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Old 25th Aug 2008, 22:54
  #907 (permalink)  
ZQA297/30
 
Join Date: Jan 2002
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I am not going to speculate on the specific cause of the accident, but will submit that it will eventually be attributed to the conjunction of a number of adverse factors.

I will illustrate with an incident that happened to me thirty odd years ago.

Taxiing out in DC-9-34, route training flight, trg Capt in RHS.
Shortly after we entered the runway backtracking (checks completed "down to the line"), got message, "please return to ramp XXX (senior civil aviation dept official) wants to talk to you.
Turn onto taxiway and official comes on radio requesting medevac for a seriously ill female. When asked if patient has Doctors certificate, answer negative. Sorry, unable to accommodate without certificate. Taxi back onto runway and proceed with takeoff.
Climbing out through 400' starting departure turn, experience some gusty turbulence and a couple of momentary stallwarning/stickshaker. WTF???
Stall recovery, flaps 15, max power.
The source of our problem then became apparent; flap/slat retracted.

Trg capt had retracted them as we cleared runway heading for the ramp, and then became involved in the decision on the medevac request. I failed to re-check (that vital PanAm et al last double-check) configuration because of numerous distractions, on PA to pax (explaining turn on to taxiway then back onto runway), checking with FAs etc.
The warning system had failed.

What broke the chain of events-luck. The aircraft was relatively light, full pax but short sector fuel. I was in the habit of fairly gentle rotation when plenty of runway was available, so we breezed through the critical zone totally unaware of how lucky we were.

Incidentally the medevac patient turned out to be the daughter of an even more senior Civil Aviation official, and she turned out to have acute appendicitis. The official called me to say I may have saved her life according to the doctor, if she had flown in that condition the appendix could easily have burst causing dangerous complications. Luck again.

PS. Prior to this incident flap/slat warning check was once per detail, it then became prior to each flt.

Last edited by ZQA297/30; 15th Sep 2008 at 23:53. Reason: add ps
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