Go Back  PPRuNe Forums > Aircrew Forums > Rotorheads
Reload this Page >

The crash of Rescue 111: ‘The worst silence I ever heard in all my life’

Rotorheads A haven for helicopter professionals to discuss the things that affect them

The crash of Rescue 111: ‘The worst silence I ever heard in all my life’

Old 9th Jan 2022, 13:09
  #21 (permalink)  
 
Join Date: Apr 2000
Location: EGDC
Posts: 9,247
Gullibell - true but it would seem the decision to cancel stand down and launch instead was between the Captain and the tasking authority - however, I would still expect him to consult the crew in light of the weather and lack of urgency of the task.

Perhaps the 'can-do' attitude of the crew, mentioned early in the report was a factor in launching with no need.
crab@SAAvn.co.uk is offline  
Old 9th Jan 2022, 15:29
  #22 (permalink)  
 
Join Date: Dec 2007
Location: Ireland
Posts: 393
Originally Posted by megan View Post
Trashing the crew brings no lessons learnt to the table.
Agree with this sentiment.

500 Fan.
500 Fan is offline  
Old 9th Jan 2022, 17:37
  #23 (permalink)  
 
Join Date: Apr 2000
Location: EGDC
Posts: 9,247
Agree with this sentiment.
perhaps that sentiment is why they never addressed the issues and Irish SAR continued to struggle for many years.

Yes, there are a lot of contributory factors to do with experience dilution, organisational structure (the IAAC didn't have a Flight Safety setup at all) and the overly lengthy report goes into them all in great detail and only points out the crews failings in vague terms. The problem is that it allows each party the ability to offset their share of the blame with the others and the effect of any major causes is lost in the noise.

I spent a lot of time professionally, teaching and mentoring junior SAR pilots and Captains for the very good reason that if you make crap choices or fail to plan properly for a SAROp, you can get quickly caught out and end up in trouble. The first rule of first aid is not to become a casualty yourself and the same applies to SAR.

If you don't find fault with poor decisions made by the crew, how are you ever going to stop the next crew doing something similar when the pressure is on?
crab@SAAvn.co.uk is offline  
Old 9th Jan 2022, 20:18
  #24 (permalink)  
 
Join Date: Jul 1999
Location: Warrington, UK
Posts: 3,667
In one particular instance I was seriously taken to task over my decision. A very senior police officer try to make a big deal out of it and made threats about my continued employ
Very strange. In my 17 years flying for the Police, I turned down many tasks due to weather and was never questioned over my decision.
MightyGem is offline  
Old 9th Jan 2022, 23:07
  #25 (permalink)  
 
Join Date: Mar 2005
Location: N/A
Posts: 4,486
I spent a lot of time professionally, teaching and mentoring junior SAR pilots and Captains for the very good reason that if you make crap choices or fail to plan properly for a SAROp, you can get quickly caught out and end up in trouble. The first rule of first aid is not to become a casualty yourself and the same applies to SAR
Your final sentence is true of any operation crab, not just SAR. Spent nearly three decades flying for an oil company owned and operated off shore operation and the operation paid no attention to rules or regs, and the aircrew to a man, including check and training, happily accepted the status quo, me included until the lights turned on in the final few years, the phrase "Normalisation of Deviance" covers the scenario at work. One of the check and trainers later went on to be the organisations regulatory overseer (FOI - Flight Operations Inspector), didn't change anything, nor did it change anything when the regulatory head office learnt of how operations were conducted
megan is offline  
Old 10th Jan 2022, 02:04
  #26 (permalink)  
 
Join Date: May 2002
Location: Wanaka, NZ
Posts: 2,570
Originally Posted by megan View Post
...Spent nearly three decades flying for an oil company owned and operated off shore operation and the operation paid no attention to rules or regs.
Not-with-standing, they must have been doing something right because you don't operate in that harsh offshore environment for 30+ years without a single accident relying on pure luck alone. I mean, it's basically the same operating environment as the North Sea, and in the North Sea how many aircraft have been lost and passengers killed over the same period? Plenty, I bet.
gulliBell is offline  
Old 10th Jan 2022, 14:19
  #27 (permalink)  
I REALLY SHOULDN'T BE HERE
 
Join Date: Dec 2005
Location: TOD
Posts: 1,698
Originally Posted by [email protected] View Post
Amateurs doing SAR.
Wrong - it was worse. Professionals doing SAR without the right training and organisational safety systems in place and not adequately overseen by a regulator. The crew paid the price for a defective system.

The Irish Air Corps were chronically underfunded in the late nineties. I have no idea about now but back then it was not unusual for flying hours on some fleets to be heavily restricted for budgetary reasons - money being conserved to make sure the maritime patrol and government jet could stay flying until the end of the financial year.



speedrestriction is offline  
Old 10th Jan 2022, 14:43
  #28 (permalink)  
 
Join Date: Apr 2000
Location: EGDC
Posts: 9,247
The crew paid the price for a defective system
Agreed but it was the crew that decided to launch in poor weather with no diversion - even a just-out-of-training student pilot could have made the decision not to go just looking at the weather.

When you know you are part of a creaking system, that is the time to be more careful not less - look after number 1!

Professionals doing SAR without the right training and organisational systems are, by definition, amateurs.
crab@SAAvn.co.uk is offline  
Old 10th Jan 2022, 16:05
  #29 (permalink)  
 
Join Date: Sep 2011
Location: USA
Age: 53
Posts: 352
Crab's commentary is the brutal truth, wherever it tends to fall on your emotional scale.
Sir Korsky is online now  
Old 10th Jan 2022, 20:51
  #30 (permalink)  
Below the Glidepath - not correcting
 
Join Date: Jun 2005
Location: U.S.A.
Posts: 1,810
Back to an earlier comment made by crab, the nature of accident reports now almost demands the listing of the myriad of secondary or tertiary factors. This is not necessarily a bad thing, but it carries the risk of diluting or obfuscating the primary causes - certainly to the uninformed or ill-informed. Sometimes there is a very obvious cause and effect linkage, but not always. In this case, simply taking off in those weather and light conditions set in motion a series of events that led to the almost inevitable and tragic outcome. The decision whether or not to lift is fundamental tenet of captaincy and airmanship, commercial or operational pressures don't suddenly increase your flying ability or improve the weather, but they do undermine your ability to make logical and safe decisions.
Two's in is offline  
Old 11th Jan 2022, 02:56
  #31 (permalink)  
 
Join Date: Mar 2005
Location: N/A
Posts: 4,486
Not-with-standing, they must have been doing something right because you don't operate in that harsh offshore environment for 30+ years without a single accident relying on pure luck alone
You'd make a good manager Gulli, that was the exact excuse management made for not complying with rules and regs, we've never had an accident, but it was only through pure luck and some skillful flying that avoided any crunched metal, all major incidents occurred in benign circumstances. Personally I had absolute faith in our maintenance, top notch. There were some major lapses in maintenance of course, it happens in all systems, such as powder found coming out from the elastomerics on the four main blades, bearings had not been installed during a rebuild, errors/incidents occurred, but in the system that prevailed you never heard of what went on unless you were personally involved. Perhaps you can tell of your interview you mentioned in a post here a short time ago, I have an idea, but not with any surety.

You'll remember the take off charts where you extracted whether you could meet cat A or B, the figures were bollox and not one pilot was aware over the years that was so, until changed at the behest of one pilot after years of agitation. Figures were such that in some areas where you thought you had cat A capability if put to the test you were going to find yourself in deep do do.

How did you go about ensuring you had an alternate for offshore operations as required by the CASA supplement in the flight manual and the Ops Manual? I could go on.

You'll remember the following, why didn't you comply?



megan is offline  
Old 11th Jan 2022, 05:14
  #32 (permalink)  
 
Join Date: May 2002
Location: Wanaka, NZ
Posts: 2,570
Originally Posted by megan View Post
...You'll remember the following, why didn't you comply?
The pilot is always going to be the poor bunny who gets stood in front of the firing squad after an accident, because surely after every accident the subsequent inquiry will find he failed to comply with the FOM in some way. And if the same pilot religiously followed the requirements of the FOM and parked the bus a few times because of it then management is not going to be happy about it and he risks being marched out the door with a don't come back Monday letter. That is the reality of the situation, it's a no win.
Some of the FOM I worked under in PNG were so ridiculously onerous there was no way to comply and get the job done. Such as requiring a 10% power margin for all external load jobs, for example. They are written by people who like a lot of words, who like big thick manuals, who have no practical insight to the needless complexities of their own making, etc. When I started agitating about making changes to manuals because what was written was stupid and stopping me from getting the job done it was viewed by management as being a trouble maker. I was happy to do all the legwork to make the changes, but treading on the toes of those in the company who were responsible for producing these rubbish operational documents seriously upsets the apple cart.
In the operation you referred to for sure there were incidents where luck was shining on them. Plenty of other examples. An S76 out of maintenance arriving at Tuna with no oil in the TRGB. But fundamentally I think the operation had such a good safety record for the reasons you mentioned, plus the pilots were all competent and operationally astute. Although I do remember a few closed door Monday morning parades in MM's office after he found out about the occasional weekend shenanigans, stories which had become highly embellished I point out, which might have stretched operational flexibility a bit too far. Especially if a company aircraft had been observed on the Tuna via Sperm Whale Head low level route.


gulliBell is offline  
Old 11th Jan 2022, 11:01
  #33 (permalink)  
 
Join Date: Apr 2000
Location: EGDC
Posts: 9,247
To continue from Two's in's post - I have seen the accident investigation system go from blaming the pilot to not blaming anyone and both are counter-productive to Flight Safety.

Blaming the pilot was often an easy way out for management (MoD for instance) to prevent organisational, supervisory, engineering or budgetary causes from being highlighted.

Not blaming anyone affords the same people the same opportunities but by obfuscation in a deluge of extraneous data instead of misdirection using a scapegoat.

Why? Because admitting fault means losing jobs, funding, credibility or, most importantly, money.

Last edited by [email protected]; 11th Jan 2022 at 12:34.
crab@SAAvn.co.uk is offline  

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Thread Tools
Search this Thread

Contact Us - Archive - Advertising - Cookie Policy - Privacy Statement - Terms of Service - Do Not Sell My Personal Information -

Copyright © 2021 MH Sub I, LLC dba Internet Brands. All rights reserved. Use of this site indicates your consent to the Terms of Use.