JetBlog! Interactive

Pilot error not to blame for Madrid air crash, say investigators

The preliminary report by investigators into the Madrid air crash appears to absolve the pilots of any blame for the accident which killed 154 people. The crash on August 20 is blamed on a fault which prevented the wing flaps from opening on the Spanair MD-82.

Initial findings by the Civil Aviation authority show the pilots followed recommended protocol in the moments leading up to the crash of flight JK5022, which was bound for Las Palmas in the Canary Islands.

Evidence from the black box data recorder indicated that the pilots made the appropriate checks on take-off but that an alert system in the cockpit failed to warn them that the wing flaps had not deployed correctly.

Two other alarms, warning of nearby ground and imminent stall, did work as the pilots struggled to gain control when the plane left the runway at Barajas airport.

Qantas probe focuses on flight control system 'irregularity'

Investigators are focusing on a potential irregularity in the flight control system of a Qantas Airways Airbus A330-300 that experienced a sudden nose pitch down mid-flight resulting in around 74 people on board being injured on October 7.

The pilots received centralised aircraft monitoring messages to say there was "some irregularity with the aircraft's elevator control system", the Australian Transport Safety Bureau (ATSB)) says in a statement today.

This statement is referring to an accident yesterday afternoon while the aircraft was at 37,000ft (11,280m) en route from Singapore to Perth.

The aircraft "climbed approximately 300ft...during which time the crew had initiated non-normal check-list and response actions", says the ATSB.

Then the aircraft "abruptly pitched nose-down, [and] during this sudden and significant nose-down pitch, a number of passengers, cabin crew and loose objects were thrown about the aircraft cabin, primarily in the rear of the aircraft".

This resulted in "a range of injuries to some cabin crew and passengers" including broken bones.

ATSB says the pilots first made a 'pan pan' emergency broadcast to air traffic control but a few minutes later called 'mayday' and requested clearance to land at Learmonth rather than continuing to Perth.

"The aircraft landed at about 15:30 local time, about 40min after the start of the event."

ATSB says the event has been classified as an aircraft accident because of the nature of the injuries.

It says of the 303 passengers and 10 crew on board, 14 people had serious - but not life threatening - injuries.

An additional group of up to 30 had serious enough injuries to receive medical treatment in hospital and up to a further 30 required first aid treatment, it adds.

ATSB says it currently has seven investigators examining or about to examine the aircraft plus Australia's Civil Aviation Safety Authority, France's Bureau Enquetes-Accidents and Airbus are involved in the investigation.

It says it plans to issue a preliminary factual report within 30 days.

Qantas says in a separate statement that the severely injured people on board the aircraft were airlifted from Learmonth to Perth by Australia's Royal Flying Doctor Service. Other passengers were flown to Perth on Skywest Airlines, it adds.

Learmonth is an airport and airbase south of Exmouth, a remote town near Western Australia's northwest coast.

Qantas' A330-300 remains in Learmonth because the ATSB is inspecting it, says the airline.

The airline's CEO, Geoff Dixon, says the carrier is assisting with the investigation and the aircraft's flight data recorders and cockpit voice recorders have been removed and will undergo assessment.

According to Flight's ACAS Daily Alert the A330-300 involved has local registration VH-QPA.

Source: Air Transport Intelligence news

Article: Business aviation shows its safety weaknesses

By David Learmount
Flightglobal

Business aviation is subject to US and international safety initiatives that appear to be welcomed by the industry, but statistics suggest many operators are not getting the message. Runway excursion resulting in serious damage, one of the accident types theoretically among the easiest to eliminate, occurs regularly.

In 2007 there were 10 reported serious runway excursion accidents involving business jets, almost all in the USA. To late September the number of business jet excursion accidents was five. The Flight Safety Foundation, which studied 251 business aircraft accidents from 1991 to 2002 recently, found that 63 of them (25.1%) involved runway excursions.

Speaking at the European Business Aviation Association Conference and Exhibition in Geneva this year, FSF president Bill Voss highlighted runway safety in all its forms as being worthy of particular attention, but excursions in particular. He said: "Data shows runway excursions are the most common type of runway safety accident (96%) and the most common type of fatal runway safety accident (80%)."

The US National Business Aircraft Association has registered the industry-wide concern with the number of runway excursion accidents and reiterated the message to its member operators. Heightened concern followed the Federal Aviation Administration runway safety awareness campaign after the National Transportation Safety Board's publication of its report on an overrun from a snow-contaminated runway at Chicago Midway airport in December 2005. The fatal Comair Bombardier CRJ100ER crash in 2006 gave rise to new terminology describing a potentially serious runway safety risk: "runway confusion" - using the wrong runway without realising it. But, as Voss pointed out, among all categories of runway safety events, runway excursions produce 80% of the fatal accidents.

Collision risk high on U.S. airport runways: safety expert

The rate of close calls on airport runways in the United States is up over last year and the risk of a collision is high, a U.S. government investigator said Thursday.

Gerald Dillingham, the General Accountability Office's top expert on aviation safety, told a House of Representatives panel that there were 24 of the most serious kinds of runway incursions — defined as an event in which any aircraft, vehicle or person intrudes in space reserved for takeoff or landing — in fiscal 2008. Download gao_rw_incursions_092508_d081169t1.pdf

That's the same number of serious incursions as last year. But since air travel and airport operations have declined this year, the rate of serious incidents — measured by number of incidents per one million takeoffs and landings — has increased about 10 per cent, Dillingham said.

Both the number and rate of all types of runway incursions, ranging from near collisions to minor incidents in which there was no threat to safety, also are up, he said.

"We all agree … that [the Federal Aviation Administration] has given a higher priority to runway safety," including following several GAO recommendations, Dillingham said. "Despite these actions the risk of runway collisions is still high."

Serious incidents down from high of 53 in 2001
FAA Chief Operating Officer Hank Krakowski said the agency has made "solid progress" this year. He noted that the 24 serious incidents in 2007 were down from a high of 53 incidents in 2001.

Wing flaps and alarm failed on Madrid crash jet

Wing flaps failed on the Spanair flight that crashed last month and an alarm that is supposed to warn pilots of the problem never sounded, according to a preliminary report yesterday on the accident that killed 154 people.

The investigators did not say whether they believed the flap fault caused the 20 August crash in Madrid that killed all but 18 people on the MD-82.

Investigators said they needed to further study a faulty air temperature gauge outside the cockpit, a problem that forced the pilot to abandon a first attempt to take off.

Spanair has described it as a minor glitch that was resolved by turning off the gauge. The plane crashed an hour later on its second attempt to take off.

However, the report said the faulty gauge might be linked to the failure of the cockpit alarm horn, which is supposed to sound when a departing plane is not properly configured to get off the ground.

The findings were drawn from the flight data and cockpit voice recorders.

FMI: The Scotsman

When a Tragedy Becomes a Crime: Prosecutors Probe Air Disasters

By DANIEL MICHAELS
Wall Street Journal
As investigators search for clues to the crash of Spanair SA Flight 5022 in Madrid last month, families of the 153 victims demand to know who is to blame. Another critical question: whether that will be determined in civil or criminal court.

For six decades, aviation regulators have sought the causes behind and responsibility for plane accidents. Victims' families have sued for damages with civil suits.

Lately, however, public prosecutors are seeking criminal accountability for mistakes that lead to air disasters, raising a thorny legal and moral question: When does human error become a crime?

"It's a Nobel Prize question, figuring out how to coordinate civil and criminal law enforcement," says Harvard Law School professor David Rosenberg.

While it isn't yet clear whether the Spanair crash will prompt criminal charges, several air accidents in Europe this decade have. One of the latest cases stems from the Air France Concorde crash in 2000 that killed 113 people. (That was before the carrier became Air France-KLM SA.) French prosecutors have charged five people and Continental Airlines Inc. with voluntary manslaughter. Among the defendants are three engineers who designed and certified the supersonic plane more than 30 years earlier. Continental and two of its employees are included because a piece of metal that crash investigators believe dropped from one of its planes is suspected of initiating the crash. All the defendants deny the charges.

National justice systems draw the line between civil and criminal cases differently. The U.S. has a range of civil penalties -- such as fines and punitive damages against individuals and companies -- that don't exist in many European legal codes, says Anthony Sebok, a professor at New York's Benjamin N. Cardozo School of Law.

In general, countries try to set a high bar for pressing criminal charges. The U.S. usually demands evidence of reckless behavior or gross negligence. In the wake of a 2003 Staten Island ferry crash that killed 11 people, for example, federal prosecutors won prison sentences for the captain, who had passed out on painkillers, and his boss, for failing to enforce rules requiring two pilots in the wheelhouse.

Wing failure focus of FAA crash probe

BY RAY HAGAR
RGJ.com

An investigation into Saturday's fatal crash of a pilot practicing in a home-built aircraft for the Reno National Championship Air Races will focus on why the wings came off, a federal official said Sunday.

Formula One racer Erica Simpson, 32, of Phillipsburg, N.J., was killed about 9 a.m. while preparing for her second year of competition at Reno Stead Airport.

"She went into a roll. She was demonstrating a roll, and the wings came off," Federal Aviation Administration spokesman Ian Gregor said. "That is what the investigation will center on."

Simpson, a commercial pilot raised in Port Wing, Wis., competed in the biplane class in 2006. She was flying a single-engine Cassult IIIM on Saturday.

Three pilots were killed in competition during last year's air races. There have been 19 fatalities in the 45-year history of the event.

The danger will prompt FAA officials to take extra precautions before the races begin Wednesday.

Japanese suspect missing washer led to 737 fuel tank fire

A Japanese investigation, into a China Airlines (CAL) Boeing 737-800 that had a fuel tank fire last year, has said it is highly possible CAL maintenance personnel failed to attach a washer to the bolt on the right wing slat and that is why the bolt moved, puncturing the fuel tank.

Japan's Aircraft and Railway Accidents Investigation Commission made the remark in its preliminary report into the CAL 737-800, local registration B-18616, that caught fire on 20 August last year soon after landing at Naha airport on the southern Japanese island of Okinawa.

The commission disclosed last year that it had found a bolt on the 737-800's right wing slat that had pierced the fuel tank creating a 2-3cm hole.

The fuel leaking from the tank then ignited creating a fire that completely destroyed the aircraft and led the 165 people on board to disembark quickly to safety.

But until the release of the preliminary report, the reason for the bolt moving had always remained unexplained.

The Aircraft and Railway Accidents Investigation Commission says since the incident Boeing has changed the design of the bolt nut to make it larger.

CAL has responded to the preliminary report by issuing a statement saying it "reviewed its maintenance records and confirmed that it completed the required inspections in a timely manner on its 737-800 aircraft" and in accordance with "Boeing's service letters and service bulletins."

"The aircraft involved in the incident completed its inspection from 6-13 July 2007, prior to the event in Okinawa," it adds.

Source: Air Transport Intelligence news

Spanair MD-82 struck terrain tail-first: investigators

Spanish investigators have disclosed that the Spanair Boeing MD-82 which crashed on departure from Madrid Barajas last week descended and struck the ground tail-first while struggling to climb away.

The aircraft travelled for 1.2km, hitting terrain three times before coming to rest.

Spain's Comision de Investigacion de Accidentes e Incidentes de Aviacion Civil (CIAIAC) revealed the information in the first update on the inquiry's progress since the 20 August accident which killed 154 of the 172 on board the jet.

It says that no marks or debris from the aircraft were found on the runway. Initial impact marks have been discovered to the right of the runway, indicating that the aircraft struck tail-first and that a section of the tail - possibly the tail-cone, which can detach to aid evacuation - came away.

The investigation agency has not confirmed the angle of attack of the aircraft at the point of impact.

CIAIAC's Francisco Javier Soto states: "[The MD-82's] movement along the ground lasted approximately 1,200m."

There is no firm indication of the height the aircraft achieved before it descended.

Specialists in the UK are extracting information from the cockpit-voice and flight-data recorders retrieved from the aircraft.

The aircraft's Pratt & Whitney JT8D-217 engines, thrust-reversers and auxiliary power unit have been recovered and stored for examination, along with some of the MD-82's avionics.

No conclusions have yet been reached over the status of the aircraft's engines or other systems at the time of the accident. The investigators are still collating data from several sources, including video surveillance, airport radar, air traffic control and maintenance personnel.

CIAIAC says that it is required to produce an initial factual report on the accident within a month.

NTSB issues brief Factual Report on Spanair Crash

NTSB Identification: DCA08RA090
Scheduled 14 CFR Non-U.S., Commercial operation of Spanair
Accident occurred Wednesday, August 20, 2008 in Madrid, Spain
Aircraft: Boeing MD-82, registration: EC-HFP
Injuries: 154 Fatal, 18 Serious.

On August 20, 2008, at 1245 local time, Spanair Flight JK5022, a Boeing MD-82 registered in Spain as EC-HFP, crashed upon take-off from Madrid Barajas International Airport, Mardrid, Spain. The flight was destined for Las Palmas De Gran Canaria Airport, in the Canary Islands. The aircraft was destroyed during the accident and 154 fatalities were reported. There were a total of 172 people on board. The Spanish Civil Aviation Accidents and Incidents Investigation Commission (CIAIAC) is the lead accident investigation authority. The NTSB sent a US Accredited Representative along with technical specialists to assist the CIAIAC.

For additional information on this accident investigation, contact the CIAIAC or check their website.