Flight Safety Information January 25, 2011 - No. 018 In This Issue FAA, NTSB Tell HAI Forum Public-Aircraft Guidance Should be Clarified Qantas jet fault causes plane to plummet 25,000ft mid-flight Pilots warned that DOD tests will disrupt GPS signals Pilot typos behind string of take-off mishaps Air France Withholds Key Report... Passenger fight that triggered a hijacking alert DC Plane With Possible Open Door Makes Vt. Landing CHC Safety & Quality Summit: Safety Management Expert Graham Braithwaite to Speak GCAA pulls up air operators on safety (UAE Thrust-reverser suspected in Sudanese 707 crash China: Balkan Officials Say U.S. Wreck May Have Yielded Jet Technology FAA, NTSB Tell HAI Forum Public-Aircraft Guidance Should be Clarified Attendees Said FAA Proposals Are A "Good First Step" John Allen, the FAA official in charge of flight standards, told HAI's Industry Forum on Public-Aircraft Operations that the agency will provide clearer guidance for operators, safety investigators and its own inspectors on how to determine when a civil-certified aircraft is being operated as a public aircraft beyond FAA oversight. FAA Flight Standards Director John Allen Allen was one of the featured speakers at the Jan. 20 forum, which about 100 people attended in Alexandria, VA, and more than 200 joined online. HAI hosted the forum as an opportunity for the FAA and NTSB to address industry questions about federal oversight of public aircraft and their operation. NTSB Member Earl Weener discussed the safety board's investigation of accidents involving public aircraft and the oversight problems they uncovered. Attendees praised the FAA's proposed revisions as a good first step in fixing unclear rules about the operation and oversight of public-aircraft missions. "Instead of shying away from the oversight responsibility, it sounds like the FAA is stepping up to it," Steve Bandy, chief pilot and director of flight operations for Columbia Helicopters in Portland, Ore., said. The forum, which he attended in person, "was a very good dialogue on a very difficult issue." "All parties agree there needs to be a simple and precise set of guidelines on the rules governing operations as public aircraft," HAI President Matt Zuccaro, who moderated the forum, said. "John Allen made clear that the FAA recognizes that need and wants to work with the helicopter industry and other government agencies on fulfilling it." Public aircraft are those owned and operated or contracted by a government agency. Such aircraft generally are operated outside the regulations and surveillance of the FAA. But U.S. regulations are unclear about who bears responsibility for the safety of those aircraft and their passengers and when aircraft shift from civil to public operations. Problems arise particularly when operators of civil- certified aircraft under Part 135 of the Federal Aviation Regulations work under contract to a government agency exempt from those rules. "The statute is vague," Allen told those attending the forum in person and online. "It is very confusing." NTSB Member Earl Weener New guidance being developed by the FAA will clarify that. Once that guidance is finalized and briefed to FAA inspectors, Allen said, "the FAA will consider all contracted aircraft operations as civil aircraft operations," until the contracting government agency provides the operator in advance with a written declaration of public aircraft status on a flight-by-flight basis and notifies the FAA in advance that it has hired that operator to conduct "eligible" public aircraft operations. "The FAA also must determine the flights in question are legitimate public aircraft operations under the terms of the statute," Allen said. Without the declarations and determination, Allen said, "the operation is civil and the FAA has oversight responsibility." Allen said the FAA will draw on the discussions at the forum in refining its guidance on public-aircraft operations and is seeking further input, which HAI members and others can offer via e-mail. The FAA hopes to issues an Advisory Circular on the subject in the near future. FMI: www.rotor.com, www.faa.gov, www.ntsb.gov Back to Top Passenger terror as another Qantas jet fault causes plane to plummet 25,000ft mid-flight Passengers grabbed oxygen masks when a Qantas jet plunged more than 25,000ft as it flew over southern Australia today (Tues). Some had to be comforted by air stewardesses as the aircraft continued its flight at just 10,000ft as it flew from Adelaide to Melbourne. The crew had to make what the airline said was a 'rapid but controlled descent' after a fault developed with the Boeing 737-400 jet's air conditioning system, resulting in the cabin becoming depressurised. Panic: A Qantas Boeing 737 (back) like the one which went into a rapid descent. It occurred after an alleged air conditioning fault caused the cabin to depressurise The jet, with 99 passengers and six crew on board, landed safely at Melbourne Airport and Qantas said later that there was no flight safety issue. 'Emergency services, I believe, were on standby but were not required,' said a spokesman for the airline. 'Engineers are now assessing the aircraft.' One passenger, who declined to be named, told the Herald Sun newspaper: 'All of the oxygen masks dropped down. The captain came across and said: "This is an emergency."' Passengers were ordered to keep the oxygen masks on for about five minutes. Another passenger told ABC radio that the depressurisation caused some panic. 'There was a little bit of panic down the back of the plane and some passengers needed to be comforted by the hostesses,' he said. Damage: The engine on a Qantas Airbus A380 that exploded mid-air in November 'One of them was fairly panicked and a couple of hostess tried to fan her down.' The incident was one of a number of incidents to challenge Qantas's international reputation as a safe airline. Last November it had to ground its entire fleet of six A380 superjets after one of the Rolls-Royce Trent 900 engines exploded in mid-air short after take-off from Singapore. The total cost of grounding the fleet and replacing 16 of the A380 engines has been estimated to be £50million. The day after the Singapore incident, in which a number of important parts of the wing were damaged, a Qantas 747-400 aircraft had a mid-air drama when flames burst from an engine shortly after take-off from Singapore. http://www.dailymail.co.uk/news/ Back to Top Pilots warned that DOD tests will disrupt GPS signals FAA issues advisory for East and West coasts The Federal Aviation Administration has issued a warning to pilots to expect unreliable performance from Global Positioning System (GPS) instruments in the Southeast and Southwest United States, resulting from tests being done by the Defense Department. The Register, a news outlet in the United Kingdom, reported the Notice To Airmen (NOTAM) advisories about the impending tests. The first NOTAM advised that Southern California aircraft GPS be affected from Jan. 16 to Jan. 23. The Southeast will have two series of tests, the first from Jan. 20 to Feb. 11 and another round from Feb. 15 to Feb. 22. Pilots are being told that GPS may be unreliable or unavailable during the testing periods. "Several test events will be conducted and will be active for 45 minutes, followed by 15 minutes of off time," the FAA NOTAM states. "These tests may not be concurrent so pilots are advised to check NOTAMs frequently for possible changes prior to operating in the area." The test is based off the coast of Georgia, centered at coordinates N304906 by W0802811 and has a radius of 370 nautical miles. A spokesperson at the FAA said that there will be "no impact to ground vehicle GPS." That means that smart phones, automobile guidance systems and other civilian GPS functions will not be affected by the tests. "Pilots are highly recommended to report anomalies during testing to the appropriate ARTCC to assist in the determination of the extent of GPS degradation during tests," the FAA NOTAM said. http://gcn.com/ Back to Top Pilot typos behind string of take-off mishaps Seven air crew were killed in 2004 when their MK Airlines Boeing 747 cargo jet suffered a tail-strike. Picture: ATSB Crew, pilot errors behind many accidents Simple data calculations and errors common Can lead to tail-strikes or even crashes AIRLINE crew errors are a leading cause of take-off accidents and incidents, according to air safety investigators. An Australian Transport Safety Bureau (ATSB) report said mistakes made by pilots and crew worldwide have lead to near-misses and even death. The safety regulators analysed 20 international and 11 Australian take-off accidents and incidents between 1989 and June 2009 involving incorrect flight data. It found that the most common contributing safety factor was crew error (39 per cent), leading to a range of consequences, including one incident in Melbourne where a plane suffered substantial damage from a tail-strike. "There have been numerous take-off accidents worldwide that were the result of a simple data calculation or entry error by the flight crew," the ATSB report stated. In Australian the most common mistakes involved pilots and crew entering the wrong takeoff speed, followed by the incorrect aircraft weight and wrong temperature. The result of these errors ranged from a noticeable reduction in the aircraft's performance during take-off, to the aircraft being destroyed and loss of life. In one case a pilot from an overseas airline entered a figure 100,000 kilograms below the aircraft's actual weight, leading to a tail strike at Melbourne Airport in 2009. Meanwhile, seven air crew were killed in 2004 when their MK Airlines Boeing 747 cargo jet departing from Halifax, Canada, struggled to get airborne and hit a runway embankment. The plane's take-off weight was entered as approximately 240,000kg instead of its real weight of approximately 354,000kgs. Investigators also cited a Texas study of 4800 flights that found a quarter of pilots' errors were made before takeoff. Pilot and ground crew error, time pressure, fatigue, distraction, poor system design, bad procedures, a lack of reference material and poor training were cited as key factors leading to these types of mistakes. The report emphasised how critical the take-off phase of a flight is, with statistics between 2000 and 2009 showing that 12 per cent of fatal accidents occurred during take-off. This is despite the take-off phase accounting for approximately just one per cent of the total flight time. "Despite advanced aircraft systems and robust operating procedures, accidents continue to occur during the take-off phase of flight," the report said. "The takeoff is recognised as one of the most, if not the most, critical stage of flight, as there is limited time and options available to the flight crew for managing abnormal situation such as insufficient airspeed." The ATSB says that while these incidents will keep occurring due to human nature, airlines need to take action wherever possible to avoid mistakes. http://www.news.com.au/travel/news/ Back to Top Air France Withholds Key Report By ANDY PASZTOR (WSJ) Air France-KLM SA, reacting to a long-awaited outside review of its operations, on Monday said it has received and is implementing 35 safety recommendations, including the in-flight observation of cockpit crews. But contrary to earlier expectations of some of the experts it hired to assess operational procedures and safety practices, Europe's second-largest airline said it wouldn't release the report or make public the specific recommendations. The company said it has set up a joint labor-management committee to oversee responses to the findings of an independent safety-review team, made up of eight international aviation-safety experts. The panel, which worked for more than a year before submitting its formal report to the company, was given wide latitude to examine the carrier's overall safety culture, including pilot training. Air France said it has already started implementing some of the recommendations, including becoming the first European carrier to set up procedures for systematically observing pilots during actual flights. Big carriers in the U.S., Asia and Australia have long relied on such safety techniques. Air France, following a review panel's recommendations, will set up a system to observe pilots during flights. Based on confidential interviews, the independent panel also urged the airline to enhance safety practices in a variety of other areas, such as providing more-realistic simulator sessions for recurrent pilot training. According to an Air France news release, the report said that creating the outside review team "in a public manner and providing it a broad charter" to examine flight safety "was a courageous act" and an example of safety leadership "rarely seen in today's international aviation industry." From the start of the review, many safety experts inside and outside the company were enthusiastic about the process partly because they expected that, for the first time, a global airline would publicly release detailed conclusions and criticisms from independent sources. The study, according to people close to the process, challenged certain longstanding safety guidelines at Air France and raised broad questions about the effectiveness of various internal safeguards. But in the end, the airline didn't go along with suggestions from some members of the outside panel to at least release summaries or excerpts of their recommendations, along with the analysis supporting them. In an email after Air France's announcements, former Boeing Co. cockpit-safety expert Curt Graeber, the head of the independent review panel, said he wouldn't be able to discuss the findings without a green light from company officials. Pierre-Henri Gourgeon, chief executive of Air France-KLM, said that by embracing recommendations that "combine the best practices" used by other airlines globally, "Air France will place its flight- safety performance at the highest level possible." The study was launched in late 2009, six months after the crash of an Air France Airbus A330 en route from Rio de Janeiro to Paris, which killed all 228 people aboard. The cause of the accident hasn't been determined, though the crash focused attention on Air France's safety record, collection of incident data and pilot training. Back to Top Passenger fight that triggered a hijacking alert A British man was arrested yesterday after a passenger jet was diverted to Stansted Airport under RAF escort, police confirmed last night. The Etihad aircraft was travelling from Abu Dhabi to London Heathrow but was diverted when a passenger began making threats. Two RAF jets were scrambled to accompany the aircraft as it landed just before noon. A 37-year-old British national was arrested on arrival. "The pilot reported a passenger causing disruption and making threats," said Essex Police. Stansted is the capital's pre-designated airport to deal with instances of hijacking and hostage- taking. The scrambling of RAF jets allows for a plane to be shot down if it is feared that it might be used as a flying bomb. The first inkling that we, its passengers, had that this was out of the norm was when our aircraft broke through the clouds and someone shouted: "Hey, that's not Heathrow, that's Stansted." Groans filled the cabin; these soon turned into gulps. On landing, the roar of a second jet zoomed close overhead. Then the fire engines and police cars appeared on the tarmac. We later discovered we had been "escorted" in by two fighter jets. By then, we had endured five hours of intrigue and drama and no little amount of angst. The 8.25am from Abu Dhabi had seemed the most routine of flights. We were due to land 30 minutes before schedule and the journey was almost turbulence-free. Then came the diversion and, as we taxied into the remote part of Stansted, flanked by those emergency vehicles, the doubts began. "Wasn't it to this corner where the hijackers of a few years ago were ushered?" a fellow traveller whispered. The first announcement came. "As you may have noticed, we are not at Heathrow," was the chief steward's opening gambit. "There is a security issue, but everything is under control. Please be seated and await further information from the captain." The next thing we heard was the captain telling the crew to open the doors. Until then the staff were deadpan, bearing expressions which did nothing to reassure. They ignored the help-button calls made by passengers worried about connections, and ignored a mother with a screaming young child. But then they started to move and very soon every head had swivelled around to peer down the aisle. Through the back doors, policemen had appeared and swooped on their target - a white British man. Is it racist to report that the colour of his skin spread relief through the cabins? The captain spoke on the Tannoy. "A passenger made threats against Etihad," he said. "The police removed him." The fears of terrorism lifted. At one stage, non-uniformed officials moved up the cabin to find the hand luggage of a Middle-Eastern-looking gentleman. Apparently, the apprehended man had had a row with him and those nearby said he accused the other man of planting a bomb. A passenger said the detainee was breathing hurriedly. "I told a stewardess I thought he may having a heart attack," he said. A stewardess talked to the man; maybe this was when the threat was made. The captain said the authorities on the ground had made "a threat assessment" - cue the fighter jets. A chap with an iPhone was the first to alert us to their intervention. News agencies had picked up the story. A lady in her 50s who used to be a stewardess rolled her eyes. "In the old days we would never have made all that palaver," she said. "We'd have said 'there, there', sat with him, and handed him to the police at Heathrow." http://www.independent.co.uk/news/ Back to Top DC Plane With Possible Open Door Makes Vt. Landing DC-bound plane with possible open door, steering problems makes emergency landing in Vt. (AP)Air travel authorities say a United Express plane with a possible open door and steering problems made an emergency landing in Vermont shortly after taking off for Washington, D.C. The plane was carrying about 40 people and was operated by Atlantic Southeast Airlines. It had taken off from Burlington International Airport on Monday morning and had to return there. No injuries have been reported. The Airport Operations Office says a light in the plane's cockpit showed a passenger door was open and a pilot reported steering problems. Firefighters, police officers and ambulance crews from more than a dozen area agencies converged on the South Burlington airport. The airline is investigating. Chicago-based United Air Lines Inc.'s website says United Express flights are operated by various regional carriers serving the U.S. and Canada. Back to Top CHC Safety & Quality Summit: Safety Management Expert Graham Braithwaite to Speak at World's Largest Aviation Safety Conference VANCOUVER, BRITISH COLUMBIA--(Marketwire - Jan. 24, 2011) - Another world-renowned aviation safety management expert has signed on as a keynote speaker at a major aviation safety conference in Vancouver. Organizers of the 2011 CHC Safety & Quality Summit are pleased to announce that Graham Braithwaite, Director of the Cranfield Safety and Accident Investigation Centre, will be a keynote speaker at this year's event, March 28 - 30, 2011. Braithwaite, who holds a Bachelor of Science in Transport Management and Planning and a PhD in Aviation Safety Management from Loughborough University, joined Cranfield University in 2003 as Director of the Safety and Accident Investigation Centre and became Head of the Department of Air Transport in 2006. "I am absolutely delighted to be a part of what I consider to be such a world leading event. The CHC Safety and Quality Summit has established itself as the gold standard for applied safety management within the rotary and fixed wing sector of the air transport industry," says Braithwaite. "CHC's inspirational leadership in safety is always clearly demonstrated by the speakers and attendees of this event - professionals from all over the world who come to learn from each other and share their own experiences." Professor Braithwaite will be making his second consecutive address at the Summit, which will be held at the Westin Bayshore Resort & Marina in Vancouver, Canada. "The event is always exciting and forward looking; never afraid to challenge long held views in order to keep the safety message at the top of company agendas," adds Braithwaite. "I consider it a great honour to be able to work alongside CHC and the many organizations and even competitors who come together to further the cause of safety." Graham's research interests are in the fields of accident and incident investigation, human factors, safety management and the influence of culture on safety. He is a Fellow of the Royal Aeronautical Society and a Member of the International Society of Air Safety Investigators. "We are thrilled that Professor Braithwaite has agreed to join us again," said Greg Wyght, Vice President, Safety and Quality for CHC Helicopter. "His contributions to last year's Summit made him a popular speaker, and we are pleased to have him on our 2011 agenda." Graham is also is a Fellow of the Royal Aeronautical Society and Member of the International Society of Air Safety Investigators. Now in its seventh consecutive year, the Summit is an internationally recognized, non-profit aviation safety conference aimed at improving safety in aviation globally through excellence in human factors. The Summit is hosted by CHC Helicopter, one of the world's largest providers of civilian search and rescue services and transportation for the global offshore oil gas industry. CHC has over 250 aircraft operating in some 30 countries worldwide. The Summit is sponsored by Sikorsky, AgustaWestland, Eurocopter, Willis, Chartis Swiss Re and Bell Helicopter, allowing organizers to continue bringing together the best minds in aviation safety to present and share best practices with delegates from around the globe. Graham Braithwaite joined Cranfield University in 2003 as Director of the Safety and Accident Investigation Centre and became Head of the Department of Air Transport in 2006. Back to Top GCAA pulls up air operators on safety (UAE) 23 January 2011, 9:57 PMAirline operators with poor international air safety records will be kept out of UAE airspace, UAE's General Civil Aviation Authority (GCAA) said. It warned of taking legal action against air operators for breach of rules and for poor fleet maintenance. In a report appeared on a local newspaper, on Sunday, the GCCA said it has in a period covering more than two years, banned 41 air operators from entering UAE air space for violations in air safety rules. These include 19 last year and 22 in 2009. Of these two operators have been allowed to resume operations after having responded to the instructions of the GCAA. The GCCA said the move on the operators was made due to the violations by the pilots, engineers and support crews who hold permits. The violations include forgery of permits and for alcohol levels in the blood while on duty, especially the pilots. The GCAA said it had set up a full-fledged database on all air operators coming into the country. According to the report in the daily, Saif Mohammed Al Suwaidi, Director General, GCAA, said the authority has banned airline companies from a certain category of countries due to the incompetence of the civil aviation authorities there. This, according to him, was triggered because of the fears on the availability of safety and security standards and crew competence. "A number of countries suffer from severe poverty or are plunged in civil war which restricts them from carrying out their duties as per the international safety and security standards," he noted. In recent times, the type of aircraft coming under the overall ban in the UAE come in various categories. One such case is a DC8-63F which comes under the McDonnell Douglas manufactured DC-8-four-engine, narrow bodied series. The type was popular from 1958 to 1972. The operators in this case were held up for undertaking maintenance at a UAE airport hangar without obtaining a licence from the GCAA. Also from the same McDonnell Douglas line of jets which were manufactured between 1965 ad 2006 was a twin-engine, single-aisle DC-9 for neglecting safety and security standards while in UAE air space. A B-747-200 (Jumbo) was also specifically banned for violating UAE airspace regulations. The Jumbo series, the first of which flew in 1969, is still being manufactured by Boeing. Then in the latter half of last year, a L1011-500 (Lockheed L-1011 TriStar which comes under the medium-to-long range, three-engine, widebody passenger jet category) was banned. The type was rolled out between 1968 and 1984 by Lockheed-California Co. The particular plane in question was banned from operating in the UAE for failing to obtain a licence from the GCAA. An Antonov An-12's safety standards were questioned when the UAE banned the plane temporarily in 2009 after an An-12 cargo plane skidded off the runway at Sharjah International Airport. The An- 12 is a four-engined turboprop narrow bodied medium/short range transport aircraft and was designed and made in Russia, then the USSR, between 1957-73. These regulations will hit the smaller operators in the UAE's freight sector as they extensively use An-12s, the IL-76s and other Russian made hardware. http://www.khaleejtimes.com/ Back to Top Thrust-reverser suspected in Sudanese 707 crash Investigators are refining simulations of a Sudanese Boeing 707-330 freighter crash in order to determine whether a serious fault affecting the outboard right-hand engine was responsible. The aircraft came down shortly after departure from Sharjah 15 months ago, killing all six occupants, but the United Arab Emirates inquiry has been hampered by an absence of information on either flight recorder. Radar and video data has been used in a bid to reconstruct the dynamics of the accident through a simulation which has focused on two scenarios affecting the outboard Pratt & Whitney JT3D powerplant: a typical loss-of-thrust failure, or a rapid activation of reverse thrust at high power. Wreckage analysis discovered the engine's core thrust reverser was in a deployed position, as were the outer translating sleeve and the right-hand reverser clamshell. The left-hand clamshell was also "beyond the normally-stowed position", says the General Civil Aviation Authority. The GCAA has also carried out an extensive examination of the engine components and cockpit instruments in order to ascertain whether the powerplant was operating. Although flight recorder information might have yielded the crucial data, the GCAA says the only usable tape from the cockpit-voice recorder contained data unrelated to the accident flight, while the flight-data recorder was "very unlikely" to have been recording at the time of the crash. It has made appropriate recommendations to the Sudanese authorities. The aircraft was being operated by Azza Air Transport, on behalf of Sudan Airways, at the time of the 21 October 2009 accident. As the aircraft took off, the suspect engine's cowl fell from the 707. Its crew informed air traffic control of having "lost" the engine, says the GCAA, before the jet entered a right turn with 70° bank and dived to the ground some 20s after becoming airborne. Simulations have drawn from only a limited data set, including six radar hits from the control tower, and investigators have had to make several assumptions about airspeed, flap setting and the behaviour of the aircraft taken from surveillance images and witnesses. Initial results of the simulation suggest that, for a typical engine failure, rudder could be used to keep the aircraft on a straight and level course without sustained use of the control yoke. But for a thrust-reverser activation scenario, maintaining the runway heading would - in the worst case - have required full rudder, 50° yoke and 9° opposite bank to maintain heading. "Any less input would have the aircraft heading turn right, which is the direction the accident aircraft took," says the GCAA. Boeing is examining engine parts from the 707 and assisting with developing a more detailed simulation, which could provide a better match with known data, while a human factors analysis is attempting to determine the probable reaction of the crew. Source: Air Transport Intelligence news Back to Top China: Balkan Officials Say U.S. Wreck May Have Yielded Jet Technology (AP) Some of the technology in China's new stealth fighter jet may have come from the wreckage of an American stealth fighter shot down over Serbia in 1999, Balkan military officials said. A Serbian missile shot down an American F-117 Nighthawk, an early radar-evading stealth fighter, during NATO's bombing of Serbia in the Kosovo war. Civilians collected the pieces, which were strewn over a wide area of farmland. Croatia's military chief at the time, Adm. Davor Domazet-Loso, said Croatian intelligence reported "Chinese agents crisscrossing the region" buying up plane parts from farmers. A senior Serbian military official confirmed that pieces of the wreckage were removed by souvenir collectors, and that some ended up "in the hands of foreign military attachés." China unveiled its stealth fighter this month. Curt Lewis, P.E., CSP CURT LEWIS & ASSOCIATES, LLC