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Polish Government Tu154M crash

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Polish Government Tu154M crash

Old 12th Apr 2010, 02:00
  #321 (permalink)  
 
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my God...

If several recent previous posts (not yours, HM) are any indication of the level of understanding of human behaviour and safety management in aircraft accidents, then it's no wonder so many professionals despair of PPRuNe...
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Old 12th Apr 2010, 04:12
  #322 (permalink)  
PJ2
 
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grizzled;

Yes, the speculations which are clearly implausible are disappointing. It is preferable that if one does not know, one should stay silent and listen/read/think. The propensity to assume, postulate or just straight pronounce without comprehension is widespread. In a time when one can google and repeat "expertise", deep knowing does not seem to be a requirement for opening one's mouth. But there it is and always will be.

That observed, there are nevertheless a few posts which have focussed on important aspects of this sad, terrible accident. These are, (and this is NOT speculative, but merely a perception of what has been suggested thus far):

1. The notion of "pressure to land" directed towards the flight crew,

2. The kinds of approach aids available, if any, and whether they were used, or whether it was a PAR approach,

3. The exact nature of the weather, esp. vis.,

4. The nature of crew interaction (CRM), SOPs, which will only be available via the recorders,

5. The question of "mission-creep", related to point 1. By this I mean that decision-making path which leads to the 'next step' which leads to the next step etc which were all oriented towards landing rather than an intervention decision which may have broken the accident causal path; This kind of thinking slowly emerges as time pressure (and other pressures) enter the operational decision-making process. They spent a long period holding during which a number of aircraft ahead of the accident aircraft missed and diverted - these may or may not have been discussed and may or may not have factored in any decision to execute the approach.

6. The role of ATC especially in terms of weather information,

7. The role of language difficulties, if any,

8. The last might be the possibility of disorientation/loss of SA (somatogravic illusion, etc - Sochi, Bahrain) in the transition from instruments to visual references the runway especially if the visual environment was like a 'white dome' with little or no horizon.

There are others but it seems that a distillation of posts points to these issues.

All this is, of course, little consolation to the Polish people who have lost heads of state, government people and therefore both history and experience - another point raised in a few posts regarding the obvious question as to why they were all on one airplane.

I take seriously the views of those who clearly speak from experience regarding a historically strict and obedient chain of political, vice military, command which is a very different experience for those in North America.

PJ2
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Old 12th Apr 2010, 04:51
  #323 (permalink)  
 
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Quote:
...the crew of the TU 154 were dumping fuel before the missed approaches...

Utter nonsense. You cannot dump fuel on a TU5. If the problem is not that serious, you circle above the airfield to burn off fuel, in any other case you go in overweight. After a 1.5h flight and only 80something pax o/b the a/c would have been well under MLW (80t) even if it was fuelled for the return journey.

Andrasz, I mean no disrespect, but do you have experience flying or training on a TU5? Your post on this forum is the only place on the web that I've read that a TU5 cannot dump fuel. I've appreciated reading your posts on this subject, and this assertion made me even more curious. Thank you!
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Old 12th Apr 2010, 05:12
  #324 (permalink)  
 
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PJ2

As someone said long ago, "Thanks, I needed that."

Your post summarises the points that I was just too tired and frustrated to make. The last one is especially important for those of us "from the West" to understand without direct experience. Cultural differences -- in command protocols, training and philosphies, as well as major differences in the roles, responsibilites and attitudes of all the "players", including ATC of course, and even perhaps the PAX in this instance -- are a most interesting area of study in all human activity, including accident investigation and prevention.

Now, as Samual Pepys would say, "And so to bed..."
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Old 12th Apr 2010, 06:25
  #325 (permalink)  
 
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Why the rush to judgement?

This looks like yet another accident where the "what" isn't very puzzling but the "why" will have to be explained by a careful investigation. That is to say that a (seemingly) serviceable aircraft was flown into the trees short of the runway after it was taken below the MDA in weather that was reported below minimums anyway.

It's always interesting how so many people have to rush to judgement on these accidents without any more in the way of facts to go on than the bare facts of the crash itself, using pure speculation or even fantasy. I haven't seen any of that in the papers or on TV here in Germany but plenty of that on this site for so-called professional pilots. That makes me wonder how many here are commenting based on their many hours of experience operating Microsoft Flight Simulator rather than on anything to do with flying at all, let alone flying outside the States or western Europe.

It is a big world and there are many different operating philosophies in use there, when you often can find people who think it perfectly reasonable to shoot an approach to "have a look" for themselves at the weather on the approach, with no communications whatsoever in English during this whole process. Should that be anathema? Let's see what the report says about this before we try to make a final judgement.

I was very interested to read an article in a German magazine that mainly was profiling some corporate big shot. (I think this was about the former head of Porsche, Mr Wiedeking, back when he was riding high just before his big fall.) Buried in there was a story about how his flight crew was the only one to make it into someplace for an important meeting when the weather was bad, when this was meant to be read as evidence of Mr Big Shot's force of personality and its ability to bend events to suit his wishes, not that he was some sort of suicidal jerk driven by hubris. Well, I guess not everyone looks at things from the point of view of a western-trained professional pilot, perhaps not even other professional pilots and certainly not success-driven top executives!

Sometimes our priorities are not taken as the over-riding ones, when that doesn't usually result in an accident. It can seem a very weak argument to put the imaginary and purely speculative avoidance of a accident against the bare fact of not making it into your destination, especially after a planeload of reporters has already landed safely ahead of you, as in this case. That fog can form in the blink of an eye, well...

I look forward to reading the final report, about a year from now, I guess. Wild guesses from the Flight Simulator brigade I can take or leave, on the other hand, as they fight it out among themselves over who has made the best one and who is the biggest turkey of the flock.
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Old 12th Apr 2010, 06:34
  #326 (permalink)  
 
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Hello. I'm just read the article, and decided register to forum to post link to it. Something about the crew:

Google T?umacz

The original link for the proper spelling (not translated by Google) of their names:
Za?oga, która zgin??a, wcze?niej pomaga?a Haiti
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Old 12th Apr 2010, 06:48
  #327 (permalink)  
 
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Someone mentioned that QNH/QFE thing which , after 3 unsuccessful approaches, didn't make any sense to me.

But now as we know it was their 1st approach and with a relativ low experience up front this appears in a different light.

What elevation is that airport, what was the QFE/QNH ?
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Old 12th Apr 2010, 07:21
  #328 (permalink)  
 
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Hetfield

after 3 unsuccessful approaches, didn't make any sense to me.
There was ONE approach !!!

I thought we have cleared it long ago!
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Old 12th Apr 2010, 07:25
  #329 (permalink)  
 
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Sarcode2

No disrespect at all, a very valid question. I did not personally fly the Tu5, but do have ~10 years of experience operating the type. During most of that period I had access to all event & incident reports, so I am reasonably confident in my statement. The only qualifier is that we had a B-2 fleet, not the "M"s, however in this respect I am not aware of any change.

During one particular year we had a recurring issue with the oil filter sensors, with the filter blocked warning light coming on randomly on any engine, typically in high power setting situations (t/o). That warning was to be taken very seriously, as it could be a sign of metal grindings in the oil - a sign of imminent engine failure. Immediate shut-down of the affected engine and return to field was the procedure. If distance to landing was such and the a/c was above MLW, a low altitude, high drag configuration was selected to burn off as much fuel as possible (cruise consumption was ~7 tons per hour, with high drag/high power it was easily the double even on two engines, with such figures it does not take long to reach MLW, which was only 20t less than MTOW), however an overweight landing was permissible. Eventually all of the incidents were traced to harmonic vibrations fracturing one particular soldering in the sensor circuitry (which being a hairline crack, was practically undetectable, and only broke contact when vibration was near it's maximum), it was a major safety concern at the time because due to the frequency of events (1-2 every month) the crew got accustomed to the likelyhood that it is just another false alarm. I recall at least one disciplinary action after the crew only put the affected engine to idle to save on the lengthy paperwork required after an in-flight shutdown.

Mind you, neither the 737 or the 320 family has a fuel dumping system either. On most short / medium haul aircraft it is not necesary, as the MTOW/MLW difference is not great enough, and there is enough structural reserve to allow an overweight landing in an emergency.

Last edited by andrasz; 12th Apr 2010 at 07:39.
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Old 12th Apr 2010, 07:28
  #330 (permalink)  
 
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@ptkay

Please read my post.

But now as we know it was their 1st approach
At the time the discussion about QNH/QFE started talks were about 3 approaches.

Got it?
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Old 12th Apr 2010, 07:36
  #331 (permalink)  
 
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Fullforward;

Let's face some cold and hard facts of life: it's not the first and unfortunately not the last time that a perfectly sound aircraft is CFIT. Every single time it happened, human error (and frequently criminal), played the most important role. Simple like this, no rocket science.
This is hilarious, how sure you are, that it was "a perfectly sound aircraft".
Where did you get it from?
Did you complete the investigation???

What we know is that the pilot stopped communicating with ATC
and lost control (started flying to low) seconds before crash.

Did you really ask yourself why?

Maybe they were preoccupied wits some kind of technical problem,
steering, power?

Aviate, Navigate, Communicate...

They first of all tried to stay afloat, then chat with the ATC.

There are documented cases of uncontaminated engine failures
of the Soloviev engines in IL-62, Tu-154. first of all resulting
in loss of power and eventually loss of tail controls.
(I discussed it before with links and documents quoted.)

And probably the Tu-204 accident 3 weeks ago on approach to DME,
also equipped with Soloviev engines (not RR !!!) was caused by similar
problems.

ASN Aircraft accident Tupolev 204-100 RA-64011 Moskva-Domodedovo Airport (DME)

A Tupolev 204-100 passenger jet, registered RA-64011, was destroyed when it crash-landed in a forest while on approach to Moskva-Domodedovo Airport (DME), Russia.

Weather reported about the time of the accident (23:34 UTC / 02:35 local):
UUDD 212330Z 16003MPS 0100 R14R/0450N R14L/0700U FG VV001 03/02Q1002 64290050 14290045 NOSIG= [Wind 160 degrees at 3 m/sec; 100 m visibility; vertical visibility 100 ft.; temperature 3 degrees C, dewpoint 2 degrees C; runway visual range for runway 14R: 450 m, Not changing significantly and for runway 14L: 700 m improving]


Sounds familiar ??

But it was ILS approach, native Russian crew, their home airfield.
They are also paid less than 1000 EUR, they certainly had "get-home-itis".

Fullforward, does it all mean, that the aircraft was "perfectly sound".

Your logic is stunning.
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Old 12th Apr 2010, 07:40
  #332 (permalink)  
 
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@ hetfield,
sorry, my fault.
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Old 12th Apr 2010, 07:50
  #333 (permalink)  
 
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Animation of the accident:

Plej - wideo rozrywka, polityka i sport. Nowe filmy ka?dego dnia.
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Old 12th Apr 2010, 07:51
  #334 (permalink)  
dvv
 
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Your post on this forum is the only place on the web that I've read that a TU5 cannot dump fuel.
I have a copy of the TU154M Flight Operations Manual in front of me, and there's not a peep about any fuel dumping capabilites. Instead, there's this section:

4.5.7.2. Полет в зоне ожидания с целью выработки топлива
(1) В случаях выполнения незапланированной посадки необходимо, если это
возможно в сложившейся ситуации, выработать топливо до максимально
допустимой посадочной массы для данного аэродрома.
[...]
Which basically says:

4.5.7.2. Holding in pattern to burn off fuel
(1) In case of an emergency landing, it is necessary, if the situation permits, to burn off fuel down to the [aircraft] maximum landing mass, acceptable for the [intended] aerodrome.
[...]
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Old 12th Apr 2010, 08:00
  #335 (permalink)  
 
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questions for pj and chuks

I've been following the thread from the start, and welcome pj's reasoned entry into the discussion. But I don't recall any reference to his mention that the President's plane "spent a long time holding during which a number of aircraft ahead of the accident aircraft missed and diverted....." could someone please give more details on other aircraft that saw sense and went elsewhere?

And Chuks mentions that "a planeload of reporters has already landed safely ahead of you" ...... increasing the pressure to have a go.

Destination down in fog, alternates down in fog, beautiful but deadly....
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Old 12th Apr 2010, 08:04
  #336 (permalink)  
 
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Ptkay,

With respect, I have to disagree here. At present we have absolutely no indication that a technical malfunction could have played part (and the same is true for the DME Tu 204). There were reports of wreckage found far away from the main impact site, but the CNN footage clearly shows flap parts and broken trees at that point, all in accordance with the initial statements from the investigating committee that the initial ground contact was hitting a lone tree, severing the wingtip.

At present unfortunately all KNOWN pieces of information point towards a perfectly sound airplane having been flown into the ground - something that happened before, and unfortunately as long as we have humans at the controls, will happen again.

As for the D-30K engines, indeed early on it did have a bad track record on the IL6, however I am not aware of any loss of control event on the TU5M due to an uncontained failure, and the world's rather large Il-76 fleet is also powered by that. Let's not bring the PS-90 (Tu-204) into the picture, that is an entirely different new design, no relation to the old D-30. We do know that the engines were also overhauled just a few months ago (actually 'rebuilt' is more the word, a D-30 overhaul involves the replacement of practically all moving parts).

I am still waiting for any credible reports on what kind of approach was flown, and whether ground control / the crew were within legal bounds in permitting / commencing the approach. As this was a Russian military field and a Polish airforce plane, we must keep in mind that 'legal' may have been very different from what would be so under EU airline ops standards.
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Old 12th Apr 2010, 08:11
  #337 (permalink)  
 
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Captaincy Pressures

Come on guys, lots of us have been there haven't we?
Ever landed in well below minimums?
(Yes; Ops cock-up, divs disappeared, very experienced QFI flying, very experienced ex-Master Pilot in charge of ATC, committed to approach due to engine icing. Broke cloud about 80 ft.)
Ever had a senior rank lean on you to press on with an emergency as they had a meeting?
(Yes, but he accepted my decision not to)
Ever had a millionaire insist on you landing in below minimums?
(Yes, but he didn't accept decision not to, so I resigned )

But the key facts are,
1) Everyone who made the safe decision is here to talk about it, but may not still have a job or a career (or house, family, etc, etc).
2) Lots of people who made the decision to press on are by luck (others) or judgement ( "you and me obviously, Darling" ) still here and have jobs.
3) Bad decision, luck runs out; well, it's probably going too happen to fast to hurt.

I vote we wait for the audio, but even then it may not record conversations between passengers and captain, or handwritten notes. In any case, I reckon the Tblisi incident, the President's attitude and the occasion would have weighed heavy on the Captain's mind. Any chance of a post from ex-Royal Flight types (or other national equivalents)?
My condolences to those affected.
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Old 12th Apr 2010, 08:14
  #338 (permalink)  
 
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Andrasz,

I am not saying, that it WAS the reason,
but that you cannot exclude this possibility
at this stage of investigation and jump to conclusions.

Thanks again for well informed and competent comments.
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Old 12th Apr 2010, 08:16
  #339 (permalink)  
 
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Mary

Three flights were to land at the Air Base in that period of time: the first was a Yakovlev YAK-40 carrying journalists accompanying Poland's president, which made a safe landing. The second was a Russian Ilyushin IL-76, which diverted after two unsuccessful approaches. The third was the presidential Tupolev TU-154M.
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Old 12th Apr 2010, 08:19
  #340 (permalink)  
 
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Andrasz

We do know that the engines were also overhauled just a few months ago (actually 'rebuilt' is more the word, a D-30 overhaul involves the replacement of practically all moving parts).
The Il-62 accident, at that time, also a national tragedy,
took place also shortly after main overhaul.

The overhauling mechanic did a wrong cut on the turbine shaft,
resulting in shaft shear, turbine overrun and uncontained destruction.

Again, just a possibility, not jumping to conclusions.

The tu-154 aircraft in this case was relatively low time, low cycles.
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