25 years since the Kegworth Air Crash
Discussion
Read this on the BBC site yesterday. Pretty harrowing reading 
http://www.bbc.co.uk/news/uk-england-leicestershir...
I suppose unlike the other stories when pilots have managed to 'glide' airliners when they have lost all power, I suppose that in this case the pilots were unaware that they had no power until it was too late.
http://www.bbc.co.uk/news/uk-england-leicestershir...
I suppose unlike the other stories when pilots have managed to 'glide' airliners when they have lost all power, I suppose that in this case the pilots were unaware that they had no power until it was too late.
I remember it well.
I was working for an air cargo company down at Gatwick, and we used to run an artic up to Leeds overnight every night from Sunday to Thursday. Saw the news flash on TV and remember thinking he would have a bugger of a journey.
Turns out, he was involved... He was driving along, when suddenly the vehicles in front all hit the brakes and shoved their hazards on, next thing, the aircraft hits in front of him. He reckons if it was not for the hazards, it would have taken his truck out, I only have his word for this.
He got out to help and went into the aircraft, and apparently the first thing he saw was a passenger with her head turned all the way round, obviously dead.
He stayed to he help until the emergency services arrived and went on his way, obviously very shaken, stopping at the next services to call his wife. He told her to put the news on, and there was a news flash reporting the crash of a BMA DC9, he corrected this, and told her it was a BMA 737-400, he knew because he had just climbed out of the back of it.
He was never the same after that..
I was working for an air cargo company down at Gatwick, and we used to run an artic up to Leeds overnight every night from Sunday to Thursday. Saw the news flash on TV and remember thinking he would have a bugger of a journey.
Turns out, he was involved... He was driving along, when suddenly the vehicles in front all hit the brakes and shoved their hazards on, next thing, the aircraft hits in front of him. He reckons if it was not for the hazards, it would have taken his truck out, I only have his word for this.
He got out to help and went into the aircraft, and apparently the first thing he saw was a passenger with her head turned all the way round, obviously dead.
He stayed to he help until the emergency services arrived and went on his way, obviously very shaken, stopping at the next services to call his wife. He told her to put the news on, and there was a news flash reporting the crash of a BMA DC9, he corrected this, and told her it was a BMA 737-400, he knew because he had just climbed out of the back of it.
He was never the same after that..
I videotaped the news bulletin that broke the story (News at Ten, I think) and they definitely initially reported the accident as being a British Midland DC-9 - and then went on to discuss the use of aging airliners.
As we all know (as mentioned above), it was actually a practically brand new 737-400.
As we all know (as mentioned above), it was actually a practically brand new 737-400.
Sadly the bottom line is that the Crew shut the wrong engine down and crashed an otherwise serviceable a/c.
The First Officer initially correctly identified the failed engine but was overruled by the Captain. The rear crew and pax knew which engine had failed because they could see sparks and debris coming from it, but at no time was this information either asked for by the flight deck, nor passed forward by the rear crew.
The flight deck then spent an inordinate amount of time discussing where to take the a/c with their Operating Authority before diverting to East Midlands, rather than declaring a MAYDAY and putting the a/c down at a nearby airfield (Civil or Military) or even at LHR.
Having decided to go to East Midlands they then flew a poorly executed approach which may well have resulted in a Go Around (the recorded data shows that they were well off the ILS centreline).
There were a number of mitigating factors such as lack of real time experience on that mark of 737, the different (and confusing) arrangement of the flight deck compared to earlier marks and the re-arrangement of systems in that mark of 737. The latter specifically being the feeds to the Flight Deck and Cabin air conditioning packs which lead the Captain to convince himself that the starboard engine had failed (when it was the port).
In any accident there is a chain of events. Break any link in that chain and the accident will be avoided. Unfortunately, in this case, poor CRM meant that the crew failed to 1. Fly the Aircraft. 2. Deal with the Emergency correctly. 3. Deal with the aftermath in an apposite and reasonable manner. The crew concentrated on 3 to the detriment of 1 and 2.
The First Officer initially correctly identified the failed engine but was overruled by the Captain. The rear crew and pax knew which engine had failed because they could see sparks and debris coming from it, but at no time was this information either asked for by the flight deck, nor passed forward by the rear crew.
The flight deck then spent an inordinate amount of time discussing where to take the a/c with their Operating Authority before diverting to East Midlands, rather than declaring a MAYDAY and putting the a/c down at a nearby airfield (Civil or Military) or even at LHR.
Having decided to go to East Midlands they then flew a poorly executed approach which may well have resulted in a Go Around (the recorded data shows that they were well off the ILS centreline).
There were a number of mitigating factors such as lack of real time experience on that mark of 737, the different (and confusing) arrangement of the flight deck compared to earlier marks and the re-arrangement of systems in that mark of 737. The latter specifically being the feeds to the Flight Deck and Cabin air conditioning packs which lead the Captain to convince himself that the starboard engine had failed (when it was the port).
In any accident there is a chain of events. Break any link in that chain and the accident will be avoided. Unfortunately, in this case, poor CRM meant that the crew failed to 1. Fly the Aircraft. 2. Deal with the Emergency correctly. 3. Deal with the aftermath in an apposite and reasonable manner. The crew concentrated on 3 to the detriment of 1 and 2.
Eric Mc said:
I videotaped the news bulletin that broke the story (News at Ten, I think) and they definitely initially reported the accident as being a British Midland DC-9 - and then went on to discuss the use of aging airliners.
As we all know (as mentioned above), it was actually a practically brand new 737-400.
I saw that on the video. It made me smile as we now like to bash the BBC and others for being quick to get news out regardless of the actual facts with a 'it never used to be like that' when quite clearly it was! That said I'm quite glad it sounds like all the planes have been making the runway comfortably yesterday and today (well apart from the Eurofighter who didn't really try)As we all know (as mentioned above), it was actually a practically brand new 737-400.
mcdjl said:
Eric Mc said:
I videotaped the news bulletin that broke the story (News at Ten, I think) and they definitely initially reported the accident as being a British Midland DC-9 - and then went on to discuss the use of aging airliners.
As we all know (as mentioned above), it was actually a practically brand new 737-400.
I saw that on the video. It made me smile as we now like to bash the BBC and others for being quick to get news out regardless of the actual facts with a 'it never used to be like that' when quite clearly it was! That said I'm quite glad it sounds like all the planes have been making the runway comfortably yesterday and today (well apart from the Eurofighter who didn't really try)As we all know (as mentioned above), it was actually a practically brand new 737-400.
Xmas '88 was a very strange time. I traveled home on leave from Scotland on the 21 Dec and got in quite late to find my Ma in a panic over Pan Am 103 because she knew I would be going past Lockerbie. We back-plotted my journey and found I had missed the crash by about 15-20 minutes.
After Xmas a bunch of us went to the Racing Car Show at Earls Court on 8 Jan. One of us, a very good friend of mine, lived in the Burton area and traveled home that evening. It transpired he had decided to turn off the M1 on to the Ashby Rd (rather than continue on to the A50 Junction) about 5 minutes before the 737 came down.
After Xmas a bunch of us went to the Racing Car Show at Earls Court on 8 Jan. One of us, a very good friend of mine, lived in the Burton area and traveled home that evening. It transpired he had decided to turn off the M1 on to the Ashby Rd (rather than continue on to the A50 Junction) about 5 minutes before the 737 came down.
onyx39 said:
mcdjl said:
Eric Mc said:
I videotaped the news bulletin that broke the story (News at Ten, I think) and they definitely initially reported the accident as being a British Midland DC-9 - and then went on to discuss the use of aging airliners.
As we all know (as mentioned above), it was actually a practically brand new 737-400.
I saw that on the video. It made me smile as we now like to bash the BBC and others for being quick to get news out regardless of the actual facts with a 'it never used to be like that' when quite clearly it was! That said I'm quite glad it sounds like all the planes have been making the runway comfortably yesterday and today (well apart from the Eurofighter who didn't really try)As we all know (as mentioned above), it was actually a practically brand new 737-400.
In those days, the main BBC evening news was at 9.00 pm and the news broke after that had been broadcast. It happened just as News at Ten was going on air so you can kind of excuse them for jumping to the wrong conclusion.
Posted yesterday in NP&E - little response so should have put it here...
GadgeS3C said:
I'd forgotten this happened so soon after the Lockerbie crash.
http://www.bbc.co.uk/news/uk-england-leicestershir...
Just up the road from me and I travel that section of motorway quite often.
I knew a chap that was one of the ambulance drivers first on scene. With a group of friends I accompanied him on the first plane flight he made after the crash (10ish years ago so 15 years after the crash). Difficult to imagine what he was going through but nice that we were able to support him through it.
http://www.bbc.co.uk/news/uk-england-leicestershir...
Just up the road from me and I travel that section of motorway quite often.
I knew a chap that was one of the ambulance drivers first on scene. With a group of friends I accompanied him on the first plane flight he made after the crash (10ish years ago so 15 years after the crash). Difficult to imagine what he was going through but nice that we were able to support him through it.
Ginetta G15 Girl said:
Sadly the bottom line is that the Crew shut the wrong engine down and crashed an otherwise serviceable a/c.
The First Officer initially correctly identified the failed engine but was overruled by the Captain. The rear crew and pax knew which engine had failed because they could see sparks and debris coming from it, but at no time was this information either asked for by the flight deck, nor passed forward by the rear crew.
The flight deck then spent an inordinate amount of time discussing where to take the a/c with their Operating Authority before diverting to East Midlands, rather than declaring a MAYDAY and putting the a/c down at a nearby airfield (Civil or Military) or even at LHR.
Having decided to go to East Midlands they then flew a poorly executed approach which may well have resulted in a Go Around (the recorded data shows that they were well off the ILS centreline).
There were a number of mitigating factors such as lack of real time experience on that mark of 737, the different (and confusing) arrangement of the flight deck compared to earlier marks and the re-arrangement of systems in that mark of 737. The latter specifically being the feeds to the Flight Deck and Cabin air conditioning packs which lead the Captain to convince himself that the starboard engine had failed (when it was the port).
In any accident there is a chain of events. Break any link in that chain and the accident will be avoided. Unfortunately, in this case, poor CRM meant that the crew failed to 1. Fly the Aircraft. 2. Deal with the Emergency correctly. 3. Deal with the aftermath in an apposite and reasonable manner. The crew concentrated on 3 to the detriment of 1 and 2.
I think this is technically called a statistically impossible aligning of the AND gates. The First Officer initially correctly identified the failed engine but was overruled by the Captain. The rear crew and pax knew which engine had failed because they could see sparks and debris coming from it, but at no time was this information either asked for by the flight deck, nor passed forward by the rear crew.
The flight deck then spent an inordinate amount of time discussing where to take the a/c with their Operating Authority before diverting to East Midlands, rather than declaring a MAYDAY and putting the a/c down at a nearby airfield (Civil or Military) or even at LHR.
Having decided to go to East Midlands they then flew a poorly executed approach which may well have resulted in a Go Around (the recorded data shows that they were well off the ILS centreline).
There were a number of mitigating factors such as lack of real time experience on that mark of 737, the different (and confusing) arrangement of the flight deck compared to earlier marks and the re-arrangement of systems in that mark of 737. The latter specifically being the feeds to the Flight Deck and Cabin air conditioning packs which lead the Captain to convince himself that the starboard engine had failed (when it was the port).
In any accident there is a chain of events. Break any link in that chain and the accident will be avoided. Unfortunately, in this case, poor CRM meant that the crew failed to 1. Fly the Aircraft. 2. Deal with the Emergency correctly. 3. Deal with the aftermath in an apposite and reasonable manner. The crew concentrated on 3 to the detriment of 1 and 2.
That is for a smoking hole in the ground you need, A AND B AND C AND D AND E and so on to happen all at the same time, and each one is a really really small probability, so when you work out the likelihood it's close to zero.
And in all cases of major disasters the AND gates all match up, and what they thought was impossible happens.
New POD said:
Ginetta G15 Girl said:
Sadly the bottom line is that the Crew shut the wrong engine down and crashed an otherwise serviceable a/c.
The First Officer initially correctly identified the failed engine but was overruled by the Captain. The rear crew and pax knew which engine had failed because they could see sparks and debris coming from it, but at no time was this information either asked for by the flight deck, nor passed forward by the rear crew.
The flight deck then spent an inordinate amount of time discussing where to take the a/c with their Operating Authority before diverting to East Midlands, rather than declaring a MAYDAY and putting the a/c down at a nearby airfield (Civil or Military) or even at LHR.
Having decided to go to East Midlands they then flew a poorly executed approach which may well have resulted in a Go Around (the recorded data shows that they were well off the ILS centreline).
There were a number of mitigating factors such as lack of real time experience on that mark of 737, the different (and confusing) arrangement of the flight deck compared to earlier marks and the re-arrangement of systems in that mark of 737. The latter specifically being the feeds to the Flight Deck and Cabin air conditioning packs which lead the Captain to convince himself that the starboard engine had failed (when it was the port).
In any accident there is a chain of events. Break any link in that chain and the accident will be avoided. Unfortunately, in this case, poor CRM meant that the crew failed to 1. Fly the Aircraft. 2. Deal with the Emergency correctly. 3. Deal with the aftermath in an apposite and reasonable manner. The crew concentrated on 3 to the detriment of 1 and 2.
I think this is technically called a statistically impossible aligning of the AND gates. The First Officer initially correctly identified the failed engine but was overruled by the Captain. The rear crew and pax knew which engine had failed because they could see sparks and debris coming from it, but at no time was this information either asked for by the flight deck, nor passed forward by the rear crew.
The flight deck then spent an inordinate amount of time discussing where to take the a/c with their Operating Authority before diverting to East Midlands, rather than declaring a MAYDAY and putting the a/c down at a nearby airfield (Civil or Military) or even at LHR.
Having decided to go to East Midlands they then flew a poorly executed approach which may well have resulted in a Go Around (the recorded data shows that they were well off the ILS centreline).
There were a number of mitigating factors such as lack of real time experience on that mark of 737, the different (and confusing) arrangement of the flight deck compared to earlier marks and the re-arrangement of systems in that mark of 737. The latter specifically being the feeds to the Flight Deck and Cabin air conditioning packs which lead the Captain to convince himself that the starboard engine had failed (when it was the port).
In any accident there is a chain of events. Break any link in that chain and the accident will be avoided. Unfortunately, in this case, poor CRM meant that the crew failed to 1. Fly the Aircraft. 2. Deal with the Emergency correctly. 3. Deal with the aftermath in an apposite and reasonable manner. The crew concentrated on 3 to the detriment of 1 and 2.
That is for a smoking hole in the ground you need, A AND B AND C AND D AND E and so on to happen all at the same time, and each one is a really really small probability, so when you work out the likelihood it's close to zero.
And in all cases of major disasters the AND gates all match up, and what they thought was impossible happens.
I know the engineer who departed the aircraft on its last flight, think he nearly had heart failure when he found out it had crashed!
I was working for Dan Air at the time and I vividly remember walking across the ramp outside the hangar at Gatwick and seeing our first 737-400 parked after it had been grounded.
I was working for Dan Air at the time and I vividly remember walking across the ramp outside the hangar at Gatwick and seeing our first 737-400 parked after it had been grounded.
Eric Mc said:
News at Ten is/was ITV - not the BBC. It was ITV's News at Ten that ran the erroneous report.
In those days, the main BBC evening news was at 9.00 pm and the news broke after that had been broadcast. It happened just as News at Ten was going on air so you can kind of excuse them for jumping to the wrong conclusion.
BBC Newsflash reported it as a DC9 - http://www.bbc.co.uk/news/uk-england-leicestershir... (28 seconds in)In those days, the main BBC evening news was at 9.00 pm and the news broke after that had been broadcast. It happened just as News at Ten was going on air so you can kind of excuse them for jumping to the wrong conclusion.
CharlieCrocodile said:
BBC Newsflash reported it as a DC9 - http://www.bbc.co.uk/news/uk-england-leicestershir... (28 seconds in)
So they all got it wrong.onyx39 said:
The "Swiss cheese model"
[pedant mode]Slightly misleading illustration, as it suggests each layer of defence has the same risks/flaws in precisely the same location.....which sort of defeats the object a bit.
The (different) holes are meant to overlap slightly, not replicate one another.
[/pedant mode]
Crossflow Kid said:
onyx39 said:
The "Swiss cheese model"
[pedant mode]Slightly misleading illustration, as it suggests each layer of defence has the same risks/flaws in precisely the same location.....which sort of defeats the object a bit.
The (different) holes are meant to overlap slightly, not replicate one another.
[/pedant mode]
the wrong picture perhaps... bottom line... a number of scenarios line up causing the crash.. it could have been prevented in a number of places.
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