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Ten to be indicted over TAM crash

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Old 20th Nov 2008, 13:39
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CONF iture,
Did you know that the "all new" A350 is planned to fit non feed back side sticks?
Well it seems that I'm the only one concerned about that...
Fly safe.
V
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Old 20th Nov 2008, 15:30
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Did you know that the "all new" A350 is planned to fit non feed back side sticks?
Well it seems that I'm the only one concerned about that...
My apology aguadalte, I have obviously not expressed myself correctly, but I'm with you 100%

Airbus has taken unnecessary steps.
By embracing a more humble attitude, they would have developed an even far better product, but now, by ignoring the very early critics, they are stuck in their technology options.

... not in a rush to experiment their coming automatic TCAS ...
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Old 20th Nov 2008, 19:19
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But, could it happen on an Auto-Throttled aircraft?
Lemmmesee... does B747 have autothrust or autothrottles? Keywords are Quantas and Bangkok.

EDIT: I apologise for mixing-up a couple of jumbo-overruns; Quantas at Bangkok wasn't caused by not retarding throttle(s), however, Air China at HongKong and Air France at Faaa, were.

Don't blame Airbus philosophy - while it's different compared to "conventional" aircraft and takes a lot of re-learning, there's no empirical evidence that it's less safe. However I do agree that FWC that shouts "RETARD!" untill all the levers are near idle would most likely prevent the accident but pulling all the throttles back for landing must have seemed so natural to AB designers that they never considered the scenario that was played at Congohas.

Last edited by Clandestino; 29th Nov 2008 at 22:35. Reason: Brainf**t
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Old 21st Nov 2008, 00:21
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Well, CONF iture an automatic TCAS, or any other device taking control of the aircraft, against previous consent of the pilots, seems dangerous and a huge step against pilot full authority on bord...

Clandestino,
Can you please elaborate on that Qantas Bangkok situation, as I recall it has nothing to do with the Auto-Throttle/Auto-Thrust concept. (And yes, I think 747's are Auto-throttled, not Auto-Thrusted).

Here's a summary of the accident, taken from a quick look on the internet and I call your attention on what is writen in bold letters (my bold):

It can be viewed in its entirety at http://www.basi.gov.au/acci/ojh/vh-ojh.pdf. A preliminary ATSB report of the accident cited the company's Oct. 1977 policy to use flaps 25 (as opposed to flaps 30) and idle reverse thrust under normal conditions. This policy obtained maximum life of the carbon brakes on the B747-400 and reduced costs associated with maintenance as well as noise levy charges (see ASW, Jan. 3, 2000). The Accident Flight
Had the crew used reverse thrust, they probably would have been able to bring the airplane to a safe stop. However, other aspects of cockpit procedures raise substantive issues of crew coordination. When the aircraft was about 3 meters (10 ft.) above the runway and floating farther down than the ideal touchdown point, the captain, who was the pilot not flying, advised the first officer to execute a go-around. The first officer pushed the thrust levers forward just as the main landing gear wheels touched the tarmac. The captain immediately cancelled the go-around, not by saying so, but by retarding the thrust levers. As the ATSB report said, "Those events resulted in confusion amongst the other pilots (first and second officer) and contributed to the crew not selecting (or noticing the absence of) reverse thrust during the landing roll."
According to the ATSB report, the jumbo jet actually accelerated for about a 1,000 ft. after touchdown (due to residual thrust) before beginning a slow decrease in speed, but not enough to avoid hurtling off the far end of the runway. Having decided to not get airborne, the crew was waterborne, aquaplaning down the rain-slicked runway.
The ATSB report is structured in such a way that it provides a brief description in each subject area, with an itemization of significant failures and significant inadequacies in defenses. The very brevity of this approach gives a hard edge and an attention-getting potency to its findings.
Regarding cockpit procedures, the ATSB said:
"During the examination of the performance of the aircraft on the runway, it became evident that the flaps 25/idle reverse thrust landing procedure used by the crew (and which was the 'preferred' company procedure) was not appropriate for operations on water-affected runways. The appropriate approach/landing procedure was flaps 30/full reverse thrust. This had the characteristics of a lower approach speed, of being easier to fly in terms of speed control and runway aim point (for most company pilots), and of providing maximum aerodynamic drag after touchdown when the effectiveness of the wheel brakes could be reduced because of aquaplaning. Had this configuration been used, the overrun would most probably have been avoided.

(quoted from an article on BNET)

Clandestino, You may not agree with my point of view but, your argumentation has missed the whole point.
When I asked if the Congonhas accident may have happened with an auto-throttled aircraft I meant that, when retarding only one of the throttles the other(s) tend to follow. In order to retard only one of the throttles you would have to disengage the Auto-Throttle and this means a positive and intentional action. In the Congonhas case, they commited a mistake, and were completely overriden by the system. The only thing in common in both cases was poor judgement.

V.
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Old 21st Nov 2008, 02:56
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Clandestino, I would not pretend Airbus A/THR concept is "less safe" but less straight forward, certainly.

These thrust levers could remain in a frozen position 99% of the air time and still assure all the necessary thrust changes … no wonder time to time, under stress, a crew forget about them …
A/THR disconnection takes some additional thinking … why should it be that way ?
Full thrust can be produced with both thrust levers still in the unrelated idle detent …

I think Airbus forgot to keep it simple.

However I do agree that FWC that shouts "RETARD!" untill all the levers are near idle would most likely prevent the accident but pulling all the throttles back for landing must have seemed so natural to AB designers that they never considered the scenario that was played at Congohas.
I am not aware of the logic in terms of frequency, repetition, volume change, behind the RETARD auto call-outs, but in this manual thrust landing the reminder never gave up.


Well, CONF iture an automatic TCAS, or any other device taking control of the aircraft, against previous consent of the pilots, seems dangerous and a huge step against pilot full authority on bord...
I know, I know, aguadaltebut !?
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Old 21st Nov 2008, 12:49
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technology

Since my early years in school, almost 30 years ago, in the Air Force, every Flight Instructor I had, emphasized the need for planning and judgment with the phrase: "fly ahead of your aircraft".

I think that what's at stake here, is the complexity of the FBW a/c A/THR System, as well as the Flight Control Laws and Side Stick input system logics.
As I view it: The problem with this systems is that, when you're in need of your full attention (for what's going awfully wrong), you have also to "intellectualize" in step of instinctively fly basic skills.

As you said earlier (CONF iture)
Airbus has taken unnecessary steps.
By embracing a more humble attitude, they would have developed an even far better product, but now, by ignoring the very early critics, they are stuck in their technology options.
That's the hard truth and we, pilots, have now to deal with that.
Some of us, just accept it without mental reservations, others prefer to be more assertive, despite of knowing that AI will not take their argumentations into consideration.
What most embarrasses us all, is that those "lunatic ideas" come from pilots within AI and AI a/c operators.
We're only humans and the idea that human error may be "avoided" by imposing automatic responses by the aircraft, may also be considered a human error, since those systems were also designed by Man.
TCAS, EGPWS, FANS, ILS, GPS, Auto-Pilot, Auto-Throttle and a lot of other systems were a good help and are useful tools for a safer aviation, as long as they are kept under full authority of the pilots. Regarding Manual Flight, I would tend to ask for a more strait forward approach and keep it simple and with a much more "honnest input response".
Apart from intervening in this forums my only way to push for a safer use of those apparatus is to express my concerns over certain events to my company's Safety Board and to highlight those (personally) questionable issues to my co-pilots.
What I can not accept is the simplistic idea that the Congonhas Captain just "forgot" that, to land an aircraft, one has to retard the Thrust Levers. I'm not Brasilian, nor a TAM pilot, I'm just trying to be fair and responsible on my understanding of what has really gone wrong. There is always a much more complex reason for an accident, than one may expect. To learn with other pilots mistakes and to prevent future accidents. Is it not, what this is all about?

Fly Safe,
V.

Last edited by aguadalte; 21st Nov 2008 at 13:13.
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Old 21st Nov 2008, 16:51
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Sometimes we have to accept that something which in hindsight may seem completely impossible to us, is something that, to the individuals involved at the time, either makes perfect sense, or that they are simply overloaded to the point where they overlook what should be an obvious discrepancy. This is not limited to Airbus pilots either. The Helios B737 is another example of a crew missing something which "should" have been obvious.
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Old 22nd Nov 2008, 14:22
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". . . What I can not accept is the simplistic idea that the Congonhas Captain just "forgot" that, to land an aircraft, one has to retard the Thrust Levers."
Retarding the thrust levers upon touchdown, with or without reverser anomalies, requires no thought and no decision making, because it is an elementary, instinctive process applicable in all airplanes. Even during CAT-IIIB autoland, the pilot flying must keep his hand on all thrust levers, not only for the purpose of selecting reverse thrust, but to ensure that all thrust levers are in fact moved to idle detent upon touchdown.

This senseless loss of life is either a case of temporary crew insanity, or gross crew incompetence at best. The capt at the controls had retarded only the left thrust lever and applied reverse to the left engine while engine number 2 had continued to develop substantial forward thrust. The capt in the right seat lacked basic survival instinct in that he belatedly had failed to yank No.2 thrust lever to idle detent and stand on the brakes.

I wouldn't be surprised if the moderator who had deleted my previous post had done so in deference to TAM and its bullying insurers in their obvious media hyped efforts to shift blame to the airport operator, Infraero and ANAC.

The "criminal" investigation in Brasil, magnified by the media, [as is the debate in this thread] has engaged the usual hamster-wheel exercise in addressing: "Ambiguous Airbus logic," "non grooved runway", "short runway", "wet runway", "dangerous airport", "ATC," . . . anything but the obvious probable cause of "pilot error."

Yes, the pavement length is only 6365' . . . but it has been in service for many decades, wet and dry, for thousands of successful landings. The incident/accident rate for the amount of traffic is not extraordinary. Before the life of A320s, Trans-Brasil B727s had also operated at this airport. Remember?
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Old 22nd Nov 2008, 20:25
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Yes, the pavement length is only 6365' . . . but it has been in service for many decades, wet and dry, for thousands of successful landings. The incident/accident rate for the amount of traffic is not extraordinary. Before the life of A320s, Trans-Brasil B727s had also operated at this airport. Remember?
How many people have said, "but we've always done it that way", as they gazed over the smoking hole. Just because they got away with it doesn't make it right or smart.
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Old 22nd Nov 2008, 21:16
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Too true J.O.!
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Old 23rd Nov 2008, 01:23
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Excellent thread despite drift off initial topic.

Glueball,

I dislike it when ever people like yourself say "what were they thinking?" or "how did they make a such simple stuff up?"
I don't think these guys were incompetent or insane. They got caught in a hole with too little time to recover. It was caused by what could be considered a flawed system.

Not sure if you're aware, but the simple act of not putting one lever into a set detent creates major problems. Think about this-
Not only does it mean reverse on one side, climb on the other but at a glance the engine indications would have initially appeared to be what they were looking for (i.e. REV1 green only), the other engine does go from close to idle to climb power at a steady pace without the other lever moving so your hands on the levers will not notice. You're busy looking out the window tracking the centre line, the other guy is looking for ground spoilers etc. Your ears will not notice ( you expect it to get noisy). Your reflexes will push the rudder in and keep the aircraft staight potentially without your knowledge. And the first sign of something wrong could be a call of "No spoiler- negative deccel". And don't try and put the ground spoilers up with the lever because, like the thrust levers, it does not neccessarily reflect the position of the actual spoilers and you can't do it anyway. Auto brake won't work without ground spoilers. You also can't go around because you have a reverser deployed. By this time your out of runway.

I only know the basics of the accident. What is written above is hypothetical as I have not read detailed reports but I have read the pilots manual for the A320 and flow this scenario in the sim. But that is as quick as it happens and anyone could have similar happen at anytime. Yourself included.

Having flown both moving and fixed throttles/thrust levers, moving are by far superior.
The aircraft in question was smart enough to know it was on the ground, but it was not smart enough to realise that one engine was reversed the other was at climb. Maybe Airbus could at least change the logic so that in ground mode, once reverse is selected on one, the other thrust lever position is ignored and fwd idle is maximum thrust.

Clark y
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Old 23rd Nov 2008, 07:22
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Captain clark y . . . I am not from another planet. I fly 74s and I have four (4) thrust levers in the palm of my hand upon flare and touchdown; whether CAT-IIIB autoland/AT or VMC flying manual. I'm not looking at instruments during the flare and touchdown phase; I'm looking outside, at the centerline or centerline lights, rain or shine.

Ensuring that the thrust levers are closed/retarded to idle detent is done instinctively, exclusively by feel.

I can also feel by the seat of my pants . . . the onset of even a subtle application of auto brakes, [brake pressure commensurate with reverse thrust], and I can feel the onset of decelaration . . . even with rain bouncing off the windscreen and wipers whacking back and forth . . . all that without any clues from instruments.

And if there is no immediate feel of decelaration, I get on the brakes manually; without first having to think, without first having to check any settings, switches or instruments. It's just common sense, basic survival "stay'n alive" instinct.

The two TAM captains, in opposite seats had successfully landed during their previous sector with the same reverser DMI'd. For reasons unknown and unexplainable, the operating captain of this sector obviously did not have both thrust levers in the palm of his hand because he had failed to retard No.2 thrust lever.

This bizarre, elementary breakdown of human performance could be due to lack of training, lack of work discipline, lack of common sense, lack of survival instinct, or temporary insanity.
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Old 23rd Nov 2008, 16:13
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Having flown both moving and fixed throttles/thrust levers, moving are by far superior.
The aircraft in question was smart enough to know it was on the ground, but it was not smart enough to realise that one engine was reversed the other was at climb. Maybe Airbus could at least change the logic so that in ground mode, once reverse is selected on one, the other thrust lever position is ignored and fwd idle is maximum thrust.
Clark Y,

Couldn't agree more. Auto-throttles are far superior, because you can feel the aircraft, through their movement. They just give you another clue of what is going on and ATS don't. AI has suppressed that clue of auto-throttle movement to the pilots, as it has done also with the side-sticks. You have to look at your instruments to see engine response.
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Old 23rd Nov 2008, 19:50
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Originally Posted by GlueBall
Even during CAT-IIIB autoland, the pilot flying must keep his hand on all thrust levers, not only for the purpose of selecting reverse thrust, but to ensure that all thrust levers are in fact moved to idle detent upon touchdown.
Just another case scenario ... This time thrust is automatically reduced even if both thrust levers are inadvertently forgotten in the climb detent.
Too many combinations, different circumstances different logic … but digest all of them !

This bizarre, elementary breakdown of human performance could be due to lack of training, lack of work discipline, lack of common sense, lack of survival instinct, or temporary insanity.
It would be over simplistic to blame the TAM accident on Airbus shoulders, but still, how does it seem recurrent for Airbus pilots to leave one thrust lever in the climb detent when one thrust reverser is deactivated, when other types look pretty immune to that scenario ?
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Old 23rd Nov 2008, 23:04
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Glueball, it is easy to blame these pilots but you're lucky to have feel. It takes a fair amount of time to get used to the fact that 99% of the time the thrust levers are just "limit switches". An A320 was lost back in March 1998 for the same problem i.e. 1 reverser unserviceable. On landing one engine was left in idle detent the other in climb detent. The result was the aircraft ran off the runway. Hopefully we can all learn from this.

As for the witch hunt to find someone to blame and or pay, pilots are always an easy target.
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Old 25th Nov 2008, 18:05
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I believe there is something really insidious in this auto thrust philosophy.

After spending hours forgetting about those frozen thrust levers, but still brilliantly managing any thrust variation between idle and climb thrust, we can tend to unconsciously obliterate their function and keep them out of the process.

Anytime there was an auto thrust adjustment on the 757, I can remember placing my hand on the levers, almost by reflex, just to feel them moving, and moving together, sometimes even to initiate that movement or also to delay it in other circumstances ...

There was a physical materialization of any thrust change, a kind of complete cycle :
  • Instruments
  • Brain
  • Arm Hand
  • Thrust levers
  • Instruments
Nothing like it on the Bus unless you decide to get rid of the automatic process.
The Arm Hand Thrust levers are useless elements of an automatic thrust adjustment.

But on three known occasions, crews forgot to fully reconstitute that physical link and failed to retard one of both thrust levers, which lead to very serious consequences.

Blaming the TAM accident on Airbus shoulders is over simplistic, but thinking that Airbus auto thrust conception has nothing to do with it is all that much.
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Old 26th Nov 2008, 16:39
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All of the "mechanical touching & feeling" components of the interface between pilot and aircraft, have been obliterated in the case of AI FBW concept (pilot-yoke (and trim) vs pilot side-stick; pilot A-Throttle vs pilot ATS).
I remember, when I came back to the A310, after almost 7 years riding A320's that I had to "learn" how to fly a conventional aircraft again. As I fly privately SE (Pitts S2B) I never had a real hard time to do so, but I must tell you that, things that I used to do instinctively on the B737's , like Rudder or Engine Trimming, now had to be done (at the beginning), as a "procedure" that was part of our normal scan. Sometimes I even had to call the attention of my newer PF F/O's (coming from A320's), after they engaged the A/P, that they should fine trim the aircraft. Because, on the FBW family there is no need to do it, normally.
We were left free of this functions even when hand-flying FBW birds. With ATS, non-feed back Side-Sticks and GSmini, most pilots don't even remember what was the VApp they have just used for landing...(if you don't believe it, just go ahead and ask them, after landing...)
We were not completely left off the loop, but close: we have no feed-back (and no need to trim), on our stick, when changing speeds and thrust settings; we have no feed-back on other pilot's inputs on his stick; no feed-back from the ATS levers, and, on a normal flight, one has only three actions to do on the ATS levers: Setting Take-Off Thrust, setting Climb Thrust and Retarding the levers over threshold for landing...
This might be "fantastic" for "monkeys", not for pilots.
As I said before, Airbuses are great aircraft, but they could be better.
V.
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Old 26th Nov 2008, 23:23
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So, during the landing, flare and touchdown of this Fly By Wire A320 [where thrust levers are just "switches"] would your right hand be resting on your knee, or on the thrust levers. . . ? Or is this procedure altogether more complex than just that on the A320...?
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Old 27th Nov 2008, 00:37
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Cannot wait for the day some management ace decides in the name of safety that pilots should...."Fly mixed fleet"...and fly an airbus on one sector and a Boeing on another... on the same dark night!
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Old 27th Nov 2008, 14:56
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No GlueBall, (I'm currently flying A340/A330) and depending on weather, crew, flight time, airport experience and other conditions, when I decide to hand-fly the aircraft I also disengage the ATS.
Its not against SOPs, since my company leaves that decision (for trainning purposes) to the Captain, although AI philosopy is to make use of ATS and disconnect it only if ATS is not providing adequate response.
Let me tell you that, on the A310, I didn't feel the need for that "trainning" once, most of the time, one had to "accompany" the work of the Auto-Throttle, trim the aircraft for changing speeds and configurations, and feeling the reactions of the auto-throttle, receiving those clues from throttle movement.
V.
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