Norways first AW101 on its side
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Winnie firstly thanks for translating and posting the relevant bits for us non Norwegian speakers, and thanks Jim for translating the whole thing
secondly as I stated earlier with No 1 engine in accessory drive the flying control hydraulics are powered so the statement It ALSO stated in the checklist to NOT ATTEMPT to lower the collective until hydraulic pressure was coming up, preceded with a CAUTION isnt relevant to this case.
thirdly are you absolutely sure that full and free checks come AFTER the AFCS checks, the report states that they are done after No1 engine starting (to confirm that there are no control restrictions?) before the AFCS check is requested and then the rotor started. As this was skipped then another swiss cheese hole was lined up
However, the report does seem to highlight that the training received wasn't all it ought to have been.
DM
secondly as I stated earlier with No 1 engine in accessory drive the flying control hydraulics are powered so the statement It ALSO stated in the checklist to NOT ATTEMPT to lower the collective until hydraulic pressure was coming up, preceded with a CAUTION isnt relevant to this case.
thirdly are you absolutely sure that full and free checks come AFTER the AFCS checks, the report states that they are done after No1 engine starting (to confirm that there are no control restrictions?) before the AFCS check is requested and then the rotor started. As this was skipped then another swiss cheese hole was lined up
However, the report does seem to highlight that the training received wasn't all it ought to have been.
DM
Last edited by dangermouse; 16th Jan 2019 at 21:59. Reason: fat fingers
@Dangermouse there was a picture of the FRC (Flight Reference Card) that had AFCS CHECKS in bold, with thee full free and clear for each individual control immediatelyafter and not in bold type.
I put the collective lever warning as a reply to Crab et al, as a warning I understood to be PRIOR TO STARTING. Same with a 214ST which I have lots of time on, or my 135, which I have some time, on. You will likely break the lever if you try...
Cheers
H.
I put the collective lever warning as a reply to Crab et al, as a warning I understood to be PRIOR TO STARTING. Same with a 214ST which I have lots of time on, or my 135, which I have some time, on. You will likely break the lever if you try...
Cheers
H.
Winnie....there are contributing factors for sure.
But at the end of the day.....beginning with day one of a Pilot's training....in the most primary of trainers right the way to finding himself sat in the newest, most sophisticated high tech aircraft he has flown....basic skills and concepts transfer from one aircraft and level of complexity to the next.
Likewise, one's experience and progression upwards in levels of supervision, training, and safety carries the similar kinds of transferable skills and practices.
Why all of the failures that set the crew up for failure went un-noticed or acted identified and rectified?
These are not complicated ideas here I am talking about.
An example....a very simple one....in Bell Helicopters starting with the Bell 47 and forward....on two bladed systems....we learned to never start the aircraft with the blades fore and aft.....for the simple reason if they are cross ways....you cannot forget and start the aircraft with the blades tied down.
There are other reasons...but that is the simple thing.
Like wise....keepijng your hands on the flight controls is a standard practice that if used prevents some serious uh ohs....and with two pilot crews...it is easy to have one set of hands free for that purpose.
Most aircraft with elastomeric bearings do have odd Collective characteristics at start unlike the old style bearing heads so why if you moved from one type to another would that not be a transferrable bit of monkey memory?
How many mistakes did the Mishap Crew make in this roll over....have you counted them?
Gann once said....."Rule books are paper - they will not cushion a sudden meeting of stone and metal."
In this case we can substitute "Checklists" for "Rule Books" don't you think?
But at the end of the day.....beginning with day one of a Pilot's training....in the most primary of trainers right the way to finding himself sat in the newest, most sophisticated high tech aircraft he has flown....basic skills and concepts transfer from one aircraft and level of complexity to the next.
Likewise, one's experience and progression upwards in levels of supervision, training, and safety carries the similar kinds of transferable skills and practices.
Why all of the failures that set the crew up for failure went un-noticed or acted identified and rectified?
These are not complicated ideas here I am talking about.
An example....a very simple one....in Bell Helicopters starting with the Bell 47 and forward....on two bladed systems....we learned to never start the aircraft with the blades fore and aft.....for the simple reason if they are cross ways....you cannot forget and start the aircraft with the blades tied down.
There are other reasons...but that is the simple thing.
Like wise....keepijng your hands on the flight controls is a standard practice that if used prevents some serious uh ohs....and with two pilot crews...it is easy to have one set of hands free for that purpose.
Most aircraft with elastomeric bearings do have odd Collective characteristics at start unlike the old style bearing heads so why if you moved from one type to another would that not be a transferrable bit of monkey memory?
How many mistakes did the Mishap Crew make in this roll over....have you counted them?
Gann once said....."Rule books are paper - they will not cushion a sudden meeting of stone and metal."
In this case we can substitute "Checklists" for "Rule Books" don't you think?
As I said earlier - is there actually a need to engage the rotors to do a drying run?
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My question arises because on the S92 with CT-7s it is possible to do the entire procedure with the brake on because the engines are not required to run above idle Ng. It’s a drying run - do you think there’s a lot of difference in how dry an engine is after 2 minutes at hundreds of degrees C vs at hundreds of degrees C plus a bit more?
SASless, there were many mistakes by the crew, I did not count, and I do agree. I recently moved from a steamchicken (212) to an EC-135.... Huge difference.
I think the most pressing thing that I read in the report was the crews had requested time in a helicopter, ANY helicopter, just to get the feel back, but were rebuffed with "you'll get the feel back quickly!"
I have never sat in a 101 so have no clue, but initially the collective position apparently is higher than what thy were used to from a 412, and the throw is relatively small in the 101? Who knows, but there were a multitude of poor habbit things that the crews were taught in Yeovil, that led to many of the mistakes.
Being
Personally, I think the government in Norway/MOD (Norway) is to blame for most of it, due to not hiring all the necessary staff, and Leonardo, for not having the proper training materials ready/available, and MOJ (Norway) for being cheap with the training money. After all, there was a HUGE amount of money spent on this, spending a few additional hours on actual aircraft time would have proven beneficial. But that is Norway in a nutshell, "Spare seg til fant" (save yourself poor). Pinch pennies and throw big money away.
I think the most pressing thing that I read in the report was the crews had requested time in a helicopter, ANY helicopter, just to get the feel back, but were rebuffed with "you'll get the feel back quickly!"
I have never sat in a 101 so have no clue, but initially the collective position apparently is higher than what thy were used to from a 412, and the throw is relatively small in the 101? Who knows, but there were a multitude of poor habbit things that the crews were taught in Yeovil, that led to many of the mistakes.
Being
- hand on the collective during start (have mag brake so no need)
- advancing # 2, a couple second wait then # 3 EMSS (checklist said not to do simultaneously, so the didn't, but also didn't wait until the rotor had spun up to operating RRPM, which would have triggered some response as 1 engine isn't powerful enough to accelerate the rotor alone), this was learned from the instructors
- AFCS check (prior to starting rotor) not done, because 1 they weren't going flying, and 2 it often failed pre-rotor start so they had started doing it later..
- Not centering the controls (due to where it was after the AFCS check in the checklist.
Personally, I think the government in Norway/MOD (Norway) is to blame for most of it, due to not hiring all the necessary staff, and Leonardo, for not having the proper training materials ready/available, and MOJ (Norway) for being cheap with the training money. After all, there was a HUGE amount of money spent on this, spending a few additional hours on actual aircraft time would have proven beneficial. But that is Norway in a nutshell, "Spare seg til fant" (save yourself poor). Pinch pennies and throw big money away.
If a Rotors stopped, engine run will suffice....would you be happy. if an Engineer and not a Pilot did that procedure?
212man axed:
Perhaps not, technically. And with perfect hindsight we can say that they shouldn't have turned it up. But we have to delve into the mind of the helicopter pilot a little. (We don't have to delve deeply...and can't, really because with most of us there isn't much depth there.)
Consider: It was a new machine and none of the pilots had much time in it. So these two jokers were tasked with doing a ground run...a "dry run" if you will, and all that was required was running the engines. Is there a pilot among us who would not engage the rotor and bring her up to speed? I would have. You too, most likely. Admit it. (And I'm using the collective "you" here, not the cyclic "you" aimed at 212man.)
But here's the thing. And I keep harping on this all the time. If you take a helicopter rotor up to operational speed, you have to assume that you're going flying. Because...you know...you are. Even if the blades don't happen to be at an angle of attack to lift the helicopter off the ground, they're very capable of doing just that. It's like doing a "taxi test" by running a fixed-wing down the runway at takeoff speed with all the control locks in place: Stupid! No one would do that. But we dumb helicopter pilots do it all the time!
Let's cast our memory back a bit to the famous accident where the police 206B came off the dolly and ended up on its side. We've all seen the video, right? It was "just" a ground-run. We can tell from the uncowled state of the aircraft that the pilot was not intending to fly. He probably had his foot up on the doorsill, propping the door open as all of us 206 drivers do when it's hot out. More importantly, since this was just a ground-run, he probably had the cyclic and collective frictions on tight. Hey, we're not going flying, right? And then the dolly starts rolling because of the famous "SUDDEN GUST OF WIND!" The pilot grabs the controls and inadvertently gets the thing airborne. Only now...yikes!...ohmygod...damn!...what the...how the...damn...ohhhhh no...BOOM.
Sing it with me now! "Another one bites the dust...hey!"
So here's the lesson: Treat EVERY turn-up of the main rotor as a flight. Don't go to 100% unless you're ready, willing and able to be airborne.
As I said earlier - is there actually a need to engage the rotors to do a drying run?
Consider: It was a new machine and none of the pilots had much time in it. So these two jokers were tasked with doing a ground run...a "dry run" if you will, and all that was required was running the engines. Is there a pilot among us who would not engage the rotor and bring her up to speed? I would have. You too, most likely. Admit it. (And I'm using the collective "you" here, not the cyclic "you" aimed at 212man.)
But here's the thing. And I keep harping on this all the time. If you take a helicopter rotor up to operational speed, you have to assume that you're going flying. Because...you know...you are. Even if the blades don't happen to be at an angle of attack to lift the helicopter off the ground, they're very capable of doing just that. It's like doing a "taxi test" by running a fixed-wing down the runway at takeoff speed with all the control locks in place: Stupid! No one would do that. But we dumb helicopter pilots do it all the time!
Let's cast our memory back a bit to the famous accident where the police 206B came off the dolly and ended up on its side. We've all seen the video, right? It was "just" a ground-run. We can tell from the uncowled state of the aircraft that the pilot was not intending to fly. He probably had his foot up on the doorsill, propping the door open as all of us 206 drivers do when it's hot out. More importantly, since this was just a ground-run, he probably had the cyclic and collective frictions on tight. Hey, we're not going flying, right? And then the dolly starts rolling because of the famous "SUDDEN GUST OF WIND!" The pilot grabs the controls and inadvertently gets the thing airborne. Only now...yikes!...ohmygod...damn!...what the...how the...damn...ohhhhh no...BOOM.
Sing it with me now! "Another one bites the dust...hey!"
So here's the lesson: Treat EVERY turn-up of the main rotor as a flight. Don't go to 100% unless you're ready, willing and able to be airborne.
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Compressor was , Eh!
Well that is demanding stuff.!
QUIT PISSING AWAY MY TAXMONEY!
We get you new C130s ,,,,,,,,,,CFIT!
We finally get you new SAR heli, and you start washing them!!
We get you new Frigates and you broadside a Supertanker and promptly sink!
What is the latest tactics?
Killing Putin by laughter!!!??
I retired from the reserves some years ago, but expect a letter any day now!
Well that is demanding stuff.!
QUIT PISSING AWAY MY TAXMONEY!
We get you new C130s ,,,,,,,,,,CFIT!
We finally get you new SAR heli, and you start washing them!!
We get you new Frigates and you broadside a Supertanker and promptly sink!
What is the latest tactics?
Killing Putin by laughter!!!??
I retired from the reserves some years ago, but expect a letter any day now!
Compressor was , Eh!
Well that is demanding stuff.!
QUIT PISSING AWAY MY TAXMONEY!
We get you new C130s ,,,,,,,,,,CFIT!
We finally get you new SAR heli, and you start washing them!!
We get you new Frigates and you broadside a Supertanker and promptly sink!
What is the latest tactics?
Killing Putin by laughter!!!??
I retired from the reserves some years ago, but expect a letter any day now!
Well that is demanding stuff.!
QUIT PISSING AWAY MY TAXMONEY!
We get you new C130s ,,,,,,,,,,CFIT!
We finally get you new SAR heli, and you start washing them!!
We get you new Frigates and you broadside a Supertanker and promptly sink!
What is the latest tactics?
Killing Putin by laughter!!!??
I retired from the reserves some years ago, but expect a letter any day now!
There will almost always be systemic failures that contribute to accidents, but in this case the causal factor was nothing more than a schoolboy error and someone needs to take ownership of that.
Which is exactly why the report reads like a very political attempt to shift the spotlight away from Air Force and onto the MOJ and the OEM.
There will almost always be systemic failures that contribute to accidents, but in this case the causal factor was nothing more than a schoolboy error and someone needs to take ownership of that.
Norway's recent loss of a frigate illustrates the problem, poorly trained but politically correct crew on a ship whose damage control checked the boxes but did not work, so an avoidable accident turned into a total loss.
German in service rates for military equipment suggest Norway's performance is the norm, not the exception for NATO>
