Mid-Air Collision over Southern Germany (merged)

[Capt Pit Bull]

Devils Advocate,

bit stong there perhaps.

I'm reminded of the pax on the Kegworth aircraft.....

CPB

[Wedge]

"then - and not till then - is you bruv (or indeed any other layman / pax ) suitably qualified to comment on matters aeronautical"

Devil's Advocate, maybe you are playing the role of your name but that is utter nonsense.

I am not an airline pilot (an ex-wannabe), but I consider myself very well informed on matters aeronautical thankyou very much.

And besides, what about ATCOs, engineers, and even cabin crew. They are all entitled to their opinions on aviation matters as indeed are those who don't work in the industry.

Sort yourself out!

And what an excellent point Captain Pit Bull. I hope I'm never flying as pax with Devil's Advocate when there is an engine failure.

"There's a passenger who thinks that you have powered down the wrong engine"

"Oh what does he know! Tell him to shut up!"

It's 'I'm a pilot so I can't be wrong' complacency like that that leads to accidents in the first place!

[BIK_116.80]

"I paid fifty-thou for my pilot licence - so I know what's goin' on!"

No, it shows that you are not very good at shopping and that you paid too much.

[Captain Stable]

I concur. It is not good CRM to eliminate what might possibly be an excellent source of information.

Under no circumstances whatsoever can 50 secs be considered safe. Even assuming that the Tu154 had commenced descent immediately, in 50 seconds they could quite conceivably (at 800 fpm = 1 degree) have descended less than 700 feet. This does not provide legal separation.

Whatever the various causes of this awful accident, I rather suspect that many systems will require major inspection and overhaul, and some very dearly-held preconceptions torn away from people's security blankets.

[411A]

Indeed....waaaay toooo much! (should have trained in the good 'ole USA, silly boy)

Capt'n Stable...right on the money IMHO.

[FL600]

My heartfelt condolences to the families involved. I cannot imagine what the controller must be feeling. I hope that first and foremost a CSIM support group does exist in Zurich.

This event will have far reaching consequences in the aviation industry, both political and operational. Of course many questions remain, but I am Angry but not too surprised at the stupidity of the management press releases.

My personal thought... The accident occured at FL353. It seems clear that one aircraft was under an ATC clearance and one was under computer guidance... Whether the controller had made a mistake and was taking avoiding action or whether it was a preplanned conflict resolution level change, the sad truth is that nothing would had happened if the controller had not intervened and that is what makes it that much more painful.

[Alpha Leader]

German BFU statement

As mentioned by others in earlier postings, no confirmation of Russian claims that TU-154 crew alerted Swiss ATC.

However, point made by German BFU official Schlegel about the controller violating Swiss ATC regulations which demand that aircraft have to be redirected to other flight levels at least 1 1/2 minutes prior to reaching the projected intersecting point.

[3forty]

concerning Tcas orders,they take priority over ATC.Period.
If the two planes were to follow their respective Tcas instructions,the accident would be avoided.Of course,the controller had to do something and tried to separate the flights "manualy".It would take tons of guts and cold blood to remain quiet and let technology do its job.

[arcniz]

Well, Devil, your horns are certainly showing.

Now that you're making the big money, another 500 on some sim time at Charm School might be a career plus.

Aviation is still small enough that each player affects future opportunities for all the others - positively or negatively.

More than a few folks with the price of a ticket - including seasoned travelers - are somewhat anxious about being accidentally damaged while whooshing about at the speed of a pistol bullet.

To them, crossing a thousand feet apart may seem like inches - if they perceive it as a brush with eternity. Tragic events like this one are amplified by thousands of media channels and propogated worldwide at light speed. While marching through the press reporting cycle from the tragic event to the final analysis, the story appears in various forms at least several hundred times in view of many of your future customers.

Telling the pax to sit down and shut up resolves some near-term annoyance, but it is really bad for repeat business. A little compassion for their actual concerns goes a long way. Combined with some guidance from aviation professionals, it can motivate useful infrastructure enhancements to prevent future situations of this nature.

[boofhead]

Harking back to the possible delay in response to an ATC instruction to descend... I fly an airplane with imperial measurements, and a metric backup in a metric area. When I am instructed to climb/descend I need to look up the appropriate imperial value of the new altitude in order to set it on the altitude counter of the autopilot, before I can initiate the descent, whether using Vert Speed or VNAV. It matters not that I have a display of the metric altitude in front of me, since I am required to set the altitude counter (in feet) in order for the altitude alert to operate (another RVSM requirement).
So I would imagine the Russian pilots had an auto pilot panel marked in metres, and would have to go through a similar procedure before they could start the required descent, since they were operating in an imperial FIR.
50 seconds sounds a little too short a time to me..

[320DRIVER]

Excellent point Boofhead... we fly (occasionally) into "metric" airspace and each time we get a level change, we have to take our quick reference chart and convert the value to feet to set in our FCU. Airbus makes it a bit easier because there is an option to see the selected FCU altitude equivalent in metres on the lower ECAM system display.

[AA SLF]

Wedge and arcniz -

A just a humble pax/slf that does over 100k airmiles a year, I want to say THNAK YOU for your responses. Y'all are dead on regards how the pax might feel getting off of a particular flight. Several flights on American Airlines (AA) in the past couple of years I have had the flight deck come on the PA system to advise that we had "passing/crossing" traffic coming up and to not worry about it as BOTH flight decks we talking to each other on freq (actually thru ATC contacts).

Thus, when the event did occur all (at least as far as I could determine) of the pax were "excited" about the event in a positive manner (they got to see another a/c in flight) and nobody from the pax side seemed upset/nervous at all. Lots of comments like "did you see it" ; "did you get a picture of it", etc.

Very good PR points in mind for "my" airline and pax going home with a "story" to tell their friends about their trip on AA.

If one (1) pax stops to talk to a pilot at the exit you can be sure that there were others who felt the same way who just did not speak up!! There goes all of the "good will" in a flash.

-dAAvid

[3forty]

Boofhead,you may have a good point,but I fear the clearance to descent included something like "immedeatly" because of the collision threat.In that case,you just switch the bloody autopilot off and dive.

[vanman]

If as we're lead to believe there was only one ATCO on duty, as the other had left the building and was presumably therefore not readily available, then what cover would likely be available and for what likely period of time after this tragic event took place?

I'm haunted by this horrible image of a controller having to 'keep it together' for what must be an eternity whilst a relief colleague presents him/herself. Clearly, in such circumstances, their concentration might not be completely assured thereafter.

I'm sure it's all a lot more scientific??? ....... but then I'm not to sure about anything at the moment .... I freely admit to being one of those pilots who, whilst turning on all the lights and keeping 'em peeled at lower altitudes, fully believed that the combination of RCS and TCAS meant that we had never been safer at FL360. Certainly sharpen my look in the cruise now.

BTB, When I last did TCAS sim training I was being asked to generate a vertical deflection of about 3 or 4 hundred feet to successfully 'resolve' a TCAS RA. We were given demos of the likely outcome of exceeding this, ie a further conflict at the next level.

Would a 700' descent for an RA be considered excessive? My first thought is that it is..... but then I don't fly 757s.

Lastly, after reading (days ago now) earlier portions of this never ending thread, I am a bit unclear as to whether and if so how long before the impact, a reversed RA would have been received in the two flight decks?

Thanks in anticipation of any clarification (where appropriate )

PS: Devil's - I agree. Ignore, or worse, insult the punters at your peril. CPB's point is of course, absolutely correct, but also remember that the pax you p1ssed off last week is the one in the aircraft at the other end of next weeks RA!

[Alpha Leader]

German BFU releases first official summary of events

German BFU (Air Accident Investigation Bureau) provides first official summary of events leading to Monday night’s mid-air collision:

Skyguide controller appears to have been at task saturation point. Between the handover of the TU-154 from Munich Control to Zurich Control at 23.30.11 and the time of the collision at 23.35.33, the Zurich controller was responsible for four flights on one frequency and another flight on a second frequency. He was responsible for coordinating flights on two separate screens. One of the flights was on approach to Friedrichshafen airport.

All this was taking place as Skyguide was carrying out software maintenance to its radar systems, for which reason these were in fall-back mode and had been so since 2300. Given this scenario, increased separation of 7nm horizontal and 1000ft vertical was prescribed.

Both the B-757 and the TU-154 were progressing at a normal speed of 450 knots. The descent initiated by the TU-154 pilot (1000 ft/min) was also routine. However, this descent should have been initiated by ATC 90 seconds prior to the projected intersection point, whereas it is now evident that the duty controller released such instructions only 44 seconds prior to the eventual collision. The situation was further exacerbated by the fact that the TU-154 crew only reacted to ATC instructions when they were repeated to them 30 seconds before collision point.

Immediately prior to the collision just below FL360 the TCAS on one of the two planes involved released dive instructions which were monitored by ATC. There is no confirmation yet as to which a/c this emanated from, but it is currently considered likely that it was the TCAS on the B-757, as it had already initiated its descent.

Investigators confirmed again that the TU-154 was equipped with TCAS, but there are questions as to whether this was operative at the time.

With both FDR and CVR retrieved, it is now evident that the tapes are in very bad condition, being both torn and deformed. It is likely that some data will be unretrievable.

Russian media reports referring to an alleged warning by Capt. Alexander Gross radioed to Zurich control about the looming collision have not been confirmed by the German investigators.

[Wiley]

It’s time to introduce offset tracking

I have to agree with 410 (page 19) – although offset tracking would not have prevented this particular tragedy, the fact that the accident did occur in a so-called ‘First World’ RNP5 radar ATC environment clearly illustrates his point: - even in the best high tech, safety-redundant environment, the ‘error chain’ can still go unbroken right up to and, it would seem, including the last vital link, TCAS.

It’s time we all started insisting something be done about a potential problem many of us acknowledge is an accident waiting to happen - the decrease in flight safety that highly accurate GPS navigation systems have brought into the equation.

Danny, this site, your creation, has come a very long way since 1996. Can I suggest that you, with the undoubted clout you now have through this site, start a loud campaign to really hammer home the concerns I think you share with 410 and many others, including me. It’s time offset tracking was introduced, RIGHT NOW, without further delay, even in RNP5 airspace, before another accident occurs with possibly far greater loss of life.

I agree that it should be embedded, but I know that will take years to implement, so let’s make it mandatory that everyone with an FMS employs it manually above 10,000’ until the embedded offset is introduced. Bureaucracy being what it is, it’s simply not going to happen unless we insist on it – or another 800 people die in circumstances that this simple fix would so easily avoid.

It’s been said before, but it’s worth repeating yet again. Imagine the meal the lawyers are going to make of it if we ever do have a head-to-head midair (like Delhi and like the one off the west African coast) when it comes out that the many calls for offset tracking have been ignored by the authorities for years. They’ll be suing everyone right down to the assistant cleaner at ICAO HQ.

[Standard_Departure]

As an ATC I feel a little bit stunned by the report issued by BFU.

He was responsible for coordinating flights on two separate screens. One of the flights was on approach to Friedrichshafen airport.

Even though they (BFU) mentioned task saturation earlier in the statement, this should not be confused with traffic numbers, there were only five.

The important part of that statement is the fact that he was working 2 different "screens". Now if that means what I think it does, then this controller was sliding from one position to another, and doing what would normally require two controllers working two radar displays, two frequencies and two of whatever else there was at each workstation.

The implication that he was working two frequencies, and was;

Firstly - running the risk of having different aircraft transmit on different frequencies simultaneously and have one or the other get lost in the ether,

or Secondly, issue an instruction to one aircraft at one position, and start "sliding" over to the other position to monitor a manoeuvre, possibly without hanging around long enough to ensure that the previous instruction was either read-back or complied to, this is shocking.

And Skyguide, please don't tell me that this is also within your tolerance limits or acceptable standard operating procedures !!!!!

The rest of the report is insignificant to me, because, for what I can see, the bulk of the damage was done when they removed TWO vital safety nets, #1 the other controller & #2, the conflict detection equipment.

I am sorry if I sound a little upset, I am.

PS: As a sidethought, was the aircraft arriving at Friedrichshafen Airport being provided with any sort of Controlled Service, in other words being vectored to an ILS or something like that, and if so, was the ATC both Approach rated and Area rated ?

[Alpha Leader]

Standard_Departure:

Re your sidethought: 'Yes' to your question about Controlled Service - 'don't know' about the controller's rating(s).

[Standard_Departure]

Question to the pilots..

Hi there,

There has been some discussion now regarding the "apparent" lack of compliance to TCAS RA by the pilot of the T154.

My question is;

After following ATC instructions for up to 20 years, turning when they say turn, climbing when they say climb, adjusting your speed when they instruct you to do so .... is it not going to be extremely difficult to comply to a TCAS RA when you have an ATC instructing you (possibly including the words "FOR TRAFFIC AVOIDANCE" or "IMMEDIATELY, TRAFFIC, TRAFFIC") to do the exactly opposite of what the TCAS is saying?

I know the book (reg’s) say that except for GPWS, TCAS RA's take precedence over all other instructions, but what I am asking about is the practicality of that compliance under certain circumstances....

Thank you in advance

[Devils Advocate]

A 'little' bit of knowledge is dangerous thing

The point I was 'trying to make' ( though obviously not very well - i.e. I'll admit that in my previous post I used the term 'pax' too loosely, in as much that there are indeed occasionally people in the cabin with experience which is pertinent and we're all the better for them being there too ) is that just because some 'laymen' ( n: A person without professional or specialised knowledge in a particular subject ) perceives that it's unsafe doesn't mean that it is; Though, conceptually, whizzing about at the speed of a bullet, several miles above the Earth, in a pressurised aluminium tube, is seemingly a ridiculously dangerous way to travel.

Nb. W.r.t. to the psychology and flying, I was once told that aircraft manufacturers try very hard to make the pax forget the above by hiding all the control cables, etc., from view behind nice plastic panelling, i.e. sanitising the raw machine, whereas submarine manufacturers try their hardest to remind submariners at every moment that they're operating in a dangerous environment by leaving all the pipe work on view - interesting huh ?

That said, just because somebody in the cabin sees another aircraft in the sky, and that to them it might seem close, does not mean from the professional / aeronautical view point that it is.
Also if we were to broadcast a PA to the cabin every time we passed another aircraft it'd actually (imho) become bloomin' irritating, e.g "yep folks, out on the left there's another one heading our way"..... a short while later ..... "and there's another one, looks close but no need to worry"..... ditto ..... "and here comes another one" - gimme a break ! - and what if you then pass one close-by but didn't say anything (eating your dinner, or whatever) you'll almost certainly then have Johnny pax saying "Uhm, guess they didn't see that one coming, just what are they doing up there, it looked real close to me, I'm gonna write in and complain that they obviously aren't paying attention !".
Indeed, sometimes you're so busy in the flight deck ( reading the paper, doing the crossword ? ) that other aircraft just whoosh by and your none the wiser, and also some TCAS systems only go out to 5Nm so by the time you locate your target, in time to make a nice PA, it's gone past - but there's bound to be some eagle-eyed pax in the back who sees it and believes you were dead-on a collision course, and that it was only 'luck' that kept you both apart - despite the fact that ATC didn't feel the need to say anything to you about another aircraft and that the TCAS didn't even squeak.

As per my previous addition, it typically takes years to become an airline pilot, and we then similarly spend years in the air plying our trade, so it just seems a bit temeritous(?) to have somebody who maybe only flies a few times a year ( possibly doing less airmiles and flights than we do in a busy summer week ) suggest that you risked their lives by flying 'too close' to another aircraft and that they're going to write to your company to complain about you - err, run that by me again ?!

Now w.r.t. Kegworth, yes the pax might have noticed that the left ( or was it the right, or number 1 or number 2 ? ) engine was chucking out flames / sparks, but the bigger problem ( as we all know - if you've done the CRM courses ) was the mix of experience levels on the flight deck, their characters, and how they handled their emergency.
That said, it did not help that ' They were not informed of the flames which had emanated from the No.1 engine and which had been observed by many on board, including 3 cabin attendants in the aft cabin.'
Veritably you or I could have been sitting in that cabin, looking out at the left donk, and it'd have made very little difference to the outcome ( which in part is why CRM's now so popular & required ).

W.r.t. flight training costs, if ones adds up the cost of the flying training and combines that with the loss of earnings during the for one year, study period (i.e. you'll need money to live on) then I'll stand by the cost of £50k - and fyi I've got both UK & USA professional pilot licenses, and yes it is a lot cheaper in the USA, though it does also seem to be getting cheaper to get a license in Europe too.