Chapter Three

REPORT ON THE PRECISION AERIAL DELIVERY SYSTEM (PADS)

Chapter Three

Chronology of Events Following Purchase of PADS

Preliminary Training - November 1996

3.1 Training in the use of PADS commenced in early November 1996. While most CSU operators around Australia agreed to participate in training and in the use of PADS, a number of operators declined, primarily because of incompatibility of aircraft. One operator declined because of a preference to remain with the existing system, and another resigned as an area CSU rather than use PADS on the basis that flying at 100 feet was unsafe. [1]

3.2 It was initially assumed by Airservices staff that SAR Pty Ltd would carry out the necessary training. As noted in a general circular by Mr Peter Evans, General Manager of Air Traffic Services, on 28 August 1996: 'Airservices will work with Search and Rescue Pty Ltd to re-train and re-equip all of PADS compatible Civil SAR Units in the earliest time frame. This re-training is expected to commence in the first week of September'. [2]

3.3 Indeed, on this same day, in correspondence concerning negotiations on the purchase of PADS, [3] Mr Gruzman had indicated that he would be reluctant to provide the equipment if he were not to be involved in the training program:

3.4 However, contrary to those assumptions, Airservices Australia appointed Mr Frank Young of Navair Pty Ltd to oversee PADS training. At the end of negotiations on the purchase of PADS, Mr Forsyth had written to the CEO, Mr Bill Pollard:

3.5 The reason for Mr Young's involvement was explained in evidence to the Committee by Airservices Australia Chief Executive, Mr Bill Pollard:

3.6 Thus it seems that the contract for training was issued to a private company, Navair, at the request of the Airservices Chairman, on the suggestion of the Chief Executive Officer, without any tendering process being carried out, simply because Mr Gruzman had previously had difficulties liaising with two Airservices staff members, Mr Tony Marshall and Mr Peter Evans.

3.7 At the commencement of training a number of difficulties were encountered. The major problem centred on a conflict between SAR Pty Ltd and Airservices Australia as to who held ultimate responsibility for the supervision of training activities.

3.8 According to SAR Pty Ltd, Mr Young had interpreted his consultancy contract in a manner so as to give him 'entire charge of the training program', including the direction of SAR Pty Ltd staff without SAR Pty Ltd knowledge or approval. [7] Also of concern to SAR Pty Ltd was the fact that Mr Young's ideas on training differed and that he had limited experience of the operation of PADS equipment.

3.9 Airservices Australia criticised the manufacturer, SAR Pty Ltd, for not accepting the fact that problems with PADS were being encountered. According to Mr Pollard:

3.10 In the end, SAR Pty Ltd was not further involved in the training. According to Mr Gruzman: 'SAR [Pty Ltd] was entirely excluded from either input into or attempts to introduce PADS into service or detailed knowledge of their problems. No request for assistance was made'. [9] Consequently, Mr Gruzman argued, that omission was the sole source of Airservices ensuing problems.

3.11 However, both prior to and during the training exercises, Airservices personnel expressed concern at the manner in which the training was being conducted and, in particular, with the level of experience and expertise displayed by training consultants Navair.

3.12 In a report of the training weekend held on 9-10 November 1996 at Jervis Bay (NSW), Mr Marshall described some of the problems encountered:

3.13 Two days later, Mr Marshall again wrote to Mr Evans, this time expressing concern about the training carried out by Mr Frank Young:

3.14 The memo written by Mr Marshall also expressed concern about the standard exhibited by some of the contracted pilots, the fact that there was no agreed training program, the lack of some essential safety equipment within the training aircraft, and problems with the static line. Finally, it recommended, inter alia, 'that Airservices participation in PADS conversion training cease immediately' and that 'control of all CSU training be returned to Airservices, and the present waste of financial resources be ceased'. [11]

3.15 Similarly, a report from Dropmaster Instructor Mr Colin Campbell, highlighted problems experienced with the November training:

3.16 However, training was ultimately suspended not because of difficulties encountered with Navair, but because of problems associated with the behaviour of the static line: problems which only became apparent after analysis of high speed photography of the PADS drops carried out by Aerospace Technical Services. [13]

ATS Testing - November 1996

3.17 As part of the PADS training program, Aerospace Technical Services was employed to assess the suitability and safety of the equipment by way of photographic recording of the dispatch mechanism and, in particular, the behaviour of the static line during each drop. Four sorties totalling 5.5 hours were flown with 10 airborne dispatches.

3.18 The subsequent ATS report noted that of the ten deployments, partial equipment failures occurred on six occasions. [14] During video evidence shown to the Committee, Mr Michael Jones, Managing Director of Aerospace Technical Services, described some of the problems encountered during the November training. The two major concerns related to: (1) breakage of the static line (reason unknown); and (2) touching of the drogue line and the static line with the elevator and other parts of the aircraft.

3.19 Mr Jones concluded: '… whilst this equipment is deployed with an amazing amount of accuracy … the parameters for usage are very narrow. In an environment where you are doing a real rescue and where the weather conditions are marginal, having a set of conditions which are no narrow is unrealistic or difficult to actually maintain'. [15]

3.20 However, according to Mr Jones, part of ATS's brief was to ensure that the system was being used in accordance with the manufacturer's instructions. In evidence to the Committee Mr Jones stated that the briefing carried out prior to the training exercise was done in a very thorough and professional manner, and that the procedures used were not, in his opinion, a contributory factor in the problems that emerged. [16]

3.21 The ATS report recommended, failures notwithstanding, that the equipment be retained on the basis that the system was delivered with a high level of accuracy. It further recommended that no further training be carried out but that development work be done to reduce the proportion of equipment failures. [17]

3.22 In response, SAR Pty Ltd criticised the report as unprofessional and rejected the ATS test results. In doing so, SAR Pty Ltd noted that while ATS had found problems with virtually all aspects of the PADS equipment, and had had a 60% failure rate, SAR Pty Ltd itself had had over the past few months a success rate of close to 100%. Given the high success rate achieved by the manufacturer, SAR Pty Ltd argued that it was incumbent upon Mr Jones to ask why faults were occurring when ATS tested the system which had not occurred previously.

3.23 Further, SAR Pty Ltd argued that the ATS report had failed to discuss:

3.24 SAR Pty Ltd was highly critical of its exclusion from these tests because it meant that there was no expert advice available to ATS to clarify what was normal and what was not normal in the behaviour of PADS during the drops, and because, when problems arose, the manufacturers were prevented from observing them or playing any part in rectifying them. [19]

Testing - January/February 1997

3.25 Concern arising from problems encountered with training led Airservices Australia to again engage ATS, after a tendering process, to carry out further ground and flight testing on PADS 'to determine the veracity and magnitude of the PADS deficiencies and where possible, make recommendations for improvements and/or take corrective action to enable introduction to service of the PADS equipment'. [20]

3.26 As part of the testing carried out by ATS, eight sorties involving 20 dispatches of PADS equipment were planned. However, as a result of the repeated occurrence of a number of unacceptable deficiencies, the flight program was terminated five days before the anticipated completion date (8.3 hours flown of a planned 25 hour program).

3.27 During the tests four major unacceptable deficiencies were noted which could have resulted in damage or even accidents to aircraft, injury to personnel or the loss of life. (Three incidents which involved a recoil of the static line in a forward direction were subsequently reported to BASI [21]). In addition, a further 12 unsatisfactory deficiencies were identified which related to PADS equipment, procedures and documentation.

3.28 In conclusion, ATS recommended to Airservices Australia that no further PADS dropping be conducted until the deficiencies were rectified. The report further recommended that CASA certification of the PADS static line be withdrawn and that CASA closely monitor all future PADS development. [22]

3.29 However, the ATS report also noted that, notwithstanding the deficiencies, the deployment accuracy of all 20 liferafts was highly consistent and accordingly recommended that because the PADS system had 'merit in concept', a feasibility study should be conducted into retention and modification of the equipment already purchased. [23]

3.30 In response to this report, SAR Pty Ltd was again critical of the fact that tests had again been carried out by ATS in the absence of the manufacturer, particularly as the problems that had been identified in November had still not to their knowledge been fixed, nor had SAR Pty Ltd been consulted about them. SAR Pty Ltd argued that, had it been involved in the November training, further testing in January, at cost of some $100,000 - $200,000, would not have been necessary. [24]

Service Alerts and Airworthiness Directives - February 1997

3.31 On 6 February 1997, SAR Pty Ltd requested CASA to make mandatory seven Service Alerts that the company had issued in relation to the use of PADS. [25]

3.32 CASA's reply came in a letter dated 12 February and dealt with the request as follows. With regard to Service Alert Numbers 1, 2, 3 and 4, the letter noted that because they related to the performance of PADS, and did not deal directly with safety, CASA had no power to mandate them. [26]

3.33 In relation to Service Alert Number 6, the letter stated: 'CASA is not presently satisfied that the modification proposed by SAR to the static line is an appropriate resolution to the problems associated with the static lines. … A decision on the Airworthiness Directive will be dependent on CASA's analysis of the results of the tests performed by ATS and the SAR response'. [27] Similarly, CASA reserved it decision on Service Alert Number 7, pending the ATS results.

3.34 However, in a second letter of the same date, CASA noted that it had been presented with 'compelling evidence [in the ATS report of 11 February 1997] that the PADS static line, which is aircraft equipment, can create an unsafe condition to aircraft during PADS dropping activities.' Rejecting the changes proposed by SAR Pty Ltd in Service Alert Number 6 because, according to CASA, the unsafe condition would not be overcome, CASA proposed under Civil Aviation Regulation 37A, to issue an Airworthiness Directive on 19 February 1997 unless SAR Pty Ltd was able to present a valid technical argument to the contrary. [28]

3.35 In a letter of objection to CASA's proposed action SAR Pty Ltd argued that:

CASA proposes to effectively ban our development and use of PADS by properly trained and certificated operators using proper equipment and information in properly configured aircraft with conventionally rotating propellers on the basis of tests:

3.36 Then, on 16 February 1997, SAR Pty Ltd issued a statement that the 156 static lines provided under the purchasing contract to Airservices Australia, were 'illegal, bogus and potentially dangerous' because the tape supplied by the subcontracting company, Sala International Pty Ltd, was 'Military Specification Polyester Webbing' rather than the nylon webbing that had been specified by SAR Pty Ltd. While the breaking strain of polyester webbing exceeds that of nylon, 'elongation of polyester webbing is approximately half that of nylon webbing'. [30] The statement gave detailed reasons to explain how the error arose.

3.37 In a letter to CASA, SAR Pty Ltd claimed that the implications of this error were far reaching and, in particular, that all flight testing by ATS on PADS was consequently invalid. In denying responsibility for the error, SAR Pty Ltd blamed CASA for failing to detect the bogus part. [31]

3.38 Further to this, SAR Pty Ltd argued that ATS should be held liable for compensation to Airservices Australia for the cost of testing PADS because ATS did not follow up its own recommendation of 19 November 1996 that there be an investigation of the materials used for the static lines. In addition, Mr Gruzman argued, ATS should not be involved in any further PADS testing. [32] As a general disclaimer, SAR Pty Ltd argued that it had 'acted honourably and efficiently and in full compliance with its obligations as a manufacturer'. [33]

3.39 Airservices Australia, however, did not agree with SAR Pty Ltd. According to a media report, Airservices held the view that the equipment had been purchased in good faith from the manufacturer and had subsequently been found to not meet the specifications of the original contract. [34]

3.40 More significantly, however, information received by CASA from Sala International suggested that the information provided by SAR Pty Ltd with regard to the 'bogus part' was not in fact correct. In a letter to Mr Gruzman, Mr Frank Grimshaw, General Manager of the Airworthiness Branch of CASA, wrote:

3.41 Having regard to all the information provided by SAR Pty Ltd, CASA formally issued an Airworthiness Directive, effective from 20 February 1997, which stated:

The Static Line described in HSJ AVIATION drawing 0856 is prohibited from use in the release of Precision Aerial Delivery System (PADS), except for actual rescue tasks where PADS is used because of discernible risk to life or health of persons requiring assistance. [36]

3.42 In practice, the Directive makes it an offence to use the static line in association with PADS in any circumstances, with exception of a real emergency. This means that neither Airservices Australia nor SAR Pty Ltd can use the static line for training or for testing without first obtaining a permit to fly from CASA. To do this, the person wishing to use the static line must prove to CASA that the unsafe condition has been overcome.

3.43 In late February, SAR Pty Ltd wrote to CASA requesting further information on what was needed before the Airworthiness Directive could be lifted and PADS training be resumed. [37] In his reply, Mr Grimshaw explained:

3.44 The letter from CASA also explained that any other person or organisation which owned any PADS units was also able to propose a means of demonstrating that the unsafe condition with the static line had been rectified. Thus it is also open to Airservices Australia to proceed in this manner so that training can recommence.

Stalemate

3.45 There now exists a very expensive stalemate. CASA has issued an Airworthiness Directive preventing the use of PADS, except in life-threatening emergencies. Airservices Australia is unable to carry out any further training and, more importantly, is unable to use the equipment it purchased with the expectation of having it fully functional within 90 days of delivery, unless it takes on a development role and can find a way of rectifying the unsafe condition. SAR Pty Ltd, while debating endlessly with CASA over the issuing of the Airworthiness Directive, has not so far made any effort, to the Committee's knowledge, to overcome the unsafe condition.

3.46 Neither party in this stalemate accepts responsibility for the fact that the equipment purchased by Airservices Australia is currently unable to be used - it lies idle in a warehouse in Melbourne. SAR Pty Ltd maintains that the problems lie with the operators not with the system. The Chief Executive of Airservices Australia, when asked who was responsible for the PADS equipment not being in a serviceable condition at the time of purchase, stated: 'I would hold the manufacturer responsible'. [39]

Footnotes

[1] Rural and Regional Affairs and Transport Legislation Committee Examination of Additional Estimates, op cit, pp. 1895-1901.

[2] Electronic Memo dated 28 August 1996 (04:26 pm EST) from Mr Peter Evans, General Manager, Air Traffic Services, Airservices Australia, to 'Subscribers' et al. Rischbieth, Item 10 (Folder 2).

[3] Electronic Memo dated 28 August 1996 (05:28 pm EST) from Mr Paul Woodham, Facilities Management Division, to Mr Bill Pollard, Chief Executive, Airservices Australia. Rischbieth, Item 10 (Folder 2).

[4] Undated letter (fax-dated 16 February 1997) from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, et al, p.3. Faxed to the Committee on 17 February 1997.

[5] Letter dated 6 September 1996 from Mr John Forsyth, Chairman, Airservices Australia, to Mr Bill Pollard CEO, Airservices Australia. Rischbieth, Part 1 (Folder 1).

[6] Evidence, p. RRA&T 111.

[7] Letter dated 12 September 1996 from Mr Anton Gruzman, SAR Pty Ltd, to Mr Bill Pollard, CEO, Airservices Australia. Rischbieth, Part 1 (Folder 1).

[8] Evidence, p. RRA&T 47.

[9] Undated letter (fax-dated 16 February 1997) from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, et al, p.3. Faxed to the Committee on 17 February 1997.

[10] Electronic memo dated 12 November 1996 from Tony Marshall, SAR, Airservices Australia, to Peter Evans and attached report Precision Aerial Delivery System Training of Dropmaster and Pilot Instructors 9th - 10th November 1996. Rischbieth, Item 10 (Folder 2).

[11] Airservices Australia Electronic memo Sent 14 November 1996 (04:40pm EST) from Tony Marshall to Peter Evans. Rischbieth, Item 10 (Folder 2).

[12] Report dated 14 November 1996 Concerns with Navair PADS Training as at 14 November 1996, Colin L Campbell, Dropmaster Instructor. Rischbieth, Item 10 (Folder 2).

[13] Evidence, p. RRA&T 10.

[14] ATS Flight Test Report Photographic and Safety Chase Airservices Australia - PADS Document Number ATSSYD/PROJ/FUT/FLIGHT TEST PT 1 (23), Executive Summary, p. 3.

[15] Evidence, p. RRA&T 80.

[16] Evidence, p. RRA&T 81.

[17] ATS Flight Test Report, op cit, Executive Summary, p. 3. See also Evidence, pp. RRA&T 77-85.

[18] Undated letter (fax-dated 16 February 1997) from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, et al, p. 5. Received by the Committee on 17 February 1997.

[19] Ibid, p. 6.

[20] Aerospace Technical Services Report 001/97 to Airservices Australia Flight Test and Consultancy Report - Precision Aerial Delivery System (PADS), 11 February 1997, p. 3.

[21] Letter dated 13 February 1997 from Mr Michael Jones, Managing Director, ATS, to Director Bureau of Air Safety Investigation.

[22] Aerospace Technical Services Report 001/97, op cit, pp. 1-2.

[23] Ibid, p. 2.

[24] Undated letter (fax-dated 16 February 1997) from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, et al, p.6. Faxed to the Committee on 17 February 1997.

[25] Service Alerts comprise information issued by a manufacturer about an aircraft component which may be submitted to CASA for the issuing of an 'Airworthiness Directive' under CAR regulation 37A. CASA is only entitled to issue an AD in relation to an item of aircraft equipment if it considers that an unsafe condition exists, is likely to exist or is likely to develop in relation the equipment.

[26] Alert Number 5 was subsequently withdrawn by SAR Pty Ltd.

[27] Letter dated 12 February 1997 from Mr Frank Grimshaw, General Manager, Airworthiness Branch, Airservices Australia, to Mr Laurence Gruzman, SAR Pty Ltd, commencing: 'I refer to your facsimile letter to Leroy Keith …', p. 2.

[28] Letter dated 12 February 1997 from Mr Frank Grimshaw, General Manager, Airworthiness Branch Airservices Australia, to Laurence Gruzman, Chief Pilot, SAR Pty Ltd, commencing: 'As discussed with you on 5 February 1997 … '.

[29] Letter dated 13 February 1997 from Mr Laurence Gruzman, SAR Pty Ltd, to Mr Andrew Snedden, Committee Secretary, pp 1 - 2.

[30] Fax-dated letter of 16 February 1997 from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, p. 1.

[31] Undated letter (fax-dated 16 February 1997) from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, et al, p. 6. Faxed to the Committee on 17 February 1997.

[32] Ibid, pp. 7 - 8.

[33] Fax-dated letter of 16 February 1997 from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fisher, Chairman, CASA, p. 3.

[34] Sydney Morning Herald 18 February 1997, p. 6.

[35] Letter dated 18 February 1997 from Mr Frank Grimshaw, General Manager Airworthiness Branch, CASA, to Mr Laurie Gruzman, SAR Pty Ltd. Faxed to the Committee 5 March 1997.

[36] Commonwealth of Australia, Civil Aviation Safety Authority, Schedule of Airworthiness Directives, Civil Aviation Orders Part 107, AD/PADS/1 Precision Aerial Delivery System (PADS) Static Line 4/97TX.

[37] Letters dated 27 February 1997 from Mr Laurie Gruzman, SAR Pty Ltd, to The Hon Mr Justice William Fischer, Chairman, CASA, et al.

[38] Letter dated 3 March 1997 from Mr Frank Grimshaw, General Manager, CASA, to Mr Anton Gruzman, Chief Executive, SAR Pty Ltd, p. 2. (Faxed to the Committee by CASA on 19 March 1997.)

[39] Evidence, p. RRA&T 201.