Just in from the ATSB
SAFETY ACTION
Aircraft operator
On 17 April 2009, the aircraft operator informed the Australian Transport Safety
Bureau that based on their internal investigation the following areas were under
review:
•
human factors – including review of current pre-departure, runway
performance calculation and cross-check procedures; to determine if
additional enhancement is feasible and desirable, with particular regard to
error tolerance and human factors issues.
•
training – including review of the initial and recurrent training in relation to
mixed fleet flying and human factors.
•
fleet technical and procedures – including introduction of a performance
calculation and verification system which will protect against single data
source entry error by allowing at least two independent calculations.
•
hardware and software technology – including liaising with technology
providers regarding systems for detecting abnormal take-off performance.
Subject: More on Emirates - close call at YMML.
Emirates flight 407: seconds and centimetres from death
Ben Sandilands writes:
Emirates flight EK 407 and the 275 people on board were seconds and centimetres from a fiery death when it left Melbourne Airport, still touching the ground, on a flight to Dubai on the night of 20 March.
The critical moments of this incredibly screwed up takeoff have been laid bare in words and graphics in the preliminary factual report into the accident released today by the Australian Transport Safety Bureau.
It happened because the pilots entered the wrong weight figures into the flight management computers -- they were 100 tonnes under the true weight -- and didn’t engage full thrust until they reached the end of the 3657 metre runway and hitting navigational antennas and lights at a velocity of 290.8 kmh.
The Airbus A345 didn’t begin climbing until it was still blasting over grassy slopes slightly lower than the end of the runway and 292 metres beyond it pointed in the general direction of Keilor Park.
The jet then climbed to 7000 feet and did a fuel dump circuit over Port Phillip Bay before making an emergency landing back at the airport.
No-one was injured. The jet may have been damaged beyond repair and the pilots, who appeared to have flown more hours than many pilots would consider normal or prudent in their previous 30 days, have "resigned" from Emirates.
The airline is quoted by the ATSB as saying it will review some of its procedures.
These are the critical moments as detailed by the preliminary accident report.
The jet was using (as almost all airliners do) a reduced thrust "flexible" take off process that saves on engine wear and tear but is calculated to produce a safe takeoff, even with an engine failure, on the runway available, provided the data used by the flight management computers is the RIGHT data.
It began its take off roll with 3540 metres of the 3657 metre runway available. Not until 61 seconds later does the first officer start to rotate the nose of the jet up with 964 metres of runway left after a very leisurely take off roll.
About a second later the nose of the jet is pulled back much harder and higher. Eight seconds after this with 229 metres of runway left the first of three damaging tail strikes occur.
Two seconds later the jet has run out of runway and is smashing through lights and antennas in an extreme nose high attitude.
Almost immediately, and 115 metres past the end of the runway the main gear wheels register as "uncompressed" meaning they off the ground.
A further seconds later and 292 metres beyond the end of the runway and over falling ground a positive rate of climb is achieved.
But almost a minute passes before the wheels are retracted, cleaning up the air flow of the jet and aiding its ability to climb.
The captain had flown for 98.9 hours in the previous 30 days, or nearly 20 hours longer than most Qantas pilots might expect from a roster, while the first officer had racked up 89.7 duty hours.
These factual disclosures by the ATSB ought to cause a serious review by Emirates of key aspects of its operations.
Or they could set the scene for a truly horrific accident if left unaddressed, and one which no amount of generous sponsorship deals could ever overcome.
(Reference: Crikey, 30/04/09)