Shoreham Airshow Crash Trial
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Captain Scribble and Homelover
I entirely agree with your comments (aside from the personal pokes).
. I would say, especially Hunter aircrew - especially those with 2000 hours on type. And especially those with several BoI memberships under their belt.
I'm not a dinosaur (yet), but IMHO such views are now clouded on this thread by the 'JB Brexit style' of discussion into which it has evolved.
I entirely agree with your comments (aside from the personal pokes).
I think the aircrew on here know what really happened
I'm not a dinosaur (yet), but IMHO such views are now clouded on this thread by the 'JB Brexit style' of discussion into which it has evolved.
Do I need to go on?
Some of us are more interested in finding out why an experienced display pilot behaved in this way. As one of the expert witnesses put it in his trial evidence, when referring to the eight or more unconnected errors that occurred shortly after 'Point X' in the manoeuvre sequence, “Why would any display pilot in his right mind do that?”
Have you actually seen any of the detailed video coverage of the flight? If you had, I think you would probably be asking the same question.
It is the question I’m asking - and I suggest the existence of that question is not dissimilar to the situation of the late Flt Lts Jonathan Tapper and Richard Cook after the Mull of Kintyre disaster. In their case, it took many years for the finding of their guilt to be overturned by the revelation of hitherto concealed evidence. Or, incidentally, are you, Homelover, perhaps one of those people who still cling to the idea of their guilt?
But despite the confirmation of their innocence, as tucumseh and Chugalug point out, no one else has apparently even been investigated, never mind prosecuted, despite ample publicly available evidence to support such actions. And the same situation demonstrably applies in many other British military aviation fatalities, up to and including the death of Flt Lt Sean Cunningham, Red 5
Whereas Andy Hill was prosecuted - and in this case, his innocence has been established.
We still need to know, though, why he did as he did. As, I suspect, does he - to say nothing of the desperate need of the families and loved ones of the people who died that day on the A27. And, as Distant Voice suggests, an answer to that question may also have relevance for some of the other hitherto unexplained incidents.
airsound
Last edited by airsound; 6th Aug 2019 at 10:32. Reason: adding Chug
[QUOTE=airsound;10538010
We still need to know, though, why he did as he did. As, I suspect, does he - to say nothing of the desperate need of the families and loved ones of the people who died that day on the A27.
airsound[/QUOTE]
Surely the AAIB answered that. Because he wasn’t experienced or current enough on the Hunter, and because the display authorisation process was slipshod to say the least.
We still need to know, though, why he did as he did. As, I suspect, does he - to say nothing of the desperate need of the families and loved ones of the people who died that day on the A27.
airsound[/QUOTE]
Surely the AAIB answered that. Because he wasn’t experienced or current enough on the Hunter, and because the display authorisation process was slipshod to say the least.
Last edited by Timelord; 6th Aug 2019 at 14:10.
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Know the truth.....
airsound - thank you for your sensible and informed posts. It is deeply regrettable that the press completely misrepresented the court proceedings for AH, and as you say, seemed solely to rely on prosecution press releases.
it is my clear understanding that the prosecutions star witnesses were comprehensively trashed - one had clearly not done his homework about previous events involving AH, the other was forced to admit that his estimations of G were wrong. It might be helpful if some of the entrenched critics present here were aware of what a dismal case the prosecution mounted. I’m surprised the judge did not suggest that they not appear again as experts in the the future. Or maybe he did?
Whether or not previous BoIs have been subverted I have no idea - but if correct, that is truly dismal and one wonders how many more accidents and deaths might have been avoided if the plain simple truth had been sought and obtained. At least the case against AH has been heard and dismissed. But given Wing Cdr Green’s admission in court, one wonders why the AAIB does not re-examine the evidence and its report.
it is my clear understanding that the prosecutions star witnesses were comprehensively trashed - one had clearly not done his homework about previous events involving AH, the other was forced to admit that his estimations of G were wrong. It might be helpful if some of the entrenched critics present here were aware of what a dismal case the prosecution mounted. I’m surprised the judge did not suggest that they not appear again as experts in the the future. Or maybe he did?
Whether or not previous BoIs have been subverted I have no idea - but if correct, that is truly dismal and one wonders how many more accidents and deaths might have been avoided if the plain simple truth had been sought and obtained. At least the case against AH has been heard and dismissed. But given Wing Cdr Green’s admission in court, one wonders why the AAIB does not re-examine the evidence and its report.
On a side note, everyone, do be careful with your post formatting, particularly when quoting others. It is usually a missing '[' or ']' that messes up what you were trying to do. The preview button is a very useful tool for checking your post will appear as you intended, before actually submitting it, and only takes a handful of seconds to use.
Last edited by Stuart Sutcliffe; 6th Aug 2019 at 11:11.
Caramba, many thanks for kind words!
You go on to say
One does indeed wonder. But they say they've conducted a thorough review, using a team of inspectors with expertise in aircraft performance, human factors, fast jet operations and display flying. And they've decided not to reopen their inquiry. But - and I believe this is significant - they will publish a supplement to the final report, with full details of the review they conducted. Could that be a face-saver for them?
Also - and I have no firm information on this - but I believe the supplement may not be available until near the end of the year. That could account for the Coroner's decision not to launch the Inquest proper until early 2020.
airsound
You go on to say
one wonders why the AAIB does not re-examine the evidence and its report.
Also - and I have no firm information on this - but I believe the supplement may not be available until near the end of the year. That could account for the Coroner's decision not to launch the Inquest proper until early 2020.
airsound
flighthappens - you ask
Part 1.4 of the Red Arrows XX179 Service Inquiry gives some examples:
https://assets.publishing.service.go...rt_1-4-1-U.pdf
Such as:
At the Old Bailey trial, cerebral hypoxia was cited as a potential cause of cognitive impairment. Cerebral hypoxia is simply lack of oxygen in the brain (if I've understood it correctly). It can be due to a good blood supply where the blood is lacking oxygen (seen at high altitudes). Or it can be caused by a good level of oxygen in the blood, but not enough blood (G-LOC, A-LOC or some combination). Cerebral Hypoxia can also be caused mechanically, for example by stroke or strangulation.
There are other aviation cognitive impairment factors, such as heat, fumes, dehydration, illness, blood sugar, alcohol, hyperventilation and fatigue.
In the trial, alcohol was mentioned as a well known example. Alcohol was not a factor at Shoreham, but the symptoms might be: well known automatic tasks (think changing gear) are less affected than executive decisions (reaction time to unexpected events).
airsound
Is there a definition anywhere for what constitutes “cognitive impairment” in the aviation context...?
https://assets.publishing.service.go...rt_1-4-1-U.pdf
Such as:
- Pilot Disorientation (which could be visual or more medical)
- Pilot Distraction – this seems more of a Human Factor than impairment?
- Pilot Incapacitation
At the Old Bailey trial, cerebral hypoxia was cited as a potential cause of cognitive impairment. Cerebral hypoxia is simply lack of oxygen in the brain (if I've understood it correctly). It can be due to a good blood supply where the blood is lacking oxygen (seen at high altitudes). Or it can be caused by a good level of oxygen in the blood, but not enough blood (G-LOC, A-LOC or some combination). Cerebral Hypoxia can also be caused mechanically, for example by stroke or strangulation.
There are other aviation cognitive impairment factors, such as heat, fumes, dehydration, illness, blood sugar, alcohol, hyperventilation and fatigue.
In the trial, alcohol was mentioned as a well known example. Alcohol was not a factor at Shoreham, but the symptoms might be: well known automatic tasks (think changing gear) are less affected than executive decisions (reaction time to unexpected events).
airsound
they've conducted a thorough review, using a team of inspectors with expertise in aircraft performance, human factors, fast jet operations and display flying. And they've decided not to reopen their inquiry. But - and I believe this is significant - they will publish a supplement to the final report, with full details of the review they conducted. Could that be a face-saver for them?
Originally Posted by AAIB
We have also ... consulted subject matter experts on aeromedical aspects.
I also remain deeply uncomfortable with the notion that AH was too good/experienced/sensible/respected (etc) to have made the mistakes he did. That is the kind of thinking that belongs to a bygone age in human performance study and it speaks to the woeful inadequacy of the prosecution that it wasn't roundly demolished with two simple words: 'Bud Holland'.
I think the reason AH gets a harder time from today's pilots than do the VSOs of years gone by is partly that he is one of 'us' - operating in the same era, to the same societal and regulatory constraints, his actions have had a very serious impact on the display flying scene that enthused so many of us in our formative years. And then avoiding criminal accountability for it through a defence that persuaded a jury but appears not to have swayed the AAIB in determining cause or the RAF in continuing to display. We can be indignant about that without absolving the VSOs for their misdeeds; it's just that justice has never been so close to hand in their cases.
Last edited by Easy Street; 6th Aug 2019 at 14:17.
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Bud Holland ?? Not really!
Easy Street - it would seem from the USAF report that Bud Holland was the antithesis of AH!
“The accident board stated that Colonel Holland's macho, daredevil personality significantly influenced the crash sequence. USAF personnel testified that Holland had developed a reputation as an aggressive pilot who often broke flight-safety and other rules. The rule-breaking included flying below minimum-clearance altitudes and exceeding bank-angle limitations and climb rates.” (From Wikipedia).
Whereas the alleged rule breaking by AH alleged by the prosecution (Southport, Duxford) turned into nothing once the facts were examined. And character witnesses testified to AH’s safety consciousness and discipline.
The prosecution might have mounted a duff case, but they didn’t have a good hand to start with. Something of a misconceived prosecution, public interest/expectation rather outweighing any more rational appraisal.
There’s plenty of other excellent pilots who have died as a consequence of apparently bizarre decisions. So maybe CI is a “thing”.
Toodlepip.
Caramba
“The accident board stated that Colonel Holland's macho, daredevil personality significantly influenced the crash sequence. USAF personnel testified that Holland had developed a reputation as an aggressive pilot who often broke flight-safety and other rules. The rule-breaking included flying below minimum-clearance altitudes and exceeding bank-angle limitations and climb rates.” (From Wikipedia).
Whereas the alleged rule breaking by AH alleged by the prosecution (Southport, Duxford) turned into nothing once the facts were examined. And character witnesses testified to AH’s safety consciousness and discipline.
The prosecution might have mounted a duff case, but they didn’t have a good hand to start with. Something of a misconceived prosecution, public interest/expectation rather outweighing any more rational appraisal.
There’s plenty of other excellent pilots who have died as a consequence of apparently bizarre decisions. So maybe CI is a “thing”.
Toodlepip.
Caramba
Caramba,
You're inferring specifics from a general point, which wasn't that AH's flying mirrored Bud Holland's. The point is that in a putative trial of Lt Col Holland, a defence so minded could have wheeled out general after general to testify to Holland's impeccable standards, airmanship and skill. Which would have sounded impressive to a lay jury, but would have had no bearing on the circumstances of his accident.
There was no need to prove that AH had flown poorly at Southport or anywhere else: it would have been enough to show that prior excellence is no guarantee of future piloting performance.
Cheerio!
You're inferring specifics from a general point, which wasn't that AH's flying mirrored Bud Holland's. The point is that in a putative trial of Lt Col Holland, a defence so minded could have wheeled out general after general to testify to Holland's impeccable standards, airmanship and skill. Which would have sounded impressive to a lay jury, but would have had no bearing on the circumstances of his accident.
There was no need to prove that AH had flown poorly at Southport or anywhere else: it would have been enough to show that prior excellence is no guarantee of future piloting performance.
Cheerio!
Last edited by Easy Street; 6th Aug 2019 at 16:01.
I am afraid That I still do not understand what the CI was supposed to be in this case. When the question has been asked here; “what is CI?’ Examples have been quoted from Alzheimer’s to Alchohol, but none of them demonstrably applicable in this case. As I understand it, he was acquitted because the prosecution could not prove that they were NOT applicable. Is it suggested that, had AH been wired up to the right sensors at the time, something could have been measured in his physiology that accounted for his errors, or is it that some unknown and undetectable influence must have caused them?
This is a genuine attempt to understand what is to stop any pilot (or surgeon or engineer) who makes a huge blunder just saying “well, I was cognitively impaired”
This is a genuine attempt to understand what is to stop any pilot (or surgeon or engineer) who makes a huge blunder just saying “well, I was cognitively impaired”
I want to know that, too. My example would be a driver who's just caused a terrible road accident through poor judgement and claims cognitive impairment.
Timelord and Easy Street - would I be right in thinking that you were not present at the Old Bailey trial?
In the eight weeks that I was there, there were probably three occasions that really stuck in my mind as being pivotal.
The first was when a first responder talked about AH lying beside the wreckage of his aircraft, very near to death (his life was only saved shortly afterwards by the quick reactions of another first responder). AH was still conscious, and he said “I blacked out” (in flight).
The second occasion was the first time I saw the full video of the flight, alongside positional analysis. My reaction was ‘what on earth is he doing that for?’ His manoeuvres made no sense at all.
The third time was when a highly qualified aviation human factors expert identified at least eight, and possibly twelve, unconnected errors between ‘Point X’ at the start of the crash manoeuvre and the time, 23 seconds later, when it was too late to recover. Asked ‘How do you analyse the importance of those errors?’ he replied ‘One type of accident is an accumulation of errors, so they’re not independent.’ ‘Why do pilots do this?’ ‘There are many reasons. It could be a conscious decision, or it could be unconscious. But here I can’t find any relationships between the errors. They’re not related. It’s very difficult to explain. The chances of eight to twelve errors happening within the short time of 23 seconds are very remote. The probability [of this happening] is very low.
The point of that human factors evidence for me was that it wasn’t just a single blunder which you could put down to carelessness, or indiscipline, or whatever.
So Timelord’s question
is a good one. But that doesn’t mean that there is no such thing as cognitive impairment of the kind that is being discussed here. The point about all of this is that we just don’t know enough about it, and there is very little research to draw on. I understand (but I don’t know for sure) that the death of Flt Lt Jon Egging (Red 4), near Bournemouth in 2011, resulted in the RAF doing new research into the effects of G at levels lower than normally thought dangerous. But I definitely don’t know if there were any useful results from that research.
airsound
In the eight weeks that I was there, there were probably three occasions that really stuck in my mind as being pivotal.
The first was when a first responder talked about AH lying beside the wreckage of his aircraft, very near to death (his life was only saved shortly afterwards by the quick reactions of another first responder). AH was still conscious, and he said “I blacked out” (in flight).
The second occasion was the first time I saw the full video of the flight, alongside positional analysis. My reaction was ‘what on earth is he doing that for?’ His manoeuvres made no sense at all.
The third time was when a highly qualified aviation human factors expert identified at least eight, and possibly twelve, unconnected errors between ‘Point X’ at the start of the crash manoeuvre and the time, 23 seconds later, when it was too late to recover. Asked ‘How do you analyse the importance of those errors?’ he replied ‘One type of accident is an accumulation of errors, so they’re not independent.’ ‘Why do pilots do this?’ ‘There are many reasons. It could be a conscious decision, or it could be unconscious. But here I can’t find any relationships between the errors. They’re not related. It’s very difficult to explain. The chances of eight to twelve errors happening within the short time of 23 seconds are very remote. The probability [of this happening] is very low.
The point of that human factors evidence for me was that it wasn’t just a single blunder which you could put down to carelessness, or indiscipline, or whatever.
So Timelord’s question
what is to stop any pilot (or surgeon or engineer) who makes a huge blunder just saying “well, I was cognitively impaired”
airsound
Thanks Airsound. I was not present for any of the trial, but I remain a bit sceptical. My experience is that once you make a bad decision, others follow pretty quickly. Would, for example, using heights and speeds for a different type be a c**k up or cognitive impairment? What about the Hillsborough match commander, to be retried I believe on similar charges of gross negligence manslaughter. Can he claim to have been cognitively impaired when he made the catastrophic decision to open that gate?
So, apart from the near death statement that “I blacked out” the evidence for CI is just inexplicably bad flying?
So, apart from the near death statement that “I blacked out” the evidence for CI is just inexplicably bad flying?
Last edited by Timelord; 6th Aug 2019 at 19:45.
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How could a guy with THAT MUCH experience make such an error?
Jon
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@Timelord good comparison but at the time of Hillsborough the term used may have been cognitive overload or in other words too much information. In such situations it is not unknown for the person concerned to freeze or do something out of the ordinary. I am not saying that was the case with AH at Shoreham and I guess we will never know the truth.
Airsound,
I am very interested in your synopsis of the key points from the trial, particularly the expert evidence regarding the 8 / 12 unconnected errors during the key phase of the flight. To me, at face value, the notion that someone could make that number of unconnected errors in the space of 23 seconds points to something else going on, and is certainly worthy of further consideration.
Are you able to recollect what the errors were? I don't remember this being identified in the AAIB report, and certainly don't remember any significance being attached to the frequency of the occurrences. I remain puzzled as to the significance of the distinction between reopening their report and publishing an addendum, but in any event, I hope they clearly address the issue
I am very interested in your synopsis of the key points from the trial, particularly the expert evidence regarding the 8 / 12 unconnected errors during the key phase of the flight. To me, at face value, the notion that someone could make that number of unconnected errors in the space of 23 seconds points to something else going on, and is certainly worthy of further consideration.
Are you able to recollect what the errors were? I don't remember this being identified in the AAIB report, and certainly don't remember any significance being attached to the frequency of the occurrences. I remain puzzled as to the significance of the distinction between reopening their report and publishing an addendum, but in any event, I hope they clearly address the issue
Timelord - I'm afraid I'm not going to comment on your comparison with the Hillsborough match commander, because I believe his case is sub judice. It is true, however, that he also is charged with gross negligence manslaughter.
Falcon900 - probably the best account of the twelve errors appears in this report by Michael Drummond in the Shoreham Herald. And you're right - the errors did not figure in this detail in the AAIB report. Michael Drummond's report is another example, if one were needed, of the value of a local paper being able to have a good court reporter attend the majority of a trial.
https://www.shorehamherald.co.uk/new...says-1-8824257
Another well-balanced report - although not detailing all twelve errors - was by Adam Lusher in the Independent. Sad to say, that's no longer a printed paper, but it does have a good website.
https://www.independent.co.uk/news/u...-a8810671.html
These reports stand in some contrast to much of the rest of the printed press, whose representatives were often noticeable by their absence from court. Several of them seemed to have taken their stories from the 53-page summary of the prosecution case handed out at the start of the trial; they seemed unaware of the detail of the strong - and eventually successful - case mounted by the defence. I except from that criticism the excellent work of PA, the Press Association, who were present throughout. And also, most of the broadcasters took care to be present for much of the time.
It all goes to show that you shouldn't believe everything you read in the papers!
airsound
Falcon900 - probably the best account of the twelve errors appears in this report by Michael Drummond in the Shoreham Herald. And you're right - the errors did not figure in this detail in the AAIB report. Michael Drummond's report is another example, if one were needed, of the value of a local paper being able to have a good court reporter attend the majority of a trial.
https://www.shorehamherald.co.uk/new...says-1-8824257
Another well-balanced report - although not detailing all twelve errors - was by Adam Lusher in the Independent. Sad to say, that's no longer a printed paper, but it does have a good website.
https://www.independent.co.uk/news/u...-a8810671.html
These reports stand in some contrast to much of the rest of the printed press, whose representatives were often noticeable by their absence from court. Several of them seemed to have taken their stories from the 53-page summary of the prosecution case handed out at the start of the trial; they seemed unaware of the detail of the strong - and eventually successful - case mounted by the defence. I except from that criticism the excellent work of PA, the Press Association, who were present throughout. And also, most of the broadcasters took care to be present for much of the time.
It all goes to show that you shouldn't believe everything you read in the papers!
airsound
Timelord - I'm afraid I'm not going to comment on your comparison with the Hillsborough match commander, because I believe his case is sub judice. It is true, however, that he also is charged with gross negligence manslaughter.
Falcon900 - probably the best account of the twelve errors appears in this report by Michael Drummond in the Shoreham Herald. And you're right - the errors did not figure in this detail in the AAIB report. Michael Drummond's report is another example, if one were needed, of the value of a local paper being able to have a good court reporter attend the majority of a trial.
https://www.shorehamherald.co.uk/new...says-1-8824257
Another well-balanced report - although not detailing all twelve errors - was by Adam Lusher in the Independent. Sad to say, that's no longer a printed paper, but it does have a good website.
https://www.independent.co.uk/news/u...-a8810671.html
These reports stand in some contrast to much of the rest of the printed press, whose representatives were often noticeable by their absence from court. Several of them seemed to have taken their stories from the 53-page summary of the prosecution case handed out at the start of the trial; they seemed unaware of the detail of the strong - and eventually successful - case mounted by the defence. I except from that criticism the excellent work of PA, the Press Association, who were present throughout. And also, most of the broadcasters took care to be present for much of the time.
It all goes to show that you shouldn't believe everything you read in the papers!
airsound
Falcon900 - probably the best account of the twelve errors appears in this report by Michael Drummond in the Shoreham Herald. And you're right - the errors did not figure in this detail in the AAIB report. Michael Drummond's report is another example, if one were needed, of the value of a local paper being able to have a good court reporter attend the majority of a trial.
https://www.shorehamherald.co.uk/new...says-1-8824257
Another well-balanced report - although not detailing all twelve errors - was by Adam Lusher in the Independent. Sad to say, that's no longer a printed paper, but it does have a good website.
https://www.independent.co.uk/news/u...-a8810671.html
These reports stand in some contrast to much of the rest of the printed press, whose representatives were often noticeable by their absence from court. Several of them seemed to have taken their stories from the 53-page summary of the prosecution case handed out at the start of the trial; they seemed unaware of the detail of the strong - and eventually successful - case mounted by the defence. I except from that criticism the excellent work of PA, the Press Association, who were present throughout. And also, most of the broadcasters took care to be present for much of the time.
It all goes to show that you shouldn't believe everything you read in the papers!
airsound
Are we then to believe the cognitive impairment (that apparently happened before and during the fateful manoeuvre) was suddenly 'unimpaired' and fixed itself immediately prior to the crash when the pilot was clearly pulling back on the stick for all he was worth to prevent the invitable?
Originally Posted by Shoreham Herald
He was also asked about the prosecution's assertion that the tragic crash was a result of 'extremely bad piloting' and not cognitive impairment.
Dr Jarvis said: "I can’t really accept that.
"Obviously Mr Hill was very experienced as a pilot and it just doesn’t seem credible to me."
Dr Jarvis said: "I can’t really accept that.
"Obviously Mr Hill was very experienced as a pilot and it just doesn’t seem credible to me."
