This thesis discusses the U.S. Air Force aircraft accident prevention program, its background, present status and its weaknesses. It is concluded by offering suggestions for improving the efficiency and effectiveness of the program. Chapter I describes the need for an effective accident prevention program. The need is divided into human aspects, loss in combat potential, economic considerations, effects of adverse publicity, and other inimical effects including those of the loss of time, political considerations, and morale. The chapter contains a prediction of the effectiveness of future accident prevention efforts. The author predicts that because of a reduction in pilot experience, changing missions, a modified force structure, changes in types of aircraft, and a reduced amount of proficiency flying time, the number of accidents will increase in the next several years. The chapter concludes with a review of the limitations of the research. A definition of the terms used throughout the thesis is also included. A short history of aircraft accident prevention is reviewed in Chapter II. The review begins with a description of early aircraft accidents. The organizational approach to aircraft accident prevention beginning from pre-World War I through the present is examined. Chapter III examines the current Air Force aircraft accident prevention program. Six of the more important concepts forming a foundation for the program are explained. They are: (1) accident prevention, while vital, is subordinate to the mission; (2) accidents are not inevitable they can be prevented; (3) the only acceptable accident rate is zero; (4) a job well done is inherently safe; (5) safety is a responsibility of every member of the Air Force; and, (6) accident prevention is a function of command. Each of these concepts is fully described and supported by several examples. The military management of the accident prevention program is discussed with emphasis on the role of the commander and the flight safety officer. The responsibilities and duties of each are fully described. In addition, the qualifications, personal attributes, and desired training and education of the flight safety officer are reviewed. The organizational structure of the Air Force supporting the accident prevention program is described. Specific attention is paid to the staff arrangement of the safety function at Air Force level, at the major air command, and at base level. The accident prevention program is divided into two broad areas: before-the-fact and after-the-fact prevention. The following aspects of the before-the-fact prevention program are explained: (1) education and training; (2) literature and publications; (3) film program; (4) formal training of safety officers; (5) the safety survey; (6) Operational Hazard Reports; (7) the Flight Safety Council; and, (8) the materiel deficiency reporting system. The impact of the safety program on design of aircraft is also examined. A discussion of the after-the-fact accident prevention program includes information pertaining to accident investigation procedures and policies. Aircraft accident prevention philosophies and concepts are described in Chapter IV. The following concepts, important in an understanding of accident causation and prevention, are explained: (1) sequence of events concept (which states that an accident is usually the result of a series of events rather than one catastrophic occurrence); (2) known precedent concept (the fundamental causes of accidents have remained the same throughout history--failures of men or their machines); and, (3) the man-machine-media concept (which holds that both safe, efficient flight and aircraft accidents are a result of the integration of the many elements of man, machines, and the environment). Several philosophical aspects of accident prevention are also discussed. The negative and inhibitory approach of some accident prevention efforts is probed. A discussion of the "crime and punishment" and accident proneness theories are explained. The chapter closes with a discussion of the relationship which should exist between accident prevention and uncompromised mission accomplishment. Chapter V describes some of the more important weaknesses in the current aircraft' accident prevention program. The author suggests that the most important degrading factor is the system of reporting and classifying aircraft mishaps. The specific deficiencies include the requirement that accident investigation boards determine a "primary" cause of a mishap. The result of this procedure is undue emphasis on correcting the primary cause with a consequent lack of emphasis on the "contributing" causes. Other weaknesses include frequent changes in reporting criteria, disproportionate emphasis on reporting mishaps involving damage, and mechanical aspects of reporting data discovered during aircraft accident investigations. Suggestions for correction of these weaknesses are offered. The problem of inadequate accident investigations is also discussed. Poor quality accident investigations, the author concludes, are due primarily to the qualifications and limitations of accident investigation boards, improper conclusions from facts discovered during investigations, and inconclusive results from teardown deficiency reports. The author makes recommendations to improve the quality, thoroughness, and accuracy of accident investigations. A discussion of the "privileged" status of aircraft accident investigation reports, human factors as causes of accidents, and the feasibility of improving aircraft accident prevention through a tri- Service aviation safety organization is presented. The author concludes that the current U.S. Air Force aircraft accident prevention program, while successful, must be improved to conserve critical men, money, and materiel resources.

ADA 367370 Approved for public release; Distribution is unlimited. The opinions and conclusions expressed herein are those of the student-authors and do not necessarily represent the views of the U.S. Army Command and General Staff College or any other governmental agency. (References to these studies should include the foregoing statement.)