8 More Safety Recommendations Implemented from NTSB’s 2019 – 2020 Most Wanted List

Pipeline safety, helicopter emergency medical service flight operations safety and emergency response to railroad hazardous materials events were recently improved with the latest implementation of eight more safety recommendations from the NTSB’s 2019-2020 Most Wanted List of Transportation Safety Improvements.

Six pipeline safety recommendations issued to the Pipeline and Hazardous Materials Safety Administration (P-11-014, P-11-015, P-12-004, P-14-001, P-15-018 and P-15-020) were classified Jan. 23, as closed, acceptable action taken. Also recently classified as closed, acceptable action taken was safety recommendation R-14-022, issued to the Association of American Railroads. Safety recommendation A-07-112, issued to the FAA, recently was classified as closed, acceptable alternative action taken.

The acceptable action taken on these recommendations brings to 22, the total number of implemented safety recommendations from the NTSB’s 2019 – 2020 Most Wanted List.

Safety recommendations P-11-014 and P-11-015 were issued in the wake of the fatal San Bruno, California, natural gas pipeline explosion. Safety recommendation P-11-014 sought to require all pipelines, regardless of date of construction, be subjected to hydrostatic pressure tests that incorporate a spike test. Recommendation P-11-015 sought to ensure defects related to manufacture and construction are considered stable only if the pipeline was subjected to a post-construction hydrostatic pressure test of at least 1.25 times the maximum allowable operating pressure. Safety recommendation P-12-004 sought PHMSA notification in cases where a determination about pipeline threats had not been obtained within 180 days of an inspection date with a “discovery of condition.” The NTSB’s investigation of the Sissonville, West Virginia, pipeline rupture and fire spawned safety recommendation P-14-001, that sought inclusion of principal arterial roadways to the list of “identified sites” that establish a high consequence area. NTSB Safety Study 15-01 generated safety recommendations P-15-018 and P-15-020 relating to in-line safety tools and inspection.

A-07-112 was issued following the NTSB’s investigation of two helicopter emergency medical services flight crashes that involved low-altitude flight during night visual meteorological conditions. The investigations revealed safety issues related to the operability and use of radar altimeters. The safety recommendation called for the FAA to ensure the minimum equipment lists for emergency medical services operations helicopters require radar altimeters be operable during flights conducted at night. A rulemaking by the FAA now requires all helicopters in air ambulance operations be equipped with an operable FAA-approved radio altimeter and a helicopter terrain awareness and warning system. While the rule did not address minimum equipment lists, the NTSB determined the FAA’s measures that created redundancy for terrain avoidance in the event of a failure of a radio altimeter or helicopter terrain awareness and warning system, fully addressed the safety problem in an alternate way.

Safety recommendation R-14-022 was issued following the NTSB’s investigation of a Nov. 30, 2012, derailment that resulted in a release of vinyl chloride into Matua Creek, Paulsboro, New Jersey. The recommendation called for amending the United States Hazardous Materials Instructions for Rail to require train crews to immediately provide emergency response information for all hazardous materials on a train, as well as the train consist, to federal, state or local emergency responders when an accident happens. The Association of American Railroads completed the recommended revisions.

 “Many people believe the NTSB’s work is done when an investigation is completed and we determine probable cause,” said NTSB Chairman Robert Sumwalt. “But our work is really just beginning when we issue safety recommendations based on the findings of an investigation. Board members, safety advocates and other NTSB staff are dedicated to fostering the cooperation necessary to ensure those life-saving recommendations are implemented. Sometimes those recommendations are implemented swiftly, others take many years, but throughout their lifecycle, the NTSB actively advocates for their implementation,” said Sumwalt.

“Unfortunately, as we announce this very good news, we are also compelled to share that three more safety recommendations (R-12-020, R-18-005, and R-12-021) have been classified as closed, unacceptable action, including one recommendation from our “Focused 46,” said Sumwalt. “The failure to implement these safety recommendations are missed opportunities to prevent accidents, reduce the number and severity of injuries and to save lives,” he said.

The NTSB’s Most Wanted List of Transportation Safety Improvements serves as the agency’s road map from lessons learned to lives saved, identifying safety recommendations that are ripe for action and that if implemented, have the potential to prevent accidents, minimize injuries and save lives.