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Old 24th Mar 2009, 16:43
  #4122 (permalink)  
Arthur Rowe
 
Join Date: Nov 2005
Location: Vale of York
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Flipster, I agree with everything you say in your post. Unfortunately there has long been a philosophy in the RAF to 'blame the pilot' in the event of an accident. I am reminded of an accident to an F4 on an instrument approach to Leuchars one night from over the North Sea. An engine fire indication illuminated and the engine was shut down. The approach was continued on one engine until the 'good engine' lost thrust. The crew ejected and were rescued but the aircraft wreckage was never recovered.

A fleet check was carried out and it was discovered that several aircraft were cross-wired so a fire in one engine would indicate on the other engine. The Board of Inquiry deduced this was probably what had happened on this occasion. The pilot had shut down the good engine because the warning was for that engine. The engine that was on fire had eventually failed and that was the cause of the loss of thrust. The accident was the result of a technical problem. However, the Reviewing Officer decided that this was not the case; the pilot had misidentified the engine which had been on fire and had closed down the wrong engine. The cause was therefore Pilot Error.

Aircraft accidents can have many causes that may never be identified, particularly if evidence were to be destroyed in a post-crash fire. Even a cause such as the wrong length of a piece of string. A Dragon biplane was being displayed at an air show when it did a wing-over from which it never recovered, just diving into the ground. The pilot was killed. From a bystander's point of view it could have seemed like a simple case of pilot error. However the aircraft did not catch fire and evidence of the cause was recovered from the wreckage.

The pilot's seat was fitted with a Sutton Harness. When in use, the seat straps are secured onto a central spigot by a split pin. To prevent losing the split pin when it is not in use it is tied onto the harness with a piece of cord. At some time in the past the cord had become worn and been replaced. Unfortunately the new piece of cord was longer than the one it had replaced. During the display, when the pilot manoeuvered into the wing-over he pulled back the control yoke, applied aileron, and tragically the cord on the harness slipped over the parking brake lever on the right hand side of the yoke. Had the cord been the correct length this would not have happened. The pilot could not now roll the wings level nor move the control yoke forward and the aircraft spiralled into the ground.

I note that all the civil Air Accident Investigation Branch Accident Reports that I have read are written to simply state the known facts and do not indulge in speculation. They go into considerable technical detail but do not attempt to allocate blame. Perhaps the RAF should adopt a similar approach.
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