Thank you, Hisdudeness, for the guidance. I do understand that investigations of this nature take long. I will try to go the routes you suggested. Also, will go via PN next time

@Westwind1950
 

Thanks for the clarification re BFU report on the 2009 King Air crash at Egelsbach. I agree that speculation can lead one up the wrong path. This forum though does provide me with perspectives from experienced pilots that I won't otherwise have, so I read them, knowing that evidence turned up in the investigation might prove the speculation wrong.

@searchingforanswers and @lostourlovedone

The Mayday Foundation ("Stiftung Mayday") is helping the families of crew that perished in aviation accidents. If you are facing financial hardship due to your loss, you may want to get in touch with them. Their web page is currently only available in German, but the English version should be on-line again in May.

www.english.stiftung-mayday.de/index.php

Stiftung Mayday
 

Correct Links:
Stiftung Mayday - English version (English Home, no content at this time)
Stiftung Mayday (German Home)

Thanks, wozzo

I was interested to read this article posted by the Pilot who has been mentioned on this thread. Very sad reading, such an industrious, driven chap who realised the constraints of time and money on his chosen career, but persevered and had seemed to get the chance to fulfill his dream.
I'm sure Captain Jose's experiences are not unique, and that other aviators have experienced similar adversity in attaining their chosen profession, but I find his brief but very honest account of how he reached the position he had most poignant given the circumstances of what happened at Egelsbach.
Harry
Jon Jose

I would like to see some serious research done into the impact of commercial pressures on the safety of small-fleet business jet operations.

Small companies with only one or two aircraft on an AOC often have serious cash-flow problems, meaning the company can go under even if one or two sectors are loss-making (eg having to divert to an alternate, ore even de-ice). When a captain faces the prospect of losing his employment if he diverts, then he has a large incentive to take an unacceptable risk. If the captain also has a stake in the business (as here) then the incentive is even higher.

I myself have been put in such a position before, but luckily am still here to tell the tale. I've now made a personal decision to never again fly for small-fleet companies, as I don't ever want to be put into that situation again.

@Trim Stab... I think you missed something. In this case, the PIC was the owner/operator himself so any pressure here he put on himself. At least, that's the way things look at the moment. Final details are not out yet and may not be for some weeks/months to come.

Do you have ANY proof whatsoever for this accusation ?

I have managed a 1 and later 2 A/C company for 4 years and was involved in doing so for 14 years and we NEVER were close to shutdown for the loss of de/cing etc. Gear overhaul, engine overhauls...that could get you in trouble, surely, but 2 sectors with a loss? When a company is so close to being bankrupt, than it is too late already IMO.

I didn't make any allegations so there is no need for "proof". I simply suggested that it would be an interesting topic for further research.

I can certainly give from my own experience of flying with a small-fleet operator examples of situations where the captain/AOC stakeholder has taken substantial (and illegal) risks due to commercial pressure.

You didn´t?

so is fact or fiction ?

How about: Fact? Fiction? Not an allegation?

You're being pedantic. Maybe your company is an icon of perfect management, but many small companies in any industry sector struggle from month to month. As I wrote, it would be an interesting topic for further research in aviation human factors.

Granted, in this case I was.

This might be the case, but I wonder then what the authorities are up to. We had to report the financial situation regularly, 4 times a year, not only the 80.000€ available... and month to month sounds a tad different than your first statement doesn´t it?

Most certainly not, otherwise I would have pursuit a career in management.

Let's don't argue over semantics. I think everyone understood what "Trim Stab" wanted to say and also that "The Dude" ;) luckily never had to work for such an outfit. It also depends on the country that your company is based in etc.

Intermediate report
 

BFU (German Air Accident Investigation Bureau) has just released a first intermediate report in German, see page 16.

Can some experienced bizjet driver shed some light on the events, as I don´t know about Citation SOPs ?

His dudeness, you have control.

Hello!

I think you can best understand what went on, when you read the safety recommendations issued by the BFU on pages 45 and 46. A short translation:

11/2012: Until recommendations 12/2012, 13/2012 and 14/2012 have been put in place, VFR night approaches for high performance aircraft to Egelsbach shall be suspended.

12/2012: The visual approach procedures to and from Egelsbach shall be revised. The description shall be simple, easily understandable and free of contradictions.

13/2012: The definition of High Performance Aircraft (HPA) with relation to Egelsbach shall be supplemented by the speed term Vref. It shall be guaranteed that HPA aircraft can fly procedures and traffic patterns safely with their relative Vref.

14/2012: From the visual approach charts of Egelsbach it shall be evident that due to the obstacle situation the final approach must to be flown at an angle of 4.4 degrees. The obstacles shall be clearly marked on the chart.


I do not know about any „Citation SOPs“ (although I fly Citations myself, but not this model). We fly according to our company SOPs. Therefore I do not know whether their high approach speed (285kt initially - the AIP entry for Egelsbach gives a maximum approach speed of 160kt), their late configuration and their excessive descent rate on final approach (> 2500ft/min) was in accordance with _their_ standard way of operating this aeroplane or not. I also do not know why they entered a different waypoint (ECHO) into their FMS when instructed to follow the published HPA approach via Yankee One and Yankee 2 (they read back this instruction!). Not that it matters much, both routes cross the same ridge of obstacles.

So as usual we will have to wait for the final report.

But operators with an AOC ar the safest operators FACT.

The CAA say it is so.

Hello!

???

I fail to see the connection of your statement with this interim report.

But had they been operating on an AOC, there would have been some minimal common training/operating standards and some very basic operating procedures at least. Whether or not the crews adhere to those is something completely different of course. Like flight preparation (Egelsbach really is an airfield that one has to familiarise himself with _before_ flying there at night in marginal weather) stability criteria for continuing the final approach or reaction to GPWS warnings: The power settings for both engines remained at 34% (idle?) after they had heard first "SINKRATE PULL UP" and then "TOO LOW TERRAIN". (BTW: The timeline given in the interim report regarding the GPWS warnings does not make sense.)

EGPWS
 

I picked up the throttles staying at 34%, rather than TOGA (or equivalent) being selected. What should have been the proper timeline for the EGPWS to function as expected?

Hello!

The manual of "our" EGPWS (Honeywell MK V and MK VII - don't know if the Citation X has the same one on board) says (not aircraft specific!):

In case of (PULL UP and WINDSHEAR are warning alerts):


These manoeuvers are practised on every recurrent training in the simulator. Yet they never increased power and they did not disengage the autopilot, but used the pitch wheel instead to slowly raise the nose of the aircraft. Who knows why.

What I find most curious is that towards the end of the summary, when they struck the trees, the BFU noted "The autopilot was engaged at this point".

How comes there was no sign to do an AP disconnect and execute a GA?!?

Basic airmanship should tell any pilot that if you have the AP on in a descent and the EGPWS shouts at you, disconnect the damn thing and execute a GA.
It seems that they just self-constructed an IFR approach where there was none, why otherwise would they have the AP engaged so close to the field and not hand-fly it.

That's just a sad fact apparently, but again the fact that they had the AP engaged right until impact puzzles me the most.

Excuse me, that is true for any airport I go to.


Which is not necessarily wrong in my book. Let automation help you. BUT - before you do anything like that, make sure you know what you punch in (flightprep!) and be ahead of your airplane all the time.
2 nm isnt that close to have the A/P engaged. The Report says the elevator input was up to 17° Nose up and the pitch changed wtihn 2 seconds from - 4 to +20°, now call me a pussy but I think that is really rapid change most likely not achievable with the AP ENGAGED. Either by TCS or brute force someone overpowered the A/P IMO.

They were most certainly NOT stabilized or ahead of their airplane. The whole approach was...well downright bad. Speed, situational awareness etc.

Jetopa - very well summed up.

Certainly not bashing non aoc ops, but without any real compliance monitoring of private ops like this one, the lines become fuzzy and it becomes very difficult to foresee any trends with crew performance / procedures / decision making etc...especially if the PIC is also the manager of the flight dept for the operation. An LPC once a year is not sufficient to establish all of these things.

It seems pretty clear that there were some seriously bad decisions made and that they were well outside of SOP's.

FNPL.

So your LPC is done at night, in marginal wx to an unfamiliar field (btw, we have no idea weather they knew EDFE or not...)?
If not, what is it going to establish? That you can fly an ILS? Surely irrelevant to this accident.

Following your logic, the Premier in Samedan couldn`t possibly have crashed AOC ops!)...unless that was a technical (no report out yet I think)

And who do you report to, that the bosses performance is below par?

Blablabla. Yes you are.

HD - Accidents will happen, AOC and non AOC. The point I make is that with the right safegaurds in place, the risk is reduced.

Bottom line is that this accident would appear to have been totally avoidable. Trying to put a C-X into EDFE is madness anyway, but to try it in marginal weather...:ugh: This guy has paid with his life for those poor decisions, and taken others with him.

AOC or not, these type of operations should be well supported by an active and competent flight ops department, so the guy at the pointy end can concentrate on what pilots do best - flying the aircraft. Under AOC there would be line training, which is designed to pick up on and rectify any sub standard problems any given crew member might demonstrate. For the life of me I can't imagine why anyone who gets in these rather fast, complex aircraft, beit pilot or pax, wouldn't want to ensure safe and robust operations.

This isn't a pissing contest between AOC and private, simply common sense to raise the safety bar all round. I get the impression that you think you are above all of these initatives, which is a real shame for you and your pax if that is the case. We never stop learning.

Trying to cut down human error as a factor in accidents is surely a good thing?

Blah blah blah - If it is the opinion of the non PT community as a whole that this scenario is somehow acceptable, and just a bit of bad luck old chap - - - then yes I certainly am bashing it. With responsibility come accountability.

Weather conditions aside, a 4600 ft runway is hardly Naval carrier territory...

True. Also true: a C750 ain't a STOL aircraft either.

According to the FPG, it would have required 3360ft at MLM, and 2980ft at 28.000lbs (3180lbs below MLM), at 25000 2710ft. Even the 2.5 Knots of tailwind should have been bearable...LDA 27 3824ft, 09 4592ft.

I´m the first to admit that have made, do make and will continue to make mistakes. Anyone telling you different is either a liar or not in aviation.

But - I have been a commercial air taxi dude for 16 years and I´m in corporate for over 5 years now - what I`ve witnessed mostly in the air taxi aka AOC (pre and post JAR/EU-ops experience) world is, that apart from raising the levels of paper filled in, little has changed to the better.

From what I have witnessed - and I was CRE / CRI in three different AOC operations - that is simply not true. Good pilots are often the ones to say 'no' and are exactly what the companies don´t want.



When a lot of pilots can´t do things that were considered normal knowledge in the 70s, 80s and 90s then we need to ask us two questions:

1) whats wrong with the way we train and check pilots? (when exactly did you do a VFR part for an LPC or OPC in a shiny jet? All we do (cause its right there in the form to be filled in as an mandatory item) is V1 cuts and the like, which statistically is an almost non event)

2) should we forbid anything but ILS to ILS because we don´t want to train our pilots properly (think MPL as an example)?

I had written a lengthy reply, but my computer has 'eaten' that one and I don´t have the desire to re-write everything I put down before... so:

yes, I object more regulation. These guys were from the safest aviation system there is, the US/FAA. Obviously they either simply slipped through the gates or they had a very, very bad day. The report says nothing about how long they have been up, whether the PIC was on a business meeting before the flight, how long the crew took to prepare themselves ( I honestly think they did not at all). These are very important factors IMO.
OTOH having the airplane in an AOC like structure (management) might have gotten them a slot in EDDF, but if not I don´t see how the outcome would have been a different one if the cockpit crew does not prepare itself for a nonstandard, close to the minima flight/landing.
They screwed that one up royally. ("Speed checks, Flaps to 5" 35 knots ABOVE the limit for Flaps 5 shows the stress level. E in the FMS instead of Y1 & 2, the totally unstable approach, the handling of the TCAS alert -> they were way behind their airplane and not prepared at all, IMO)

Much had been posted about the behaviour of the pilots, not all was correct.

VFE (flaps 5°) is 250 KIAS - they were set at 245 KCAS

But for me there is another perspective to the accident. That is the information that has been made available via AIP to those planning to fly to EDFE, which has been proven to be irritating and a bit chaotic.

The recommendations are quite revealing:

Since all of the above should be absolutely standard and no-brainer, I see it as a major exposure of incompetency that the officials were not able to adhere to worldwide standards without being reminded.

If you have a look at the approach charts yourself (partly scanned in the report) you might agree that they are quite cluttered with irrelevant information. Four pages of bureaucratic non-sense (e. g. repeating the depicted VFR traffic pattern in words - in case you cannot read a map) do not contain a hint that could have saved lifes again. But you are reminded to keep your transponder on and to "report overflying the compulsory reporting points". (sic!) But you do not find the hint for the 4,4° glideslope in the lengthy description of the approach. You find it in the Aerodrome Chart - if you are looking there for approach info, that is.

Egelsbach AIP is for me a perfect example for non-priorisation of information. It's printed in the map (not in the several pages text part) that "Take-offs and landings by students without instructor are not allowed." But NOT that the terrain is higher east of the field.

The last fatal accident occurred 2,5 years before in a KingAir 90, they impacted only 50 meters away. The maps weren't amended with any terrain warning.

@TripleBravo: Good points.

By the way, the interim report is also available in English:

http://www.bfu-web.de/cln_030/nn_223...tin2012-03.pdf

How do I find the English version?

Thanks

Two years ago we were tasked to fly to dusseldorf then egglesbach. During a three hour layover in dusseldorf I took a look at the charts for egglesbach to prepare for our arrival in what were likely to be marginal conditions.

The charts were a confusing mess and so full of contradictions that I decided to visit the CAA office to get a copy of the AIP. The two gentlemen i met were at first very helpful but were not able to find anything. They then offered me help with the charts we had printed from egglesbach web site. They too were confused by what they read. Two pilots and two German CAA employees sat on the ground couldn't figure out half of what was going to be required of us later in the day at a time when we would be scrabbling around barely 1000 ft agl, and at 200 kts.

We decided to land elsewhere.

I have taught biz owners how to fly their jets for some time. A common component is an ego that translates 'if he can do it, I can do it'...which tends to serve them well in business, but if I land their jet with ease on a short runway, then I later learned that's like planting a flag on Everest, now they want to rush up the hill to do what I did.

Combine that with my attitude that 'you can do it, I'll teach you'...can get some guys in trouble.. WHEN I AM NOT THERE.

More often then not, biz owners just don't have the experience flying around year after year experiencing what pro pilots see...they have the money to buy the plane, they get signed off, now they think they are as good as the rest of us that do this for a living.

Make the condition at night, some wind, marginal visibility, add in the fact that they don't have short field experience, so instead of knowing to plant it on the numbers, or doing a go around, they run it down the runway a third like they were taught, 20 knots fast...the plane floats, anti lock brakes come on...they throw the buckets out when they aren't planted, so now they have 500 ft of runway left at 100 knots, committed and they don't have rubber on the ground. They can't stop, they can't go around.

Few pilots honestly have critical flight operation (CFO) experience where they HAVE to fly the aircraft to it's performance limitations, and sometimes beyond...they are working in the margins of how they were taught and the runway or conditions that day won't allow it, they have to push their abilities and aircraft to get the job done, and most guys have never done that, so they can get themselves in trouble.

Putting a ten on a 4600 ft field requires critical airspeed control, hitting the numbers, generally with a very low stabilized approach, at speeds that are on the slow side of normal, everything is 'done' on downwind, all that has to be done is hitting the numbers and stopping the aircraft. The danger is getting to low on the approach side, or landing to far down, to fast, buckets out on the other end.

So bottom line, these guys weren't up to the task, and the passengers paid for it.

Silleypeoples,

I have not flown with a lot of owners, however your description of real life experiences and perception of realities seems very correct.. Anyone can go out and fly and make things happen - on the rare yearly occasions things are ever so slightly different from the ordinary and thats were a professional pilot with experience in his belt sees what lies ahead - as opposed to an less experience pilot - and makes crucial and life saving decisions (diversion, early established, on the numbers speed approach etc. etc.). Owners or less experienced "co-pilots/captains" may think they've got what it takes - it's only human. When you say NO as a pilot - thats when you realize you have come a long way - not when you say YES!

Silleypeoples, thanks for a very valid contribution! :ok:

Hi Sillypeoples, how true. I lost an owner in a PC12 in line with what you describe: ego, marginal weather, wrong speed, low experience... :sad:

Sillypeoples, that sums it up pretty accurately! :D

Thanks Kitekruncher for the translation....I appreciate it. I landed a CE560XL there last year in daylight and VERY VFR conditions. Obviously in an Excel, no problem. I personally would NOT attempt a night landing UNLESS it was TRULY CAVOK there.

Jetstar2Pilot

This is why a well known German operator stopped flying into Egelsbach with their C560s altogether, from what I heard...