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Safety Recommendation Details

Safety Recommendation A-97-082
Details
Synopsis: On 5/11/96, about 1415 eastern daylight time, a McDonnell Douglas DC-9-32 crashed into the everglades swamp shortly after takeoff from Miami International Airport, Miami, Florida, the airplane, N904vj, was operated by Valujet airlines, inc., as Valujet flight 592. Both pilots, the three flight attendants, and all 105 passengers were killed. Before the accident, the flightcrew reported to air traffic control that it was experiencing smoke in the cabin and cockpit. Visual meteorological conditions existed in the Miami area at the time of the takeoff. The destination of the flight was Hartsfield International Airport, Atlanta, Georgia. Flight 592 was on an instrument flight rules flight plan.
Recommendation: TO THE AIR TRANSPORT ASSOCIATION: Develop, in cooperation with the FAA and U.S. Postal Service, programs to educate passengers, shippers and postal customers about the dangers of transporting undeclared hazardous materials aboard aircraft and about the need to properly identify and package hazardous materials before offering them for air transportation. The programs should focus on passenger baggage, air cargo, and mail offered by U.S. Postal Service customers.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Unacceptable Action
Mode: Aviation
Location: Miami, FL, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA96MA054
Accident Reports: In-Flight Fire and Impact With Terrain Valujet Airlines Flight 592 DC-9-32, N904VJ
Report #: AAR-97-06
Accident Date: 5/11/1996
Issue Date: 9/9/1997
Date Closed: 1/12/2010
Addressee(s) and Addressee Status: Air Transport Association of America, Inc. (Closed - Unacceptable Action)
Keyword(s): Hazmat

Safety Recommendation History
From: Air Transport Association of America, Inc.
To: NTSB
Date: 1/27/2010
Response: Letter Mail Controlled 2/3/2010 5:47:17 PM MC# 2100042 - From James C. May, President and CEO: The Air Transport Association (ATA) and its member airlines for years have worked diligently and collaboratively with federal agencies to educate the traveling and shipping public about the dangers of transporting undeclared hazardous material aboard commercial aircraft. These agencies include the Federal Aviation Administration, the Pipeline and Hazardous Materials Safety Administration, the Transportation Security Administration, and the U.S. Postal Service. Given that cooperative, long-term engagement, your January 12 letter closing out NTSB Safety Recommendation A-97-82 as unacceptable, and concluding that "ATA does not appear to have taken the action recommended" was surprising and disappointing. We disagree with that conclusion. We would never tolerate such an outcome nor would those in the federal government with whom we have worked in this endeavor accept such a result. We have described our ongoing, joint efforts in detail to the staff of the National Transportation Safety Board. Educating the public about hazmat dangers is a serious, continuing task. It is also a shared task. Airlines clearly have important roles to play but so do government entities. Above all, we must continue to work together to achieve our common goal of reducing the threat of undeclared hazardous material aboard commercial aircraft.

From: NTSB
To: Air Transport Association of America, Inc.
Date: 1/12/2010
Response: NTSB staff contacted ATA staff to learn about activities the ATA has started or completed in response to this recommendation. ATA staff described a number of activities implemented by the U.S. Postal Service (USPS) to prevent the shipment of undeclared hazardous material in packages mailed. The NTSB is aware that Safety Recommendation A-97-79, issued to the USPS at the same time as Safety Recommendation A-97-82, asked the USPS to take similar action and was classified Closed Acceptable Action on November 16, 1999. However, the ATA believes that the situation today is different than it was in 1997 when this recommendation was issued. In particular, a number of security activities for aircraft cargo that were implemented after the attacks of September 11, 2001, have also decreased the risk of undeclared hazardous material being transported on an aircraft. In particular, ATA staff pointed out these current activities related to non-postal cargo carried on airliners: 1.As a result of the increased security requirements implemented after the September 11, 2001, attacks, the Transportation Security Administration (TSA) is now required to screen all baggage. During the course of these screenings, TSA personnel look for and remove prohibited hazardous material items. 2.The FAA requires airlines to provide passenger addresses when undeclared hazardous goods are removed from luggage by the TSA. The FAA then sends letters to passengers involved in these incidents, in an effort to educate them and prevent potential violations during future travel. 3.The Pipeline and Hazardous Materials Safety Administration developed the SafeTravel website to inform the traveling public about hazardous materials and other materials that should not be shipped on an aircraft. The website has information on a wide variety of common, but prohibited, dangerous materials with which passengers typically travel. 4.The TSA and air carriers have embedded links to the SafeTravel website on their websites. 5.Airlines have incorporated dangerous goods awareness tips into their in-flight magazines. 6.A number of the all-cargo carriers developed detailed programs to educate customers and prequalify shippers of potentially hazardous goods. The NTSB considered the information provided by ATA staff, but we disagree that the shipment of undeclared hazardous materials in passenger baggage is no longer a problem. This recommendation is now over 12 years old, and the ATA does not appear to have taken the action recommended. Therefore, Safety Recommendation A-97-82 is classified CLOSED -- UNACCEPTABLE ACTION.

From: Air Transport Association of America, Inc.
To: NTSB
Date: 2/23/2009
Response: Barbara Vaiter, Managing Director, Cargo Services, ATA, email dated 2/23/09: Thank you very much for your patience in this matter. As you noted, A-97-82 (copies attached) recommends development of programs to educate U.S. Postal Service (USPS) customers about the dangers of transporting undeclared hazardous materials on aircraft. As you can imagine, many things are much different today in the air cargo world than ten years ago. Below I have attempted to outline the major areas where improvements and programs by USPS and other government agencies, in collaboration with air carriers, have addressed concerns raised by NTSB. First, I would like to offer a clarification. All U.S. Mail transported in the bellies of passenger aircraft is tendered by USPS. U.S. postal customers do not directly tender mail to the airlines as baggage or air cargo. This reduces the points of acceptance and has enabled government and industry to be more focused in communicating with the general public using mail services to ship potentially hazardous items. Secondly, subsequent to the terror attacks of 9/11/2001, TSA air cargo security measures were mandated which implemented screening of mail transported on passenger aircraft. As a result, USPS adopted the following Aviation Mail Security Program: Due to heightened security, all mailpieces weighing over 13 ounces bearing only postage stamps as postage must be presented to an employee at a retail service counter at a Post Office. Mailpieces weighing over 13 ounces bearing only postage stamps as postage deposited in collection boxes, lobby drops, or left on counters, in lobbies, or on postal docks will be returned to the sender. Mailpieces weighing over 13 ounces bearing only postage stamps as postage that are left in customer mailboxes will not be picked up by the carrier. Instead, the carrier will return the mailpiece to the customer's mailbox. The additional security measures implemented as a result of heightened aviation security concerns have had the unintended effect of an increased level of scrutiny and awareness of hazardous materials by requiring a personal hand-off from the least sophisticated shippers to the USPS. Third, as a result of the requirement to tender mail at a retail service counter, the shipper will be faced with the attached Notice #107 Let’s Keep the Mail Safe regarding hazardous materials which the Postal Service displays at all retail stores. In addition, Poster 138 found at most mail acceptance locations, is a guide for shipping common hazardous, restricted and perishable materials. Fourth, USPS has addressed the hazmat education issue in greater depth by leveraging the use of their public website. Those persons shipping or planning to ship by air using the postal system can visit the USPS Security & HazMat webpage to basic information What is a Hazardous Material such as pasted below, to more detailed and technical Resources to Help Determine Mailability and the Hazardous Materials Program section which warns the public that Mailers are responsible for Ensuring no hazardous material is mailed unless it is permitted under Postal Service mailing standards described in the Domestic Mail Manual 601.10 What is a Hazardous Material? Hazardous materials come in a wide variety of forms and can be chemical, biological, radioactive, or a combination thereof. If a material or substance can cause harm to someone or something, it can be considered a hazardous material. The Postal Service’s definition of a hazardous material includes many common household and consumer products. These items may not be hazardous during normal use or storage in your home but can present a significant hazard when placed in the mail due to vibration, temperature changes, and variations in atmospheric pressure. Some examples of commonly-used items restricted or considered hazardous under USPS regulations include: Perfumes Nail polish Flea collars or flea sprays Aerosols Bleach Pool chemicals Paints Matches Batteries Fuels or gasoline Airbags Dry ice Mercury thermometers Cleaning supplies Items previously containing fuel Glues Fireworks Other items, such as alcoholic beverages (beer, wine, liquor), are not considered hazardous but are prohibited and boxes displaying such markings are also prohibited. If you are unsure whether a material is considered hazardous or is prohibited, please contact 1-800-ASK-USPS or your local Business Mail Entry Unit. I don’t believe that most, if not all of these resources and procedures existed for mail transported by air back in 1997. The value of the Pipeline and Hazardous Materials Administration’s (PHMSA) SafeTravel website for passengers packing potentially hazardous materials in their baggage, and the educational and awareness campaigns implemented by the Postal Service directed to the mailing public, have contributed to improving awareness and compliance with hazardous materials regulations. Barbara Vaiter, Managing Director, Cargo Services, ATA, email dated 3/16/09 Thanks for the feedback. I guess I chose to read the last highlighted sentence to mean that the programs would focus on the various items (baggage, cargo and mail) that might be offered by USPS customers. The way I had interpreted the documents you provided, undeclared passenger hazmat was not determined to be a probable cause of the ValueJet incident. Consequently, I had some difficulty wrapping my head around the broad scope of recommendation A-97-82. Nonetheless, I will attempt to outline some of the major steps taken by industry and government over the past decade. Hopefully this will show why the 1997 NTSB statement: the ValueJet accident and the incidents that have occurred since clearly demonstrate that the shipment of undeclared hazardous materials in air transportation is a serious problem that has not been adequately addressed may not be the case today. Below are just a few of the ways that the issue has been addressed; the FAA’s Office of Hazardous Materials could likely provide many more examples: 1.Through regulation, post-911 requirements for acceptance of checked luggage require the TSA to screen all baggage for the presence of explosives or other items that could pose a security threat. During the course of TSA baggage searches, screeners have been trained to identify common hazmat and prohibited items and coordinate with air carrier personnel for removal from baggage. These procedures were not in place in 1997 and subsequent to their implementation, the number of undeclared hazardous items removed from passenger baggage has increased exponentially. 2.FAA implemented comprehensive passenger notification processes through regulation, requiring airlines to provide passenger addresses when undeclared hazardous goods are removed from luggage by TSA. It is our understanding that as a result of these requirements, FAA has issued a substantial number of letters to passengers involved in these incidents, in an effort to educate them and prevent potential violations during future travel. 3. PHMSA’s http://safetravel.dot.gov website outreaches directly to the air traveling public on a wide variety of common, but prohibited, dangerous materials that passengers typically travel with. While initially developed to address the emerging threat of lithium batteries in laptop computers and personal electronics carried on board by passengers and packed in their luggage, the website continues to expand to provide public education on many types of undeclared hazmat such as aerosols, ammunitions, and self-defense spray. 4.Air carriers, as well as TSA, have embedded links to the SafeTravel site from the travel pages of their websites. Several airlines have additionally added tips and links during on-line check-in as an integral step in boarding pass creation. 5.A significant number of carriers have incorporated dangerous goods awareness tips into their inflight magazines. In the past few years, dangerous goods information has become as common as, and delivered in conjunction with, prohibited items lists related to security. 6.Some of the nation’s largest all-cargo carriers have developed robust, detailed programs to educate customers and pre-qualify shippers of potentially hazardous goods. One program that comes to mind includes educational brochures, and even an on-line training program for shippers (see http://fedex.prosperitylms.com/req/fedex_student/index.cfm ) I hope the above will assist in rounding out the ATA response to include passenger baggage and air cargo shipments. As you are undoubtedly aware, people, their bags, and cargo transported on passenger aircraft are routinely screened for potential explosives and other dangerous items that could pose a security threat. An unintended consequence of this has been increased public awareness and an opportunity for industry to leverage security-related screening and educational communication to improve safety awareness and mitigate potential for the introduction of dangerous goods in aviation.

From: NTSB
To: Air Transport Association of America, Inc.
Date: 5/6/2003
Response: The Safety Board notes that the ATA has requested documentation from its members that will support a detailed discussion of the issues raised by this recommendation, and that the ATA will provide a formal response within 45 days. The Safety Board appreciates the ATA's commitment to re-survey its members regarding the safety issues involved with undeclared hazardous material shipments on aircraft. Pending the results of this survey and the ATA's planned discussion on this issue, Safety Recommendation A-97-82 is classified OPEN -- ACCEPTABLE RESPONSE.

From: Air Transport Association of America, Inc.
To: NTSB
Date: 2/21/2003
Response: Letter Mail Controlled 3/6/2003 3:10:48 PM MC# 2030138 - From Malcolm B. Armstrong, Senior Vice President, Operations and Safety: With respect to Recommendation A-97-82, we have re-issued a request to our members for documentation that will support a detailed discussion of the numerous issues raised within this single recommendation. We expect to be able to provide a formal response within 45 days.

From: NTSB
To: Air Transport Association of America, Inc.
Date: 3/23/2001
Response: NMC# 100652: The Safety Board would appreciate learning of the status of any current, completed, or planned activities taken in response to these recommendations. If there are no such activities, please inform the Board so that we may close the recommendations. Copies of the recommendation letters are enclosed for your reference. Please address your reply to Ms. Carol Carmody, Acting Chairman, and refer to Safety Recommendations A-87-69, A-97-82, and A?00?55 in your response.

From: Air Transport Association of America, Inc.
To: NTSB
Date: 10/6/1997
Response: MC# 971380: - From Carol B. Hallett, President and Chief Executive Officer: Thank you for sending me Safety Recommendation A-97-82, dated September 9, 1997, containing the NTSB's recommendation regarding hazardous material education programs. Well before the May 11, 1996, ValuJet accident, ATA had been engaged in such education programs among our members and in conjunction with governmental agencies. I am pleased to bring to your attention the following relevant actions undertaken by the ATA airlines. In November, 1996, ATA organized a "HAZMAT- COMAT" conference which was open to ATA members and non-members alike. The conference was held in cooperation with FAA Hazardous Materials Branch and DOT-R&SPA. This two-day long event covered classification and packaging of hazardous materials used in the operation of aircraft fleets, training and record-keeping requirements, FAA enforcement, and an overview by an NTSB Hazardous Materials staff member. Feedback from the conference was very positive, confirming the need and ATA's desire to continue this type of effort. ATA representatives also aided DOT and FAA in the development of the informational brochure, These Fly ... These May Not, of which DOT printed 10 million copies. ATA shares the NTSB's concerns with regard to undeclared hazardous materials shipments. As NTSB staff is aware, ATA has, through the work of its Dangerous Goods Board, maintained an on-going program relating to hazardous materials safety, shipment and storage. For example, on July 30, 1997, even prior to receiving your commication, the ATA Dangerous Goods Board arranged a meeting with representatives of the United States Postal Service (USPS), DOT-R&SPA and FAA Headquarters Hazardous Materials personnel. ATA proposed a plan to address mail issues by aiding the USPS in a review of postal acceptance and handling rules for the carriage of certain hazardous materials. We are awaiting a response from the Postal Service for meeting dates.