NTSB update on Asiana 214

[StinkyMonkey]

Ironbutt: No it would not... Also, the bus would go into Alpha Floor if attempted be flown this slow...

[ironbutt57]

monkey...think....commence descent inVS mode to attempt to capture the glideslope.they were..set GA altitude at some point.they did..continuing the descent in VS as they did....realize you are not descending fast enough and "pull open descent.the Boeing version a level change button which they did....surprise!!! the airplane climbs to the altitude set in the MCP!!....seen it done by SO many times....the Alpha floor...yes you are right...but i wasn't talking about that...

[AirRabbit]

Originally Posted by Rat 5

Here might be a clue why skills have deteriorated; because it is an SOP.
It is the training departments who have allowed skills to deteriorate and the XAA's who have allowed them to do it. Training = money. If it can be designed out of the operation by the use of automatics & SOP's then money is saved and the perception is safety is enhanced. ... I hope there will be a change to that mind-set, but I do not hold my breath.

Rat 5: This post is probably THE most cogent, articulate, precise, and ACCURATE summary of the situation I’ve read in any document or heard in any discussion so far … particularly your description of the “doorstep” on which the responsibility should be placed – training – and your naming the 2 organizations that are the primary culprits in this travesty – the company training department and the regulator … and, I almost stood IN my chair and punched the air when you put the “icing on the cake” with your comment that the reason this travesty is allowed to continue is that “…money is saved and the perception that safety is enhanced is advocated.” The members of this industry should all recognize the value of your description … but … as you so correctly lament “…I do not hold my breath.” We need someone, someplace, who occupies such a visible or recognizable position that will allow whatever this person says to have such a significant impact on the organizations you named, and/or on the traveling public that buys tickets on airplanes, that this issue will be addressed! This person, where ever he/she is, must be willing to stand up and shout, very loudly, over and over, just exactly what you said, to motivate these 2 organizations to fix this very “fixable” calamity! Failing that, this industry is likely going to continue to suffer these kinds of completely avoidable disasters!

[ironbutt57]

Yes...Rat has hit the nail on the head...any profile not published in an FCOM is beyond the skill set of these "pilots in a can"...

[BaBaBoey]

- silverhawk

I think that's too simplistic.

Bad training is bad training; bad pilots are bad pilots, no matter what your ethnic background/home country ... plenty of 'first world' pilots crash too due to their own errors/inexperience.

[misd-agin]

Dozy -
"For one thing, if we take KAL's vastly improved safety record since the top-down operational and safety overhaul a little over a decade ago into account, its apparent success certainly appears to clearly indicate that the oft-cited "cultural issues" can be overcome"




Read the interviews. Lots of comments about higher and lower status. It's alive and well in their cockpit. The issue is was it, or was it not, part of the cause?


Training checks are scripted.


The investigation needs to look into the statement about 'scripted' check rides. AQP is also somewhat scripted.

[AirRabbit]

Originally Posted by BaBaBoey

Bad training is bad training; bad pilots are bad pilots, no matter what your ethnic background/home country ... plenty of 'first world' pilots crash too due to their own errors.

I’m afraid it’s not this simple. People apply to be pilots. These people aren’t pilots until they are trained. Of course there are some people who are more prone to assimilate the training more completely or more easily, and, of course background, experience, and education, can affect how well a person learns, assimilates, and demonstrates what was taught … but it is still true that training takes a person and makes a pilot – good training takes a person and makes a good pilot, and on occasion it makes a superb pilot. Bad training takes a person and makes … what? a pilot? a good pilot?, a superb pilot? … not hardly! Bad training can produce little else but someone who shouldn’t be IN an airplane cockpit, at all!

[AirRabbit]

WOW! I’m going to have to start paying a lot closer attention to this section of this forum … there are some here who are hitting the nail on the head over and over again!

Originally Posted by misd-agin

Training checks are scripted.

The investigation needs to look into the statement about 'scripted' check rides. AQP is also somewhat scripted.

Misd-agin … spot-on accurate, sir. While there are some good points about AQP, the same perceptions described by Rat 5, above (that being that “money is saved while the perception that safety is being enhanced), are also at the heart of AQP. Advocates of AQP cite the “advanced training” precepts used, but the real fact is that “how” a program is structured is a very minor player in the quality of the final product. IF anyone looks closely at an AQP program (of course, that would be very difficult to do, because the AQP-approved airline and the regulator maintain each AQP program as “proprietary” and no one is allowed to obtain a copy) they would see training programs authorizing lesser capabilities in the training equipment used, authorizations to substitute one flight task for one or more other required flight tasks, allowances to set their own standards of performance on all tasks, and they are allowed to adjust recurrent training to much wider intervals … all of which allow substantial cost savings. It was during the investigation into the Colgan accident, outside of Buffalo, New York, a couple of years ago, while focusing on stall training, where it was suspicioned that the accident flight crew were trained on stalls but were trained inadequately … simultaneously, it was recognized that some AQP approvals allowed windshear training to substitute for training and testing on stall recognition and recovery. In other words – the accident crew were trained but inadequately so – and that was wrong – but at least some AQP airlines didn’t train any of their crews on stalls, at all, and they were judged to be products of better training that increased their operational safety … what? After this discovery, each AQP airline was supposed to have been advised that they must begin stall recognition and recovery training.

The same culprits cited by Rat 5, above, are the culprits here – the company training department and the regulator. Anyone recognize a trend?

[DozyWannabe]

Originally Posted by misd-agin

Read the interviews. Lots of comments about higher and lower status. It's alive and well in their cockpit. The issue is was it, or was it not, part of the cause?

I did read them! I was talking about the "cultural" issues being overcome at KAL, not Asiana - the latter may require a similar audit. I mentioned KAL as an example of how perceived negative aspects of "culture" are not insurmountable, with the right approach.

Training checks are scripted.

The expat pilots who said that retired from Asiana 2 and 4 years ago respectively. It may still be an issue, but there are other issues at Asiana which warrant attention too - specifically the focus on punitive measures almost as soon as you join, and the disconnect between what the crew of the flight said about strong CRM and the actuality, whereby the command gradient in the flight deck seemed at times uncertain.

I got the distinct impression that the PIC and check Captain were each expecting the other to call Go-Around for some time before they decided to do it themselves.

[Lonewolf_50]

Dozy, you may want to think about this in a different light:

who signed for the aircraft: the check captain or the captain who was being checked?

Put another way, who the hell is in charge of the mission?

[Sorry Dog]

Originally Posted by jazz hands

Q: Before you had to do that, when you were still like at 300 feet or something, did you feel you had to go around at that time?

A: That’s very hard because normally only in our Korean culture the one step higher level the final decision people he did he decide the going around thing. It’s very important thing. As a first officer or the low level people they dare to think about the go around thing. It’s very hard.

Q: In your mind, then, and I don’t want to put words in your mouth, you tell me, did you feel that as the pilot in the left seat flying the airplane that you had the authority to do, commence a go around yourself?

A: Go around thing. That is very important thing. But the instructor pilot got the authority. Even I am on the left seat, that is very hard to explain, that is our culture. How can I say, during cruise also, when we met the turbulence condition, things like that, easily, B777 go into the maximum airspeed, so that’s the limitation. In that case, I never ever thought about that I controlled that condition because instructor pilot handled that, that sort of limitation thing. So that is a, they control the autothrottle system, things like that. I was also the company investigation team also, I know the investigation or the QAR thing, so my experience said to me the regulation and authority is very obvious to me. So, uh, yeah.

Q: And when you say the regulation is very obvious to you, you mean that there is a regulation that says only the PIC can do go around.

A: Yeah, that is obvious to me, but up to now I thought the very dangerous condition, now I am a captain position. I can do that, but it is very hard, yeah.

Q: So just to close this one out, did you expect that only the instructor pilot could decide to go around?

A: Basically, and the regulation, yeah.

Maybe they are being 100% honest, yet am I the only one who is thinking the crew is maybe playing the "culture" card to cover for gross piloting error. Not that they would expect that to completely excuse them, but if the culture card is taken at face value then their crucifictions should become less painful since the "institution" would bare some blame as well.

You would think that concept of CRM would be covered enough in company training, so that it becomes hard to say with a straight face that only the most senior of the flight crew can call for a GA... yet here they are saying that.

Contrast that to the CVR transcript where the jump seater felt empowered enough to call out "Sink Rate" in english and korean ... I assume to alert the PF to check that, but nobody says check speed until it's too late.... so there is enough CRM going on to alert the PF about vertical speed and I assume horizontal speed is okay in that case too, but it's just that nobody called that out until too late. I think it's reasonable to assume that speed warnings weren't called out in time is because nobody up there noticed that. I just don't see how one say that it's OK to call out sink rate, but it would be a culture fo-pah to say hey pilot, check our speed, we're 15 below target... but nobody said because... breaking news here : Nobody was checking the speed (at least not when it was crucial to do so)

[RAT 5]

Guys: I did not say anything about 'bad training'. I intimated that the training was perhaps inadequate, in an overall sense. If you write extensive SOP's based on the use of automatics, and then train the pilots to operate the a/c in that manner, it can not be called 'bad training'. My question is whether these people are being trained as 'pilots' or a/c operators in an automatic mode. I suspect more of the latter than former. My philosophy is that this is fine as long as the pilot is aware of and fully cognisant with the limitations of the automatics and the envelope of the a/c. Thus when the automatics do not function as required, or are not available to accomplish the task, the pilot is fully capable of taking over manually.
It is this closing statement that I put forward for discussion. I wonder if the XAA's are interested in being included. I wonder if the airlines give a toss. If the recent prangs of serviceable a/c over the past 2 years are not a wake up call then I fear for the industry and the old adage of air is the safest way to travel. Sadly, as with most things, when it is noticed they are going awry, things get worse before they get better.

[flarepilot]

remember when we had check rides in the sim every six months and someone thought, why not call it AQP and do it every year?


it is about money

it is about culture

our culture is : if anyone can do something to keep a plane from crashing,they should do it, (simply put, not actual words).

At Vref, I would have said, you are at vref and should be vref plus five.

at vref minus 5 I would say: you are slow...add power

at vref minus 10 I would say: I've got the plane and I would add power


I sure wouldn't wait until vref minus 35 or so.


lonewolf makes a good point...who was in charge? sounds like NO ONE WAS...

First World Plane

First World Airport

4th World culture.


It isn't racism, I'm sure there are some darn fine Korean pilots...But the culture or ego has to be checked at the cockpit door.

I would make sure that both the check cp and the guy in the left seat never flew again

I would talk to the third pilot who mentioned speed and put him in charge of culture change at the airline...I would also set up a minimum Decibel level for callouts

[iwrbf]

Not a media monkey nor am I trying to pull some stunt. An honest question:

Still any airlines out there which try to keep their personnel (flying crews, that is) on a non-magenta-addiction level?!

In other words: Will I jeopardize my fate on the next regular flight regardless of the airline I'll be flying with?

No pun, honest conclusion. Maybe a bit shocked and frustrated?!

[barit1]

My background: 30+ years ago I rode jump seat - on worldwide carriers - monitoring engine ops and environments.

At that time there was a training focus on Specific Behavioral Objectives (SBOs): i.e. When this happens, the proper response is that. Thus you handled single failures successfully, but not necessarily multiple failures. I see this as like the "scripted" checks many have mentioned here. And the old-timers - going back to WWII is some cases - saw this SBO training as "lightweight".

My question: Now I'm sure a few on this thread were SBO trained, and individually have progressed far since those days. What parallels and what distinctions can you make?

[Willie Nelson]

There has been a subtle yet important change at my outfit (primarily Airbus) recently when the company changed the wording of our SOP's to state then when all factors had been considered the practice of autopilot and auto thrust off is encouraged.

Thankfully, all the go arounds that I have ever conducted have been reported, acknowledged by a simple "thank you for your report" response and that has been the end of it. Unfortunately, very few of my offsiders ever take the opportunity to take this opportunity. I can only conclude that the cultural change needs to spread through all levels of the company.

[bubbers44]

Flare pilot, sounds about right to me. That is what I have always done. That is why we have two pilots, both thinking, and both responsible for the safe operation of your flight.

[bubbers44]

Reports from Zite and other reports confirm nobody was flying the airplane and since they couldn't hand fly well used automation incorrectly so crashed. This will continue until pilot skills are restored.

[AerocatS2A]

Originally Posted by flarepilot

remember when we had check rides in the sim every six months and someone thought, why not call it AQP and do it every year?

Are you saying you only do sim checks once a year?

[RAT 5]

A discussion point: There has been much opinion-ating here, me as well, on basic handling skills being lost. I suspect it's come mostly from old farts. I flew much GA and then started in the glamour life on B732. In those days the infrastructure was very primitive, relatively, even in some european areas, and definitely in Africa. The a/c were primitive, relatively. Thus the pilots had to be much sharper about everything in their environment, AND they had to be able to fly the a/c to a high standard. If you couldn't then there were some airports that were just damn dangerous. They were bad enough anyway, but if you couldn't handle the a/c you were in dire straits. You couldn't write extensive trained monkey SOP's for these places. You trained to a high standard of manual flying and operational skills, trusted your crews, especially the captains, and relied upon them to make airmanship judgements. When that didn't happen you ended up on Air Crash investigation.
Going into the major, relatively, airports you could be more relaxed as radar led you by the nose, or let you go visual onto a nice big runway with all the bells and whistles and much flat ground around. BUT, the basics of monitoring what was happening never stopped. It was natural. You didn't switch ON in the greek islands and OFF in London. You were ON all the time because that was your attitude. The a/c were basic and sometimes broke.
Nowadays, with better reliability, multiple backups, FBW a/c full of automatic this and that, and a training belief that the a/c automatics are the best way to fly, they are infallible, will not let you go outside the envelope, is it any wonder that pilots sit there expecting it all to happen for them. If it goes wrong the a/c will either tell them with messages, wailers, bells etc. or it will take over and protect itself.
Even back in B757 days I had instructors from the old B732/727's howling at students to "fly the FD." They didn't emphasise that you also needed to maintain a good instrument scan to ensure the FD was being your friend; NO, it was, "it is always correct so follow it". You can stall with a beautifully centred FD, or equally fly into the ground. This attitude followed on when the autopilot was in charge; punch the MCP and watch the FMA and then relax.

I wonder: has the technological advance run away so much that the a complacency has seeped into the profession? What is sure is that the training philosophies have not kept pace in parallel with technology; nor the checking methods & standards. There is also something in the financial management attitudes. Why are we paying all these people so much money to sit there & push buttons exactly as our SOP tells them to do, monkey fashion, and nothing ever goes wrong. It's child's play. With these opinions at the top is it no wonder standards have slipped. Perhaps it is not perceived necessary any longer to have high standards, only adequate standards. The technology will take care of the odd deficiency. Punch the buttons, navigate onto the ILS and let it do its thing. No crashes = the highest standards. Hm?
Some chickens are coming home to the roost.

But back to the question: has the advent and rapid spread of FBW a/c and almost fail-safe automatics led to the dilution in handling skills and the rather casual attitude found in some flight decks? Especially considering that many pilots no start on this generation of a/c.