Armavia A-320 accident report now available
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Ut Sementem Feeceris
Sobering reading. Alarming similarities to the Gulf/Bahrain accident - go-around / missed approach at night with lack of visual cues. Somotogravic illusion leading to inapproprite control inputs and CFIT......
Recommended reading.
A4
Recommended reading.
A4
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Also interesting to read about the lousy CRM and non adhearance to SOP which contributed to the accident.
Fatigue was mentioned several times in the report but unfortunately not as a contibuting factor, as far as I could see.
Fatigue was mentioned several times in the report but unfortunately not as a contibuting factor, as far as I could see.
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And as well as the above, the dreaded get-in-alitis factor. Nevertheless, the whole chain of events was set off by a rather odd national procedure which allows ATC to break off your approach on the basis of weather readings! Just who is flying the aeroplane?!
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Remarkable how many fully airworthy Airbus aircraft have impacted the surface because the crew failed to understand or interpret the flight modes on display.
I am convinced that the multiple automatic mode changes that occur particularly when operating at the edge of the envelope; the fixed detent thrust levers and the non-interconnected joysticks significantly contribute to pilot disorientation.
Is the A380 cockpit any different or will such disasters also be possible?
If I were an A380 Flight Manager I would decree that the aircraft only be flown using all autopilots, even for take-off, GPWS and TCAS. Non-precision and visual approaches would be banned.
I am convinced that the multiple automatic mode changes that occur particularly when operating at the edge of the envelope; the fixed detent thrust levers and the non-interconnected joysticks significantly contribute to pilot disorientation.
Is the A380 cockpit any different or will such disasters also be possible?
If I were an A380 Flight Manager I would decree that the aircraft only be flown using all autopilots, even for take-off, GPWS and TCAS. Non-precision and visual approaches would be banned.
Last edited by Basil Smallpiece; 9th Jul 2007 at 08:43. Reason: typing error
Ut Sementem Feeceris
OK Basil - I can think of two. GulfAir and ArmAvia. I do not know if you fly the Airbus - I suspect not. If you read the report it is patently obvious that the instruction to discontinue the approach was very poorly executed. I'm not having a go at the crew or the obvious CRM issues - but the facts are that the aircraft was operated in a totally non standard way in contravention of the FCOM.
There may well have been "mode confusion" - but that's not unique to Airbus and I'm not going to turn this into a A versus B debate - somotogravic illusion is not type specific!!! Personally I think the non moving THR LVR's is a red herring. In 10 years it has never caused me a problem as there are aural and visual cues to tell you what's happening.
I think the primary confusion was the overspeed warning because the flaps had not been retracted on the go-around - hence retarding the levers (albeit briefly). The crew went from a low energy situation ("SPEED SPEED SPEED"), which they reacted to correctly, to an overspeed (due flaps) in a short period of time - confusing yes, but entirely avoidable IF they had followed the standard procedures/FCOM. The susequent actions upto impact point to a total breakdown of SA.....
It's easy I know sitting here but it does re-enforce that you MUST be prepared for the unexpected. IF you are told to "turn right heading 240° and climb 2000'" whilst fully configured on the ILS at 3 miles just EXACTLY HOW are YOU going to achieve that? This is something I put to my trainees and if anything it emphasises that whilst in essence it's straightforward you do need to THINK about what you are going to do and the order in which you are going to do it.
As with all accidents / reports, I hope we can all learn something from this one - as I said earlier, recommended reading.
A4
There may well have been "mode confusion" - but that's not unique to Airbus and I'm not going to turn this into a A versus B debate - somotogravic illusion is not type specific!!! Personally I think the non moving THR LVR's is a red herring. In 10 years it has never caused me a problem as there are aural and visual cues to tell you what's happening.
I think the primary confusion was the overspeed warning because the flaps had not been retracted on the go-around - hence retarding the levers (albeit briefly). The crew went from a low energy situation ("SPEED SPEED SPEED"), which they reacted to correctly, to an overspeed (due flaps) in a short period of time - confusing yes, but entirely avoidable IF they had followed the standard procedures/FCOM. The susequent actions upto impact point to a total breakdown of SA.....
It's easy I know sitting here but it does re-enforce that you MUST be prepared for the unexpected. IF you are told to "turn right heading 240° and climb 2000'" whilst fully configured on the ILS at 3 miles just EXACTLY HOW are YOU going to achieve that? This is something I put to my trainees and if anything it emphasises that whilst in essence it's straightforward you do need to THINK about what you are going to do and the order in which you are going to do it.
As with all accidents / reports, I hope we can all learn something from this one - as I said earlier, recommended reading.
A4
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Hi Basil,
You have clearly not been on the flight deck of an airbus. Your assertions are rubbish, with proper training the bus is an excellent instrument or visual flight platform for manual or automatic flight.
I too wish the thrust levers moved but in the instictive way that fully pushing them forwards gives TOGA thrust and pulling them all the way back gives you idle they are perfectly satisfactory.
You have clearly not been on the flight deck of an airbus. Your assertions are rubbish, with proper training the bus is an excellent instrument or visual flight platform for manual or automatic flight.
I too wish the thrust levers moved but in the instictive way that fully pushing them forwards gives TOGA thrust and pulling them all the way back gives you idle they are perfectly satisfactory.
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A4 - here are a few that I can think of:
300/600: China Airlines Nagoya
310: Kenya Abidjan, Aeroflot Siberia, Tarom Bucharest
320: Air France Basle, Indian Bangalore, Air Inter Strasbourg,
330: Test Toulouse
Plus countless other non fatal incidents...
300/600: China Airlines Nagoya
310: Kenya Abidjan, Aeroflot Siberia, Tarom Bucharest
320: Air France Basle, Indian Bangalore, Air Inter Strasbourg,
330: Test Toulouse
Plus countless other non fatal incidents...
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Shall I start my long list for Boeing, Douglas or Bombadier etc.. ?
Shall I start my long list for Boeing, Douglas or Bombadier etc.. ?
The problem is not Airbus or Boeing. It is humans that are not unfailable and are on the wrong track mentaly. And the pilots might not have had enough or poor training.
The differences between airline quality is in one part, how much they spent on crewtraining. But will never be accounted for.
I would wish, I could see a benchmark about crewtraining compared to accidents.
But that is an almost impossible task. The more training you give as an operator the less accidents you can expect.
That is the truth, not that the FMA is not good. Which you will find, by the way, also on other aircraft.
Me, flying presently an American Heavy aircraft and been flying Airbuses and Fokkers as well. I can tell you, the system is basic, easy and almost foolproof.
Fly an engine failure at T/O on an A346 and just do absolutely nothing, yes nothing. The aircraft will continue climbing in a very shallow turn with about 8-10 NM diameter and return to the old place with constant height gain.
Do it in cruise, do again absolutely nothing, shallow descent and straight flight. One wing slightly lowered by 2degrees bank.
Try it in the SIM and you will be surprised.
But pilots are from their personality more conservative then the average human being and more unable to make changes in their personal habits and opinions.
Don´t be afraid about airbus. They build very nice aircraft and that is good and brings Boeing to the point, that they got to change from old a/c to newer technologies and better a/c to compete.
S***, again that Boeing-Airbus thing
The problem is not Airbus or Boeing. It is humans that are not unfailable and are on the wrong track mentaly. And the pilots might not have had enough or poor training.
The differences between airline quality is in one part, how much they spent on crewtraining. But will never be accounted for.
I would wish, I could see a benchmark about crewtraining compared to accidents.
But that is an almost impossible task. The more training you give as an operator the less accidents you can expect.
That is the truth, not that the FMA is not good. Which you will find, by the way, also on other aircraft.
Me, flying presently an American Heavy aircraft and been flying Airbuses and Fokkers as well. I can tell you, the system is basic, easy and almost foolproof.
Fly an engine failure at T/O on an A346 and just do absolutely nothing, yes nothing. The aircraft will continue climbing in a very shallow turn with about 8-10 NM diameter and return to the old place with constant height gain.
Do it in cruise, do again absolutely nothing, shallow descent and straight flight. One wing slightly lowered by 2degrees bank.
Try it in the SIM and you will be surprised.
But pilots are from their personality more conservative then the average human being and more unable to make changes in their personal habits and opinions.
Don´t be afraid about airbus. They build very nice aircraft and that is good and brings Boeing to the point, that they got to change from old a/c to newer technologies and better a/c to compete.
S***, again that Boeing-Airbus thing
Last edited by Engine3firehandle; 9th Jul 2007 at 10:54. Reason: tipo
Ut Sementem Feeceris
Ok Basil,
Please correct me if I'm wrong.
Air China, Nagoya. Inadvertant activation of go-around mode by FO. Crew subsequently tried to fight the aircrafts pitch/thrust (go-around) leading to a stall.
Kenya - no recall
Tarom - similar to Air China but "rescued"?
Aeroflot - Siberia..... Don't let your son fly the aircraft..... situation not recoverable.
Air France - Basel. Been done to death. Lot's of conspiracy theories. Bottom Line - if you fly a jet at 30' towards a forest (instead of the 400' as briefed) don't forget that the engines will take a while to spool up FROM IDLE.
Bangalore - OP DES (Thrust to idle) selected on approach. High sink rate developed with intervention by crew too late. Flight directors were not being operated in accordance with FCOM.
Air Inter - Mode confusion. 3.3° desired (approx 900fpm) 3,300 fpm selected.
A330 - Toulouse. Go around with simulated engine failure during ALT* - leading to stall?
The A300, 310 accidents were essentially pilot error. Procedures not being followed. The aircraft was performing "as instructed".
The Basel (Habsheim), Bangalore and AirInter accidents were in the early days of the FBW Airbus series. Without a doubt mode confusion played a part in the AirInter and this was addressed by Airbus with a new FCU design. The Habsheim accident - well read the timeline, the aircraft did exactly as it was told to do. Bangalore. Two inexperienced Capts. Check Capt was NOT authorised by Airbus to instruct. Deselection of ONE flight director (no no on Airbus) cause inappropriate thrust mode.
A330 - Accident during test flight. I think it had somethingto do with no low speed protection during ALT* with oei?
For me the over-riding factor that comes out of the above is you MUST understand what the aircraft is doing and be FULLY familiar with the FCOM. If you accidentally trigger go-around mode (old Airbus and (Boeing?)) DON'T FIGHT IT - especially if the trim is automatically winding NOSE UP. Just go with it - swear under your breath - vector round again. NEVER try to rescue a bad approach.
Mode confusion. When you select a mode on the FCU (MCP on Boeing?) then (hopefully!) you expect confirmation not only from the FMA (Flight Mode Annunciator) but also the secondary indicators (OP DES - I expect to see the thrust reduce to IDLE and a pitch down.) If I select FPA -3° I expect to see 700-900 fpm V/S - if I see 3,000 fpm then something isn't right.
It all comes down to Training. It is the reponsibility of Trainers, AND Trainees, to ensure that modes, and there consequences, are fully understood. A thorough understanding and full appreciation of what you EXPECT to see will make your life a lot easier - particularly close to the ground in a non-normal scenario which isn't the time to scratching your head and asking questions.
If the weather is cr@p - slow down!!! Take your time!! Don't try to be "slick".
If you rush and screw it up you just going to be up in the wx longer.
No aircraft is perfect - and the Airbus is usually singled out for criticism. If you are trained properly and make sure you understand the aircraft and its systems (which is a licence requirement) then the Bus is very capable and very easy to fly.
A4
Please correct me if I'm wrong.
Air China, Nagoya. Inadvertant activation of go-around mode by FO. Crew subsequently tried to fight the aircrafts pitch/thrust (go-around) leading to a stall.
Kenya - no recall
Tarom - similar to Air China but "rescued"?
Aeroflot - Siberia..... Don't let your son fly the aircraft..... situation not recoverable.
Air France - Basel. Been done to death. Lot's of conspiracy theories. Bottom Line - if you fly a jet at 30' towards a forest (instead of the 400' as briefed) don't forget that the engines will take a while to spool up FROM IDLE.
Bangalore - OP DES (Thrust to idle) selected on approach. High sink rate developed with intervention by crew too late. Flight directors were not being operated in accordance with FCOM.
Air Inter - Mode confusion. 3.3° desired (approx 900fpm) 3,300 fpm selected.
A330 - Toulouse. Go around with simulated engine failure during ALT* - leading to stall?
The A300, 310 accidents were essentially pilot error. Procedures not being followed. The aircraft was performing "as instructed".
The Basel (Habsheim), Bangalore and AirInter accidents were in the early days of the FBW Airbus series. Without a doubt mode confusion played a part in the AirInter and this was addressed by Airbus with a new FCU design. The Habsheim accident - well read the timeline, the aircraft did exactly as it was told to do. Bangalore. Two inexperienced Capts. Check Capt was NOT authorised by Airbus to instruct. Deselection of ONE flight director (no no on Airbus) cause inappropriate thrust mode.
A330 - Accident during test flight. I think it had somethingto do with no low speed protection during ALT* with oei?
For me the over-riding factor that comes out of the above is you MUST understand what the aircraft is doing and be FULLY familiar with the FCOM. If you accidentally trigger go-around mode (old Airbus and (Boeing?)) DON'T FIGHT IT - especially if the trim is automatically winding NOSE UP. Just go with it - swear under your breath - vector round again. NEVER try to rescue a bad approach.
Mode confusion. When you select a mode on the FCU (MCP on Boeing?) then (hopefully!) you expect confirmation not only from the FMA (Flight Mode Annunciator) but also the secondary indicators (OP DES - I expect to see the thrust reduce to IDLE and a pitch down.) If I select FPA -3° I expect to see 700-900 fpm V/S - if I see 3,000 fpm then something isn't right.
It all comes down to Training. It is the reponsibility of Trainers, AND Trainees, to ensure that modes, and there consequences, are fully understood. A thorough understanding and full appreciation of what you EXPECT to see will make your life a lot easier - particularly close to the ground in a non-normal scenario which isn't the time to scratching your head and asking questions.
If the weather is cr@p - slow down!!! Take your time!! Don't try to be "slick".
If you rush and screw it up you just going to be up in the wx longer.
No aircraft is perfect - and the Airbus is usually singled out for criticism. If you are trained properly and make sure you understand the aircraft and its systems (which is a licence requirement) then the Bus is very capable and very easy to fly.
A4
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Kenya - no recall
Crew did not react properly to a stall warning after t/o:
The investigation showed that the pilot flying reduced the pitch attitude but did not apply TOGA thrust on the engines
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Originally Posted by basil smallpiece
If I were an A380 Flight Manager I would decree that the aircraft only be flown using all autopilots, even for take-off, GPWS and TCAS. Non-precision and visual approaches would be banned.
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@Basil
You never flew an AIRBUS! Your point......Non-precision and visual approaches would be banned................
is totally off! Non precision approaches with an AIRBUS (flown acc FCOM) is always a pleasure to execute!
Visual approaches: peace of cake, if you know what you are doing.
As A4 mentioned, you got to know the flight modes!
You never flew an AIRBUS! Your point......Non-precision and visual approaches would be banned................
is totally off! Non precision approaches with an AIRBUS (flown acc FCOM) is always a pleasure to execute!
Visual approaches: peace of cake, if you know what you are doing.
As A4 mentioned, you got to know the flight modes!
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And what exactly did the Air Transat FMS have to do with running out of fuel? Seems to me like Basil has an axe to grind. If we're going to start talking about fuel exhaustion best stay away from those 767s too.
I Have Control
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Enough already
Folks, please stop rising to Basil's silly baits. The person is no pilot, clearly evidenced by his first "contribution"..Take-Off with all autopilots, ditto GPWS & TCAS....good grief, this website is plagued by amateurs who seem to love pretending to be commercial pilots.
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From the report
My bolding. Without a A v B argument developing would the Bus drivers care to comment on this aspect. Is it an area/scenario you cover in the sim (Train like you expect to fight, fight as you have trained)? Man/machine interface aspects?
I realise they were likely not following procedure (co-ordinating their efforts) here as well, but I ponder the reason why the copilot failed to press the button if he realised things were going pear shaped..
While intervening, the co-pilot had not pressed the take-over pushbutton, therefore both pilots’ control inputs were added and averaged. Such dual piloting is prohibited by the A320 FCOM. At that time the actions of the two pilots were not coordinated. The Captain twice moved the side stick half-way backwards , possibly, reacting to the EGPWS, but at the same time the co-pilot was inadvertently making nose-down inputs, which might have led the Captain to believe that the aircraft response to the control inputs in the pitch channel was not adequate.
I realise they were likely not following procedure (co-ordinating their efforts) here as well, but I ponder the reason why the copilot failed to press the button if he realised things were going pear shaped..