Originally Posted by
L39 Guy
I will preface my response by saying that there is lots of blame to go around and when I criticize the pilots understand that this is also a criticism of their airline employer as well as their national CAA.
In all three MCAS incidents, immediately upon lift-off the aircraft was into an Unreliable Airspeed situation (stick shaker, disparity between the various airspeed indicators). This is a recall (memory) checklist - set an attitude/power setting (10 degrees/85% with flaps, 4 degrees/70% clean - don't quote me on those numbers as I am not MAX qualified), autopilot and auto throttles off, etc. This is a simple emergency procedure.
Neither the Ethiopian nor Lion Air accident aircraft pilots did this checklist. In fact, the Ethiopian Captain asked for the autopilot on, contrary to the checklist. Getting the power back from take-off to 85% or less would have most helpful in controlling the speed and hence the trim forces when manual trim was required later. I think it is fair to ask why four B737 MAX rated pilots did not do a simple, memory checklist and remember, this is along before the flaps went to zero and MCAS kicked in.
When the flaps were selected up and the aircraft was in manual flight the MCAS did its thing, namely provided an uncommanded nose down trim. Anybody hand flying the jet surely could not miss this as the trim was uncommanded, downward and produced a lot of nose down trim; manual electric trim was available including continuous nose up trim to both stop MCAS and return the aircraft to a neutral trim - this is basic flying skills. Nevertheless, neither crew did not do the Stab Trim Runaway procedure which, again, is a simple, memory checklist...manhandle the aircraft and shut off the stab trim cut-off switches. Once again, how is it that the four pilots in these two aircraft did not do a simple recall checklist? Worse, on the Lion Air flight on the same aircraft previously, the operating crew did not know to turn off the stab trim and it took a jump seat pilot from another airline to point this out.
Pilot error is too often the go to explanation for an accident and I don't like it one bit however why did these pilots, all MAX endorsed, not do two simple, memory checklists particularly the Ethiopian crew that should have been acutely aware of this issue following the Lion Air accident.
This.
But not exactly. The 737NG (I'll bet the Max is the same) QRH Unreliable Airspeed checklist, after the memory items, goes on for 4 pages of fault isolation. To accomplish one thing - configure the aircraft to continue and for a safe landing. The UA checklist is a one-size fits all, meant for any phase of flight, but a read between the lines is that the checklist mostly is meant for cruise flight. One thing the UA checklist does not say is - ignore all the warnings and flashing lights, retract the flaps and press on. Both accident crews did precisely that after not accomplishing even the memory items of the UA checklist, and after flap retraction caused the trim problems associated with the MCAS/AOA fault. Both airplanes had normal trim during the initial climbout so neither crew was facing a trim runaway. Had they promptly recognized the initial problem as unreliable airspeed, done the memory items and checklist then chances are they may have never retracted the flaps, stayed at pattern altitude and returned to base.