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Norfolk Island Ditching ATSB Report - ?

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Norfolk Island Ditching ATSB Report - ?

Old 9th Dec 2017, 08:53
  #1241 (permalink)  
 
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Call me picky, but I’d really like to know:

- what assertions of fact made by Mr Davies and Mr Aherne are incorrect

- what calculations done by Mr Davies and Mr Aherne produced the wrong result

- what analyses of the regulatory requirements by Mr Davies and Mr Aherne are wrong

- what logic used by Mr Davies and Mr Aherne is a fallacy.

My summation (which could be wrong) of their analysis is that even if the PIC of NGA could legally have uploaded full fuel (which they say he might not lawfully have been able to do), he still ends up with insufficient fuel to make it to somewhere else after being unable to land at YSNF.

I do note that neither Mr Davies nor Mr Aherne asserts that the PIC made no mistakes. Quite the opposite, on my reading.
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Old 9th Dec 2017, 09:42
  #1242 (permalink)  
 
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The pilot has to have regard to these matters but doesn't have to do anything specific about them.
"have regard but not do anything" - I find that faintly ridiculous, and wouldn't want to walk into court with that as my defense. In any case I disagree, but hey-ho.

he still ends up with insufficient fuel to make it to somewhere else after being unable to land at YSNF.
I don't think anyone disputes that. The long sector inbound to Norfolk meant that the destination was (under ICAO Annex 6) a "remote aerodrome", in that the aircraft couldn't carry enough fuel for an alternate. Under Australian rules at the time, and as an airwork flight, that was legal. International Authorities generally require two hours holding for a remote aerodrome and don't classify Air Ambo as airwork. In that sense the pilot was operating under a regularory system which was less safe than international standards.
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Old 9th Dec 2017, 10:00
  #1243 (permalink)  
 
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The pilot was not prosecuted because there was little chance of conviction and the operator and CASA would be dragged through the mud by the defence.
Mmmm, are you sure of that? I would think that IF they had presented the case to CDPP for further action, that it would be the CDPP who made the decision or otherwise to pursue the prosecution any further. But that is just a grade 9 educated mechanic's thoughts.
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Old 9th Dec 2017, 10:18
  #1244 (permalink)  
 
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Originally Posted by Checkboard View Post
"have regard but not do anything" - I find that faintly ridiculous, and wouldn't want to walk into court with that as my defense. In any case I disagree, but hey-ho.


I don't think anyone disputes that. The long sector inbound to Norfolk meant that the destination was (under ICAO Annex 6) a "remote aerodrome", in that the aircraft couldn't carry enough fuel for an alternate. Under Australian rules at the time, and as an airwork flight, that was legal. International Authorities generally require two hours holding for a remote aerodrome and don't classify Air Ambo as airwork. In that sense the pilot was operating under a regularory system which was less safe than international standards.
Well CB, that’s precisely the point.

The PIC could have made zero mistakes (even those conjured up by the Monday morning quarterbacks) and he could have carried full fuel (even assuming it was legal, given the other stuff on board the aircraft), and the aircraft is still in the drink, somewhere.
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Old 9th Dec 2017, 10:34
  #1245 (permalink)  
 
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Maybe. If he had turned up with 2 hours holding, then the chance of finding a weather window and performing a successful approach would have been strong.

... and if not, then the preparations for ditching (in the aircraft and on the ground) would have been significantly better.
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Old 9th Dec 2017, 11:49
  #1246 (permalink)  
 
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Looks like you are slowly joining the dots LB about a PICs responsibility. You have to give yourself the best chance of avoiding the pitfalls of marginal aircraft, remote airports and unreliable forecasting.

I understand him to be saying that you have to know the specific gravity of the particular fuel to be uploaded, as the weight of the fuel and the weight of medical staff, patient, patient’s partner and medical equipment all contribute to MTOW. It also makes a difference to how much ‘thrust for the buck’ that you get. And TOW affects how quickly you can get ‘up there’.

Apparently the SG of jet fuel varies, substantially, across various ports.

I understand one conclusion of his analysis against the applicable requirements is that the Westwind couldn’t actually comply in many operational circumstances.
Nothing new here and none of it would have or should have been unknown to the crew.

My summation (which could be wrong) of their analysis is that even if the PIC of NGA could legally have uploaded full fuel (which they say he might not lawfully have been able to do), he still ends up with insufficient fuel to make it to somewhere else after being unable to land at YSNF.
You are not wrong but refer to my previous comment and also Checkboard's comment:

Maybe. If he had turned up with 2 hours holding, then the chance of finding a weather window and performing a successful approach would have been strong. ... and if not, then the preparations for ditching (in the aircraft and on the ground) would have been significantly better.
So the question is why wouldn't you load as much fuel as possible? R Davies has never flown a Westwind, B Aherne has never flown fixed wing so I lean towards the experience of someone like Checkboard who reckons that full fuel was possible. Going to somewhere like NFI its the only thing that going to buy you time when the weather turns bad. That's a Captain's decision. I don't accept the mob rule that the PIC was an innocent victim. Sure the system was flawed but it always has been.
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Old 9th Dec 2017, 19:49
  #1247 (permalink)  
 
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Would full fuel have been legal at the SG of the actual fuel being uploaded and the weight of medical staff, the patient and her partner and medical equipment? You seem to be suggesting that these numbers somehow depend on Mssrs Davies and Aherne’s aeronautical experience. The numbers are the numbers, as you well know.

Who said the PIC is an “innocent victim”? All I’ve ever said is that if he’s to be shafted for the holes that he drilled in the Swiss cheese, so should everyone else that did the same.

“The chance of finding a weather window and performing a successful approach would have been strong.” Speculation. The weather could have got worse. And again, we see that the PIC’s level of culpability seems to depend on the coin toss of weather.

Everyone survived the ditching! My inexpert view in relation to the ditching is that the PIC’s biggest mistake was failing to broadcast a mayday stating the position at which the ditching was going to be carried out. He was just lucky that the coin fell the other way and someone spotted his flashlight.

At least we all seem to be in agreement that even if he’d carried full fuel, the PIC was committed to a ditching somewhere if he couldn’t get into YSNF. I assume everyone agrees that the least-worse place to do that was in close proximity to YSNF, rather than in the middle of the ocean during a doomed-to-fail attempt to get to an alternate?
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Old 9th Dec 2017, 20:06
  #1248 (permalink)  
 
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The revised, and quite comprehensive ATSB report, said that full fuel was OK.

The weather at Norfolk was frontal. It could onlLy get better, and couldn't get worse than "you can't get in". As the front passes, your chances improve. The weather reports show that.

Yes, if they couldn't land, they were committed to a ditching but a successful ditching needs a successful rescue to match it. This one was based on a guy seeing a torch in a direction that no one else was looking.

The best place to ditch is next to the harbour that the rescue boat is going to launch from, after you have told them that that is where you are going to ditch.

I honestly, given the time they had and the nature of ditching, do not blame the pilot one bit for not doing that. To ditch an aircraft at any time, but especially at night in a remote sea, would have been insanely stressful for everyone. A level of stress that honestly precludes comment

The fuel uptake, you can talk about. But the ditching - that is beyond the experience of anyone here and simply cannot be commented on, other than - it worked and everone lived.

Last edited by Checkboard; 9th Dec 2017 at 20:25.
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Old 9th Dec 2017, 20:10
  #1249 (permalink)  
 
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I’m sorry, but “the ATSB says full fuel was OK” doesn’t cut it with me.

I take your point about the weather, though. Still a coin toss I reckon.
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Old 10th Dec 2017, 02:31
  #1250 (permalink)  
 
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Well LB all the information required to work out how much fuel was required and what could have been uplifted is available in the documents you had links to. The raw data is in the report such as the Pelair method of fuel calculation. It would seem that CB can't answer your questions so sit down with a coffee and work it out for yourself. You might be able to source more info from the crazies at Aunty because they seem to be your biggest fan club. While you are there ask them about their own conspiracy about what happened to Gobbledock. He seems to have disappeared with nary a fare thee well or tribute to his sterling work over the years. Methinks Sarcs (akaP2) has done the murky Machiavellian on him and removed him from the boards.
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Old 10th Dec 2017, 06:38
  #1251 (permalink)  
 
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All I’ve ever said is that if he’s to be shafted for the holes that he drilled in the Swiss cheese
Que? You don't understand the Reason model if you're making a statement like that.

A lot of the after-the-fact quarterbacking on here is cringeworthy. The silent majority knows that 'airmanship' trumps 'legal' every day/night of the week.
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Old 10th Dec 2017, 06:49
  #1252 (permalink)  
 
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I'm having a go at the weight and fuel calculations for this flight, bit of brain teasing.

Which of the weights are in dispute?
Which of the fuel loading calculations are in dispute?

I want to compare those with mine, and maybe yours if you have done the same.
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Old 10th Dec 2017, 08:46
  #1253 (permalink)  
 
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At least we all seem to be in agreement that even if he’d carried full fuel, the PIC was committed to a ditching somewhere if he couldn’t get into YSNF
Nothing is so black and white. Extra fuel also gives you more decision making time when thinking about peeling off to an alternate. It also makes the option of diverting look more attractive if you are going to reach your alternate with a good amount of fuel in tanks.
Fuel is marvellous for improving decision making.
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Old 10th Dec 2017, 19:28
  #1254 (permalink)  
 
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Errrrm, I think you’ll find that it didn’t matter how much longer the PIC would have had to think about “peeling off to an alternate” if he’d uploaded full fuel. The aircraft was never going to make it to an alternate after arriving at YSNF.

As you say, fuel has many marvellous effects. But it cannot break the laws of physics.

Last edited by Lead Balloon; 10th Dec 2017 at 19:43.
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Old 10th Dec 2017, 20:16
  #1255 (permalink)  
 
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I suspect by "peeling off to an alternate" 73qanda means peeling off to an alternate at a pre-flight planning calculated enroute diversion point/PNR well before NF, rather than trying
to make it to an alternate after arriving at YSNF
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Old 10th Dec 2017, 20:42
  #1256 (permalink)  
 
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Perhaps a better option would have been to not use Norfolk Is. At all. However, the acute commercial/patient considerations and the almighty $$ dictate otherwise. Extra fuel? It is not cheap in the pacific. An extra dollar per litre would add thousands of dollars to the cost base. Landing charges/customs? Cheaper at NLK than Auckland? Less track miles via NLK. Save hundreds in airnav charges and get a very crook patient to AU quicker.

Hindsight is a wonderful thing and none of us were there that night but have gotten away with it with luck in similar situations.

Last edited by The Banjo; 10th Dec 2017 at 21:04.
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Old 10th Dec 2017, 21:04
  #1257 (permalink)  
 
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If only the pilot had not been misled by the incomplete weather information he was provided.

“We had some really bad news about the weather at YSNF that would have been very useful for you to know before you committed to continue to YSNF, but we didn’t volunteer it because we didn’t legally have to. You, on the other hand, Mr PIC of NGA, have to do more than what’s legally required, and assume that we could have bad news for you but not tell you unless you ask.”

Counter-intuitive systems create traps.

Last edited by Lead Balloon; 10th Dec 2017 at 21:25.
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Old 10th Dec 2017, 21:11
  #1258 (permalink)  
 
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It is not cheap in the pacific. An extra dollar per litre would add thousands of dollars to the cost base.
The fuel in Samoa was half the price of the fuel at Norfolk. It would have paid to carry fuel in rather than uplift it at Norfolk.
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Old 11th Dec 2017, 03:05
  #1259 (permalink)  
 
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As you say, fuel has many marvellous effects. But it cannot break the laws of physics.
But as many have stated, particularly those with actual operational experience, it can buy you time. Even 1360lbs of fuel can buy you time if used wisely.

If only the pilot had not been misled by the incomplete weather information he was provided.
As Sunfish is often fond of saying," to put that another way", If only the pilot had obtained complete weather information.

You, on the other hand, Mr PIC of NGA, have to do more than what’s legally required, and assume that we could have bad news for you but not tell you unless you ask.”
Day in, day out for every single flight. Its called operational control and it is entirely the PIC's responsibility. Use every available resource. Not, rely on every available resource.

Those in the "PIC was a victim camp" cite the 0803 SPECI not being provided as evidence of a cover up and a conspiracy theory. If your entire operation and decision making comes down to one weather report to a destination known for its unpredictable weather events then you shouldn't be in the LHS. From what I have read recently the PIC still thinks that the 0803 SPECI not being passed on to him was the cause of all his troubles.
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Old 11th Dec 2017, 03:26
  #1260 (permalink)  
 
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Wow - So if you have more fuel, you have more time? I’ll have to write that down in my “Big Book Of Wisdom I’ve Learnt From People With Actual Operational Experience”.

I’d like to learn more: At what time do you make what radio calls to obtain complete weather information on the flight that NGA ditched? Precise times and precise terminology thanks, LL.

I reiterate what the Operator’s submission to the Senate Inquiry said:
The aircraft transferred to Auckland at 0839 but did not request the latest Norfolk weather until 0904 when they were given the 0902 SPECI which showed broken (BKN) cloud at 1100 feet and OVC cloud at 1500 feet. This finally alerted them to the situation at Norfolk Island. However a much more severe SPECI was issued earlier at 0830 showing a marked deterioration of the weather with cloud BKN at 300 ft and OVC at 900 ft. This was well below the landing minima and if it had been passed to the aircraft on first contact with Auckland would have alerted the crew to the true situation with time enough to divert. At 0839 the aircraft was still around 32 min away from the last diversion point to Tontouta as shown in the timeline in the report. Additionally, if the Nadi controller had passed the 0830 SPECI to the aircraft when it was issued there would have been even more time for the crew to assimilate the changing weather and take appropriate action. As it was the critical 0830 SPECI was never passed to the crew. [NOTE: In the Pelair submission, the bolded text in the quote above is in red font.]
So it seems the operator also took the view that a trap was set for the PIC by what was volunteered in contrast to what was withheld.

You use phrases like “conspiracy theory” in an attempt to discredit people who have a different view than you. It does you no credit.
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