PPRuNe Forums - View Single Post - Jet goes down on its way to Medellin, Colombia
Old 21st Dec 2016, 12:24
  #983 (permalink)  
A0283
 
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Thanks for responding.
@YRP
But A0283 surely any root cause(s), if there are multiple causes for this particular accident, had to be before the departure. … But anything that happened after they pushed the throttles forward on departure is just reaction not cause.
That depends on definitions. Some may find that academic, but aerospace is ‘art and science’ if we like it or not. If you use the word “cause” then you would have to define the difference between root and general causes. Root suggests main or single. If you use the word “cause” at all, then in my perception an accident always is a series of (minor, medium, major,...) causes. A cause would then be something going wrong that is not limited (minor,medium, major,...) by the ‘aerospace system’. There are a lot of ‘limiters’ in the system, examples are redundancy, training, experience, procedures, rules, etcetera. For an accident to happen you need multiple causes with multiple limiters failing along a specific timeline. Based on that, your “reactions” are causes. Also, reaction may not be a conventient word. In some cases accidents happen because people/systems react, but in others because they do no react. So in general you will have multiple causes even after you push the throttles forward. After takeoff the FO might have said “we will not be able to make it” and say “I take control and we return”. The FO might have reacted to the low fuel warnings (if they got them) by a Pan or Mayday... etcetera. In each case there would probably be serious @#$%, but not an accident.

@SteinarN
Regarding the root cause, I would say it is simply that the airline company and the pilot/owner was a "cowboy" totally neglecting any prudent planning and industry standard for flight planning, safety margins, CRM and whatever. So, the root cause goes well before what happened on the departing airport.
If it turns out that the company/pilot was a ‘cowboy’ then big questions would be how did they get in that position, how did they stay in that position (introduce Venezuela), and even why they and their crews survived for such a long time. Which means you also have to look at the multiple causes and limiters in the years before and on the pre-departure side. Indeed well before what happened on the departing airport.

@Finally, accident reports generally talk about cause(s) and contributing factors. In some cases the investigation runs into issues that are neither but should be mentioned. In this case doubts about the quality and consistency of the various AIP maps should be mentioned.
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