Comair CRJ crash in Kentucky
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west coast
lamenting the way things were? how about designing a modern system that doesn't have the phrase:
WHY DID IT DO THAT?
as part of the lexicon.
if you become skilled at pushing buttons with your head down, your finger will get sore and your plane will run into something.
how about a little of both worlds?
Safest time for our industry? perhaps in the US, or the UK...have you seen how many crashes in the aviation third world?
computers are great, but when man serves the computer and not the other 'way around, time to worry.
lamenting the way things were? how about designing a modern system that doesn't have the phrase:
WHY DID IT DO THAT?
as part of the lexicon.
if you become skilled at pushing buttons with your head down, your finger will get sore and your plane will run into something.
how about a little of both worlds?
Safest time for our industry? perhaps in the US, or the UK...have you seen how many crashes in the aviation third world?
computers are great, but when man serves the computer and not the other 'way around, time to worry.
With the greatest respect I would venture to add that I do not believe there is such a thing as a "simple screw up" that assigns all blame to the flight crew. There is always a chain of circumstance, or as most of you call it, "the holes in the cheese lining up".
As a former airline staff I am well aware of the forensic bastardry with which airline managers treat delays of any sort, and I would like to suggest that profesional pilots are "delay averse". I therefore wonder if the loss of ten or so minutes prepping the wrong aircraft may be more signifigant then realised.
Although only a lowly PPL, I have almost come to grief by getting rushed into a flight that made mincemeat of my usual careful preparations and I can imagine it could just as easily happen to a professional under the wrong circumstances.
As a former airline staff I am well aware of the forensic bastardry with which airline managers treat delays of any sort, and I would like to suggest that profesional pilots are "delay averse". I therefore wonder if the loss of ten or so minutes prepping the wrong aircraft may be more signifigant then realised.
Although only a lowly PPL, I have almost come to grief by getting rushed into a flight that made mincemeat of my usual careful preparations and I can imagine it could just as easily happen to a professional under the wrong circumstances.
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This is tragic and I believe that it could have happened to any one of us. We are all human (not robots, yet!) and for what ever reason, we all make mistakes.
At this stage nobody really knows why this happened. Pilots, ATC etc. It's all guess work. Usually there are a combination of events that lead up to this kind of incident.
Lets wait until the report comes out before pointing fingers and even then, I hope, that instead of pointing fingers, we can all learn a thing or two, regardless of whos jobs whos and try to avoid a similar result in the future.
In the mean time we could all see it as a bit of a wake up call!
At this stage nobody really knows why this happened. Pilots, ATC etc. It's all guess work. Usually there are a combination of events that lead up to this kind of incident.
Lets wait until the report comes out before pointing fingers and even then, I hope, that instead of pointing fingers, we can all learn a thing or two, regardless of whos jobs whos and try to avoid a similar result in the future.
In the mean time we could all see it as a bit of a wake up call!
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I have read all the posts on this thread with great interest.
It is a tragic occurrence and like many have said, until the official enquiry issues it's final report, there is little point in speculation, educated though most of it may be. We can all say this or that may have happened and it is very hard not to jump to conclusions.
What I find very sad on this, and many other originally well intended threads, is the need for many "professionals" to turn educated debate into personal attacks on others they disagree with. It turns an intensely interesting debate into a childish squabble and detracts from the whole raison d'etre of pprune.
This is a very well read forum and no doubt also read by families of those directly involved in any incident.
Gentlemen, decorum please.
It is a tragic occurrence and like many have said, until the official enquiry issues it's final report, there is little point in speculation, educated though most of it may be. We can all say this or that may have happened and it is very hard not to jump to conclusions.
What I find very sad on this, and many other originally well intended threads, is the need for many "professionals" to turn educated debate into personal attacks on others they disagree with. It turns an intensely interesting debate into a childish squabble and detracts from the whole raison d'etre of pprune.
This is a very well read forum and no doubt also read by families of those directly involved in any incident.
Gentlemen, decorum please.
Autorise a L'atterrissage
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Absolutely, Speedpig.
However.
It remains a Fact that innocent passengers put simple trust in those up front to get it right. Each and every time.
I do, each time I board an aircraft.
A mistake was made here. An avoidable mistake. And anyone who flies, not just the bereaved, are entitled to call those who are responsible for those who made the mistake to account.
However.
It remains a Fact that innocent passengers put simple trust in those up front to get it right. Each and every time.
I do, each time I board an aircraft.
A mistake was made here. An avoidable mistake. And anyone who flies, not just the bereaved, are entitled to call those who are responsible for those who made the mistake to account.
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...held to account?
What do you suggest, Leclairage?
Jail the concerned First Officer just like the Greek authorties did with a Swiss Air Captain years ago, with an overrun at ATH with a DC-8?
Jail the concerned First Officer just like the Greek authorties did with a Swiss Air Captain years ago, with an overrun at ATH with a DC-8?
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We as an industry can always do better. I simply tire of reading comments that indicate things were better back when the poster was actively involved in aviation.
I'm sure that somewhere within the records there is a similar event from many decades ago,in which basic airmenship slipped up. Old time skills or not.
Sometimes we need to stop and remember this is the safest modern transport aviation has ever been before comments about the good old days come up. In 20 years hopefully it will be even safer, yet the I remember when folks will still be around.
I'm sure that somewhere within the records there is a similar event from many decades ago,in which basic airmenship slipped up. Old time skills or not.
Sometimes we need to stop and remember this is the safest modern transport aviation has ever been before comments about the good old days come up. In 20 years hopefully it will be even safer, yet the I remember when folks will still be around.
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Absolutely, Speedpig.
However.
It remains a Fact that innocent passengers put simple trust in those up front to get it right. Each and every time.
I do, each time I board an aircraft.
A mistake was made here. An avoidable mistake. And anyone who flies, not just the bereaved, are entitled to call those who are responsible for those who made the mistake to account.
However.
It remains a Fact that innocent passengers put simple trust in those up front to get it right. Each and every time.
I do, each time I board an aircraft.
A mistake was made here. An avoidable mistake. And anyone who flies, not just the bereaved, are entitled to call those who are responsible for those who made the mistake to account.
If you think your flights occur without mistakes, you are *mistaken*. Every flight has a number of mistakes that are either caught and corrected OR have insignificant consequence.
Entitled? Entitled to live in a world where there are no mistakes? Be sure and email me when you find it. Or for that matter, when you find a profession where mistakes are not made. I would warn you... if you are concerned about mistakes, STAY AWAY from hospitals. A survey a few years ago in the US revealed you had a better chance of checking your luggage and it arriving at your international destination than you did getting out of a hospital without some error of consequence (mistaken diagnosis, improper medication, insuffient medication, wrong medication, over medication, improper procedure.. the list goes on). One site lists as deaths due to health care errors at close to *100,000*. Can you imagine if the airlines approached even 1/100th of that??? http://www.surgeryencyclopedia.com/L...al-Errors.html
Entitled? By whom??????
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Absolutely, Speedpig.
However.
It remains a Fact that innocent passengers put simple trust in those up front to get it right. Each and every time.
I do, each time I board an aircraft.
A mistake was made here. An avoidable mistake. And anyone who flies, not just the bereaved, are entitled to call those who are responsible for those who made the mistake to account.
However.
It remains a Fact that innocent passengers put simple trust in those up front to get it right. Each and every time.
I do, each time I board an aircraft.
A mistake was made here. An avoidable mistake. And anyone who flies, not just the bereaved, are entitled to call those who are responsible for those who made the mistake to account.
What you seem to be saying is that if there is an established procedure, and a pilot deviates from it, then a clear cut case of pilot error has been established.
The adoption of this approach makes it very easy to decide who to blame after an accident has happened, but unfortunately human performance is not so mechanistic and so this way of thinking does nothing to help avoid accidents in the first place. Indeed it may increase the risk by setting up a culture which increases the feelings of pressure experienced by pilots.
So what is also required is that those who organise the systems within which pilots work pay attention to design factors that are known to increase or decrease the risk of a mistake being made. For example in this case it would have been prudent for those designing the taxiway layout to factor in the risk of confusion.
This does not let the flight crew off the hook, but when you get on an aeroplane you are also trusting everybody who ISN'T up front, but who contributes to the operation of the aircraft, to have done the best they possibly can to design the operational environment in such a way that it minimises the chances of a mistake being made, and has the maximum reasonable degree of defences against mistakes that are made.
If you have a confusing airport layout you KNOW that you are increasing the chances of a mistake being made, so you either change it or compensate for it.
It is true that there need to be sanctions against individual failures that are a consequence of loss of attention, but if you assume that training systems for flight crew are robust, and that incompetents never reach or remain on the flight deck - a circumstance that you DO have the right to trust in - then punishment based control focused on the person who makes the mistake doesn't do much at all for aviation safety, and may even make things worse.
It does, however, make angry and grieving people feel better, and allows those other people who are only there in spirit on the flight deck (or in the maintenance hangar) to continue making THEIR mistakes with impunity. What we passengers really rely on is professional integrity, we cannot rely on people who will never make a mistake because if that were a requirement for employment as a pilot there would be no airline industry.
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49 people are dead. Crucifying the survivor won't bring them back. It may be hard for some people to imagine themselves making the same mistake as this crew did, but sooner or later someone will make a similar mistake. An investigation that seeks to find out how the mistake happened and to come up with a practical way of preventing it happening again will be a far better service to the bereaved than a witchhunt.
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Entitled
Guys,
As a PAX I buy my ticket and take my chances. The same chances that I take when I step on a train, cross the road, get in a hire care, breath, whatever. The crew up front do their best with what they have - if its not good enough this time round, my bad luck perhaps. The crew trust the mechanics, the mechanics trust the manufacturer's & the FAA (or whoever) that they guessed or calculated it right... I'm just at the end of a trust chain and hope that it is not I the weakest link
But its same for food, I trust that the store is not going to supply me with bad food, and the store trusts the supplier and so it goes, its all trust chains and there is always a weakest link in every chain.
Life is a lottery and if you are not prepaired to gamble, die now and save the words, me I'll take my chances and hope that the system of checks and balances catches most of the errors, before they take effect...
gofer
As a PAX I buy my ticket and take my chances. The same chances that I take when I step on a train, cross the road, get in a hire care, breath, whatever. The crew up front do their best with what they have - if its not good enough this time round, my bad luck perhaps. The crew trust the mechanics, the mechanics trust the manufacturer's & the FAA (or whoever) that they guessed or calculated it right... I'm just at the end of a trust chain and hope that it is not I the weakest link
But its same for food, I trust that the store is not going to supply me with bad food, and the store trusts the supplier and so it goes, its all trust chains and there is always a weakest link in every chain.
Life is a lottery and if you are not prepaired to gamble, die now and save the words, me I'll take my chances and hope that the system of checks and balances catches most of the errors, before they take effect...
gofer
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Gofer ,
Finally someone with good sense.
Everyone make mistakes .
The question is :
1 . Were the pilots doing their job with professionalism and concentrated in what they were doing?
So it was a mistake , bad luck for all involved.We don`t have to blame anybody but to learn with their mistakes.
2 . Were the pilots chating about non-related duty subjects ,or with any kind of reckless behavior?
So they are guilty because they were negligent.
And that`s it.
Finally someone with good sense.
Everyone make mistakes .
The question is :
1 . Were the pilots doing their job with professionalism and concentrated in what they were doing?
So it was a mistake , bad luck for all involved.We don`t have to blame anybody but to learn with their mistakes.
2 . Were the pilots chating about non-related duty subjects ,or with any kind of reckless behavior?
So they are guilty because they were negligent.
And that`s it.
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It's OK to make mistakes ....
Entitlement to a risk free mode of transport? No, I think this group recognises that this this unattainable, but we should ACTIVELY seek this goal.
Airlines and ATC are to be congratulated for their zest to tackle MUDA (Japanese for waste see here) it brings the cost of flying down, brings the punters in and keeps us all in business! BUT ...
... the flying public (through the processes of training and licencing airline, airports and their staff) should be entitled to a flight that embodies with equal zest the process of 'mistake-proofing' its operations ('Poka-Yoke').
Many in this thread have pointed out that Human factors played an important role in this accident; we make mistakes, get over it!
My problem is that whilst it's OK to make mistakes, every one should be unique! It's not OK to make the same mistake twice!
If SOPs are so long, and turn-arounds so short that they don't get followed, we're going to make the same mistake twice. Not acceptable
Airlines and ATC are to be congratulated for their zest to tackle MUDA (Japanese for waste see here) it brings the cost of flying down, brings the punters in and keeps us all in business! BUT ...
... the flying public (through the processes of training and licencing airline, airports and their staff) should be entitled to a flight that embodies with equal zest the process of 'mistake-proofing' its operations ('Poka-Yoke').
Many in this thread have pointed out that Human factors played an important role in this accident; we make mistakes, get over it!
My problem is that whilst it's OK to make mistakes, every one should be unique! It's not OK to make the same mistake twice!
If SOPs are so long, and turn-arounds so short that they don't get followed, we're going to make the same mistake twice. Not acceptable
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From the aviation-industry.com email newsletter today (sorry, haven't had a chance to go and find the original source):
The investigation into the crash of flight 5191 at Lexington's Blue Grass Airport (in Kentucky) has taken a new turn following a decision by a Federal judge yesterday.
An order that will allow attorneys and their clients to have outside experts inspect both the wreckage and all materials related to the crash has been passed. It is reported that any evidence uncovered by the independent experts will be made available to others seeking claims against the airline. On top of the usual lines of enquiry, air traffic control and the aircraft model itself may – according to attorneys – be investigated following a number of letters from current Comair and Delta employees who claim to have vital knowledge.
An order that will allow attorneys and their clients to have outside experts inspect both the wreckage and all materials related to the crash has been passed. It is reported that any evidence uncovered by the independent experts will be made available to others seeking claims against the airline. On top of the usual lines of enquiry, air traffic control and the aircraft model itself may – according to attorneys – be investigated following a number of letters from current Comair and Delta employees who claim to have vital knowledge.
An American Girl
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The following should be treated as RUMOR as it appears in the media and is not the factual result of official professional investigation:
"LEXINGTON, Kentucky (AP) -- Comair was using an outdated chart of Lexington's Blue Grass Airport when one of its planes took off on the wrong runway and crashed in flames, and the airline is now urging pilots to use "extreme caution," according to an e-mail obtained by The Associated Press."
Link to full text of article:
http://www.cnn.com/2006/US/09/12/com....ap/index.html
God bless the pilots, cabin crew, PAX and everyone else affected by this tragedy.
"LEXINGTON, Kentucky (AP) -- Comair was using an outdated chart of Lexington's Blue Grass Airport when one of its planes took off on the wrong runway and crashed in flames, and the airline is now urging pilots to use "extreme caution," according to an e-mail obtained by The Associated Press."
Link to full text of article:
http://www.cnn.com/2006/US/09/12/com....ap/index.html
God bless the pilots, cabin crew, PAX and everyone else affected by this tragedy.
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When this thread started, I printed a LEX airport diagram off the Internet, then noticed it did not tally with the map shown in an early post.
It did not seem that important then... after all mine was only a diagram off the Internet, hardly an authorative source.
Not one second did it occur to me, that the pilots might have been looking at "my" map, rather than an updated one.
For the moment, let's treat it for what it is: a rumour.
But it could be another hole in the cheese.....
It did not seem that important then... after all mine was only a diagram off the Internet, hardly an authorative source.
Not one second did it occur to me, that the pilots might have been looking at "my" map, rather than an updated one.
For the moment, let's treat it for what it is: a rumour.
But it could be another hole in the cheese.....
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Many posts
I have read through the entire list of postings on this accident. There are many angles, there are many thoughts, there are many ideas BUT let me ASK a quesion if I may. When you, yes that is ALL OF YOU aviators out there, line your aircraft up on the DEPARTURE runway surely you set the HEADING BUG to the nose of the aircraft and BEFORE you release the brakes/apply power you CHECK that the aircraft is on the HEADING that you want it to be on? Don't you?
I was taught to fly by a South African ex Spitfire and Mosquito pilot in Basic Training and he told me if NOTHING else at least make sure you are taking off from the right runway!
Just a thought!
I was taught to fly by a South African ex Spitfire and Mosquito pilot in Basic Training and he told me if NOTHING else at least make sure you are taking off from the right runway!
Just a thought!
Last edited by MercenaryAli; 12th Sep 2006 at 21:45.
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CNN are also covering the outdated charts...
http://us.cnn.com/2006/US/09/12/coma....ap/index.html
http://us.cnn.com/2006/US/09/12/coma....ap/index.html