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Tutor Mid-air report.
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Probable contributory factors 3. Conspicuity. The white colour scheme of the tutor, presenting very little contrast with a bright background of cloud, was a probable contributory factor. Couldn't agree more. We have been complaining about this at Yeovilton for the past 2 years. You cannot see the Grob when it is in the circuit and if they don't paint it another colour soon then this tragic accident is likely to happen again. |
Anybody know where to find the boards recommendations?
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This is so sad that one simple thing could have prevented this
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This is so sad that one simple thing could have prevented this WRT to the factors involved, Conspicuity was only listed as a "Probable Contributrary Factor". The Board's finding on the causes is considerably more lengthy. YS |
Very true but there was only one cause of the accident. There were many factors which contributed to the single cause.
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Having flown the G115 civil version, I've always wondered about wearing a bone dome. Same for Bulldogs. I have flown wearing the type I think is similar and it felt very unnatural in a light a/c and beingunused to it limited my head movements.
Did the enquiry look into this aspect? Sir George Cayley |
Not wishing to be too tangential over a tragic event such as this, but given it is now 2010, does the MoD really think a gash scan of a massive paper document that now becomes a brazillion Megabyte PDF is really someone's idea of being "electronically available"? Just asking.
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Sir George,
WRT helmets in the Grob, it's not really an issue. I've flown both with and without helmet (mil and civvy G-115) and to be honest I actually prefer it with a helmet, it certainly doesn't restrict lookout. From the findings, and the reconstructions used, it looks like an unfortunate case of "same way, same day, under a wing/nose to each other" with the addition of airspace considerations bottling people into a specific area. Unfortunately those factors led to the loss of two really nice blokes and two young ladies who I'm sure would have gone on to bigger and greater things. Two's in - This is the MOD, it still takes me half an hour to check my email (which I can only do from work) |
Midair collision happens because neither pilot saw the other in time to take
evasive action. There are a lot of contributing factors involved here, not just the white colour of the Tutor. 1) Some witnesses mention that one of the aircraft performed a wingover shortly before the collision. Does this imply showing off? with insufficient lookout before performing maneuvers? 2) The structure of the Tutor canopy certainly offers an obstruction to the view. This requires an even more careful scan, many aircraft suffer from airframe blocking the view. 3) One of the pilots was wearing corrective lenses. I don't see mentioned if these were varifocals or not, varifocals screw up your peripheral vision. 4) I cannot imagine that wearing a bonedome improves your field of view or makes it easier to look around. 5) Should it not be part of the PIC's training to practice actually jettisoning a canopy -preferably on soft grass. 6) Taking off together in close formation is a very military sort of thing to do, is the usual thing to carry on then flying near each other? Without a plan, or a qualified observer in radio contact with the other aircraft, this was asking for trouble. Formation flying, or ariel photography require special care. Flying kids around requires even greater care. I suggest that if the military are responsible for flying kids around, that they do not takeoff together, that at least 10 minutes should space their departures, that the sortie be plannned to be separate, to different areas, the flights to be planned and the plan followed. |
Mary,
I appreciate you might not be fully informed, so I'll give you the benefit of the doubt rather than assume you're some journo out fishing... 1) Some witnesses mention that one of the aircraft performed a wingover shortly before the collision. Does this imply showing off? with insufficient lookout before performing maneuvers? 2) The structure of the Tutor canopy certainly offers an obstruction to the view. This requires an even more careful scan, many aircraft suffer from airframe blocking the view. 3) One of the pilots was wearing corrective lenses. I don't see mentioned if these were varifocals or not, varifocals screw up your peripheral vision. 4) I cannot imagine that wearing a bonedome improves your field of view or makes it easier to look around. 5) Should it not be part of the PIC's training to practice actually jettisoning a canopy -preferably on soft grass. 6) Taking off together in close formation is a very military sort of thing to do, is the usual thing to carry on then flying near each other? Without a plan, or a qualified observer in radio contact with the other aircraft, this was asking for trouble. Formation flying, or ariel photography require special care. Flying kids around requires even greater care. To suggest, as I think you do, that these two pilots operated with anything other than the utmost care is, in my mind, pretty poor form. |
Originally Posted by BigGreenGilbert
(Post 5429004)
<snip>
My own (cynical) view is that the MoD deliberately does it this way to make it difficult to search and copy and paste from such documents. |
The missing details
This report seems to have plenty of detailed technical information but very little information on the action and intentions of those involved
We're not told, for examp[le, how many cadets turned up at UWAS for these flights - but that two were randomly selected. The odds of randomly selecting two cousins must be pretty long. Both girls were issued with parachutes - but did they know, or were they told, how to use them? The two girls aged 13 and 14 had never flown in the Tutor - or indeed any - aircraft before. However both were put in the left hand seat. Was this with a view that they should handle the controls at some point? If so, was one - or perhaps both - of them actually flying their respective aircraft at the time of impact.? If one or other was flying - was their instructor's attention focussed on them rather than watching where the aircraft was going? The RAF Inquiry should have interviewed other cadets who have been taken up on similar flights to ascertain how these air-experience flights are actually conducted in practice. |
Judging by some of this speculation some people have too much time on their hands...........oh hang on a minute, do you think the position of the stars might have had some effect?
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The RAF Inquiry should have interviewed other cadets who have been taken up on similar flights to ascertain how these air-experience flights are actually conducted in practice. 60-odd years, the Service knows how they are conducted in practice. What could the cadets tell them that is not already well known? Or are you inferring something was going on that should not have been? |
Gash scans and PDF
Perhaps it's a legal thing so the MOD can prove the electronically published report is a direct copy of the original?
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Korrol, in the Tutor the LHS is the 'passenger' seat, the captain of the aircraft sits on the right. All the instrumentation is laid out in front of the RH occupant. This is so trainee pilots get used to the layout of stick in right hand, throttles in left. For the cadets to be in the LHS is normal. Try Google for an image of the Tutor cockpit and you'll see what I mean.
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Korrol - your points:
This report seems to have plenty of detailed technical information but very little information on the action and intentions of those involved. The "actions and intentions of those involved" were exactly that same as the actions and intentions of the pilots in any AEF flight; namely to pass on their knowledge of, and their enthusiasm for, flying to the air cadets. We're not told, for examp[le, how many cadets turned up at UWAS for these flights - but that two were randomly selected. The odds of randomly selecting two cousins must be pretty long. Why do you need to know how many turned up at UWAS. You obviously have no idea how the AEF system works. Flying slots are allocated to ATC Wing HQs. The Wing HQs detail squadrons to attend for flying. The squadrons bring the allocated number of cadets to the AEF, where they are briefed and prepared for their flights. The AEF programmes all of the cadets to fly and flies them. They are not "randomly selected" from a cast of thousands, but if an ATC squadron happens to have cadets related to each other (highly likely and pretty common) the odds of them coming flying on the same day are pretty good. A fair few of our squadrons have sets of brothers and/or sisters, and they pretty much always come flying on the same day. Both girls were issued with parachutes - but did they know, or were they told, how to use them? The cadets are shown a safety film and they are also briefed on the use of the parachute. Incidentally, they are not "issued with" the parachutes, they are correctly fitted with them. The two girls aged 13 and 14 had never flown in the Tutor - or indeed any - aircraft before. However both were put in the left hand seat. Was this with a view that they should handle the controls at some point? If so, was one - or perhaps both - of them actually flying their respective aircraft at the time of impact.? If one or other was flying - was their instructor's attention focussed on them rather than watching where the aircraft was going? I don't know about you and your own particular level of skills, but I can walk and chew gum at the same time, and I can monitor the cadet's actions and still manage to keep a good and thorough look out for other aircraft, maybe even a better look out than when I am actually demonstrating and teaching a particular point to a cadet. The RAF Inquiry should have interviewed other cadets who have been taken up on similar flights to ascertain how these air-experience flights are actually conducted in practice. There are 12 AEFs in the country, each of which is staffed by experienced and highly professional pilots. These AEFs have been operating safely and successfully for a VERY long time and, as has been said, the "system" knows EXACTLY how each AEF flight is actually conducted in practice. I have no idea what your agenda is with these questions, but you obviously think that AEFs are operated by gash people in a gash manner with no regard for the safety of the cadets. Nothing could be further from the truth. We all know precisely what our responsibilities are for looking after the cadets whose parents entrust them into our care, and we do our level best to ensure that safety. I don't know just how long you have been involved with aviation, but everybody who has been in the aviation world for more than 5 minutes knows that accidents happen and that a lot of these accidents are indeed just random events that are immensely difficult to prevent. The fact is that the Tutor is very difficult to see. We know that and are, therefore, particularly diligent about looking for the "other aircraft" that may not see us. |
Originally Posted by ab33t
(Post 5428060)
This is so sad that one simple thing could have prevented this
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The terminology used in Mary Meagher's post suggests that she/he is in some way involved in aviation, which makes the naivety of some of her/his comments quite astonishing. Thanks Anonystude and Wholigan for putting her and Korrol right on some of their points, something they could have done for themselves had they read the reports correctly, eg mixing up a formation takeoff with one timed at one minute intervals.
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Wholigan has it absolutely spot on.
Having been to a number of AEF's regularly as both a cadet and as VR(T) staff, I can say that there is a very high standard and degree of consistency between all of them with regards to safety briefing - be it on the aircraft, or on the parachute. All cadets are shown how to use the parachute on fitting. Knowing how many cadets turn up for an AEF detail is irrelevant, however cadets from one or many units may turn up for an AEF detail. Certainly where I have attended, around 30 cadets will be detailed to fly in a session. In choosing which order to fly cadets in, it is most likely from my experience that those who have not flown will fly first, and those who have flown most will fly last (or possibly not at all in the case of any delays or weather issues), followed possibly by staff. The fact that these 2 girls were related is likely to be tragic but not unlikely coincidence, as neither had flown, being cousins they were likely to have attended together, therefore their 3822 record of service books may have been together in the pile, and having not flown therefore were likely to be at the top of the pile. AEF flights for cadets are not a rare uncommon event - the Tutor is detailed, and was partly purchased to provide these flights. They happen week in, week out at all the AEF's around the country. it is an experienced and professional operation. |
Thorough report
Overall a very well considered Serivice Inquiry into a tragic event.
It confirms that "See and be Seen" is all very well if (a) the pilot can see out of the cockpit and (b) the other a/c is obvious to the Mk1 eyeball. The current Tutor canopy design leaves much to be desired when compared to the old Bulldog or Firefly - especially in turns steeper than 30 degrees when having to look past the central spine. The advice for a "go forward"/harness is laudable as the current design pins the shoulders back. Conspicuity/Colour is another factor cited - the report has much to say on contrast and suggests slightly darker airframe colours (than background for daylight ops) are better with the advantages of fluorescent paint schemes debatable. TCAS is recommended but there is no comment on the false indications these devices can give during high G / Aerobatic or pitching manoeuvres. It remains to be seen what can be implemented to improve matters. |
That cr*ppy pdf
I don't think that it's a legal requirement; that would be covered by the existence of the paper document, if necessary.
No, it's the appalling and inconsistent state of the MOD's (not just the RAF's) IT kit. Not many people have a way of making pdf files and they are probably unaware that it would come out much smaller and neater if it were straight from the original file – electronically. If only the MOD had continued with Macs ... |
If only the MOD had continued with Macs ... |
Minor addition about the varifocals. Missus Fairy (a dispensing optician of some years standing) tells me that varifocals DO interfere with peripheral vision and that you need to look with your nose to cover the gap.
Whether any of the crew were wearing varifocals I don't know, and I don't know if it was a factor in the accident but I wanted to pass this snippet on. |
Metman - The number of cadets at St Athan is usually substantially lower than 30, and it was not uncommon to have single figures turn up. Thus as you say, it is actually reasonably likely that 2 relations could be randomly selected to fly at the same time (especially with 3 a/c operating AEF).
To all those that seem to have an agenda(or think the RAF/AEF does) - remember, a lot of people involved in the AEF (both regular, VR and VR(T)) give up their time (both paid and unpaid) to make sure these kids have a great time and get something out of it. They're not there to show off how great they are, but to try and give the kids an experience they don't get anywhere else. That frequently involves doing things like aerobatics, which are not done for the purpose of showing off, but can be fantastic for building confidence in sometimes quite timid teenagers who are out of their comfort zone. It's a fantastic system, that is the envy of many youth organisations the world over. It's tragic, but sometimes accidents do indeed happen, in all walks of life, not just aviation. Fly safe everyone |
To Anonystrude: Thank you for answering my points, and correcting any misinformation. Yes, I do still fly, and have more than 3,000 hours, though never in or near the military, and I am not a piscatorial journalist.
Nevertheless perhaps some of my points could prove useful. Trying to prevent anything like the Tutor Mid-air from happening again......hopefully the organisation will look respectfully at suggestions from another discipline; I have flown over the years as an instructor on more than 3,400 flights, with all ages. 1. We must have a different understanding of the term wingover. 2. You agree the canopy structure can possibly obscure the view of other aircraft. 3. Post 27 concurrs with my warning about varifocal lenses. 4. Nope, never wore a bonedome, except once in a microlite. I can only imagine its effect on your scan. Can you turn your head enough to look back over your shoulder while wearing it? 5. If finding the canopy handle in the Tutor is difficult, perhaps this requires a mod? Has an actual jettison ever been practiced to your knowlege? Not much use wearing a parachute if you can't get rid of the canopy. 6. As for those takeoffs, Tankertrash nav finds my ignorance astonishing. Quite true, I have no experience at all of either formation takeoffs or those timed at l minute intervals. NEVERTHELESS, the report says, in part 1.3, item 1, that the Tutors took off at 1037 and 1038, and maintained approx. l minute separation during a standard VFR departure to the West. The actual collision took place at l046, approximately 8 minutes later. Why are you then so scornful of my suggestion that " at least 10 minutes should space their departures, that the sortie be planned to be separate, to different areas, the flights to be planned, and the plan followed"? And as for pba target's idea that aeros "can be fantastic for building confidence in sometimes quite timid teenagers who are out of their comfort zones", inflicting aeros on beginners, in my experience, puts most of them off for life. |
4. Nope, never wore a bonedome, except once in a microlite. I can only imagine its effect on your scan. Can you turn your head enough to look back over your shoulder while wearing it? As noted in the report, the absence of a go-forward facility on the Tutor's shoulder straps is a minor hindrance to rear-sector lookout; some wizened old UAS QFIs of my acquaintance advocate slightly loosening the shoulder straps once airborne to achieve the same effect. Why are you then so scornful of my suggestion that " at least 10 minutes should space their departures, that the sortie be planned to be separate, to different areas, the flights to be planned, and the plan followed"? My own main observation from this accident concerns the use of ATC services during medium-level general handling by us military fliers. For years, the culture was to get rid of ATC ASAP - "squawking 7000, enroute". It seems that was in operation on this fateful day at St Athan. My own corner of the RAF is moving away from this, probably as a result of years of medium-level operations in Iraq (where it was the norm to have some sort of ATC service at all times). Now, more and more crews are getting a Traffic Service whilst conducting medium-level training - with the general reduction in military traffic, it's usually possible to get a quiet frequency, and the gain in situational awareness is huge. Sometimes you get ATC talking when you're trying to deal with a JTAC on the other radio, but hey, that happens on ops as well! So kids, get a radar service (unless you're at low level - but then you've only got half the sky to search:ok:) |
1. We must have a different understanding of the term wingover. Why are you then so scornful of my suggestion that " at least 10 minutes should space their departures, that the sortie be planned to be separate, to different areas, the flights to be planned, and the plan followed"? |
Thank you, Easy Street, for your considered reply. I am relieved to learn that the RAF is willing to accept assistance from controllers for situational awareness. Those of us forced to share some of the narrow VFR corridors remaining with medium level fast jet traffic (spotted one, where is the other guy?!*&@!) will be much happier. We are also grateful to the military radar services, particularly Brize.
Still hoping for an answer to my other question; has anybody actually practiced an emergency jettison of the Tutor canopy? Best regards |
And as for pba target's idea that aeros "can be fantastic for building confidence in sometimes quite timid teenagers who are out of their comfort zones", inflicting aeros on beginners, in my experience, puts most of them off for life. The pilots at the AEFs are some of the most professional and experianced people I have ever met and none of them need to show off as most have been there and bought the t-shirt,you would not believe the former ranks and background of some of them .I would trust any of them with my life and have done,even more I have trusted them with both my sons lives and would not hesitate in doing so again. |
Mary, to address a few of your points:
1. We must have a different understanding of the term wingover. 2. You agree the canopy structure can possibly obscure the view of other aircraft. 3. Post 27 concurrs with my warning about varifocal lenses. 4. Nope, never wore a bonedome, except once in a microlite. I can only imagine its effect on your scan. Can you turn your head enough to look back over your shoulder while wearing it? 5. If finding the canopy handle in the Tutor is difficult, perhaps this requires a mod? Has an actual jettison ever been practiced to your knowlege? Not much use wearing a parachute if you can't get rid of the canopy. However, it has always been SOP to practice the abandon drill at least once a month. It's a currency, so if it hasn't been practiced, you don't fly until you have. This drill included a TOUCH drill of the jettison handle i,e, the canopy isn't actually jettisoned. Since the accident, the base I was at not too long ago (with an EFT sqn and AEF) started regular demonstrations of actually jettisoning the canopy. Not sure if this is a fleet-wide implementation though. 6. Has already been answered. I don't think a 10 minute interval would help, as 10 minutes later, you'd be in the same airspace anyway. All AEF's and EFT Sqns (as far as im aware) have now "sectorised" their airspace. Prior to take off, they mark down what sector they're planning on operating in on a board in ops. e,g, if someone will be operating in the north sector, then the next pilot will operate in the east/west/south sector for example. Personally I think TCAS would be an excellent addition. When I flew the Tucano (which has TCAS) I was amazed at how many aircraft were out there!! And as for pba target's idea that aeros "can be fantastic for building confidence in sometimes quite timid teenagers who are out of their comfort zones", inflicting aeros on beginners, in my experience, puts most of them off for life. I still remember my first AEF flight with very fond memories. It included Aero's and I loved every second of it. 10 years later, and I'm in the RAF doing the best job in the world. |
To reinforce some of the stuff above:
Helmets are fine. AEF pilots are all current or ex mil who have loads of experience and training wearing these things. They do not inhibit lookout which is taught from minute one of day one. From my Grob RHS I can see the fin if I wish (and I do). Wingovers (gentle or less so) are an ideal way to clear a massive area of sky prior to aeros. In my experience, introducing beginners to aeros is a fantastic way to generate the biggest grins you ever see. Very rarely do cadets ask not to and then there's plenty of other things to do. AEF flying is astonishingly rewarding. Having been introduced to flying in the back of a chippy 30+ yrs ago, it is now a pleasure to do the same for others. DH |
Mary - Aeros would never be "inflicted" on someone... but it's fairly easy to build up to them in a short space of time without scaring/making sick the person involved.
As for the "getting rid of ATC and squawking 7000" as soon as possible, my memory may be failing me, but did Cardiff ATC not change from providing a service to the AEF to asking them to go en-route where possible due to increased workload? I didn't read any mention of it in the report, and I may have the wrong end of the stick. Mary - I've popped the canopy on the ground, but not all the way off, because, as I understand it, doing so would bear no resemblance to popping it it in flight, as in flight the principle is you pop it, push the leading edge up and back, then let the airflow do the rest of the work. Not sure if that's what you are referring to? |
There are always lessons to be learned after an accident (or a close shave, which we have all had).
Here we had two white coloured aircraft, the colour that most pilots agree is the most difficult to see in the air. Undoubtedly a failure of the "see and be seen" principle occurred. Most of the discussion seems to be patronisation / thinly veiled criticism of the AEF organistation, some of it based on ignorance. What lessons might be learned by the gliding fraternity? |
Canopy jettisons and egress trials were something done in the past at A&AEE Boscombe Down, but only in a 1 g environment. Aircraft (or just sections of them) were placed in front of the blower tunnel and 4 RR Merlins provided an airflow upto 500+ Knots. Canopies could be jettisoned, ejector seats fired and even crew abandonments carried out (catch nets provided).
To my knowledge the last unassisted abandonments conducted were on the Shackleton AEW (could the crew clear the radome when using the under nose escape hatch?) that means the Tutor as well as the Viking and Vigilant gliders haven't been tested even after fatal mid-air betwen two Vikings at RAF Sealand where the failure to jettison the canopy properly was identified by the investigation. Could canopy jettisons and crew abondonments be conducted? Yes, the Blower tunnel is still at Boscombe Down. Will trials be conducted? No, they cost too much :ugh: |
Easy Street: good points on the whole. However:
"the absence of a go-forward facility on the Tutor's shoulder straps is a minor hindrance to rear-sector lookout; some wizened old UAS QFIs of my acquaintance advocate slightly loosening the shoulder straps once airborne to achieve the same effect." It is not a minor hindrance - loosening them is against SOP and HASELL checks. The straps are there for a reason and the shoulder straps back up the negative g strap (which is too long at shortest setting for most) during aeros. Other a/c have a a mid torso fixing behind the seat with go-fwd setting. The Tutor has individual fixings for each shoulder meaning no flex to rotate the torso. "Now, more and more crews are getting a Traffic Service whilst conducting medium-level training - with the general reduction in military traffic, it's usually possible to get a quiet frequency, and the gain in situational awareness is huge." Tutors operate mostly below 5000 feet due to low climb rate. For EFT work a Traffic Service has proven unworkable due to a shortage of controllers and busy teaching environment. It may work for AEF. Quiet frequencies have been used for decades for teaching but are now under threat as this report suggests - increasing Mental Air Picture by using the radio more often. Professor Plum: "The view from a Tutor is much better than that of a C150/152 which have aerobatic versions, and generally better than most other SEP aircraft too." The view sideways and straight ahead is very good in the Tutor. The problem arises when you want to carry out turns steeper than 30 deg AoB or aerobatic pitching manouevres. Previous trainers such as the Chipmunk, Bulldog and Firefly were far better in this respect. Most Civilian SEP are used for A to B PPL flights not aerobatics. There are very few C150 Aerobats flying cf almost 100 Tutors and for lookout below a Cessna has an advantage. Almost all those Civilian a/c used for aerobatic training have superb Field of view eg: Extra 300, CAP10, Yak52, etc... Canopy Ejection: The proceedure is more complicated than described by posters. It does not pop open. Indeed when the canopy is flown in the vent position (speed below 100KIAS) it will tend to move forward and try to close itself unless locked. The red emergency pull handle does NOT release the canopy - it unlocks it. The larger handle must then be rotated through almost 180 deg. Then the INSIDE arm has to be used to push the canopy frame backwards and upwards. The proceedure takes a good few seconds to complete. As far as I am aware only one Tutor has lost a canopy airborne - In 2004 a canopy detached due to vibration after a propellor blade detached in flight. "Since the accident, the base I was at not too long ago (with an EFT sqn and AEF) started regular demonstrations of actually jettisoning the canopy. Not sure if this is a fleet-wide implementation though." First I have heard of it and sounds very expensive. |
ShyTorque asks
Most of the discussion seems to be patronisation / thinly veiled criticism of the AEF organistation, some of it based on ignorance. What lessons might be learned by the gliding fraternity? Possibly he is confusing this incident with the other tragedy later last year, when a glider flying straight (according to its flight recorder) was in collision with an AEF Tutor in an area where, minutes before, a professional ATPL (flying a glider) has reported to Brize an airmiss with an AEF Tutor performing aerobatics. NATS tapes show an extremely high level of GA aircraft, particularly gliders, in this 'choke point' of airspace. It is not known how many of the gliders were carrying appropriate anti-collision systems (certainly mine was). The systems carried are much more appropriate than TCAS, which is optimised for warning against aircraft in low density airspace, which in such a situation would be saturated and useless if all aircraft carried one; whereas FLARM warns only against close converging targets and highlights those with an actual collision risk. No doubt the report on this tragic accident will analyse the causes and make appropriate recommendations, and I am content to wait for the conclusions of those with all the information, and the responsibilty of trying to prevent a repetition. |
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