B777 rejected take off. Confusion on flight deck.
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B777 rejected take off. Confusion on flight deck.
British Airways Boeing 777 engine fire warning during takeoff followed by rejected take off and evacuation. . NTSB report just out should be vital reading by all Australian operators. Successful outcome of passenger evacuation but confusion in the flight deck with an engine on fire was potentially deadly.
https://app.ntsb.gov/pdfgenerator/Re...=HTML&IType=FA
https://app.ntsb.gov/pdfgenerator/Re...=HTML&IType=FA
Augmented operations in a 2 Crew certified aircraft can throw up all sorts of negative distractions along with the “extra set of eyes” benefits. In the BA rejected T/O and evacuation, the observations and inputs from the Relief pilot certainly contributed to the successful evacuation. However less disciplined or sometimes mistaken, relief Crew present in the cockpit can interfere with decision making and checklist order. We train as 2 Crew in our renewals so we expect a certain flow and tempo while executing non normals. Too much or inappropriate feedback from extra crew can upset the running of a unannounced Electronic checklist ( Emergency Evacuation).
l am certain Australian operators with augmented crews are aware of these traps.
It is a detailed and interesting report but not sure if it qualifies as vital reading. Do you think Australian operators are prone to the same confusion ?
l am certain Australian operators with augmented crews are aware of these traps.
Have I misunderstood your point?
I wouldn’t call it confusion.
Nothing like any scenario they’d trained for.
You make the most of your experience, training and what is going on around you and do your best to stick with the script.
It never goes by the script!
Nothing like any scenario they’d trained for.
You make the most of your experience, training and what is going on around you and do your best to stick with the script.
It never goes by the script!
My point is that we can’t train for all scenarios and the next evacuation will probably have different challenging circumstances. Therefore it is not vital that we specifically prepare for this scenario as I understood the initial post alluded to.
We should be prepared for any “script”.
Still as I said it was an interesting read.
It is a detailed and interesting report but not sure if it qualifies as vital reading. Do you think Australian operators are prone to the same confusion ?
Augmented operations in a 2 Crew certified aircraft can throw up all sorts of negative distractions along with the “extra set of eyes” benefits. In the BA rejected T/O and evacuation, the observations and inputs from the Relief pilot certainly contributed to the successful evacuation. However less disciplined or sometimes mistaken, relief Crew present in the cockpit can interfere with decision making and checklist order. We train as 2 Crew in our renewals so we expect a certain flow and tempo while executing non normals. Too much or inappropriate feedback from extra crew can upset the running of a unannounced Electronic checklist ( Emergency Evacuation).
l am certain Australian operators with augmented crews are aware of these traps.
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Couple of things I noticed.
1 Autothrottle wasn’t disconnected in the initial RTO actions. See this a lot in the sim, particularly with low speed RTOs.
2. Captain did their bit of the evac checklist from memory, which resulted in the aeroplane being evacuated with the number 2 engine running for 45 seconds or so after the evacuation was ordered. While Boeing gives some flexibility to Captains to manage checklists by memory if they see fit, this doesn’t seem like the ideal time to implement this policy and could have resulted in a very serious outcome for passengers adjacent to the number two engine.
3. The FO tried to open the outflow valves in accordance with the checklist but appears to have left the switches in AUTO, meaning no manual control. The valves would have been open anyway on the ground so no biggy, but interesting to see how the FO thought he had done the checklist but appears to have missed a step.
Easy to discuss it from here while not sitting in a burning aeroplane, but it appears slowing things down just a little and reading and actioning the checklist carefully in a high workload/ stress environment with a considerable startle factor in play, may have led to a better outcome. No one died and they all walked away but there are definitely learnings to be taken away from this. I know I’ve taken something out of reading it.
1 Autothrottle wasn’t disconnected in the initial RTO actions. See this a lot in the sim, particularly with low speed RTOs.
2. Captain did their bit of the evac checklist from memory, which resulted in the aeroplane being evacuated with the number 2 engine running for 45 seconds or so after the evacuation was ordered. While Boeing gives some flexibility to Captains to manage checklists by memory if they see fit, this doesn’t seem like the ideal time to implement this policy and could have resulted in a very serious outcome for passengers adjacent to the number two engine.
3. The FO tried to open the outflow valves in accordance with the checklist but appears to have left the switches in AUTO, meaning no manual control. The valves would have been open anyway on the ground so no biggy, but interesting to see how the FO thought he had done the checklist but appears to have missed a step.
Easy to discuss it from here while not sitting in a burning aeroplane, but it appears slowing things down just a little and reading and actioning the checklist carefully in a high workload/ stress environment with a considerable startle factor in play, may have led to a better outcome. No one died and they all walked away but there are definitely learnings to be taken away from this. I know I’ve taken something out of reading it.
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Why wouldn't crews be being trained for high speed and low speed regime engine fires/failure? My airline most certainly trains for an event just like this. Startle factor always tests our true abilities and preparation.
Easy to discuss it from here while not sitting in a burning aeroplane, but it appears slowing things down just a little and reading and actioning the checklist carefully in a high workload/ stress environment with a considerable startle factor in play, may have led to a better outcome. No one died and they all walked away but there are definitely learnings to be taken away from this. I know I’ve taken something out of reading it.
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The report also mentioned that due to the delay in shutting down #2 only two exits could be used and these became “choked” by passengers trying to evacuate, a CC nightmare I imagine, pax
evacuating with their hand baggage trolleys won’t have helped either.
evacuating with their hand baggage trolleys won’t have helped either.
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I think this accident is a perfect example of how startle factor can ruin the flow of what is otherwise a ‘standard’ sim failure. A friend of mine described a similar effect with an EFATO which resulted in smoke in the flightdeck/cabin and flames visible from the engine. He said the shock made the whole scenario completely different to sim training.
Two youtube clips worth sharing:
BA 777 at Las Vegas. Around the 3:00 mark you can see the slides come out but the smoke on the far side is still being blown away from the jet blast off the RH engine. You can just see the R4/3 slides appear as well but they’re clearly being blown around until the engine is shutdown.
Dynamic Airways 767. As soon as the first rear slide appears you can see it being blown away by the jet blast from the RH engine. Makes it quite difficult for the pax to use.
Two youtube clips worth sharing:
classic bang just before V1 with a fire. A standard sim exercise
Pull up to a stop and halfway through the drills the instructor says ‘Yep that’s great, let’s move on to the next lesson’.
Nothing like a real fire to ramp it up to the next level.
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That’s my point. A Sim exercise. You know it’s coming and you’ve gone through it the night before, verbatim.
Pull up to a stop and halfway through the drills the instructor says ‘Yep that’s great, let’s move on to the next lesson’.
Nothing like a real fire to ramp it up to the next level.
The sim is always trained to do an Evacuation, and never is a scenario given where a thought process developed of whether an evacuation should be done, or would it be better to keep the pax in their seats? The scenario is always created where the pilots MUST do an evacuation to tick the box in the matrix. So when it happens for real, and the crew have to actually consider what they are going to do, they haven't trained for any form of decision making during such an event where the adrenaline will be high. The sim events are just a case of playing it by numbers. Fire before V1, stop, Evacuate. So they are trained to be robots, which as this event has shown, may not result in the best handling of such an occurrence.
and never is a scenario given where a thought process developed of whether an evacuation should be done, or would it be better to keep the pax in their seats?
The sim events are just a case of playing it by numbers. Fire before V1, stop, Evacuate. So they are trained to be robots, which as this event has shown, may not result in the best handling of such an occurrence.
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Curious about this CB. What aspect of LAS ATC are you critical of? If you are referring to the YouTube video, be aware the ATC audio is not in synch with the video. ATC had already activated the fire services before the aircraft asked for them.
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A bit harsh to say that there as confusion, when you watch it in real time the stop to evacuation seems entirely reasonable to me. Sure it could of been done ‘better’ but I just hope that given a similar set of circumstances I can be in the pub later on reflecting on the successful evacuation of all on board with no serious injuries. I thought the report showed a crew who worked particularly well together to ‘trap’ each other’s lapses and generate a successful outcome, that is why there is two or three of us. Well done to the cabin crew as well who seem to have made excellent assessments of their respective doors and if they should be used.
Originally Posted by Willadvise
What aspect of LAS ATC are you critical of?
It is obvious there was "procrastination" in the cockpit and in fact, the Evacuate command only came after the jumpseater came back from the cabin. I can't help but think that if ATC has said "you're ablaze", the evacuation would have come much earlier.
Liked the yank who said it looked like a brake fire... and Ground One asking to close the runway.
