Plane plunged 6000 feet per minute

[clayton4115 56]

A MISTAKE by an air traffic controller was among a number of communication lapses that plunged a commercial flight from Melbourne to Adelaide into a rapid descent last year, a report into the incident has found.The Australian Transport Safety Bureau (ATSB) said the Boeing 737 was approaching Adelaide on March 9 using an instrument landing system (ILS) when it went into a rapid descent, falling at about 2,000 metres per minute.The pilot managed to regain control of the aircraft, pull out of the descent and land without incident. The ATSB said the air crew had been directed by an air traffic controller to use ILS even though there had been previous notifications that the system was being worked on and was not to be used that day.It said about 40 seconds before the plane entered the ILS glide path the pilots were told that they were cleared for the ILS approach."The pilot in command acknowledged and read back the clearance," the ATSB report said. "The controller later reported that at the time the fact that the glide path was not available had slipped his mind."The inadvertent slip by the approach controller was the final action of a number of lapses or omissions that led the pilots to believe the ILS was available, despite previous advice."As a result of the incident the aircraft operator issued two safety briefings to pilots and an Airservices Australia investigation found that while there were adequate safeguards in the system, many had been breached.The ATSB said Airservices Australia had since issued 19 recommendations of which 10 had already been acted on and the remaining nine would come into force by June 30 this year.

[Mike S KPDX 597]

...sothe pilots failed to reveiw NOTAM's I suspect.

[Guest]

Pilot followed orders from ATC and used the ILS being confident ATC wouldn't let him use it if it weren't operational.Probably he figured the ILS to have been just cleared for use after having been offline earlier, voiding the NOTAM. ATC in this would probably get such information before aircraft in flight do.

[Mike S KPDX 597]

good point, thanks

[Guest davidvoogd]

Either way wouldn't you notice the aircraft decending too rapidly for a normal glide slope?

[Byrna 0]

It seems like the plane was set for an autoland or the auto-pilot was set to capture glide-scope, am I right?Just goes to prove how much over-reliance on automatic computerized airplane systems can be much more fatal than simply going manual for the final approach. This is why I've read that many pilots do not like doing a fully auto-pilot-based flight.What do you think?John

[Guest]

I guess someone did notice as the aircraft didn't crash :)

[Guest Shalomar]

Donny AKA ShalomarFly 2 ROCKS!!!If glideslope is inop, wouldn't they see a flag on EHSI, or notice lack of indicator?It's not just on landing that automation combined with mistakes can be more deadly than manual. Years ago I remember reading about an autothrottle equipped DC9 taking off from La Guardia. Maybe the captain selected climb power then was dissatified with rate of acceleration, but for some reason when past V1 sombody MEANT to push the "max accelerate" button. (That's what the newspaper article called it.) Accidentally, the "Max decelerate" was selected. With no time to figure it out, the crew tried to stop. The takeoff runway extended onto a pier over the river. So did the forward door, though the plane remained dry. After stopping the Cap ordered an evac. It was night, and first class passengers started sliding down into the river. There were drownings. Ironic due to lack of fire on board. No pilot would ACCIDENTALLY manually put his plane into decelaration.The 767 that hit a mountain in South America? The copilot programmed both FMS's (under company policy, the Cap programs his to crosscheck mistakes) and attempted to add a U.S. VOR as a waypoint. He only entered the first two letters. Some South American VORS have two letter IDs, and you guessed it, the FMS accepted it as a valid waypoint. They were at a safe altitude above terrain on their INTENDED flight path.Kinda scary, people can die nowadays from pushing the wrong button.But... A "heavy" was coming in to land. The Cap thought he detected wind shear. He called "TAKEOFF POWER!" The copilot took off power, and they went in. At least in that case, a properly pressed TO/GA button available to the Captain would have come in handy.Best Regards, Donny:-wave

[CF104 0]

Hi Donny,Just adding a bit more detail and corrections to your post :)>>It's not just on landing that automation combined with>mistakes can be more deadly than manual. Years ago I remember>reading about an autothrottle equipped DC9 taking off from La>Guardia. Maybe the captain selected climb power then was>dissatified with rate of acceleration, but for some reason>when past V1 sombody MEANT to push the "max accelerate">button. (That's what the newspaper article called it.)>Accidentally, the "Max decelerate" was selected. With no time>to figure it out, the crew tried to stop. The takeoff runway>extended onto a pier over the river. So did the forward door,>though the plane remained dry. After stopping the Cap ordered>an evac. It was night, and first class passengers started>sliding down into the river. There were drownings. Ironic due>to lack of fire on board. No pilot would ACCIDENTALLY manually>put his plane into decelaration.I think you may be refering to this accident:http://www.ntsb.gov/ntsb/brief.asp?ev_id=2...206X00888&key=1It had nothing to do with the auto throttles and was caused by the pitot heat being off..... and there were no fatalities.>>The 767 that hit a mountain in South America? The copilot>programmed both FMS's (under company policy, the Cap programs>his to crosscheck mistakes) and attempted to add a U.S. VOR as>a waypoint. He only entered the first two letters. Some South>American VORS have two letter IDs, and you guessed it, the FMS>accepted it as a valid waypoint. They were at a safe altitude>above terrain on their INTENDED flight path.Actually it was a 757-223:[url="http://www.airdisaster.com/cgi-bin/view_details.cgi?date=12201995

[Guest kombi]

>Pilot followed orders from ATC and used the ILS being confident ATC >wouldn't let him use it if it weren't operational.>Probably he figured the ILS to have been just cleared for use after >having been offline earlier, voiding the NOTAM. ATC in this would >probably get such information before aircraft in flight do.However if the ILS was not radiating, then the pilot should have recognised the lack of indications and reacted appropriately. The same would apply if ATC had cleared the pilot for an ILS approach and then the ILS failed.It's probable that the pilot failed to monitor the aircraft correctly, assuming that the autopilot would do all the work.

[mgh 89]

JohnIf the Australian investigators follow UK Air Accidents Investigation Branch (AAIB) approach they wouldn't blame anyone.The fundamental purpose of the AAIB is: To improve aviation safety by determining the causes of air accidents and serious incidents and making safety recommendations intended to prevent recurrence ...It is not to apportion blame or liability.