Sveriges Radio P4 Norrbotten is a radio channel that covers the area where the plane crashed. They are reporting that work with retrieving plane parts have started (as reported the 13th of June) and they are concerned about how the remaining fuel might affect wild life.

Nothing is mentioned about the crew, but having a little knowledge about the area, I would suspect there is very little to do. Polar foxes, wolves, lynx, bears and other predators might have already done their deeds. As I said before, this area is very remote and there are no roads. The ground has not been stable enough (or snow free enough) for retrieving crews to get there until now. Northern Sweden is very similar to, lets say, Alaska, for you who wonder about the environment in which the plane crashed.

I am hoping they find wreckage that might explain why the IRU stopped working! Nothing is mentioned about that in the broadcast.

For those who are interested in hearing Swedish: a link to the broadcast: Det norska postflyget ska nu bärgas - P4 Norrbotten | Sveriges Radio

Sorry I didn't update this immediately I found it. Been busy!

Just an interesting incident.
A recent CRJ lost all airspeed indications over Switzerland.

http://avherald.com/h?article=499b2f03&opt=0

Hoping for an update on this!

Update on this:

Nothing.

Not a word. Zero. Not even local local radio has said anything to my knowledge. Granted, I doubt I know about all amateur radios with very short range capabilities, but the channels I can reach - zilch. Also granted, I am not privy to internal information within Svenska Haverikommissionen - simply because I do not work there... :-)

The official site from SHK - Statens haverikommission is equally quiet. They are working with French, Norwegian, Spanish officials. No mention of an estimated month of completion of the report.

I get the feeling this IRU problem might be a hard one to crack. Still, some little tidbit of information would be nice.

Final report seems to be out
Utredningar - Olycka vid Oajevágge i Jokkmokks kommun med flygplanet SE-DUX av typen Canadair CRJ 200
In Swedish, anyone feel like translating it?

quote 1 : the aeroplane was level flight at FL330 when the incident occurred .
quote 2 : The aeroplane collided with the ground in an inverted position at t80,
one minute and twenty seconds after the start of the event.
quote 3 : The erroneous attitude indication on PFD 1 was caused by a malfunction of the Inertial Reference Unit (IRU 1).
quote 4 :The accident was caused by insufficient operational prerequisites for the management of a failure in a redundant system.

Frightening to read the sequence of events . if you think it could have been be you.

So, once again, instrument failure leading to a crash. The holes in the Swiss cheese line up yet again.. A chilling read!

CRJ down in Sweden
 

http://www.havkom.se/assets/reports/RL-2016_11e.pdfh)

According to my understanding of the report, this would be a probable sequence of events:

Pilots briefing maps, using lights and reducing night vision.
IRU malfunctioning.
Pilots startled by strange PFD displays.
Pilots taking action.

No communication who is in control and no double checking of instruments can be heard on the CVR.

This was one malfunctioning instrument that would have been easy to spot if a comparison had been made between LHS and RHS. Noone did, noone thought "pitch, power" and landed safely.

How many AF447 will there continue to be?

A very sad read, I feel for the crew. This underscores what I have been taught in de sim after the AF accident: you have to compare ALL indications when faced with unusual attitudes, never instinctively react to just one parameter.

If your PFD shows a ridiculously large nose up pitch angle then your airspeed should decrease. It is impossible for the speed to remain stable with such a pitch angle. If it does, something does not add up...

Very sad but at that time of night most would be startled. But again it shows how modern cockpits & automation has eroded basic flight skills. Something I found coming from a more basic type where a good instrument scan was natural. To tunnel vision as everything you need is on the PFD. Methinks in the past a artificial horizon failure woul just cause a que? Moment as your instrument scan (more like a total look) would immediately alert you to it not being right. I realise the pfd saves the big scan but think it is a human brain thing. More human research should have been done before creating complex displays.

This was an accident stemming from a 'hazardous misleading display', which according to AMC 25.1302 2.1 requires that 'The probability of indication of dangerously incorrect information without a warning being given should be Extremely Remote'.

We might ask why the certification process involving the equipment manufacturers (IRS and EFIS), the airframe and simulator manufacturer, and various national regulatory authorities involved in certification did not identify this hazard. Was the probability proven by numbers, or risk assessed such as the crew were expected to notice (regulatory generated black swan).
The EFIS software appears to have been designed to remove the alerts, the accident was 'as designed'; thus how did the various checking processes fail to meet the safety requirement.
The above questions are easy to ask with hindsight, but how might these aspects be turned into foresight.

Is the current emphasis on LoC training, immediate action, and SOPs now biasing pilots to react with little thought, no crosschecking, particularly in surprising situations.
Is the industry generating this type of accident, misunderstanding or seeking to address the difference between what is assumed to happen against the reality of rare accidents, with unrepresentative regulation.
Can the current safety and regulatory processes be expected to identify and manage events beyond the certification boundaries.
There are many approaches to safety, all necessary for achieving the current high level of safety, but is their more recent application now endangering future safety. Regulatory restraint, 'SOP for everything', and train for 'everything', except that not everything can be foreseen, offers diminishing safety return. There is greater need for the interpretation of requirements for training, emphasis on a checking mentality vs educating and understanding, which if misapplied decrease the opportunity for experience further weakening crews' ability to manage the unforeseen. This accident may have been foreseen, but it was parked the other side of a regulatory line 'of assumption' to become 'unforeseeable', yet still expecting crews to manage the surprise when it happens.

Time to change the way we think about safety.

All they had to do was a quick cross-check. If the right and st.by displays were in agreement, keep flying normally. Switch source on the left, or turn it off.
No idea what they were thinking...

The old aviation adage applies today just as it did yesterday. When your surprised by something unusual often the best thing to do is nothing.
Thanks for the update.

Sit on your hands and count to ten. One thinks it would have helped save the day, but who knows. The Swiss cheese holes are lining up in more and more accidents.

The final report is chillingly clear. PF startled by the aural warning and all the blue on the PFD instinctively pushed the nose down without thinking. PNF seeing correct display was totally out of the loop on why. All this in the small hours on a 5th & last leg, with cockpit lights on for the approach briefing during a pitch black night with zero outside visual references. By the time they started to get their act together the situation was beyond recoverable.

Here we have two different hazards, and by design there's logic that gives priority to one of the hazards (unusual attitude) vs. the other (instrument miscompare). There are a number of risk-based assumptions in creating that priority list, which now will need to be revisited.

Yes, I read the report and my initial thought was: What were they thinking?: Right side agreed with the St.by instrument. Fly the right side, ignore the left side.
Pretty basic, but yes, I understand they were tired, lights were on, etc, etc.
Well, too late now and there is lessons to be learned here: Same as in basic training: Fly the good side, don't rush too into action, etc.

When you have a mechanical gyro in the center of your panel in the back of your mind maybe you might think "My attitude gyro just died".

The beautiful Integrated PFD's are just so convincing.

There are warnings on both PFD's if the two PFD's differentiate (PIT, ROL, HDG). Those warnings were absent since the two PFD's went into declutter mode, because of the unusual "false" attitude on PFD1.
The simulator the 2 pilots regularly trained on, had those warnings present even in declutter mode. But not the real airplane, manufacturer was criticized by SHK.

The probable cause why they didn't check the standby attitude indicator, was that they were subjected to - 1G to +3G & many auditory and visual warnings.

Google translate from the final report by SHK:
"That none of the pilots of the situation verbally referring to standby attitude indicator can be explained by the two experiencing a complex situation because of the varying G loads and a great amount auditory and visual warnings. This has probably contributed further to cognitively
tunnel vision and focus on each PFD."

It's easy to be a hot-shot pilot in front your computer! But if you read the whole report it's more understandable why it happened.

Exactly. Hearing what the fault was first and then knowing exactly what to do is not the same as an instinctive reaction to an unusual presentation on your PFD. I suspect most would at minimum, make some kid of significant input to an unusual attitude suddenly presenting itself.

Always happy to see the could-never-happen-to-me-itis in post-occurrence threads.
Hindsight is always 20/20; after every accident you can say oh all they had to do was x, etc...
The rational brain is suppressed in situations like these.
The only way to deal with them is frequent high-stress training and accumulating as much of theoretical knowledge as possible.
Take a look at this (what they were seeing):

https://i.imgur.com/I3JhewY.png
© Swedish Accident Investigation Authority | Creative Commons Attribution 2.5 Sweden

Alarms screaming at you, negative G's hitting you, you don't know what's happening, adrenaline rushing through your body with your body clock asleep, no outside visibility, you're disoriented; yes, I can definitely see them losing it. At that point it would've been difficult to recover. I agree the initial reaction was not supposed to be so swift as the flight was smooth and stable but what do they teach us: never trust your senses in LVC, your ADI is your life. And this instrumental piece of equipment, which was guiding the pilot his whole life without error and which had earned his deep trust, ended up betraying him.

To include the (only) two recommendations:

How about instigating additional and more frequent training including curricula concerning human performance in distress, communication, crosscheck, unusual attitude recovery, high altitude flight dynamics...

When you have a 'STALL, STALL' warning yelling at you for a full minute and you still don't figure you're in a stall, we have a different set of problems to solve.

It's easy to shove it on the two fellows who can't defend themselves and call it a day, but remember, a fish rots from the head down.
The next time you load up and takeoff, know that the fish is still rotting and the clock is ticking. 'Safe flight.

"the fact
that there was no training method for effective communication in an
unexpected or abnormal situation and that the crew therefore had not
practised this contributed to the crew not being able to jointly identify
the problem in time"

The operator has to be the main culprit here, not having a training standard that at least addresses this BASIC CRM issue.
Any "normal" fault detection should at least be confirmed by 2 or more parameters, and cross referenced between the crew.

Both crew was relative "low experienced" guys, however in my opinion the operator does not seem to have had a sufficient high standard of training, leading to an event like this being allowed to happen. Basic CRM and Error fault management seems to have been completely lacking.

Wrist Watch : Absolutely. Fully agree with you .
After an accident ,Humans and pilots in particular always tend to (and like to) go into a safe protection mode : "this will not have happened to me " . We all have this .
Writing about it here brings nothing except perhaps make themselves feeling better.

We have numerous human factors studies explaining you the "why" and "what" happens in your body/brain when faced into a extreme highly stressed situation . Listening to multiple audio warnings and blinking warning lights rather add to the confusion/stress rather than helping to solve the problem . So I always get a bit annoyed when I read that : " they had a stall warning and did not react as they should have ...etc..."

Likewise, focusing on a single wrong display in isolation and being mind set in correcting it, disregarding other options, is a well known phenomena, known to be aggravated when occurring in middle of the night.
The 3 Miles Island nuclear accident report covers it quite well.
More recently the AF447 BEA report mentions it as well.

What make some posting here so sure they would not be subject to the same human factors ?

The fact that it took 80 seconds from flying a fully serviceable aircraft, until it was all over, in itself is a chilling factor!

And it's true I believe, it could happen to us all, if the Swiss Cheese holes lines up correctly, it's easy to be keyboard experts. Let's not mention the F or S word, because of course nobody wants to ever acknowledge that.

Yes, a very sad event. It is disappointing that these guys were not effectively trained to a standard that is required to operate the aeroplane at the safety factors required by its certification. Sad, and a hard lesson for others to learn from!

One thing to keep in mind that as much as we'd like to think otherwise, all humans are NOT created equal. We have people with above average skills and cognitive abilities, and people below average. The top 75 percentile will pass any exam designed for the average, the pilot profession is no different. Automation, SOPs and CRM have made enormous advances towards ensuring that the real-life performance of those with above and below average skills are not that far apart anymore. However there always be the odd unexpected situation where superior skills save the day (Sully) and below average skills lose it (AF or this one).

The direct cause in this case was the PF reacting subconsciously to one piece of information, which was seeing a big and increasing piece of blue of the PFD, no doubt the result of many hours of training and conditioning to follow the ADI regardless any sensory illusions. It would have required that extra touch of superior skills given the circumstances to grasp that if speed, altitude and power setting did not change, the indication must be false.

Given the rarity and unforseeable nature of such failures, it is very difficult to effectively train for them, as by their very nature the required action goes contrary to what one was prmarily trained to do. On the other hand, I'm sure everyone who have read the report will sit on their hands for a few seconds in a similar situation. It is a matter of learning from and avoiding other's mistakes.

IMO, to handle the situation in this event only required training to be able to perform at the minimum standard of skill for being qualified to operate this aeroplane. This event did not require non-standard superior skills to resolve safely, just the correct proceedures! INU failure or Instrument comparitor warnings are not rare or "unforseeable" failures, I have experienced several, including one at night IMC after T/O as PF, and they will continue to happen.

Given that it was middle on night the PF may not have been fully aware of how fast the display had changed.
Even if fully awake he may have had the sensation of having nodded off for a bit so would be less likely to suspect a technical fault.

Anyone who has ever had a close call (or worse) with falling asleep while driving knows the feeling...

Extract from the ACCIDENT REPORT:
"According to the aeroplane’s manufacturer,
the autopilot was most likely automatically disconnected due to
differences in the pitch servo commands. The aural warning remained
active for the next 18 seconds."

There were three pilots on board, PF, PM and AP. Once the one who did all the work decided to quit the job, the other two could not handle the situation. I put it down to yet another case of total capitulation to automation.

They were doing the approach briefing, so this is not likely. He knew that his attention was elsewhere for some time, and was completely startled by the unexpected change in the display when looking back. As several posts earlier noted, with the benefit of hindsight it is easy to say what should have (not) been done, but I really wonder how many would have fallen for the trap under similar circumstances.

andrasz:
Thanks for correction, have not had time to read full report.

May still be partly a 'my fault? technical fault?' decision with known distraction pushing the 'my fault' branch.

Of course even if 'my fault' the correct action is not necessarily immediate extreme corrective action in the same way that swerving to get back on the road is much more dangerous than the initial drifting off.

As others have pointed out it is much easier to see all of this from a calm place in front of a keyboard.

Some real hero pilots here sat typing from the comfort of their laptop keyboards...

Unless you have worked for the operator then you know Jack about the training so please learn a little respect.

The crews that WA have are very good stick and rudder pilots, this event could have happened to anyone...in the middle of the night half asleep at the controls it's a different storey than sitting in your armchair in front of a keyboard ....

+1 Livesinafield.A few have andrasz. Brave person to put up his hand say couldn't happen to me.

There is nothing new under the sun, for those who wish to criticise rather than understand, some previous accidents brought about for exactly the same reasons.

Korean Air Cargo Flight 8509 - Boeing 747, Stansted
Air India Flight 855 - Boeing 747, Bombay
Copa Airlines Flight 201 - Boeing 737, Panama to Cali

Possibilities

Pan Am Flight 816 - Boeing 707, Papeete
Viasa Flight 897 - DC-8, Portugal

At every SIM we always have to do an EFATO, a OEI ILS to a go-around and a OEI NPA to land.

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.

Pilots should of course be able to fly manually. (I have flown Southampton to Prague with no autopilot - and it is possible, but very tiring, keeping to +/- 200' for 2 and a half hours). However, there is no getting away from the fact that skills become rusty if not used. In addition, some situations such as AF447 have never been seen by most pilots. (see my post #1119 in the AF447 number 12 thread).

It is all very well writing words on a page in the FCOM/FCTM about how to deal with a problem, but another prospect entirely to recognise and deal with a possibly complex, confusing problem, with no external cues, no previous practice and no warning.

If you showed a concert violinist a piece of Stephane Grapelli music, (jazz violin), and let them read it as much as they wanted, but did not allow them to play or practice it even once; how would it sound the first time they were asked to actually play it? Perfect, or awkward and stilting? Being different from the concert music they were used to, they might not initially be able to play it at all.

In reality of course, the concert violinist would practice the music on their violin over and over again at home before performing it, but we cannot take our airplane home, or use the SIM to practice, and yet we are expected to be able to recognise and react correctly to every possible situation, even if we have never experienced it at all.

Several posters referring to keyboard warriors as in suggesting that nobody could have survived an instrument failure and everybody would have died in the same scenario.
:mad:
This scenario has been along for year: One side goes to :mad:, look at the 2 other attitude instruments and compare. Then fly.
Had it happened at night over South America in a B-767.
The secret to survival in this business is to learn from other's mistakes, not just your own. Many similar accidents have happened in the past, hence quite a few companies practice this in the simulator as well as unusual attitude recovery.
It can be confusing, but that is what we train for and get paid for, the good, the bad and the ugly.
This malfunction was very survivable: Compare instruments, rignt side is good: "you got it, you fly it".

The report gives a comprehensive overview of the limitations of human performance, but then by inference, cites the human as a cause by requiring more procedures and training.
More callouts and procedures are unlikely to be effective, particularly in situations where human mental resources are minimal and also because hearing degrades before the other senses.

Many (most) LoC accidents involve misunderstanding a complex situation, and based on this, inappropriate action results in upset conditions; the aircraft were not 'upset' to begin with. Also, each crew member's understanding appeared to differ such that it was impossible to communicate helpful information, at least until the event progressed, often to the point on no recovery.

Because of the human limits we should not expect to see any cross monitoring or CRM in this type of accident. This is an important safety issue particularly as the industry increasingly relies on these safety aspects, in extreme situations like in this accident they may be unavailable.
We cannot expect the humans to cover for system failures in remote or confusing situations. The reliability of modern technology is now so good that when it cannot function (extremely remote), neither can the human. Furthermore, because it is difficult to identify the circumstances and contributions associated with 'extremely remote' events beforehand, it is unlikely that we can provide targeted training; and why train for the last accident which may have no relationship with the next one (excepting the need for improved awareness and surprise management).

The industry should also consider other less obvious factors which could influence pilot behaviour. E.g. how is upset recovery training taught, has the industry over promoted quick reactions to make a nose-down control input, what scenarios are trained in the simulator.
These 'minor', apparently inconsequential contributions could be disregarded, but in extreme circumstance they may be a significant, although not an immediate apparent aspect. The industry has to be aware of 'Meldrew moments' * "I don't believe it'.

This is similar to citing human error as a cause, which should trigger the need to look deeper in the accident; thus any potential contribution judged "I don't believe it ...' should be reconsidered, look deeper for underlying assumptions associated with a less obvious contribution.

* 'Meldrew moments' (MM) from a British tv comedy involving the catchphrase "I don't believe it'.

@ Uplinker
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 anticipation, but these guys hadn't had that training yet). Would it have made a difference - who knows?

Quite likely.
If you see something in the box one day, then see it on the line the day after, you already "know what to do".