Cypriot airliner crash - the accident and investigation
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I finally after going through 185 pages found the CVR and FDR transcripts. I agree, the keypad was used to get in about a minute before the left engine flamed out. Too bad he couldn't have gotten in earlier. Descending and reviving the pilots would have saved the day. Thanks for the help BOAC. My wife says I can't find anything without her help. She asks me do you think my uterus is a tracking device? You can't find anything by yourself.
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Our pilots locked themselves out of the cockpit on the ground one day on a 737 200 and used a ladder to get through the cockpit window. Our ground instructor told us they could have just pulled the external APU fire handle and when the power came off the door lock, it would open. As I said before we always had to use the manual lock for overnight security when the plane was unpowered on the B757 with the new electric keypad locks.
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I remember enquiring about the status of the door, whether it defaulted to open on an absence of power. That was before the report came out and before we knew if the steward had entered the flight deck before or after the first flame-out. I stand to be corrected by someone holding the Boeing book in their hand, but I am confident of the source of the info. They said a flame-out wouldn't unlock it (either side).
Proposed 737 Cabin Altitude Warning Lights
Just noticed this Boeing Fleet Team Digest 737-FTD-31-06003 which “has been initiated to investigate the potential to improve the warning system through the addition of warning lights to supplement the existing aural warning system.”
It goes on to say that “Design change solution selection (hardware change) is imminent. Additional visual indications in the flight deck are under consideration.”
This is very good news.
S&L
It goes on to say that “Design change solution selection (hardware change) is imminent. Additional visual indications in the flight deck are under consideration.”
This is very good news.
S&L
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That's very interesting, considering they already said no, before the Helios crash, and after it said they had no plans for any such light.
What does Boeing Fleet Team Digest 737-FTD-31-06003 mean? New research, a test programme?
What does Boeing Fleet Team Digest 737-FTD-31-06003 mean? New research, a test programme?
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Research, testing... Or the solid sound of the stable door being locked after the horse has already found clover miles away?
Notwithstanding that, I'm amazed that so little is said of certain aspects of the aetiology of this tragic event.
Notwithstanding that, I'm amazed that so little is said of certain aspects of the aetiology of this tragic event.
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Aetiology? Aetiology? Blimey, that's a big word for PPRune. I'm sure it's never before appeared in these august pages.
I had to reach for my New Shorter Oxford for the meaning and here's what I found:
1. The assignment of a cause. 2. The philosophy of causation; the part of a science which treats of the causes of its phenomena.
Rockhound
I had to reach for my New Shorter Oxford for the meaning and here's what I found:
1. The assignment of a cause. 2. The philosophy of causation; the part of a science which treats of the causes of its phenomena.
Rockhound
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We have two articles from yesterday's Cyprus Mail online:
Helios tragedy: where does the truth really lie?
By Dimitris Yannopoulos of the Athens News
THE FINAL demise of Helios/Ajet has had the side-effect of virtually silencing dissent over the causes of the accident as detailed in the Air Accident Investigation report. And whereas the ‘full truth’ about the fatal sequence of events on flight HCY511 would bring little consolation to the 121 victims’ families, the grounded airline has reason to undermine the credibility and accuracy of the Tsolakis investigation in the impending civil liability hearings.
It is no accident, therefore, that the operator of the doomed Boeing 737-300 took little time to mount a head-on challenge to the basic premises and conclusions of the report. But the company wasn’t alone in this complex and highly technical dispute.
The ‘single-cause hypothesis’ (pressurisation selector switch set in manual during pre-flight maintenance) on which the report hinges had already come under fire from engineers, pilots and aviation experts during the first couple of months after tragedy of August 14.
“From the first moment I heard Tsolakis hint at this scenario in September 2005, I couldn’t fathom how the wrong setting of the switch could go unnoticed by two experienced pilots for long enough to allow a normal takeoff, let alone to bring a whole airplane crashing down after 2.30 hours of pilot-less flight,” said former Olympic Airways pilot Yiannis Tsovalos.
“After reading the final report, my doubts and unanswered questions have multiplied,” Tsovalos said. “There are just too many instances before and after takeoff in which rapid and steep pressure changes in the cabin couldn’t possibly go unnoticed in the ears of all the occupants, especially the 25 children among them – long before the alarms sounded in the cockpit and both crew and passengers were incapacitated by hypoxia,” he added.
But apart from recurrent indications of physical discomfort and abnormal air sounds in the aircraft ignored by everybody aboard the flight, the report’s main hypothesis also implies that the captain and the first officer must each have made a string of incredible mistakes or omissions during their independent pre-flight check of different components of the pressurisation system; first, the captain by not checking that the main air-outflow valve was fully open when the plane was still on the ground and the first officer by not checking that the mode selector switch was in auto.
They must then both have missed the abnormalities on the pressurisation panel during a dozen challenge-and-response checklist procedures before and after take off.
“All this sequence of errors seems implausible or even improbable, but we can hardly call it impossible,” notes Olympic Airlines ground engineer Costas Ardavanis. “After all, this is why such fatal air accidents are so rare,” he added. “The problem is that alternative explanations and theories are no less hampered by doubts than the official ones,” Ardavanis said.
He was referring to alternative theories about “insidious, non-recurrent electrical malfunctions that could affect the pressurisation system, due to inbuilt wiring faults”, which some Helios technicians have suggested to put the blame on the manufacturer, Boeing Co.
“Such a build-up of electrical and electronic glitches is difficult to pinpoint even in the check-ups of a fully functional plane, let alone in the wreckage of an air crash,” Ardavanis said. “The sceptics’ doubts are beset by the same lack of unambiguous evidence as that of the official investigation,” he stressed.
To underscore these doubts, Helios submitted in July 2006 a lengthy rebuttal of Tsolakis’ confidential draft report, issued only to interested parties a month earlier. The airline’s formal comments included a report written by the former ground engineer of Helios at the time of the accident, Alan Irwin.
Irwin had conducted a ‘practical test’ in his native UK to disprove Tsolakis’ assumption that he had left the switch in manual after a pressurisation check conducted on the aircraft a few hours before its fateful flight. However, Tsolakis refused to include the airline’s formal comments in his final report or answer Irwin’s refutation of its central thesis. “The fact that Tsolakis has kept silent about our comments shows that he has no confidence in his own arguments,” former Helios CEO Dimitris Pantazis has told the Athens News.
But shortly after Helios lodged a complaint about this with the Cypriot Commission of Inquiry, its chairman Panayiotis Kallis announced that he would bar any further testimony disputing the report’s conclusions regarding the causes of the accident.
The report scenario is founded on the single assumption that the Helios chief engineer left the pressurisation mode selector in manual with the outflow valve (OFV) at about 14.6° from the closed position (110°), which the flight crew failed to notice when they started their various pre-flight preparations.
Irwin’s submission contested this scenario by showing, in a practical test, that extreme pressure fluctuations would occur during the aircraft start sequence if the mode selector and valve were in that position.
Under normal circumstances, there are no significant fluctuations of cabin pressure while the aircraft is on the ground because the selector is set at automatic and the OFV is driven fully open. Even when all the doors are closed this is sufficient to keep the cabin at the same pressure as the outside world.
Under the conditions assumed by the report, however, when the passengers are on board and the last door is closed, the air can only escape through the partially closed OFV and natural leakage points. So the aircraft starts to pressurise rapidly. Next, immediately before engine start, the air supply to the cabin is switched off and the cabin would start to depressurise fast. Finally, after the engines are started, the air supply to the cabin is forcefully reinstated, and with the outflow valve nearly closed, the cabin would start to pressurise abruptly. All the aircraft occupants would immediately feel the effects of each of those three abnormal pressure changes on their ears and the attention of the flight crew would be naturally drawn to the pressurisation panel to rectify this situation.
“Pilots are very aware that it is very important that the aircraft is not pressurised for take off, or landing,” explained air accident investigator Phil Giles, who co-operated with Helios in the drafting of its comments on the Tsolakis report. “If the aircraft is pressurised and an emergency occurs on the ground that required an aircraft evacuation, it would not be possible to open the doors and hatches to allow the occupants to escape.”
According to Giles, the report finds no hard evidence that the pressurisation system was left in manual by the engineer and only “circumstantial evidence” that it was in that position shortly after takeoff.
By not considering any alternative scenario and failing to counter the statement by the Helios engineer, the air accident report would have been obliged to reopen the investigation and start again, as its whole accident scenario was based on this single assumption, argued Giles.
In fact, there are several elements in the report that could form parts of an alternative scenario. Ardavanis pointed out that it may be highly significant that the plane appeared to suffer continuous air leakages in most of its recent flights.
The report states (p. 115): “All these messages [showing the valve below 3 degrees opening angle for more than five consecutive seconds] were recorded immediately after takeoff and indicated a continuous leakage situation with the aircraft that likely persisted for the last 74 flight legs.”
Could this be an indication that Helios engineers and crew were fully aware of the plane’s constant air-leakage, which often made it necessary to resort to manual control of the valve in order to keep it tightly shut for longer than normal?
Another unanswered question concerns the immaculate behaviour of the plane’s autopilot in the final stages of the flight. “Why does the plane deviate northwards by 14 miles from the pre-programmed flight path as it turned back to the KEA-VOR holding pattern after the missed approach over the Athens airport?” asked Tsovalos.
And when the plane finally broke from the holding pattern after losing the left engine, was it the autopilot that saved it from taking a spiral nosedive into the sea?
If so, why did the same autopilot not turn the plane back to the holding rounds or towards the Athens airport but drove it northwards over Evia on a straight-line path? Was Prodromou in full
or partial control of the plane by that time?
Copyright © Cyprus Mail 2006
---------------------------------------------------------------
Helios: ‘the simplest explanation is probably the best’
By Elias Hazou
All things being equal, the simplest solution tends to be the best one
Ockham’s razor
THE axiom above, attributed to the 14th century English logician William of Ockham, states that the explanation of any phenomenon should make as few assumptions as possible, eliminating, or “shaving off”, those that make no difference in the observable predictions of the explanatory hypothesis.
In other words, when multiple competing theories are equal in other respects, the principle recommends selecting the theory that introduces the fewest assumptions and postulates the fewest hypothetical entities.
It is perhaps apt to apply this to the speculation surrounding the events of August 14, 2005, when a Boeing 737 jet crashed into a hillside at Grammatikos, killing all 121 people on board.
To many in the aviation industry, the verdict of the accident report would seem to adopt a warped version of Ockham’s approach: go with the simplest answer, chucking out “unnecessary” assumptions.
Now, according to Akrivos Tsolakis’ report, the primary cause of the crash was human error: the two pilots had failed to notice during checks before and after takeoff that the cabin pressurisation mode selector was in the manual position. The data suggests that the Helios ground engineer had set the selector on manual the night before the flight, following a pressure leak test. Had the switch been set to automatic, it would have allowed the cabin to pressurise by itself.
After take-off, the plane did not pressurise and the two pilots failed to recognise “the warnings and reasons for the activation of the warnings”, including a cabin altitude warning horn and the dropping of oxygen masks. Presumably, that is because the sounds emitted for takeoff configuration and cabin altitude warnings are identical.
The steady loss of cabin pressure led to the onset of hypoxia (oxygen deprivation), causing the pilots and passengers to pass out. The jet flew on autopilot for hours before it ran out of fuel and smashed into the ground.
But some feel this explanation is far too simple, almost conveniently so. Others flip the argument on its head: the theory fits perfectly, and is backed up by the data. The answer’s staring you in the face, they say.
David Learmount, Operations & Safety Editor for Flight International, adheres to this latter standpoint.
“Is it credible that the pilots did not carry out the pre-flight and the after-takeoff checklists? Well yes, it is. Based on my experience, these things are entirely possible.”
Yet given the plane’s tainted history – including a serious decompression incident in December 2004 – how plausible is it that the pilots were not versed in these problems? Indeed, it’s more than likely that the two aviators had flown the actual jet – together or separately – on past occasions. So what are the chances the problem of August 14 2005 snuck up on them, catching them completely unawares?
“Look,” says Learmount, “from the information we have, it’s clear that this was not an ideal crew to work as a team. And believe me, it’s not the first time that the co-pilot sits around, his arms folded, waiting on the captain’s cue.
“This is precisely what Tsolakis pointed out in his report: the absence of proper crew resource training at the airline. We’re not saying the pilots were total incompetents or clueless. We’re saying they made mistakes, but actually they were victims themselves – victims of Helios’ practices.
“The report says the aviators assumed there was something wrong with the takeoff configuration warning, and not pressurisation. This fixation with a preconceived idea is often the cause of crashes or near misses. How else to explain that they kept climbing, instead of levelling the plane or returning to base? It’s obvious: they never realised the plane was losing pressure.”
In December 2004 incident, the fated plane, the Olympia, was bound to Warsaw from Larnaca. It returned to Larnaca after decompression in the cabin, and was grounded for a week while inspectors got to work.
The subsequent technical log read “NFF” – No Fault Found. In other words, engineers had looked at the plane and found nothing wrong with it. The plane was cleared to continue flying.
So, should the jet have been recalled or grounded for good? What is standard practice in the aviation industry?
“If it says NFF, then you have done all you can. There’s no reason to stop the plane from flying,” offered Learmount.
Moreover, Learmount said Boeing had not contested any of the technical aspects of the accident report. The Mail has independently confirmed this.
“It’s important to remember that accident reports never claim the absolute truth. Their purpose is to state the probable cause.
“Bottom line: we’re as close to the truth as we’ll ever get,” he said.
“Sure there are grey areas,” he added. “There almost always are. But the Tsolakis report is a
good one.”
Copyright © Cyprus Mail 2006
Helios tragedy: where does the truth really lie?
By Dimitris Yannopoulos of the Athens News
THE FINAL demise of Helios/Ajet has had the side-effect of virtually silencing dissent over the causes of the accident as detailed in the Air Accident Investigation report. And whereas the ‘full truth’ about the fatal sequence of events on flight HCY511 would bring little consolation to the 121 victims’ families, the grounded airline has reason to undermine the credibility and accuracy of the Tsolakis investigation in the impending civil liability hearings.
It is no accident, therefore, that the operator of the doomed Boeing 737-300 took little time to mount a head-on challenge to the basic premises and conclusions of the report. But the company wasn’t alone in this complex and highly technical dispute.
The ‘single-cause hypothesis’ (pressurisation selector switch set in manual during pre-flight maintenance) on which the report hinges had already come under fire from engineers, pilots and aviation experts during the first couple of months after tragedy of August 14.
“From the first moment I heard Tsolakis hint at this scenario in September 2005, I couldn’t fathom how the wrong setting of the switch could go unnoticed by two experienced pilots for long enough to allow a normal takeoff, let alone to bring a whole airplane crashing down after 2.30 hours of pilot-less flight,” said former Olympic Airways pilot Yiannis Tsovalos.
“After reading the final report, my doubts and unanswered questions have multiplied,” Tsovalos said. “There are just too many instances before and after takeoff in which rapid and steep pressure changes in the cabin couldn’t possibly go unnoticed in the ears of all the occupants, especially the 25 children among them – long before the alarms sounded in the cockpit and both crew and passengers were incapacitated by hypoxia,” he added.
But apart from recurrent indications of physical discomfort and abnormal air sounds in the aircraft ignored by everybody aboard the flight, the report’s main hypothesis also implies that the captain and the first officer must each have made a string of incredible mistakes or omissions during their independent pre-flight check of different components of the pressurisation system; first, the captain by not checking that the main air-outflow valve was fully open when the plane was still on the ground and the first officer by not checking that the mode selector switch was in auto.
They must then both have missed the abnormalities on the pressurisation panel during a dozen challenge-and-response checklist procedures before and after take off.
“All this sequence of errors seems implausible or even improbable, but we can hardly call it impossible,” notes Olympic Airlines ground engineer Costas Ardavanis. “After all, this is why such fatal air accidents are so rare,” he added. “The problem is that alternative explanations and theories are no less hampered by doubts than the official ones,” Ardavanis said.
He was referring to alternative theories about “insidious, non-recurrent electrical malfunctions that could affect the pressurisation system, due to inbuilt wiring faults”, which some Helios technicians have suggested to put the blame on the manufacturer, Boeing Co.
“Such a build-up of electrical and electronic glitches is difficult to pinpoint even in the check-ups of a fully functional plane, let alone in the wreckage of an air crash,” Ardavanis said. “The sceptics’ doubts are beset by the same lack of unambiguous evidence as that of the official investigation,” he stressed.
To underscore these doubts, Helios submitted in July 2006 a lengthy rebuttal of Tsolakis’ confidential draft report, issued only to interested parties a month earlier. The airline’s formal comments included a report written by the former ground engineer of Helios at the time of the accident, Alan Irwin.
Irwin had conducted a ‘practical test’ in his native UK to disprove Tsolakis’ assumption that he had left the switch in manual after a pressurisation check conducted on the aircraft a few hours before its fateful flight. However, Tsolakis refused to include the airline’s formal comments in his final report or answer Irwin’s refutation of its central thesis. “The fact that Tsolakis has kept silent about our comments shows that he has no confidence in his own arguments,” former Helios CEO Dimitris Pantazis has told the Athens News.
But shortly after Helios lodged a complaint about this with the Cypriot Commission of Inquiry, its chairman Panayiotis Kallis announced that he would bar any further testimony disputing the report’s conclusions regarding the causes of the accident.
The report scenario is founded on the single assumption that the Helios chief engineer left the pressurisation mode selector in manual with the outflow valve (OFV) at about 14.6° from the closed position (110°), which the flight crew failed to notice when they started their various pre-flight preparations.
Irwin’s submission contested this scenario by showing, in a practical test, that extreme pressure fluctuations would occur during the aircraft start sequence if the mode selector and valve were in that position.
Under normal circumstances, there are no significant fluctuations of cabin pressure while the aircraft is on the ground because the selector is set at automatic and the OFV is driven fully open. Even when all the doors are closed this is sufficient to keep the cabin at the same pressure as the outside world.
Under the conditions assumed by the report, however, when the passengers are on board and the last door is closed, the air can only escape through the partially closed OFV and natural leakage points. So the aircraft starts to pressurise rapidly. Next, immediately before engine start, the air supply to the cabin is switched off and the cabin would start to depressurise fast. Finally, after the engines are started, the air supply to the cabin is forcefully reinstated, and with the outflow valve nearly closed, the cabin would start to pressurise abruptly. All the aircraft occupants would immediately feel the effects of each of those three abnormal pressure changes on their ears and the attention of the flight crew would be naturally drawn to the pressurisation panel to rectify this situation.
“Pilots are very aware that it is very important that the aircraft is not pressurised for take off, or landing,” explained air accident investigator Phil Giles, who co-operated with Helios in the drafting of its comments on the Tsolakis report. “If the aircraft is pressurised and an emergency occurs on the ground that required an aircraft evacuation, it would not be possible to open the doors and hatches to allow the occupants to escape.”
According to Giles, the report finds no hard evidence that the pressurisation system was left in manual by the engineer and only “circumstantial evidence” that it was in that position shortly after takeoff.
By not considering any alternative scenario and failing to counter the statement by the Helios engineer, the air accident report would have been obliged to reopen the investigation and start again, as its whole accident scenario was based on this single assumption, argued Giles.
In fact, there are several elements in the report that could form parts of an alternative scenario. Ardavanis pointed out that it may be highly significant that the plane appeared to suffer continuous air leakages in most of its recent flights.
The report states (p. 115): “All these messages [showing the valve below 3 degrees opening angle for more than five consecutive seconds] were recorded immediately after takeoff and indicated a continuous leakage situation with the aircraft that likely persisted for the last 74 flight legs.”
Could this be an indication that Helios engineers and crew were fully aware of the plane’s constant air-leakage, which often made it necessary to resort to manual control of the valve in order to keep it tightly shut for longer than normal?
Another unanswered question concerns the immaculate behaviour of the plane’s autopilot in the final stages of the flight. “Why does the plane deviate northwards by 14 miles from the pre-programmed flight path as it turned back to the KEA-VOR holding pattern after the missed approach over the Athens airport?” asked Tsovalos.
And when the plane finally broke from the holding pattern after losing the left engine, was it the autopilot that saved it from taking a spiral nosedive into the sea?
If so, why did the same autopilot not turn the plane back to the holding rounds or towards the Athens airport but drove it northwards over Evia on a straight-line path? Was Prodromou in full
or partial control of the plane by that time?
Copyright © Cyprus Mail 2006
---------------------------------------------------------------
Helios: ‘the simplest explanation is probably the best’
By Elias Hazou
All things being equal, the simplest solution tends to be the best one
Ockham’s razor
THE axiom above, attributed to the 14th century English logician William of Ockham, states that the explanation of any phenomenon should make as few assumptions as possible, eliminating, or “shaving off”, those that make no difference in the observable predictions of the explanatory hypothesis.
In other words, when multiple competing theories are equal in other respects, the principle recommends selecting the theory that introduces the fewest assumptions and postulates the fewest hypothetical entities.
It is perhaps apt to apply this to the speculation surrounding the events of August 14, 2005, when a Boeing 737 jet crashed into a hillside at Grammatikos, killing all 121 people on board.
To many in the aviation industry, the verdict of the accident report would seem to adopt a warped version of Ockham’s approach: go with the simplest answer, chucking out “unnecessary” assumptions.
Now, according to Akrivos Tsolakis’ report, the primary cause of the crash was human error: the two pilots had failed to notice during checks before and after takeoff that the cabin pressurisation mode selector was in the manual position. The data suggests that the Helios ground engineer had set the selector on manual the night before the flight, following a pressure leak test. Had the switch been set to automatic, it would have allowed the cabin to pressurise by itself.
After take-off, the plane did not pressurise and the two pilots failed to recognise “the warnings and reasons for the activation of the warnings”, including a cabin altitude warning horn and the dropping of oxygen masks. Presumably, that is because the sounds emitted for takeoff configuration and cabin altitude warnings are identical.
The steady loss of cabin pressure led to the onset of hypoxia (oxygen deprivation), causing the pilots and passengers to pass out. The jet flew on autopilot for hours before it ran out of fuel and smashed into the ground.
But some feel this explanation is far too simple, almost conveniently so. Others flip the argument on its head: the theory fits perfectly, and is backed up by the data. The answer’s staring you in the face, they say.
David Learmount, Operations & Safety Editor for Flight International, adheres to this latter standpoint.
“Is it credible that the pilots did not carry out the pre-flight and the after-takeoff checklists? Well yes, it is. Based on my experience, these things are entirely possible.”
Yet given the plane’s tainted history – including a serious decompression incident in December 2004 – how plausible is it that the pilots were not versed in these problems? Indeed, it’s more than likely that the two aviators had flown the actual jet – together or separately – on past occasions. So what are the chances the problem of August 14 2005 snuck up on them, catching them completely unawares?
“Look,” says Learmount, “from the information we have, it’s clear that this was not an ideal crew to work as a team. And believe me, it’s not the first time that the co-pilot sits around, his arms folded, waiting on the captain’s cue.
“This is precisely what Tsolakis pointed out in his report: the absence of proper crew resource training at the airline. We’re not saying the pilots were total incompetents or clueless. We’re saying they made mistakes, but actually they were victims themselves – victims of Helios’ practices.
“The report says the aviators assumed there was something wrong with the takeoff configuration warning, and not pressurisation. This fixation with a preconceived idea is often the cause of crashes or near misses. How else to explain that they kept climbing, instead of levelling the plane or returning to base? It’s obvious: they never realised the plane was losing pressure.”
In December 2004 incident, the fated plane, the Olympia, was bound to Warsaw from Larnaca. It returned to Larnaca after decompression in the cabin, and was grounded for a week while inspectors got to work.
The subsequent technical log read “NFF” – No Fault Found. In other words, engineers had looked at the plane and found nothing wrong with it. The plane was cleared to continue flying.
So, should the jet have been recalled or grounded for good? What is standard practice in the aviation industry?
“If it says NFF, then you have done all you can. There’s no reason to stop the plane from flying,” offered Learmount.
Moreover, Learmount said Boeing had not contested any of the technical aspects of the accident report. The Mail has independently confirmed this.
“It’s important to remember that accident reports never claim the absolute truth. Their purpose is to state the probable cause.
“Bottom line: we’re as close to the truth as we’ll ever get,” he said.
“Sure there are grey areas,” he added. “There almost always are. But the Tsolakis report is a
good one.”
Copyright © Cyprus Mail 2006
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What a welcome relief Elias Hazou's succinct, rational article brought to the interminable maunderings of ex-Olympic pilot Tsovalos and the assorted self-serving musings of Helios management, all dished up without a single credible alternative cause being offered.
Rockhound
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Guardian reports
Guardian today blames accident on bullet proof cockpit doors post 9/11.
http://www.guardian.co.uk/airlines/s...975128,00.html
http://www.guardian.co.uk/airlines/s...975128,00.html
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Private Eye reports
The current Private Eye (a UK satirical magazine that also reports hard news) contains the following story (not available on the web):
Missed Alarm Bells
...
Veteran pilots of the 737-300 have told the Eye that one of the key problems is that the cabin high altitude warning alarm for pilots is identical to the alarm that sounds when instruments are not set properly for take-off, i.e. the configuration warning. The Boeing argument for using the same horn system is that if the aircraft is in the air, it cannot be a configuration warning.
...
The [accident] report covers only parts of the pilots' concerns and makes clear that there are no plans to change the warning system - merely a proposal for better training and revised manuals to help pilots "understand and recognise the difference between the two meanings of the warnings horn". So that's all right then.
...
Veteran pilots of the 737-300 have told the Eye that one of the key problems is that the cabin high altitude warning alarm for pilots is identical to the alarm that sounds when instruments are not set properly for take-off, i.e. the configuration warning. The Boeing argument for using the same horn system is that if the aircraft is in the air, it cannot be a configuration warning.
...
The [accident] report covers only parts of the pilots' concerns and makes clear that there are no plans to change the warning system - merely a proposal for better training and revised manuals to help pilots "understand and recognise the difference between the two meanings of the warnings horn". So that's all right then.
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Pilot Error!?
'Veteran pilots of the 737-300 have told the Eye that one of the key problems is that the cabin high altitude warning alarm for pilots is identical to the alarm that sounds when instruments are not set properly for take-off, i.e. the configuration warning.
And which veteran was that I wonder?
Which instruments are monitored by the Take-Off Config Warning, I wonder?
Even if we wrote the articles ourselves they would still end up factually incorrect when they appear in print. It must be a rule of journalism to 'alter' a few words here and there to make it seem more realistic.
I do not wish to speak ill of the dead but I feel my minimal aquaintance with the Captain, Hans Juergen-Merten might be worth a mention. He was dour, somewhat taciturn and none too quick to react to any situation outside his sphere of comfort. For this reason he was still an FO in his late forties, when I knew him. He had been with many different airlines and I am sure had a wealth of experience but that doesn't make him any less prone to misdiagnosing the fault, as has been shown by his conversation with Dispatch and subsequent departure from his seat to sort out the cooling problem.
I think the Accident report has it about right, in spite of errors and ommisions. The red herrings thrown in by Helios and others on this thread do nothing to expand the well of human knowledge in this area, they simply obscure the truth.
The crew ballsed it up, sadly for them and 121 families they leave behind.
And which veteran was that I wonder?
Which instruments are monitored by the Take-Off Config Warning, I wonder?
Even if we wrote the articles ourselves they would still end up factually incorrect when they appear in print. It must be a rule of journalism to 'alter' a few words here and there to make it seem more realistic.
I do not wish to speak ill of the dead but I feel my minimal aquaintance with the Captain, Hans Juergen-Merten might be worth a mention. He was dour, somewhat taciturn and none too quick to react to any situation outside his sphere of comfort. For this reason he was still an FO in his late forties, when I knew him. He had been with many different airlines and I am sure had a wealth of experience but that doesn't make him any less prone to misdiagnosing the fault, as has been shown by his conversation with Dispatch and subsequent departure from his seat to sort out the cooling problem.
I think the Accident report has it about right, in spite of errors and ommisions. The red herrings thrown in by Helios and others on this thread do nothing to expand the well of human knowledge in this area, they simply obscure the truth.
The crew ballsed it up, sadly for them and 121 families they leave behind.
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I expect there are more than a few good pros who would not be welcome at the dinner table.
To me the TO config/Cabin alt potential confusion is just one part of the chain. The thing less remarked on is the fact that the Master Caution came on when the masks dropped at the same time as the light for the cooling fans came on, possibly leading them to diagnose that as the cause of the Master Caution, rather than the masks dropping. All of which could allow for enough time to elapse for hypoxia to set in, since they had not halted the climb. They did not halt it because they misunderstood the TO config warning.
Most would probably have caught it when the Master Caution came on, but with that cooling system fault, uncorrected for the previous 74 cycles, its understandable they jumped to that conclusion. Given another couple of minutes they might have caught that error too, but by then they were unconscious.
All horribly insidious.
To me the TO config/Cabin alt potential confusion is just one part of the chain. The thing less remarked on is the fact that the Master Caution came on when the masks dropped at the same time as the light for the cooling fans came on, possibly leading them to diagnose that as the cause of the Master Caution, rather than the masks dropping. All of which could allow for enough time to elapse for hypoxia to set in, since they had not halted the climb. They did not halt it because they misunderstood the TO config warning.
Most would probably have caught it when the Master Caution came on, but with that cooling system fault, uncorrected for the previous 74 cycles, its understandable they jumped to that conclusion. Given another couple of minutes they might have caught that error too, but by then they were unconscious.
All horribly insidious.
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Kallis Commission
I have just learnt that the Kallis Commission in Cyprus has named those it considers responsible for the Helios accident. I was told that they are 2 ex heads of Cyprus DCA; both UK CAA inspectors who audited Helios; Helios COO; the flight crew and two management pilots. Kallis made it known that he would consider no evidence that contradicted the Greek AAI&ASB Report. So effectively criminal responsibility was determined directly from the Greek accident Report even though the investigators did not even interview the two UK CAA Inspectors so their evidence was new.
A very worrying developement.
A very worrying developement.
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Here's a bit of an update on the legal status of the claims against Boeing, etc., from today's Cyprus Mail online edition:
Helios relatives: we’ll keep going after Boeing
By Elias Hazou
RELATIVES of the victims who perished aboard a Cypriot airliner 24 months ago have vowed to bounce back after a Chicago court denied a lawsuit against plane manufacturers Boeing.
Last week, the United States District Court, Illinois, upheld a motion by defendants Boeing that the trial should not be held in the United States.
“This is definitely not the end of the road,” Loizos Papacharalambous, one of the lawyers representing the aggrieved families, told the Mail yesterday.
“It does not force us to revise our strategy. We’re still going after Boeing, but either in Greece or Cyprus,” he added.
In his ruling, Judge George W. Lindberg said last week that “Cyprus would be a far more convenient forum for this litigation than the United States because of the ease of access to sources of proof in Greece, the pendency of related litigation between Helios and Boeing in Greece, and the strong public interest in having these actions decided in Greece.”
Boeing’s motion to have the case dismissed in the United States was granted subject to certain conditions, one of which was “the defendant shall provide plaintiffs [relatives of the crash victims] with access, in Cyprus and Greece, to all evidence and witnesses in their custody or control that are relevant to any issue raised in actions refiled in Cyprus or Greece.”
Moreover, the judgment stated that the “defendant shall pay any damages to awarded by the Cyprus and/or Greek courts in the refiled actions, subject to any right of appeal.”
Ninety relatives, representing 92 of the individuals who were killed in the crash, had filed a consolidated lawsuit against Boeing, seeking compensation for product liability, negligence, and breach of warranty. The relatives are accusing Boeing of a string of build and design omissions on the Boeing 737-300 that they believe contributed to the calamity.
They also hold now-defunct Helios responsible for pilot and maintenance errors.
Papacharalambous conceded that in one sense the ruling was a setback, since damages awarded in the United States are far more substantial than in Greece, and certainly than in Cyprus.
On the island, where the law is based on the Anglo-Saxon model, you need to prove that the claimant is a financial dependent of the deceased.
And the so-called “bereavement award” is fixed at £10,000.
By contrast, the US legal system is not constrained in this respect; compensation is at the discretion of the judge, and is based on considerations such as the pain of the relatives.
Still, Papacharalambous was confident that everything was on track, hinting that having the case heard in Greece might be a blessing in disguise, “since we now have all the documentation and witnesses in place.”
The Mail has also learned that Boeing had in the meantime offered an out-of-court settlement, which was turned down by the relatives and their lawyers.
According to the sources close to the case, the plane giants had offered a “package deal” covering both the claims against them as well as Helios Airways.
Both Boeing and Helios are insured with Global Aerospace, the world's largest aerospace insurance underwriter.
So far, only six families representing Greek nationals who were aboard the ill-fated aircraft have agreed to compensation of around 250,000 euros each.
According to conventional wisdom, the main reason why the lawsuit against Boeing should be filed in Greece is because the accident happened inside Greek territory.
Still, in the cutthroat business that is litigation, some might argue that the flight was doomed even before it entered Greek airspace.
In fact, this was more or less the verdict of a fact-finding report into the accident released last year.
According to the report, the plane failed to pressurise, and the pilots were rendered either unconscious or killed.
“We are not disheartened,” said Nicolas Yiasoumis, spokesman for the victims’ relatives committee in Cyprus.
He pointed out that they had sought damages in the United States because the higher payouts there would have given some measure of comfort to the orphans left behind.
He said relatives of the victims would be meeting with their lawyers to discuss their next steps.
Copyright © Cyprus Mail 2007
Helios relatives: we’ll keep going after Boeing
By Elias Hazou
RELATIVES of the victims who perished aboard a Cypriot airliner 24 months ago have vowed to bounce back after a Chicago court denied a lawsuit against plane manufacturers Boeing.
Last week, the United States District Court, Illinois, upheld a motion by defendants Boeing that the trial should not be held in the United States.
“This is definitely not the end of the road,” Loizos Papacharalambous, one of the lawyers representing the aggrieved families, told the Mail yesterday.
“It does not force us to revise our strategy. We’re still going after Boeing, but either in Greece or Cyprus,” he added.
In his ruling, Judge George W. Lindberg said last week that “Cyprus would be a far more convenient forum for this litigation than the United States because of the ease of access to sources of proof in Greece, the pendency of related litigation between Helios and Boeing in Greece, and the strong public interest in having these actions decided in Greece.”
Boeing’s motion to have the case dismissed in the United States was granted subject to certain conditions, one of which was “the defendant shall provide plaintiffs [relatives of the crash victims] with access, in Cyprus and Greece, to all evidence and witnesses in their custody or control that are relevant to any issue raised in actions refiled in Cyprus or Greece.”
Moreover, the judgment stated that the “defendant shall pay any damages to awarded by the Cyprus and/or Greek courts in the refiled actions, subject to any right of appeal.”
Ninety relatives, representing 92 of the individuals who were killed in the crash, had filed a consolidated lawsuit against Boeing, seeking compensation for product liability, negligence, and breach of warranty. The relatives are accusing Boeing of a string of build and design omissions on the Boeing 737-300 that they believe contributed to the calamity.
They also hold now-defunct Helios responsible for pilot and maintenance errors.
Papacharalambous conceded that in one sense the ruling was a setback, since damages awarded in the United States are far more substantial than in Greece, and certainly than in Cyprus.
On the island, where the law is based on the Anglo-Saxon model, you need to prove that the claimant is a financial dependent of the deceased.
And the so-called “bereavement award” is fixed at £10,000.
By contrast, the US legal system is not constrained in this respect; compensation is at the discretion of the judge, and is based on considerations such as the pain of the relatives.
Still, Papacharalambous was confident that everything was on track, hinting that having the case heard in Greece might be a blessing in disguise, “since we now have all the documentation and witnesses in place.”
The Mail has also learned that Boeing had in the meantime offered an out-of-court settlement, which was turned down by the relatives and their lawyers.
According to the sources close to the case, the plane giants had offered a “package deal” covering both the claims against them as well as Helios Airways.
Both Boeing and Helios are insured with Global Aerospace, the world's largest aerospace insurance underwriter.
So far, only six families representing Greek nationals who were aboard the ill-fated aircraft have agreed to compensation of around 250,000 euros each.
According to conventional wisdom, the main reason why the lawsuit against Boeing should be filed in Greece is because the accident happened inside Greek territory.
Still, in the cutthroat business that is litigation, some might argue that the flight was doomed even before it entered Greek airspace.
In fact, this was more or less the verdict of a fact-finding report into the accident released last year.
According to the report, the plane failed to pressurise, and the pilots were rendered either unconscious or killed.
“We are not disheartened,” said Nicolas Yiasoumis, spokesman for the victims’ relatives committee in Cyprus.
He pointed out that they had sought damages in the United States because the higher payouts there would have given some measure of comfort to the orphans left behind.
He said relatives of the victims would be meeting with their lawyers to discuss their next steps.
Copyright © Cyprus Mail 2007
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National Geographic - Helios Documentary
Did you see the documentary? Kept clear of both Boeing and Helios issues and the findings of the Kallis Commission.
Apparently the Kallis Commission in Cyprus names the two UKCAA guys who did the various Audits of Helios among those it considered criminally liable. It is strange that the AAI&ASB hadn't interviewed either of them, yet the Final Report made much of the alleged Audit deficiencies of Helios.
The CAA Inspector who gave evidence to the Kallis Commission pointed out that he had not been interviewed by AAI&ASB. He said that there were no outstanding audit items at the time of the accident and that there were never any level 1 findings. He said that the airline was as safe as any other in Cyprus.
Put simply, the deficiencies did not exist and Helios Airways was operating in accordance with JAROPS at the time of the accident. You cannot do more than that.
However, the Kallis Commission declined to accept any evidence that disagreed with the AAI&ASB Report.
The AAI&ASB does not appear to have made representations about this misuse of their Report despite the widespread publicity, and the author being President of the SE Europe Branch of the FSF! See the FSF Joint Resolution Regarding Criminalization of Aviation Accidents.
How open can you afford to be when questioned by any government accident investigation body in future?
Apparently the Kallis Commission in Cyprus names the two UKCAA guys who did the various Audits of Helios among those it considered criminally liable. It is strange that the AAI&ASB hadn't interviewed either of them, yet the Final Report made much of the alleged Audit deficiencies of Helios.
The CAA Inspector who gave evidence to the Kallis Commission pointed out that he had not been interviewed by AAI&ASB. He said that there were no outstanding audit items at the time of the accident and that there were never any level 1 findings. He said that the airline was as safe as any other in Cyprus.
Put simply, the deficiencies did not exist and Helios Airways was operating in accordance with JAROPS at the time of the accident. You cannot do more than that.
However, the Kallis Commission declined to accept any evidence that disagreed with the AAI&ASB Report.
The AAI&ASB does not appear to have made representations about this misuse of their Report despite the widespread publicity, and the author being President of the SE Europe Branch of the FSF! See the FSF Joint Resolution Regarding Criminalization of Aviation Accidents.
How open can you afford to be when questioned by any government accident investigation body in future?
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Who were the main contributors to the National Geographic documentary?
I had not seen big fraidy cat's post in March, so I failed to spot the insurance angle. In a way it is a happy coincidence that both Helios and Boeing have the same insurer. But in another way it is something which should be scrutinised and monitored extremely closely.
Aviation insurers of this ilk are not just financially implicated bystanders. By choosing to buy-in to big aviation business by taking over risk, they share in the manufacturing and operations ventures as surely as any shareholder, and after this incident it appears that the one insurance company may actually have been controlling the show on behalf of both the main affected 'aviation' parties (by routinely enforced subrogation of the rights of their insurance customers).
I have been continuously amazed that we have learned so little from this accident despite the passage of time. I keep wondering why. Since the accident we have learned of several other pressurisation incidents but there seems to be little appetite for raising awareness of any general problem. The simple act of breathing, or even pausing for breath, seems to be one of those things we too easily take for granted in our quest for quickness and low cost.
What, if any, knowledge is being suppressed by Global Aerospace here? All eyes should be upon Global Aerospace not Boeing or Helios or others. Global will be trying to save their own shareholder's money. If they are behind the limited offers of compensation, then they have allegedly been upsetting bereaved relatives by their actions. If so, that's ruthless, cruel and unforgiveable. After all this time, and so many apparently related pressurisation incidents of varying severity almost daily, where are the real facts? Is there suppression of what actually is wrong with pressurisation systems? If so that is ruthless, scandalous and unforgiveable. So are Global Aerospace really doing the industry any favours on this one by calling the shots? If they are indeed the primary insurers for both the main parties here, then in the immediate hours after this accident occurred they will have stepped in and stated to both Helios and Boeing "we have control", and they will still be commanding now...
I had not seen big fraidy cat's post in March, so I failed to spot the insurance angle. In a way it is a happy coincidence that both Helios and Boeing have the same insurer. But in another way it is something which should be scrutinised and monitored extremely closely.
Aviation insurers of this ilk are not just financially implicated bystanders. By choosing to buy-in to big aviation business by taking over risk, they share in the manufacturing and operations ventures as surely as any shareholder, and after this incident it appears that the one insurance company may actually have been controlling the show on behalf of both the main affected 'aviation' parties (by routinely enforced subrogation of the rights of their insurance customers).
I have been continuously amazed that we have learned so little from this accident despite the passage of time. I keep wondering why. Since the accident we have learned of several other pressurisation incidents but there seems to be little appetite for raising awareness of any general problem. The simple act of breathing, or even pausing for breath, seems to be one of those things we too easily take for granted in our quest for quickness and low cost.
What, if any, knowledge is being suppressed by Global Aerospace here? All eyes should be upon Global Aerospace not Boeing or Helios or others. Global will be trying to save their own shareholder's money. If they are behind the limited offers of compensation, then they have allegedly been upsetting bereaved relatives by their actions. If so, that's ruthless, cruel and unforgiveable. After all this time, and so many apparently related pressurisation incidents of varying severity almost daily, where are the real facts? Is there suppression of what actually is wrong with pressurisation systems? If so that is ruthless, scandalous and unforgiveable. So are Global Aerospace really doing the industry any favours on this one by calling the shots? If they are indeed the primary insurers for both the main parties here, then in the immediate hours after this accident occurred they will have stepped in and stated to both Helios and Boeing "we have control", and they will still be commanding now...
I watched the documentary. It pretty much covered what happened. The 2 pilots were portrayed as incompetent - especially the East German Captain. Even when he radioed the company after take off he was told by the ground engineer to check the pressurisation switch was in auto. He was shown as being confused - probably because he was approaching unconsciosness. Anyway what I and I expect everybody else would like to know is the role of the steward who was seen in the Captain's seat shortly before the crash. It's obviously only guesswork. It said at the beginning of the programme that he was called out for the flight - he was learning to fly or had some flying experience (maybe had a PPL?) and was hoping to become a Helios Captain. When the cockpit voice recorder was analyzed, the flight deck door was heard to open and before that the noise of the door security code being punched in so he obviously knew that so it was nothing to do with the electrics coming offline. It was also suggested that he had been in the cockpit on at least 1 occasion before the descent. Out of 4 portable oxygen bottles that were found - 3 had been used. He was shown to be the only person to be conscious even though his girlfriend(a stewardess) was on the flight. The intercepting fighter pilots saw him in the Captain's seat calling on the radio but nothing was heard. The voice recorder picked up him making Mayday calls so he obviously didn't know how to change the radio frequency as it was still on Larnaca approach/departures.
So to sum up it seems this guy was conscious for the whole flight. WHATEVER DID HE DO FOR 3 HOURS? Bearing in mind his inability to change the radio frequency to 121.5 he didn't seem to know much about operating an aeroplane so I am not suggesting that he could have saved the day flyingwise but he could have gone into the flt deck hours earlier. 3 HOURS in an emergency situation is an awful long time! Probably this post should be in the medical section for a head shrinker to analyze now that Inspector Morse is no longer around. I find it absolutely fascinating just imagining what was going through his mind for all that time. Will be interested to hear other peoples' views.
So to sum up it seems this guy was conscious for the whole flight. WHATEVER DID HE DO FOR 3 HOURS? Bearing in mind his inability to change the radio frequency to 121.5 he didn't seem to know much about operating an aeroplane so I am not suggesting that he could have saved the day flyingwise but he could have gone into the flt deck hours earlier. 3 HOURS in an emergency situation is an awful long time! Probably this post should be in the medical section for a head shrinker to analyze now that Inspector Morse is no longer around. I find it absolutely fascinating just imagining what was going through his mind for all that time. Will be interested to hear other peoples' views.
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Didnt see the updated national geographic documentary, however id like to say that Andreas definately would have known how to use the radio. Problem is, he wouldnt have known about selecting to 'mask' to activate the transmissions through the mask system. He was more than a student, and in fact help a Jar Atp licence. There is also no ways in my opinion that he would have been sitting around for three hours watching evryone go unconscious, and not had tried to do something about it.