Q/ Can you spot the difference between lucky & unlucky?

Reference AuntyPru Forum: Hoodlum we may have a problem?

Gobbledock quote:

Shit I hope the Indo’s listen to what the astute Alan Stray taught them and they don’t follow the Beaker template for incident investigations. Otherwise there will be ATR’s dropping from the sky over Indo waters!

Tick tock

Update: Also now on the Planetalking blog, see my comment HERE:

“…Damaged Virgin Australia turbo-prop risked crashing for five days
ATSB alerts the world to a safety issue that could have crashed a Virgin Australia turbo-prop…”

Ben Sandilands

Damage to the T-tail of the Virgin Australia ATR

Update – via SMH today:

Plane lucky: an aviation escape
Date July 11, 2016 – 12:00AM

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Martin Aubury

An ATR 72-600 aircraft operated by Virgin Australia prepares to land at Sydney Airport. Photo: Brendon Thorne

In February 2014 the crew of a small airliner flying from Canberra to Sydney mishandled their flight controls; one pilot pushed, the other pulled. The ATR 72 operated by Virgin entered such a violent manoeuvre that a flight attendant was seriously injured and the aircraft encountered loads far beyond what it was designed to sustain. Somehow it held together. Structural damage was so severe that the ATR 72 was visibly twisted, but nobody noticed and for the next five days the weakened airliner stayed in service.

Several months later, in December 2014, the pilots of an AirAsia Airbus A320 flying from Indonesia to Singapore made a similar mistake. They mishandled their joint response to a sudden deviation from steady flight; one pushed, the other pulled. The airliner did not recover. All 162 on board died. In due course Indonesian authorities published a timely and thorough accident report. AirAsia was vilified and Indonesian aviation in general denigrated.

It took a year longer for the Australian Transport Safety Bureau to tell us of the near-disaster here. ATSB’s interim report, published last month, went largely unnoticed; perhaps we were too distracted by the election campaign. The report is sketchy and understates the seriousness of what went wrong. The report tells us what happened in the air but says little about why the damage was not found on the ground.

The captain and co-pilot of the ATR 72 each have a control column connected by cables and links to two moveable surfaces called elevators, hinged along the rear edge of the horizontal tail. Normally a pull on either control moves both elevators up; this exerts a down load on the tail and the aircraft pivots nose up.

Modern designs like the ATR 72 have an extra safety feature. The left and right systems are copies of each other, such that left control column connects directly to the left elevator and right control connects to right elevator. In normal operation, the left and right systems are connected together and move in unison. However, if either of the systems jams, a clutch between them opens and either the captain or co-pilot can safely fly the aircraft with the functioning system.

During descent to Sydney the ATR 72 increased speed unexpectedly. The co-pilot, who was flying the aircraft tried to slow it, by reducing power and by pulling back on his control column to raise the aircraft’s nose. The captain was unsure if the co-pilot’s response would be sufficient, so gently pulled on his own control to assist. With both pilots making simultaneous nose up inputs, the aircraft rapidly pitched up. The co-pilot responded immediately by reversing his control input, to nose down. Opposite control inputs from captain and co-pilot had the unintended consequence of left and right elevator control systems uncoupling from each other. This then caused left and right elevators to move in opposite directions; a configuration for which the aircraft was never designed.

As ATSB puts it “…..asymmetric elevator deflections resulted in a large asymmetric aerodynamic load being generated on the horizontal stabiliser. That load exceeded the design strength requirements for the stabiliser structure, resulting in significant damage. Such a large exceedance has the potential to result in catastrophic damage to the stabiliser and a subsequent loss of control.”

Later analysis showed that much of the aircraft structure was overloaded, some by 47 per cent. Damage was extensive and when eventually found took months to repair. The whole of the tail structure, vertical and horizontal, had to be replaced.

ATSB coyly concedes pilots make mistakes. “Despite pre-existing, well-established and trained procedural risk controls to prevent dual control inputs in normal operation, the risk controls were readily, but inadvertently, bypassed by the crew on this occasion.”
Much the same mistake contributed to the AirAsia crash. The A320 is a bigger airliner than the ATR 72 and its controls are more complicated, as was the accident scenario. Plus, we know from cockpit recordings that miscommunication compounded the confusion.

The Indonesian captain and French co-pilot spoke in English but it was not their native tongue. The captain needed the co-pilot to assist by pushing his control forward to make the aircraft pitch down. The captain should have instructed “Push Down” but repeatedly said “Pull Down, Pull Down”. The co-pilot continued to pull, opposing the captain. The A320 crashed and reinforced the stereotype of unsafe aviation in Indonesia.

By contrast the Australian crew quickly regained control and avoided showering wreckage over outer Sydney. Point is, neither the crew nor Virgin’s maintenance organisation realised that the ATR 72 was seriously weakened. It seems appalling that the damage was not found for five days and that ATSB’s interim report does not explain how this came about. Suffice to say, all who flew in the damaged ATR 72 were in grave peril.

Sometimes luck alone keeps Australia’s aviation reputation safe.

Martin Aubury is a retired aeronautical engineer who has been involved with aircraft design and regulation for more than 50 years.

Read more: http://www.smh.com.au/comment/plane-lucky-an-aviation-escape-20160708-gq1i4k.html#ixzz4E4Q4rObV

“..Let’s do the timewarp again..” – Seaview? Lockhart? PelAir? Mildura? & now VARA ATR accident?? – we seem to be stuck in an endless loop of bureaucratic obfuscation, manipulation & blame shifting when it comes to the dire state of affairs in aviation safety administration and investigation in this country.

From the above SMH article let us reflect on the two last lines written by Martin Aubury (who I would regard as a person infinitely qualified to give an ‘expert’ opinion):

“..It seems appalling that the damage was not found for five days and that ATSB’s interim report does not explain how this came about. Suffice to say, all who flew in the damaged ATR 72 were in grave peril.

Sometimes luck alone keeps Australia’s aviation reputation safe…”

So here we are nearly a month after the interim report was released (& 874 days since the accident occurred) and there is still no acknowledgement from the powers to be; or signs of a ramping up of the investigation by the ATSB; that would reflect the serious observations & implications as stated by Mr Aubury.

Obviously our politicians are that self-absorbed and that wrapped up with major party argy-bargy & political toxicity, that they simply don’t give a toss about the safety of the travelling public and the possible risk of a 20 tonne aircraft, with potentially sixty odd POB, lobbing into someone’ s backyard pool in inner Sydney suburbia. Well here is a reminder to those political elite what that could kind of look like:

Q/ Can you spot the difference between lucky & unlucky…

Yet how many red light warnings will our pollies & aviation safety bureaucrats choose to ignore before our ‘luck’ runs out.

The following is a quote from a recent Christine Negroni Forbe’s article on MH370:

But in a case of history repeating itself, the ATSB is once again trying to wrap up a complex case with a tidy statement. It has adopted a “trust us we know what we’re doing” approach to questions about the reliability of a conclusion that the plane is not in the zone searched.

What Australia has now that it didn’t have in its tarnished investigation of the Pel-Air crash, is another government to which it can return the files and direct all further questions, and that is Malaysia.

In July, the missing Flight 370 will once again become solely Malaysia’s problem with no improvement in transparency over what the Australians have offered. Expect to remain mystified.

Even Christine Negroni has a sense of déjà vu when it comes to her previous experiences with Oz aviation safety, AAI & the Australian government agencies involved.

Caution – You are now entering the ‘TIMEWARP ZONE’:

Christine Negroni: http://christinenegroni.com/upside-down-air-accident-investigation/

“..I am not one to encourage politicians to start sticking their noses into matters of aviation safety. It is WAY too tempting for them to grandstand. But in the case of the Australian Senate and the ditching of a medical transport plane in November of 2009, how could they not?

After all, it is not often that government bureaucrats behave so badly that the politicians wind up looking moderate, but that is just what’s happening in Canberra. Worse, the unfolding scandal seems to indicate that the two agencies that should be more attuned than the average Joe to the complexities of causal chains and the futility of blame in accident investigations have been tone deaf…

..I don’t know how politics works in Australia; Capt. James got someone’s attention, some questions were asked and darned if two members of Parliament, David Fawcett and Nick Xenophon don’t start asking questions, too. Over the past several months the startling answers are beginning to emerge. Turns out Pel-Air, the operator for whom Capt. James was flying that night, had been a subject of concern to the Civil Aviation Safety Authority, specifically for its shortcomings in pilot training and fatigue risk management. Both of which were issues in the air evac flight.

This is discovered because after the accident, the regulator commissioned an audit of the operator and (Kudos here!) a review of its own oversight.

“It appears as if there were indicators that could have identified that the Pel-Air Westwind operation was at an elevated risk and warranted more frequent and intensive surveillance and intervention,” the report states. What CASA failed to do was share the results of the audit, called the Chambers Report with the ATSB. It probably would have broadened the ATSB’s narrow conclusions about the accident.
Confronted with reason to believe the flight crew was only a partial contributor to the accident, the Australian senators called the heads of both agencies into hearings. To John McCormick, director of Aviation Safety for CASA they ask the question, why did you not share with the ATSB, the results of the audit showing serious infractions by the operator of an airplane involved in an accident?

McCormick’s astonishing reply – as reported by Australian aviation reporter Ben Sandilands – was that McCormick did not consider the information relevant since, the accident was entirely the fault of the captain.

Though you probably don’t need them, let me repeat that with italics; entirely the fault of the captain.

I was still trying to fathom how anyone with the title “director of aviation safety” could utter those words when I read his further rationale. The information was withheld from the safety board so as “not to contaminate its decision making.” Yup, if you keep information from investigators, it won’t affect their decisions, and that’s what we call uninformed decisions. Most folks try to avoid them.

Between the ATSB’s skim-the-surface conclusion in its probe, and CASA’s retro-style, blame-the-folks at the pointy end of the accident, something very strange is going on in Australia’s air safety world. When the guys with the pocket protectors launch in with the double talk and the politicians start to sound reasonable, that’s upside down, no matter what side of the equator you’re flying on…”