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Category: <span>Interim Report</span>

Ethiopia Airlines B737-8 (MAX) ET-AVJPreliminary Report is released


The Aircraft Accident Investigation Bureau of Ethiopia released the preliminary report on the crash Ethiopian Airlines flight 302, Boeing 737-8(MAX), ET-AVJ. The flight took off from Addis Ababa Bole Int. Airporten route for Nairobi, but the Angle of Attack sensor recorded value became erroneous. The crash resulted in 157 fatalities. The report is available here

LionAir Flight Updated


On the flight prior the LionAir accident flight on the Boeing Max registered as PK-LQP, an off-duty fully-qualified Boeing 737-MAX 8 pilot was traveling home on flight JT-43. The plane encountered problems similar to the next flight that crashed it (i.e. the LionAir accident flight from Denpasar to Jakarta.) The crew aboard the earlier flight managed to land the aircraft at the destination. Based on the crew’s entry in the AFML, the engineer at Jakarta flushed the left Pitot Air Data Module (ADM) and static ADM to rectify the reported IAS and ALT disagree and cleaned the electrical connector plug of the elevator feel computer. The aircraft was subsequently released to carry out flight JT610.(A different crew manned the fatal flight.) The pilot was interviewed by the Kantor Komite Nasional Keselamatan Transportasi–Ministry of Transportation of the Republic of Indonesia (KNKT). The KNKT committee is responsible for investigating and reporting air transportation system accidents, serious incidents and safety deficiencies involving air transportation system operations in Indonesia.

The KNKT estimates that the release of the final report for Lion B38M in August or September 2019.

The KNKT is cooperating with Ethiopian Authorities but will make no official comment. News media reports suggest that on the earlier LionAir flight, a third pilot had occupied the observer’s seat in the cockpit of flight JT-43 and that this pilot identified the automatic trim runaway issue at hand and initiated that the trim cut out switches be used.

The preliminary report on the LionAir crash is located HERE.

Mozambique Plane Crash Final Report


On Jan 9th 2014 Namibia’s Accident Investigation Commission released the preliminary report of the LAM E190 crash over Botswana/Namibia on Nov 29th 2013. The conclusion at that time was that the captain intentionally crashed the aircraft. On November 29, 2013, there were 28 passengers and 6 crew aboard the Embraer ERJ-190 flown by LAM Linhas Aereas de Mocambique, and it was enroute at FL380 over northern Botswana when the flight descended and radio contact was lost. The burned out wreckage was located by villagers in Bwabwata National Park (Sambesi Region) on Nov 30. A news article on April 15 2016 indicated that the final report was released, although we have not verified it.

The captain in charge of the aircraft, Herminio dos Santos Fernandes, was alone in the cockpit at the time of the crash. The copilot had left for the lavatory.

The unverified article says that the final report was compiled by Theo Shilongo, deputy director of the directorate of aircraft accident investigations, who was the investigator in charge, and Hafeni Mweshixwa as the co-investigator. It was signed off by works and transport minister Alpheus Naruseb. When it is available to the public, it should be available at the Directorate of Aircraft Accident Investigations Namibia (DAAI).

An interim report of the accident is below. The interim report indicates “The DAAI will provide updates on the investigation and safety recommendations as they become available until completion of the final report” in accordance with the provisions of ICAO Annex 13.

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BEA on SwiftAir Air Algeria (Burkina Faso to Algiers) Crash July 2014

Accident 24 July 2014 in Gossi, Mali to the MD-83 registered EC-LTV operated by Swiftair S.A.

Press release from the BEA and the Commission d’Enquêtes Accidents et Incidents de l’Aviation civile (Mali)

Following the publication of the Interim Report on 20 September 2014 in Bamako (Mali), investigative work has continued, based on the analysis of the accident flight parameters. Progress made in this work has led the Republic of Mali Commission of Inquiry and the BEA to communicate jointly the following information.

On 24 July 2014, the MD-83 registered EC-LTV was performing scheduled night flight AH 5017 from Ouagadougou (Burkina Faso) to Algiers (Algeria). Takeoff occurred at 01h15, the climb towards the cruise altitude took place without any significant events, and the crew made several heading changes in order to fly around a storm cell. The autopilot and the autothrottle were engaged. The aeroplane reached the cruise altitude of 31,000 ft, that’s to say about 9,500 m. The autopilot then switched to the mode that maintains the altitude and the autothrottle to the mode that maintains the speed (Mach).

About two minutes after levelling off at an altitude of 31,000 ft, calculations performed by the manufacturer and validated by the investigation team indicate that the recorded EPR , the main parameter for engine power management, became erroneous on the right engine and then about 55 seconds later on the left engine. This was likely due to icing of the pressure sensors located on the engine nose cones. If the engine anti-ice protection system is activated, these pressure sensors are heated by hot air.

Analysis of the available data indicates that the crew likely did not activate the system during climb and cruise.

As a result of the icing of the pressure sensors, the erroneous information transmitted to the autothrottle meant that the latter limited the thrust delivered by the engines. Under these conditions, the thrust was insufficient to maintain cruise speed and the aeroplane slowed down. The autopilot then commanded an increase in the aeroplane’s pitch attitude in order to maintain the altitude in spite of this loss of speed.

This explains how, from the beginning of the error in measuring the EPR values, the aeroplane’s speed dropped from 290 kt to 200 kt in about 5 minutes and 35 seconds and the angle of attack increased until the aeroplane stalled.

About 20 seconds after the beginning of the aeroplane stall, the autopilot was disengaged. The aeroplane rolled suddenly to the left until it reached a bank angle of 140°, and a nose-down pitch
of 80°

The recorded parameters indicate that there were no stall recovery manœuvres by
the crew.

However, in the moments following the aeroplane stall, the flight control surfaces remained deflected nose-up and in a right roll.

CORRECTIVE ACTIONS

At least two similar events occurred, in June 2002 and in June 2014, with no serious consequences.

The event in June 2002 was the subject of an NTSB investigation report. On 4 June 2002, the McDonnell Douglas MD-82, registered N823NK performing Spirit Airlines flight 970, suffered a loss of thrust on both engines, in cruise at an altitude of 33,000 ft, that is about 10,000 m. The two pressure sensors, located on the engine nose bullets, were blocked by ice crystals, leading to incorrect indications and over-estimation of the EPR. The crew noticed the drop in speed and the precursor indications of a stall just before disengagement of the autopilot and putting the aeroplane into a descent. They had not activated the engine anti-ice systems. This event occurred during the day, outside the clouds.

On 8 June 2014, the MD83 registered EC-JUG belonging to Swiftair, which was performing a passenger transport flight at flight level FL 330, suffered a drop in speed while it was flying during the daytime above the cloud layer. The crew detected the problem, put the aeroplane into a descent and activated the engine anti-ice systems without reaching a stall situation, then continued the flight.

This background, as well as the data on the accident to flight AH5017, was shared with the European Aviation Safety Agency (EASA) and through EASA with the American authorities (FAA); they should serve as the basis for future publication of corrective measures aimed at assisting crews in identifying and responding to similar situations to those encountered at the time of this accident.

NEXT STEPS

The investigative work is continuing, in particular on the analysis of:

the flight parameters to complete the scenario described above,
possible crew reactions, despite the absence of Cockpit Voice Recorder data from the accident flight, which remain unusable to this day,
the training and follow-up of Swiftair crews,
previous events and the follow-up undertaken.

The publication of the final report is planned before the end of December 2015.

Download Interim below:

https://airflightdisaster.com/wp-content/uploads/2015/04/ec-v140724.e1.en_.pdf


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News You Didn’t Hear in February: Pilots Arm Detaches Leading to Hard Landing

The carrier is Flybe.

The aircraft was on a scheduled commercial air transport flight from Birmingham to Belfast
City, with the commander, in the left flight deck seat, as pilot flying. It was night, and
although there was no low cloud affecting the airport, the wind at Belfast was a strong
west?south-westerly, gusting up to 48 kt. Before the approach, the commander checked
that his prosthetic lower left arm was securely attached to the yoke clamp which he used to
fly the aircraft, with the latching device in place. But his arm came off, leading to a hard landing.

Official report:


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TWA Flight 800 report Questioned

James Kallstrom, who headed up the investigation into the 1996 crash for the FBI says the original report is legitimate.

But six retired investigators from TWA, the National Transportation Safety Board, and the Air Line Pilots Association say the final report of the 1996 accident, “TWA Flight 800” was falsified. They say the accident was either a terrorist attack or a failed military operation. The cadre of retired investigators are calling for a new investigation by the feds. Others argue that there’s no question the explosion was an accident. 230 people died after Flight 800 took off from JFK.

Originally there were several theories put forward: a missile theory ,a bomb-on-the-plane theory, a meteor strike theory. All of these theories were discarded when an exploding fuel tank was concluded to be the cause.

The retirees have appealed to families to ask for the case to be reinvestigated. Many family members are disturbed by the idea of renewal of the case which they believe is simply hype to push a new documentary “TWA Flight 800.”

NTSB Reports on Dreamliner Battery Fire in Boston

briefing
Briefing March 7, 2013

We no longer have to conjecture about the Japan Airlines 787 battery fire in Boston because the National Transportation Safety Board has released an interim factual report with nearly 500 pages of related documentation.

A live webcast forum is scheduled for April in Washington to investigate the design, technology and certification lithium-ion batteries.

Attached is the report which contains the details of what happened, and examination findings to date.

Interim Report on Battery

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