Air France flight 447

http://af447.typepad.com/af447/

I believe one simple thing would have saved that plane. If the two control sticks had been "slaved" together, so that when one moves, the other would also move, the second copilot would have known that the first copilot had the stick back. Unfortunately, the way Airbus chose to build the plane, when one pilot is flying, the only way the other pilot knows the position of the stick is if the first pilot tells him. That is insane.

It is fascinating stuff, and I hope you don't mind if I bring to your attention Roger Rapoport's new extensive book on this subject. I won't link to it, to avoid breaking any posting rules, but I do suggest you check it out. He is the only journalist who's spoken to all sides in this story and gets behind the headlines. The book is called The Rio/Paris Crash and you can find it on Amazon, iTunes etc.

Going through the transcript, I'd prefer to be in a Boeing - at least the co-pilot will know the junior pilot is pulling back on the stick. Airbus diehards will say CRM is the main cause, maybe that is true, but the lack of CRM was probably exacerbated by the dual input mode on an Airbus.

Also, here are the stats again: Accident hull losses: 6 for A330, 1 for B777. Fatalities: 338 for A330, Zero for B777. Injuries: 106 for A330, 47 for B777. In service: 812 for A330, 924 for B777. I rest my case.

This crash and the resultant loss of 228 lives occurred almost simply because those in control were talking past each -- there was a breakdown in standard system cross-checks --- there was the fundamental flaw that pilots would not talk to each other, that they could suffer communication breakdown at a critical time. The system did not tell them what each were doing.

All of our endeavours, our technology leaps will always require that great managers are the ones that overlook, supervise these complex systems.

This is not incredibly different from how the Financial Crisis that have played out in Europe and the United States have developed into very serious, deep problems that threaten the entire system, way of life.

After having read the full transcript in French and English, I am fully confident of the follow:

Despite the initial issue of the auto-pilot malfunctioning, the main issue is obviously human error. Most importantly, the captain should have never left 2 co-pilots for such a long time in the cockpit, and if he did, he should have answered the desperate calls from the co-pilots.

Having said that, I fully agree with Juris. The main issue is that the IT folks and the company heads, in spite of their talent to render flying safer and more automatic, obviously do not have the communication structure or support to communicate the intricacies of the technology they just perfected. So, they develop computer modules under a tight deadline, and because of profit motives and the pressure to perform under the rapid technological innovation wave ,leave out the most important: Focused and thorough initial training and continuing training under the "What if" /contingency scenario to operate the plane for when the auto-pilot disengages. Moreover, the right delivery channels is not being used especially vis-avis module updates for AIRBUS (or BOEING)-e-learnings, emails, quick classes are used instead of comprehensive teachings for circumstances just like the one in the AF 447 situation. As I am forever greatful for technology, as a consultant for change and technology, I cannot stress enough the urgency to slow down the IT process to leave room for proper and thorough "human" training and co-existance of instinctual behavior under pressure. Is the head IT engineer explaining the process in simple understandable lingo to the head trainer, so they in turn can relay to any pilot around the world so to understand it enough to use the knowledge under pressure; Or is it being lost in translation? Are the quality engineers given enough room to veto a technology if the users are not 110% fluent with the workings of it? Are the regulatory bodies of the airline industry cutting costs and wait till a tragedy happens before make vital corrections to avoid danger in the air.

Please, let's not lose our "checks and balances" system in the airline industry for the sake of profit, excitement, and speed. Let's slow down and go back to the basics of dominance of human initiative over machinery, most importantly in "what if" scenarios where machinery suddenly fails and pilots have to go back to being pilots.

I am amazed that more attention is not paid by journalists to the issue of Fly By Wire used in all the newer (post A320) Airbus aircraft. I wrote a long piece for The Guardian (25th Sept 1987) and a much longer story for The Washington Post (2 April 1989) on the philosophic air safety issues of these aircraft and set out the case neatly. I draw readers attention to a new examination of a Qantas incident with an A330: http://www.atsb.gov.au/newsroom/2009/release/2009_02.aspx
You will find copies of these articles at:http://jimbeatsonjournalist.blogspot.com/

Why are pitot tubes even necessary, vulnerable as they are to blockage? I seem to remember a crash in Africa that was found to have been caused by insects nesting in these same tubes while the aircraft was parked on the ground.

My $400 mobile phone can measure the speed of my car in motion with high precision by using GPS. Surely an aircraft auto-pilot could do the same?

Pretty scary. It's easy enough to criticize Bobin — his shortcomings are evident — but wrong, I think, to make him the scapegoat. I see plenty to criticize elsewhere:

Procedures and policy. Two first officers? That doesn't make any sense. The least experienced pilot was at the controls. The more experienced pilot should have taken control at the first sign of trouble. But the captain should have been at the controls anyway. He took his break on schedule even though they were heading into a storm when he should have waited until they were through it. Why were they flying into a storm, anyway? These days we have pretty good information on weather and airliners routinely avoid storms.

The aircraft. Central to the matter is the performance of the innovative control system of the aircraft. Every aspect of this having any bearing on the incident needs to be looked at objectively.

Air France will have incentive to put as much blame as possible on the subordinate officers and minimize that on the airline and its aircraft. BAE will have incentive to blame the pilots and the airline, and defend its control system. It will be interesting to read how fault is apportioned in the final report.

I disagree.

What is often missing from arguments like "too much automation makes people stupid" is that all this innovation allows people to practice a lot more. Take non-standard situation like this one. In the past, people literally had to fly a plane to learn to respond to things like this one. These days it is possible to simply sit at the flight simulator and learn what to do.

Not only this, but with a lot of important information being automated, it is really easy to set a buzzer if some flight parameters become bad.

As a result, by historic standards these days American and European airlines, that actually take care of things like that one, have very low crash rate. Things are not so smooth in, say, Russia, but it is exactly due to the fact that US/Europe are moving into the right direction when it comes to aviation.

Anyone citing the PM article as a legitimate piece of journalism has not read anything else. Especially pertinent is the third BEA report. The multiple failures of the Airbus flight management system which gave the pilots alternating over speed and stall warnings, was a classic example of non-graceful system failure. The BEA report states that although the system knew the angle of attack, it was not displayed to the pilots. When airspeed is non-reliable, angle of attack becomes the truth teller. When the horizon is not visible, it is the only truth. Not displaying it to the pilots is prima facia evidence of misfeasance. Further, the report indicates that there was an up trim generated by the flight management system that was probably sufficient to stall the aircraft. That the BEA lays the ground work to 'blame the dead guys' ignores the routing of the flight through the displayed storm. All other flights that night went 100-200 miles west and had smooth flights. What Air France rules prevented that diversion? Even if the French system refuses to identify the failures of Airbus and Air France, we should not jump on board and help the wrongful persecution.

Jouris is most correct. A plane should always have a non-computerized fly by wire system of last resort. To think that 2 pilots did not see, feel, perceive the wrong angle (the single most basic thing in flying) is to say that there is far too much confusion and overabundance of signals in that plane's cockpiy

Oddly enough, as harrowing as that article is, I did feel comforted, just because so much had to go wrong, and keep going wrong. Compared to when I'm bicycling, and just one little thing has to go wrong for me to get creamed.

I think this transcript makes it clear that humans can't be trusted to fly planes.

The instrumentation and autopilot must be both resilient and with multiple redundancies - and it should never automatically disengage. Instead, it should only warn the pilots that it has less than 99.999% confidence of the flight path, and give pilots the joint choice to intervene if they think the know better.

Its almost excruciating to imagine the last moments of Flight 447. Falling rapidly into the abyss of the mid-Atlantic. The transcript paints a horrific picture of indecisiveness.

All we can do is to incorporate that scenario into flight training programmes and pray such an event never repeats itself.

Reads like a possible script for Airplane III

Someone please tell me the young co-pilot got his aviation licence by dishonesty! The alternative is just too depressing.