Date of occurrence:

O-2/18

Safety study (class investigation) of search and rescue operations with helicopters operated by the Swedish Maritime Administration

The Swedish Accident Investigation Authority (SHK) received information about a number of occurrences where the Swedish SAR-helicopters (search and rescue), operated by the Swedish Maritime Administration (SMA), had not been available as expected. Due to this SHK made a synoptic pre-study which revealed that under a period of approximately seven months there were twelve such occurrences. The pre-study resulted in SHK initiating a theme study regard­ing rescue services by Swedish SAR-helicopters. The investigation is based upon five occurrences that have been more thoroughly examined.

The investigation shows that the Swedish Maritime Administration fulfils the general requirements regarding search and rescue, which mainly is performed by other resources than helicopters. However, there are obvious difficulties to maintain readiness at the five helicopter bases that SMA controls. The investi­gation shows that in adherence to the five examined occurrences, the helicopter units has had limitations which resulted in them not being in operation on 13 individual occasions. This has influenced the performance of SAR-operations to a variable extent as well as the readiness for search and rescue in general, which, in turn, has influenced the ability for the armed forces to execute their flight operations.

The investigation concludes that the factors that mainly have influenced the availability are the fact that the organization is undersized in relation to the ambitions set out in the SMA program for search and rescue, and the conflict between employer and employees, which was on-going during the time in ques­tion. The investigation also shows that there is potential for improvements regarding the Swedish Transport Agency’s (STA) possibilities to carry out inspection of the maritime search and rescue services, SMA’s planning of the helicopter services based upon operational risk management, and the legislation for public access and confidentiality. Of these, the two latter has also influenced the availability.

The size of the helicopter services is too small in relation to the ambition to maintain SAR-helicopter readiness on five bases in the country at all times. With the current number of helicopters (seven) and the required maintenance, it is not even in theory possible to keep up readiness at five bases at all times. If the need of training is taken into consideration, the circumstances are even worse and one can conclude that also the number of crews is too small.

There has been a severe conflict between employer and employees. The conflict has influenced the safety climate negatively and possibly damaged the safety culture. The conflict has directly influenced the operational risk management procedure that is performed before each flight operation, and has on a number of occasions hindered helicopters to take off as the results have showed a negative influence on crew members’ status. The negative result has been reinforced by the fact that the planning of the operations is such that there are regularly circumstances that causes unnecessary high values in the risk assessment, which increases the risk that flight operations cannot be carried out. Another circumstance that has influenced the conflict is the deficiencies in the legislation regarding public access and confidentiality. Due to these deficien­cies, the air personnel have a weaker protection of integrity than in other aviation business.

Chairperson

Jonas Bäckstrand

Investigator in charge

Jörgen Zachau

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Last updated:
19 December 2019