NTSB cites ATC error as probable cause of near mid-air collision over Gulfport-Biloxi International Airport

January 21, 2012

The NTSB cited an operational error by a tower air traffic controller as the probable cause of a near mid-air collision involving a commercial jetliner and a small private plane over the Gulfport-Biloxi Airport.

On Sunday, June 19, 2011, at 12:35 p.m. CDT at Gulfport-Biloxi International Airport, a Cessna 172 was cleared for takeoff on runway 18 by the tower air traffic controller. Sixteen seconds later, the same air traffic controller cleared an Embraer 145, a commercial passenger flight, for takeoff on runway 14, the flight path of which intersects the flight path of runway 18.

While both airplanes were about 300 feet above the airfield, the Embraer passed in front of the Cessna. The closest proximity between the two planes was estimated to be 0 feet vertically and 300 feet laterally.

The Embraer 145, N13929, operated as ExpressJet flight 2555 (dba Continental/United Express) was carrying 50 passengers and 3 crewmembers, and was bound for Houston Bush Intercontinental Airport (IAH) where it landed uneventfully.

The Cessna 172P Skyhawk, N54120, operated on a local  instructional flight carrying an instructor and a student.

No one in either airplane was injured in the incident.

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Pakistani court rejects Airblue accident investigation report

January 20, 2012

The Peshawar High Court in Pakistan rejected the inquiry report of the fatal Airblue Airbus A321 accident, judging it incomplete.

On December 20, 2011,  the inquiry report into the fatal Airblue Airbus A321 accident was submitted to the Peshawar High Court in Pakistan. The investigators concluded that the crew had violated procedures during an attempted approach to land at Islamabad in inclement weather.

The Peshawar High Court on January 20  rejected the report, stating it was incomplete and inconclusive in several aspects that were mandatory for the inquiry.  The court issued orders to the Civil Aviation Authority to constitute a board to “revisit the findings from the starting point up to the crash, within three months.”

Additionally, the chief justice called for an inquiry on the performance of Pakistan International Airlines (PIA) “regarding its crew, flying fleet, communication system, lights, landing, taking off and fitness certificates”.  He added that experts should also check the capabilities of the captains and crew members and submit its report to the court within 90 days.

Source: The News International, The Express Tribune, Dawn


EASA orders inspection of A380 for cracks in wing rib feet

January 20, 2012

The European Aviation Safety Agency (EASA) issued an Airworthiness Directive (AD), ordering inspection of certain Airbus A380 aircraft for the possible presence of cracks in the wing rib feet.

The AD states:

Following an unscheduled internal inspection of an A380 wing, some rib feet have been found with cracks originating from the rib to skin panel attachment holes (Type 1 cracks according to Airbus All Operator Telex (AOT) terminology).

Further to this finding, inspections were carried out on a number of other aeroplanes where further cracks have been found. During one of those inspections, a new form of rib foot cracking originating from the forward and aft edges of the vertical web of the rib feet has been identified (Type 2 cracks according to Airbus AOT terminology). The new form of cracking is more significant than the original rib foot hole cracking. It has been determined that the Type 2 cracks may develop on other aeroplanes after a period of time in service.

This condition, if not detected and corrected, could potentially affect the structural integrity of the aeroplane.

For the reasons described above, this AD requires a Detailed Visual Inspection (DVI) of certain wing rib feet. This AD also requires reporting the inspection results to Airbus.

This AD is considered to be an interim action to immediately address this condition. As a result of the on-going investigation, further mandatory actions might be considered.

The cracks were discovered by Airbus engineers while performing repair work to a Qantas A380 that had suffered an uncontained engine failure near Singapore’s Changi Airport. Singapore Airlines also discovered some cracks in on the L-shaped feet of the wing ribs. The feet attach the rib, a vertical fixture, to the cover of the wing.

On January 9th a spokesman for the Australian Licensed Aircraft Engineers Association demanded that all A380 aircraft should be grounded for inspections. Airbus reported that all planes were safe to fly and that the cracks did not pose a safety threat.

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FAA assigned Curaçao and Sint Maarten Cat. 2 safety rating

January 20, 2012

The U.S. Department of Transportation’s Federal Aviation Administration (FAA) announced that Curaçao and Sint Maarten do not comply with international safety standards set by the International Civil Aviation Organization (ICAO), based on an assessment of each country’s civil aviation authority.

As a result, the FAA has assigned both Curaçao and Sint Maarten an International Aviation Safety Assessment (IASA) Category 2 rating. With a Category 2 rating, Curaçao and Sint Maarten air carriers will not be allowed to establish new service to the United States, but can continue existing service. Both countries were previously part of the Netherlands Antilles, which had a Category 1 rating.

A Category 2 rating means a country either lacks laws or regulations necessary to oversee air carriers in accordance with minimum international standards, or that its civil aviation authority – equivalent to the FAA for aviation safety matters – is deficient in one or more areas, such as technical expertise, trained personnel, record keeping or inspection procedures.

As part of the FAA’s IASA program, the agency assesses the civil aviation authorities of all countries with air carriers that operate or have applied to fly to the United States and makes that information available to the public. The assessments determine whether or not foreign civil aviation authorities are meeting ICAO safety standards, not FAA regulations.

Countries with air carriers that fly to the United States must adhere to the safety standards of ICAO, the United Nations’ technical agency for aviation that establishes international standards and recommended practices for aircraft operations and maintenance.

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Loss of control and poor CRM cited in fatal Ethiopian Boeing 737 accident near Lebanon

January 17, 2012

Flight ET409 flight profile

The Lebanese Ministry of Public Works & Transport released their investigation progress report regarding the January 2010 fatal accident involving a Ethiopian Flight 409 off the coast of Beirut.

On January 25, 2010 a Boeing 737-8AS (WL) passenger jet, registered ET-ANB, was destroyed in an accident 6 km southwest off Beirut International Airport (BEY), Lebanon. All 82 passengers and eight crew members were killed. The airplane operated on Ethiopian Airlines flight ET409 from Beirut International Airport (BEY) to Addis Ababa-Bole Airport (ADD).

The flight departed at night on an instrument flight plan. Low clouds, isolated cumulonimbus (CB) and thunderstorms were reported in the area. After take-off ATC (Tower) instructed ET 409 to turn right on a heading of 315°. ET 409 acknowledged and heading 315° was selected on the Mode Control Panel (MCP). As the aircraft was on a right turn, Control suggested to ET 409 to follow heading 270° “due to weather”. However, ET 409 continued right turn beyond the selected heading of 315° and Control immediately instructed them to “turn left now heading 270°”. ET 409 acknowledged, the crew selected 270° on the MCP and initiated a left turn.
ET 409 continued the left turn beyond the instructed/selected heading of 270° despite several calls from ATC to turn right heading 270° and acknowledgment from the crew. ET 409 reached a southerly track before sharply turning left until it disappeared from the radar screen and crashed into the sea about five minutes after the initiation of the take-off roll. The flight recorder data revealed that ET 409 encountered during flight two stick shakers for a period of 27 and 26 seconds. They also recorded 11 “Bank Angle” aural warnings at different times during the flight and an over-speed clacker towards the end of the flight. The maximum recorded AOA was 32°, maximum recorded bank angle was 118° left, maximum recorded speed was 407.5 knots, maximum recorded G load was 4.76 and maximum recorded nose down pitch value 63.1°.

Probable causes:

  1. The flight crew’s mismanagement of the aircraft’s speed, altitude, headings and attitude through inconsistent flight control inputs resulting in a loss of control.
  2. The flight crew failure to abide by CRM principles of mutual support and calling deviations hindered any timely intervention and correction.

Contributing factors:

  1.  The manipulation of the flight controls by the flight crew in an ineffective manner resulted in the aircraft undesired behavior and increased the level of stress of the pilots.
  2.  The aircraft being out of trim for most of the flight directly increased the workload on the pilot and made his control of the aircraft more demanding.
  3.  The prevailing weather conditions at night most probably resulted in spatial disorientation to the flight crew and lead to loss of situational awareness.
  4.  The relative inexperience of the Flight Crew on type combined with their unfamiliarity with the airport contributed, most likely, to increase the Flight Crew workload and stress.
  5.  The consecutive flying (188 hours in 51 days) on a new type with the absolute minimum rest could have likely resulted in a chronic fatigue affecting the captain’s performance.
  6.  The heavy meal discussed by the crew prior to take-off has affected their quality of sleep prior to that flight.
  7.  The aircraft 11 bank angle aural warnings, 2 stalls and final spiral dive contributed in the increase of the crew workload and stress level.
  8.  Symptoms similar to those of a subtle incapacitation have been identified and could have resulted from and/or explain most of the causes mentioned above. However, there is no factual evidence to confirm without any doubt such a cause.
  9.  The F/O reluctance to intervene did not help in confirming a case of captain’s subtle incapacitation and/or to take over control of the aircraft as stipulated in the operator’s SOP.

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Hong Kong CAD issues final report on A340 attempted taxiway takeoff

January 14, 2012

Chart of runway 07L and taxiway A at Hong Kong

The Hong Kong Civil Aviation Department released the final investigation report into the serious incident involving an Airbus A340 that attempted to take off from a taxiway.

The serious incident occurred on November 27, 2010. The incident flight involved a Finnair Airbus A340-313X which operated on flight AY070 from Hong Kong-Chek Lap Kok International Airport (HKG/VHHH) to Helsinki-Vantaa Airport (HEL/EFHK).

The incident occurred at night time and in good visibility conditions. One of the runways was closed for maintenance.  The north runway (07L/25R) remained operational with runway 07L in use for both arrivals and departures.

Flight 070 was cleared by ATC to taxi on taxiway B westbound for departure on runway 07L. When the aircraft was approaching the western end of taxiway B, ATC cleared the aircraft for take-off on runway 07L. The aircraft took the normal right turn at the end of taxiway B towards runway 07L but then took a premature right turn onto taxiway A, a taxiway parallel to and in between the runway-in-use and taxiway B. With the help of the Advanced Surface Movement Guidance and Control System (A-SMGCS) provided in the Control Tower, ATC observed that the aircraft commenced take-off roll on taxiway A. On detecting the anomaly, ATC immediately instructed the pilot to stop rolling and the aircraft was stopped abeam Taxiway A5, approximately 1400 metres from the beginning (western end) of taxiway A.

The following causal factors were identified:

  1. A combination of sudden surge in cockpit workload and the difficulties experienced by both the Captain and the First Officer in stowing the EFB computers at a critical point of taxiing shortly before take-off had distracted their attention from the external environment that resulted in a momentary degradation of situation awareness.
  2. The SOP did not provide a sufficiently robust process for the verification of the departure runway before commencement of the take-off roll.
  3. The safety defence of having the First Officer and the Relief Pilot to support and monitor the Captain’s taxiing was not sufficiently effective as the Captain was the only person in the cockpit trained for ground taxi.

French pilot: 6 months suspended sentence in accident case

January 11, 2012

A French pilot was received a six months suspended sentence for causing an accident in Pau, France that killed one man on the ground.

On January 25, 2007 a Fokker 100 passenger jet, operated by French carrier Régional, overshot the end of the runway at Pau following an aborted takeoff. Upon crossing a road, the left main landing gear struck the cabin of a truck, killing the driver.

The BEA investigation concluded that “the accident resulted from a loss of control caused by the presence of ice contamination on the surface of the wings associated with insufficient consideration of the weather during the stopover, and by the rapid rotation pitch, a reflex reaction to a flight of birds.” BEA also noted as one of the contributing factors, that there was “limited awareness within the [French] aviation community regarding the risks associated with the icing on the ground and changes in the performance of the aircraft involved in this phenomenon”.

The pilot in command of the flight was being charged with  homicide and unintentional injuries. A criminal court in Pau decided on a six months suspended sentence and a 20.000 Euro fine for the airline.

Source: Sud-Ouest (3-1-2012)

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