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-   -   Spanair accident at Madrid (https://www.pprune.org/rumours-news/339876-spanair-accident-madrid.html)

justme69 24th August 2008 21:31

The repairs were reported on the press and on TV by spokepersons for the technician as both, having being "disconnected" and having the "fuse removed".

The most sensible scenario seems to be: Pilot informs PAX that he is not proceeding with (first) T/O because a 'red light warning indicator came on' and he is unsure about what it is and wants it checked out by techs, they return to gate (or service area) and repair tech and pilot decide the fault indicated is with the heater to assist probe readings in some weather conditions. Since no danger of those weather conditions exist, they decide in compliance with manual procedures to disconnect it and both signed the plane fit-to-fly. The Pilot informs PAX that it was a fault with a "heat sensor" that was fixed already and they were ready to take-off.

What 'warning light' the pilot was talking about is, of course, not clearly stated anywhere.

agusaleale 24th August 2008 21:45

http://www.elmundo.es/elmundo/2008/08/24/espana/1219602930.html
 

Los familiares de las víctimas del avión siniestrado el pasado miércoles en Barajas nunca podrán conocer las conversaciones de los pilotos que están grabadas en las cajas negras del aparato MD 82 porque están sometidas a "un código de confidencialidad".
Así lo ha asegurado el subdirector de Spanair, Javier Mendoza, al cerca de centenar de familiares de víctimas del accidente con los que se ha reunido durante una hora en el Hotel Auditorium de Madrid y a los que ha mostrado unas diapositivas de cajas negras y croquis sobre su ubicación en un avión de las características del siniestrado.
"Las grabaciones, nunca se harán públicas", ha insistido Mendoza, que ha precisado que únicamente servirán para avanzar en las investigaciones que llevan a cabo la comisión creado a tal efecto por Aviación Civil y el Juzgado de Madrid encargado del caso.
The relatives of the victims of the Spanair flight will never know the conversations betwen the pilots that are recorded in the black boxes, because they are submitted to a "confidentiality code", said Javier Mendoza, Spanair´s vicedirector to one hundred of relatives in Hotel Auditorium in Madrid. He showed them the photos and draws of the black boxes and their position in a plane like the one that suffered the accident. "The recordings will never become public", insisted, and will only be used for investigations to be done by the comission designed to study the case.

PAXboy 24th August 2008 21:52

boardingpass asks about this:

...owed their escape to being thrown from the plane into a stream, thereby avoiding severe burns
One possibility is that, as they shot off the end of the slide - they landed in water.

pappabagge 24th August 2008 22:06

The Canadian Lesson
 
The Canadian Lesson, or "Lex Canada" post the SWR111 disaster; despite Canada having - at least on the statute books - a total capping of public CVR and/or ATC R/T disclosure, it only took a matter of months if not weeks before the world was able to access, download or by other means listen to the actual voices of those involved as the situation developed.

As Spain is involved, I can only imagine the timescale will in this case be shortened by a power of ten.

Transparency, my rear end! :oh:

justme69 24th August 2008 22:08

Survivors have said to find themselves amid mud/water outside the airplane already (didn't specify if still attached to their seats). One survivor speaks of relatives seated by her side and another ambigously accounted as "by her other side" (but could easily be in front, or across the aisle). She said her partner (or brother, I forget) was still by her side (another survivor if I recall correctly) but the other relative, when she went to "check on her" was not in the "right (relative) place" and actually she 'found someone else there' and couldn't find her relative nearby.

Remember virtually no large section of the airplane survived the impact and the fire just took care of whatever was left, but the airplane was already broken in many (actually way many) parts.

This wasn't exactly a large chunk of the plane seats that produced lots of survivors, but an area with relative few obstacles and much softer (and wet) ground where some of them ended up still in not-too-large chunks of fuselage. They say to have felt the shallow water and walk off/crawl off by themselves. One of them, an emergency rescue worker herself that happened to be a passenger in that flight, realized she had a broken femur when she tried to stand up twice after feeling water 'awoke her' and tried to help nearby victims, not very succesfully.

Once the in-flight recordings reach the judiciary system here in Spain, as it has been stated, if they are anywhere near "interesting" they will be leaked to press in all likeness in a short time. This country does not believe in "secret anything".

overthewing 24th August 2008 22:11

That warning light...
 
Warning: not a pilot, so probably about to use all the wrong terminology.

Passenger evidence suggest the pilot saw a warning light displayed, but wasn't sure what it meant.

Of course, it could be that the passenger didn't pick up the pilot's words accurately, but assuming that he did, is it usual for a warning light to be difficult for a pilot to interpret, ie needing an engineer's analysis? I imagine pilots get frequent warning lights, and I've always assumed they could make reasonable sense of them on the flightdeck. If they can't, does that suggest a problem that needs a bit of careful analysis by maintenance staff?

If it was a warning light, that would suggest that the relevant systems had detected something wrong. Would the activation of a probe heater normally set off a red light, or is the pilot simply 'notified' that the heater has switched itself on? Does it make sense for the probe heater to set off a warning light?

The heater deactivation seems to be about the only unchallenged fact we've been given so far, and something about it doesn't make sense to me. If the red warning light was a bit of a mystery, could it be that the 'solution' didn't fix the real problem?

aa73 24th August 2008 22:29


Today Spanair announced that the reason for returning to the gate was the heating system of the temperature sensor. In other words the heating to prevent ice getting on the temperature probe. It was disactivated by the mechanic according to the MEL. The airplane is aloud to fly with it for 10 days before it needs to be repaired. Since the weather was good and there were no icing conditions the decision to depart was correct if what Spanair sais is correct.
It's been a while since I've flown the 80... but doesn't the Thrust Rating Indicator require an input from the TAT probe to compute a thrust setting, whether reduced or max?

Could the inop TAT probe have possibly computed a false thrust setting that results in one much lower than required? (similar to Air Florida, except that ice on the P2 probe caused that one.)

Just curious, what do you folks think?

justme69 24th August 2008 22:37

I'm not a pilot or crew member, but have flown enough to figure out that pilots would usually inform the PAX generically of some warning light/indicator calling for a return to gate to have it checked.

It is quite normal for the pilot just casually mention he/she is unsure of what the problem may be and is opening the doors to allow a technician come on board to check it out.

With a device as "remote" and probably little used in practice on Spain's weather as the outside air temperature probe intake heater, it's reasonable the pilot wasn't compleatly sure what the heck was going on with whatever indication he saw (which maybe wasn't even a "warning red light" but any other light or indication and he was just small-talking the PAX). There was talk of an "overheating warning indicator light" at the beginning of the reports of the accident, but probably that was more of a "heating device malfunction indicator light" instead.

Also, the pilot probably just casually mentioned something like "the heat probe has been fixed" rather than bore the passengers with the more correct "The heating device assisting the temperature probe has been bypassed/disconnected/whatever"

So just take all the reports on a "warning light" or "the pilot being unsure what it was" as 3rd or 4th hand account of casual small-talk on the side of the pilot to the PAX rather than hard, factual accounts.

Unfortunately the more "technical" explanation offered by Spanair didn't mention the exact nature of the indication that the pilot saw (i.e. whether it was a light indication of the device being on when it should've been off, a diagnostic light indicator of some malfunction with the device, the lack of light when there should've been one, etc). What was clearly stated is that both pilot and technician decided it was the heating device causing the problem/warning and it was disabled for the duration of the flight as it wasn't necessary for the expected weather conditions of the flight.

PJ2 24th August 2008 22:46

pappabagge;

The Canadian Lesson, or "Lex Canada" post the SWR111 disaster; despite Canada having - at least on the statute books - a total capping of public CVR and/or ATC R/T disclosure, it only took a matter of months if not weeks before the world was able to access, download or by other means listen to the actual voices of those involved as the situation developed.
Just for the record, it is CVR conversations that are primarily covered by Canada's Safety Board Act. ATC conversations are considered private and privileged under the Act as well but that has been challenged under Canada's Privacy Act by the courts, (which have also challenged the CVR part of the Act and won in one specific case). The following is a small part from the Safety Board Act:

Privilege for on-board recordings



(2) Every on-board recording is privileged and, except as provided by this section, no person, including any person to whom access is provided under this section, shall
(a) knowingly communicate an on-board recording or permit it to be communicated to any person; or
(b) be required to produce an on-board recording or give evidence relating to it in any legal, disciplinary or other proceedings.
Practically speaking, with ACARS trackers, scanners and whatnot and the internet it is too high an expectation that Pilot-ATC conversations will not be subject to you-tube exposure etc, such as the SR111 tapes are. However, the SR111 CVR recordings are not available on the web - only the ATC part is.

Cheers,
PJ2

el # 24th August 2008 22:55

Justme69, all what you say makes perfect sense.
However, nobody so far has been able to confirm how a probe heater malfunctioning (overheat or what else) would lit some light (which one exactly ?) in the panel.
Another unanswered question is about layout of the CBs, which ones are close to the one controlling RAT heater ?
Certainly these are not crucial questions now, but having a definite answer would help dispelling rather than supporting certain theories.

On the investigations side, I learn from Spanish media, that Spanair had denied relatives access to CVR recording, meaning it has been listened already by someone. Consequently, the box reportedly damaged is the FDR, hopefully useful data can be extracted anyway.

justme69 24th August 2008 23:01

It is the flight data recorder the one damaged, while the voice one seems to be in good enough shape. Indeed, a perfectly precise explanation of what made the pilot call-in for a technician is not known, speaking only of a generic "malfunction indicator/red light", but of course could be anything else. What is clear is that technician and pilot agreed it was that device's fault and turning it off would solve the problem temporarily.

overthewing 24th August 2008 23:02


Unfortunately the more "technical" explanation offered by Spanair didn't mention the exact nature of the indication that the pilot saw (i.e. whether it was a light indication of the device being on when it should've been off, a diagnostic light indicator of some malfunction with the device, the lack of light when there should've been one, etc). What was clearly stated is that both pilot and technician decided it was the heating device causing the problem/warning and it was disabled for the duration of the flight as it wasn't necessary.
I'm sure you're right about the announcement to PAX. I'm just curious to know what the pilot would actually see if the probe heater were to switch itself on while still on the ground. Does some kind of light come on in the flightdeck? Assuming that the operation of the heater is a 'silent' activity in normal conditions, ie not notified to the pilot, is there some system for detecting that it's operating when it shouldn't be?

I wonder if any MD-80 pilots / engineers could answer?

(I've spent years of my professional life untangling problems where the real cause is often nothing to do with the visible symptoms, and something about that warning light niggles me.)

xkoote 24th August 2008 23:08

It's a shame........
 
Quote from 777fly,


Xcoote,

Your ignorance of aircraft handling techniques, aerodynamics and mechanics indicates that you cannot be a commercial pilot, surely?

I have no experience of MD80 operation, but if the free air stall speed is 200kts, it will fly at speeds well below that figure while in ground effect.

For other posters, ground effect has nothing to do with air density.
Mr 777fly,

1. Unfortunate how your post singlehandedly dropped the grade of this thread quite a few points.

2. It his highly advisable when insulting someone else you be able to do what kindergarten teachers always say before a test: "Start by writing the name correctly"

3. I never stated that the plane won't fly without slats. I said a certain speed is required.

4. The MD80 strikes it's tail at around 10°. Does anybody know for certain if at this "theoretical" speed 10° of body angle is enough to get the plane airborne?

5. A poster posted 2800 m of runway required in Madrid's case. But it is with flaps 15°. Remember that in a belanced runway departure and on this lenght of runway they would have taken off with less than 5° of flaps.

6. pichu17, we're definitely Mad Dog collegues. This is als a question I had and posted from the beginning. The story of lights in the cockpit and the time when they noticed simply does not add up.

7. Just to give some an idea, at 65t, the flaps up/slat retr stall speed is at around 175 knots. At 2000 feet and 30° the ground speed would be at almost 190 knots.

Hence my question again. (written in italics for those who think I'm arrogant) I find it quite a feat for this plane to rotate and become airborne without flaps or slats, wobble around, then come back down, leave the runway and come to a stop before runway end. It may be possible if we have overestimated this plane's TO weight, which can entirely be the case.

Again to 777fly, it's a shame why you felt the urge to insult a poster based on one post I made where I just wondered how it was possible.

Xander

p.s. a few interesting quotes from the Northwest 255 NTSB report. I highly recommend reading it.


"Witnesses generally agreed that flight 255’s takeoff roll was longer than that normally
made by similar airplanes. They stated that the flight began its rotation about 1,200 to 1,500 feet
from the departure end of the runway, agreed that it rotated to a higher pitch angle than other
DC-9s, and agreed that the tail of the airplane’came close to striking the runway."





Assuming proper takeoff configuration, the airplane should have lifted off between a 6” and 8”
noseup pitch attitude. In this instance, the airplane rotated to an 11” noseup attitude, stabilized at
that attitude, and accelerated to a higher airspeed before liftoff


ExSp33db1rd 24th August 2008 23:43


Never heard this at all...

HarryMann - not a criticism, but I agree with NigelOnDraft, in operating 4 eng. heavies from 1958 to 1994, I also never even heard of timing to V1, but that doesn't mean it was never suggested, but I'm pretty sure it never went beyond the Boffin stage if so, however I was told by a senior RAF Training Captain on V-Bombers that at certain airfields they worked out a distance to achieve V1, or aborted, but it did need marker boards, and the distance was variable for each and every take-of of course, being related to full power, or reduced power take-offs - and a lot of other factors as well, it just wasn't practical for a Worldwide airline to encompass.

el # 24th August 2008 23:57

This very discussion about "time/distance to V1", and the obvious possibility that is automatically checked / flagged by a system, has been had recently on pprune, but I don't remember on which thread.

If I'm not wrong, the outcome was that even if at first it seems something easy and inexpensive to implement in the interest of safety, it can also be opposed for reasons that I don't remember now, but are quite convincing when you hear them.

I do remember however that certain pilots stated they made silent or briefed commitment to abort if they not had reached, say, one half of R/W at the 100 Knts call that some do.

One further demonstration of how difficult is to have changes in the aviation industry and how tortuous is the road to the Good.

Rananim 25th August 2008 00:42


"The National Transportation Safety Board determines that the probable cause of the accident was the flightcrew's failure to use the taxi checklist to ensure the flaps and slats were extended for takeoff. Contributing to the accident was the absence of electrical power to the airplane takeoff warning system which thus did not warn the flightcrew that the airplane was not configured properly for takeoff. The reason for the absence of electrical power could not be determined."

After liftoff, the wings of the airplane rolled to the left and the right about 35” in each direction.

The flight characteristics used to determine the stall speed of the DC-9-80 series airplanes are, in part, “A roll that cannot be readily arrested.. ”


The CVR recording showed that the flightcrew neither called for nor accomplished the TAXI checklist. The first item on the TAXI checklist required both pilots, in response to the checklist’s challenge, to check and verify orally that the flaps and slats were positioned correctly. This item was
not performed, and the flightcrew did not discover that the airplane was configured improperly for takeoff. The omission of the TAXI checklist was further corroborated by the flightcrew’s inability to
engage the autothrottles at the start of the takeoff because they did not, as required by the TAXI checklist place the TCI in the “T.O.” mode.
However, they were able to rectify this omission by the time the airplane accelerated to 100 KIAS. Once the takeoff began, however, there was little chance they would detect any of the visual cues--the flap indicators in the up position, the absence of the blue takeoff light on the slat indicator light panel, and the absence of the ART ready light--that
might have alerted them to the fact that the airplane was not configured properly. All of the visual cues relating to the flaps and slats were located outside, or on the perimeter of, those areas normally
monitored by the captain and the first officer during takeoff. The Safety Board concludes that the failure of the flightcrew to accomplish the TAXI checklist in accordance with required procedures
was the probable cause of this accident.
Quotes from the NTSB report on NWA 255,a DC-9 that crashed on takeoff August 1987 in Michigan,USA.

Evidence against engine failure at Madrid is growing so maybe the answer lies in the past with this DC-9 crash?Is there any connection between the MEL work carrried out and disabling of takeoff config warning system??
I know practically nothing about the MD but the report spoke of 2 automated stall protection systems for the DC9;autoslat and stick-pusher,but both are disabled with slats retracted.Stall recovery technique is to apply and call for MAX POWER,FLAPS 15,release back pressure and avoid secondary stall.

The report speaks of six lines of defence against such an omission(failure to perform a checklist) :


The first line of defense was human vigilance; the second, another crewmember detecting error; the third, secondary indications, such as cockpit displays and instrumentation; the fourth, warning and alerting devices;the fifth, persons other than crewmembers detecting the error, i.e., ATC personnel or ground personnel; and the sixth, machines that take action on their own to rectify the error, i.e., the DC-9-82’s autoslat and stick pusher systems.
If you apply it to the Madrid case you can see how each line of defense could easily have been breached:
-vigilance-the tech problem and return to gate may have distracted crew and lowered vigilance levels
-another crew member detects the problem-"Do you want the before takeoff checklist?" or even "Did we do the checklist?"-again the tech problem could have upset their natural rhythm
-cockpit displays-the blue slat light or ART ready light-TCI not in TO mode distracts them and they miss all the signs and theyd be looking outside mostly anyway.
-warning device-takeoff warning system may have been disabled without the crew realising-was it checked pre-flight?Who checks it?both pilots?Its a major item..in my book,the skipper must check it but many airlines now have the First Officer checking these vital systems pre-flight while the skipper enters the flightplan in the computer!wrong way round.
-ATC-wouldnt apply here
-automated systems-autoslat/stickpusher disabled because slats retracted.

If it wasnt a takeoff warning system fault,then the other possibilities might be:
-blown tire at high speed..improved climb takeoff at hot/high airport,tailwind,slope.. all present at Madrid..
-thrust reverser deployment..but then why the bank left and then right?
- overweight or improper loading...with 2 engines working and correct takeoff configuration,less likely unless the discrepancy was sizeable..combined with another problem,like an engine failure or tire blowout,would be deadly.

sevenstrokeroll 25th August 2008 00:49

Pichu 17 is quite right
 
pichu 17 is quite right...a current indication would not be present on the ground for the RAT probe heater.

AS I said earlier, if the RAT probe was being heated on the ground the EPR information would be very wrong.

Therefore, I believe the plane "thought" it was in the air (when the RAT probe is heated)...being "in the air" the takeoff configuration warning wouldn't warn the pilot if the flaps/slats were not extended.

IF the mechanic just disabled the heater of the RAT probe and didn't understand the plane "thought" it was in the air, the stage was set for disaster.

Of course by "thought it was in the air" simply means the ground shift mechanism wasn't working properly in one way or another.

BelArgUSA 25th August 2008 01:25

The 3 "killers"
 
Please research some discussions published in Pprune about the "3 killers"...
One or two years ago...
The 3 single reasons why an airplane will crash on takeoff...
TRIM, FLAPS, SPOILERS...
Check list completed or not - every time I line up for takeoff, I CHECK my 3 killers.
xxx:
:ugh:
Happy contrails... repeat after me... TRIMS-FLAPS-SPOILERS

Dairyground 25th August 2008 01:27

Deviation to the left
 
VanHorck and PJ2 (posts #771 and 772)


The El Mundo graphic shows a deviation to the left before veering off to the right. First time i heard that one! Deviation to the left due to the left engine failing and over-correction to the right leading to touching the right wing briefly as often stated?
There is a claim by a distant observer, reported in post #202, that dust was being raised from the ground on the left of the runway before the first grounding of the right wing. Whether reflecting reality or otherwise, that report may underly graphics that show an initial deviation to the left.

HarryMann 25th August 2008 01:29


The 3 single reasons why an airplane will crash on takeoff...
TRIM, FLAPS, SPOILERS...
Maybe add ICE to that... (a form of inadvertant configuration malaise)


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