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Old 23rd Sep 2008, 01:32
  #1969 (permalink)  
Join Date: Jan 2008
Location: Herts, UK
Posts: 746
100 pages and 2000 posts...

What occurs to me now is:

Including Madrid, there have been 'at least four'* occurences of DC-9/MD-80 take-offs without flaps/slats being set where the TOCWS hasn't worked....

ZQA297/30's Post #919

This does not endear one to the current (disparate) approach taken to collect and disseminate incident data, or co-ordinate and enforce effective preventativeactions... be it hardware, software, SOPs, training.

I have been re-reading the full Court of Inquiry into Trident/LHR/Staines fatal accident (1972 )
l.e. devices raised 60 kts and 2 miutes early in climb-out (apparently inexplicably, no VCR then)
Very experienced Captain on type, (3 others in cockpit) - but was stressed (possibly to point of subtle incapacitation)
Not specifically trained for that one eventuality (a configuration stall (rapid onset) and the shaker/stick push coming almost together)

It was thought at the time that this inadvertant device retraction was totally unprecedented, yet it was found subsequently that it had occurred twice before in the same airline: a knowledge trail was there, though a weak one.
There were many other factors of course, as always, mainly indirect ones (noise abatament profile just intiated, an unfortunate SOP etc)
NB. Many inquiry recommendations, one of which was '... nobody allowed in cockpit without a flying role or under training' i.e distraction by occupants of 4th seat

In both cases the aircraft wouldn't fly as expected and the crew couldn't work out quickly enough why - configuration!

The point - Prior warning information in both cases existed, but bureaucracy played its inevitable role and was 'downgraded' in relevance... eventually to be lost in the ether.

Yet another accident that couldn't/shouldn't have happened...but did.

* but how many has there actually been, 5, 6, 10 ?

Last edited by HarryMann; 23rd Sep 2008 at 09:51.
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