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-   -   UPS 747 Dubai Final Report (https://www.pprune.org/rumours-news/519857-ups-747-dubai-final-report.html)

clayne 25th Jul 2013 10:33

Yes it is amazingly thorough and how it should be done. I was surprised, honestly. I do hope UPS takes action against whoever the rogue shipper was. 2 hard workers are dead and countless hours into an airframe are completely lost.

Cows getting bigger 25th Jul 2013 11:57

Agreed, exceptional report.

Eclectic 25th Jul 2013 12:08

Impressively thorough report.
Two good lives wasted for an insignificant consumer bauble.

Events a bit like SAA 295
Then it was 81 seconds from first alarm to CVR failure.

Desert185 25th Jul 2013 14:31

Exceptional report.

I knew the Captain, who was a fine man, a loving husband and father and a very conscientious crewmember. I watched him progress from FE, to FO, then Captain on the Classic. We had many good flights and layovers.

Poor crew was dealt a bad hand on that flight. I can't help but think that having a Classic, three-person crew might have resulted in a more successful outcome. When things go really ugly, a good PFE/FE is a big asset.

Swissair at Halifax was a real eye-opener. I remember doing an onboard fire scenario in the simulator where it was emphasized to get the airplane on the ground (or ditch if over water) within 15-20 minutes. That's a pretty tall order in real time when there is heavy smoke, poor comm with ATC, the smoke mode fails with #1 Pack and your O2 quits. Imagine being over 30 West or someplace similar at night. I never bought into the FL250 fire fighting technique, particularly with Li batteries onboard or an O2-fed fire. Sometimes you get the bear, and sometimes the bear gets you, I guess.

I'm retired from UPS, but I understand they now have EVAS and fire resistant ULD's. Glad to hear. Any on board fire/smoke mitigation is a good thing.

Speed of Sound 25th Jul 2013 14:38

I agree with others about the quality and detail of this report, which makes it even more astonishing that virtually nothing is said about an absence of cockpit door or a screen, other than that they are generally absent on a freighter.

I'm amazed that a report which suggests video recording of the flight deck and even a 'pre-recorded audio checklist', would not at least make a suggestion that some form of barrier be considered to prevent smoke ingress into the flight deck.

Smoke killed the Captain and smoke stopped the FO from having a fighting chance to put it down on some tarmac.

A sad, sad story and I agree with others about some legal redress from the rogue battery shippers.

givemewings 25th Jul 2013 14:42

I only read the summary on AvHerald, but it did surprise me to read that generally, no sim training is done with pilots in a smoke-filled environment. This is a standard training item for cabin crew, why not pilots?? Or are their operators who do such training?

I too hope they go after the shippers who falsified the decs (because that's what it is). I used to ship and accept freight, one of my jobs was to inspect the parcels and some of the items that were other than described was crazy. And in most cases all because the shipper thought fees or customs charges would be less :ugh:

As for parachuting, it was successfully done on a study in the US where they crashed a 727 on autopilot- however, just like DB Cooper, they used the stairs. Doubtful it could be done normally unless modified like the A350 another poster mentioned. I recall something about Air Force One having (or previously having) this ability but not sure if I am getting confused with the escape pod/hatch which is not designed for parachute egress...

Lithium battery fires have always been covered in FA training, however since UPS some airlines have installed containment equipment onboard. I trained with this within the last 3 months and hope I never have to use the bloody thing for real!

Una Due Tfc 25th Jul 2013 15:36

Excellent report, but will anything be done? It seems to me that there is a lack of protection for the crews flying freighters. Once no fee paying passengers die then the public and the regulators seem to quickly forget. I sincerely hope after this and the AAR 744F to see Li-ion batteries go the same way as chemical oxygen generators i.e. only by land or sea. A passenger 777 almost got brought down in China a couple of years ago by a Li battery fire in the cargo hold too.

Eclectic 25th Jul 2013 17:42

Of the 9 747 hull losses, since the beginning of 2000, 7 were freighters.

Willit Run 25th Jul 2013 19:16

Since the two 747 fire accidents; a lot has been learned and contemplated about. We now regularly do drills in the sim, from a regular cruising flight level, to see how well and fast we can don the masks and goggles; one person runs as much of the checklist as he can whilst the other trys his best to get the ship on a runway in good enough shape to walk away, within 12 minutes!!!
In this scenario, the plane is likely to burn up anyway, so saving ones arse is the main focus here.
The industry learned that we must keep one pack on, preferably, pack one, if thats deferred, pack three must be on; to make sure the smoke evacuation system works as designed.

The thought of ditching a 747 for a fire is something I hope no one ever has to do. It scares the beejeebies out of me just thinking about it.
Our company has installed EVAS systems as well, but we have received no training yet to use them.

I wish we could have some specially made battery ULD's that would make surviving one of these fires a little more assured.

From our HAZMAT guru, supposedly, there have been no cases of properly tested lithium ion batteries causing problems. Only non-tested batteries. (Except for maybe that 787 issue).

Luckily for us, we always have a ride-on mechanic and usualy several deadheaders who could help.

These two guys didn't have a chance. From the point of the first fire alarm to being unable to see, was like 3 minutes! Im amazed they did as well as they did. they had everything against them.

Una Due Tfc 26th Jul 2013 00:53

The 777 incident I mentioned was caused by a baggage handler dropping a suitcase that had a laptop in it. I read the incident report while I was on freq on our briefing system so the finer details escape me but I remember the cause and the airline involved. If li-ion batteries are mishandled then they can fail very easily, and the symptoms may not be noticed for quite some time. Luckily this 777 was on climb out when the crew got a fire warning, imagine if they had been at cruising level.....

Brian Abraham 26th Jul 2013 01:14

Those talking of parachutes, the KC-135 and E-6 (the military 707) both have blast doors to enable parachute egress, though the 135 crews have had their parachutes taken away as a cost saving measure.

A little difficult to see how a similar arrangement may be incorporated for crews on the upper deck of a 74, outside of a scramble down the stairs to access a hatch on the lower deck.

Air Force pulls parachutes from KC-135s

amicus 26th Jul 2013 01:53

I worked on this terrible crash as an expert witness for several months and I hope and pray that all this excellent report's safety recommendations are implemented without hesitation or modification, the brave crew who perished and freight pilots everywhere deserve nothing less.
Those poor souls suffered and died because of totally inadequate regulations, a very dangerous and unacceptable cargo,and overall deficiencies in both A/C design and equipment.
Let us shout and holler until these safety regulations and hazardous cargo regulations are fixed and corrected as so excellently detailed in this fine report. Let us get it done in their memory and never ever take no or delays or inaction for an answer.

Una Due Tfc 26th Jul 2013 01:57

Well said Amicus. Laptops and Pro spec cameras should be carry on only, and pallets of Li-ion batteries should be banned from air freight period. If there is thermal runaway in a pallet of these things at altitude then the crew is :mad:

Sqwak7700 26th Jul 2013 10:58


Experience from this accident investigation in conjunction with FAA experiments suggest passive fire suppression in large cargo compartments due to oxygen deprivation may not be effective.
Uh, any other freighter pilots that have a problem with this statement? How does the FAA retain a valid certification for freighter aircraft with Class E compartments while simultaneously acknowledging this little gem.

Why can't we have the same level of protection in the main deck as we do in the lower lobes? I know it takes more structure, but the prediction in the accident report is for 4.1 more hull losses between now and 2021. At the very least, make self-fueled hazmat a road or water transport only class.


I hope and pray that all this excellent report's safety recommendations are implemented without hesitation or modification, the brave crew who perished and freight pilots everywhere deserve nothing less.
Unfortunately, the regulatory agencies have a very bad record implementing safety recommendations from accident report. I can only speak for the US system on this, but the NTSB is regularly ignored by the FAA on these recommendations. It usually takes 3 or 4 major accidents before the FAA finally begins to implement the safety recommendations of the NTSB.

Take fatigue for example, it has been a factor in almost every accident and the FAA happily ignores any NTSB recommendations on how to mitigate it.:hmm:

last747fe 31st Jul 2013 02:03

I was a classic engineer with Ups and flew this route many many times. I flew with this Captain when he was an FO and as a captain. Great guy. I was overseas when this accident Happened and for many months was devastated thinking had I been there as a PFE It might of had a different outcome. After reading this excellent prepared report, I now see that for sure there would have been 3 dead crew members. The rapidly damaged structure would have negated any system recovery attemps. Once the liner was breached and ducting dammaged there was no way to remove the smoke. I might have been able to have provided O2 for the Captain and provided a few more moments before the end.

Heathrow Harry 31st Jul 2013 07:35

Slightly off topic but everyone should realise how fast a little bit of smoke can turn into a lot in less time than it takes to read this

I was once in an office when smoke started to come through the floor - just a thin stream but in 2 seconds the place was solid and we just got out and closed the door and evacuated the building

If you ever see smoke treat it as the worst emergency there is - and you might get out

Bergerie1 31st Jul 2013 10:07

Heathrow Harry,

I couldn't agree more! And I speak from experience.

Capn Rex Havoc 1st Aug 2013 07:49

givemewings-

The company I work for uses smoke in the simulator for the smoke/fire drills. It is extremely realistic at night, with the smoke generated so thick that it is indeed hard to see the items on the overhead panel. Guaranteed to make one sweat, and appreciate how hard these poor blokes from UPS had it.

givemewings 1st Aug 2013 16:03

Cheers Rex. Seems there's a few, but not all, doing this. I just wondered since it's so widespread (pretty much across the board actually) with CC, why not with pilots? Perhaps now it will be...

Mr Angry from Purley 1st Aug 2013 19:21

SQWARK 7700
Take fatigue for example, it has been a factor in almost every accident and the FAA happily ignores any NTSB recommendations on how to mitigate it.Sqwark
Not the appropriate forum but do you want to substantiate the above claim?:\


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