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Flt. Lt. Sean Cunningham inquest

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Flt. Lt. Sean Cunningham inquest

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Old 11th Jan 2014, 13:46
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I've been present a few times when ejection seats have been stripped, serviced, totally re-built and installed in an aircraft. Everything is done to the book because you can't test the seat before use, and every critical check during re-build is countersigned.


I only have one question. Despite who or what (even an animal) sitting in the seat), when the black and yellow has been pulled, and the seat is clear of the aircraft, how does any amount of cough medicine, or whatever else, affect the opening of the 'chute???? That's down to the barostat surely. I would have thought user intervention of any sort at that point would be purely incidental. These seats are designed to work properly even if the user is unconscious after ejection.


I'd lay odds on the medicine angle is a cover up!
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Old 11th Jan 2014, 13:51
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More likely just a clear fact presented to the coroner.
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Old 11th Jan 2014, 13:53
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"Is this staffing level shortage indicative of the RAF squadron strength as a whole?"

Nutty,

In my (not inconsiderable) recent experience numbers of troops is certainly an issue, especially due to 'diversions'. However, more painful is the comparatively lower levels of experience available on the trade desks than years gone by, touched on by Sqn Ldr Higgins.

This has been caused by a number of factors - redundancies, PVR, and a misguided manning policy of moving people around after 5 years. Fine when you have larger numbers of personnel, you can absorb it, but when you are down to the bare bones anyway, each experienced guy leaving hurts a lot more. Replacements from another type takes so much time to bring on, as there's no capacity for full-on mentoring of the new guys, not the way I was inducted that's for sure.

What Sqn Ldr Higgins describes has been the norm on the FJ sqns I've known in recent years, with the pressure to keep the pilots even minimally current tangible. Every so often we see that the Reds flew more displays than ever, yet they're doing it with a smaller workforce?

Sean must have been terrified for those last seconds when he realised he'd not separated. I hope this inquest does him full justice, doesn't just end up with someone on the Reds being a sacrificial lamb, and leads to a Service culture that acknowledges the present limits of manpower and equipment and plans accordingly.
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Old 11th Jan 2014, 13:57
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More likely just a clear fact presented to the coroner.
...and seized on by the media as a means of inflating the story. I doubt that self medication was a significant factor and fail to see how it could be used as a cover up for anything. Too many conspiracy theories.
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Old 11th Jan 2014, 14:11
  #25 (permalink)  
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how does any amount of cough medicine, or whatever else, affect the opening of the 'chute????
It doesn't. But it does help the inquiry or inquest build a complete picture of the individual and the organisation. Same with the mobile phone. If there are instances where rules and procedures are not being adhered to it highlights a number of factors;

1. If those rules are pointless, why are they not being challenged and removed?
2. If they are valid, why are they being ignored?
3. How does the command structure view such rules and the somewhat arbitrary nature of compliance?

It's all well and good lining up the holes in the cheese to point out the MoD are crass, negligent, malfeasant and all the other things we know them to be, but that's a two-way street. The unit and the individuals will also come under that spotlight and any examples of non-standard or non-compliant behaviour will be subject to scrutiny, already under the BoI.

As an authorising officer I would ask crews to imagine how any of their actions would look to a subsequent Board of Inquiry before they did them. This is exactly what is happening here, albeit at the inquest. Minor infringements of rules, or the ignoring of rules by those entrusted to apply them, can sometimes be signs of stress, overstretch or command issues, thus they form part of the overall indication of the health of the unit.
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Old 11th Jan 2014, 14:14
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I think you will find, it all has relevance, the seat may not have functioned as prescribed, but that is not the whole story, one accident is often a culmination of several sets of circumstances.

A pilot possibly operating under the weather and errors happening within the cockpit resulting in the seat firing.

An inexperienced engineering team, grossly undermanned, operating to tight schedules and being rushed to generate aircraft without sufficient time to do the task correctly with inadequate manuals and without breaks

A management team aware of all of these failings within the team, but failing to address them or putting a stop or a reduction in the programme until they are addressed.

A senior management team in the RAF ignoring the serious undermanning issues and pressures being exerted on the team to comply with the planned programmes.

A Government cutting back on Service personnel and overburdening them with tasks without regard to safety and operational capability, and those senior officers playing lip service to the problem without standing up for those they are supposed to lead.

Everyone of those issues lead to and compounded to make this accident happen, without learning from, understanding and addressing all of those problems, one would simply be playing lip service to an inquiry and not learning from it.
And without the inquiry and the facts being laid out for all to see and learn from, you are in effect setting a whole series of actions off again that will lead to more deaths in the future.
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Old 11th Jan 2014, 14:30
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Here's a fact for you. In the 80's that shackle would have been tested/inspected in the ejection seat bay every 6 months. It then changed to every 12 months, then it changed to every 24 months........ no idea what it is now (they were talking 5 yrs when I left the RAF). I also believe all the unit ej seat bays are now shut down and seats are now crated up and serviced in one location. When I worked in ej seat bays (3 tours) it was not unusual to be called out to sqns for a 2nd oppinion on things the sqn armourers were not happy with, this is not possible now.

Glad I'm not working under the engineering conditions the lads have to suffer now.............
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Old 11th Jan 2014, 14:46
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When I worked in ej seat bays (3 tours) it was not unusual to be called out to sqns for a 2nd oppinion on things the sqn armourers were not happy with, this is not possible now.
And how often did this result in a not fit for use seat being "grounded" instead of being flown?
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Old 11th Jan 2014, 14:49
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As an Engine trade posted onto Jags at Bruggen I had to do a three day course at the Bruggen armoury on the seat, I wonder if the still do the same.
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Old 11th Jan 2014, 15:03
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Until the cause of:

a) the initiation of the ejection and...

b) the failure of the main parachute to deploy....

...are known, speculation as to whether a mild overnight medication had any effect is inappropriate in my opinion. It may become relevant, but right now, it's not.

I have never, in 31+ years flying in the RAF, seen a ban on mobile phones in the cockpit. They should either be in Flight Mode or turned off, but the mere presence of a mobile phone, turned off, in the cockpit, is irrelevant. Perhaps the army were finding their crews were actually using them on the flight line.

Clearly they didn't have the special mobile phones that surgeons, movers & the AARC have.
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Old 11th Jan 2014, 15:43
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I hope this inquest does him full justice, doesn't just end up with someone on the Reds being a sacrificial lamb, and leads to a Service culture that acknowledges the present limits of manpower and equipment and plans accordingly.
Could have picked a number of quotes on this thread to highlight this point, which seems so widely misunderstood...

It is not the job of an inquest to apportion guilt or blame or indeed to be seen to do so. It is the job of an inquest to establish the cause of death, or to record an open verdict and that is all. Ergo an inquest cannot dispense justice of any kind.

That's a good post by Two's In btw.

I'd lay odds on the medicine angle is a cover up!
Utter nonsense. The coroner would have ordered an autopsy. The person doing it would present results. To do otherwise, would be to break the law.
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Old 11th Jan 2014, 16:03
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One of the 'advantages' of inquests and inquiries is that a number of lessons can be learnt. Sure, there is often a very small number of causal factors but if other things can be identified..........

I'm not an FJ expert but the little nuggets that I would be looking at, irrespective of their (non) contribution to this sad accident, would include mobile phones (try using your mobile on the apron at many civil airports ), procedures for helmet visors/oxygen masks and self-medication. None of the above should be considered as criticism, it is just best practice in an industry where we should always be looking to manage risk rather than just ignoring it.
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Old 11th Jan 2014, 16:43
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Mad Jock: And how often did this result in a not fit for use seat being "grounded" instead of being flown?

I have never known in my 36yrs, a 'not fit for use' seat being flown, who could (or would) auth that?
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Old 11th Jan 2014, 16:56
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Sorry that's not what I was meaning I am a civi BTW who served in the army none aviation.

What I meant was if it was common that when you got called over as the expert on the seats you discovered a problem which might have slipped through if they hadn't had the onsite "expert" readily available.
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Old 11th Jan 2014, 17:51
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A Servicing Bay staff member would tend to have a greater in depth knowledge of the seat and It's foibles, hence calling them in to give you a second opinion, you would tend to defer to that knowledge and go with their recommendation.
At the end of the day, if everything else goes t*ts up! it is that one item that is going to save a life.

It wasn't common to call them in, but it did happen occasionally to verify your feelings and offer advice to make a sound judgement.


Added, but that was when I was serving when each Station tended to have bays on Station.

Last edited by NutLoose; 11th Jan 2014 at 18:23.
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Old 11th Jan 2014, 21:05
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Seadrills
Secondly, I understand from a friend in the AAC that mobile telephones are not allowed in the cockpit and should be left at the line. But it seems as though every aviator I talk to always, always flies with their mobile phones with them.

Any significance to those 2 points ?
Not if it's turned off and hence, not transmitting.
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Old 11th Jan 2014, 22:22
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In case any of the self-professed non-experts were getting too deeply into the significance of in-cockpit mobile phones to this accident, I thought I'd point out that the ejection sequence of the Mk 10 seat involves no electric or electronic components. The system is operated entirely by gas pressure from percussion-initiated pyrotechnic cartridges (and the command ejection system in the Hawk is also gas-operated). This makes the system immune to electromagnetic interference and thus there is no way that stray mobile phone transmissions could have played a direct part in the accident chain.
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Old 12th Jan 2014, 10:19
  #38 (permalink)  
 
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Easy,

I believe that the relevance of the carrying of mobilephones is that of distraction. In my later flying career, when flying a crewaircraft I witnessed a few times crew members being distracted by incoming messages.Of course aircrew should be allowed to carry mobiles, however, the phonesshould remain switched OFF and in a pocket/bag whenever involved in theoperation of an aircraft. The same if true of other entertainment items such asiplayers.
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Old 12th Jan 2014, 10:34
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I used to fly some operational sorties where the mobile phone issued by Ops was the pre-briefed tertiary method of comms.

It was used successfully to that effect on occasions, and somehow I doubt it had any effect on the aircraft's on board, steam driven, valve technology....

And no, it was some "special" type of mobile phone...
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Old 12th Jan 2014, 12:17
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Biggus

You miss the point. There is a difference between theAuthorised use of a Service Issued mobile device to the random and indiscriminateuse of a private mobile. One of the problems that we faced was educating theyounger generation in what that difference is! Any unauthorised use of a mobiledevice in an aircraft MAY distract someone from their primary task. Somethingas simple as an incoming Message may cause an individual to miss a vital actionor check! If the phone is switched ON it can be the cause of an error beingmade.
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