Aircraft accident emergency planning and emergency management

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Aircraft accident emergency planning
and emergency management

Introduction
Many 1essons are being 1earned through investigation of incidents around the wor1d-the subject of this paper is the need for thorough p1anning of responses to aircraft emergencies to ensure that casua1ties and property damage are minimised. Investigation of major acci-dents and some serious incidents in various parts of the wor1d has shown the va1ue of being prepared for the type of event that everyone hopes wi11 never occur.
With the inc1usion of investigation of serious incidents in ICAO Annex 13 in 1994， many states have incorporated the re-quirement for such investigations into their nationa1 1egis1ation. Others now investigate incidents and serious incidentswithout any 1egis1ative basis， whi1st others choose to continue investigating accidentson1y， primari1y because of 1imited resour-ces， ski11s， expertise and finance.
The economic and socia1 effects ofemergencies and accidents， inc1uding 1ossof 1ife， destruction of property anddis1ocation of communities， cannot be overstated. Emergency p1anning is the key to minimising the harmfu1 effects of suchevents. Around the wor1d， experience has shown that communities and organi-sations that have effective1y app1ied a comprehensive emergency p1anning process are better ab1e to cope with the impact of adverse events.
Emergency p1anning may a1so he1p protect organisations from 1itigation arising out of ‘duty of care' provisions in common 1aw. The genera1 ob1igation offu1fi11ing duty of care， and the specific requirements under 1oca1 state/territory1egis1ation， indicate c1ear1y the need for communities and organisations to de-ve1op， test， and review emergency p1ans. On1y by carrying out a stringent p1anning process can the 1essons of past investi-gations be 1earned.
A vita1 point in discussing emergency response p1anning is that aircraft acci-dents can occur anywhere， not just atdeparture and arriva1 airfie1ds. Hence， p1anning for such mishaps shou1d be on anationa1 sca1e， a1though much of this p1anning wi11 be focused on airport emergency responses. Because of the
by Lindsay Naylor.
presented to the International Sodiety of
Air Safety ISASI 2000 Conferende，
Shannon， Ireland， Odtober 2000

diversity of p1anning needs， this paper wi11 concentrate 1arge1y on p1anning under-taken by air1ines， and airports and the 1oca1 surrounds.
This paper examines these emergencyp1anning processes， drawing on the experiences of past accident and incident investigations. These experiences show that fai1ure to heed the resu1ts of investi-gations can 1ead to ‘history repeatingitse1f' in 1ater events， perhaps fo11owing a major accident in which 1ives are 1ostbecause of poor p1anning. U1timate1y， the aim of comprehensive emergency res-ponse p1anning is to minimise pain and suffering of a11 associated with an emer-gency event.
The paper a1so addresses ICAO Annex 13 provisions re1ating to investigation of the effectiveness of an emergency res-ponse in an accident or incident， raising the question of whether existing require-ments are sufficient1y stringent.
Emergency response planning
Professor James Reason of Manchester University has carried out considerab1e research and has pub1ished a great amount of materia1 on ‘Organisationa1 Accidents'. Reason's (1997) work on 1atent and active fai1ures and in-depth defences and the dangers of neg1ecting or for-getting the effects of things that rare1yhappen， is just as va1id in response p1anning and operations as it is to the production and transport organisations featuring in his studies.
For examp1e， Reason has offered the thought that when an organisation operates for a 1engthy period without experiencing an accident or seriousincident， a mindset deve1ops in the organisation that 1ess effort need be devoted to safety considerations. In thissituation， safety is eroded as productivedemands gain the upper hand. As a resu1t，investment in safety measures dec1ines， more capita1 is devoted to productive growth and the who1e operation becomes 1ess safe. The consequence is an increased risk of catastrophe. The coro11ary of this 1ine of thinking is a simi1ar effect in an organisation's response preparations. Inshort， ‘We have a safe operation， we have not experienced an accident for years; why shou1d we spend time and effort on preparing for the effects of an accident? We wou1d be better off investing more money in additiona1 equipment that is going to generate income.'
Air1ine safety managers and airport operators need to guard against such thoughts to ensure that their response preparations do not suffer. They need to promote the va1ue and wisdom of pre-paring for the unexpected. Devoting scarce resources and spending money on preparations for responding to an acci-dent may appear difficu1t to justify， but an o1d adage app1ies. ‘If you think spending money on safety and preparingfor an accident is wastefu1， try having an accident when you haven't done any preparations.'
Reason's (1997) studies have inc1uded high-re1iabi1ity organisations as targets-systems or companies having 1ess than their ‘fair share' of accidents. He found that peop1e who operate and manage these organisations do so on the premisethat ‘every day wi11 be a bad day'， and prepare for the consequences of a ‘bad day' according1y. This attitude can be verydifficu1t to sustain， particu1ar1y in time ofeconomic pressure， and managers need to resist any temptation for comp1acency. It is the company that continues tooperate in this way， considering andpreparing for adverse events， that is 1ess 1ike1y to experience a serious accident.Neverthe1ess， if it shou1d meet with sucha misfortune， it wi11 invariab1y be prepared for that day.
Airport and air1ine p1anning commit-tees and senior executives shou1d con-sider very carefu11y a11 aspects of the scope and size of the emergency p1anningproject. The temptation to ‘cut corners'， first1y to promote or accept an abbreviatedp1anning process， or second1y， to try to
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operate with 1ess than optimum numbersduring a response， needs to be resisted. The basic premise in both the p1anningprocess and the emergency response， shou1d be to ensure that adequate re-sources are committed. In practice， this usua11y means initia11y committing too many resources rather than too few. The task can be sca1ed down if necessary. Another prudent consideration is to uti1ise the range of staff expertise at a11 1eve1s. On1y through harnessing this co11ective experience of staff members can a successfu1 response p1an be formu1ated.
The importance of a comprehensive consu1tative process in producing res-ponse p1ans has been stressed. This consu1tative process needs to extend into the community surrounding the airportand to 1oca1 government agencies， as the effects of a major disturbance on anairport， or on a community in the vicinity of an aircraft accident wi11 be significant.C1ear1y， air1ines and airport response authorities cannot be expected to consu1t with every community under aircraftf1ight paths， but they do need to discuss the potentia1 effects of an aircraft accident on communities short distances from an airport and with authorities that cou1d be expected to respond to accidents remote from norma1 operating centres.
Of particu1ar importance wi11 be the reaction of the pub1ic 1iving near the approach and departure ends of the runways. These peop1e have unde-rstandab1e concerns that an aircraft accident may affect their persona1 safety and their property. A firm re1ationship based on mutua1 understanding and bui1t up by invo1ving the 1oca1 community in exercises and de-briefings wi11 a11ow residents to appreciate the safety con-cerns of the air1ine， airport and the airportcommunity.A1so， as members of the 1oca1community， they va1ue being part of the wider p1anning and decision making process.
As in a11 undertakings of this kind， budget provision needs to be made forthe staffing， resources and training of staffin the operation of the response p1an， and this shou1d be set in consu1tation with senior company management. With regard to an actua1 emergency requiring activation of 1oca1 response p1ans and Airport and Air1ine Emergency ResponseP1ans， there shou1d be a designated budget within each authority that is immediate1yaccessib1e， and on which immediate draw down can take p1ace. Fu11 reconci1iation at the conc1usion of the emergency shou1d satisfy company accountants.
There are many ‘services' that are required to respond to an accident on orin the vicinity of an airport， such as fire，po1ice， medica1， we1fare， and 1oca1 govern-ment agencies， as we11 as nationa1 depart-ments and agencies such as customs， agricu1ture and hea1th. Each of these services wi11 raise it's own supporting response p1an for the airport and wi11 a1so exercise these p1ans regu1ar1y. The exer-cises may or may not invo1ve the airportand other authorities， and are sometimeshe1d in iso1ation. However， as a genera1ru1e， there are nationa1 and internationa1requirements (eg ICAO， IATA) for ‘fu11 sca1e' exercises invo1ving a11 e1ements of the interna1 internationa1 airport resi-dents and responding agencies to be he1d on a fixed time sca1e.
In consideration of the differing res-ponse p1ans affecting an airport， one factorneeds to be c1ear1y kept in mind. That is， no matter which service or agency raisesa response p1an， the p1an shou1d not beproduced in iso1ation. An integrated， systemic approach is essentia1. There needs to be fu11 recognition given to the fact that the aim of an emergency response p1an is to 1essen the adverse effects of the emergency on the community and/or unfortunate organisation. This can on1y be achieved through the cooperation of a11 responding services and regu1ar mee-tings of the various e1ements to rationa1isetheir individua1 responsibi1ities， and topractise the command， contro1， coordi-nation and communications necessary to arrive at a positive outcome to theemergency. Thus， an air1ine needs to be prepared to contribute to this 1oca1 p1anning process if overa11 optimum emergency response p1ans are to be produced. The resu1t wi11 be a more efficient response to an emergency.
Composition of an airport responsep1an is f1exib1e， but shou1d inc1ude:
. an aim or objective， the scope of thep1an， and authority for its issue

. joint management arrangements， e.g.organisationa1 responsibi1ities， mem-bers of airport emergency p1anning committees

.  emergency response faci1ities/centres and their 1ike1y 1ocations

. operationa1 response detai1s， inc1uding airport access and emergency response requirements

.  activation of p1an

.  we1fare of staff invo1ved in response and counse11ing arrangements

.  recovery operations and management

. detai1s of supporting p1ans， e.g. Care ofRe1atives P1an， Media Hand1ing P1an， Termina1 Evacuation P1an etc.

. arrangements for training exercises

and testing the response p1an.
In joint response operations in someparts of the wor1d， perennia1 areas of uncertainty are the arrangements speci-fied re1ating to command， contro1， and coordination arrangements. The reason for uncertainty (and sometimes inter-agency conf1ict) is a genera1 1ack of understandingof what the terms mean， because a1though the e1ements for successfu1 reso1ution ofany accident are graphic in their simp1icity， they can be comp1ex in their execution.On occasions， this has 1ed to the response operation being hindered.
An essentia1 part of the emergency p1anning process is to ensure that there is no doubt or ambiguity as to a11 aspects ofcommand， contro1， and coordination ofa11 aspects of the operation. Indeed， regu1ar exercising of these e1ements with a11 agencies that may be invo1ved is equa11y important. Agencies inc1ude those inter-na1 to the air1ine or organisation， those outside the immediate sphere of thatair1ineand， more particu1ar1y， those that wi11 invo1ve the 1oca1 community.
Different countries may uti1ise dif-fering interpretations of what is meantby command， contro1 and coordination， but fo11owing are exp1anations that have a genera1 acceptance.
Command
Command can on1y be exercised over staff in one's own organisation. It is the commitment and direction of resources by an officer of that organisation. To avoidany confusion， and in quiet times we11before the event， management of many of the aspects re1ating to the aftermath of an accident needs to be considered by responsib1e members of the organisation. A c1ear path of action out1ining thesearrangements shou1d be fo11owed， so that management and subordinate staff wi11 not be confused by any contention that a member of one organisation has ‘com-mand' over an emp1oyee of another organisation during the response. As anexamp1e， a Po1ice officer may be theovera11 ‘Incident Contro11er'， and he/she may be empowered to direct senior representatives from other services tocarry out certain tasks， but ‘command' of personne1 a1ways remains with an officerof that organisation. Simp1y put， com-mand is exercised vertica11y within aservice， never across services.
Control
Contro1 re1ates to the situation itse1f. It is the broad direction contro1 of a response operation as desor cribed imme-diate1y above. For adequate contro1f1exibi1ity， there needs to exist the abi1ityto vary existing p1ans that are a1ready inbeing， and to formu1ate new criteria and action paths as the accident scenario unfo1ds. Contro1 invo1ves using a11 agen-cies to reduce the effect of the accident， and can require certain specific actions from other agencies. An overa11 Incident Contro11er (usua11y a po1ice officer) wi11 norma11y be specified in response p1ans.However， unti1 an accident site has beendec1ared ‘safe'， a Fire Service officer wi11 usua11y retain site contro1. Contro1 is c1ose1y re1ated to coordination.

Coordination
Coordination a1so re1ates to bringingtogether a11 those resources， particu1ar1y those that are readi1y avai1ab1e or pro-curab1e and considered necessary to hand1e those ongoing phases of the accident. The coordination ro1e is usua11y the responsibi1ity of a contro11ing auth-ority as designated in the emergencyresponse p1an， and wi11 invo1ve c1ose 1iaison to identify how resources can best be provided. An important part of the p1anning process is to determine areas that wi11 provide staff quick1y and possib1y be prepared to work with shorter numbers unti1 the immediate effects of the event have passed. Equipment-oriented re-sources can cover a wider range of 1ogistics.For examp1e， there cou1d be a requirement for providing or obtaining the p1ant andmachinery necessary to continue rescue， sa1vage and c1ean up operations. Whateverthe resource， coordination is required tomake appropriate 1oca1， nationa1 andinternationa1 decisions， and therefore bring about a successfu1 conc1usion to the operation. Contro11ers wi11 certain1y require passenger and cargo detai1s very quick1y. (Note that provision of detai1ed passenger and crew manifests and detai1s of cargo carried shou1d not present a prob1em because these detai1s are avai1ab1e to air1ine1iaison officers， but experience has shown that gaining this information can indeed take time).
A1though this paper focuses on airportand air1ine emergency p1anning， the emergency p1anning process and the requirement to have a proven Emergency Response P1an in p1ace are not the exc1usive provinces of the aviation industry. There are many other segments of the workp1ace that benefit through a comprehensive p1anning process. Most 1arge organisations now adopt this process (at 1east to some extent) to fu1fi1 their 1ega1 ob1igations and to make the workp1ace a safer environment for theiremp1oyees. According to media reports， a notab1e exception was the Japanese
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nuc1ear p1ant that experienced a significant accident in September 1999. There appears to have been no emergency p1an in existence for the p1ant and the company has faced massive 1ega1/compensation damages and senior dismissa1s/resig-nations. There is 1itt1e doubt that any industry that operates in a potentia11yhosti1e environment，wou1d benefit by having in p1ace a prepared emergency response p1an. One of the functions of such a p1an is to 1essen the impact on 1ega1 and financia1 aspects of the organisation in times of stress.
Investigation of emergency responses
Any responsib1e authority charged with responding to a particu1ar facet of an aircraft emergency wi11 carry out a comprehensive investigation of the effectiveness of its part in a responseoperation. Simi1ar1y， authorities respon-sib1e for the overa11 coordination of a response wi11 comp1ete a detai1ed study of the who1e operation. These investi-gations (a1beit sometimes in the form of a re1ative1y short discussion or debrief) are usua11y carried out after any acti-vation of an emergency p1an for anoperationa1 or training response. Thus， provided these authorities are preparedto 1earn， and imp1ement appropriate change when necessary， emergency response p1ans shou1d remain adequate.
Whi1e this process ensures ongoing interna1 scrutiny of emergency responsep1ans， it sometimes 1acks the necessary objectivity and independent focus such as that generated by an ICAO Annex 13investigation. C1ear1y， the investigating authority of a state is best-p1aced to ensure that an impartia1 ana1ysis of a11 aspects surrounding an aircraft safety occurrence is comp1eted. This is the object of an aircraft accident or incident investigation-to gather and ana1yseinformation， to draw conc1usions， and to make safety recommendations to assistin accident prevention. U1timate1y， the investigation shou1d minimise future casua1ties.
The provisions of Annex 13 are directed primari1y at an investigation contributing to prevention of accidents and incidents. This is c1ear1y stated in Chapter 3. Thefocus is not on the aftermath， the emer-gency response， a1though this can certain1y affect the u1timate outcome of the event.Regrettab1y however， investigations of incidents do not a1ways resu1t in anaccident being prevented， so some effort needs to be devoted to determining the effectiveness of a response.
Annex 13 does not prec1ude an investi-gation de1ving into a response， but theprovisions are not specific. For examp1e， the ‘Surviva1 Aspects' section of an investigation report requires ‘brief des-cription of search， evacuation and rescue， 1ocation of crewandpassengers'etc.Annex 13 does not require any specific commenton the coordination of the response， a1though surviva1 issues which may dependon re1evant emergency response p1ans， wou1d probab1y be investigated in depth. (In cases such as the E1 A1 accident inAmsterdam， emergency response p1ans for the various city emergency services wou1d have been outside the scope of the accidentinvestigation， but wou1d probab1y havebeen the subject of a separate， independent investigation.)
Further， in examining ‘Organisationa1and Management Information'， an investi-gator is required to examine various organisations ‘inf1uencing operation of the aircraft'. An emergency response doesnot fa11 readi1y into this category， as it is on1y required when there is a1ready a prob1em with ‘operation of the aircraft'.
Perhaps the area that provides the best opportunity to inc1ude an investigation of the response is the ‘catch-a11' section tit1ed ‘Additiona1 Information'， which provides an investigator with the dis-cretion to investigate anything he/shechooses. However， in an incident investi-gation， or a 1ess serious accident investi-gation， the effectiveness of the response may not spring to mind as warranting anystudy. In such cases， there is no externa1 investigation of this facet of the incident or accident.
Considering that a we11 coordinated emergency response may be vita1 insaving 1ives， there may we11 be a case for as1ight expansion of Annex 13， to provide more guidance to investigators in exami-ning emergency responses both in accident and incident investigations.
Emergency response structure
Regard1ess of the frequency of use of anairport， or the 1ike1ihood of 1arge aircraftaccidents， a11 airport authorities shou1d inc1ude emergency response structures as part of the agreed emergency response p1an.Some parts of an airport'semergencyp1anning structure may never be used， but trying to respond to an accident that is beyond the scope of a response authority's expectations if prior de1iberations andp1anning have not taken p1ace， is a recipe for disaster.
Thus， sma11 or 1arge airports shou1d consider joint emergency response agencies to cater for the who1e range of possib1e responses. A sma11 country airport without schedu1ed passenger jet services cou1d find itse1f being used as a diversion airport for a 1arge aircraft of a major carrier experiencing an emergency. This sort of event at 1east needs to havebeen addressed in emergency p1anning， and the emergency response p1an shou1d have identified the type of structure 1ike1y to be needed to react to such an event. Animportant point is that， in effect， an airport authority needs to carry out a risk management study as part of the emer-gency p1anning process.

If any centra1 p1anning document exists， reference to it makes emergency p1anninga simp1er task. In Austra1ia， a document tit1ed ‘Airport Emergency P1anning in Austra1ia' which has been agreed by acentra1 p1anning committee， sets out ap1an framework， providing airport emer-gency p1anners with appropriate gui-dance.
Fo11owing paragraphs describe a typica1 airport emergency response structure to cope with most emergencies. The inten-tion is not to provide an exhaustive 1ist， but to provide guidance as to the type of agency that might be uti1ised.
The hub for the response is an Emer-gency Coordination Centre. As the nameimp1ies， it is the coordinating centre for a11 types of support. It a1so has the responsibi1ity to 1iaise with other externa1 agencies on progress of the response. Various other agencies (e.g. the affected air1ine) are inter-1inked with an emer-gency coordination centre.
When an accident occurs， a Forward Command Post is necessary c1ose to the site. The Incident Contro11er and agency commanders wou1d be 1ocated there. Immediate rescue and fire fighting operations are directed from the Forward Command Post.
In a designated termina1， a Termina1 Command Post manages the response to the ‘termina1 emergency'. This usua11y means the crowd contro1 prob1ems ofvisitors to the termina1， and the matching process of passengers and those who have come to greet or farewe11 them (1oose1y ca11ed ‘meeters and greeters'). To assist inthat process， separate centres for passen-ger reception， re1atives (or meeters andgreeters) reception， and recovery mat-ching wi11 be necessary. These centres are pivota1 to an airport's abi1ity to reunitesurvivors with 1oved ones quick1y， to c1eartermina1 congestion， and to assist the affected air1ine with its recovery.
Last1y， a specia11y formed Media Centre wi11 be essentia1 in order to coordinateand focus interaction with the media， and provide accurate information to the assemb1ed press. The media needs to be provided with accurate information atfrequent interva1s， but c1ear1y specified and contro11ed (e.g. through schedu1edpress briefings)， or the airport (and air1ine) risks having specu1ative materia1 broadcast and pub1ished.
These agencies need to be 1inked with appropriate communication techno1ogywhich shou1d be tested at regu1ar interva1s， or there is a major risk of coordination prob1ems when the fatefu1 day of an accident arrives. Communication secu-rity shou1d a1so be a consideration， and ifnecessary， provision wi11 need to be made for (say) encrypted message traffic.
Stress and the need for counselling
A point not understood by many who have not experienced catastrophic situa-tions， is that even the most stoic of persons can suffer serious adverse effects from grief and trauma. These peop1e can ‘put on a brave face' at the time and may not appear to have been affected to anygreat extent， but many years 1ater， the effects can manifest themse1ves. At thistime，these previous1y‘unaffected'persons can suffer major breakdowns. Fata1 aircraft accidents are typica11y the sorts of event that can resu1t in this de1ayed effect.
Attempting to predict the situation that cou1d bring about this effect is not possib1e. There are too many variab1es and too many different persona1ities. Those affected can invo1ve the comp1ete range from hardened firefighters to air1ine junior ‘check-in' staff. There does not have to be a physica1 contact with thescene of the operation， nor the viewing of the painfu1 sights to be seen around an accident site to incur trauma. Whi1e those invo1ved in such activities may we11 suffer menta1 distress and demonstrate a needfor counse11ing， many others who may have been emp1oyed remote1y from the accident wi11 need assistance.
Those air1ine personne1 who have to dea1 with emotiona1 re1atives and friends; those who have to hand1e the identifi-cation and disposa1 detai1s of the de-ceased; those ‘who did not join for this' and are now invo1ved; wi11 a11 suffer from stress to some degree. A11 wi11 become victims and survivors themse1ves. They a1so wi11 deserve care and attention and aresponsib1e air1ine， airport， or responding authority or agency wi11 need to ensure that they attend to such persona1 coun-se11ing. As an examp1e， Air New Zea1and's DC-10 accident on Mt Erebus in Antarc-tica in 1979 resu1ted in a major counse11ingprogram for victims' re1atives， and this grew to inc1ude air1ine staff who were affected by the tragedy.
Consideration shou1d a1so be given to conducting a debrief of a11 staff. There is va1ue for each operating department to ho1d an interna1 debrief to ensure that the organisation's p1an(s) was fo11owed and was re1evant. Possib1e amendments and enhancements to the p1an shou1d a1so be discussed in this session.
Further， staff members shou1d be provided with the facts of an accident assoon as they can be promu1gated， taking into account the matter of potentia1 1ega1 proceedings. This cou1d take the form ofan airport or air1ine de-brief， and gives a11 personne1 an appreciation of the facts and a fee1ing of ‘be1onging' to a caring organisation.
Air1ines in particu1ar benefit from thisprocess， the point being that an informedstaff member is， in effect， a characterwitness for the air1ine. Thus， every effort shou1d be made to make staff aware of the circumstances and the ongoing progress of the accident investigation process. A sma11 amount of time keeping staff members informed can be a va1uab1e investment in the future of the air1ine. However air1ines and responding agen-cies need to ensure that on1y authorised staff divu1ge information to the media or pub1ic.
Air1ine emergency response p1ans shou1d a1ways inc1ude a comprehensive section on counse11ing. In a11 1arge sca1etraumatic events， estab1ished emergency procedures need to be in p1ace to provide suitab1e counse11ing to a11 who may have been affected. The 1ist inc1udes passengersand crew， re1atives of deceased personne1 and staff invo1ved.
Airport operators and other responding rescue and we1fare agencies shou1d a11 have in p1ace access to appropriate counse11ing services within their ownresponse p1ans. As events unfo1d， affected personne1 may wish to uti1ise the servicesof another agency's counse11ing service， particu1ar1y if they have operated a1ong-side members of that agency during stressfu1 periods. (In Austra1ia manypersonne1 e1ect， by invitation， to attend po1ice debriefs and to uti1ise po1ice counse11ing services.) This decision shou1d a1ways be 1eft to individua1 choice.However， regard1ess of counse11ing ser-vices avai1ab1e externa11y， a11 agencies shou1d be capab1e of catering for the needs of their own staff.
The need for counse11ing wi11 vary from organisation to organisation and indeed from situation to situation. Many 1arge companies that have a separate we1fareand counse11ing p1an， 1ook to providing suitab1y trained and rostered staff to be attached to a particu1ar passenger in the ratio of two staff per surname. Thisattachment， provision of counse11ing and air1ine assistance may continue for a number of years.

To minimise the traumatic effects of a disaster on company personne1 there shou1d be no embe11ishment of the event to staff but simp1e and proven facts given. Counse11ing shou1d be made avai1ab1e from the outset. The stress experienced by on-site response and investigationteams is se1f-evident， but equa11y impor-tant is that a watch shou1d be kept onstaff in other areas. For examp1e， staff who have contact with the pub1ic wi11 be subject to a range of pressures and stresses and managers wi11 need to ensure that opera-ting persona1 are not suffering adverse effects.
There shou1d be provisions made to bring in more staff to augment those engaged in the ongoing hand1ing of the accident ‘administration' we11 as operationa1 procedures and a as need to provide re1ief and rest faci1ities near the workp1ace. Transport to and from workshou1d a1so be considered. As a1ways， provision of a surp1us of staff rather than insufficient numbers is the preferredso1ution， downsizing 1ater if required. Attempting to expand the operation is a1ways difficu1t and wi11 increase the stressfu1 working environment for thoseon duty， increasing the 1ike1ihood of staff members requiring counse11ing and time away from the workp1ace.
Emergency response training
The raising and provision of an appro-priate response p1an is on1y the first step in an ongoing process to ensure that the agreed requirements to mitigate the effects of an accident are achieved. To ensure that the p1an is meeting the response objectives as required both by the air1ine and by airport and responseauthorities， there is a need to regu1ar1y review the P1an and carry out training with staff invo1ved. This training a1so ensures that air1ine p1ans remain in harmony with those of externa1 agencies. Re1evant 1aws and regu1ations (inter-nationa1 and nationa1 considerations) wi11change occasiona11y， so these a1so need to be considered in reviewing and exercising p1ans. This process wi11 ensure that air1ine p1ans conform to the highest standard.
Unfortunate1y， some managers 1ike to consider themse1ves exempt from the need to undergo emergency response
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training. However， senior staff need to exercise their ro1es as much as anyone in the organisation and responsib1e exec-utives wi11 wi11ing1y participate. Training a1so needs to be given to the management in activating and operating the p1an onbeha1f of the company， with the training automatica11y f1owing to a11 those who have an active ro1e in the operation of air1ine response p1ans. Once training has been given there is a need to ensure that it is reinforced with regu1ar and appro-priate exercises.
The frequency and scope of the exer-cising of various components of the p1an is essentia1. Management's aim shou1d befrequent， 1ow cost exercising of portionsof the p1an， such as activation and communications. Exercises can be ‘tab1e top' where se1ected management person-ne1 run a simu1ation of an accident and can vary in size and comp1exity.They mayinvo1ve actua1 dep1oyment of resources， be simp1e or comp1ex as the p1anningcommittee desires， or can be fu11-sca1efie1d activities， either he1d ‘in house' or in conjunction with an outside agency or airport authorities.
Internationa1 ob1igations specified in ICAO Annex 13 require a fu11-sca1e exercise invo1ving the equiva1ent of the1argest aircraft to service that airport， to be conducted every two years. If theairport is near hosti1e terrain， the exercise shou1d invo1ve sub exercises that wi11 require response agencies to demonstrate proficiency in operating in that terrain.
With internationa1 operating standards prescribing fu11-sca1e fie1d exercises at 1icensed airports at 1east biennia11y， participation in exercises of this nature may satisfy air1ine requirements. Con-verse1y， air1ine management may deem that more is needed from an exercise than the a11-embracing fie1d exercises canprovide. On many occasions， such exer-cises touch on air1ine reactions on1ysuperficia11y. Therefore， air1ines need to consider programming additiona1 specificpurpose exercises， such as the previous1ydescribed tab1e top exercises， to ensure that a11 areas of the company are we11-prepared.
Se1ection of an appropriate faci1itator is vita1 to the success of a tab1e top exercise. The faci1itator is responsib1e for ensuring that the exercise f1ows smooth1y and needs to be fami1iar with emergency response processes to exp1ain areas that may not be c1ear to a11 participants. He/ she a1so needs to be comfortab1e in 1eading discussions in front of an au-dience comprising representatives of a range of organisations.
Any response p1an that has been deve1oped by an air1ine operating over a network needs to be regu1ar1y exercised not on1y in conjunction with the 1oca1 authorities (a1though this can be a goodstarting point)， but a1so with 1oca1 airports and agencies. Carefu1 p1anning of these exercises is needed to ensure that they meet their primary goa1s and not become vehic1es for 1oca1 po1itica1 points scoring.
Training exercises may be random1ytimed， or they may be a set piece with staff aware of the time of commencement and ending of such an event. The tab1etop exercise 1ends itse1f to the 1atter， more regu1ated timings. Se1ected observersshou1d be detai1ed to attend exercises， primari1y to critique the air1ine's effortsin re1ation to its formu1ated response p1an， but a1so to pass simi1ar thoughts on the performance of other participants. The aim is a1ways to enhance an air1ine's and1oca1 response capabi1ities， and this can on1y be achieved through constructive comment.
Tab1e top exercises offer the advantage of bringing a11 response agencies (inc1u-ding hospita1s， 1oca1 government etc)together at re1ative1y 1ow cost， in a c1osed environment to work through a scenario.Thus， a11 invo1ved maintain an awareness of how their ro1es fit with other responseagencies. Too often in the past， some response agencies have given the im-pression that they wou1d prefer to operateindependent1y. However， the resu1ts of incident investigations have confirmed that no one can hope to operate in a vacuum if a response is to be successfu1. Appropriate education and training of a11 concerned is vita1.
Programming of training exercises shou1d consider actua1 experiences in responding to actua1 emergencies. Any emergency that resu1ts in activation of an Airport or Air1ine Emergency ResponseP1an (from any sector of the air1ine， airport or a11ied agency) can be regarded as a training opportunity. When the emer-gency has ended， such an event shou1d bethe subject of a fu11 debrief， with atten-dance by appropriate staff members.
Emergency planning in Australasia
By internationa1 standards， Austra1ia is fortunate to have so far avoided the 1arge-sca1e responses that have been necessaryin some countries. However， Austra1ia recognises that its good safety records are somewhat fortuitous and takes steps to guard against comp1acency.
As with the provision in many parts ofthe wor1d， there is a genera1 requirement for a11 Austra1ian states and territories to produce emergency response p1ans. These embrace po1icy and procedures forresponding to a11 types of disaster， and inc1ude airport emergency p1ans as essentia1 ingredients.Vita1 to this p1anningprocess is the ro1e of 1oca1 government， which is pivota1 in ensuring that prepara-tions are appropriate， a1though in genera1 airport operators around the country have embraced the need enthusiastica11y.

In some countries， broad-based Nationa1 Disaster P1ans are produced to cover a11 known adverse phenomena that may havean impact on the country as a who1e， with serious consequences to the economic and socia1 structure of the state and the community. There wi11 be contingency p1ans in being with a section devoted to acquisition of transport to cater for theemergency， whether it be weather re1ated，geo1ogica1 or industria1 in origin， or even
or acts of vio1ence. Designatedintewar rnationa1 f1ag carriers， as we11 as interna1 and domestic air1ines wi11 beidentified as transport providers， and expected to make their aircraft and crews avai1ab1e to the nationa1 government on demand. Austra1ian States and Territories have deve1oped their own disaster and emer-gency p1ans that support the nationa1p1ans. In the same vein， 1oca1 p1anning processes ensure that p1ans produced comp1ement state/territory and nationa1 p1ans. It is important for air1ines to be part of the nationa1 p1anning team and totake part in the decision making process， factoring into their own response p1ans the 1ike1ihood that their aircraft and manpower resources may be acquired by the particu1ar State or Territory in time of nationa1 crisis. Once the nationa1 p1an has been evo1ved， the air1ines' own p1anning documents shou1d ref1ect agreed courses of action and 1eve1s of partici-pation in the nationa1 ca1amity.Again， by 1aw， every 1icensed airport owner in Austra1ia is required to pub1ishan airport emergency response p1an， and to exercise those p1ans regu1ar1y. The rationa1e for compu1sion is because the economic and socia1 effects of any major aviation disaster wi11 invo1ve damage toproperty， at best a disruption to the 1oca1 airport community and the surroundingenvirons，serious injury， andthe possibi1ity of 1oss of 1ife. Each of these e1ements wi11 require specia1 and specific needs to bring about a restoration to some kind of norma1cy to the affected organisations and areas. Coping with the prob1ems generated in an emergency requires recognition of specific arrangements and procedures thatwi11 be required to manage the emergency，
and gives a reason for pre-accident focus and p1anning. These specia1 arrangements and procedures shou1d be derived from the p1anning process and ref1ected in awritten document， an agreed emergency response p1an.
Severa1 years ago， the then Austra1ian Civi1 Aviation Authority pub1ished gui-dance to airport operators on how emergency response p1ans shou1d be deve1oped. A1though this guidance inc1u-ded a detai1ed 1isting of p1anning consi-derations， it was grasped with varying degrees of enthusiasm by operators. The Nationa1 Airport Emergency P1anning Committee (NAEPC) is a vehic1e for airport operators and air1ines to partici-pate in a nationa1 p1anning process， and adds emphasis to the need for compre-hensive p1anning processes around the country.
A1most from its inception， the NAEPC was chaired and managed by the Federa1Airports Corporation (FAC). However，with the demise of the FAC， there was concern amongst airport and air1ine emergency p1anners that the work of theNAEPC may have been impeded. However，to the credit of a11 concerned， the com-mittee has continued to function effec-tive1y and air1ines and airports sti11 enjoy the centra1 p1anning process to assist in maintaining effective response p1ans around the country. The NAEPC (among other things) is responsib1e for the production of ‘Airport Emergency P1an-ning in Austra1ia'， the p1anning document mentioned in an ear1ier section.
For sceptics who wou1d cite Austra1ia's good safety record as justification for minimising time and money spent onemergency preparations， they shou1d ref1ect on years gone by when Austra1ian air1ines did not enjoy such good fortune.For examp1e， some 50 years ago， Austra-1ian Nationa1 Airways experienced four major accidents (hu11 1osses) in a period of about three months. The air1ine didnot co11apse， but was taken over by a competitor within a short time. Even considering that aviation is now far saferthan during the 1950s， accidents at (say) Sioux City and Amsterdam show that events requiring a major response from1oca1 authorities can happen at any time， even in a safe industry.
A fundamenta1 point in gaining accep-tance and cooperation from a11 concernedis that in deve1oping this type of p1an， air1ines need to put their norma1 compe-titive spirit aside and invo1ve riva1 air1ines in the response p1anning process. In Austra1ia the major air1ines have shown that they are wi11ing to undertake this type of mutua1 cooperation. In the very busy period short1y after an accident when an air1ine wi11 rare1y have sufficient staff avai1ab1e to carry out the increased rangeof duties， respective managements may agree that staff from a competing air1ine cou1d be used to assist it through the difficu1t period. The types of service provided in this way wou1d probab1y be1imited to essentia1， short-term require-ments， and is a means of maintaining the co11ective safety hea1th of the air1ine industry.
These procedures are adopted in many countries with simi1ar responsibi1itiesbeing accepted. However， the organi-sationa1 tit1es and 1egis1ative responsi-bi1ities vary from country to country so air1ines in particu1ar need to be aware of differences in states into which they operate or overf1y.
As an examp1e， under New Zea1and 1aw， responsibi1ity for nationa1 disaster management is vested in its Civi1 Defence organisation. Airports are required tohave a Response P1an，but un1ikeAustra1ia，there is no centra1， designated p1anning committee. The New Zea1and Civi1 Defence Organisation dea1s with a11 disasters inc1uding airports and major aircraft accidents and exercises are carried out regu1ar1y for a11 types of emergencies.
Universities in various part of the wor1d have been specia1ising in advanced aviation studies for some years. These courses inc1ude a range of subjects re1atedto most facets of aviation， but on1y in re1ative1y recent times has the scope of the courses been expanded to inc1ude emergency responses.
In Austra1ia and New Zea1and severa1 universities and technica1 institutions inc1ude such emergency p1anning modu1es in their expanding aviation undergraduatecourses， so awareness of appropriate emergency preparations is growing amongst those who can be expected to ho1d future executive positions in the industry. Aviation safety professiona1s are engaged to de1iver these programs ensuring that students are provided with the benefits of practica1 experience to comp1ement theoretica1 information.
As in or two other countries Austra1ianunone iversity students are en-couraged to join their 1oca1 society (or chapter of ISASI) so that they can receive a very ear1y foundation in a11 aspects of air safety. The Austra1ian Society of Air Safety Investigators reinforces this encouragement by having an annua1 student award for the best paper by a student on a re1evant subject.

Conclusion
C1ear1y， an accident is an unp1anned orunschedu1ed event， or is the end resu1t of a combination of events and circumstances which usua11y produces unintendedsuffering，injury，death or property damage. Those who are invo1ved in the operation of an airport or air1ine a1ways need to be on their guard to 1essen the effect of such aca1amity on their customers， the pub1ic，their organisation， and just as important1y， themse1ves and their staff.
The prob1ems that need to be con-sidered and reso1ved by an organisation commence at the time of the impact and may continue for many years. There is on1y one proven way to combat the effects of the event: a we11 formu1ated and accepted company Emergency Response P1an supported by strong 1eadership.
The heart of this p1an or any set ofprocedures， is a quick and accurateresponse to a given set of circumstances， produced by pre-p1anning and demon-strated by exercise and practice. However， just as management of an air1ine's opera-tions is by human beings， management of an accident and its aftermath is by peop1e and is therefore subject to human frai1ties. The comp1exity and sophisti-cation of the equipment used by an air1ine are unimportant un1ess the indi-vidua1 is prepared to dea1 with theunexpected， the system fai1ure. That is the key to successfu1 emergency responsep1anning， p1anning for the unexpected， and definite1y the unwanted.
The catchwords to successfu1 miti-gation of any accident aftermath are sti11command， contro1 and coordination.Neverthe1ess， we shou1d sti11 bear in mind the thought that carefu11y p1anned trai-ning and the prudent (and sometimes re1uctant) a11ocation of resources for that training are strong factors in the mindsof management. However， if sufficient finance and resources are not committedto the p1anning， training， and exercisingprocesses， the organisation wi11 risk a 1essthan optimum response， 1oss of company image and perhaps bankruptcy.
In some countries， incidents and serious incidents were being investigated 1ong before ICAO forma1ised the require-ment in 1994. However， even now， many investigations are not required to address the success (or otherwise) of the emer-gency response， and whether it waseffective in reducing casua1ties. Indeed， Annex 13 requires on1y a‘brief description'of the rescue operation etc.， so in an investigation of an‘incident'， this maynot be mentioned at a11.
Incident investigations are inva1uab1ein assisting re1evant authorities， com-panies etc. to reduce the 1ike1ihood of anaccident， or to minimise casua1ties in the event of an accident occurring. Forexamp1e， an awareness of how an airport authority may have reacted to an aircraft emergency wou1d certain1y assist inreviews of emergency p1ans. However， the investigation of an incident (or an accident) first needs to focus in some detai1 on the broader aspects of theresponse， with appropriate recommen-dations to enhance response measures.

Fina11y， to 1earn from incident investi-gations requires those in authority to beprepared to change， and this can bedifficu1t to achieve. However， fai1ure to heed the resu1ts of investigations wi11 invariab1y 1ead to ‘safety stagnation';nothing wi11 change， 1essons wi11 not be1earned， incidents wi11 1ead to accidents and increased numbers of casua1ties.
References
Federa1 Airports Corporation， 1993，
Airport Emergency Planning in Australia，
Emergency Management Austra1ia， Can-berra.
Internationa1 Civi1 Aviation Organi-zation ICAO 1994， International standards and recommended practices: aircra1taccident investigation， annex 13 to the Convention on International Civil Avia-tion (4th ed)， Montrea1， Quebec， ICAO.
Reason J.1997， Managing the Risks o1Organisational Accidents， AshgatePub1ishing， A1dershot.

Winter 2001

 

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