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Signs of turbulence at Boeing existed long before the 737 Max tragedies

If the company is serious about reclaiming its position as the world’s leading jetbuilder, it needs to change its approach. ( Altro...

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I just had to reprint this from a B737-700/800/8Max/9Max pilot. It’s long but stays on point.

It's a bit more than a "procedural mistake." Accelerating out of the envelope and killing everyone on board is a tad more than a bit of a procedural error. It's an outright failure to fly the damn airplane. This isn't debatable or within the realm of question. A procedural mistake, albeit a glaring one, was reversing the runaway trim procedure. Failing to fly the airplane, however, is not simply a procedural mistake. It's far, far beyond a procedural issue, and this is no matter of semantics.

There is considerably more to glean from this event, and this will be done for some time yet to come. None the less, the report is also considerably more detailed than typically issued in a preliminary from the NTSB, and farther reaching, with adequate information from the CFR, FDR, and other data to paint a very clear picture. That picture isn't going to get washed away as additional investigation is done. It will only be clarified.

Some other arguments I’ve been seeing lately: So since when has pilot error resulted in a plane being grounded?

The nations which initiated groundings of the type design did so illegally and without evidence, in violation of the Chicago Convention. The groundings were political. This has already been addressed. They said it was “out of caution”. What happened later on, kept the aircraft grounded. Therefore, it is not grounded due to either accident.

What the Max did do, was make a runaway stab malfunction happen a bit easier than before. Nonetheless. It has always had memory items, and there has always been a procedure for this. Trim running unwanted cannot be confused because it “stops” followed by it running again. This is what training is suppose to prevent. That confusion people like to argue about. It doesn’t matter if the trim is running unwanted and then it stops, so what? Are you going to allow it to do just that for the entire flight? What the hell?? These exact thoughts can perfectly sum up the crew

An ab initio crew with no experience outside their own operation, one of who was deeply underqualified and inexperienced, this wasn't an issue of procedure, but of one pilot in far over his head, and the other who held ultimate responsibility for the safe outcome of the flight, but who failed to fly the airplane.

We can read the report and see that the crew made an attempt to use the control wheel trim switch to move the trim, but barely, giving up right away, and who turned off the trim with the cutoff, then turned it back on and let it run away, knowing what was happening, verbalizing it and memorializing it, as they accelerated beyond control. The aircraft wasn't beyond control until they did that, but they made it so. This wasn't procedure. It wasn't even technique. It was a failure to fly the airplane.

We can also see that despite the overspeeding, and never moving the throttles back, and with the trim cutoff switches in the appropriate cut off position, when the CA asked the FO to trim manually, the FO did trim. But he manually trimmed it nose down. Fatal mistake. He then reported to the CA he tried to trim it, can't get the nose up because “it's not working." They then re-engaged the stab trim switches in their desperation, and sealed their fate.

The death of the pilots and crew and passengers is the fault of the pilots, without question, and there is no debate that they flew the aircraft well beyond the design certification and operating limits of the airframe and type certificate, nor that they violated the procedure, not that they knew the procedure, nor that they were fully aware of the problem, it's nature, and the fact that it stemmed from one angle of attack indicator (and which one). All clearly identified and spelled out in the preliminary report.

One could argue all day long that if the crew didn't get into the airplane, or if the crew hadn't climbed out of bed that day, then no mishap would have occurred...but that is also speculation, and irrelevant.

We know that faulty data came from an AoA probe. We know that the MCAS feature ran the trim. We know that spurious cockpit warnings, airspeed data, AoA data, shaker, etc, occurred. This has never been in question.

None of those made the aircraft crash.

The fate of the aircraft was in the hands of the crew, whom the passengers expected to be competent pilots, rather than passengers who let the airplane accelerate to destruction, killing all.

Neither AoA probes, nor MCAS, nor shakers, nor trim, nor airspeed errors, nor cockpit warnings made the airplane unflyable or caused it to crash. It took a crew failing to fly the airplane, failing to do their job, failing to accomplish the most basic of tasks, to not allow the aircraft to crash, but to CAUSE it to become uncontrollable...thanks to excess airspeed and failure to follow the procedure that they knew and verbally identified and performed. The crew killed everyone by not doing their job, and that is incontrovertible. So yes, the blame needs to go where it belongs. That’s how every accident in aviation has worked. I’ve witnessed pilots slammed by the NTSB which took me by surprise, mostly because it was a maintenance issue leading up to the event, but their reason for the crew error was correct. That’s just how these investigations are suppose to be; looking at the entire situation. Everything. Everybody.

Just for the record, procedure to disable MCAS, which should be done regardless of whether or not it’s running constantly or in small movements. This procedure has been the same for many decades and has been around since the first flight.

Runaway stabilizer procedures in the 737 go something like this:

1 - Turn off the autopilot to see if it's causing the problem.

2 - Oppose the trim manually with the yoke. If that stops it, you're done.

3 - If that doesn't work, then you turn off the stab trim cutout switches.

If MCAS is getting some kind of erroneous AOA signal and inputting an unwanted nose down pitch, guess what? Those procedures will stop it. If pilots at airline X get to step 2 and think they're good and MCAS starts another input after it's initial 10 second trim, then they go to step 3.
Aviate, navigate, communicate! Nuf said!


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