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psolk

Another Air France Near Miss...

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This one from 2011...

Scary how close they came to flying another perfectly good aircraft into the ground. Thank goodness for the relief pilot, they saved it at 63 feet AGL!!!
http://www.avherald.com/h?article=460700a7&opt=0



Report: Air France B772 at Paris on Nov 16th 2011, continued to descend despite go-around
By Simon Hradecky, created Monday, Apr 8th 2013 13:43Z, last updated Monday, Apr 8th 2013 13:47Z
An Air France Boeing 777-200, registration F-GSPP performing flight AF-471 (dep Nov 15th) from Caracas (Venezuela) to Paris Charles de Gaulle (France), was on a Category III ILS approach to CDG's runway 08R, low visibility procedures were in effect, descending through 320 feet AGL at 136 KCAS and 1 degree nose up attitude, when a Master Caution Warning was issued and the flight mode announciators reverted from "LAND 3" to "LAND 2". The captain (ATPL, 14,370 hours total, 6,645 hours on type) was pilot flying, the relief pilot (7,490 hours total, 5,271 hours on type) on the observer seat called out "Alarm", the first officer (7,823 hours total, 3,258 hours on type) called out "go-around", the captain responded by pushing the throttles forward to initiate the go-around disconnecting autothrottle in the process. A nose up pitch command on the control yoke is recorded however insufficient in strength to disconnect the autopilot. While the aircraft began to accelerate the attitude changed from +1.15 degrees to -0.5 degrees. The captain ordered the flaps to be reduced to 20 degrees, the pitch decreases further to 2 degrees nose down. The relief pilot called out "Pitch!" 10 seconds after the go-around was initiated both crew pulled the yoke now resulting in the autopilot disconnecting, the aircraft pitched up sharply resulting in +1.84G vertical acceleration, the attitude changed from 2 degrees nose down to 7 degrees nose up and subsequently reducing to 4 degrees nose up when the control yoke was returned to neutral, speed was now 169 KCAS. The relief pilot again called "Pitch!". The crew applied nose up input on the control yoke, the aircraft reached its lowest point of 63 feet AGL at 180 KCAS, the nose rose to 11 degrees nose up in 2 seconds and subsequently 19 degrees nose up and the aircraft climbed out to safety. Climbing through 870 feet the gear is retracted and the crew positioned the aircraft for a second approach, that resulted in a safe landing.

The French BEA released their final report in French complaining, that the cockpit voice had been deleted prior to the BEA getting access to it although the crew initially had preserved the recordings, and concluding the probable cause of the serious incident was:

inadequate monitoring of flight parameters by the flight crew.

Contributing factors:

- partial execution of the go-around procedure
- inadequate management of the autoflight systems during the go-around
- a conflict between actions taken and actions planned by the aircraft manufacturer with respect to go-around or safe continuation of approach


The BEA reported that regardless of the weather the continuation of the approach could be considered provided the automation remained in "LAND 3" or "LAND 2" mode. However, with the Master Caution Warning a go-around was mandatory by procedures.

The BEA reported that the captain said in post flight interviews, that the flight had been generally smooth, the aircraft was on final approach descending through about 350 feet AGL with the crew trying to gain visual contact with the approach lights, when the relief pilot called out "Alarm" and the first officer "go-around". Instead of pushing the TOGA button the captain mistakenly operated the autothrottle disconnect button resulting in the autothrust system to disengage, he pushed the throttle levers forward to maximum thrust manually. He did have ground view and estimated the landing was possible, the "NO LAND3" indication however created confusion. He noticed that the autopilot had disengaged, he couldn't tell whether this was the result of an autopilot disconnect button pushed or whether this was an automatic disconnect as result of control inputs. The landing gear was retracted at 400 feet AGL.

The first officer reported he did not monitor the pitch attitude after calling go-around because he became busy configuring the flaps. Most of the go-around activity occurred after the relief pilot had called "Pitch!"

The relief pilot reported that after seeing "NO LAND3" on the EICAS he saw no reaction by the flight crew and called "Alarm" in accordance with the category III procedures for any anomaly below 1000 feet AGL, the first officer responded by calling "go-around", the captain made a gesture coincident with the application of go-around procedures (pushing the throttle levers forward). However, the flight mode announciators continued to indicate G/S (indicating the autopilot was still tracking the glideslope) and the pitch attitude remained low. Upon calling "Pitch" the captain applied nose up control inputs, however these inputs were insufficient to get the aircraft climb out, he therefore called "Pitch" a second time which resulted in satisfactory action to conduct the go-around.

The BEA analysed that there were 4 different phases in the crew reactions to the NO LAND3 indication. First was the first 8 seconds following the indication which went undetected until the relief pilot called out "Alarm". Only then the first officer called "Go-Around" and the captain applied maximum thrust, the yoke position however did not change, the autopilot continues to track the glideslope.

The second phase, the subsequent 9 seconds, was characterized by lack of crew actions, the speed increasing, the nose attitude decreasing and insufficient control inputs to disengage the autopilot. The BEA analysed that the crew did not monitor the flight parameters and did not intervene to adjust the flight trajectory, effectively losing control of the flight trajectory.

The third phase, following the first call of "Pitch", sees both pilots pulling the yoke resuling in +1.84G vertical acceleration, probably in response to the "Pitch" call by the relief pilot, however insufficient to arrest the descent and initiate the go-around. While the first officer seemed to now be monitoring the flight parameters with respect to a go-around, it appeared the captain was following a different plan to continue the approach when he pushed the yoke forward against the force of the first officer returning the yoke to neutral.

The fourth phase, following the second call of "Pitch", sees the captain relinquishing the forward force on the yoke with the force to pull the yoke still applied by the first officer resulting in the aircraft pitching up, stopping the descent and starting to climb out.

The airline took an immediate safety action by issuing an information circular to all Boeing 777 crew relating to a go-around without TOGA selection.

No safety recommendations were released as result of the investigation.

 


Have a Wonderful Day

-Paul Solk

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Simon Hradecky, didn't he create (program) the original Squawkbox or something along those lines with SATCO?

 

Why was alarm called out?  Because they couldn't see the runway?


10700k / EVGA 1070

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Because the Flight Mode annunciators switched from Land 3 to Land 2...  Although TBH I am not 100% sure what that means or why it would have happened...


Have a Wonderful Day

-Paul Solk

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In the 777 the nose pitch up motion when applying power is cancelled out by the software in its FBW.

The captain seemed to have expected nose up when he applied go around power but the aircraft held pitch as it was programmed to do. Autopilot never disconnected so this must have been a rather embarrassing episode to review for the Captain in command.


Will Reynolds

 

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Sounds like the PIC tried to pull back on the yoke but without enough force to disco the A/P and the AC continued it's path to earth until they caught it...  Sounds like it was actually the relief pilot who caught it though, not the PIC...  Scary...


Have a Wonderful Day

-Paul Solk

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Because the Flight Mode annunciators switched from Land 3 to Land 2...  Although TBH I am not 100% sure what that means or why it would have happened...

 

I'm not familiar with the details of the A340 (really need Rónán to reply for that), but generally for a full autoland the ILS signal needs to be received by multiple radios (so the autopilot can cross-reference and check for errors). Going from Land 3 to Land 2 presumably means that only 2 radios are showing the correct signal, rather than the required 3. Just a guess though.


John-Alan Pascoe

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Nope, Land 3 means three autopilots engaged for redundancy, Land 2 ( NO LAND 3) meant the aircraft downgraded to 2 ap's.

 

Airbus has CATIII dual and will downgrade to CATIII single since it has two autopilots.

 

I think on the 777 you will also lose rollout guidance with NO LAND 3 on the FMA

 

The 777 would have auto landed without any issues on 2 ap's, from what I breifly read they where also visual.

 

Will have a proper read when I get home.

 

Regards


Rob Prest

 

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I'm not familiar with the details of the A340 (really need Rónán to reply for that), but generally for a full autoland the ILS signal needs to be received by multiple radios (so the autopilot can cross-reference and check for errors). Going from Land 3 to Land 2 presumably means that only 2 radios are showing the correct signal, rather than the required 3. Just a guess though.

Two radios, but the downgrade from CAT III dual to CAT III single is caused by an auto-pilot failure as mentioned by Rob. Bear in mind this incident was in a Boeing 777 though not an A340 (or my A330 either for that matter).

 

There has been a string of high profile loss of control incidents caused by pilots in Air France of late, it's causing quite the stir, they're in real need of some intensive training on basic aircraft handling and aerobatics.

 

Couple of interesting points I noticed was that when the Captain elected to Go Around, he didn't disengage the auto-pilot and manually fly the manouver, but instead trusted the AP to fly the procedure, I'm not sure if that's common place in AF, but with us certainly, we disengage everything and hand fly a go-around, it's the best way to do it as it makes certain that you begin the climb earlier, the AP can always be re-engaged later.

 

When the Captain did try to let the autopilot perform the GA, he wasn't 1) paying attention to his FMA and 2) he wasn't even looking at his PFD to realise that they were gaining speed fast and weren't climbing. This lasted 9 seconds before again the relief pilot had to step in and alert  them to the fact that they weren't flying the plane.

 

They didn't notice that their status had downgraded from Land 3 to Land 2 for 8 seconds, and only then noticed when this was alerted to them by the relief FO. It's absolutely imperative in an Auto-Land to be constantly monitoring the status of the aircraft.

 

Shows a very serious lack of competence on the part of these pilots, considering the fact that these were likely senior pilots given that they were on the 777, it's striking how they could let something like this happen.

 

AF really need to get their act together and start providing more thorough and rounded training to their pilots.

 

Regards,

Ró.


Rónán O Cadhain.

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Two radios, but the downgrade from CAT III dual to CAT III single is caused by an auto-pilot failure as mentioned by Rob. Bear in mind this incident was in a Boeing 777 though not an A340 (or my A330 either for that matter).

 

Woops, I stand corrected. Had it mixed up with this incident: http://blogs.crikey.com.au/planetalking/2013/03/13/why-air-france-should-be-banned-from-non-eu-skies/

 

I was wondering why they kept referring to a yoke, and had it pegged as a translation error :blush:.

 

On a side-note it doesn't sound like the captain was intending for the AP to fly the go-around as he did pull back on the yoke (just not strongly enough).


John-Alan Pascoe

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On a side-note it doesn't sound like the captain was intending for the AP to fly the go-around as he did pull back on the yoke (just not strongly enough).

I had thought that initially, but no one disengages the AP by pulling on the yoke/side stick unless in an absolute panic, and if you were in said panic, you certainly wouldn't leave the aircraft fly unintended, you'd do it to make large corrective inputs into the aircraft. Besides, it's next to instinctive to hit the big red button to disengage the AP, it's what you do, it's part of the motion.

 

If he had intended on hand flying it he should have been pulling back much harder, because the nose wasn't going up at all, he wasn't flying his aircraft.

 

Interesting article on Banning Air France from European Airspace, it'd be a bold move, but something tells me it's not as remote a possibility as some may think, one more big accident and they're gone, and if the rate of incidents they're having keeps up, that accident won't be too far away.

 

Regards,

Ró.


Rónán O Cadhain.

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Don't you have to push TOGA in case A/THR was on for go around and disengage A/P by pushing DISC twice on T7? Pulling the yoke seems like panic action out of despair to me.


Jan Betlach
 

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The first that came to mind was the American airlines instructor going click click............click click in this video,

 

http://www.youtube.com/watch?v=h3kREPMzMLk


Jim Driscoll 9900k@5000,2080TI@1950
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Don't you have to push TOGA in case A/THR was on for go around and disengage A/P by pushing DISC twice on T7? Pulling the yoke seems like panic action out of despair to me.

I may be wrong but I think if you pull back with a certain amount of force it will cause the A/P to disco.  I could be totally off though.


Have a Wonderful Day

-Paul Solk

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If I was at home on my FSX simulator showing someone how to land and they had to call out pitch twice I'd be pretty embarrassed. And I'm on a $2500 simulator, not the $75mil real thing with pax in the back. I'm sorry, but no excuse for slacking off at a critical phase in flight.

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