[Peetwo]

ATSB AO-2023-008 (56 day non-compliant with ICAO Annex 13) prelim report review cont/-  

"K" beginning to sort out the 'Wheat from the Chaff':

Of the winnowing of Wheat from Chaff.

One of the most difficult (least liked) jobs we have toiling for Aunt Pru is 'winnowing' – fact from fiction, without friction; agenda from base intent; and rumour from reality. All fraught with peril; particularly the 'rumour' elements. Much depends on 'who' told the tale, their 'agenda' and why. Sometimes, it is no more than a third or fourth hand yarn, embellished for effect; or, for a laugh in the Pub. But, every once a while, a part of a puzzle lands on screen, or the phone rings – and one element, a nugget if you will, of information lands which, stand alone is 'something of nothing', noted and tucked away. Then, there is the 'other' type of rumour; the one which steadily gains credibility through 'source' and diversity of provider. These are the interesting ones – of the no smoke without fire type. They are also problematic for many reasons. For example; 'we' were very interested in the back room rumours emanating from the Coulson 737 fire bombing event.

Bloggs - “I think most of us are sitting quietly shaking our heads, unable to speak or type...

True enough; the wise knew to await the report; the 'safety action' speaks volumes:-

Following the accident, Coulson Aviation issued operations bulletin 2023-01 advising their large air tanker pilots operating in Australia that their minimum retardant drop heights and VDROP air speeds had been increased from 150 ft above ground level and 1.25 VS to 200 ft above ground level and 1.35 VS. Their B-737 normal checklist was amended accordingly to reflect their new minimum VDROP air speeds.

That's biggish lump of machinery to be throwing around, low, slow, heavy, close to the deck in hot bumpy weather, smoke etc, etc. Boeing 'book numbers' are very good for 'normal' operations – but I doubt there is section dedicated to 'agricultural' ops. Perhaps in the 'Sim' and 'on paper' it all looks kosher; but the 'safety' advice reflects what many believe to be the core issue. Clearly, someone wrote the ops spec in use at the time into the 'book' and CASA senior inspectors must have approved it as part of the AOC issue. Looks very much, on the surface at least, that some senior folk who thought it all 'hunky-dory got their collective 'hunks and dory's muddled. Or, did they?  Rumour #1 says perhaps not. That, alone was worth some homework, all the way back to the beginning. So we began digging and rummaging through the history of the application, operational approval and the event.

It has been impossible to gather anything that even vaguely resembles 'fact' let alone 'provable' evidence. Rumour by the cart load, opinion by the bushel; speculation and gossip enough for a small mountain of the stuff. In short; nothing that could withstand a legal challenge. However; there were a few tales from the woods which were at least consistent, a thread running through tapestry which touched the same points. Whether true or false we have no idea; pure speculation and pub conjecture will not pass any legal litmus test. So, dear reader, I shall leave it up to you to decide if there is indeed 'something rotten in the state of Denmark'. Paraphrased below, nut shell version are the most consistent, most reiterated rumours we were offered. True of False – I have no idea. Handing over....

Item 1:- Senior CASA inspectors were, for the reasons stated in the ATSB safety actions, opposed to the issue of the Coulson AOC - as presented.

Item 2:- These worthies were overruled by Reg Services based on preference being given to an opinion based on personal relationship and faith in that element of the equation.

Item 3:- There allegedly exists a small mountain of internal complaints against Reg Services top dogs; the usual stuff alleged bullying, harassment etc, etc. Along with calls for a major change of the top order.

Item 4:- Apparently, the calls for change are ignored by the top floor. Seems that the protection of certain species is a prerequisite of executive KPI bonus for 'diversity'.

These persistent rumours have no supporting evidence non whatsoever. I could even be just making it all up as I go along. Consistency and diversity of source however make one wonder about smoke and fire.

Aye well, no pleasure taken in it all; leaky buckets are of neither intrinsic or practical value. However, duty done and there's an end to it. FWIW.

Toot toot.....

Hmm...in addendum to the above, I note that Popinjay's 'attributable to' comments were reported on by the other Aunty: https://www.abc.net.au/news/2023-05-03/a.../102297164

Australian Transport Safety Bureau finds Boeing 737 crashed into ridge while fighting fire

By Keane Bourke and Grace Burmas

Posted Wed 3 May 2023 at 12:29pmWednesday 3 May 2023 at 12:29pm, updated Wed 3 May 2023 at 4:09pm


The Boeing 737 crashed while fighting bushfires on WA's south coast in February. (ABC News)

Key points:

• The Boeing 737 was fighting a bushfire in WA's south in February
  
• A report says the plane clipped a ridge line, leading to the crash
  
• Miraculously, the pilots escaped through a cockpit window
  

A Boeing 737 firebombing aircraft which crashed in Western Australia's south earlier this year hit a ridge line while dropping retardant, a preliminary investigation has revealed.

The Large Air Tanker, a civilian aircraft that was converted for firefighting and operated by Coulson Aviation, had been helping crews fight a bushfire in the Fitzgerald River National Park when it crashed on February 6.

At the time, the Australian Transport Safety Bureau (ATSB) confirmed it was the first time a 737 had been "lost" in Australia.

Both pilots escaped with minor injuries before most of the huge plane was destroyed by fire, with Premier Mark McGowan describing their survival as a "miracle".

Investigators from the ATSB found the pilots attempted to pitch the plane up from the low-altitude drop before its engines could accelerate, seconds before it hit the ridge line.

"Flight recorder data shows the throttles were advanced and the engines had accelerated just before the aircraft struck a ridge line with the stick shaker activating," ATSB Chief Commissioner Angus Mitchell said.

"The aircraft then cleared a small line of foliage, before impacting the ground a second time and sliding to rest.

"Fortunately, and remarkably, both pilots were able to exit the aircraft through a cockpit window, and suffered only minor injuries."

In its preliminary report, the ATSB said the two pilots had been tasked with tagging and extending an existing retardant line, with a target altitude of 500 feet descending to 400 feet.

Pilots made mayday call

Flight data shows the air tanker emptied three-quarters of its load, before the captain stopped the drop because the retardant line was entering a burnt area.

The pilots then repositioned the aircraft to drop the remaining retardant, which was when the accident occurred.



The report found the co-pilot did not announce any deviations during the accident and later reported they were likely focused on the air speed indicator and radio altimeter.

After they hit the ridge, the aircraft cleared a small line of foliage before impacting the ground a second time and then sliding to rest, with the crew issuing an all-stations mayday call.

Cabin door stuck

"Both pilots were unable to open the cabin door as it had buckled and the co-pilot was unable to open the right-side window," the report read.

Realising the plane was on fire, the captain managed to open the left side window on a second attempt, allowing the pair to escape.

Crews believed the pilots were trapped inside the aircraft and dropped retardant on the tanker, before the duo were rescued by helicopter with minor injuries.

Despite the extensive fire damage to the aircraft, the ATSB was able to download files from both the flight data recorder and cockpit voice recorder.



Investigations are continuing and a final report will be prepared.

"Should a critical safety issue be identified at any time during the course of the investigation, the ATSB will immediately notify relevant parties so appropriate and timely safety action can be taken," Mr Mitchell said.

The ATSB said Coulson Aviation had increased its large air tanker minimum retardant drop heights and airspeeds as a result of the preliminary findings.

Opposition calls for review into firebombers

WA Shadow Emergency Minister Martin Aldridge called for "deep consideration" from the government and regulator over the use of large aircraft to fight bushfires.

"Operating these large air tankers in these types of conditions isn't without risk," he said.

"That's why the opposition has been calling for the government and indeed, the Civil Aviation Safety Authority (CASA) as the regulator, to review the operation of firebombing aircrafts, particularly large air tankers in an Australian context."

Mr Aldridge said he was yet to hear a response from CASA since the crash.

"It will be interesting to see, noting that Coulson themselves have adjusted their operating conditions, whether or not CASA will reinforce those with regulations to ensure that similar aircraft operating within Australian jurisdictions remain safe over fire grounds." - P2: Good questions from that man??

Transport Minister Rita Saffioti said she had not been fully briefed on the preliminary report, but acknowledged the "inherent risks" involved in aerial firefighting.

She said the WA government would "continue to work with the federal government in relation to the safety of our skies".

"In particular, the safety of aerial firefighting, which is now an essential part of managing fires across the state," she said.

It is with a degree of irony that less than 3 weeks before the accident, on the Coulson Aviation webpage, there was this press release: Coulson Aviation Awarded Australian Large Air Tanker Contract Facilitating Continued Support of Bush Fire Season 

..Port Alberni, B.C. – January 17, 2023 – Coulson Aviation is excited to announce it has been awarded the contract for Australia’s National Large Air Tanker (LAT). The converted Boeing 737, Tanker 139, is the newest addition to Coulson’s FireLiner™ fleet and will be based in Sydney, New South Wales but will support additional locations in-country as needed. As the National LAT, Tanker 139 will wear the name “Phoenix” as a result of a naming competition last year via local Australian schools and joint winners Bishop Druitt College Coffs Harbour, St Patrick’s College Campbelltown, and Christian College Geelong.

“Coulson is proud to provide our state-of-the-art aircraft to the Federal Australian Government. This aircraft is an incredibly efficient bomber and the crews that operate each of our aircraft are second to none,” said Coulson Aviation Australia CEO Britt Coulson. “Working alongside dedicated Australian firefighters, Phoenix will be one of the key assets supporting this upcoming bush fire season,” said Britt...

Let us not forget that the man who was accused by Bruce Rhoades (may he RIP -  ) in conducting a 'Venomous, Vicious, Vindictive and Vexatious' campaign against him and his flight adventure business...

 

...was appointed last year as the COO of Coulson Aviation Australia.

Again, via the Coulson website: https://coulsonaviation.com.au/new-chief...australia/

..Coulson Aviation Australia is excited to welcome Craig Martin to the role of Chief Operating Officer (COO).

Craig is the former Executive Manager of Regulatory Oversight at Australian federal aviation regulator Civil Aviation Safety Authority (CASA) and brings more than 30 years of experience in the aviation sector.

Coulson Aviation Australia CEO Britt Coulson said Craig is a welcome addition to the organisation, which continues to grow and evolve its business in Australia.

“It’s a pleasure and an honor to have Craig as part of our team. He brings a deep knowledge and practical understanding of the new CASA Flight Operations Regulations which we believe will enable Coulson Aviation to expedite the building of a strong national aerial firefighting fleet in support of the Australian Federal, State and Territory governments,” he said.

“A key focus for Craig will be supporting the needs of NSW Rural Fire Service, and ensuring the expansion of our organisation continues to meet the regulatory and safety outcomes required of operators authorised by CASA to develop national aerial firefighting capability...

Finally (for now) I note the following CASA legislative instrument exemption awarded to Coulson and signed by the former holder of stakes Executive Manager and now the 'Regulatory Oversight' EM (IE CM's former role: https://www.casa.gov.au/about-us/who-we-...xt-version) Rob Walker: https://www.casa.gov.au/fixed-wing-firef...aviation-0







Note that this exemption was apparently repealed on the 30 June 2022??   

MTF...P2