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-   -   NYT: How Boeing’s Responsibility in a Deadly Crash ‘Got Buried’ (https://www.pprune.org/rumours-news/629009-nyt-how-boeing-s-responsibility-deadly-crash-got-buried.html)

bunk exceeder 21st Jan 2020 16:30

Asiana in SFO kind of springs to mind. Still in VNAV PTH, so autothrottles sort of in but not really, and no ILS so not tracking the glideslope when the autothrottles would have definitely been in like every other approach always. But the handling pilot somehow didn’t know what was going on, nor did the other three notice, where hands on throttles would have helped and there should have been been, and always should be an obsessive focus on airspeed. And vertical speed for that matter.

HPSOV L 21st Jan 2020 18:25


Originally Posted by bunk exceeder (Post 10668131)
Asiana in SFO kind of springs to mind. Still in VNAV PTH, so autothrottles sort of in but not really, and no ILS so not tracking the glideslope when the autothrottles would have definitely been in like every other approach always. But the handling pilot somehow didn’t know what was going on, nor did the other three notice, where hands on throttles would have helped and there should have been been, and always should be an obsessive focus on airspeed. And vertical speed for that matter.

That’s not quite what happened. The trainee was slightly high on approach and had selected FLC mode to increase the descent rate. When he then input the Missed App Alt into the MCP the aircraft started to climb to the new, higher altitude. He disconnected the autopilot and closed the thrust levers manually to regain the profile from above. In doing so the auto throttle did an indirect mode change from speed controlling to HOLD which, as we all know in hindsight, will not wake up.
As in the Turkish case the situation was coincidentally masked by intercepting the glide path from above and it occurred at the end of a long duty.
Now years later Boeing is fixing the HOLD trap in new aircraft, but a simple EICAS caution should have been introduced years ago.
Ditto the Dubai 777 crash due to TOGA confusion. They should’ve introduced aural feedback for inactive switch selection but they haven’t.
So, given FOQA fear g/a are the norm these days this accident will happen again. In fact it came damn close a couple of weeks ago.

The airmanship argument is a distraction that gives the manufacturers a free pass.


RetiredBA/BY 21st Jan 2020 18:52

Perhaps I have been missing something, BUT in my experience of the 737 ( a delightful aircraft)
as a TC with 7000 hours on type I used to teach that if the automatics are not doing exactly what you require, or you dont quite understand a particular aspect of the system, disconnect the AP and AT and FLY the damned thing.

It is, after all, just an aeroplane, fly the jet as such, using the yoke and thrust levers, simple.,

If you cant do that you should not be in airliner cockpit.

HPSOV L 21st Jan 2020 19:35


Originally Posted by RetiredBA/BY (Post 10668229)
Perhaps I have been missing something, BUT in my experience of the 737 ( a delightful aircraft)
as a TC with 7000 hours on type I used to teach that if the automatics are not doing exactly what you require, or you dont quite understand a particular aspect of the system, disconnect the AP and AT and FLY the damned thing.

It is, after all, just an aeroplane, fly the jet as such, using the yoke and thrust levers, simple.,

If you cant do that you should not be in airliner cockpit.

Well that’s what the Asiana guy thought he was doing.

I’ve sat in many flight safety and CRM sessions and bar talk over the years where old hands tut-tutted and said “how could they do that?”. And years later the same get caught out themselves in similar circumstances.

The subtle point is that in all these cases the aircraft state wasn’t recognised due to masking or distraction. Humans take time to perceive and comprehend an unexpected situation when they have a preconceived mental plot. It took Sullenberger 30 seconds.

That’s why, in this age of system complexity and monitoring automation, it is vitally important that manufacturers keep improving cockpit ergonomics and don’t get let off the hook.

Herod 21st Jan 2020 19:37


It is, after all, just an aeroplane, fly the jet as such, using the yoke and thrust levers, simple.,

If you cant do that you should not be in airliner cockpit.
Well said that man

Twitter 21st Jan 2020 19:55

Actually it’s not so simple in the Max case - flying manually allows MCAS to run - AP on inhibits MCAS.

In fault mode, switching off the automatics - or thinking you have, leads to this Gotcha, where you still have a rogue system fighting you.

As it happens, leaving flap out and or AP engaged would have enabled an approach to land - but who could know that at the time?

So the macho just fly it method has its limits.

PJ2 21st Jan 2020 20:09


Originally Posted by RetiredBA/BY (Post 10668229)
Perhaps I have been missing something, BUT in my experience of the 737 ( a delightful aircraft)
as a TC with 7000 hours on type I used to teach that if the automatics are not doing exactly what you require, or you dont quite understand a particular aspect of the system, disconnect the AP and AT and FLY the damned thing.

It is, after all, just an aeroplane, fly the jet as such, using the yoke and thrust levers, simple.,

If you cant do that you should not be in airliner cockpit.

It is surprising and somewhat disappointing that "holier than thou" hindsight & blame statements still have credibility among aviation people.

"What you think should have happened does not explain people's behaviour." - Sidney Dekker, Ch. 5, "They Should Have . . .", p.39, The Field Guide to Understanding Human Error;

alf5071h 21st Jan 2020 21:38

Re PJ2 ref to S Dekker # 49;
the very apt publication of Dekker's report below to the Dutch Authorities which the NYT cites as being dismissed following Boeing intervention, # 1.

Only read the summary so far, but … concluding …

"A breakdown in CRM (Crew Resource Management) cannot be substantiated for TK1951."

"The length of B737 type training at THY, as well as procedural compliance at THY, appear to at least match industry standard."

"Post-accident manufacturer recommendations that, in effect, tell flight crews to mistrust their machine and to stare harder at it not only mismatch decades of human factors and automation research, but also leave a single failure pathway in place."

"Shortly after the accident, Boeing issued a bulletin to all 737 operators and announced that it “will warn crews about fundamentals like flying the aircraft, monitoring airspeed, [and] monitoring altitude” (Learmount, 2009).
The only defense against a designed-in single-failure path, in other words, are the pilots who are warned to mistrust their machine and to stare at it harder. Such a reminder, oriented only at the human operator in the system, is hardly credible after three decades of in-depth research into automated airliner flying and the subtle and pervasive ways in which automation on the flight deck (and particularly its subtle failure) affects human performance (e.g. Wiener & Curry, 1980, Sarter et al., 1997). For flight crews of Boeing 737’s, like the crew of TK1951, there is no sufficient training, no written guidance or documentation, and no likelihood of line experience that would insulate them from the kind of automation surprise that happened near Amsterdam on the 25th of February."


https://www.onderzoeksraad.nl/nl/med...t_s_dekker.pdf

CargoOne 21st Jan 2020 21:55

Meanwhile Airbus is doing A350 fully automated take off trials - one step closer to make a significant improvement to the flight safety by eliminating the weakest link...

safetypee 21st Jan 2020 22:28

CargoOne, re your 'weakest link' # 51,
See # 50, read the report, then reconsider where the weakest link is.
Human, most probably, but not those flying the aircraft, nor requiring elimination.

retired guy 21st Jan 2020 22:32


Originally Posted by Snyggapa (Post 10667829)
statistically, there must be. And also statistically, nearly half of your pilots will be below average.

Don't design products to be safe only if used by the average pilot

Serious question - has anyone ever come off a long duty period and into a sim to see how their fatigued self reacts in an emergency?

Hi Synggapa
your maths is of course correct. There must be an average pilot half way between the best and the worst. Now the worst has to exceed the minimum requirement, and in a good airline that minimum will be above the CAA bar by some good margin. So your worst pilot is still pretty good. Your average pilot, a bit like me , somewhat better. and while not the best in the world, still hitting high ratings with no fail points and minor debriefing areas.And then the best pilots way up there much higher and probably get 100% in proficiency. Every time. So you can let your average pilot fly anything you can throw at him. Then there are the 200 airlines that aren’t allowed to fly in EU AIRSPACE. They clearly lie below the minimum EU. EASA requirement and their average pilot must have a lot difficulty passing checks etc.

as for being tired after a long day, yes I have and once or twice had to do my OPC after, on following morning. . Can’ t remember outcome so must have been ok.
doe that cover what you wanted.
R Guy

OldnGrounded 21st Jan 2020 22:38

Dutch regulators have just published the study cited in yesterday's NY Times story:


A Decade Later, Dutch Officials Publish a Study Critical of Boeing

After a Boeing 737 crashed near Amsterdam more than a decade ago, an expert study that sharply criticized the manufacturer was never published by the Dutch safety authorities, and its key findings were either excluded or played down in their accident report.

On Tuesday, the Dutch Safety Board, which had commissioned the study, reversed course — publishing it a day after The New York Times detailed the findings.

The Times’s review of evidence from the accident, which killed nine people on a Turkish Airlines flight in 2009, showed the study’s conclusions were relevant to investigations into two more recent crashes of Boeing aircraft that killed 346.

[Read The Times’s investigation here.]

The study, by Sidney Dekker, acknowledged that the pilots made serious errors but also found that Boeing bore significant responsibility. It accused the company of trying to deflect attention from its own “design shortcomings” with “hardly credible” statements drawing attention to the pilots’ mistakes.

A spokeswoman for the board had told The Times last week that Dr. Dekker’s study was confidential. But in a statement on Tuesday, Jeroen Dijsselbloem, chairman of the Dutch board, said the study had been posted online because the board’s “current practices” had changed. “We now publish as much as possible,” he said.

The board also defended its investigation of the 2009 crash, which involved a 737 Next Generation, or NG, a predecessor to the 737 Max. The more recent accidents involved the Max, which has been grounded since last year as investigations continue.

Mr. Dijsselbloem noted “the key question” for those investigations was whether lessons from 2009 “were sufficiently learned by Boeing and the American authorities.”

Multiple aviation experts who had read Dr. Dekker’s study told The Times its findings had not been sufficiently incorporated into the final Dutch accident report. In addition, the Times learned, the Dutch removed or minimized criticisms of Boeing after pushback from a team of Americans that included the manufacturer and federal safety officials.

Jan Paternotte, a member of the Dutch House of Representatives, praised the study’s release but called for a hearing of those involved, saying he believed he would secure the necessary support during a committee meeting on Wednesday. “Boeing has been capable of strong-arming outside parties if it serves the short-term interest of the company,” he said. “When safety is at stake, that is a problem.”

The Dutch board on Tuesday acknowledged that it had changed portions of its draft report after the Americans raised objections, but called that “standard procedure” and noted that the Americans’ comments were included in an appendix.“The Dutch Safety Board does its work in strict independence,” Mr. Dijsselbloem said. “The Board decides independently on the outcome of its investigations, the content of its reports and its conclusions and recommendations.”

A Boeing spokesman referred questions to the National Transportation Safety Board, which led the American team that commented on the Dutch draft report. An N.T.S.B. spokesman declined to comment.

The Federal Aviation Administration, which was also a member of the American team participating in the 2009 inquiry, said in a statement that it was “following a thorough process for returning the Boeing 737 Max to passenger service.” The agency added that it was working with international safety regulators to review “proposed changes to the aircraft” as well as “recommendations from safety experts who have examined our certification processes.”

The Dutch board’s final report, released in 2010, focused blame on numerous mistakes by the pilots, including their failure to notice a dangerous drop in speed and their incorrect response to an alert warning of an impending stall. The report contained statements — some nearly verbatim and without attribution — that were originally written by the American team and further emphasized crew errors.

The Times found striking parallels between the accident and the 737 Max crashes. In both cases, design decisions by Boeing allowed a single faulty sensor to activate a powerful computer command. In both cases, Boeing had known of the potential sensor failures but determined that pilots would react correctly and recover the plane. And in both cases, Boeing didn’t include information in the pilots’ manual that could have helped them respond to the malfunctioning automation.

Boeing, the F.A.A and the N.T.S.B. noted that the system involved in the earlier accident differed significantly from the one blamed in the Max crashes. But aviation safety experts, including a senior F.A.A. official who was not authorized to speak publicly, told The Times that the similarities were noteworthy.

Dr. Dekker’s report “should have woken everybody up,” one said. Instead, “the issue got buried.”

zerograv 22nd Jan 2020 00:09


Originally Posted by retired guy (Post 10667666)
In what way was Boeing not forthright about 737 at Amsterdam design please? Not being picky- just don’t get the point.
Thanks
R Guy

A few paragraphs from what the NYT wrote. Link is at the very begining of this thread.


Critically, in the case of the NG, Boeing had already developed the software fix well before the Turkish Airlines crash, including it on new planes starting in 2006 and offering it as an optional update on hundreds of other aircraft. But for some older jets, including the one that crashed near Amsterdam, the update wouldn't work, and Boeing did not develop a compatible version until after the accident.

Five years before the Turkish Airlines crash, Boeing was aware that a sensor malfunction could idle the engines improperly, but the company decided it wasn't a safety concern, the Dutch investigators wrote.

The safeguard was available in 2006, but the change wouldn't work on some 737 NG models, like the Turkish Airlines plane, that used an autothrottle computer made by a different company. After the 2009 crash, Boeing developed a version of the update compatible with those computers, and the F.A.A. required airlines to install it.

Old Dogs 22nd Jan 2020 01:16

https://www.cbc.ca/news/business/boe...fety-1.5426571

FlexibleResponse 22nd Jan 2020 05:03

Very well researched, analyzed and presented, by Sidney Dekker. A belated well done sir!
A shame that the report has taken 10 years to surface. It is still as valid today as it was then.

Just read pages 117-121 "Findings and Conclusions" if you are time constrained.

https://www.onderzoeksraad.nl/nl/med...t_s_dekker.pdf

Old Dogs 22nd Jan 2020 05:35


Originally Posted by FlexibleResponse (Post 10668496)
Very well researched, analyzed and presented, by Sidney Dekker. A belated well done sir!
A shame that the report has taken 10 years to surface. It is still as valid today as it was then.

Just read pages 117-121 "Findings and Conclusions" if you are time constrained.

https://www.onderzoeksraad.nl/nl/med...t_s_dekker.pdf

The fact that it was buried is criminal, in my view, but it shows the power of Boeing, ..... and America.

safetypee 22nd Jan 2020 06:55

Captain Biggles 101, and RetiredBA/BY, Herod, - just disconnect the autos - click click -

The operator needs sufficient information to trigger the point at which to act. Reliance on deduction or situational feedback of aircraft motion - when the aircraft is flying as expected, is not tolerable mitigation for (known) weakness in design. cf Aisiana.
Instead of looking at people as a hazard, to be guarded against; see them as an asset, a help in managing unusual situations as they do very successfully in operations every day. With such a view, then rare misjudgments in challenging situations are best answered by considering what more can be done in the operational environment, including automation, to assist people manage a wider range of situations.

HPSOV L, #44, 46, PJ2 # 49 :ok:


alf5071h 22nd Jan 2020 07:57

fdr, #58 :ok: No such thing as an average pilot.

A valuable list of regulatory references.

Many countries and individuals should heed the chastisements, but the most important language, that written in American English ( NW manufacture and regulation, and South Side Mall DC dialects ), is absent.

Even after stating a 'truth', it has to be recognised and heeded as important. Furthermore, 'truths' have to withstand legal advice as how to design, certificate, document, and present training requirements.
The industry has to be increasingly reminded of the challenges on its integrity; the need for safety above protectionism.

Well done to the Dutch Investigators in openly posting the 'Dekker report'; something more significant than the original accident report, and which raises the standards for investigation, reporting, and acting on recommendations.

Similarly for Dr Dekker; the HF report should be promoted as an HF primer - not detracting from the excellence of his books.
His report must be required reading for people at all levels of manufacture and regulation, especially bean counters and lawyers, and not least ourselves.
A gateway for change, improving our industry.

retired guy 22nd Jan 2020 07:58


Originally Posted by OldnGrounded (Post 10668084)
I don't think anyone is arguing that the Turkish Airlines crew wasn't largely responsible for the AMS crash. The point is simply that Boeing also had some responsibility and worked hard, apparently along with US regulators, to keep references to that out of the investigative reports.

Ok point taken and apologies for missing your well made argument.
R Guy

the_stranger 22nd Jan 2020 08:36


Originally Posted by safetypee (Post 10668528)
Captain Biggles 101, and RetiredBA/BY, Herod, - just disconnect the autos - click click -

The operator needs sufficient information to trigger the point at which to act.

Shouldn't the MEL have been sufficient information to not use the autothrust?

As a known complaint, with two succesful flights before, surely they had that information if they did their job?


sleeper 22nd Jan 2020 09:24


Originally Posted by Twitter (Post 10668553)
So it is. When you have presidents and their cohorts talking in thug speak and acting thug act, you mustn’t be surprised to see that behaviour further down the ranks.

If you want it to be great again, much work is required.


May I remind you that the president hinted at here was nowhere near being one when the turkish accident happened.

Bergerie1 22nd Jan 2020 09:27

Cap'n Biggles Sir,

Your excellent post about the need for the industry to give pilots the chance to hone their skills in everyday operations is very much to the point. When the automatics start doing something that is not as intended, we need not only better annunciation, but even more important, to have pilots who are sufficiently confident and well-practiced in their handling skills that they can immediately detect a departure from the intended flight path/configuration/speeds/altitudes/etc using the primary flight instruments, and then be able and confidently to handfly until the problem has been sorted.

From what I read, these days at a distance, current airline SOPs actively discourage the development and maintenance of these skills.

fdr 22nd Jan 2020 09:58


Originally Posted by the_stranger (Post 10668593)
Shouldn't the MEL have been sufficient information to not use the autothrust?

As a known complaint, with two siccesful flight before, surely they had that information of they did their job?

MMEL:

22-04 Autothrottle Systems C/1/0.
May be inoperative provided approach minimums do not require its use.

34-20-01 Radio Altimeter Systems

20-01-03. C/2/1 (M)(O) May be inoperative deactivated provided:
a) Approach minimums or operating procedures do not require its use,
b) Associated autopilot is not used for approach and landing,
c) Autothrottle is not used for approach and landing, and
d) Associated flight director is not used for approach and landing.
NOTE: During takeoff with one radio altimeter inoperative, the flight directors and autopilot should be controlled by the FCC on the same side as the valid radio altimeter (i.e., the first flight director and/or autopilot to be engaged must be receiving valid radio altitude data).

TK1951's fault was an airborne fault, and the MEL (a subset of the MMEL above) is not specifically applicable at that time, any NNCL or abnormal checks would apply. The MMEL hints to the interaction of an RA and the AT, but it isn't a glaringly obvious relationship when encountered at 500' AGL.

RetiredBA/BY 22nd Jan 2020 11:00


Originally Posted by HPSOV L (Post 10668253)

That’s why, in this age of system complexity and monitoring automation, it is vitally important that manufacturers keep improving cockpit ergonomics and don’t get let off the hook.

.....and even more important that basic handling skills are improved by many operators.

I have never flown a. NG but we had none of the current electronics in a -200, we managed perfectly
well but the arrival of the -300 made life even easier.

Sad to see the decline in basic skills of so many operators, almost all cost driven.

BDAttitude 22nd Jan 2020 11:27


Originally Posted by FlexibleResponse (Post 10668496)
Very well researched, analyzed and presented, by Sidney Dekker. A belated well done sir!
A shame that the report has taken 10 years to surface. It is still as valid today as it was then.

Just read pages 117-121 "Findings and Conclusions" if you are time constrained.

https://www.onderzoeksraad.nl/nl/med...t_s_dekker.pdf

Indeed. And the second to last sentence should be hanging in any office of engineers designing and developing automation systems. Not only in aviation. But especially on the left coast of the US (Yes I'm looking at you Boeing & Tesla!).

The only defense against a designed-in single-failure path, in other words, are the pilots who are warned to mistrust their machine and to stare at it harder. Such a reminder, oriented only at the human operator in the system, is hardly credible after three decades of in-depth research into automated airliner flying and the subtle and pervasive ways in which automation on the flight deck (and particularly its subtle failure) affects human performance (e.g. Wiener & Curry, 1980, Sarter et al., 1997).

BRE 22nd Jan 2020 12:09


Originally Posted by Captain Biggles 101 (Post 10668403)
Well, here's the real problem. Put simply, there are far too many pilots that cannot perform and fly aircraft properly within its normal flight envelope well in all normal conditions, let alone with complex demanding technical issues when least expected and possibly fatigued. Talk to most long term sim TREs and they will tell you they have witnessed terrible things. The real question is how did we get to this? What lowered the standards? Who permits this? Are we heading in the wrong direction with children of the magenta just obsessed with the OFDM improved event safety stats, whilst we now witness terrible crashes where crews handle some serious events badly creating crashes? Look at Air France the crews pulling back for an eternity not recognising the stall; look at Turkish, not monitoring speed and thrust; look at several airliners below stall speed 85-100 kts with severe upsets following high power go arounds badly handled by crew. The writings in the wall, we need higher standards, and less self regulated back slapping.

Indeed, if crews cannot perform to the highest standards, they should not be on the flight deck. We cannot just blame solely aircraft design. This is a job for professionals to be just that.

The sooner we bring back respect for experienced professional flight crew the better. Right now there is a constant race to the bottom, whereby financial incentives push airlines to constantly favour inexperience pulling in at the bottom end, to the detriment of experience and safety. Then the self regulated training and checking just pushes crew through onto line. We need higher standards of training, experience and ability on the flight deck, then we must support those standards to be practised and maintained ready for any eventualities requiring that full demonstrated competence. Get rid of children of the magenta and get back to the important basics.


Not sure about that. There were plenty of accidents on steam powered aircraft that were due to loss of SA and lack of professionalism in the old days.

OldnGrounded 22nd Jan 2020 12:55


Originally Posted by retired guy (Post 10668569)
Ok point taken and apologies for missing your well made argument.
R Guy

No problem. We're all just trying to sort out a truly complex and confusing situation.

FYI, here's the relevant finding re: inadequate documentation, item 6 of Dekker's findings and conclusions:


Based on their training and documentation, the TK1951 crew would have believed that they had protected their aircraft and its flight from any pre-existing problems with the left RA. The right autopilot (known as Autopilot B or CMD B) had been selected on, and the right Flight Control Computer (known as FCC B) was giving it inputs.

Boeing pilot training materials and documentation do not reveal that the autothrottle always gets its height information from the left Radio Altimeter, that, on pre-2005 737NG models, it doesn’t cross-check its RA input data with other RA data; and that the right RA does not provide input to the autothrottle—even when FCC B has been selected as Master and Autopilot B is flying (which was the case for TK1951).

Clandestino 22nd Jan 2020 14:47


Originally Posted by alf5071h (Post 10667448)
The NYT article, and the accident report, should reinforce the wake up call emerging from the Max saga. Not specifically directed Boeing, FAA, NTSB, but for world manufacturing, regulation, investigation and operations.
Alternatively as a bold safety statement, publishing the report anonymously with the objective of learning and changing even at this late stage.

Uh-huh. It was the world's company that designed and built 737-800. It was the world's certifying authority that rubber-stamped it. It was the world's investigation organization that put the pressure on the Onderzoeksraad to play down the technical aspects of the disaster so it seems that the world was quite responsible. I wish there were some way we could narrow down the responsibility, at least to the country level or so.


Originally Posted by Brian Pern (Post 10667650)
Today's sky gods are so full of themselves with all the latest shimmy kit, they don't have an inkling of airmanship.

Safety statistics do not corroborate your claim.


Originally Posted by Old Carthusian (Post 10667681)
There will always be pilots who are unable to respond effectively in an emergency or anomalous situation just as there are pilots who can do so successfully.

So, in which group falls the captain of FlyDubai 981? Could he fly the missed approach or not?


Originally Posted by wonkazoo (Post 10667727)
What the heck is "airmanship" and why is it so great at saving airplanes that have been poorly designed??

The greatness of airmainship lays in the fact it is cheaper than properly designing the aeroplanes plus you can always count on the (volunteer) army of fans to berate the pilots killed in the poorly designed aeroplanes for the lack thereof, thereby moving the focus from design to pilot.


Originally Posted by maxxer (Post 10667731)
As slf that article gives me shivers and i think this thread should be deleted asap.

You might be able to stop the PPRuNE, but in the grand scheme of the things, PPRuNe is insignificant compared to the New York Times and it's the one you can't stop. Reporters have smelled the blood.


Originally Posted by fox niner (Post 10667791)
The only up-side of flying a 737, is that it makes you a better-than-average pilot. If you can fly a 737, than you can fly ANY Boeing airplane.

I am glad to read that, as I have found 738 to be far easier to fly than Q400 and maybe I'll be searching for another type rating pretty soon.


Originally Posted by alf5071h (Post 10667822)
wonkazoo, Ascend Charlie, et al,

Airmanship is a personal attitude to flying, why we do it, how we do it. Airmanship must grow with training, experience, and personal exposure. It is not just about staying alive or not bending the airplane or yourself, it is about walking off the airfield knowing that you have both performed and crafted an activity. You have been totally aware of what you have done and why you enjoyed it, and a that point you owe nothing to anyone.

If we go by this definition, that leans heavily on the pilot's self-appraisal instead of the consequences of his or her actions, well then late Arthur "Bud" Holland would be one of the airmanshipest pilots that have ever walked the Earth. If we conveniently edit Czar 52 flight out of his biography, that is.


Originally Posted by Captain Biggles 101 (Post 10668403)
Put simply, there are far too many pilots that cannot perform and fly aircraft properly within its normal flight envelope well in all normal conditions, let alone with complex demanding technical issues when least expected and possibly fatigued.

Safety statistics do not corroborate your claim.


Originally Posted by Captain Biggles 101 (Post 10668403)
Talk to most long term sim TREs and they will tell you they have witnessed terrible things.

Pilots who perform terrible things are retrained until they do their flying in non-terrible way or are washed out.


Originally Posted by Captain Biggles 101 (Post 10668403)
The real question is how did we get to this?

We got to what? To humongous discrepancy between real world's flying safety and PPRuNeload of claims we are doomed because pilots today can't fly? I would guess that huge holes in understanding how the modern aviation works and unwillingness to face the fact that air travel has never been safer were filled and compensated by industrial quantities of imagination and self-righteousness. Whether psychotropic substances played part, I can't speculate at the moment.


Originally Posted by Captain Biggles 101 (Post 10668403)
Are we heading in the wrong direction with children of the magenta just obsessed with the OFDM improved event safety stats, whilst we now witness terrible crashes where crews handle some serious events badly creating crashes?

If there is really a plot to improve safety stats by killing less passengers and crew, I will gladly join it.


Originally Posted by Captain Biggles 101 (Post 10668403)
We cannot just blame solely aircraft design.

You as "we" don't matter at all. FAA is blaming design enough that it grounded it and keeps it grounded.


Originally Posted by Captain Biggles 101 (Post 10668403)
Right now there is a constant race to the bottom, whereby financial incentives push airlines to constantly favour inexperience pulling in at the bottom end, to the detriment of experience and safety.

There are no statistics or studies to corroborate your claim that safety is somehow diminished through the lack of experience. Personally, as someone who has flown with quite a few MPLs, ex-fast jet jocks and wobble to planks, I find the claims that the training standards are getting lower or that MPL is the doom of us all fairly ridiculous. Actually, those who tried hardest to kill me, themselves, our cabin crew and our passengers were the graybeards in the LHS who picked up all the wrong habits through experience.









flash8 22nd Jan 2020 18:54

We have been here before have we not, albeit many, many years ago with the THY DC-10 at ermenonville, a senior Convair engineer (subcontractor) on the project warned of a "fundamental failure mode" with the cargo door latching mechanism, which for reasons that remain murky to this day were never actually fixed on the fateful aircraft (ship 29) resulting in catastrophe.

That was the time the FAA chief admitted (wouldn't happen today) they were "Fat, dumb and happy" (verbatim) in oversight, a remarkable statement, they were the only party to come out with a little self-respect from the whole tawdry affair.

That there were no emails, social media or such back then of course, and the stamp on the forms that said the door work had been carried out seemingly falsified (again this was never resolved) with all and sundry denying everything (although the smoking gun was the Applegate memorandum) shows that today, hiding is far more difficult.

There are certainly parallels even though the cases are forty five years apart.

Incidentally the lawsuits that followed were the largest in history at that time (mid 1970's) with McDD never (I believe) admitting full culpability.

Old Carthusian 22nd Jan 2020 23:31

So, in which group falls the captain of FlyDubai 981? Could he fly the missed approach or not?

Tragically the evidence indicates not and the clue is in the conduct of the Aeroflot flight.

OC

OldnGrounded 22nd Jan 2020 23:51


Originally Posted by Old Carthusian (Post 10669086)
So, in which group falls the captain of FlyDubai 981? Could he fly the missed approach or not?

I think that captain falls into the group of exhausted pilots repeatedly fatigued by inhuman rostering. Among other things.

Clandestino 23rd Jan 2020 04:56

You got it in one, OldnGrounded, now let me help our friends with somewhat Manichean worldview that separates pilots into sharply defined categories of "good" and "bad" by reminding them that the official report of A6-FDN catastrophe is full of references to successful first windshear escape and go-around, before the second, fatal one. So if we go by the philosophy that there are good and bad pilots (and its quite sinister implication, pervading the MAX threads that the bad pilots destroyed the good aeroplanes) , we would be at loss to explain how the good pilots turned into the bad in the matter of hours.

RetiredBA/BY 23rd Jan 2020 08:45


Originally Posted by Twitter (Post 10668261)
Actually it’s not so simple in the Max case - flying manually allows MCAS to run - AP on inhibits MCAS.

In fault mode, switching off the automatics - or thinking you have, leads to this Gotcha, where you still have a rogue system fighting you.

As it happens, leaving flap out and or AP engaged would have enabled an approach to land - but who could know that at the time?

So the macho just fly it method has its limits.


Excuse my ignorance but isnt the MCAS switched off by the stab.trim cutout switches ?

Trimming by the handwheel.

Nothing macho ( or holier than thou etc.,) about flying a 737 manually, just basic flying skill, which should be possessed by EVERY pilot.

Old Carthusian 23rd Jan 2020 09:43


Originally Posted by Clandestino (Post 10669212)
You got it in one, OldnGrounded, now let me help our friends with somewhat Manichean worldview that separates pilots into sharply defined categories of "good" and "bad" by reminding them that the official report of A6-FDN catastrophe is full of references to successful first windshear escape and go-around, before the second, fatal one. So if we go by the philosophy that there are good and bad pilots (and its quite sinister implication, pervading the MAX threads that the bad pilots destroyed the good aeroplanes) , we would be at loss to explain how the good pilots turned into the bad in the matter of hours.

Clandestino

I would say that 'bad' and 'good' are being used to create unrestricted generalizations. Even though it is the case that there are indeed such 'types' and that certain people are indeed trying to smear the pilots in the MAX accidents to protect Boeing you make your point poorly. The example chosen is a case of a pilot getting it horribly wrong and the first successful go around is irrelevant to the outcome apart from being one of the links in the causal chain which led to a lot of unnecessary deaths. I am all in favour of greater automation as it is likely that it would eliminate accidents like this one but to my mind the issue is more to do with corporate irresponsibility and the moral bankruptcy reigning at Boeing. A pilot should have all the information he needs about his aircraft to be able to fly it successfully. Unfortunately it is an aspect of American corporate life that uncomfortable facts, flaws in the product and developments are hidden if they impact the bottom line. The Boeing behaviour in the Turkish accident is regrettably not unusual and will continue, if not at Boeing, at other companies. It is always thus where money is placed on a pedestal.

The answer is that the regulatory authorities resist this kind of pressure and remain pure. However, this is perhaps a pipe dream.

OC

OldnGrounded 23rd Jan 2020 13:01


Originally Posted by RetiredBA/BY (Post 10669317)
Excuse my ignorance but isnt the MCAS switched off by the stab.trim cutout switches ?

Trimming by the handwheel.

Nothing macho ( or holier than thou etc.,) about flying a 737 manually, just basic flying skill, which should be possessed by EVERY pilot.

Actually, it may well be that trimming with the hand wheels could take as much or more strength than could be mustered, together with some rather fancy (and untrained) flying skills, at some attitudes and dynamic loads. This issue has been part of the discussion since soon after ET 302 went down. Here's a starting point:

https://www.satcom.guru/2019/04/stab...and-range.html

Twitter 23rd Jan 2020 14:00


Originally Posted by RetiredBA/BY (Post 10669317)
Excuse my ignorance but isnt the MCAS switched off by the stab.trim cutout switches ?

Trimming by the handwheel.

Nothing macho ( or holier than thou etc.,) about flying a 737 manually, just basic flying skill, which should be possessed by EVERY pilot.

No point in going over it all again R Baby but briefly those switches don’t switch off MCAS - they switch off the Stab trim, which MCAS attempts to operate. MCAS can only be disabled by Slats out or and AP on.

My poorly made point was that disconnecting AP/AT and flying manually will not on it’s own get you out of this mess, as it would out of most others. Indeed, leaving the AP engaged would be beneficial in the special case of MCAS rogue operation. Problem is the Speed Disagree situation / Stall warning preventing this.

As recommended by Oldn’ see early threads for more on this and Trim wheel diameter problems.

Manual flying is of course not macho (some commentators are.) It is one of the most satisfying things to do and probably why we became pilots.

Ian W 23rd Jan 2020 17:42


Originally Posted by Twitter (Post 10669508)
No point in going over it all again R Baby but briefly those switches don’t switch off MCAS - they switch off the Stab trim, which MCAS attempts to operate. MCAS can only be disabled by Slats out or and AP on.

My poorly made point was that disconnecting AP/AT and flying manually will not on it’s own get you out of this mess, as it would out of most others. Indeed, leaving the AP engaged would be beneficial in the special case of MCAS rogue operation. Problem is the Speed Disagree situation / Stall warning preventing this.

As recommended by Oldn’ see early threads for more on this and Trim wheel diameter problems.

Manual flying is of course not macho (some commentators are.) It is one of the most satisfying things to do and probably why we became pilots.

Switching off stab trim (Stab Trim Cut Out Switches) prevents any stab trimming and that stopped Version 1 MCAS having any effect. So it may have been running inside the STS subsystems - but it could not do anything to affect the operation of the aircraft. From reports the updated MCAS will not repeatedly operate so the main problem of MCAS re-initializing and repeating a ND trim after any electric trim input has been removed in the Max from now on. The initiation of the problem caused by the single point of failure of only using one AoA vane has also been removed by the MCAS being linked to both AoA vanes. In other words the direct MCAS threat has been removed.
So your post should really use the past tense.

BDAttitude 23rd Jan 2020 17:57


Originally Posted by Ian W (Post 10669656)
Switching off stab trim (Stab Trim Cut Out Switches) prevents any stab trimming and that stopped Version 1 MCAS having any effect. So it may have been running inside the STS subsystems - but it could not do anything to affect the operation of the aircraft. From reports the updated MCAS will not repeatedly operate so the main problem of MCAS re-initializing and repeating a ND trim after any electric trim input has been removed in the Max from now on. The initiation of the problem caused by the single point of failure of only using one AoA vane has also been removed by the MCAS being linked to both AoA vanes. In other words the direct MCAS threat has been removed.
So your post should really use the past tense.

We haven‘t seen the updated version life, have you? Just vapour ware. Can‘t see why past tense should be mandatory.

retired guy 23rd Jan 2020 21:34

[QUOTE=BDAttitude;10669672]We haven‘t seen the updated version life, have you? Just vapour ware. Can‘t see why past tense should be mandatory.[/QUOTE

HI BD
I think the three basic fixes to MCAS were developed long ago. It’s just that loss of confidence in FAA is slowing down approval. Past tense is appropriate because by the time it’s recertified, which it will be, the Max Will be the most tested airplane ever- maybe more than Concorde. You have no evidence that it’s “vapour ware”- apart from a hunch?
here is some well reasoned commentary from a couple of sources. Looks good to me.Boeing’s worst ever nightmare just got even worse with an announcement from the company yesterday that its own best estimates for ungrounding of the plane by the FAA have been shifted back to mid-2020.

Updating 737 MAX customers and the investment community yesterday Boeing said that:

“We are informing our customers and suppliers that we are currently estimating that the ungrounding of the 737 MAX will begin during mid-2020. This updated estimate is informed by our experience to date with the certification process. It is subject to our ongoing attempts to address known schedule risks and further developments that may arise in connection with the certification process. It also accounts for the rigorous scrutiny that regulatory authorities are rightly applying at every step of their review of the 737 MAX's flight control system and the Joint Operations Evaluation Board process which determines pilot training requirements.

Returning the MAX safely to service is our number one priority, and we are confident that will happen. We acknowledge and regret the continued difficulties that the grounding of the 737 MAX has presented to our customers, our regulators, our suppliers, and the flying public. We will provide additional information about our efforts to safely return the 737 MAX to service in connection with our quarterly financial disclosures next week”.

Having fallen 5.5% on the back of media reports Boeing shares were suspended ahead of the formal announcement. With close to 5,000 737 MAX planes ordered and so far, 387 of the grounded planes delivered to airline customers and maybe close to 400 currently stored awaiting delivery the next six months will be crucial to Boeing as they also will to airline customers that had hoped the aircraft would have been ungrounded this month and to those that had planned on receiving new aircraft.

In respect of ungrounding the airplane Boeing remains in the hands of the FAA just as it also does internationally with other global regulators that have followed suit in grounding the airplane. Additional software related issues announced by the company earlier this month relating to the power-up monitoring function that verifies some system monitors are operating correctly will likely be a partial cause of the additional delay in ungrounding but with the FAA having been found wanting in the manner in which certification of the 737 MAX was conducted there can be little doubt that regulators are not prepared to allow the aircraft to fly again until they are satisfied on each and every issue involved including airline pilot training is deemed perfect.

Boeing has itself worked extremely hard to ensure that when the 737 MAX is allowed to return to airline service that each and every issue has been resolved. The change in CEO from Dennis Muilenburg to David Calhoun has had a dramatic impact right across the company and led to some radical changes. This is very evident in the more honest, open and transparent manner in which that Boeing is keeping its customers, investors and airline community involved. There may of course be other issues that we may never know about and that relate to how the two tragic incidents occurred – this including possibilities of incorrect pilot operation in regard of the MCAS flight control system that is judged to be the main issue behind both incidents. But the point is that Boeing has put its hands up, taken full responsibility for what occurred and to ensure that when the 737 MAX flies again it will begin the long process of earning a reputation of being a very safe plane.

Speculation as the whether the 737 MAX will fly again is nonsense – it will and my personal view is that while the next couple of years are going to be tough as Boeing reverses the negative profile that has been attached to 737 MAX since the grounding. Boeing has taken all the many negative aspects surrounding the 737 MAX on the chin and it is in my view nonsense to suggest that it might walk away from 737 MAX and, as I heard suggested earlier today, possibly move back to producing 737-800’s.

The cost of 737 MAX accidents and subsequent grounding has been put at around $9.2 billion so far. Undoubtedly this will rise further still in the months ahead. Nevertheless, Boeing is a strong company and it will in my view pull through this crisis in its affairs albeit that there remain many bumps for the company over the next year.

In respect of order Boeing has said that number of 737 MAX planes ordered since the grounding roughly match the number of cancellations received. Airlines continue to have confidence that together Boeing and the FAA regulators will get this right and that 737 MAX will have a good future.

Getting the 737 MAX airplane back in the air is not just an issue for Boeing but also one for its competitors. Growth this year will have been negatively impacted by the 737 MAX grounding and while it is only Boeing’s reputation that has suffered, I venture to suggest that the whole industry has suffered as a result.

As to speculation as to whether Boeing might begin the process of designing a replacement aircraft, for the 737 MAX soon, I would say that this is no more likely today than it was two years ago. 737 MAX just as the main and hugely successful Airbus A320 NEO family of aircraft have evolved from their predecessor aircraft. To design, research, develop and build a completely new aircraft and take it through to certification is a ten-year process. However, I venture to suggest that the next generation single aisle/ narrow body replacements for 737 MAX and the highly successful competing Airbus A320 NEO family of aircraft will be very different from those that we fly in today.

Boeing will not allow itself to fall behind its competitors but I do not believe that it is ready to move into a single aisle replacement process yet. The commercial aircraft industry isn’t built like any other – new aircraft today have to be designed to accommodate not only the needs of the airline industry customer, technological and potential cost advantage but in this day and age, acceptance of greatly increased environmental pressures placed on the manufacturers and which translates to achievement of greatly improved fuel efficiency and ultimately, making greater use of non-fossil fuels.

The bottom line is that the next generation of commercial aircraft will be very different from those of today and it just maybe that while the commercial aircraft industry will continue to grow as those continents such as Africa and South America that have not enjoyed the benefits that we have provide new areas of growth whilst those of us in mature markets place even greater emphasis on environmental issues and cost. Whatever, just as Airbus undoubtedly will, I also believe that when it has moved through this dreadful crisis in its affairs, Boeing will also prosper.


alf5071h 23rd Jan 2020 21:57

Dutch House of Representatives wants to question Boeing
 
Translation from
https://www.telegraaf.nl/nieuws/1151...rkish-airlines

THE HAGUE - On 6 February, the House of Representatives wants to question Boeing's chief executive David Calhoun about a plane crash at Schiphol in 2009. The central question will be whether pressure has been exerted from the United States on investigations by the Dutch Safety Board (OVV). It remains to be seen whether Calhoun will come.

The committee has also invited, among others, OVV chairman Jeroen Dijsselbloem and researcher Sidney Dekker, who was involved in the investigation. Former OVV chairman Pieter van Vollenhoven is also on the guest list.
A Boeing 737 from Turkish Airlines crashed on 25 February 2009 shortly before landing at Schiphol. Nine passengers were killed. The OVV investigated and concluded that the crash was caused by a defective altimeter, in combination with crew errors.

Minister Cora Van Nieuwenhuizen (Infrastructure) said on Tuesday that she cannot assess whether the story is correct. "The OVV itself must state that," said the minister. In her view, it is common for the parties involved to be able to comment on the findings of the Research Council, as long as that is limited to factual inaccuracies. "There must of course never be any influence on recommendations or conclusions."

There must of course never be any influence on recommendations or conclusions.




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