AeroSafety World September 2011

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Entire Issue
 

AeroSafety World September 2011
76 pages. [PDF 9.1M]

The outside air was cold enough to cause water dissolved in the Pilatus PC-12/45’s Jet-A fuel to form ice crystals in the main fuel filter and components in the left wing tanks, blocking the fuel flow. The pilot’s efforts to balance the fuel and to correct the low-fuel-pressure condition were not working. He diverted the flight to an alternate airport but lost control of the airplane while maneuvering to land. The PC-12 crashed near the runway, killing all 14 people aboard.

The NTSB said that the probable causes were “the pilot’s failure to ensure that a fuel system icing inhibitor was added to the fuel [and] his failure to take appropriate remedial actions after a low-fuel-pressure state (resulting from icing within the fuel system) and a later fuel imbalance developed.” Mark Lacagnina details the sequence of events.

Also in the September issue: The FAA postpones a final rule on duty time limits and rest requirements; American Airlines introduces a new “just culture” policy for maintenance and engineering technicians; an accident that revives concerns about go-arounds after touchdown in turbine-powered airplanes; and other important safety articles.

Features
 

Tipping Point (Text only)

In its final report on the March 22, 2009, accident, the U.S. National Transportation Safety Board (NTSB) said that the probable causes were “the pilot’s failure to ensure that a fuel system icing inhibitor was added to the fuel [and] his failure to take appropriate remedial actions after a low-fuel-pressure state (resulting from icing within the fuel system) and a later fuel imbalance developed.” [Download PDF 5 pages. 549K]

Waiting (Text only)

Issuance of a new package of flight and duty time limitations and rest requirements for U.S. airline flight crewmembers — years in the making — has been delayed again. The projected date for release of the final rule describing the new requirements is now Nov. 22. [Download PDF 3 pages. 1.5M]

Finding a Foothold (Text only)

Aviation maintenance organizations have been slow to implement formal fatigue risk management systems, despite their unique opportunities to employ some of the most effective types of fatigue countermeasures, according to a report by the U.S. Federal Aviation Administration Civil Aerospace Medical Institute. [Download PDF 4 pages. 189K]

Just Policy (Text only)

On June 15, the American Airlines Maintenance and Engineering Organization (known as M&E) implemented a new policy designed to enhance the company’s ability to learn from errors and violations in the workplace, and to identify the most effective actions we can take to prevent their reoccurrence. [Download PDF 5 pages. 307K]

Another Look at Smolensk (Text only)

Erroneous on-track, on-glide-path callouts by an air traffic controller during a radar-assisted nonprecision approach likely encouraged the flight crew to continue the approach despite the presence of thick fog, according to an independent report by Polish authorities on the April 10, 2010, crash of a Tupolev 154M at Smolensk, Russia. [Download PDF 2 pages. 198K]

Point of No Return (Text only)

Knowledge of the deceleration/acceleration forces and human factors involved in rejecting a landing after touchdown — especially on a contaminated runway with significant crosswind — should inform flight crews’ risk assessments before arrival in a regional jet or other turbine-powered airplane, says a U.S. academic researcher. [Download PDF 6 pages. 656K]

Dusty and Gusty (Text Only)

Dust storms pose a significant hazard for aviation. Not only do they drastically reduce visibility, they also are associated with very strong winds that can seriously affect an aircraft in flight. Engines can be damaged by ingesting the dust. [Download PDF 5 pages. 924K]

Need to Notice (Text Only)

There has been a great deal of discussion lately about organizational responsibility versus individual responsibility for aviation mishaps. Although the main body of research for the last 30 years has shown that aviation accidents mainly are organizational accidents, the role of the individual — the pilot, maintenance technician, dispatcher, etc. — cannot be discounted. The answer to the organization/individual dilemma might lie in the role of perception in hazard identification. [Download PDF 5 pages. 479K]

Departments
 

Executive’s Message | FRMS and You (Text only)

I just left a big meeting at the International Civil Aviation Organization about the realities of implementing fatigue risk management systems. [Download PDF 1 page. 92K]

Editorial Page | How’s It Going? (Text only)

According to the responses to a survey we recently conducted, it is going pretty good, with some areas of concern. By “it,” I mean the state of safety culture in the aviation industry. [Download PDF 1 page. 80K]

Air Mail | Letters From Our Readers (Text)

ASW remains the pre-eminent magazine for aviation safety, and your efforts are to be commended. [Download PDF 1 page. 180K]

Safety Calendar | Industry Events (Text only)

A listing of aviation safety-related conferences, seminars and meetings. [Download PDF 1 page. 91K]

In Brief | Safety News (Text only)

Oxygen mask hoses in airliner cockpits should be made longer to ensure that pilots have full access to emergency equipment located in the cockpit, the U.S. National Transportation Safety Board says. [Download PDF 3 pages. 244K]

Data Link | Runway Excursions a Continuing Threat (Text only)

One of the 13 runway excursion accidents was fatal — the overrun at Mangalore, India, on May 22, which cost 158 lives. Excursion accidents represented 33 percent of total accidents, compared with 19 percent in 2009 and 30 percent in 2008. [Download PDF 4 pages. 265K]

Info Scan | Before and After (Text only)

Many corporate managers work long hours and travel often. It is hard to imagine a company, however, that would expect a high-level executive to keep a schedule like the one above regularly, every working day and/or night. [Download PDF 6 pages. 128K]

On Record | Ice Blocks A330 Pitot Probes (Text only)

The following information provides an awareness of problems in the hope that they can be avoided in the future. The information is based on final reports by official investigative authorities on aircraft accidents and incidents. [Download PDF 8 pages. 237K]

Smoke Fire Fumes | Selected Events in the U.S. June–July 2011

Selected Smoke, Fire and Fumes Events in the United States, June–July 2011 [Download PDF 1 page. 43K]

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