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Qatar 77W at MIA

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Old 18th Sep 2015, 12:32
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To me is seems very strange such accident can apparently go unnoticed for some time.

Shouldn't the pilots know they went outside the "envelope" of the runway and report this such that a runway inspection is initiated?

Do the ground structures not have electronic status checks such that airport authorities immediately know something is very wrong?
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Old 18th Sep 2015, 12:55
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Do the ground structures not have electronic status checks such that airport authorities immediately know something is very wrong?
I do not know the system MIA has but in all the airports I know you will only get a warning when you put the lights on . On this direction for take off those lights will have been off. It was night, so most probably nobody noticed until next morning during runway inspection I would say. ( or/unless if they changed QFU in the meantime)
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Old 18th Sep 2015, 13:07
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Originally posted by 1978
To me is seems very strange such accident can apparently go unnoticed for some time.

Shouldn't the pilots know they went outside the "envelope" of the runway and report this such that a runway inspection is initiated?
Very strange indeed, as you'd expect an experienced crew to know where a normal (even at max de-rate/assumed temperature) rotation point lies on a runway.

The bold METARs out of the inevitable list () seem to suggest a take-off between 23:53Z and 00:53Z, which would be 19:53LT and 20:53LT. So it would have been nighttime in MIA.
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Old 18th Sep 2015, 13:14
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T1 = temporary runway in the OPT

Amazing. The provider of this EFB probably had a committee deciding what codings to use for what situation. How does anyone come up with T1 = temporary? What has '1' got to do with it, or was this 'phase 1' of runway maintenance? Isn't "Temp" a better coding?

The aircraft travelled along taxiway S, running parallel to the runway, before being cleared to line up at the intersection.
This clearance was acknowledged by the 777’s crew,


This would suggest the crew requested T1. It would not be for ATC to offer it. I wonder if anyone in ATC thought, "that's odd, they've never done that before." It's not for ATC to 2nd guess the crew. It would have been unusual for ATC to ask, "are you sure about T1." but it might have closed the holes, except the crew might have said, "yes."

Back to a discussion there was a while ago about an AF trying to rotate a heavy a/c many kts too slow. Naturally it was the wrong weight in the EFB. The discussion brought up the point about having a 'feel' and 'mental gross error check' for performance calculations & takeoff speeds. Surely the same could be said for this case about TORA/TODA. I assume the crew knew the TODA from T1. With a little thought about past operations I would have expected there to be a "seems a little short to me. What do you think?" moment, before punching numbers into a computer and accepting the results willy nilly.
Sadly that is what the modern human has become. In all my cadet teachings, as an old fart, I gave examples of various gross error checks and mental estimates for different scenarios, both on grounded in the air, aligned with stories about the consequences of those who didn't make them. I don't think too many airlines, even on command courses, educate their crews in this time aged technique. It is disappointing, in cadet training, to see load sheet figures added up with a calculator. What ever happened to brain power? Even worse considering that cadet pilots are usually required to have a maths/science orientated education.
It was still quite common to see low hour F/O's blindly follow VNAV PTH and not consider Distance v Height. Often VNAV was rubbish and they then asked why it was adding thrust and suddenly changed to 'below path' or dived, accelerated now being 'above path'. The answer had been staring at them for a few minutes, if they had cared to observe.
I have some nervousness that EFB's, though great in paper saving and perhaps allowing higher TOW's, might also lead to more erroneous takeoffs. The gross error checks is perhaps one defence. Having both pilots use their own EFB's to cross check the performance result doesn't help if the basic data that is entered is duff gen. Rubbish into both EFB = same rubbish out of both.
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Old 18th Sep 2015, 13:15
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As has been mentioned and I alluded to. I would put money on this being confusion between T1 and #T1.
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Old 18th Sep 2015, 15:21
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The chap who is PNF certainly doesn't sound like he knew he had run out of runway and hit something, at least to my untrained ear.
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Old 18th Sep 2015, 16:24
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Another unnecessary "close call"?

Thank goodness for the decision to use frangible light post designs many decades ago (an idea that was once even strongly resisted by some facilities advocates due to higher costs at the time, thus precluding adding more lighting installations elsewhere).

Is this perhaps another case underscoring the need for human factors review the designs of supporting systems like EFBs? as well as the administrative aspects of denoting performance/V speed calculation methods used by flight crews?

This kind of event has happened a lot over jet transport history. Is it also time to again push for implementing readily technically addressable acceleration prediction advisory methods, giving much earlier advisories to the crew if an error in acceleration versus available runway distance is detected?? Let's hope and advocate that those efforts now may again advance?

Thank goodness for the robust damage tolerant design of recent modern jets and especially the T7. This event also may perhaps be shown to underscore the utility of a FADEC's ability to quickly and accurately re-set thrust at the max limit, if and when needed, and if commanded. It also again points out the inherent advantage of twins to have more robust runway distance remaining margin to a safe liftoff and initial climb, to accommodate either unexpected adverse met conditions, or performance calculation weight errors, ...for the all-engine takeoff case.

As to the earlier comment about wheel height versus aft fuselage height, and what part of the aircraft hits light stanchions first,...I's suggest the comment author watch the pictures of a T7 Vmu test liftoff. The wheels may not necessarily or always be the lowest point of the aircraft for some period (distance during climb away) after liftoff, depending on T/W, theta dot after liftoff as a result of the aircraft's center of rotation changing, acceleration rate, and liftoff speed above stall margin.
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Old 18th Sep 2015, 17:52
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2020 Local dep Miami what's that on Crews local Doha time 0320 Local.
How long is the slip @ MIA?
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Old 18th Sep 2015, 17:55
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Some similarity to Emirates 407 although that was a ZFW entry problem rather than an inappropriate intersection. The result was not much different, though.

It shouldn’t be beyond the wit of man to have a simple, autonomous check from the aircraft’s point-of-view that it can actually take off on the runway and/or intersection that has been selected. When you line up, it knows the TORA, OAT, thrust setting, wind component, flap, weight, etc. A master caution like RAAS “CAUTION, SHORT RUNWAY” could prevent accidents like this happening in the first place.
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Old 18th Sep 2015, 18:16
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EFB OPT

The potential for error with the OPT is substantial. A latent risk factor within a defined process is difficult to detect. SOPs may provide for the flight crew independently working all of the calculations out, but operational expediency tends to result in short circuiting of such protocols. A takeoff chart gives some level of awareness of the overall situation, but it still is open to errors, in fact, more error opportunities exist.

The good news is that indeed two engine aircraft tend to perform well, on two engines, but 8500' at heavy weight is a tough deal for a 773ER, at sea level at warm temperatures. If the engines work, you are doing OK, the same error on a B747 A380 would be catastrophic, AEO liftoff is not much earlier than OEI case, and so normally happens well beyond mid field and towards the DER.

Part 25.113(a)(2) requires a 115% margin for distance to attain 35' for the TODA. So for say a 12,500' runway+clearway, the 35' point is at 1630' before the end of TODA. For a large aircraft, the aircraft is also assumed to be at V2 plus a maximum margin, but more importantly a minimum margin of V2 (25.111(c)(2)) ... which is going to be around 90m/sec ~ 300FPS. That means about 5.3 seconds after getting to 35' you should be passing the end of the clearway. On all engines, the 4 engine aircraft, and 2 engine aircraft as well have climb rates of around 2000FPM or greater, (minimum 2nd segment gradients apply for OEI, 25.121(b)(1)... all is better...), which gives about... 210' above the departure end of the TODA (35'+175'). In the real world, the speed is allowed and does rise above V2, and the outcome is that there is an initial reduction in the climb gradient until establishing a constant target speed, but the rate of climb once established is higher than V2's rate of climb. Overall, the crossing altitude is slightly lower, around 180'... So... when you look out the window and see the neat takeoffs that just get over the fence, know that if the aircraft had done a reject, that probably would end badly, and if the aircraft isnt getting to the types of heights that the all engine case shows, (and which are noted as information in every Boeing FCTM) then you do well not to have an engine failure. If you want to take the analysis a step further, the FCTM also indicates the time to achieve liftoff after commencing rotation, and that gives you a simple spot on the runway where the rotation should occur. The same manual, the FCTM also gives pretty simple analysis of the visual cutoff from the cockpit, and that gives a simple indication as to what should and what should not be observable in front of the aircraft as you reach Vr. As an example, for a B744, that is around 3800' from the end of the TODA if you are on a limiting 12,500' runway, with maximum clearway. Rotate gets to be done around 2 seconds before you lose sight of the first of the TDZ markings for the opposite end of the runway. For the B777, and other twins, you get much more runway in front at that time... should not be exciting at all on all engines, just gets more interesting with the failure case.

Bottom line is that awareness of the performance of the aircraft is worth the effort, even if you don't get comfort from the outcome. Lets see... B773ER, 6700nm GC route right hand down... making money... TOW will be over 725,000lbs, and need over 9200 ft of runway, (still air, 300 pax, 12T cgo... ). still air, 490K ZFW would need 10,500' ISA +15 SL, 0WC, packs off... Stated as a ZFW limit, the T1 taxiway would need a 440K ZFW in still air, and that would increase by around 15K per hour of flight time reduction from still air.... i.e., +390 lbs per knot of TWC overall on the flight plan... None of these
calculations are hard, and they can be done by the system easily, and provide the flight crew a choice of acceptable options which they confirm with the OPT.



Final point, this latest event is more or less a rerun of an event that I personally experienced from the cabin of a B777 once while dead heading. Being aware that the runway being used is too short is pretty unpleasant to experience. luckily on the day, the workers on the runway ducked. Crew even took a derate... The company involved eventually examined the issue, and held the pilots accountable, for known deficiencies in the processes and practices of the system; hardly a global solution and barely surprising management behaviour for a pathological flight operations department.

Short runways and big airplanes on long flights don't mix, and if the computer says they do, then checking the assumptions is probably what your family and customers may appreciate. Big picture prior to walking to the jet is worth the effort, there is a relatively simple correlation between weights and runways that can be considered before leaving the hotel or the despatch office...

The crew of this flight should not be beaten up by the management for a latent error, however, the flight crew are the guys and girls at the pointy end of the spear, and they have a vested interest in keeping the blue side up, they are the first to the scene of the accident. Punitive response by management would be adverse to flight safety, but is pretty much a standard industry response; shooting the messenger is untidy and hardly improves outcome reliability.

Will QR and the QCAA improve operational flight safety? Always interesting to see.
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Old 18th Sep 2015, 18:28
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When they press the tab RUNWAY for the calculation from the EFB they show this " 09#T1 ". They deemed that was the performance from the intersection T1. This symbol " #T1 " means temporary runway. It is just a NOTAM for the runway 09. The symbol for the performance from intersection if would existed should be " 09/T1 " with " / " not with " # ". From runway 09 for the 777 there is no any intersection performance . They confused with the symbols.
As has been mentioned and I alluded to. I would put money on this being confusion between T1 and #T1.
T1 = temporary runway in the OPT

Amazing. The provider of this EFB probably had a committee deciding what codings to use for what situation. How does anyone come up with T1 = temporary? What has '1' got to do with it, or was this 'phase 1' of runway maintenance? Isn't "Temp" a better coding?
This is the legacy codebreaking stuff where the user interface is designed by engineers to 1960's IBM command line standards (back when people were cheap and computers were expensive).

Remember all the FMS route mods and 'you forgot to enter the leading zero on the 610 foot crossing restriction in the box'?

I've also ranted here before about the cryptic flight plan paperwork and the obscure NOTAM format suited to 1930's teleprinters.

We've come a long way in trapping errors and closing the holes in the cheese. However, we need to streamline the user interface more so these idiotic gotchas with the slant and hashtag (as the symbol is now called by some) never make it into the cockpit.

The Sky-God era where some folks bragged proudly about how complicated the departure and preflight procedures were and how they would never make the same mistake as a mishap crew is over, here in the U.S. at least. On the other hand, the era of playing video games on a phone while PF in metric RVSM airspace has arrived, I'm afraid.

The tablet EFB's are far from a mature product with their own quirks but adding more graphics to the interface sure helps me see when I'm looking at the wrong data.

Sunset at MIA on 15th was 19:25 with nautical Twilight @ 20:15.
Was it cloudy?
Scheduled departure time was 20:20.
Actual departure time was 20:37 - was it already dark?
I get the same numbers, actually, nautical twilight ended at 20:15 local so they were in astronomical twilight which is, for takeoff in an urban area, already quite dark. The sun would have been 16.8 degrees below the horizon at 20:37 EDT from what I see on Heavens-Above.
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Old 18th Sep 2015, 18:59
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GPS Confirmation

Would it be crazy (or even supported by hardware) for the EFB to know the long/lat for the entered intersection takeoff point and make bad noises if the GPS does not agree? Simple automatic check of the entry?
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Old 18th Sep 2015, 19:04
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Nice couple of posts, guys.
I still think many see the solution as adding more automated internal system checks; i.e. the computer will say "entry error" or some such. I've noticed over the past 30 years that the more 'safeguards' are put in place the more they become relied upon; and that was before Microsoft & Apple took over the world. Pilots were told that there were inbuilt safety guards so they could not make a mistake. Guess what, sometimes they didn't work e.g. the G-IV crash in another thread. The auto throttle inhibition didn't work. The Spanair (MAD) takeoff config didn't work. etc. etc. And let's not get into FBW stuff. In human factor terms this is dulling to the educated brain, and we pilots are all supposed to have one of those. It has been said so many times that one problem with modern a/c is the human has become a monitor; our educated brains are acting at too low a level of activity. We are lulled into complacency and blind trust. It's almost as if there is no more fear about aviating. It's as if we think, arrogantly, that we belong aloft. It is our world. It is not.
Even the AA Cali crash was lack of X-check in a rush, and by todays standards that was a simple a/c. What will be the pitfalls of the future? Engineers will be trying to eliminate pilot screw ups with technology. I wonder if we are reaching the point of diminishing returns?
One thing is already happening: the level of education and ability to be sitting up front has been diluted. It is now seen as a basic job. Follow the SOP's, QRH, EFB and you'll be fine. T's & C's have reduced accordingly. MPA, MPL, self funded jet training with 150hrs etc. etc. See the thread on robots & pilot replacement. Project forward 100years.
However, we are here today. I think technology is progressing at the pace of the design engineers and not at the pace of pilot (human) adaptation. I see all the reports from the human factor professors about the change from command pilot to monitoring pilot. Where were they at the design phase? It seems a lot of hind sight; meanwhile the basic training/checking remains the same as yonks ago. There is a lack of coordination in the whole process.
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Old 18th Sep 2015, 21:00
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Serious question, and to be clear I only fly small stuff (as my handle indicates), but why would any crew elect to take off from an intersection with a 777 fueled for a LH flight and - presumably - full pax/cargo?
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Old 18th Sep 2015, 21:24
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Bravo - RAT5 - spot on!

"I've noticed over the past 30 years that the more 'safeguards' are put in place the more they become relied upon"

I think there's another aspect of this reliance - less attention to the issue, since "George" has it. The automation may work well, within its limitations, engendering "blind trust" as you put it, but inattention born of honest experience that the automation "always works" is hard to overcome. Help Captain Sullenburger!

Cali was also a case that since the pilots were not giving position reports, the actual progress of the flight was not readily on their minds in any detail. Again the navigation system doing its (limited) job very well and when the unanticipated change of plan occurred, the fact that the pilots were not had its sad consequences. This is real human factors, I'm afraid, and we need to design flight deck automation with that in mind.

So, perhaps the automation, where it can really help, should be used, but we need to design it so the pilot's head and hand must still be engaged.
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Old 18th Sep 2015, 23:04
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Is this trip crewed with 3 or 4 pilots? 24 hour layover/3 day trip?


As a side note, the above picture appears to be taken from the fence looking west. The road is airport service road inside the fence. Just outside the fence is Perimeter Road, running around the east and south side of the airport.


Just east of perimeter road is a canal, 80' or so wide, some vegetation and trees followed by the large MIA Employee parking lot just east. My estimation from driving the road and parking for two decades is the tail cleared the west lot boundary trees by 100' or less.


Always thought I stood a chance getting wiped out by the overloaded old corrosion corner, straight pipe DC-8's clawing for altitude off RW09.


It was always humorous with the old car alarms. 3000+ cars wailing and flashing at once for 5+ minutes after those max power pipes thundered and crackled by overhead..


The entry error does make a lot of sense if the verbiage is accurate. Once we read something electronic as true, it's tough to realize it's BS.
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Old 18th Sep 2015, 23:47
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Always thought I stood a chance getting wiped out by the overloaded old corrosion corner, straight pipe DC-8's clawing for altitude off RW09
Fine Air had a DC-8-61F in 1997 that load shifted on takeoff and plowed into the area off the end of 27R:

The DC-8 crashed on its belly on a field directly west of the end of the runway (about 300 yards) traveling in a straight line.

The DC-8 missed the auto transport loading facility at the south end of the Miami City Rail Yard just north of the end of the runway, and also busy cargo operations facilities along the very busy NW 25th Street feeder to the airport's cargo area just to the south of the end of the runway. The aircraft nearly missed two factories, a commercial building, and the Budweiser Distribution Center in unincorporated Miami, Florida between the populated residential suburbs of Miami Springs and Doral, FL. It skidded across the open field and onto NW 72nd Ave, a roadway that is typically full of traffic during the lunch hour but was surprisingly quiet at 12:36p EST when it came down. The plane's wreckage skidded quickly across the roadway and onto the parking lot of a commercial mini-mall across the street from the empty field; it took out 26 cars in the lot. At that time the mini-mall was a hub of computer parts distributors specializing in South American commerce.

The plane's wreckage fell four feet short of the entrances to three shops. It missed two occupied cars and a truck that were waiting for the traffic signal at the intersection of NW 31st Street and NW 72nd Avenue, less than 30 yards (27 m) away. Inside one of the cars in the parking lot sat a man who had just arrived back at his shop in the mini-mall after picking up lunch for his wife and himself. He was unable to make it out of the car and was caught up in the fireball that engulfed the multi-lane avenue, field, and parking lot.

The only deaths were those of the three aircrew members, a company security guard on the flight, and the man in the parking lot.
https://en.wikipedia.org/wiki/Fine_Air

And I remember going the other way off runway 9R on a hot afternoon to the islands with Caribbean hand luggage (televisions and heavy boxes that don't show on the weight and balance). In a 727 with the smaller engines you could read license plates on Le Jeune Road as you got airborne.

I also remember Sarkis and Pan Aviation and the Jetstar...

Last edited by Airbubba; 19th Sep 2015 at 02:06.
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Old 19th Sep 2015, 00:25
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but why would any crew elect to take off from an intersection with a 777 fueled for a LH flight and - presumably - full pax/cargo?
For the same rerason we use derated power... to save time and money. If there is no need to spend another 10 minutes taxiing, especially if you're running late, going from the intersection is a sound idea. You just have to get the numbers right...
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Old 19th Sep 2015, 00:32
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Question Intersection takeoffs

RAT 5: good posts, but......

This would suggest the crew requested T1. It would not be for ATC to offer it. I wonder if anyone in ATC thought, "that's odd, they've never done that before." It's not for ATC to 2nd guess the crew. It would have been unusual for ATC to ask, "are you sure about T1." but it might have closed the holes, except the crew might have said, "yes."

Not at all sure that was the case. At my airport, you hardly ever hear a crew asking for an intersection takeoff; 95% of the time it's ATC asking "can you accept an intersection X takeoff?" followed by "we'll run the numbers and let you know". Besides, why would a heavy like a 773 going all the way to Doha want an intesection takeoff? That does not sound right to me.

Again, at my airport (KLAS which is hot and high - 2200'AMSL) the daily KAL 773 always takes the LONGEST runway and sometimes even the OPPOSITE direction (which is slightly downhill) taking sometimes an hour delay in doing this while ATC traffic management clear the airspace. Nothing in my previous life as a pilot rated on a half dozen Boeings and one Airbus and 4+ years airport operations experience working with ATC, would make sense for this type of departure.

Having said as much, I have to wonder if ATC did not think it unusual. Did this flight/aircraft type previously takeoff from T1?

I think there might be more to the story and certainly the nomenclature T1 and #T1 needs to be looked at closely. That, to me, sounds like a big no-no but I can only speak from an Airbus EFB, not Boeing......
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Old 19th Sep 2015, 01:49
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Airbubba, minor point, but Fine Air went down off the west end of 27R on the north side, now known as 26L.


Terrible things happen from the simplest mistakes, not much different from those done daily in office cubicles around the world where nobody dies.
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