safety Lead Role for Cross-Functional Implementation I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Education & Training – Short Term Executive Level - Senior Leaders Applications & Integration - Focal Points/Planners Essentials - Mid-level Managers/Supervisors Fundamentals - “Working” Level Introduction – All – Long Term - Institutionalized into all Training & Education I n t e g r i t y - S e r v i c e - E x c e l l e n c e
FLY SAFE! I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Lessons learned from a mishap Safety consciousness does not make you invulnerableinvulnerable If you have not done it in a while, rethink it Watch how a person does something, not just that they are doing something When tired, slow down
Cadet Injuries on the RISE! Pre-existing conditions – Non-reported condition aggravated by CAP activity Horseplay – Goofing off, rough housing Goofing off CPFT – No warm up or enforcement of proper exercise Team sports – Not appropriate or unsupervised (tackle football) Not appropriate New members – No safety education Passing out in formation – Hydration, nutrition, locked knees
Tire pressure Several tire related mishaps – Tire integrity – Pilot technique – Tire pressure NTSB report on a Learjet mishap in 2008 – All four mains severely under inflated – Under inflation compromised tire integrity – Tire failed after V-1 (S-1 for military); pilot attempted abort – Failed tire also damaged sensor which retracted thrust reversers resulting in takeoff thrust during abort – Aircraft departed runway…Four killed, two injured
Use ORM and Stay Safe