Ethiopian air lines flight goes down all killed

Hugh, that looks like a very good summary of the situation. As you say, the crashes cannot be blamed solely on pilot error (or systematic airline procedures error - the Lion Air earlier problems should have prevented the crash, even with the piloting deficiencies).

But the author of this piece has taken the viewpoint "the major contributing factor to these accidents was pilot error". It would be equally valid to consider that since the proposed changes to MCAS software would prevent the occurrence of any similar crashes, "the major contributing factor to these accidents was the design and implementation of the MCAS", and it should have been designed that way in the first place. In reality, for the crashes to happen required both factors to be present (and others including the failure of Lion Air systems to get the aircraft grounded before the flight as a result of previous issues).

I am sure you are well aware of the "Swiss Cheese" model for aviation safety.

Boeing knew about 737 MAX problems months before 2018 Lion Air crash, but didn't tell FAA
Boeing knew about 737 MAX problems for months, but didn't tell FAA until after 2018 Lion Air crash - ABC News (Australian Broadcasting Corporation)

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Originally Posted by DiscoMick

Boeing knew about 737 MAX problems months before 2018 Lion Air crash, but didn't tell FAA
Boeing knew about 737 MAX problems for months, but didn't tell FAA until after 2018 Lion Air crash - ABC News (Australian Broadcasting Corporation)

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There's another from the WSJ attached to this post along similar lines.

If I'm reading that right the AOA disagree alert was supposed to be a standard feature that just didn't work out of the box. The article appears to state the "AOA disagree" indicator was standard but only worked when the "optional" AOA indicators were provisioned.

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do you think the FAA should be held liable for this?

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Originally Posted by Eevo

do you think the FAA should be held liable for this?

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If that question was for me then the answer is "I don't really know". I'm more interested in the final reports and investigative outcomes.

I'm not much for apportioning liability or even speculating as I don't know enough to claim a fully formed opinion.

What I will say is it appears both disasters could have been averted by either better trained and more experienced pilots *or* aircraft that didn't have a pathological system fault.

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Originally Posted by BradC

If that question was for me then the answer is "I don't really know". I'm more interested in the final reports and investigative outcomes.

I'm not much for apportioning liability or even speculating as I don't know enough to claim a fully formed opinion.

What I will say is it appears both disasters could have been averted by either better trained and more experienced pilots *or* aircraft that didn't have a pathological system fault.

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As with most aviation accidents, the end result needed several factors to be present, in this case including a seriously deficient aircraft system and insufficient pilot experience and/or training, but also a lack of oversight by FAA, poor management decisions by Boeing, poor maintenance management and fault and incident reporting by Lion Air (and, I expect, Ethiopian and probably other operators).

It is clear to me that the liability is widely shared, although it will be interesting to see where the court decisions land. (Probably take years!)

The recent Moscow Superjet accident is another example of an accident with multiple contributing factors clear even at this early stage. From what we have heard so far the flight had an incident, possibly a lightning strike but possibly an electrical issue, shortly after takeoff, that resulted in a return to the airport. According to one account, they were out of contact, although their transponder said there was an emergency. It is unclear whether they had a landing clearance.

Apparently the lack of communications and perhaps urgency to land led to landing without dumping fuel, so it may have been landing at above maximum landing weight. The combination of this weight and possibly handling errors (by the relatively inexperienced captain) and weather led to the collapse of the main gear, followed by fuel tank rupture and fire. So what was the "cause" of the accident?

I don't believe the SS-100 has a fuel dump capability. It's about the same size as the Embraer 190 I used to fly. The B737 doesn't either. I imagine they would be similar (procedurally) with overweight landings (immediate return to land) - it's certainly a consideration, but not a limitation. Provided your landing performance data for the proposed runway is valid, just run the Overweight Landing Checklist and let the engineers do an inspection once back on the ground. Of course, time permitting you would go somewhere and hold to burn off sufficient fuel to get below MLW. In the B737-800 the difference is about 13T if departing at MBRW. That's a lot of holding!

For an uncontained engine fire you have about 15 mins to complete your checklists, set up for the return, get the cabin crew to prepare for an emergency landing/evac etc, before you're facing catastrophic structural failure from the fire. Concorde took less than 2 mins. If the departure airport is doing instrument approaches, it will take you most of that time to get back (if under radar control). If it's visual, you could get it back in 5-7 mins with everything abbreviated.

With the Moscow prang and no-comms, I suspect the crew were concentrating on working the problem and simply ignoring ATC until ready to talk to them. The old analogy 'aviate-navigate-communicate' springs to mind. I remember I had an engine failure about 12 years ago late on descent into Sydney. The first officer was pilot flying and I was doing the radios and managing the problem. We got to the point where I gave them the PAN call and all the information they needed for our arrival. I wanted to continue with the remainder of our checklists and get set up for the approach and landing. Every time I would get part way into it, ATC would interrupt and ask me for more (unnecessary IMO) questions. In the end I said something like "We're very busy here completing checklists and preparing for landing. Give me a heading I can fly for 5 mins uninterrupted and don't call me unless it's important. I'll call you when we're ready to continue". He was a bit miffed, but basically when something like this is going on, you don't want any outside interruptions unless absolutely necessary in the interest of safety. The Moscow crew probably just didn't verbalise it. I'm not criticising ATC. They do a fantastic job. Sometimes they need to realise they are not our priority in a non-normal situation.

An example of excellent controlling is one occasion we had a smoke/fumes in the cabin out of Melbourne at about 20000' climbing out (almost your worst nightmare). We got our initial actions done, told ATC what they needed to know (again) and said we require an immediate return to land. He was onto it straight away. He coordinated with the other controllers and basically said "all runways available - where do you want to go?". I told him where we wanted to go, and he made it happen. Minimum of fuss. Minimum radio disruptions. We were airborne a total of 20 mins. Felt like an hour.

I think the FAA must share some responsibility for what Boeing has done. I haven't seen many industries where self-certification (effectively what FAA allowed Boeing to to) actually works for the end-user/buying public. Look at the caravan industry - it's full of charlatans producing overpriced, under quality products. The data on the compliance plate in most instances, particularly weights, are a fairytale.

Fox and hen house springs to mind.

John.

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Originally Posted by Hugh Jars

I don't believe the SS-100 has a fuel dump capability. It's about the same size as the Embraer 190 I used to fly. The B737 doesn't either.

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Could you clear something up for me? I have read elsewhere that short and medium haul airliners do not have fuel dump capability at all. Only long haul. Is that true in all cases?

Thanks again for your explanation Hugh. Reminds me of the one really serious in-flight emergency I have faced while PIC. (not including the Bonanza with electrical failure leading to hand-cranked gear extension!)

This was flying a Grumman AA-5 from Lilydale to Dubbo - over The Rock it dropped a valve. My immediate thought was I'd lost a prop blade, but quickly realised the vibration was power dependent not rpm dependent, and I managed to stretch the glide to do a straight in landing at Wagga. Communications were not exactly top priority, especially since the panel was shaking so violently that changing channels was not feasible. Lesson - in a single, plan as high as possible - gives you more choice if the fan stops.