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Written in Blood

 



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Posted August 13, 2013

That phrase has such a dramatic, gruesome ring to it. I used to see it in Approach articles about what we now would call a “willful violations,” except it was during the years before we recognized the complexity (and lethality) of human factors. Back then it was just guys being dumb, lazy or reckless.

“Follow the checklist! It was written in blood!”

Alas, like everything else safety-related, the phrase eventually became just another cliché to help put people to sleep. Which is a shame, because there’s a reason why such phrases become clichés — they’re true. “Look before you leap.” “A stitch in time saves nine.”

I often saw the phrase in relation to NATOPS, perhaps because aviation had more than its share of flaming death and destruction. I remember thinking that it would be more effective in NATOPS if the words were printed in blood-colored ink with little pretend drops coming off them, with a footnote citing the actual mishap. Today, in digital versions, you could hyperlink the new warning or procedure to a description of the mishap that triggered it.

Writing lessons learned in figurative blood isn’t a military thing. I used to ride around in rural Nebraska with my uncle. We’d come to an occasional intersection or a curve where a black-and-green skull-and-crossbones sign had been posted by a local insurance company, marking a fatal wreck.

"Written in Blood" graphic

At the Atlantic Ocean end of Shore Drive in Virginia Beach, there used to be a huge billboard that specified how many people had died in wrecks during the past couple decades. I always find Shore Drive — a winding, tree-shrouded road between First Landing State Park and the boondocks of Joint Expeditionary Base East — to be a pleasant relief from strip malls and traffic lights. Drunks heading inland at 2 a.m. find it treacherous.

A few miles inland on Shore Drive, you arrive at Lesner Bridge, where the Chesapeake Bay meets the sprawling Lynnhaven River. In the permanent shade beneath the bridge, another billboard announced how many people had drowned in the powerful currents while fishing or crabbing.

Writing this blog, I was casting about for an actual example of “written in blood” when a watchstander on a submarine drowned. He had been complying with the rules for wearing a personal flotation device (PFD); as a direct result of this fatality, the rules were expanded to include what he’d been doing. In this case, PFDs are now mandatory all the time for topside watchstanders on submarines, not just after dark or in bad weather.

It would be nice if everybody understood and remembered why the new rule is in place, and if that awareness made them extra careful about complying. But people forget the original mishaps. A traumatic event becomes a mere statistic, lumped into a line chart.

It’s hard to keep people from rewriting lessons in their own blood.

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