Creating risks, the DC plane crash: risk analysis and investigation
Wreckage is seen in the Potomac River near Ronald Reagan National Airport in Washington, D.C., on Thursday, Jan. 30, 2025. Petty Officer 2nd Class Taylor Bacon, U.S. Coast Guard via AP.
The tragic crash resulting in 67 deaths seems preordained ("Boats return to the Potomac River for D.C plane crash recovery and investigation," Philadelphia Inquirer).
For years, it's been written that because of restrictions on airspace use around the White House, planes fly to and from National Airport through extremely narrow corridors and tight elevations ("Pilots have long worried about DC’s complex airspace contributing to a catastrophe," AP, note: it requires going into a good library articles database to get older links).
But I don't recall these articles discussing airplanes also having to negotiate airspace with military helicopters on training missions from various bases along the Potomac River, like Fort Belvoir, the duty station for the helicopter involved in the crash.
A Reddit thread shared an interesting article, "Why You’ve Never Been In A Plane Crash" (Asterisk Magazine) about airplane crash investigation not being focused on "blame" as much as the process/system that likely generated the crash, with a focus on structural change.
It discusses a case in Los Angeles, and how a series of near misses similar to the final crash bred complacency. The New York Times article, "Washington Crash Renews Concerns About Air Safety Lapses" sounds like it could have been pulled from the files on the LA crash, detailing ongoing process issues at National Airport, which, scarily, appear to be more common across the country. From the article:
WMATA Fort Totten crash, CBC photo.Clues emerging from the moments before the deadly collision Wednesday night between an Army helicopter and an American Airlines passenger jet suggest that multiple layers of the country’s aviation safety apparatus failed, according to flight recordings, a preliminary internal report from the Federal Aviation Administration, interviews with current and former air traffic controllers and others briefed on the matter.
The helicopter flew outside its approved flight path. The American Airlines pilots most likely did not see the helicopter close by as they made a turn toward the runway. And the air traffic controller, who was juggling two jobs at the same time, was unable to keep the helicopter and the plane separated.
The same kind of complacency at the airport ("Near-misses at Washington airport worried pilots well before fatal crash," Reuters) seems comparable to WMATA's Metrorail which experienced a number of signals failures induced near misses before the 2009 crash that killed 9 ("WMATA circuit failure," 2009).
Plus things could have been even more discombobulated because of the Trump Administration's call for air traffic controllers to leave government service ("Air traffic controllers were initially offered buyouts and told to consider leaving government," AP). OTOH, Trump blamed DEI and the Biden Administration ("Trump was challenged after blaming DEI for the DC plane crash. Here’s what he said," AP).
Labels: business process redesign, disaster planning, incompetence and failure, risk analysis, risk management and redundancy

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