Aces High Bulletin Board
General Forums => The O' Club => Topic started by: Yeager on September 08, 2005, 02:55:48 PM
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NEW YORK -- Neither the German pilot nor the Cypriot co-pilot of an airliner that crashed Aug. 14 near Athens could speak the same language fluently, and each had difficulty understanding the other's English, the International Herald Tribune reported in an article published in Wednesday editions of the New York Times.
The Herald Tribune, citing several people connected with the investigation into the crash, said the crew members of the Cypriot airliner became confused by a series of alarms as the plane climbed, failing to recognize that the cabin wasn't pressurizing until they grew mentally disoriented because of lack of oxygen and lost consciousness.
A total of 121 people were killed in the crash after the plane climbed and flew on autopilot, circling near Athens until one engine stopped running because of a lack of fuel. The sudden imbalance of power, with only one engine operating, caused the autopilot to disengage and the plane to begin to fall, according to the newspaper report.
Investigators pieced together the story of the crash from many sources, the Herald Tribune said. Among other things, the investigators determined that the pilot wasn't in his seat because he was up trying to solve a problem that turned out to be one of the lesser threats facing the plane, the newspaper reported.
The plane that crashed, a Boeing 737-300, underwent maintenance the night before. The maintenance crew apparently left a pressurization controller rotary knob out of place, according to the officials connected to the investigation, and the crew didn't catch the mistake during preflight checks the next day. This meant that the plane couldn't pressurize properly, the Herald Tribune said.
At 10,000 feet, an alarm went off to warn the crew that the plane wouldn't pressurize. Crew members mistakenly thought that the alarm horn was a warning to tell them that their controls weren't set properly for takeoff, the officials told the Herald Tribune.
The climb continued on autopilot. At 14,000 feet, oxygen masks deployed as designed, and a master caution light illuminated in the cockpit. Another alarm sounded at about the same time on an unrelated matter, warning that there was insufficient cooling air in the compartment housing avionics equipment, the newspaper said.
The radio tapes showed that this created tremendous confusion in the cockpit. Normally an aircraft cabin is held at 8,000 feet pressure, so the crew at over 14,000 feet would already be experiencing some disorientation because of a lack of oxygen, the newspaper reported.
During this time, the captain and co-pilot discovered that they had no common language and that their English wasn't good enough for the complicated technical conversation required to fix the problem, according to the report.
The crew members called the maintenance base in Cyprus and were told that the circuit breaker to turn off the loud new alarm was in a cabinet behind the captain. The captain got up from his seat to look for the circuit breaker, apparently ignoring the confused co-pilot.
As the plane continued to climb on autopilot, the air grew so thin that the crew became seriously impaired. The captain lost consciousness first on the floor of the cockpit, followed by the co-pilot, who remained in his seat, according to the officials who spoke to the Herald Tribune.
The autopilot did as it was programmed to do, flying the plane at 34,000 feet to Athens and entering a holding pattern. It remained in a long circling pattern, shadowed by Greek military jets, until fuel ran low and one engine quit, according to the report.
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Thank god for the FAA's certification requirements of "Can you speak and read english fluently" Doesn't ICAO have a crew requirement of the same language?
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Originally posted by Wolfala
Thank god for the FAA's certification requirements of "Can you speak and read english fluently" Doesn't ICAO have a crew requirement of the same language?
That will get PCed one day too.
Sad sad stuff above.
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The probably left it in Manual with the outflow valve open and it failed to pressurize.
That's why there's a checklist.
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I've been flying for most of my life - but I don't know of a single instance of a crew certified in the US that couldn't communicate with each other to troubleshoot atleast in the same language, with the exception of the FO occasionally being a mongoloid. Its unacceptable and a completely preventable accident. Thats why the PTS standards on every certification has a checkoff "USE OF CHECKLISTS"
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It's pretty obvious that the company was not too awfully concerned about who they hired to fly their aircraft, not too concerned about a serious Line Check program, a serious Flight Safety program.........
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I'm amazed they were actually allowed to fly with this kind of crew.
Already for years attention has been on the cockpit teamwork...
They sure did alot of things wrong, which shouldn't have happened even with one pilot knowing the stantard procedures.
Just too odd they just let the autopilot climb with all the alarms going off.
Bad T/O config alert at 10,000ft.. yeah.. right.
Couldn't they have figured something easier than that?
I wonder what their salary was, because even on the invidual level their actions, under the current light, seemed to be far from professional.
Same goes for the maintenance...
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Originally posted by Fishu
I'm amazed they were actually allowed to fly with this kind of crew.
Already for years attention has been on the cockpit teamwork...
They sure did alot of things wrong, which shouldn't have happened even with one pilot knowing the stantard procedures.
Just too odd they just let the autopilot climb with all the alarms going off.
Bad T/O config alert at 10,000ft.. yeah.. right.
Couldn't they have figured something easier than that?
I wonder what their salary was, because even on the invidual level their actions, under the current light, seemed to be far from professional.
Same goes for the maintenance...
I get the T/O config warning before I even get 80 % of N1 - exactly the point.
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First, folks, to put this in perspective:
This is a small island. Everybody knows each other. There's also a culture in this island where petty personal intrigues lead people to "cut off the nose to spite the face". Since the helios crash, there has been 4 weeks of nothing but news -- mostly manufactured -- on Helios. Hell, even whining about the "Cyprus Problem" has taken a backseat, and that means it's serious. Politicians here and in Greece are using the crash for their own advantage: the previous administration set up the DCA (=Cyprus FAA); the current administration runs it. Many prominent politicians under the previous administration own significant shares in Libra/Helios. It's all shady, at this point, and don't believe what you read.
about that article: the "young, inexperienced F/O was 41 years old with something like 7000 flight hours. I find it _very_ hard to believe that any educated cypriot would not speak english fluently -- this is not Greece (I say that because I often have to switch to french or italian when talking to educated Greeks). The Captain, on the other hand, apparently was flying for East German carriers until 1990.
Toad's scenario sounds plausible. Then it gets missed on the checklist, then the horn sounds at 10,000 feet, and the crew thinks they've got something malfunctioning somewhere (since the cabin alt alarm is the same horn as the takeoff configuration horn; they think they've got a spurious horn, and try to sort it -- the same thing's happened a few times on other 737s). At 14k, the electronics bay overheats.
Now, the rest of it -- well, it depends on the timing. The ATC tapes may show them being increasingly confused as hypoxia set in, but I'd find it hard dto believe they told ATC "we're having trouble understanding each other" before hypoxia.
It would certainly make sense though that both of them were trying to sort the horns, and nobody was flying the aircraft (=level off to solve the problem).
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Rather than passing out while troubleshooting the lack of pressurization why not decend to 10,000 feet first then figure out the language problem?
14,000 feet is thin air but not enough to completely lose consciousness right?
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As a side note, it's 99% sure that the Electronics and Equipment overheat was because of the failure to pressurize.
The main outflow valve is in the lower aft fuselage but cabin air is also exhausted through the E&E bay to cool the equipment racks. So, no pressurization, no cabin air exhausted because there's no differential pressure.
Basically, this is all just "checklist discipline". They didn't run the Pre-Flight checklist correctly, an unbelievable failure of professionalism.
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Originally posted by Edbert
Rather than passing out while troubleshooting the lack of pressurization why not decend to 10,000 feet first then figure out the language problem?
Apparently they never realized they had failed to pressurize at all.
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Originally posted by Toad
Apparently they never realized they had failed to pressurize at all.
I would think that the oxygen masks falling out might have been a hint. Maybe the crew in the cockpit could not see that but I'd have expected a stewardess to have said something, assuming she spoke a language they could understand.
Sad to think how ways this could have been avaoidable.
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Unless they opened the door it's unlikely they'd see the masks down. There's just a little peephole like they sell in hardware stores for your front door.
As for the F/A's calling, I'd expect that on a US line because the training is that one of the pilots will call on interphone as soon as possible to explain the problem. If this doesn't come in a reasonable amount of time. the F/A's are told to check on the cockpit. This is for any unusual situation, not just masks dropping. However, on some foreign carriers this may not be "procedure". In any event it doesn't look like standardized procedure was much of a concern at Helios.
Prevented? Yah, no cheese. How about the pilot not flying accomplishing the Pre-flight checklist then reading it to the pilot flying who visually verifies correct switch positions and setting before responding with the appropriate switch position.
It should have never happened at all. It should have been "fixed" prior to engine start.
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Originally posted by Edbert
I would think that the oxygen masks falling out might have been a hint. Maybe the crew in the cockpit could not see that but I'd have expected a stewardess to have said something, assuming she spoke a language they could understand.
Sad to think how ways this could have been avaoidable.
For those of us who have never been in an altitude chamber - they might need some education on the subject. I did the chamber while attending the University of Illinois - infact we drove down to Oaklahoma City to an USAF base just for that. It may sound stupid, but here's the thing: simple tasks, when you are hypoxic, aren't simple.
Here's what I did when I was above 20K off 02. They had those little blocks they give kids - ya know, the square peg in the round hole type. I was fitting stuff where it wasn't ever going to fit, and I remember being frustrated as ****. Other simple tasks, 2+2 = 1. U get the jist of it.
Anyways, I know atleast over here, above I think it is 40K, 1 crew member is required to be wearing O2 at all times. Now short of changing the reg to require O2 above 10K regardless of pressurization, the key is following procedure, getting a challenge response from the FO and CA - and NEVER relying on learned memory.
If you don't do the procedures...well...people die.
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It's like asking a FDB to gun for a BOP...
Just inconceviable!
:rolleyes:
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Heh, my response to hypoxia was stubborness... they gave us 3 and a half minutes at 20k to do the test (some simple questions, some operations, some more questions "do you need oxygen right now?").
Since I hadn't finished it, I wouldn't let it go when they told us to.
It took about 3 or 4 times telling me to let go that I finally did it.
Other reactions in the group ranged from histerical laughter to plain dumbness.
At 14k the hypoxia set in would be veeery slow. Been flying at 12-13k in an unpressurized airplane wearing an O2 concentration indicator in my finger (very useful gadgets, not very expensive) and it never fell much.
20k, that's another story.
Daniel
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Well, the USA is overpopulated so I feel the schools need to teach Ebonics and not require people of this country to learn a common language. That way when the next disaster occurs it will kill more people. I find it funny that people in other countries know English better then people that where born here in the US.
How sad it is when people die from lack of communication.
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As I mentioned in a previous thread on the subject a very similar incident happened to an Aer Lingus 737 in 2000. The aircraft failed to pressurise but with several other distractions the crew failed to notice. It was only after a period of confusion and persistent visits to the flight deck by a cabin crew member and the deployment of the pax oxygen for the Captain to take any serious action. He was clearly hypoxic and even went on the PA to advise pax that they really didn't require oxygen.
Here's the report. It's makes sobering reading and I think would have ended the same way as the Helios flight if it wasn't for the persistence of the senior cabin crew member as mentioned in text.
http://www.aaiu.ie/AAIUviewitem.asp?id=3504&lang=ENG&loc=1280
There full report is on a PDF file. It also contains an interesting description of the effects of hypoxia.
I believe the language aspect mentioned in the Helios report is a red herring. Hypoxia is insidious and any difficulty in communication may very well have simply been an effect of lack of oxygen. Otherwise there are strong similarities in both incidents.
I think the final Helios report will strongly resemble the Aer Lingus one only with a fatal conclusion.
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Originally posted by Xargos
How sad it is when people die from lack of communication.
Even sadder when they die because "professionals" fail to run a checklist correctly.
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And the whole ordeal would have been avoided with a simple 'low cabin pressure' voice alarm instead of playing a damn buzzer for 10 different alarms.
Hell even a distinctive alarm sound would've probably been enough.
The aircraft was 60's tech.
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Originally posted by MrRiplEy[H]
And the whole ordeal would have been avoided with a simple 'low cabin pressure' voice alarm instead of playing a damn buzzer for 10 different alarms.
Hell even a distinctive alarm sound would've probably been enough.
The aircraft was 60's tech.
The annunciators havn't changed in the new models. If they followed PROCEDURE - they, and everyone else would be alive. Don't blame the plane for the human ****up - it did precisely what it was designed to do - including dropping masks, if that wasn't a more obvious hint to everyone around, I don't know how much more blatent you can get.
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Just a simple question:
Would the crew have been able to take countermeasures against hypoxia if they had been given an audible 'low cabin pressure' warning in the cockpit?
Thanks in advance.
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Originally posted by MrRiplEy[H]
Just a simple question:
Would the crew have been able to take countermeasures against hypoxia if they had been given an audible 'low cabin pressure' warning in the cockpit?
Thanks in advance.
If it were in English, aparrently not.
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Apparently they could both speak english enough to understand that. Apparently they got confused with multiple buzzers and horns screaming simultaneously and had to spend critical time identifying the source of the warnings. Apparently due to the fact that the same buzzer was used for a more common warning it was falsely read as something else than it really was.
Apparently that got them killed.
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Originally posted by MrRiplEy[H]
And the whole ordeal would have been avoided with a simple 'low cabin pressure' voice alarm instead of playing a damn buzzer for 10 different alarms.
Hell even a distinctive alarm sound would've probably been enough.
The aircraft was 60's tech.
Guess it depends on the basic intelligence level of the crews you hire. I suppose if you hire folks with absolutely no common sense you had better have a voice nanny the explains the problem in detail and reads them the appropriate emergency checklist. Better yet, computerize all the responses to emergencies and just have the crew sit on thier hands.
The altitude warning horn can't be confused for the takeoff warning horn by anyone who's gone through a decent training program and has even a modicum of experience, as any Captain should.
If they had a Takeoff configuration warning it would have occured on....suprise... takeoff.
Now, if you manage to takeoff and climb to 10,000 feet without a warning there's no way for anyone with experience to confuse that warning for a takeoff configuration warning should it occur right at 10,000 feet.
Anyone with any systems knowledge and sim training will immediately recognize that horn as a cabin pressurization warning when it sounds going through 10k.
Now what sort of whiz-bang modern technology do you suggest that will ensure the Pilot Flying and the Pilot Not Flying always correctly accomplish the Pre-Flight checklist and do a correct challenge and response reading of the checklist before they start engines?
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Cockpit Resource Management.
It's a dragon that aviation safety organizations have been fighting for decades.
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Hehe, you haven't seen boeing's latest Toad (stolen from a post on pprune.org):
Boeing have changed the procedures to get them in line with the rest of the Boeing family, that is what we have been told. This to ease transition training between the different Boeing models.
So, who reads what?
Preflight: Read by FO, respond according to area of responsibility.
Before start: Same as above.
Before taxi: Same as above.
Before take off: Read by pilot monitoring, response by PF. This checklist only contains Flaps.
After takeoff: Read by PM, response by PM.
So the FO is both reading and responding for that item.
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as a beginer pilot..im glad to read the mistakes form others.
Glad they found out what happened..that is nastttyy
thank god my only failure on checklists so far was failing to turn on fuel pumps while taxing back from fuel up....sat at pumps for 3 min ....figuring out why my plane wasnt starting...thought id.."skip th echecklist"..as i was "just " taxing back to my parking spot..
i felt really dumb..and rellly upset taht i failed to do my checklists..and it could of been my life ..and others...kik my self good..
as far as the checklist go...
You guys ever listen to the CVR box of the flight that ran into tht Patomic river?....where the FO says...."De Icing off"...and Co pilot says ..yes...and it was snowing outside?....
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The "Preflight: Read by FO, respond according to area of responsibility." means that depending on the item either the Captain or the F/O must respond.
On our checklists, the pilot designated will "visually verify switch postion or status, and then make the response to the pilot challenging."
"Reverse Print" items are critical to flight safety. "These require a response from both pilots. The first response will be made by the pilot being challenged. The challenger will then confirm with an echo response." In other words, both pilots verify and respond.
"Each checklist item will have a designator indicating the pilot(s) responsible for verifying accomplishment of that item. This designator also indicates the pilot(s) who will respond aloud to that time, it the item is either a challenge and response item, or critical item."
On my most recent (2003) B-757/767 checklist, the Captain is designated as responsible for verifying that the Cabin Altitude Control is SET and the Air Conditioning panel is SET and responding with those words. IIRC, it was the same on all the 737 models I flew.
Doesn't seem like the Helios Captain verified that the panels were set correctly.
I'm not sure what sort of warning system you install to make sure someone runs a checklist professionally.
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I've failed to use checklists a few times because of forgetfulness, and the moment I realized what happened, I mentally slapped myself.
There's nothing 'cool' about flying without a checklist, it's a tool to stay alive. You don't use your fingernails instead of a screwdriver just because 'screwdrivers are for n00bs'.
During my training, I remember once when I landed in the Warrior while flying solo and realized that I had never done the approach checklist. This means that, in addition to other stuff, my fuel pump was not on and I hadn't toggled tanks. I was lucky in that my active tank was still pretty full, and that the mechanical fuel pump didn't crap out, but I was chilled at the thought of what would have happened if it hadn't been one of those 'lucky days'.
The 'Killing Zone' book I read about what kills pilots lists complacency as a major killer. It describes a situation where, say, someone skips a step in a preflight and has a successful flight. Later on, they skip it more and more as 'optional' because the repeated incident free flights train them that it's not a big deal. ...right up to the time when something happens that the step would have caught. After reading that, I mentally challenge myself on every aspect of flight that I can. I don't want to be one of those guys who can't pass a check-ride one year after they get their certificate (a significant portion of new pilots let their skills lapse as time passes, an FAA study found).
These guys are dead and can't defend themselves, but it sure sounds like this could have been prevented.