B-737 Cargo Plane down in Hawaii
Join Date: Nov 2004
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My type has a TL indication, commanded EPR target if you will. Already rated a few years when I copied someone's technique to visually observe that doughnut to move - on the dead engine - as I retard.
Later adding an extra eyeflow to confirm what the remaking good engine is doing AFTER closing the faulty TL. BEFORE actioning the master switch/fuel shutoff. Which is a pretty universal.
Later adding an extra eyeflow to confirm what the remaking good engine is doing AFTER closing the faulty TL. BEFORE actioning the master switch/fuel shutoff. Which is a pretty universal.
The Kegworth avoidable accident was largely down to very poor CRM. Do I even recall the captain taking over as PF and taking the AP out!!
The crew were very much system-biased, ie where the AC bleed was fed from; all the (correct) indications were there to be seen on the EICAS, but they erroneously chose to ignore them!
The crew were very much system-biased, ie where the AC bleed was fed from; all the (correct) indications were there to be seen on the EICAS, but they erroneously chose to ignore them!
There is no EICAS on the 400. The engine instruments also come in two versions, analogue and what I call 'half-glass', the older analogue easier to read in my opinion. With the 200, EPR is the top row replaced by N1 on the 300 onwards. I see wrong identification more than I should in the Sim and rushing is the common cause. Never rely on yaw if the engine is surging and just take your time reading the dials. As in all accidents there were many factors in the Kegworth accident including poor communication with the F/A's.
Looking at the fuselage break in the Hawaii ditching it makes me smile to read the ditching drills in the manual. You can't learn everything from books, sometimes you have to make it up as you go along.
Looking at the fuselage break in the Hawaii ditching it makes me smile to read the ditching drills in the manual. You can't learn everything from books, sometimes you have to make it up as you go along.
Is this a hint that the NTSB's final report will indicate that the non-operational discussions were a causal factor?
I notice the FAA -NTSB are still using gender specific pronouns, marvellous. Here in the land of wasted opportunity, the ATSB now refer to individuals as they, them or their.
Excerpt from FO 2nd interview:
Q. Is the rudder pressure -- does it take a lot of pressure when you lose an engine to hold it or is it kind of like tiptoe touching pushing rudder?
A. It does in the simulator. But in the airplane, it didn't. It wasn't (indiscernible) that much. I was surprised. I remember being surprised that it wasn't like the simulator.
Q. By not the simulator, I just want to make sure I in my head I have it correctly -- you're saying in the simulator it took a lot of pressure. And in the --
A. Yes.
Q. -- airplane, it did not. Correct?
A. (No audible response)
The FDR data appears to indicate that initially the problem was a partial loss of thrust on the #2 engine, which surprised the FO because the Transair sim training was for complete loss of thrust.
Q. Is the rudder pressure -- does it take a lot of pressure when you lose an engine to hold it or is it kind of like tiptoe touching pushing rudder?
A. It does in the simulator. But in the airplane, it didn't. It wasn't (indiscernible) that much. I was surprised. I remember being surprised that it wasn't like the simulator.
Q. By not the simulator, I just want to make sure I in my head I have it correctly -- you're saying in the simulator it took a lot of pressure. And in the --
A. Yes.
Q. -- airplane, it did not. Correct?
A. (No audible response)
The FDR data appears to indicate that initially the problem was a partial loss of thrust on the #2 engine, which surprised the FO because the Transair sim training was for complete loss of thrust.
Excerpt from FO 2nd interview:
Q. Is the rudder pressure -- does it take a lot of pressure when you lose an engine to hold it or is it kind of like tiptoe touching pushing rudder?
A. It does in the simulator. But in the airplane, it didn't. It wasn't (indiscernible) that much. I was surprised. I remember being surprised that it wasn't like the simulator.
Q. By not the simulator, I just want to make sure I in my head I have it correctly -- you're saying in the simulator it took a lot of pressure. And in the --
A. Yes.
Q. -- airplane, it did not. Correct?
A. (No audible response)
The FDR data appears to indicate that initially the problem was a partial loss of thrust on the #2 engine, which surprised the FO because the Transair sim training was for complete loss of thrust.
Q. Is the rudder pressure -- does it take a lot of pressure when you lose an engine to hold it or is it kind of like tiptoe touching pushing rudder?
A. It does in the simulator. But in the airplane, it didn't. It wasn't (indiscernible) that much. I was surprised. I remember being surprised that it wasn't like the simulator.
Q. By not the simulator, I just want to make sure I in my head I have it correctly -- you're saying in the simulator it took a lot of pressure. And in the --
A. Yes.
Q. -- airplane, it did not. Correct?
A. (No audible response)
The FDR data appears to indicate that initially the problem was a partial loss of thrust on the #2 engine, which surprised the FO because the Transair sim training was for complete loss of thrust.
Had a sim session once with the other pilot simulating incapacitation immediately after lift-off, plus an engine failure occurring on number 1 and simultaneous engine fire indication on number 2 (the engine still providing thrust). Yes, a quite unrealistic scenario, but it absolutely helped me learn to analyse the problem first before rushing into action.
Had a sim session once with the other pilot simulating incapacitation immediately after lift-off, plus an engine failure occurring on number 1 and simultaneous engine fire indication on number 2 (the engine still providing thrust). Yes, a quite unrealistic scenario, but it absolutely helped me learn to analyse the problem first before rushing into action.
Shut down the good engine on a twin happens relatively often. So the pilots did a good thing only idling the assumed faulty one. Why did it never appear to them to give the idling engine a shot while they had already called for the coast guard. Task saturation? I would think you firewall all power you have if you go down over an ocean at night. Why stick to a wrong decision making if there is very little to loose if you try the other options? May be the training is not optimal for those situations?
That being said, I worked with a guy that - since there had never been a successful ditching of a jet with high bypass, underwing engines - figured we could save a lot of weight and money getting rid of the rafts and all that other stuff since it'll never be needed (this was before Sully - but to be fair the Hudson is much different than open ocean).
Shut down the good engine on a twin happens relatively often. So the pilots did a good thing only idling the assumed faulty one. Why did it never appear to them to give the idling engine a shot while they had already called for the coast guard. Task saturation? I would think you firewall all power you have if you go down over an ocean at night. Why stick to a wrong decision making if there is very little to loose if you try the other options? May be the training is not optimal for those situations?
Final report probable cause: The flight crewmembers’ misidentification of the damaged engine (after leveling off the airplane and reducing thrust) and their use of only the damaged engine for thrust during the remainder of the flight, resulting in an unintentional descent and forced ditching in the Pacific Ocean. Contributing to the accident were the flight crew’s ineffective crew resource management, high workload, and stress.
N810TA Final Report
N810TA Final Report
Only half a speed-brake
The difference between losing one or two on a twin lies with the training and proficiency requirements of the TR/licence.
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Well that report makes for pretty depressing reading. Interesting that no mention of the crew’s training record is made so I guess not relevant.
Also, why oh why is it so hard for Americans to just say “Mayday”? The low quality of US radio procedures contributed to this accident. Imagine if it had been a passenger flight?
Shaking my head in disbelief 😳
Also, why oh why is it so hard for Americans to just say “Mayday”? The low quality of US radio procedures contributed to this accident. Imagine if it had been a passenger flight?
Shaking my head in disbelief 😳
I agree that U.S. aviation comms have room for improvement but don’t think the struggle with comms during this accident was contributing.
As with many such events there are various things one could focus on, however I'm interested in two things:
(1) ".... while the airplane was climbing through 700 ft and noted an issue with the left engine, so he [the captain] decided to immediately return to the airport. The captain reported that the company chief pilot criticized him for returning to the airport without performing the relevant abnormal checklist."
While I get that checklists are there for a reason I posit that blind adherence to said list(s) may sometimes get in the way of flying the 'plane and optimal crew/passenger safety? It would seem to me that, notwithstanding the flawed identification of the failed engine, had an immediate return to land occurred it's likely there would have been a better outcome, and that the CP's admonishment of the captain has some bearing on this outcome.
For the avoidance of doubt, this is not a criticism! I'm rather more interested in people's views re the rigid adherence to checklists following EFATO close to the originating aerodrome and when immediate return is possible.
(2) In the same vein, there are many instances of miss-identification of failed engines, Kegworth being one of the more obvious ones. When I did my training for multi-engine multi-crew operation we spent a lot of time on this very issue because of the lessons taught to us by such past events. However the issue, clearly, continues to raise its head.
To that end I posit whether it is better to shut down a supposedly failed engine, or in fact to immediately advance all throttles (if needed to keep flying) and continue to fly the aircraft to touchdown?
Obviously this is germane to partial or even complete loss of power on one engine only, and I recognise that there is risk to this strategy along with the obvious benefits of correct identification, however with particular regard again to EFATO close to the originating aerodrome, and the time taken up + risk of things going wrong during the identification process etc, I question whether there might be a better/simpler way to address such events?
FP.
(1) ".... while the airplane was climbing through 700 ft and noted an issue with the left engine, so he [the captain] decided to immediately return to the airport. The captain reported that the company chief pilot criticized him for returning to the airport without performing the relevant abnormal checklist."
While I get that checklists are there for a reason I posit that blind adherence to said list(s) may sometimes get in the way of flying the 'plane and optimal crew/passenger safety? It would seem to me that, notwithstanding the flawed identification of the failed engine, had an immediate return to land occurred it's likely there would have been a better outcome, and that the CP's admonishment of the captain has some bearing on this outcome.
For the avoidance of doubt, this is not a criticism! I'm rather more interested in people's views re the rigid adherence to checklists following EFATO close to the originating aerodrome and when immediate return is possible.
(2) In the same vein, there are many instances of miss-identification of failed engines, Kegworth being one of the more obvious ones. When I did my training for multi-engine multi-crew operation we spent a lot of time on this very issue because of the lessons taught to us by such past events. However the issue, clearly, continues to raise its head.
To that end I posit whether it is better to shut down a supposedly failed engine, or in fact to immediately advance all throttles (if needed to keep flying) and continue to fly the aircraft to touchdown?
Obviously this is germane to partial or even complete loss of power on one engine only, and I recognise that there is risk to this strategy along with the obvious benefits of correct identification, however with particular regard again to EFATO close to the originating aerodrome, and the time taken up + risk of things going wrong during the identification process etc, I question whether there might be a better/simpler way to address such events?
FP.
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What I think this incident shows is that EFATO or engine failures in general should not be rigidly flown at V1 with a bang and total loss of thrust. Having them occur at some point will force pilots to engage the grey matter and actually think about the problem - like you say First Principal; sometimes it might be better to continue to touchdown. If I’m fully stabilised at 500ft into my home base, CAVOK and an engine winds down would I do a go around or just continue to land? I know what I would do.
BD
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