Flight Safety Information January 24, 2011 - No. 017 In This Issue Air France to Disclose Review's Criticisms ALPA Pilot Leaders Endorse New Pinnacle Airlines Contract FAA Proposes $170,000 Civil Penalty For Pemco World Air Services Preliminary report issued on Iran Air A300 engine failure and runway excursion at Stockholm Poland to reconstruct jet crash that killed president Loss of contract weather observers worries Alaska pilots Chicago-bound airplane makes emergency landing in Oakland US Airways flight en route from Chicago to Phoenix makes emergency landing in Omaha American Airlines Passenger Punches Flight Attendant Due to Blocked Restroom NTSB assists with Air Burkina incident in Paris FAA inaugurates LaGuardia tower Cathay A330 incident prompts call for ICAO action on aviation fuel supplies Air France to Disclose Review's Criticisms By ANDY PASZTOR And DANIEL MICHAELS (WSJ) Air France-KLM SA, in a bid for greater openness, is slated to release the findings of an independent review broadly critical of some of the airline's past safety practices and internal safeguards.The conclusions, which cap a wide-ranging, yearlong assessment by an international panel of eight aviation experts hand-picked by senior Air France officials, are expected to be unveiled Monday, according to people familiar with the issue. The review is unusual not only because of its frequently critical tone, but also because the airline's management tentatively plans to make portions public. Among other things, the report is expected to question some of the carrier's pilot-training efforts, highlight lapses in cockpit discipline over the years and stress the importance of making flight crews more proficient in dealing with onboard automation failures. Overall, people close to the process said, the report has identified various shortcomings in the traditional safety culture of Europe's second-largest airline. As a result, these people said, the report is expected to recommend a wide range of procedural and internal oversight changes, partly intended to ensure that details of incidents and safety threats are quickly analyzed and communicated throughout the carrier. Air France already has adopted many of the recommendations, which is likely to take some of the sting out of the criticism. Still, safety experts said it was unusual for a large company, especially an airline, to give outsiders such latitude publicly to expose gaps in safety systems. The project was initiated by Chairman Jean-Cyril Spinetta in late 2009, six months after the crash of an Air France Airbus A330, which killed all 228 people aboard en route from Rio de Janeiro to Paris. The cause remains unknown-with search teams continuing to look for Flight 447's data recorders-but the crash immediately focused attention on Air France's safety record and pilot training. Over the weekend, company officials and members of the study team- led by former Boeing Co. safety executive and U.S. human-factors specialist Curt Graeber-declined to comment on specifics before the report's official release. Other members of the team include Nick Sabatini, the former top safety official at the Federal Aviation Administration; John Marshall, former head of safety at Delta Air Lines Inc.; and David Woods, a risk-management specialist and Ohio State University professor. "I can't think of another example of a major airline bringing in this kind of high-powered group for such a comprehensive review," said Bill Voss, president of the Flight Safety Foundation, a global air-safety advocacy organization based in Alexandria, Va. "It's extraordinary that they are willing to release the results," said Mr. Voss. The process "gives me confidence there will be follow-through." In addition to focusing on specific training, technical and flight-safety issues, according to people tracking the report, portions are expected to touch on aspects of the strained pilot-management relations that have roiled Air France in the past. The study team briefed Air France- KLM Chief Executive Pierre-Henri Gourgeon on Friday The report calls for making pilot-training sessions more realistic, partly by including actual in-flight incidents involving Air France pilots in periodic simulator sessions. Some safety managers inside the company had concluded that simulator training needed to be updated and varied to enhance pilot skills. For years, many large carriers in the U.S. and other regions have routinely incorporated recent, real-life scenarios in simulators. Reflecting the latest safety priorities of European plane maker Airbus, a unit of European Aeronautic Defence & Space Co., the review also encourages steps to help pilots use stand-by instruments if automated systems fail or provide suspect readings. Other safety experts have identified longstanding training shortcomings and management weaknesses at many airlines around the globe to help crews respond to such emergencies. The panel, known as the Independent Safety Review Team, is slated formally to present its report Monday to an Air France committee that includes representatives of both management and trade unions, according to an airline spokesman. The carrier had four significant crashes between 1999 and 2009. Mr. Gourgeon previously said the carrier's safety record before the Rio crash was better than the global industry average, but afterward was only average. Following the 2009 accident, Air France and its pilots sparred over safety procedures and training. Many air-safety specialists outside the airline suggested a contributing factor in the crash was improper response by the pilots to faulty speed sensors. Air France pilot unions spoke critically of the carrier's training, while many outsiders criticized the safety record of Air France pilots. In the fall of 2009, Air France sent a memo to its cockpit crew members instructing them to follow safety procedures more closely and stop criticizing the carrier. The airline's largest pilot union said the memo was inappropriate. Since then, Air France safety officials have made presentations at industrywide safety conferences emphasizing the importance of pilots strictly following internal rules and procedures for deciding when to land, or break off airport approaches, in poor visibility and stormy weather. The carrier also has worked extensively with Airbus and Boeing safety experts, among others, to better understand the dangers of tiny ice particles clogging external speed sensors and causing flight-control computers to malfunction. The independent review marked the second time in six years that Air France initiated a sweeping safety assessment of its operations. In the wake of a 2005 crash of an Air France A340 on landing in Toronto, management commissioned an internal review. The plane caught fire and was destroyed after rolling off the runway, but there were no fatalities. Finished in 2006, that report was distributed to more than 4,000 company pilots and was widely praised for its frankness about shortcomings within the carrier. Although Air France has said its executive committee made formal decisions to implement the report's recommendations, critics of the airline continue to maintain management didn't aggressively pursue the changes. Following the 2009 crash of the A330, which took off from Rio and was going through a violent thunderstorm, Air France quickly replaced some onboard air-speed indicators on certain of its Airbus planes before the equipment swaps were mandated by regulators. The airline also issued alerts warning pilots about the proper use of onboard radars to identify the size and intensity of storms. The latest team of experts had a sweeping mandate to look into everything from general pilot decision making to how effectively Air France collects, assesses and distributes data stemming from safety lapses that could be warning signs of future incidents or accidents. There have been numerous signs of management's sensitivity about the findings: Air France twice before delayed announcing completion of the outside review, and over the weekend a spokesman indicated it wasn't clear exactly how the findings would become public. Back to Top ALPA Pilot Leaders Endorse New Pinnacle Airlines Contract Pinnacle, Mesaba And Colgan Pilots Broker Agreement In Just 102 Days Pilot leaders representing almost 3,000 pilots flying under the Pinnacle Airlines Corp. banner have endorsed a tentative agreement that would unite pilots from three airlines under a single contract, paving the way for the smooth integration of one of the world's largest regional carriers. The Master Executive Councils (MECs) from Pinnacle Airlines, Mesaba Airlines and Colgan Air unanimously approved a joint collective bargaining agreement (JCBA) that was negotiated in only 102 days. ALPA pilots from the three carriers will now vote on whether to ratify the five-year agreement. "The proposed JCBA is a remarkable achievement that will yield concrete gains for every Pinnacle Airlines Corp. pilot. It meets the Pinnacle, Mesaba and Colgan leadership's stated goals of providing immediate improvements to the pilot group and advancing individual careers, while also positioning our merged airline for continued growth and prosperity," said Capt. Scott Erickson, Pinnacle MEC chairman. ALPA leaders began the process of merging the three groups after Pinnacle Airlines Corp. bought Mesaba last summer. The airline holding company purchased Colgan in early 2006 and has stated it plans to phase out Colgan, make Pinnacle an all-jet airline and Mesaba an all-turboprop operation serving passengers of Delta, United/Continental and US Airways. "The danger was that management would use the merger as an opportunity to whipsaw our pilot groups," said Mesaba MEC Chairman Capt. Mark Nagel. "We resolved to cooperate as a team to craft one contract and one seniority list, and we have achieved an agreement that will improve work rules, pay, benefits, and job security for every pilot at Pinnacle, Mesaba and Colgan. We look forward to working together as one airline to enhance the careers of all the pilots in our system." If the agreement is ratified, the next step in merging the three groups will be to create a joint seniority list. The Pinnacle, Mesaba and Colgan pilot merger committees have begun working on a joint list, with a target completion date of May 1. "This is a unique moment in the history of the Association and our pilot groups," said Colgan MEC Chairman Capt. Mark Segaloff, who was also recently elected as an ALPA executive vice president. "To rapidly negotiate a joint collective bargaining agreement and then secure the support of three MECs speaks volumes about the hard work that was put forth in the joint negotiations by our JNC. We all have a lot to be proud of in this agreement, and we urge every Pinnacle Airlines Corp. pilot to vote 'yes' when it comes to them for a vote." FMI: www.alpa.org Back to Top FAA Proposes $170,000 Civil Penalty For Pemco World Air Services Another Company Fails To Administer Drug And Alcohol Testing The FAA is proposing a $170,000 civil penalty against Pemco World Air Services of Dothan, AL, for allegedly failing to administer pre- employment drug tests for two individuals the company hired for safety-sensitive positions. The FAA also cited Pemco for failing to carry out required follow-up drug or alcohol testing on eight individuals reinstated after completing return-to-duty training during 2008. In all, the company failed to carry out 24 required follow-up tests. Failing to administer the pre- employment and reinstatement tests are violations of the Federal Aviation Regulations. The FAA inspected Pemco's pre-employment test program three times, and each time the FAA determined it had not complied with the requirements. Those findings resulted in proposed civil penalties. Pemco World has 30 days from receipt of the FAA's enforcement letter to respond to the agency. FMI: www.faa.gov Back to Top Preliminary report issued on Iran Air A300 engine failure and runway excursion at Stockholm The Swedish Accident Investigation Board SHK issued a preliminary report on a serious incident that occurred in January 2010 involving an Iran Air Airbus A300 which suffered a runway excursion during an aborted takeoff. The aircraft involved, an Airbus A300-600 registered EP-IBB, had earlier the same day been operated from Tehran with flight number IRA 763, destination Stockholm/Arlanda. After a brief period on the ground, EP-IBB was planned to return to Tehran as flight number IRA 762. At the time of the incident there were 149 passengers and 23 crew on board the aircraft. The performance calculations and other operational issues were performed by the pilots before departure. The aircraft take-off mass on departure had been calculated to 148.4 tonnes, and due to the runway conditions at the time decision was taken to use maximum engine power for the take-off. Before take-off the flaps were set to 8° and the slats to 15° by the pilots. It was a rolling take-off from runway 19R at Stockholm/Arlanda. About 12 seconds after autothrottle for take-off had been initiated, the pilots heard a faint bang from the left side of the aircraft. Both throttles were retarded about one second after the bang, and at the same time the aircraft turned sharply to the left. The speed at that time was about 60 knots. The pilots were unable to counter the turn, and the aircraft left the runway about 400 metres from the threshold of runway 19R. The time from the audible bang to the aircraft leaving the runway was about 8 seconds. The aircraft nose wheel dug into the ground and the aircraft stopped after powerful retardation about 50 metres from the edge of the runway. Inspection at the incident site showed that a large number of small metal pieces were present in the exhaust part of the left engine and on the ground behind the aircraft. Damage to the aircraft - apart from that to the left engine - was limited to the landing gear and aircraft external lights. The passengers exited from the aircraft in the normal way, using external stairs. No personal injuries were sustained during the incident. The investigation is continuing with a focus on metallurgical examinations in respect of the engine failure and further simulator tests, with the aim of investigating the conditions for symmetrical braking with different conditions being present in connection with engine failure. www.aviation-safety.net Back to Top Poland to reconstruct jet crash that killed president Warsaw, Jan 23 (IANS/RIA Novosti) Poland plans to reconstruct the crash that killed then Polish president Lech Kaczynski, a top official said. A Tu-154 plane that crashed near Smolensk, in western Russia, in April 2010, was carrying Kaczynski and 95 other senior Polish officials to a ceremony to honour Polish soldiers killed by Soviet secret police in 1940. A plane that is to be deployed now for reconstructing the chain of events is the only vehicle of Tu-154 type at the disposal of the 36th Special Aviation Regiment of the Polish Air Force, which transports high-level officials. 'This will be a flight to confirm several moments, in particular if the crew could have taken any actions after the order 'Be off' and find out the reasons why they failed to perform these actions,' said Miroslav Grokhovsky, deputy head of the Polish investigation commission. He said security will be stepped up during the experiment, but did not provide further details. Meanwhile, TVN24, a television news channel in Poland, said the experts 'will not try' to reconstruct the weather conditions during the crash. Russia's aviation authorities released a report earlier this month citing pilot error as the main cause of the tragedy. Polish officials criticised the report, claiming it lacked evidence. http://www.sify.com/news/ Back to Top Loss of contract weather observers worries Alaska pilots Two dozen manned weather sites across Alaska are getting a closer look by the National Weather Service, and aviators are worried about losing what they say is vital weather data for flying around or over dangerous terrain. Correctly gauging the height of clouds in a mountain pass, for example, often means the difference between life and death in the cockpit. Observations from certified contractors in remote areas can provide that type of information. But there are difficulties that come with that, and the National Weather Service is questioning whether there might be a better way. The weather service forecasters use observations from contracted, private citizens to aid them in predicting weather across Alaska. While the observations are helpful, they might not be crucial to the weather service's overall mission, and the service is re-evaluating its use of the contracted sites, according to Angel Corona, chief of the service's data acquisition branch, which oversees the contracts. "For our means, we could say, 'Well, we don't need those anymore for our needs, so they're going to go away,' but obviously we're affecting other people," Corona said. The discussion arose from reports that two of the sites -- both of which help pilots navigate frequently traveled mountain passes -- had either stopped reporting or planned to stop. One station at Big River Lakes stopped sending observations in mid- December. Another at Hayes River is set to stop at the end of January. The two stations gave pilots a good idea of what the weather was doing on the east side of Lake Clark, Merrill and Rainy passes, three mountain passes west of Anchorage, according to the Alaska Airmen's Association. Many pilots are concerned about those closures and the possibility of more to come, Airmen's Association President Adam White said. "(That's) a big impact on aviation and the safety of making that decision on whether a person should fly or not fly, and sometimes the only way to know that, now, is to get up and stick your nose in it, which is not the best option," White said. MANNED WEATHER OUTPOSTS Neither station closed as part of the weather service's re-evaluation, Corona said. At Big River Lakes, a certified observer was no longer in the area. At Hayes River, the contract was expiring without another observer to take over, he said. Discussions are ongoing with the Federal Aviation Administration and Alaska pilots about how to get reliable, accurate weather information, Corona said. Still, the closure of both stations underscores why it's hard to get reliable weather observations from people in remote parts of Alaska. The observers have to be certified to make sure their observations are accurate, Corona said. People are scarce in rural Alaska, by definition. So it can be difficult to find anyone willing to take on the task of making painstaking records of the weather there, on top of whatever else they're doing to support themselves, Corona said. "We recognize the problem, but I guess other people have to recognize that we have certain criteria that have to be met, and that's what we're trying to do," he said, adding that the FAA sets the rules by which the weather service and its contractors must abide. There are also hundreds of FAA weather cameras and dozens of unmanned weather stations in Alaska that provide data, Corona said. The weather service is working with the FAA to see if any changes will be mitigated by those other data sources, he said. PILOTS CONCERNED White, with the Airmen's Association, is aware of the problems of maintaining this weather-gathering network. "Unfortunately, some of those sites, from time to time, go down," White said. They're hard to get to, and if the technology fails, the cameras may be inoperable for extended periods of time, he said. "We're getting better with some of that weather data, but we're taking a step in the wrong direction when we start losing weather sources," White said. "It is not the right idea to just go out not knowing what the weather's like, hoping you can make it. That's a recipe for disaster, and we know what the accident season has been like here in Alaska lately." FAA WANTS RELIABILITY Corona said there have been no plans so far by the weather service to stop contracting with the other 22 manned weather sites, some of which have been around since the 1970s, he said. There also may be a misconception in the aviation community that the service is cutting sites to save money, Corona said. "We don't know what our alternatives are going to be," Corona said. "To say that we're going to save money -- I don't know that we're going to save any money." Money is always going to enter into a discussion of how an agency uses its funds to provide the most efficient, reliable service it can, Corona said in a later interview. But saving money is not the main focus of the National Weather Service's evaluation of the sites, he said. All sides seem to agree that it's a good idea to take a look at the myriad sources pilots use to paint a comprehensive picture of Alaska's weather. What that picture will look like in the future is yet to be determined. http://www.thenewstribune.com/ Back to Top Chicago-bound airplane makes emergency landing in Oakland A Southwest Airlines flight en route to Chicago from San Francisco International Airport had to make an emergency landing at Oakland International Airport after a warning light alerted the flight crew. The pilot on flight 450, which left SFO at 2:51 p.m. Saturday, decided to make an emergency landing in Oakland after the light illuminated. That light can indicate an overheat in the wheel well, said Southwest spokeswoman Brandy King. "As they are trained to do, the pilot landed at the nearest airport," she said. "They had an uneventful landing." Once on the ground, the Boeing 737 was met by fire crews but they found no overheating or fire and the plane was taken in for maintenance, King said. The 86 passengers on board were moved to another Southwest plane and departed an hour and a half later than their original take-off time, she said. http://www.mercurynews.com/ Back to Top US Airways flight en route from Chicago to Phoenix makes emergency landing in Omaha OMAHA, Neb. (AP) - A U.S. Airways flight en route from Chicago to Phoenix has made an emergency landing in Omaha after reporting electrical problems. Phil Jensen, operations supervisor at Eppley Airfield, says the airplane landed without incident just before 9:30 a.m. Sunday. He says it was having steering problems and needed to be towed to a gate. Flight records show the Air Bus 320 left O'Hare International Airport about 7:10 a.m. and was scheduled to arrive in Phoenix at 10:15 a.m. Jensen says mechanics are looking at the plane to determine the cause of the problems and whether it can continue on. Jensen says there were 107 people on board. Back to Top American Airlines Passenger Punches Flight Attendant Due to Blocked Restroom Reports now show that a 63-year-old man, who was apparently enraged by a beverage cart that was blocking his path to the bathroom, punched a flight attendant. This, once again, proves that when someones got to go, they got to go. This 63-year-old Massachusetts man was on an American Airlines flight that was bound for JFK. He became very upset when his path to the bathroom became blocked by a beverage cart. He reportedly kicked and knocked over the beverage cart and then punched the flight attendant. Sources went on to say that the man's name was Michael Isabelle. He was flying into New York from Rio de Janeiro when he punched flight attendant Carlos Carrico in the stomach after the crew member grabbed his arm. A spokesperson for American Airlines said that they had a disruptive passenger on the flight. He was subdued and turned over to the local law enforcement on arrival in New York. The report goes on to show that Carrico, a fellow flight attendant and a passenger put plastic cuffs on Isabelle after wrestling him to the ground. The New York Port Authority police then took Isabelle into custody upon landing. The crew took him to a hospital for a psychological evaluation. The flight attendant did not file criminal charges against the old man. Once again, this shows the kind of thing that some flight attendants have to put up with while trying to serve passengers. Although they are there to help people, some passengers tend to get short with them. Overall, it proves just how hard it is to work with the public on a day-to-day basis. http://www.comparecarrentals.com/ Back to Top NTSB assists with Air Burkina incident in Paris The US NTSB is assisting the French government to determine why an Air Burkina MD-83 almost ran out of fuel after several landing attempts in poor weather at the Paris Orly airport on 12 January. According to the NTSB's preliminary report, the aircraft was being ferried with its landing gear extended when the crew "determined that it did not have enough fuel to proceed to its destination and decided to return to Orly". The NTSB has not provided information on the aircraft's route that day. ATI's ACAS database shows that Air Burkina, based in the West African nation of Burkina Faso, has a fleet of three aircraft, including an MD-83, and flies a route between Ouagadougou in Burkina Faso and Paris Orly via Marseille. "Air traffic controllers directed the flight to go around twice due to poor geographic positioning of the airplane for landing," the NTSB says. "The flight landed uneventfully on the third approach during weather conditions below minimums." http://www.flightglobal.com/ Back to Top FAA inaugurates LaGuardia tower The US FAA today inaugurated a new $100 million air traffic control tower at the LaGuardia airport in New York, replacing a tower that had been in place since 1964. The 71m-high (233ft) facility includes Airport Surface Detection System Model X (ASDE-X) equipment that allows controllers to track surface movement of aircraft and vehicles. Controllers in the tower will also be using the FAA's Integrated Control and Monitoring System (ICMS), which consolidates information including navigational aid displays into one screen. "LaGuardia Airport plays an important role in our country's aviation infrastructure," says US DOT secretary Ray LaHood. "This modern tower will help enhance the safety and efficiency of air travel in and out of the New York metropolitan area." Source: Air Transport Intelligence news Back to Top Cathay A330 incident prompts call for ICAO action on aviation fuel supplies Hong Kong's Civil Aviation Department (CAD) has urged the ICAO to issue requirements to ensure the quality of aviation fuel supplies at airports, as part of an ongoing investigation into a Cathay Pacific Airways Airbus A330 incident last April. The aircraft, registration B-HLL, made an emergency landing at Hong Kong International Airport on 13 April 2010 after it issued a Mayday call, following malfunctions in both Rolls-Royce Trent 700 engines. Investigations into the incident have pinpointed fuel contamination as the likely cause behind the seizure of engine valves, the CAD has said. Analysis of engine fuel components found spheres containing carbon, oxygen, sodium, chlorine and sulphur and were mainly sodium polyacrylate, which was "consistent with the super absorbent polymer material used in the filter monitors on a fuelling dispenser". The contamination is believed to be related to the fuel that the aircraft had received from a refuelling stand at Indonesia's Surabaya Juanda International Airport, says the CAD. It is not known yet, however, how the contamination came about and how it entered the aircraft. The airport had started extension work to a hydrant refuelling circuit serving 10 stands before the incident, but investigations later found that these procedures were "not in line with the guidelines and practices commonly used by the aviation fuel industry". Refuelling at five stands, including the one that served the Cathay A330, was carried out before the re-commissioning was completed. Subsequent investigations found that four fuel dispensers had their filter monitors replaced from 10 to 15 April 2010 because of "high differential pressure readings", which indicates that the monitors were clogged. Tests on the dispenser that refuelled the A330 also showed that the filter monitors had "absorbed a significant amount of water", says the CAD. The affected hydrant refuelling circuit was taken out of operation following the incident and remains so, it adds. Investigations into the airport's refuelling practices also found that the dispensers were not being operated at the correct flow rates, and the recording and monitoring of the weekly differential pressure of the dispensers were not carried out properly. PT Pertamina, which carries out refuelling at the airport, has taken measures to monitor the delivery of aviation fuel and taken steps to correct the earlier lapses, says the CAD. However, it adds that more needs to be done to regulate the quality of aviation fuel supplies at airports, as airlines "depend largely on aviation fuel suppliers at airports to provide quality fuel to aircraft". "There are no international civil aviation requirements for oversight and quality control of aviation fuel supply, including refuel operations procedures and associated training requirements for the relevant personnel at airports," says the CAD. Its investigation into the incident is continuing. The CAD is carrying out the work with the UK's Air Accident Investigation Branch, French investigation agency Bureau d'Enquetes et d'Analyses, Indonesia's National Transportation Safety Committee and the US National Transportation Safety Board. Airbus, Rolls-Royce and Cathay are also assisting with the investigation. Source: Air Transport Intelligence news Curt Lewis, P.E., CSP CURT LEWIS & ASSOCIATES, LLC