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NASA / Getty Images file
A NASA video focuses on a piece of debris falling from the external tank, then striking the left wing of the space shuttle Columbia during its launch on Jan. 16, 2003. Investigators say the damage led to the shuttle's destruction 16 days later during atmospheric re-entry.
HOUSTON — Ten years ago, the Columbia tragedy showed that not everyone at NASA had learned the most important safety lesson from the shuttle Challenger disaster, more than a decade earlier. Will the new teams now stepping forward into the American spaceflight arena have to relearn the same bitter lesson?
Beyond the tragic loss of life, the greatest tragedy of the space shuttle Columbia was that NASA should have known better. As an organization and as a team, the agency learned nothing new from the 2003 disaster. Rather, the disaster was a harsh reminder of what NASA had forgotten. Or, as the German philosopher Friedrich Hegel, wrote, "The only thing we learn from history is that we learn nothing from history."
After the Columbia and its crew of seven astronauts were lost, an independent investigation board delved deeply into the immediate causes of the disaster. But the board's director, retired U.S. Navy Adm. Harold Gehman, set his team an even more profound task. He wanted them to find out why, just 17 years after operational errors and bad engineering decisions doomed the space shuttle Challenger and its seven astronauts, the same types of management flaws had reinfected NASA's culture and struck again with equally hideous results.
The fundamental safety rule had been to base no belief purely on hope. Safety was a quality that had to be explicitly verified. To assume that all was well unless there were visible hazards was imprudent and irresponsible. Convenient, unverified assumptions of goodness had led to the loss of Challenger and its crew — and Gehman wanted to find out if the same kind of lapse had led to Columbia's loss.
Retrace the final, tragic flight of the space shuttle Columbia, from its launch to its catastrophic end on Feb. 1, 2003.
Over the ensuing months, as investigators developed these deeper insights through extensive interviews and document reviews, they regularly conducted news briefings to answer questions about what they were discovering. I attended those briefings as a newly hired space analyst for NBC News, and I had a tough question on my mind.
"How much of your 'NASA safety culture' assessment," I asked, "could have been written before the accident?"
Gehman paused, thought deeply, and then sighed. “Maybe three-quarters of it,” he acknowledged.
This was a dramatic moment: NASA itself could have done the diagnosis and come up with the get-well prescription without the cost of seven lives.
No accident
As it turned out, neither the 2003 Columbia disaster, nor the 1986 Challenger disaster, nor the robotic Mars mission failures of 1999, nor the cascade of near-death experiences of American astronauts aboard the Russian Mir space station in 1996 and 1997, were "accidents" in any traditional sense of the word. They weren't out-of-the-blue surprises, striking without warning. They didn't happen because "space is hard," as NASA apologists repeatedly proclaimed. It wasn't because we were pushing a fearsome frontier and just had to expect, and accept, such losses.
These bad things happened mostly because attitudes toward safety got soft. And as complacent carelessness and time-saving shortcuts crept into the culture, many people had noticed, had given warnings, and had been ignored.
There were many members of NASA's space team who continued to keep faith with the rigorous standards that had gotten America to the moon in the Cold War space race. Those space workers would later come to feel they were betrayed by their colleagues who had dropped the ball, and broken the chain, and made conscious choices that had lethal consequences.
It wasn't a matter simply of hindsight. People inside and outside had been noticing the shift and raising objections to increasingly careless management choices, as front-line workers were overruled for schedule and budget reasons.
As a senior worker at the Johnson Space Center in the mid-1990s, I had been assigned more and more safety-related duties in addition to my primary specialization, orbital design work. As I learned more of the principles of flight safety, I saw more and more disconnects with the way it was being practiced, especially with regard to the diplomatically motivated "shuttle-Mir" program.
Following a series of near-fatal crises while American astronauts were aboard Mir in 1997, NASA managers prepared arguments for continuing the project — a continuation directed by White House officials. One manager wrote, "Despite concerns, there is no hard evidence that Mir is currently unsafe." Another asserted, "The experts that we had asked, the majority of them, determined that there were no technical or safety reasons to discontinue the program."
I had already learned enough about NASA's "best practices" to recognize that these officials had it completely backward. In the real world, you don't assume safety and seek evidence of danger — especially when working with the Russians, who regularly covered up flight hazards. You must decide positively to continue only after a thorough hazard review, and without it, you do not continue. If a vocal minority, or even one engineer objects, you address those concerns head-on.
Looking back, looking forward
After leaving the NASA program in 1997, I was able to write more candidly about these safety concerns, both with respect to the mismanagement of a fleet of Mars robots in 1999 and a book chapter on Mir safety in 2002
I concluded an article written for Scientific American with a warning: "NASA will have to address its systemic weaknesses if it is to avoid a new string of expensive, embarrassing and perhaps in some cases life-threatening foul-ups."
Quoting retired colleagues whose judgment I had learned to respect, I noted in a 2000 report for New Scientist that critics were accusing NASA of "repeating the errors that led to the Challenger disaster."
"The consequences of a future accident could, also, be fatal," I wrote, three years before the Columbia disaster. "So far, no more human lives have been lost, but the question NASA must answer is whether this will continue."
So when Admiral Gehman acknowledged that an accurate diagnosis of the systemic flaws leading to the disaster could have been made before seven astronauts died, I knew he spoke the truth. And I knew that the next generation of "safety hawks" and pain-in-the-ass picky whiners in the space effort would need to be more effective than I was.
Those chapters are yet to be written.
More about the Columbia tragedy:
- 10 years later, Columbia's loss still stings
- NASA celebrates its fallen astronauts
- Film finds uplifting story amid Columbia's loss
- Special report on the Columbia tragedy
NBC News space analyst James Oberg spent 22 years at NASA's Johnson Space Center as a Mission Control operator and an orbital designer. He is the author of several books on space history and space policy.
Leave a Comment:
Reading the headline I thought NASA was playing tennis
so, here is my take on this. Until we invest the majority of the money in the math and science it takes to do it right, we will continue to fail. We spend a maximum of 25% (likely much less) on the real math and science. We spend 30% on government oversight, and the test on useless contractor program and financial management. Let's get real.
It's sad that NASA has decided to retreat into the past instead of continuing to build bleeding edge technology. The Space Shuttle was 70s technology, Alpha technology, version 0.1, the first reusable manned cargo spacecraft. Instead of pushing forward, NASA has retreated backward, to it's glory days of Apollo. They have decide to build a version 2.0, 60s technologies, Spam in a Can, where the cargo is the Man, Apollo capsule on steroids. Nothing bleeding edge here, nothing that hasn't already being done and should be done by Private Enterprise. And in fact, is already being done by Private Enterprise, a company called SpaceX and their Dragon capsule. NASA's new Spam in a Can, version 2.0, Apollo on Steroids, is sadly to say, less innovative than SpaceS's Dragon and over ten times the cost. Sad to see that NASA is being run by Managers and Bus Drivers. I doubt if they have one Rocket Scientist left at an organization that's only goal seems to be to re-live it's past.
Okay, smart guy, what's the mission? Are you saying that bleeding edge space craft must have wings? What are you saying, anyway? You're just saying spam in a can over and over. So, what? First of all, What's wrong with having a space capsule??? It is safer and cheaper, ultimately, than the space shuttle.
Look, I loved the space shuttle. I grew up with the space shuttle. I was a major supporter of it and I miss it. But, at the end of the day, it was a big rig that could bring large sensitive loads back to Earth. That's the capability that is lost. Everything else can be done with capsules and heavy lift launch vehicles. So, again, I ask you... What's your point, RocketScientist?
NASA is not stuck in the past, no matter how many times you say it. They are leading designers and developers. SpaceX founder Elon Musk has said as much and has also said that his company would not be where it is today without the forward thinking folks at NASA.
Once again the editors proof THEIR work, I think some of them even comment on THEIR stories.
Looks like that was scrambled, should be "unless there were visible hazards." Thanks for noting, will fix.
I find it very odd that anybody expects better of the government. Frankly, I'm shocked NASA ever had the actual expertise and skills to safely make it to the moon and back.
It's time for the era of government-dominated space flight to end.
To automatically assume that private industry will do it better is flawed. Just look at the decisions BP made in Gulf of Mexico.
I agree with FlyMe
The government did tolerably well when it was in charge of industrial output in WWII and NASA put a man on the moon, after all
any organization - private or otherwise, will have its share of mishaps and blunders
NASA is an organization of human beings. Human beings are fallable. We rely on systems and procedures to make up the difference. Unfortunately, systems and procedures are the creation of human beings, and therefore, are also fallable, because they are susceptible to outside influences and breakdowns, and to be successful, humans must consistently apply and understand them.
Many of the problems NASA has faced are due to the fact that it is given mandates that are often contradictory. To explore space safely and cheaply is inherently contradictory. If we are going to explore space safely, then cost has no bearing on safety decisions. If we are going to explore space cheaply, then safety is going to have to yield occasionally to value judgments about how safe is safe enough in order to keep costs down. Throw in non-technical political objectives, and you get an organization that will occasionally be at odds with itself. NASA does not exist in a vacuum. We can hardly blame the organization if we give it goals that are inconsisent. Apollo was a huge success because the flow of funding, technology, support, and talent was unrelenting through the Apollo 11 landing, and remained high only until public and Congressional support waned after later Apollo missions, then it was closed down.
From a technical perspective, I am glad the shuttle era is over. It was an amazing machine and a sight to behold, but it was also flawed from the start. Elements of the intelligence services wanted a shuttle big enough to perform espionage activites from space. Thus, the shuttle we got was actually much larger than the one originally envisioned and could only be protected by the fragile tiles and not a single piece ablative heat shield. Further, it was flawed by the concept that humans and cargo should fly together on the same vehicle. Cargo rating a vehicle, and human rating a vehicle, are not the same standards of safety. Moreover, you end up with a vehicle that is liable to be full of compromises. Better to launch the cargo on one vehicle optimized for cargo, the humans on another vehicle optimized for humans, and rendezvous in space.
In terms of re-entry, the blunt-edged capsule is the safest design we know of. Going back to that (for Constellation, or Orion, or whatever they are calling it now) doesn't represent any kind of retreat from the leading edge of space development. It represents a realistic assesment that the shuttle concept could not fully live up to its billing of being safe, cheap and reusable. Of those choices, pick two. Safe and cheap won't be reusable. Cheap and reusable won't be safe. Reusable and safe won't be cheap. So, since we are going back to safe and cheap, reusability is at an end. More capable Apollo-style capsules will give us the ability to go back to the moon or to rendezvous with an asteroid. But as far as humans lugging stuff into space on a big truck like the shuttle, that day is over. The technology of orbital rendezvous and docking has proceeded well enough that you can have multiple small launches of smaller vehicles, that can then be docked in space, more effectively than launching a single huge vehicle into space.
and this is news why?
unfortunately, this is just how we (humans) are. i've witnessed this same type of mentality throughout my working life: construction.
i see and hear about more emphasis on safety from companies, but it's not the real concern.
the real concern is what it's always been: MONEY.
to be fair, i know some people truely believe in safety.
because of tougher safety laws & fines, safety is a concern because it effects the bottom line, profit. it doesn't cost as much if you're safe, you get a safety bonus if you have a good safety record.
a disaster may be tragic, but it's still not a problem as long as it happens to someone else.
It doesn't cost as much if you are safe? I think you need to either elaborate on what exactly you mean, or else you need to rethink what you've said there.
If you mean beings safe doesn't cost as much in terms of human life and potential casualties, maybe..
But safety, from a bottom-dollar perspective, increases the price tag on any system or product. Safety is one of the main drivers in the cost of human spaceflight. If safety were not an issue then reliability would be the main driver, because reliable spacecraft make profits.
Very well said, ChrisMcK. "Many of the problems NASA has faced are due to the fact that it is given mandates that are often contradictory. To explore space safely and cheaply is inherently contradictory." I've read that NASA was allotted 10% of the U.S. budget when we went to the moon. By the time of the Columbia accident, NASA was given less than one tenth of 1%.
You are also correct in stating that the shuttle was flawed from the start. I would direct anyone who is interested in how the orbiters themselves came to be constructed and serviced by multiple contractors (all of them civilian, by the way) to read "Prescription for Disaster: From the Glory of Apollo to the Betrayal of the Shuttle" by Joseph and Susan Trento. The political decisions made by the Nixon administration set the program up for ultimate failure.
We don't yet live a Star Trek future, where we can board a reusable shuttle craft for space travel. The cost to ensure the occupants' safety is too high for what the American taxpayers are willing to spend. Therefore, we must use proven expendable capsules for now if we wish to continue space exploration -- and maintain U.S. supremacy before a foreign power squeezes us out.
Professor Feynman identified the problems within NASA's culture during the Challenger investigation, and in fact outlined them in an appendix to the resulting report (He was infuriated that nothing about this had been put into the main report, and refused to sign it unless the appendix was put in. Of course, the people objecting were the ones that were driving the report.) Obviously the leadership at NASA paid no attention to it, if in fact they read it.
NASA needs an overhul before starting up another manned flight program. Get rid of half the managers, and stop telling engineers to "Put on their managers hats". Go back to the "Go/No-Go" environment where *any* objecting voice will halt a flight until that issue is resolved. Private enterprise is ok but don't forget that unlike a government agency they don't answer to the public, almost everything they do can can be kept in the dark, and they don't have any better track record than the government when it comes to disasters.
While I agree safety is paramount, and many of the mistakes and deaths could have been avoided through rechecks and using proper safety procedures, ultimately we are still human. We still make mistakes. We are not infalible and are prone to making errors based on pride or just lack of oversight.
However, the problem is now that NASA is no longer in the space race. How is this now possible? How could the American public allow this to happen? True we do have problems here on Earth that we need to fix...many problems. But at the same time, it's a PROVEN FACT that science created for space exploration has created many technologies we now use today which gave us a technological edge. The race to the moon program gave us so many different technologies that many of them were used for business applications. Prime example...Velco. We need that today and creating new space ships for travel is what's needed today. If we could take and upgrade the technology of the 70's Space Shuttle with today's technology levels, the new craft would be safer, smarter, more powerful, and efficient than ever.
I do also believe that creating a longer range ship, and also expanding on the ISS technology will allow us to take science into space and create things never before dreamt of. Using the ISS as a launching pad to attach newer, larger modules, we could create science labs that could study human diseases, research newer technolgies, manufacturing of possibly stronger, lighter, more adaptable materials. Heck if they can do this in Star Trek, why can't we work toward that goal now?
That O ring that was made in Berea Kentucky when I went to college in Richmond Ky. That plant was shuttered and all workers let go within 2 weeks of the first space shuttle disaster. Only later was it determined that the o ring lived up to it's specs. the problem was the liquid nitrogen leaking onto the o ring and taking it outside it's engineering specs. Tell that to a bunch of people out of work on a knee-jerk, feel-good witch hunt. Reminds me of gun control these days. Look at the root cause before you do stomething stupid and emotional. And don't forget NASA was a front for the nuclear arms race.... so of course they aren't really in business anymore....
The o-ring itself was perfectly fine, provided it was used under the conditions for which it was designed, which it was not on Jan. 28, 1986. It was the design by which the booster segments were connected ("field joints" I think they are called) that was flawed. The connections weren't robust enough to stand up to the stresses of launch without deforming, creating an opening in the joint. When they deformed, a "blowby" event could occur, where hot exhaust gasses from the interior of the booster went through the opening caused by the deformation in the joint. During warm weather launches, the o-ring material was pliable enough that it could "re-seal" the joint. This happened so much before Challenger that it actually was incorporated into launch expectations and not recognized as a serious flight risk.
However, on Challenger, it was so cold that the o-ring material was no longer sufficiently pliable. At launch, a large portion of it was burned away, and the remainder couldn't form a complete seal. During the initial ascent, deposits of aluminum oxide from the booster material formed a temporary blockage in the area where the o-ring was burned away, temporarily creating a seal, but obviously this was not a designed-in feature. When the shuttle met an area of high turbulence, the oxides disintegrated, and the gap in the joint again allowed hot gasses to vent out, which progressively burned a hole in the external tank and mounting which allowed the shuttle to disintegrate under aerodynamic stresses. It didn't really "explode" in the sci-fi movie sense, but disintegrated under stress.
Tap, you have no idea what you're talking about.
I'm looking at the actual report:
1. There was no defect found in the O-rings
2. The O-ring failure was due to low ambient air temperature, which was outside the specifications of the O-rings.
3. Liguid nitrogen had nothing to do with it. The O-rings in question were on the solid rocket booster (SRB), and there in no liquid nitogen within them.
4. The main cause of the accident was a management decison to operate the vehicle outside of specifications, which resulted in a failure of 3 O-rings, allowing blow-by to intercept the main fuel tank.
Oh, and which ballistic missiles did NASA work on? How did they front the nuclear arms race? (Actually, it was the other way around, NASA's first rockets were borrowed from the military)
I take it your field of study in college wasn't aerospace engineering...
The space shuttle Columbia tragedy was an
act of sabotage. The first country to put a battery of laser cannons on Mars
will rule the Earth. Laser cannons already exist and because of this act of
sabotage, the Russians and Chinese now control outer space. Please visit my
websites www.sabotagecolumbia.info
where all downloads are free and www.sabotagecolumbia.com
where I sell my books.
You must be right. All I have to do is suspend the laws of physics & everything makes sense (I was really impressed with your "laser cannons can shoot across the universe" statement on your website. I guess if I live a couple of billion years I need to sidestep a meter.)