Chinook - Still Hitting Back 3 (Merged)

[taxydual]

Where, on earth, is this thread going?

[cazatou]

jayteeto

So what you are saying is that "crews started at all times of day" and never bothered with a Met Brief.!!!!!!?

Is that correct?

Or do you wish to reconsider that post?

[taxydual]

Olive Oil

ME = Multi Engined Aircraft
RW = Rotary Winged Aircraft

Apologies, to BEagle, for stepping in with an answer.

[KG86]

jayteeto

So what you are saying is that "crews started at all times of day" and never bothered with a Met Brief.!!!!!!?

Is that correct?

Or do you wish to reconsider that post?

Jayteeto has no need to reconsider that post.

Aldergrove was, at that time, a busy military base and a busy civil airport. The two activities were, however, completely separate, on opposite sides of the airfield. The Met Office was on the civil airport side. Crews could not travel to the civil side as they were dressed in military flying suits and armed. The Met forecasters were not required to travel to the military side. Indeed, such a journey could have put them at risk if they were seen going in and out of a military establishment.

From the outset, support helicopter crews are trained to operate independently, in remote locations, where access to met is limited. They become expert at interpreting written met reports, METARs and TAFs, and the implications for their ac and mission/task. They will be checked on this skill every year during the STANEVAL visit.

So the crew in this case did not attend a formal met brief, nor could they. But they will have pored over the latest met info, briefed this as a crew, and probably briefed the duty authoriser to that effect, as their out brief.

The fact that they did not attend a face-to-face met brief is a complete red herring.

[cazatou]

Mull of Kintyre

It is now approaching "Bed time" here in the Southwest of France. It is the start of the "Holiday Season" so the number of French Military aircraft that fly over us at (quote) 200 ft (unquote) are starting to decrease and will become zero during August. (Upsets the Tourists).

Before I retire I thought I would share with you all something I picked up on the "web" which May interest you.

" For some time the coastline of Kintyre, and in particular the area around the Mull, has been known to pilots as a dangerous area to fly at low level because of the freak weather conditions that frequently affect the coastline."

The first recorded military air accident on the Mull was in 1941 when an Armstrong Whitworth Whitley from 502 Sqn crashed on the west slope of Beinn na Lice. Since then there have been nineteen recorded air accidents in the vicinity of the Mull and over a hundred and twenty lives have been lost
The following is an extract from a letter written to the Daily Telegraph (13 December 2000) by Sqn Ldr D Kinch.

"In light winds and high relative humidity, layers of fog and low cloud form adjacent to the Mull to obscure the high ground completely."

The Met Men knew this - but it appears that 'SF' Pilots did not stoop so low as to consult Met Forecasters.

Comments Brian?

[cazatou]

KG 86

I believe that a certain US General expressed his opinion on a point of view, not dissimilar to yours, in a succinct and understandable way.

Bovine Scatology

[bast0n]

The argument that competent pilots flew a serviceable aircraft into the ground when they could and should have prevented it is gaining credence here.

At last some people are seeing through the fog of the blinkered. The fact that most accidents are caused by the well known build up best described as "nibbled to death by ducks" does not explain the last few minutes/seconds of this tragedy. This aircraft slammed into the ground and I firmly believe that basic airmanship could have prevented this happening. At the end of the day, breakfast, met briefs, packed lunches, Fadec, Tans, DR nav, possible in flight problems et all do not excuse a crew from flying the aircraft in a safe and professional manner. My posts above are not trying to persecute the crew, but rather to say that they made a few tragic errors of judgement in the last minutes of the flight. There, but for the grace of god, so many of of us would have perished in the perilous business of flight if luck had not gone our way. We are all human and make mistakes. Why on earth can this not be acknowledged in this case?

As an aside - I feel the snide remarks made about fellow aviators who may not have had the fun of flying helicopters in this role to be misguided. Airmanship is an across the board responsibility and can justly be commented on by those who, whatever their role, have the safety of themselves and their passengers at heart.

David B

[Cows getting bigger]

Double standards. How many military CFIT, with more compelling evidence, have resulted in a finding of gross negligence?

[ShyTorque]

ShyTorque
Are you are suggesting that this non-operational passenger transit sortie was conducted under the same "suck it and see" weather criteria as your missions in NI? I hope not. Passengers should not have to accept an increased level of operational risk and that they might just go home one day in a wooden box, even if that is the way the pilots approached their work.

The argument that competent pilots flew a serviceable aircraft into the ground when they could and should have prevented it is gaining credence here.

Olive Oil, I agree 100% that passengers should not have been required to accept an increased level of operational risk. Please read my previous posts on the subject!

The aircraft, as a type, was unairworthy and should not have been used for this flight, or any other. These passengers should have been flown in a tried and trusted aircraft, possibly by Cazatou's previous unit in an aircraft with a proper Release to Service (clearance to fly) in the prevailing weather conditions. A Mk1 Chinook, as the Captain requested, could have done it in complete safety, had one been available, or the passengers should have been flown by a civilian airline carrier using an aircraft with a valid Certificate of Airworthiness. A civilian airline who flew an unairworthy type of aircraft on a passenger flight would probably have it's Air Operator's Certificate revoked, accident or not. The RAF blamed its pilots, who were ordered to take the unairworthy type against their wishes, instead.

[Vertico]

ShyTorque

Thank you for restating what should be obvious to anyone reading, let alone contributing to, this thread: that ZD576 was unairworthy at the time it took off.

All other speculation pales into insignificance against this fact.

No-one knows (or will ever know) just what happened in the last few seconds of flight, but a loss of control is clearly one possibility. That alone could account for no-one being able to "fly the aircraft". As we all should accept, that mere possibility alone renders the "gross negligence" finding untenable.

[Brian Dixon]

Folks,
I started work at 08:00 yesterday and it is now 02:00 today (23 May) despite what the post time says. I'm a little tired and I want to go to bed. However, as the 15th anniversary of this terrible accident approaches, I feel the need to reaffirm what this whole thing is about.

1. 29 people lost their life and 29 families lost loved ones.
2. 2 highly skilled pilots were subsequently blamed for the accident.
3. AP3207 – RAF Manual of Flight Safety, Chapter 8, Appendix G, page 9 states "ONLY IN CASES IN WHICH THERE IS ABSOLUTELY NO DOUBT WHATSOEVER SHOULD DECEASED AIRCREW BE FOUND NEGLIGENT"
4. Accident investigation evidence states it cannot confirm the pre-impact serviceability of the aircraft.
5. There was no accident data recorder or cockpit voice recorder and nobody alive knows what was going on in that aircraft during the final few moments.
6. The Mk2 Chinook, at that time, had a very problematic introduction to service, so much so that...
7. It was flying operationally with a limited release to service and the test pilots had refused to fly it until their concerns were addressed.
8. The Board of Inquiry did not attribute any human failings towards the pilots and the verdict of gross negligence was introduced upon review by the Reviewing Officers who have admitted to using speculation whilst reaching their opinions.

I welcome meaningful debate, genuine questions, a different interpretation of the limited known facts that are available and even the odd bit of banter. Personal insults and 'my job was better/harder/tougher than your job' comments are better placed somewhere else.

So, may I ask that we all please get back on topic and show this subject the respect it deserves?

Finally:

The Met Men knew this - but it appears that 'SF' Pilots did not stoop so low as to consult Met Forecasters.

Comments Brian?

Yes, Caz. I'll comment. Insulting, ill-founded and way beneath your usually well-presented and reasonable standards.

Best I go to bed. (I'm sure I'll be posting an apology in the morning!)

My best, as always,
Brian

"Justice has no expiry date" - John Cook

[tucumseh]

We are all human and make mistakes. Why on earth can this not be acknowledged in this case?

While it is entirely possible the pilot(s) made an error of judgment, that does not excuse the actions of their seniors, who had a Duty of Care obligation.

As a great man once said “An error does not become a mistake until you refuse to fix it”. Assuming, of course, you have time to fix it. That luxury may not have been available in the final moments of ZD576; the most obvious reason being the statistical probability of a fault occurring. I base this statement on the long history of faults (and defects, a quite different thing indicating deeper Quality of Design issues) in the 57 hour life of the aircraft as a Mk2, the recommendation from Boscombe that it should not be flying and, finally, the ludicrously caveated Release To Service which clearly demonstrates even the most basic Airworthiness procedures were not implemented in this aircraft. That is, the Build Standard was not maintained.

For good reasons, very few here understand this last bit. The Safety Case or Safety Argument MUST reflect the in-use Build Standard, so by definition that Standard MUST be maintained. ANYONE remotely experienced in this highly specialised function would take one look at the Mk2 RTS and say “Build Standard not maintained”. (They wouldn't even have to be shown the admission from 2 years later, which resulted in a contract to correct this on certain systems). Ergo, you have possibly the single most serious breach in the airworthiness audit trail, as the Authority cannot validate or verify the evidence he has used to support their signing of both the MAR and RTS.

That this ability to demonstrate, validate and verify was being compromised by huge and successive cuts in the funding and was notified almost daily throughout 1991, 92 and 93. Despite these warnings, a quite deliberate decision was taken to compromise airworthiness. The warnings specifically said that the nature of the process meant problems would emerge gradually and accumulate, but by the time they manifested themselves it would be very costly and almost impossible to regress and take corrective action. In 1991, the prediction was it would take up to 3 years for the practical effect to bleed through the system, by which time the safety argument on most aircraft related kit would be invalid.

The warning also reminded the 2 Star (in our case) of the first rule of Maintaining the Build Standard. It is not volume related. That is why it was managed and funded separately – the funding cannot be cut proportionately when fleet numbers reduce or the Treasury demands a 25% chop in support costs. Since 1991, this activity, such as it is, has been lumped with “support”, so takes a financial hit with everything else.


In direct contrast, the staffs responsible for;

• Maintaining the Airworthiness of the Mk1,
• Attaining Airworthiness in the converted Mk2, and,
• Maintaining Airworthiness in the Mk2

made a series of errors which, despite being given ample opportunity and time to correct, they did not. They knew exactly what effect their decisions would have. They made a deliberate decision to state (falsely) that the Build Standard had been maintained, yet issued an MAR and RTS which clearly shows it had not. This is implicit in any MAR or RTS, but in my experience those responsible can rarely explain what I’ve said here. They don’t know the detail, so can’t understand where the Devil is lurking.

Their mistakes were compounded by serial breaches of the airworthiness regulations they were bound by, all of which adds up to, in my opinion, Gross Negligence.

The only possible thing I can say in their defence is that, at the time, the Project Management Guidelines were in the process of being replaced by the ludicrous and ill-fated Chief of Defence Procurement Instructions (CDPIs). The CDPI intended to instruct project managers on how to maintain Build Standards made the cardinal error so common on this thread (and, notably, by the Reviewing Officers) – it confused Serviceability with Airworthiness. A lengthy tome, it was completely and utterly without relevance to the subject. It did not even mention the relevant Def Stan, which had been updated the previous year. (All the CDPI had to do was say "Comply with the Def Stan and permanent LTC Instructions"). Ah, compliance. MoD don't do compliance. That was December 1993.

[Cows getting bigger]

Olive, for a start try the Isle of Harris Shakleton, 30 Apr 1990.

There are more involving two or more aircrew.

[cazatou]

Cgb

Olive oil did specify 2 competent pilots. If you read the BOI (in full) on that one you would wonder how it took so long for such a tragedy to occur. The Sqn Cdr already had one major accident under his belt (ejection from a JP at Acklington in 1965) - although that one was down to the "Fault Free Fire Detection System" which was anything but "Fault Free".

[Arkroyal]

Bast0n,

Hello David. I see some of your innate mischievousness in your posts, and as you are quite new to the debate, I would think you haven't trawled through the whole thread.

You say:

My posts above are not trying to persecute the crew, but rather to say that they made a few tragic errors of judgment in the last minutes of the flight. There, but for the grace of god, so many of of us would have perished in the perilous business of flight if luck had not gone our way. We are all human and make mistakes. Why on earth can this not be acknowledged in this case?

And You'll find no-one here to say you cannot be right. You may well be.

The thrust is that, like all of us who but for the grace of God, might have wound up in this position, the benefit of any doubt must lie with deceased aircrew. The RAF's rules in force at the time had to prove negligence 'beyond any doubt whatsoever'. It failed to do that, and found two fellow professional pilots guilty, effectively of manslaughter, on no more than supposition and theory. No hard evidence exists.

[bast0n]

Hullo Ark Royal

Believe it or not I have been watching this for a very long time although I did not join Pprune until fairly recently. I have read it through though skipping some of the obvious nonsense.

I don't think that anywhere have I stated that I agreed with the senior Crabs
actions in condeming the poor pilots, as they did all those years ago. I am only trying to make the point that the probability is that they flew a flying aircraft into a cloud with a rock in it. Careless in the extreme, probably. Negligent? Maybe. beyond ALL doubt? No.

I admire the tenacity of those trying to reverse the decision, but I will not hold my breath for a succesful outcome.

David

[cazatou]

KG 86

Re your post #4501

"crew did not attend a formal met brief, nor could they."

The evidence given on oath to the BOI was that Flt Lt Tapper did indeed go to Met for briefing that morning.

There appear to be 2 possibilities:

1. Your statement is incorrect at least in part.

2. False evidence was given to the BOI

Comments?

[Airborne Aircrew]

You kids really need to learn to focus. You are 226 pages into speculating about what happened when the issue really boils down to the simple question "was the finding of gross negligence warranted or fair?". You can prattle on all you like and make unprofessional barbs at each other but the reality is that the government doesn't give a rats arse about why you think the aircraft crashed nor do they care to quash the existing findings because then they would have to acknowledge the possibility that the Mk. 2 Chinook should not have been used at all, let alone on this flight, a fact which carries it's own negative implications.

The simple fact is item eight, (below), demonstrates that the Reviewing Officers have chosen to ignore AP3207 in that the finding is an opinion based on speculation. Confine you energy to this one, simple point and your chances of reaching the result you desire will multiply exponentially. Continuing to bash on about breakfast and met briefs is exactly what they want you to do.

1. 29 people lost their life and 29 families lost loved ones.
2. 2 highly skilled pilots were subsequently blamed for the accident.
3. AP3207 – RAF Manual of Flight Safety, Chapter 8, Appendix G, page 9 states "ONLY IN CASES IN WHICH THERE IS ABSOLUTELY NO DOUBT WHATSOEVER SHOULD DECEASED AIRCREW BE FOUND NEGLIGENT"
4. Accident investigation evidence states it cannot confirm the pre-impact serviceability of the aircraft.
5. There was no accident data recorder or cockpit voice recorder and nobody alive knows what was going on in that aircraft during the final few moments.
6. The Mk2 Chinook, at that time, had a very problematic introduction to service, so much so that...
7. It was flying operationally with a limited release to service and the test pilots had refused to fly it until their concerns were addressed.
8. The Board of Inquiry did not attribute any human failings towards the pilots and the verdict of gross negligence was introduced upon review by the Reviewing Officers who have admitted to using speculation whilst reaching their opinions.

[bast0n]

Airborne Aircrew

To know if the finding of gross negligence is fair or not one needs to try to find out from the available evidence what happened during this flight - especially the last few minutes. If the aircraft was deemed un-airworthy and so and so on, it got as far as the Scottish coast with no apparent problems or calls of distress from the crew. They were happy to fly the aircraft on that day, or extremely silly to get airborne in an aircraft that they thought was unsafe. To fly an aircraft that is unserviceable is fine - but unsafe, no. I have no idea of what the reviewing officers were thinking when they made their decision to alter the findings, but reasons they must have had. We may not agree, but don't chastise us for trying to get to crux of the matter - why they flew an apparently serviceable aircraft into a chunk of rock.

I also wonder, like you, why after all these years some charity could not be shown towards these unfortunate pilots and their families. The benefit of the doubt - whatever happened on that day would be a kind action.

[BEagle]

Airborne Aircrew makes a very honest point - no-one really knows why the aircraft hit the Mull beyond any doubt whatsoever.

Nevertheless, I consider that comments about the preparation for flight are irrelevant from anyone except RW aircrew intimately familiar with the conduct of such flights. Whether you're a recce puke, fag charioteer, tanker wanquerre, trimmer, kipper mate, mud mover, corgi carrier, shiney, bona mate or whatever (those are banter nicknames, not insults, by the way) - your opinion may be at best naiive and at worst distracting.

Incidentally, bast0n, you may be reassured to know that I have a written undertaking from the next Prime Minister, David Cameron, that he will indeed overturn the findings of Wratten and Day 'unless presented with overwhelming evidence to the contrary'. He is a decent, honest guy and I trust his promise completely.