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Air India Responsible for May 2010 Crash

In George’s Point of View


Crew Resource management (AKA Cockpit Resource Management) came about as a resource for competent pilots with deficient people skills. This is crucial because a pilot does not fly in a vacuum but as part of a team. CRM teaches pilots how to improve communication, a crucial supplement to normal training. CRM helps a crew avoid potentially antagonistic work environments, such as the one that occurred in Mangalore, on May 2010, the Air India Crash which killed 158.

It has come to light that Air India did not provide mandatory CRM training. This deficit is clearly reflected in pilot behavior, and violates international norms. The court of inquiry is considering inadequate CRM as a key factor in the Mangalore crash.

Anyone reading or hearing the transcript knows that leadership and decision making on this flight was not up to standard. The Captain failed to discontinue the ‘unstabilised approach’ after touching down halfway down the runway, and persisted in continuing with the landing, despite three calls from the First Officer to ‘go around’ and a number of warnings from EGPWS. If there had been adequate CRM training, the captain would have known to listen to the first officer and warnings; and barring that, the F.O would have known to follow his own (correct) judgement.

Air India Express did not even have a CRM safety training division.

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    Identificação de DNA no caso do voo 447 da Air France. Ótimo… agora vem a Escolha de Sofia.

    ler em Inglês
    Para aqueles que podem estar lendo isso em outro idioma, cabe explicar a expressão Escolha de Sofia. A expressão tem sua origem em um romance de mesmo nome, escrito por William Styron, no qual a protagonista, Sofia, é uma mãe forçada a fazer uma escolha impossível: cabe a ela escolher entre a sobrevivência de seu filho ou de sua filha. Não lhe é permitido escolher a ambos, com o sacrifício de sua própria vida (o que seria a escolha da maioria das mães). Caso se recusasse a escolher, os dois morreriam. Por isso, a expressão ‘escolha de Sofia’ tem sido aceita na cultura americana como um paradigma da escolha impossível.

    É a mais expressão mais apropriada para nossa atual situação.

    Segundo os relatórios da polícia, testes laboratoriais bem sucedidos extraíram amostras viáveis de DNA do tecido de aproximadamente 50 corpos de vítimas do voo 447. A extração comprova que o DNA pode ser utilizado para se identificar os corpos.
    Entretanto, no início da semana, dois juízes parisienses encarregados dos resgates, Sylvie Zimmerman e Yann Danielle, decidiram, com relação aos restos mortais, que “com o fim de preservar a dignidade e por respeito aos familiares enlutados, os restos das vítimas que estão muito degradados não devem ser recuperados. Apesar de terem sido realizados testes nos dois corpos recuperados, com o fim de checar a possibilidade de identificação, nenhum outro deverá ser içado”.

    Muito embora os juízes tenham decidido que os corpos não devem ser retirados do mar por isso ser muito traumático para as famílias, há familiares que desejam ver seus entes queridos resgatados. Por isso, não ficaremos surpresos se tal decisão for contestada por familiares que considerem ainda mais traumático deixar aqueles que amam no mar; ainda mais agora, quando estão tão perto.

    Pode ser que tal decisão não tenha sido definitiva, mas significou que os resgates podem ser suspensos após a realização dos testes.
    Apesar de o presidente da associação de familiares, Nelson Marinho, ter dito que “essa operação traz muita esperança às famílias, que agora têm alguma expectativa de encontrar os corpos de seus entes queridos, a fim de lhes dar um funeral adequado”, parece que alguns familiares não querem ter de enfrentar as presentes condições dos corpos.

    As famílias e os juízes logo enfrentarão uma escolha de Sofia.

    O assunto não seria um problema se:

    – os corpos estivessem localizados em um lugar de fácil acesso, de onde não fosse difícil recuperá-los;
    – todas as famílias concordassem;
    – os testes pudessem ser realizados rapidamente, sob a água e de imediato;
    – se os restos estivessem em melhores condições.

    Mas nada disso é verdade. Os corpos estão em um lugar obscuro e não ficarão lá por muito tempo, a não ser que algo seja feito para protegê-los. Se não forem recuperados agora, serão provavelmente perdidos para sempre.
    As famílias têm opiniões e necessidades distintas. Algumas se encontram transtornadas com o trauma dos resgates, porque os fatos recrudescem o sofrimento iniciado há apenas dois anos. Outras têm alguma esperança de que um funeral normal ajude a encerrar o episódio. Sem dúvida, há aquelas que têm sentimentos profundos, mas não conseguem decidir entre recuperar os corpos ou deixá-los no mar.

    Os testes de DNA devem ser feitos em laboratório, levam tempo, e significam que, para uma analise mais precisa, os restos precisam ser recuperados para identificação. E, depois de dois anos imersos em água salgada, sob a mesma pressão suportada pelas caixas pretas, os corpos, que já não se encontram em boas condições, ficarão ainda mais deteriorados com o resgate.

    Qualquer que seja a decisão, lembremo-nos de que a lei não é imutável, mas algo vivo. Esperemos, pelo bem das famílias, que aqueles que se sentem aptos a julgar as escolhas dos outros optem, neste caso, por favorecer os desejos de cada família, em vez de se tornarem um obstáculo.

    As famílias já sofreram o suficiente.

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    Clear and Present Danger

    I don’t know if we should blame George Jetson and his hover car commute to work, or Bruce Willis’s talkative flying taxi in The Fifth Element, but the fiction world (or at least the world according to movie directors) predicts a day when flying cars will endure a traffic filled commute identical to gridlock traffic that occurs on rush hour highways. It’s a completely irrational view, given the state of contemporary air traffic control. I don’t see it happening. At least, not until planes or flying cars can defy gravity and manage to hover motionless on demand, the flying car commute to work can’t happen. Not with our current protections. And that’s a good thing. The extra safety measures we have today are essential, because because gravity works. We can only hope our safety measures are adequate, or better than adequate. Just to keep from falling, physics requires that planes have to hurtle through the air at high speed to stay aloft, and require a multitude of safety measures to keep from colliding at all angles. Planes rely on pilots, of course, but also air traffic control, which is supposed to monitor plane trajectory and make certain that planes are miles apart. Commercial planes also have the TCAS (traffic collision avoidance) system which relies on on board transponders that monitor airspace around a plane, in order to avoid airborne collisions.

    I have ranted before about the misnomer of the near miss. If two planes nearly collide, they nearly hit. If they almost miss (i.e. near miss), then it must have actually hit. So I dislike the term, because it doesn’t mean what it sounds like it means. I’d be happy to play around with the semantics, though, if it meant we could avoid the actual situation of planes colliding or nearly colliding. It’s a crucial thing to consider, especially since there were two near air collisions plus a collision a couple of weeks ago.

    One (nearly) happened when a United Airlines San Francisco-Newark flight (155 passengers and six crew), and a Newark-Memphis ExpressJet (47 passengers and three crew) flew within 200 feet laterally and 400 feet vertically. The Expressjet was taking off; and the United pilot was ordered to abort their landing, and circle the airport but instead chose to land the plane.

    The preliminary report for the United flight says that “on Thursday, April 24, 2014, about 1503 eastern daylight time, a near midair collision occurred at Newark Liberty International Airport (EWR), Newark, New Jersey, when an Embraer ERJ145, departing EWR runway 4R for Memphis, Tennessee, passed in close proximity to a Boeing 737-800 arriving from San Francisco, California, intending to land on runway 29. Both aircraft were on regularly scheduled 14 Code of Federal Regulations Part 121 passenger flights and under control of EWR airport traffic control tower (ATCT) at the time of the incident. There was no damage reported to either aircraft, or any injuries to passengers or crew.

    The B737 contacted the EWR tower on the Bridge Visual approach to runway 29. The local controller instructed the pilot to follow a B717 ahead, and cleared the pilot to land on runway 29. When the B717 was on short final, the local controller instructed the ERJ145 pilot to line up and wait on runway 4R. After the B717 crossed runway 4R, the local controller cleared the ERJ145 for takeoff. At that time, the B737 was about three miles from the runway 29 threshold. The ERJ145 did not actually begin its takeoff roll until the B737 was about 1 mile from the runway 29 threshold. The local controller recognized that the spacing was insufficient and instructed the B737 to go around. He provided traffic advisories to both the B737 and the ERJ145 pilots and instructed the ERJ145 pilot to maintain visual separation from the B737. The ERJ145 pilot responded that he was going to keep the aircraft’s nose down. The B737 overflew the ERJ145 at the intersection of runways 29/4R.

    According to recorded Federal Aviation Administration radar data, the closest lateral and vertical proximity was approximately 0.03 miles and 400 feet.”

    The preliminary report for the ExpressJet flight says that “On Thursday, April 24, 2014, about 1503 eastern daylight time, a near midair collision occurred at Newark Liberty International Airport (EWR), Newark, New Jersey, when an Embraer ERJ145, departing EWR runway 4R for Memphis, Tennessee, passed in close proximity to a Boeing 737-800 arriving from San Francisco, California, intending to land on runway 29. Both aircraft were on regularly scheduled 14 Code of Federal Regulations Part 121 passenger flights and under control of EWR airport traffic control tower (ATCT) at the time of the incident. There was no damage reported to either aircraft, or any injuries to passengers or crew.

    The B737 contacted the EWR tower on the Bridge Visual approach to runway 29. The local controller instructed the pilot to follow a B717 ahead, and cleared the pilot to land on runway 29. When the B717 was on short final, the local controller instructed the ERJ145 pilot to line up and wait on runway 4R. After the B717 crossed runway 4R, the local controller cleared the ERJ145 for takeoff. At that time, the B737 was about three miles from the runway 29 threshold. The ERJ145 did not actually begin its takeoff roll until the B737 was about 1 mile from the runway 29 threshold. The local controller recognized that the spacing was insufficient and instructed the B737 to go around. He provided traffic advisories to both the B737 and the ERJ145 pilots and instructed the ERJ145 pilot to maintain visual separation from the B737. The ERJ145 pilot responded that he was going to keep the aircraft’s nose down. The B737 overflew the ERJ145 at the intersection of runways 29/4R.

    According to recorded Federal Aviation Administration radar data, the closest lateral and vertical proximity was approximately 0.03 miles and 400 feet.”

    A second close call occurred outside of Hawaii; but the preliminary reports have not been posted yet. Proximity between United Airlines Kona-Los Angeles Flight 1205 and a westbound US Airways Jet initiated a TCAS alert on the United flight. The Los Angeles-bound United pilot took evasive action and made a steep dive to avoid a collision. TCAS (and the alert pilot) saved the day, after what appears to have been an air traffic control error on the ground in Honolulu.

    All four of the planes were better off than the two planes that collided on April 27, in Port Richmond, resulting in one fatality and two injuries. A Cessna and a Hawker collided in midair over San Pablo Bay north of Brother Island off Richmond, California. The Sea Fury landed at Ione, California, and the Cessna impacted the waters of San Pablo Bay. Two occupants aboard the Sea Fury were uninjured.

    The preliminary report for the Cessna indicates that a couple of days after that near accident, a collision occurred. On April 27, 2014, about 1606 Pacific daylight time, a Cessna 210E, N4962U, and a Hawker Sea Fury, N20SF, collided in flight near Port Richmond, California. Sanders Aircraft, Inc., was operating both airplanes under the provisions of 14 Code of Federal Regulations (CFR) Part 91. The private pilot in the Cessna sustained fatal injuries; the commercial pilot and one passenger in the Sea Fury were not injured. The Cessna was destroyed during the accident sequence, and the Sea Fury sustained substantial damage to the empennage. Both cross-country personal flights departed Half Moon Bay, California; the Sea Fury departed about 1530 and the Cessna departed at an unknown time. Both airplanes were en route to Eagle’s Nest Airport, Ione, California. Visual meteorological conditions (VMC) prevailed, and no flight plans had been filed.

    The National Transportation Safety Board investigator-in-charge (IIC) interviewed the Sea Fury pilot. The Sea Fury pilot stated the he and the Cessna pilot had flown their airplanes to Half Moon Bay to display them at an open house for the airport.

    The pilot reported that after departure, he flew over the airport, and rendezvoused with a Beechcraft A36 Bonanza for a photo shoot over the Golden Gate Bridge in San Francisco, California. They flew several 360-degree patterns over the bridge, completed their photo work, and he set his course for the return to Ione.

    While en route the Sea Fury pilot broadcast on a common frequency, and the Cessna pilot responded with his position. The Sea Fury pilot made visual contact with the Cessna, which was ahead and to his left. He broadcast to the Cessna pilot that he would pass low and to the left. The Cessna pilot responded that it would be a good picture. The Sea Fury pilot replied that probably not due to the speed differential; the Sea Fury airspeed was about 200 miles per hour. The Sea Fury pilot proceeded on a path that he thought would allow adequate separation; however, as he was passing the Cessna, he felt and heard a thump and he realized that the two airplanes had collided. He pulled up and looked over his shoulder and he observed the Cessna inverted and going down.

    The Sea Fury pilot stated that he concentrated on flying his airplane, and initiated a climb, and conducted a controllability check to determine that he could control the airplane in the current configuration. He wanted to avoid populated areas, so he continued toward his home airport. While en route he contacted company personnel, who decided to fly another company airplane to meet and examine the Sea Fury’s condition. The Sea Fury pilot lowered the landing gear, and did a controllability check to include turns. He lowered the flaps, and repeated the testing. He reduced airspeed to a landing compatible speed of 130 mph, and checked controllability again. Determining that he had adequate control to land, he made a full stop landing at his home airport.

    The Sea Fury is silver in color and the Cessna has blue wingtips with blue paint on the leading edge of both wings, on top of the cowling, and along the sides of the fuselage.

    During the postaccident examination of the Sea Fury it was noted that the top remaining portion of the vertical stabilizer was crushed aft and down with blue paint transfer marks on the aft portion of the remaining metal. The operator reported that the missing vertical stabilizer section was about 12 inches long. The rudder had crush damage. The right elevator separated outboard of the middle hinge and about 3 feet of the elevator was missing. About 3 feet of the outboard section of the right horizontal stabilizer was missing. The outboard fracture surface was jagged and angular, and the upper surface had crushed inboard in an accordion fashion. Blue paint transfer marks and scratches were observed on the upper surface and within the folds of the metal.

    The Cessna descended into San Pablo Bay, and the wreckage was retrieved on April 30. The recovered wreckage consisted of the fuselage and the engine. The left wing was not located. The propeller separated from the crankshaft, and was not located.

    A similar report for the Hawker has also been published.

    Flight has become commonplace, but we can not take it for granted.

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  • Thanksgiving Wishes

    Thanksgiving table served with turkey, decorated with bright autumn leaves
    It is time again for Thanksgiving. In my heart, I feel Thanksgiving every day, perhaps because in my business I am constant touch with families of victims. I work closely with people in all stages of loss. I have to admit, it takes a toll. Even the news of the day takes a toll-the deaths of children abroad in bombings, this bus crash in Tennessee, the latest crash: they all take a piece of me. There are so many times that I can bring hope or help; I can’t help but wish I could always do so. There are so many who have so much. I feel deeply for those who are struggling to get their lives on track, and those who have to scratch for meals wherever they may be.

    As this day of Thanksgiving approaches, I extend my condolences to all those who have suffered loss or deprivation. I pray that this season, everyone has everything they need, peace of heart, peace of mind, and tables full of blessings. At the same time, I give thanks for every moment, for my friends, family and health, and all the blessings of those close to me. Have a happy Thanksgiving.

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    Air India: False alarm?

    What: Air India Airbus en route from Delhi to Jammu
    Where: Delhi
    When: August 3, 2011
    Who: 122 passengers
    Why: After takeoff, the pilots noticed an emergency alert, and returned to Delhi where they made a safe landing. The plane was inspected, and the flight continued.

    In George’s Point of View


    This alert may be an indication of bad reportage, or bad aviation safety practices; I don’t know which, but it is one or the other. When there is an alert, reputable airlines usually go over the plane with a fine toothed comb until the problem is located.

    But according to reports, the alert was immediately determined to be false, and the plane went right back out to make the flight. Reputable airlines usually fly in a replacement plane to take over the flight so the plane with the problem is cleared.

    So. Either this plane was sent out too soon, without a thorough inspection. Remember, Air India has an acknowledged safety problem. Are they playing Russian roulette with their passengers’ safety?

    Or. The reportage does not make it clear that another plane was flown in.

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  • To Family and Friends

    Now we lay 2011 to rest, a year to be thankful for.

    They are all years to be thankful for, even when they are times that try our souls. Our lives are the testing grounds that reveal our mettle. Of course life changes us; life is the crucible that forges the metal of which we are formed. So even if it has been an uphill challenge, it is a path we have climbed successfully; it has been another year to thank God for. We climbed to the summit to plant the flag of 2011 at the topmost peak. Join me while I shout, “Wahoo! We made it!” A year of turmoil; a year of deliverance and grace, of salvation.

    So now we can pause and note the passing of 2011. Life chips away at us, smoothes the edges. When I think of how the passing year changed me, the changes are real but ephemeral, as hard to pin down and hold on to as a note of music, or a beam of light. I hope this year has made me a little kinder, a little stronger, a little more patient, a little more of a better man. It is easier to imagine time as a flowing river, with each moment being a unique sip of the water of life. I cannot let the year fade into history without acknowledging my gratitude and wonder. God is the source of the river of life. I can nod and smile at the scientists as they argue their big bangs (or some other competing cosmological paradigm). I am ok with science. God made scientists too; and if there was a bang, God was behind it. Einstein talked about life as a vast library we are born into; like preverbal infants, we can see the books in the library, and order in the universe, even if we cannot read the words. I do not need to hold the pencil of God to know the hand that wrote the book of life.

    For another year, Molly and I wish you the very best New Year’s Day, and a 2012 filled with great health, and an overabundance of love and happiness.

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    Air India Flight Returns to New Delhi due to Smoke in Cabin

    airindialogoAir India flight AI 137 had to return and make an emergency landing at Indira Gandhi International Airport, in New Delhi, India, on January 26.

    The plane took off for Milan, Italy, but had to return shortly afterwards after smoke was detected in the cabin.

    The Boeing Dreamliner plane landed safely. All 167 passengers aboard remained unharmed.

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