37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 1407640 |
Time | |
Date | 201611 |
Aircraft 1 | |
Make Model Name | B757 Undifferentiated or Other Model |
Operating Under FAR Part | Part 121 |
Flight Phase | Parked |
Component | |
Aircraft Component | Oxygen System/General |
Person 1 | |
Function | Other / Unknown |
Events | |
Anomaly | Deviation - Procedural Published Material / Policy |
Narrative:
The purpose of this narrative is not to report an accident or violation. Contrarily; it is intended to illustrate the extremely dangerous methods employed by [airline company] for the servicing of crew oxygen cylinders on [company] aircraft. The intent is to prevent an accident which is bound to occur sooner or later. This accident is 100% avoidable if action is taken now.on the date and time indicated above; I was assigned the task of a routine 2 service on a B757. One of the requirements was to service crew oxygen which indicated 1240psi. The 2svc paperwork for this aircraft calls for servicing at pressures below 1500psi. The only way to do this is to physically remove the cylinder from the aircraft followed by placing the cylinder on a service cart where it can be connected to high pressure storage cylinders allowing the crew cylinder pressure to be increased to a serviceable level. The serviceable cylinder is then installed in its original location on the aircraft. B757 fleet aircraft maintenance manual describes the procedure for cylinder removal and installation and was followed for this task. A related log page was created. General maintenance manual describes approved servicing methods and safety precautions. Two things make this procedure hazardous beyond all sense of safety and well-being:1) access to the crew cylinder on 757 (and all other) aircraft require a ladder as other lifting platforms cannot be safely situated near the access door. The 737 even requires a short step ladder to access the forward cargo pit. The individual tasked with servicing must negotiate the ladder; 10-12 feet in the case of the 757; while holding the fully charged cylinder with one arm in order to position the cylinder for installation. There's no other way to do it.2) the crew oxygen cylinders were never designed to be handled in this regard as evidenced by the lack of safety features such as a screw on safety cap (that covers and protects the valves) found on supply cylinders. These shipping/supply cylinders were designed to be moved and handled and are done so; safely; all the time provided the safety caps are properly installed. In the case of removal and handling of aircraft crew oxygen storage cylinders; once all restraints are released; one must grasp the bottle by the valve assembly in order to remove it from it's mounting structure. Nowhere in [the maintenance manual] does the instruction to handle the cylinder by the valve assembly exist. The instructions are to remove the cylinder; without regard to method used to do so. There are no provisions available to render this bottle safe in this condition. We; as [standby] mechanics have been required to view safety videos regarding safe handling of pressurized gas cylinders and this current method of crew oxygen servicing defies every safety item in that safety video and; indeed; that of common sense. Nowhere in osha regulations could I find statements supporting the use of valves as handles. There was an incident at [another airport] not long ago that resulted in loss of life that was due to an unconfined pressure vessel. The practice of carrying a pressurized crew cylinder with one arm while climbing or descending a ladder is simply unacceptable.
Original NASA ASRS Text
Title: A maintenance technician reported a dangerous procedure being used to service oxygen bottles on aircraft.
Narrative: The purpose of this narrative is not to report an accident or violation. Contrarily; it is intended to illustrate the extremely dangerous methods employed by [Airline Company] for the servicing of crew oxygen cylinders on [company] aircraft. The intent is to prevent an accident which is bound to occur sooner or later. This accident is 100% avoidable if action is taken now.On the date and time indicated above; I was assigned the task of a routine 2 service on a B757. One of the requirements was to service crew oxygen which indicated 1240psi. The 2svc paperwork for this aircraft calls for servicing at pressures below 1500psi. The only way to do this is to physically remove the cylinder from the aircraft followed by placing the cylinder on a service cart where it can be connected to high pressure storage cylinders allowing the crew cylinder pressure to be increased to a serviceable level. The serviceable cylinder is then installed in its original location on the aircraft. B757 Fleet Aircraft Maintenance Manual describes the procedure for cylinder removal and installation and was followed for this task. A related log page was created. General Maintenance Manual describes approved servicing methods and safety precautions. Two things make this procedure hazardous beyond all sense of safety and well-being:1) access to the crew cylinder on 757 (and all other) aircraft require a ladder as other lifting platforms cannot be safely situated near the access door. The 737 even requires a short step ladder to access the forward cargo pit. The individual tasked with servicing must negotiate the ladder; 10-12 feet in the case of the 757; while holding the fully charged cylinder with one arm in order to position the cylinder for installation. There's no other way to do it.2) The crew oxygen cylinders were never designed to be handled in this regard as evidenced by the lack of safety features such as a screw on safety cap (that covers and protects the valves) found on supply cylinders. These shipping/supply cylinders were designed to be moved and handled and are done so; safely; all the time provided the safety caps are properly installed. In the case of removal and handling of aircraft crew oxygen storage cylinders; once all restraints are released; one must grasp the bottle by the valve assembly in order to remove it from it's mounting structure. Nowhere in [the Maintenance Manual] does the instruction to handle the cylinder by the valve assembly exist. The instructions are to remove the cylinder; without regard to method used to do so. There are no provisions available to render this bottle safe in this condition. We; as [standby] mechanics have been required to view safety videos regarding safe handling of pressurized gas cylinders and this current method of crew oxygen servicing defies every safety item in that safety video and; indeed; that of common sense. Nowhere in OSHA regulations could I find statements supporting the use of valves as handles. There was an incident at [another airport] not long ago that resulted in loss of life that was due to an unconfined pressure vessel. The practice of carrying a pressurized crew cylinder with one arm while climbing or descending a ladder is simply unacceptable.
Data retrieved from NASA's ASRS site and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.