Report: Lack of Adequate Precautions Caused Accident That Killed Three During SpaceShipTwo Test

Photo Credit: The Spaceship Company

Photo Credit: The Spaceship Company

In July 2007, a test of a hybrid nitrous oxide-fueled rocket engine that Scaled Composites planned to use on its SpaceShipTwo space plane failed. The resulting explosion killed three and injured three more. The California Occupational Safety and Health Administration, or Cal/OSHA, has released its investigation report which was obtained under the California Public Information Act. Details of which were posted on the Knights Arrow website.

The release of this information has provided a clearer understanding of what took place that day—until now, other than the fact that the accident occurred and people were injured and killed, little was known about the details surrounding the event.

One of the things that the report states is that Scaled Composites failed to provide adequate training about the hazards involved with the nitrous oxide rocket fuel the company uses in its spacecraft prior to the accident.

Cal/OSHA discovered that Scaled Composites allowed employees to view the Cold Flow Test at a nearby fence. It is not clear whether or not those killed during the accident were at this fence or if this is just one of the issues Cal/OSHA discovered during its investigation.

The investigation report lists the violations for which Scaled Composites was cited. Some of these include the following:

  • Enough time existed prior to the accident for the problems to be noted and addressed.
  • The management had actual knowledge of the conditions.
  • Scaled Composites did not institute a written method or procedure to correct unsafe conditions while conducting the test of the propulsion equipment.
  • These issues violated common industry practices.
  • Scaled Composites failed to monitor the test site during the time of the accident to ensure that employees were not exposed to amounts of nitrous oxide in excess of 50 parts per million.
  • There was a lack of either barriers or adequate distance between the test site and those viewing the test.

To gain an understanding of common safety practices during test firings, AmericaSpace reached out to several rocket manufacturers and requested information regarding how far back viewers are kept from these tests. During tests of ATKs, four and five-segment solid rocket boosters, viewers are kept at a distance of over a mile. Pratt & Whitney Rocketdyne requires those viewing their tests to be a minimum of 825 feet away, at their A2, B1, and A1 test stands. Information obtained from P&WR states the following concerning the origination of the company’s safety standards: This distance was established per OSHA regulation CFR 1910.110, Process Safety Management, due to the quantity of Hydrogen available on these test stands. 

This appears to highlight a separation between how established space firms, such as P&WR, and newer firms, such as Scaled Composites, view the potential risk involved with these tests. 

The Mojave, Calif.–based firm’s entry into the Ansari X PRIZE was the now-famous SpaceShipOne spacecraft and its WhiteKnightOne carrier aircraft. This duo launched into sub-orbital space twice within the required two-week timeframe and won the contest.

Having accomplished this, Scaled Composites entered into an arrangement with billionaire Sir Richard Branson’s Virgin Group. This would see the creation of Virgin Galactic and eventually The Spaceship Company.

The findings in this investigative report highlight concerns that have been raised regarding the manner in which a number of the commercial start-up companies conduct their business.

14 comments to Report: Lack of Adequate Precautions Caused Accident That Killed Three During SpaceShipTwo Test

  • Newspaniard

    Are you saying that there should be no new start-up companies and all new stuff should be done by the fat cats? Are you saying that accidents don’t happen? Are you suggesting that in the succeeding years, nothing has been done to remedy the safety shortcomings? Are you subsidized by a Virgin competitor?

    • Newspaniard,
      The information contained within this article came to our attention last week (hence its timing). It details the fact that Scaled Composites did not follow established safety practices which led to the deaths of three and three more being injured. While those in the NewSpace community would like to cover up the causes behind tragedies such as this, the correct response would be to accept Cal/OSHA’s findings and accept responsibility. Instead? People such as yourself try to deflect blame and cast accusations.
      AmericaSpace is funded by a single sponsor, who works in the oil & tech industries as well as advertising revenue. So, no, unfortunately for you, no ties to any Scaled competitors. We’re a media outlet that was hoping NewSpace would handle tragedies like this one in a mature fashion and accept responsibility. Given your immature response – I guess it was just wishful thinking. Newspaniard, if you want to get upset with someone, you need look no further than Scaled – and yourself. Three people died and rather than hold the responsible party accountable – in a pathetic show of misplaced loyalty – you attack those who highlight the problem. Be an adult, look in the mirror and learn two words: Personal Responsibility.
      That’s what we’re “saying.”
      Sincerely, Jason Rhian – Editor, AmericaSpace

      • Karol

        Jason, the absolutely ludicrous newspace knee-jerk remarks “Are you saying that there should be no new start up companies and all new stuff should be done by the fat cats? and “Are you subsidized by a Virgin competitor?” provide valuable insight into the thought processes of some of the newspace disciples. The blind thinkspeak fanaticism, heretical denounciations, and willingness to deny obvious truths in preference to absurdities are at best . . . unnerving. Countless times I have read your posts on AmericaSpace that the commercial sector (even a “commercial” sector that receives over 70% of its funding from taxpayers) can handle LEO matters while NASA sets about deep space exploration. Perhaps in dealing with the NASA-bashing howler monkeys it is best to remember the sage advice, “Never try to teach a pig to sing, it only wastes your time and annoys the pig.”

        • Karol,
          While I agree with most of what you say, I still feel that, with the proper amount of time to allow them to mature, NewSpace might be able to bring the cost of access to orbit down, for this to happen we need multiple companies competing with one another.
          What we’re seeing here is the response of a fan & fan stands for fanatic. Having said that, we’ve been compiling a list of NewSpace troll tactics. After this latest nauseating example, I think it’s time that we posted it. The folks that behave this way need to have their tactics detailed, they need to be called to account.
          Sincerely and with thanks, Jason Rhian – Editor, AmericaSpace

  • Neil Shipley

    Let’s not be melodramatic here. Scaled Composites is developing a new engine. Sometimes accidents happen. They’ve been called on it and will likely have made sure that what lead to this accident doesn’t ‘happen again.
    Should we prevent any commercial airline that has an accident stop flying? No, that doesn’t happen.
    So let’s just move on knowing that there are risks in everything and we make provision the best we can. Sometimes not enough.

    • Neil,
      Where’s the “melodrama”? Is it “melodrama” to detail Cal/OSHA’s findings? Yeah, not so much – nice try. Sheesh, what is it with you thin-skinned NewSpacers that makes you think it’s acceptable that the facts behind accidents should not be revealed? That’s how you correct the problems and make sure that they don’t happen again. That doesn’t happen by pretending that the accident never occurred. You once described my perception of NASA as being “romantic.” Let me say this, stating (as you just did) that we should trust companies to make the right decisions for our safety? Isn’t just blindly “romantic” it is also naive, dangerous and stupid. Did you trust Exxon after Valdez? Take off the rose-colored NewSpace glasses Neil.
      Also, does this extremely generous philosophy you have toward NewSpace company safety standards – extend to established firms? I bet it doesn’t. When you hold one company accountable and another far less so, that seems…hypocritical.
      As for “move on” – in your case it’s more like, “ignore that three people died & three were injured.” Move on, I guess that’s Australian for Cover up.
      Jason Rhian – Editor, AmericaSpace

      • Neil Shipley

        Hi Jason. You seem really fired up! Don’t quite understand why exactly?

        You know, the chances are that Scaled worked out where they went wrong well before the investigating committee did, and implemented the necessary changes.

        All I was saying is that accidents happen and you hope that people learn from them. It doesn’t matter what industry, the process is the same. Accident —> Investigation —> Results / Recommendations / Requirements / Legislatation —> Changes in the industry — > Reduction in risk of accidents (one hopes). You can’t of course, design or engineer out all risk. You just do your best and in the commercial world, aim for the best cost / benefit outcome you can obtain.

        Anyway, I’m not saying that Scaled should be let off, they shouldn’t.
        But what I’m saying is that risk is a part of any business, some are riskier than others. NASA had issues with Shuttle and addressed them in the same way. Just they got bit twice. Scaled may yet suffer additional accidents but like NASA, Boeing, SpaceX, you name it, they’ll continue on trying to do better.
        This isn’t a NewSpace / OldSpace thing and I never brought that up.
        It’s simply the way the world works. Make a mistake, pay for it.

        And incidently, I’m not attacking your country so have the courtesy not to do so with mine. We all have our faults.

        You know, as an observation, the U.S. of America seem to be a land of considerable contradiction. You put up with or ignore so much that seems incredibly important and yet get fired up over something that, in the scheme of things seems pretty small by comparison. That’s not meant as an ‘attack’ incidentally, just an observation, wondering why sort of? It’s definitely noticable to many non-Americans and a friend of mine from Viginia, who’s lived in Australia for quite a while, agrees. Perhaps we’re just a bit more laid back over here. Oh well!

        Cheers.

        • Neil,
          My being “worked up” probably has something to do with the fact that people like you are trying to cover up or downplay the facts behind the death of three people. Ask yourself, if your family was killed due to shoddy safety standards – wouldn’t you want to know why & to make sure it never happened again? I got into this business when we lost shuttle Columbia. I think that might be the source of your problem. Your comments about how companies handle themselves seem very gullible & naive. I guess this stems from you having no experience with these matters other than what you’ve seen on the TV. Me, I know the men and women who fly the machines, they’re more to me than flashing pictures on my TV, they’re people I know, my friends, the people I work around. Their lives matter to me – You apparently don’t share this opinion. The fact that you’re oblivious as to how your insensitive posts could have upset anyone – speaks volumes.
          “The chances are…” What if the chances are that they didn’t fix things Neil? You seem happy to have people put their lives in jeopardy to support your movement. However, you doubtlessly would be demanding for an investigation if this wasn’t a NewSpace company.
          In the U.S. we don’t “hope” people will be accountable – we “hold” them accountable. If your family died on a SpaceShipTwo flight – would you just say, “Oh well, they’re dead – accidents happen.”?
          The problem Neil is that while yes, mistakes happens, when NASA has had one people like you have howled for blood. Turnabout is fair play. If NewSpacers want to play the game they & their supporters need to learn that mistakes have consequences. One of those consequences is that your faults will be made public.
          You keep saying how laid back Australians are, now that this works against you & I turn it back to you – you cry foul? Now that the subject turns against you you want to say it isn’t a NewSpace/OldSpace matter? Nice try, weak, but nice. Too many of your posts working against you on that matter Neil. Again – hypocrite much? As both of us are former military, I’m really disappointed you’d work so hard to excuse sub-standard work. But then I forget how biased you are.
          I’m sure that the families of the three people killed are glad you deem their death’s “small.” I’m sure that’s of great comfort to them. Glad to see you’re the typical condescending know-it-all NewSpacer & are all-to-happy to make deaths due to sloppy safety standards seem inconsequential. Three dead, three injured, but as you say “Oh well.” You know, you’re right, given how incredibly noxious & vile your comments are, who can take you seriously enough to get worked up? Then again, you’re very useful – to show readers why NewSpacers such as yourself & their opinions – are worthless. You epitomize everything wrong with NewSpace, the arrogance, the unearned moral authority the smug, condescending attitude. Your posts should scare the hell out of anyone considering to fly commercial flights into space. “Safety? Who needs safety? I’m sure they did the right thing and after all, if they didn’t – it’s such a “small” thing. In the end, if their lack of safety kills us? ‘Oh well – mistakes happen!” Read your posts Neil – that’s essentially what you’re saying.
          Sincerely and with much gratitude, Jason Rhian – Editor, AmericaSpace

  • Karol

    Moreover, I seriously question the honesty and motivation of anyone who, rather than addressing the issue of substantial safety violations bordering on negligence, chooses to attack the fairness, impartiality, and journalistic integrity of AmericaSpace. The best strategy to destroy any news publication is to impugn their motivation, to suggest bias and distortion, to make unsubstantiated allegations of “pay-offs” or “subsidies”, thereby destroying their credibility. It is far more dificult to present a cogent, factually-based, well-reasoned argument. AmericaSpace has taken great pains to be impartial, accurate, and open to honest, reasoned, respectful discussion. Statements such as, “Are you subsidized by a Virgin competitor?” do absolutely nothing to advance a logical discussion and serve only to reprehensibly attack what any sentient being who has read AmericaSpace knows to be a first-rate source of unbiased information. Even when the writers and editors have strongly held beliefs on a particular issue, they strive for impartiality and welcome intelligent opposing opinions. Any articles based upon the opinion of the editor or writer are clearly labeled as such. Agree with AmericaSpace. Disagree with AmericaSpace. In either event have the intellectual integrity and courage to address the facts and issues. Save the unsubstantiated, malicious, highly offensive, allegations of “AmericaSpace being subsidized by a competitor” for your favorite gnuspace site where the Kool-Aid drinkers of your cult will swallow anything.

    • Karol,
      Exactly. These “people” have no respect for those who were killed. They cannot defend the apparent lack of adequate safety standards, rather, all they are left with is to attack the messenger who highlights the flaws. It’s nauseating, it’s pathetic, it’s disgusting – it’s NewSpace.
      Before the trolls come out in typical howler monkey fashion – you brought this on yourself. Problems need to be highlighted – before even more people are killed.
      Sadly not even surprised, Jason Rhian – Editor, AmericaSpace

  • Neil Shipley

    Jason, the above response to my post was less than polite. Seems like you and most of the posters I’ve read on this site need to get perspective but that’s up to you.
    I can’t seem to post without being abused. Well other sites welcome my comments.
    Time will show how NASA hsf holds up in the future. I hope they do great things but honestly can’t see it happening anymore.
    Goodbye and all the best with your site.

    • Neil,
      Your comments have been less than polite to those killed. You need to gain that perspective & as usual your “that’s up to you” sounds like a proclamation from on high. I note you fail to address how your posts might be the cause of the “abuse” you’ve been receiving. AmericaSpace, unlike other “sites” doesn’t allow for people to say anything in the name of NewSpace. You can’t post without sounding condescending, disrespectful & arrogant & that has its consequences. Please stay on the sites that tolerate that sort of thing – it has no place here. So, everyone else but you needs to gain perspective? Wow. You ever consider it might be you that needs to get some perspective? No, of course not…
      Sincerely & with thanks, Jason Rhian – Editor, AmericaSpace

    • All,
      Sometimes, I get a note from someone on the inside, who, due to the current regime, has to remain anonymous for fear of reprisals. Today was just such a day. To Mr. Shiply & NewSpaniard – this is their response:

      Mr. Rhian,

      You are right about Scaled Composites needing to take responsibility for the deaths and injuries that it caused. Too many times I have seen engineers with tunnel-vision that are more concerned about mission/project success than individual safety. It is up to safety professionals to be their conscience and remind them of OSHA regulations and industry standards. My guess is that this company did not have an industrial safety professional on staff.

      I do not agree with some of the posters’ attitudes that accidents are inevitable. There is a degree of risk in everything that we do. Yes, there is a risk to the astronauts when they are launched in shuttles and rockets, which they know about and accept. However the risk to the employees on the ground should be minimal, because the company should follow regulations and industry practices. The risk that SC employees take by coming to work is not the same as the astronauts’. Just like the risk that NASCAR drivers accept is much higher than the spectators, as pointed out after the tragedy at Daytona on Saturday.

      I’m sure that Mr. Shipley would reiterate we should behave as good little NewSpace sheep – but I think that those of us who choose to think for ourselves – will decide otherwise.
      Sincerely and with thanks, Jason Rhian – Editor, AmericaSpace