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Boeing 777 plane crash-lands at San Francisco airport


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Posted (edited)

Hi,

the findings of this crash have been posted by the NTSB. It makes for interesting reading.

The NTSB determined that the flight crew mismanaged the initial approach and that the airplane was well above the desired glidepath as it neared the runway. In response to the excessive altitude, the captain selected an inappropriate autopilot mode and took other actions that, unbeknownst to him, resulted in the autothrottle no longer controlling airspeed.

As the airplane descended below the desired glidepath, the crew did not notice the decreasing airspeed nor did they respond to the unstable approach. The flight crew began a go-around maneuver when the airplane was below 100 feet, but it was too late and the airplane struck the seawall.

"In this accident, the flight crew over-relied on automated systems without fully understanding how they interacted," said NTSB Acting Chairman Christopher A. Hart. "Automation has made aviation safer. But even in highly automated aircraft, the human must be the boss."

Edited by khaosai
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Posted

Wow, I didn't realize the NTSB report on the crash was approved and issued in July of this year (2014).

Not very encouraging for anyone considering flying Asiana, and the actual findings read much worse that the descriptive post immediately above.

Here's the Probable Cause section from the executive summary:

Probable Cause

The National Transportation Safety Board (NTSB) determined that the probable cause of this accident was the flight crew's mismanagement of the airplane's descent during the visual approach, the PF's unintended deactivation of automatic airspeed control, the flight crew's inadequate monitoring of airspeed, and the flight crew's delayed execution of a go-around after they became aware that the airplane was below acceptable glidepath and airspeed tolerances.

Contributing to the accident were (1) the complexities of the autothrottle and autopilot flight director systems that were inadequately described in Boeing's documentation and Asiana's pilot training, which increased the likelihood of mode error; (2) the flight crew's nonstandard communication and coordination regarding the use of the autothrottle and autopilot flight director systems; (3) the PF's inadequate training on the planning and execution of visual approaches; (4) the PM/instructor pilot's inadequate supervision of the PF; and (5) flight crew fatigue, which likely degraded their performance.

That's a whole lot of blame on the flight crew and, indirectly, on the airline for apparently failing to ensure proper training and operating standards.

Not going to make me a likely passenger anytime in the foreseeable future.

https://www.ntsb.gov/investigations/summary/AAR1401.html

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