Mangalore (final)..
Over it; however - Somehow, the event at MNG keeps creeping into thoughts; stray notions pop up when the thinking gear is at idle (or playing Darts). The event has officially been put aside with the 'bases' neatly covered and the cracks papered over; but, something keeps nagging away. I try putting myself in each pilot seat; (even tried the ATCO stool).
“I have often tried to imagine how I might have acted differently. Always I end up in the same place.”
That place being in the right hand seat of the inbound aircraft.
Blackburn - “A review conducted by Airservices following the accident concluded that both aircraft were provided with, and acknowledged receipt of, mutual traffic that contained all relevant information.”
If we put that aside; we are left with a 13 second 'transmission' from the ATCO:-
“Between 1120:15 1120:28 Controller again called the pilots of AEM. Pilot responded and traffic information about JQF shortly to depart Mangalore was passed and acknowledged.”
So, lets start the clock about 11:22:19.
“Between 11:22:19 1123:00 JQF Departure report to controller. Information was provided that the aircraft was passing 2,700 ft on climb to 7,000 ft and tracking to LACEY.”
“Controller advised the pilots that AEM was inbound to Mangalore in JQF's 12 o’clock position, for air-work, passing 5,000 ft on descent to not above 4,000 ft. AEM was apparently 10-11 NM from YMNG”.
By about this time, both fellah's in the right seats should have been paying a lot of attention. 10 miles ≈ 2.3 minutes (±) - a potential 'conflict' to deal with. Just a 'bread and butter' event operating OCTA. How many times during a day do IFR flights 'self separate? 'Lots of' is the ball park answer. So how long would you allow the flying pilot to establish contact with the opposite direction traffic and arrange separation? Not too long I should say. Q - “Got that traffic mate” A – “Yes advised them that we will maintain 5000 until clear”. Choc frog answer #1.
In the opposition aircraft; a similar scenario should be developing: “Comms established maintaining 4000' until clear”. Choc frog answer #2.
In the right hand seat, all should be quiet and content with this information provided. If it was not; then its time for the grown ups to step in and settle the quarrel;; the doomsday clock was ticking and - Murphy was lurking.
The gods alone know what the ATSB 'simulation' of cockpit 'vision' cost; it is totally irrelevant to IFR operations (may be useful to junior VFR maybe) but IFR is a mental picture game- in IMC, OCTA all you have is the 'mind-map' of where you are and where the opposition is; this is a dynamic, fast moving, fluid situation. Communication is paramount in this routine, almost everyday occurrence, when the weather is liquid and lousy.
Oh! I don't know; but I feel the ATSB could have done a better job on this one. It reaches deep into fundamental operating practice across the spectrum; ATC, training, pilot attitudes, communication systems etc, etc. I particularity dislike this push toward more dependence on ADSB separation becoming the norm. Sure it is a great tool; but no more than that; it cannot replace an active, plugged in, situation aware mind on the flight deck. When it matters; really matters, it is that mind, not a machine which will save the day. One may only require that facility once or twice in a lifetime of flying – but when needed, it must be fully operational, when the clock is ticking.
Sorry to bang on; but the more I think about the Mangalore event; the more aligned 'holes' in the Reason cheese I find. But; as the prophets say:-
“Once is happenstance. Twice is coincidence. Three times is enemy action.
Toot – (and - back in my box) – toot.......
Over it; however - Somehow, the event at MNG keeps creeping into thoughts; stray notions pop up when the thinking gear is at idle (or playing Darts). The event has officially been put aside with the 'bases' neatly covered and the cracks papered over; but, something keeps nagging away. I try putting myself in each pilot seat; (even tried the ATCO stool).
“I have often tried to imagine how I might have acted differently. Always I end up in the same place.”
That place being in the right hand seat of the inbound aircraft.
Blackburn - “A review conducted by Airservices following the accident concluded that both aircraft were provided with, and acknowledged receipt of, mutual traffic that contained all relevant information.”
If we put that aside; we are left with a 13 second 'transmission' from the ATCO:-
“Between 1120:15 1120:28 Controller again called the pilots of AEM. Pilot responded and traffic information about JQF shortly to depart Mangalore was passed and acknowledged.”
So, lets start the clock about 11:22:19.
“Between 11:22:19 1123:00 JQF Departure report to controller. Information was provided that the aircraft was passing 2,700 ft on climb to 7,000 ft and tracking to LACEY.”
“Controller advised the pilots that AEM was inbound to Mangalore in JQF's 12 o’clock position, for air-work, passing 5,000 ft on descent to not above 4,000 ft. AEM was apparently 10-11 NM from YMNG”.
By about this time, both fellah's in the right seats should have been paying a lot of attention. 10 miles ≈ 2.3 minutes (±) - a potential 'conflict' to deal with. Just a 'bread and butter' event operating OCTA. How many times during a day do IFR flights 'self separate? 'Lots of' is the ball park answer. So how long would you allow the flying pilot to establish contact with the opposite direction traffic and arrange separation? Not too long I should say. Q - “Got that traffic mate” A – “Yes advised them that we will maintain 5000 until clear”. Choc frog answer #1.
In the opposition aircraft; a similar scenario should be developing: “Comms established maintaining 4000' until clear”. Choc frog answer #2.
In the right hand seat, all should be quiet and content with this information provided. If it was not; then its time for the grown ups to step in and settle the quarrel;; the doomsday clock was ticking and - Murphy was lurking.
The gods alone know what the ATSB 'simulation' of cockpit 'vision' cost; it is totally irrelevant to IFR operations (may be useful to junior VFR maybe) but IFR is a mental picture game- in IMC, OCTA all you have is the 'mind-map' of where you are and where the opposition is; this is a dynamic, fast moving, fluid situation. Communication is paramount in this routine, almost everyday occurrence, when the weather is liquid and lousy.
Oh! I don't know; but I feel the ATSB could have done a better job on this one. It reaches deep into fundamental operating practice across the spectrum; ATC, training, pilot attitudes, communication systems etc, etc. I particularity dislike this push toward more dependence on ADSB separation becoming the norm. Sure it is a great tool; but no more than that; it cannot replace an active, plugged in, situation aware mind on the flight deck. When it matters; really matters, it is that mind, not a machine which will save the day. One may only require that facility once or twice in a lifetime of flying – but when needed, it must be fully operational, when the clock is ticking.
Sorry to bang on; but the more I think about the Mangalore event; the more aligned 'holes' in the Reason cheese I find. But; as the prophets say:-
“Once is happenstance. Twice is coincidence. Three times is enemy action.
Toot – (and - back in my box) – toot.......