CRJ down in Sweden
T D, it's not as simple as you suggest; biased by hindsight? (#279)
We cannot assume that pilots will understand the situation as requiring a cross check.
The PF may be concentrating on what appears to be a sudden pitch upset manoeuvre, the PM surprised by the PF nose-down response, where the situation according to PM apparently requires a nose up manoeuvre, and not necessarily seeing the comparator alert.
The pilots cannot deduce that 'the right side is good' without comparing both EFIS with the stand-by ADI and then confirming which two displays agree; this takes time and mental effort, neither of which may be immediately available.
Trained for confusion, or confused by training. There is a level of confusion where the human cannot manage.
We cannot assume that pilots will understand the situation as requiring a cross check.
The PF may be concentrating on what appears to be a sudden pitch upset manoeuvre, the PM surprised by the PF nose-down response, where the situation according to PM apparently requires a nose up manoeuvre, and not necessarily seeing the comparator alert.
The pilots cannot deduce that 'the right side is good' without comparing both EFIS with the stand-by ADI and then confirming which two displays agree; this takes time and mental effort, neither of which may be immediately available.
Trained for confusion, or confused by training. There is a level of confusion where the human cannot manage.
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. T D, it's not as simple as you suggest; biased by hindsight? (#279)
We cannot assume that pilots will understand the situation as requiring a cross check.
We cannot assume that pilots will understand the situation as requiring a cross check.
Why does some people think it is hard or extremely complicated?
Basic instrument flying, nothing more.
Some of you guys are confusing me: Does a failed screen or attitude indicator justify a death sentence? Is it like loosing both wings and the tail at FL350 over the Atlantic in the winter with no parachute?
NO.
The airplane was perfectly flyable, all they had to do was fly it.
Why do we even argue or disagree?
The certification requirements require the combination of false IRU information and the inability to display a comparator warning be extremely remote(Alf #280 and previous): where -
'Extremely Remote Failure Conditions are those not anticipated to occur to each aeroplane during its total life but which may occur a few times when considering the total operational life of all aeroplanes of the type.'
And
'Extremely Remote Failure Conditions are those having an Average Probability Per Flight Hour of the order of 1x 10-7 or less, but greater than of the order of 1 x 10-9.'
However the particular EFIS design removes the comparator display for pitch values (true or false) greater than 30deg, thus the loss of display and warning is not a combination of two failures but just that of the IRU.
The reported in-service IRU failure rate was less than the required combined value, thus should be considered as not meeting the requirements.
'Extremely Remote Failure Conditions are those not anticipated to occur to each aeroplane during its total life but which may occur a few times when considering the total operational life of all aeroplanes of the type.'
And
'Extremely Remote Failure Conditions are those having an Average Probability Per Flight Hour of the order of 1x 10-7 or less, but greater than of the order of 1 x 10-9.'
However the particular EFIS design removes the comparator display for pitch values (true or false) greater than 30deg, thus the loss of display and warning is not a combination of two failures but just that of the IRU.
The reported in-service IRU failure rate was less than the required combined value, thus should be considered as not meeting the requirements.
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Surely, or am I being too simple as I've never experienced it, but does 'seat of the pants' come into this analysis somewhere? Hugely difficult if you've spent all your life relying on your eyes; I know. Do we always need a comparator to tell us something is fishy?
I've never been given a frozen attitude or incorrect attitude instrument in recurrency training. I'm sure it would be hugely positive and rewarding, but sadly most outfits lack imagination. The UA box ticking is no big deal, and the new airspeed unreliable procedure frustrating and time consuming before you arrive at the correct input which you should have known all along. The first scenario is recall and piloting, the second is QRH driven.
In this scenario they guys would have had to be very smart & very disciplined without panic. If it goes inverted while you are trying to figure it out, doesn't help.
Why don't we experience some 'limited panel' flying in todays jets? It will teach you a great deal about your a/c and your own strengths & weaknesses. Is it because of "it ain't supposed to happen" thinking?
IMHO training in pre-planned scenarios with pre-planned responses has limited values. In-depth training to understand the a/c & yourself gives a broad solid foundation to apply in a multitude of unforeseen scenarios. The STN B747 was a simple frozen ADI, which caused a crash. It is not the only crash from such an apparently simple isolated failure. I say simple because the PM has correct data confirmed by all the basic performance instruments. It then becomes a CRM and handling exercise; to arrest the situation before a crash.
Never seen it. What a waste of simulator time; an ideal opportunity missed to gain real positive training, and avoid that confusion.
I've never been given a frozen attitude or incorrect attitude instrument in recurrency training. I'm sure it would be hugely positive and rewarding, but sadly most outfits lack imagination. The UA box ticking is no big deal, and the new airspeed unreliable procedure frustrating and time consuming before you arrive at the correct input which you should have known all along. The first scenario is recall and piloting, the second is QRH driven.
In this scenario they guys would have had to be very smart & very disciplined without panic. If it goes inverted while you are trying to figure it out, doesn't help.
Why don't we experience some 'limited panel' flying in todays jets? It will teach you a great deal about your a/c and your own strengths & weaknesses. Is it because of "it ain't supposed to happen" thinking?
IMHO training in pre-planned scenarios with pre-planned responses has limited values. In-depth training to understand the a/c & yourself gives a broad solid foundation to apply in a multitude of unforeseen scenarios. The STN B747 was a simple frozen ADI, which caused a crash. It is not the only crash from such an apparently simple isolated failure. I say simple because the PM has correct data confirmed by all the basic performance instruments. It then becomes a CRM and handling exercise; to arrest the situation before a crash.
Never seen it. What a waste of simulator time; an ideal opportunity missed to gain real positive training, and avoid that confusion.
Tower Dog, not wishing to compare you to Victor Medrew (post 280), but confusion (failed screen etc) is a symptom of disbelief.
Many people could not believe AF or Colgan, but more often the simpler view is more relevant. Humans can be maxed out and in those circumstances they do what some view in hind-sight as 'unbelievable', but at the time, momentarily, was perfectly reasonable for the pilots flying the aircraft.
RAT, 'seat of the pants', yes and pitch trim to fly the aircraft. But there again when the brain is maxed out then the senses may not make sense, even if ever observed consciously.
Many people could not believe AF or Colgan, but more often the simpler view is more relevant. Humans can be maxed out and in those circumstances they do what some view in hind-sight as 'unbelievable', but at the time, momentarily, was perfectly reasonable for the pilots flying the aircraft.
RAT, 'seat of the pants', yes and pitch trim to fly the aircraft. But there again when the brain is maxed out then the senses may not make sense, even if ever observed consciously.
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. Many people could not believe AF or Colgan, but more often the simpler view is more relevant. Humans can be maxed out and in those circumstances they do what some view in hind-sight as 'unbelievable', but at the time, momentarily, was perfectly reasonable for the pilots flying the aircraft.
Not being Monday morning quarterback or kicking dead colleagues, got lots of empathy because in many cases, I have been there, done that but survived.
Could tell stories all day about the flying I have done in old and tired airplanes over 37 years in the third world countries with bad maintenance, etc, etc.
This is not about me however, maybe I was lucky, or had a strong fear of dying, or both.
When I see people flying perfectly good airplanes into the ground however, and people on the Internet cooking up excuses about confusing situations or it could have happened to all of us, I tend to disagree and get sad, most of these are so damn unnecessary and you don't have to be Chuck Yeager to look across the panel and see if "his side is good" or with Colgan, add power and push forward on the yoke.
Guess my life is pretty simple.
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The reason TD is that you were brought up & have many hours on 37 year old aeroplanes. The latest pilots don't have that experience & have most of their flt time using modern instrumentation.
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When I see people flying perfectly good airplanes into the ground however, and people on the Internet cooking up excuses about confusing situations or it could have happened to all of us, I tend to disagree and get sad, most of these are so damn unnecessary and you don't have to be Chuck Yeager to look across the panel and see if "his side is good" or with Colgan, add power and push forward on the yoke.
Guess my life is pretty simple.
Guess my life is pretty simple.
Although the pilots in the cockpit and their actions directly relates to the outcome of the situation, there is a company behind, and a regulator behind the company. The regulator has the ultimate responsibility to establish safe minimums for the required training, both with regards to achievement of initial qualification, but also with regards to onwards training with the goal of sustaining a certain level of piloting skills and airmanship. The regulator also have the responsibility to assure that those minimums are adhered to by the company. The company on the other hand has an obligation to provide its crews with the best possible training, but since money makes the world go round, they will most likely only be interested in meeting the minimum requirements.
So as I see it, the regulator is at fault by setting the bar to low.
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One problem I see in todays world of training to minimum requirements is this; the trainers try to beat into crews A.N.C. but, they are also taught to beat in to the crews every time there is a problem, PF "state malfunction." PM does his best and with conformation of PF a QRH is called for. This is the rote of training. DoNot act as a cowboy, on your own, outside the checklist.
So now you have a scenario where nobody has a clue what is going on; the a/c is hurtling terrain-wards; is still controllable if you're quick and decisive, but by whom?? Ah, the big question. Somebody has to make an executive decision and decide what to do without a checklist and the usual nice calm process. There is a bull that has horns that need grasping PDQ. This goes against all the training rituals, but it is pure survival and the brain of some will be confused by the conflict and feel rudderless.
Those of us brought up in a less stringent era, and more pilot orientated, will not feel as restricted about doing whatever is necessary and argue the toss later on. I often found the modern youngsters, when faced with a piloting situation for which there was no black/white SOP or QRH, hesitated. Not their fault, but a training system fault. They had forgotten how to think as pilots first and crews of XYZ second. Normally they can succeed with the latter, but occasionally circumstances combine to thwart your coziness, and the former is required. That attitude needs to be there or you will flounder on the rocks.
Me thinks this debate has been had many times before on here; perhaps more general, but still the same subject. It comes around more than anything else.
So now you have a scenario where nobody has a clue what is going on; the a/c is hurtling terrain-wards; is still controllable if you're quick and decisive, but by whom?? Ah, the big question. Somebody has to make an executive decision and decide what to do without a checklist and the usual nice calm process. There is a bull that has horns that need grasping PDQ. This goes against all the training rituals, but it is pure survival and the brain of some will be confused by the conflict and feel rudderless.
Those of us brought up in a less stringent era, and more pilot orientated, will not feel as restricted about doing whatever is necessary and argue the toss later on. I often found the modern youngsters, when faced with a piloting situation for which there was no black/white SOP or QRH, hesitated. Not their fault, but a training system fault. They had forgotten how to think as pilots first and crews of XYZ second. Normally they can succeed with the latter, but occasionally circumstances combine to thwart your coziness, and the former is required. That attitude needs to be there or you will flounder on the rocks.
Me thinks this debate has been had many times before on here; perhaps more general, but still the same subject. It comes around more than anything else.
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Agree, but for some reason nothing (or very little) is done about it by the regulators. I am of the impression that the beancounters have persuaded the regulators that the price we (as a profession) are paying now, is the price of doing business, and the regulators have accepted this offer on behalf of all of us.
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. So as I see it, the regulator is at fault by setting the bar to low.
They can only do what they are thought and nuthin else?
I disagree, but I am from a different area I guess and those years flying bush in Alaska without no books and with no "training" made me look different at flying airplanes. As in "Do whatever it takes" to go home and have a beer.
Enough said, not going to argue anymore, different times I guess, and a good thing this was a cargo flight: A lot less dead bodies being scattered around the tundra in Sweden because of a faulty image generator.
The reason TD is that you were brought up & have many hours on 37 year old aeroplanes. The latest pilots don't have that experience & have most of their flt time using modern instrumentation.
Most of the time we were too tired, 30 hour duty days, bunch of time zones.
.Those of us brought up in a less stringent era, and more pilot orientated, will not feel as restricted about doing whatever is necessary and argue the toss later on.
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I wonder how many of those involved in accidents like this one, Collagen and AF447, actually spent their first 1000-1500 hours piloting an aircraft equipped with a minimal level of automation, thereby learning basic aircraft handling by heart. Instead we now have crews piloting complicated machines with high level of automation, while having as low as 250 hours of real stick and rudder time under their belt. And after 2000 or 3000 hours on type they are considered experienced although their total stick and rudder time still rests at 250 hours plus a few minutes on every second flight. Furthermore, the needed skills will diminish over time, and both pilot and more so their company and regulators have a tremendous responsibility to do something to maintain it.
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Yes, but apparently that part is not thought well enough to some pilots, and the fact that they are not "what if'ing" is not caught in the sim during recurrent training.
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. Of course they have some responsibility, but the problem is that from their first flight at a civilian flight school, they are placed in an environment and thought a mentality that does not prioritize or foster basic pilot skills like the skills you earned in the bush. For many young pilots, this is unfortunately and not by their own fault, their understanding of aviation.
Much higher age/hour requirements maybe? Not with a looming pilot shortage, the airlines would be screaming for more warm bodies in the right seat, at whatever cost, just fill the seats..
(One of my buddies is a sim instructor for a well know LCC, now teaching primary guys on the B-737 with 160 to 180 HR total time, then they get spoon-fed from there and into the cockpit of a real 737-800 with 190 pax. Bon Voyage, hope the old man does not get a heart attack)
In my world, I had 5300 hours total time before climbing into a jet the first time, 31 years old. Late bloomer perhaps but I had practiced staying alive for 10 years after I got my Commercial Pilot License.
Don't have the answer, but if I was in charge of training or recruiting, I would look for survival skills, rather than book skills.
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Sorry to chime in like this, but this is an area in which I have knowledge. So, my two cents...
I'm really really sure that the regulator in Sweden has all kinds of standards set and measured. I promise you that if someone does it the German way, it is Sweden. Sure, there might be some kind of oversight somewhere, but if there was ever someone to learn a lesson from others regarding unusual attitude cockups, be sure the Swedes had it covered by Jan 1st 2010.
No, what I think is more likely is the trend of misunderstanding the given information, or a lack of interpretation or imagination of what is happening. Airplanes, like cars!, are being more and more complex and require more tuning to comprehend. That is what is deadly.
Remember that in the early days, crashes were often caused by mechanical malfunctions. Clever design and improved skills in building has minimised those incidents. Now, it is the human that is lacking.
I'm really really sure that the regulator in Sweden has all kinds of standards set and measured. I promise you that if someone does it the German way, it is Sweden. Sure, there might be some kind of oversight somewhere, but if there was ever someone to learn a lesson from others regarding unusual attitude cockups, be sure the Swedes had it covered by Jan 1st 2010.
No, what I think is more likely is the trend of misunderstanding the given information, or a lack of interpretation or imagination of what is happening. Airplanes, like cars!, are being more and more complex and require more tuning to comprehend. That is what is deadly.
Remember that in the early days, crashes were often caused by mechanical malfunctions. Clever design and improved skills in building has minimised those incidents. Now, it is the human that is lacking.
Last edited by MrSnuggles; 14th Dec 2016 at 22:31. Reason: clarifying
you don't have to be Chuck Yeager
suggesting that nobody could have survived an instrument failure
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Remember that in the early days, crashes were often caused by mechanical malfunctions. Clever design and improved skills in building has minimised those incidents. Now, it is the human that is lacking.
Airplanes these days are pretty damn idiot proof and reliable, but us being humans, we can still cock it up, and we do. Coltan, AF, Bolivian RJ 85 and many others.
None of us are bullet proof. Had a few close calls being fatigued and too greedy to call it quits. My bad, and a bit of luck.
One learns from experience, sadly these low-time guys who crashed the mail flight in Sweden were just hanging on, not much experience to learn from and the Luck Bucket went dry.
R.I.P. Gentlemen and to the rest of you rookies: Pay attention and get ready for a high tech airplane wanting to kill you: Stay one step ahead and be slightly paranoid.
Uplinker:
In the light of recent accidents, I think that two other mandatory elements should be added to every SIM from now on:
1. Unusual attitude recovery.
2. Primary instrument failure, identification and recovery.
Mad (flt) Scientist:
The first of those already exists, and was even started at the operator (1.18.3 in the report details this - the requirement was going to be effective in May, the accident happened in January; the operator had started to train their crews....
In the light of recent accidents, I think that two other mandatory elements should be added to every SIM from now on:
1. Unusual attitude recovery.
2. Primary instrument failure, identification and recovery.
Mad (flt) Scientist:
The first of those already exists, and was even started at the operator (1.18.3 in the report details this - the requirement was going to be effective in May, the accident happened in January; the operator had started to train their crews....
Drain Bamaged
It's not much of an "unusual attitude" from the aircraft itself.
Than "just" a flight instrument(s) caking on you, and you would still continue straight and level without any actions from your part.
Figuring that out when it happen can be the hard part.
...If you see what I'm trying to mean...
Than "just" a flight instrument(s) caking on you, and you would still continue straight and level without any actions from your part.
Figuring that out when it happen can be the hard part.
...If you see what I'm trying to mean...
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Read and reread the report and still I find something troubles me, the initial reaction timing. According to DFDR elevators were moved by PF at T3, this being 3s after the failure and 1s after the AP disconnect. By this stage, yes, the PFD had risen to 13.7deg PU, so a very rapid pitch (indication) excursion, significantly greater than would be seen (and believed) in normal ops.
Nevertheless, why did PF respond so quickly ( 3s is quick) without ANY somatogravic change of state? I am puzzled by this and it is not explained directly in the report.
It worries me to think that it is within the scope of normal pilot behaviour to react instantaneously to a major change in the displayed flight trajectory without 'feeling' it also. Let me be clear, this is not about som. Illusion or recovery from UA.
Nevertheless, why did PF respond so quickly ( 3s is quick) without ANY somatogravic change of state? I am puzzled by this and it is not explained directly in the report.
It worries me to think that it is within the scope of normal pilot behaviour to react instantaneously to a major change in the displayed flight trajectory without 'feeling' it also. Let me be clear, this is not about som. Illusion or recovery from UA.