Flight Safety Information January 10, 2020 - No. 008 In This Issue Iranian Missile Accidentally Brought Down Ukrainian Jet, Officials Say, Citing Early Evidence 'Designed By Clowns' And 'Supervised By Monkeys': Internal Documents Of Boeing Employees About 737 Max Ukrainian Air Disaster Highlights Iran's Troubling Air Safety Record Airbus A321-231 (WL) - Hard Landing (Turkey) Boeing employees pushed back on "stupid" airlines and regulators who asked for more pilot training Nationwide pilot shortage allowing for younger pilots to fly commercial planes. Aircraft and Helicopter Accident Investigation from SCSI DTI Training Canada Najeeb E. Halaby Graduate Student Fellowship RESEARCH SURVEY Laura Taber Barbour Aviation Scholarship Fund Iranian Missile Accidentally Brought Down Ukrainian Jet, Officials Say, Citing Early Evidence Western intelligence showed that Iran was responsible for the plane crash, suggesting that the deaths of those aboard were a consequence of the heightened tensions between Washington and Iran. WASHINGTON - American and allied officials said on Thursday that they had intelligence that missiles fired by Iranian military forces were responsible for the downing of a Ukrainian jetliner and the deaths of all aboard this week in Iran, most likely by accident. The disclosures suggested that the deaths were a consequence of the heightened tensions between Washington and Tehran that have played out since an American drone strike killed a top Iranian general last week. Prime Minister Justin Trudeau of Canada, citing a preliminary review of the evidence, called for a full investigation "to be convinced beyond all doubt." The jetliner was carrying 63 Canadians among its some 176 passengers and crew. "We recognize that this may have been done accidentally," Mr. Trudeau said at a news conference in Ottawa. "The evidence suggests very clearly a possible and probable cause for the crash." President Trump, speaking earlier at the White House, said only that he suspected that the downing of the plane was the result of "a mistake on the other side." Senior American officials were more forthcoming, saying that they had a high level of confidence in their findings. American intelligence agencies determined that a Russian- made Iranian air defense system fired two surface-to-air missiles at the plane, one official said. And video verified by The New York Times appeared to show an Iranian missile exploding near a plane above Parand, near Tehran's airport, the area where the jetliner, Ukraine International Airlines Flight 752, stopped transmitting its signal before it crashed. Those aboard the plane most likely faced horrifying final moments, starting with an explosion as the missiles detonated just outside it, sending shrapnel and debris spiraling through the fuselage. The plane turned back toward the airport, then began its uncontrolled descent toward the ground. American satellites, designed to track missile launches, detected the firing of the Iranian short-range interceptor. United States intelligence agencies later picked up Iranian communications confirming that the system brought down the Ukrainian airliner, officials said. An initial Iranian report released on Thursday said that the plane, bound for the Ukrainian capital of Kyiv, was in flames before it hit the ground but sent no distress signal. A security camera captured its impact: first the predawn darkness, then a series of blinding bursts of light in the distance, followed by a storm of burning debris in the foreground. Even before world leaders and American officials confirmed the intelligence assessment, the mysterious circumstances of the disaster had raised suspicions that a missile brought down the airliner. The crash occurred hours after Iran launched a barrage of ballistic missiles at American military targets in Iraq, and Tehran, bracing for possible American retaliation, readied its ample air defense system. After Iran began firing missiles early on Wednesday in retaliation for the killing of Maj. Gen. Qassim Suleimani, international airlines rerouted flights away from Iran, and the Federal Aviation Administration barred American carriers from the airspace in the region. The new information about the tragic mistake with its air defense systems raised questions about why Iranian authorities had not stopped flights in and out of Tehran. Iran denied that its military was responsible for the crash of the plane, a Boeing 737. Ali Rabiei, an Iranian government spokesman, called it "a big lie" and blamed the accusations on "psychological warfare" against Tehran. "The United States is making the pain of the families worse," Mr. Rabiei said in a statement. Iranian officials questioned the Western account, saying the plane would have exploded if hit by a missile. The air defense system used Wednesday, however, is designed to explode near aircraft, creating shrapnel that takes a plane out of the sky, rather than directly hit it. In addition to denying responsibility, Iran invited the National Transportation Safety Board of the United States to assist in the investigation despite previous reports that the Americans would not be involved, according to correspondence reviewed by The Times. The board assigned an investigator to the crash, a spokesman said on Thursday evening. Iranian authorities recovered the plane's "black box" flight data recorders, but they were damaged by the crash and fire, the Iranian report said. That raised the possibility that some of the information stored in them electronically had been destroyed, but investigators can retrieve useful data even from damaged recorders. Iran also invited Boeing, the jet's manufacturer, to help investigate the black box, a government spokesman said, according to Iran's official news agency, IRNA. Boeing is "supporting the N.T.S.B. in the investigation," said a spokesman, Gordon Johndroe. Sanctions against Iran prevent Boeing from contacting its government without an export license, the people said, and Mr. Johndroe said the company is applying for one. Canadian investigators were also arranging to visit the crash site, a senior government official said. Ukraine was negotiating with Iran to allow investigators to search the site for possible rocket fragments, Oleksiy Danilov, the secretary of the National Security and Defense Council of Ukraine, told Censor.net, a Ukrainian news outlet. Ukrainian officials want "to find out the causes of the tragedy," President Volodymyr Zelensky of Ukraine said in a videotaped address released on Thursday. "We will definitely find out the truth. We will conduct a detailed and independent investigation." Mr. Zelensky also sought to pre-empt criticism of the Ukrainian authorities for allowing the flight to take off soon after the Iranian attacks on American targets in Iraq. He said that Tehran's airport had been operating as usual at the time, noting that other European airlines were taking off and landing. Evidence gathered by American and allied intelligence contradicted Iran's denials. The American military's Space-Based Infrared System, which relies on satellites in various orbits to track the launch and flight path of ballistic missiles, detected the missile launch. While American missile defense sensors are primarily meant to defend against long-range launches, they can often detect launches of air defense systems, including those designed to work at low altitudes, officials have said. On Wednesday, American officials combined the information from the satellites with intelligence from intercepted calls to determine what brought down the plane. The infrared system had also detected the antiaircraft missile fired by Russia-supported separatist fighters in eastern Ukraine in 2014 that brought down Malaysia Airlines Flight 17, officials said at the time. All 298 people aboard were killed. Russia first sold Iran the air defense system - which NATO calls SA-15 and Russia refers to as Tor - in 2005, prompting American protest. The Iranian military could have positioned the system, which is designed to operate at medium to low altitudes and intercept both aircraft and guided weapons, to defend the airport if officials believed the United States military was intending to counterattack after Iran's ballistic missile strikes. Three to four people operate the system, tracking nearby aircraft by radar. But determining friendly civilian aircraft takes skill, and mistakes are possible, particularly in charged situations. Echoing Mr. Trudeau, Prime Minister Boris Johnson of Britain confirmed that intelligence pinned the shoot-down on the Iranian government and that it "may well have been unintentional." Mr. Trump was more evasive earlier in the day. "Somebody could have made a mistake on the other side," Mr. Trump said. "It was flying in a pretty rough neighborhood and somebody could have made a mistake." https://www.nytimes.com/2020/01/09/world/middleeast/iran-plane-crash-ukraine.html Back to Top 'Designed By Clowns' And 'Supervised By Monkeys': Internal Documents Of Boeing Employees About 737 Max Aircraft The Boeing Company (NYSE: BA) on Thursday released internal documents pertaining to employee communications about the 737 Max aircraft between 2013 and 2018, which suggests that the employees deliberately ignored the safety issues with the now- grounded line. What Happened According to the documents reviewed by the Wall Street Journal, the Boeing employees mocked the aviation regulators around the world, including the Federal Aviation Administration, and suggested that Boeing was willing to compromise on safety procedures in order to avoid simulator training for the pilots. "Would you put your family on a MAX simulator trained aircraft? I wouldn't," an employee wrote in a 2018 email, the Journal reported. The 737 MAX aircraft was grounded in March last year after two fatal crashes involving the line in Indonesia and Ethiopia killed 346 people. Another employee, a management pilot, said that he was worried he wouldn't be "forgiven by god for the covering up" he did in the previous year. "Can't do it one more time. Pearly gates will be closed," the pilot said, suggesting that he aided in circumventing safety requirements, according to the Journal. "This airplane is designed by clowns, who in turn are supervised by monkeys," another employee said in an email seen by the Journal. Why It Matters Another set of transcripts released in October last year had shown that Boeing employees were aware of the "egregious" and "fundamental" problems that remained with the aircraft even after it was put into the air, causing outrage among the regulators. The Chairman of the House Committee on Transportation and Infrastructure, Rep. Peter DeFazio (D -- OR 4th District), who is leading the House inquiry into the Boeing aircraft, described the documents as "incredibly damning." "They paint a deeply disturbing picture of the lengths Boeing was apparently willing to go to in order to evade scrutiny from regulators, flight crews, and the flying public, even as its own employees were sounding alarms internally," DeFazio said in a statement on Thursday. Boeing has focused on fixing the technology glitches required to get the F.A.A. approval and get the aircraft back in the air, but the repairs and subsequent approval are taking longer than expected. An internal audit by Boeing in December revealed previously unknown design flaws in the engine panel and wiring. A recent crash of a Boeing 737 aircraft in Iran that killed 176 people spells new trouble for the company. Whether it was a technical glitch with the aircraft that caused the crash or an Iranian missile remains a point of contention with the United States, Canada, and the United Kingdom suggesting the latter, and Iran denying the allegations. Price Action Boeing's shares closed 1.5% higher at $336.34 on Thursday. The shares were further 0.3% up in after-hours trading. https://www.yahoo.com/finance/news/designed-clowns-supervised-monkeys-internal- 091851980.html Back to Top Ukrainian Air Disaster Highlights Iran's Troubling Air Safety Record The Ukraine International Airlines (UIA) disaster on January 8, when flight PS-752 crashed soon after takeoff from Tehran with the loss of all 176 passengers and crew on board, reinforces Iran's poor record when it comes to aviation safety. The cause of the tragic episode remains in doubt for now. The Boeing 737-800 aircraft crashed shortly after taking off from Imam Khomeini International Airport, heading for the Ukrainian capital Kiev. Initial reports from Iran stated the plane had crashed after an engine caught fire, but suspicions of something even more concerning soon emerged. Canadian prime minister Justin Trudeau said the following day that intelligence from Canadian and other sources pointed to the plane being hit by a missile, albeit perhaps unintentionally. Later that day, aviation safety experts at OppsGroup changed their view on whether the plane was shot down from "possible" to "very probable". Iranian officials maintain the plane was not hit by a missile. The head of the Civil Aviation Organization of Iran has urged the world to wait until investigators have completed their work. Nonetheless, the working assumption for most in the industry is that the plane was shot out of the sky by a surface-to-air missile (SAM) while climbing away from Tehran - not least because of apparent video footage of the incident emerging and the discovery of anti-aircraft missile debris allegedly found near the crash site. Just who might have fired the missile and why remain matters of conjecture, however. Justin Bronk, a research fellow at the UK defence think-tank the Royal United Services Institute (RUSI), points out that "Iran has no reason to want to make its own airspace seem unsafe for civil air traffic". He suggests the most likely culprit is "a badly trained or inexperienced crew" of the Russian-made SA-15 Tor M-1 SAM system based near Mehrabad Airbase on the outskirts of Tehran who "made a series of tragic and incorrect assumptions." The incident draws fresh attention to Iran's poor safety record which, by most measures, is the worst in the Middle East region. There have now been 22 fatal air accidents in the country since 2000, according to the Aviation Safety Network (ASN). In records that go back to 1919, the ASN has recorded 152 air accidents in Iran, far ahead of the second-worst country Egypt which has suffered 126 incidents over that time. Including the UIA disaster, there have now been 63 incidents involving fatalities in Iran, with a total loss of life of 2,152. Only two other countries in the region have seen more than 1,000 deaths from air accidents, with Saudi Arabia suffering 1,019 deaths and Morocco 1,016. The countries with the best air safety record in the Middle East include Qatar which has had the fewest incidents at just six. It and Kuwait have both had just one incident involving a fatality and Kuwait has the lowest aviation death toll in the region with just four fatalities. The UIA crash is the worst in Iran since February 2003, when 275 people died when a Russian-built Ilyushin Il-76MD carrying Islamic Revolutionary Guards Corp personnel crashed into a mountain near the city of Kerman during strong winds. One particular problem for the Iranian aviation sector - although not relevant in the case of the UIA crash - is the impact of U.S. sanctions on the country. This has prevented local airlines from buying newer aircraft or even accessing spare parts. As a result, airlines have had to strip some planes for parts and many of the aircraft flying in Iran today are relatively old. According to Airfleets.net, the average age of aircraft used by leading airlines such as Iran Air and Mahan Air is often well over 20 years and in some cases more than 30 years. https://www.forbes.com/sites/dominicdudley/2020/01/10/ukrainian-air-disaster- highlights-irans-troubling-air-safety-record/#4664649c7ba2 Back to Top Airbus A321-231 (WL) - Hard Landing (Turkey) Date: Friday 10 January 2020 Time: ca 07:35 Type: Airbus A321-231 (WL) Operator: Nordwind Airlines Registration: VQ-BRS C/n / msn: 7686 First flight: 2017-05-09 (2 years 8 months) Engines: 2 IAE V2533-A5 Crew: Fatalities: 0 / Occupants: Passengers: Fatalities: 0 / Occupants: Total: Fatalities: 0 / Occupants: Aircraft damage: Substantial Location: Antalya Airport (AYT) ( Turkey) Phase: Landing (LDG) Nature: International Scheduled Passenger Departure airport: Moskva-Sheremetyevo Airport (SVO/UUEE), Russia Destination airport: Antalya Airport (AYT/LTAI), Turkey Flightnumber: N41801 Narrative: Nordwind Airlines flight 1801, an Airbus A321-200, made a hard landing on runway 18C/36C at Antalya Airport, Turkey. The nose landing gear was pushed into the fuselage, penetrating the cabin floor. The nose landing gear tyres burst and the forward fuselage section suffered serious damage. According to a report made by the captain after landing, the flight performed a stable ILS approach to runway 36C. He attributed the hard landing to 'windshear' over the threshold. A go-around was executed during which the navigation and attitude indication failed. Smoke entered the cockpit and the flight declared a Mayday. Subsequently a low pass was made over runway 36C so the Tower could assess the damage to the aircraft. Then a dual hydraulic failure occurred, and the fight again declared a Mayday. A left-hand visual approach was flown to runway 36C and the aircraft landed. The runway was vacated and the aircraft was then shut down. https://aviation-safety.net/database/record.php?id=20200110-0 Back to Top Boeing employees pushed back on "stupid" airlines and regulators who asked for more pilot training Boeing's internal emails don't paint a pretty picture of its corporate culture. A new round of emails Boeing shared with the US Federal Aviation Administration in December, and gave to Congress on Thursday, showed its pilots regarded inquiries from airlines and air safety officials with disdain. The internal exchanges show the employees focused on getting Boeing's commercial and regulatory partners to drop requests for simulator training on the new 737 Max, which ultimately was involved in two deadly crashes that killed nearly 350 people. (The Verge has published a full set of the emails and messages.) In 2017, shortly after Malaysia's Malindo Air became the first airline to start flying the 737 Max, a sister airline in the Jakarta-based Lion Air group requested a flight simulator to train pilots on the newly acquired plane, to the irritation of a Boeing technical pilot. Technical pilots are Boeing employees that work with airlines and regulators on training, among other things. "Now frigging [airline name redacted] may need a sim to fly the Max, and maybe because of their own stupidity," the pilot wrote in an instant message (pdf, p. 33). "I'm scrambling to figure out how to unscrew this now! idiots." The pilots' names were redacted. In October 2018, Lion Air, part of the group, became the first airline to crash while flying the Max, killing 189 people, but it is not known if the Boeing pilots were discussing that airline or another in the group. The Seattle Times reported the airline's request for simulator training might have come in relation to the airline flying to India, as the exchange linked the request to India's regulator, the Directorate General for Civil Aviation. "Not sure if this is Lion's fault or DGCA's yet," the pilot said. In another exchange, the Boeing pilot told a colleague he had advised the airline to send the Indian regulator an email from him with a list of all airlines using the Max just based on computer training "to make them feel stupid about trying to require any additional training requirements." Because the plane was certified as a variation on an earlier 737 model, limited training was required for pilots trained on the older planes, a key component of Boeing's marketing of the Max. Simulator training for pilots at airlines is expensive, but it could have helped familiarize them with a new feature, the Maneuvering Characteristics Augmentation System, or MCAS. Instead, pilots weren't made aware of or trained on the new flight control system, which was added to make the plane perform like earlier models in the 737 series. It was capable of pushing the plane's nose sharply down during early minutes of the flight, and it activated on it two fatal flights, which included an Ethiopian Airlines crash in March, which led to the 737 Max's global grounding. An internal email from the 737's chief technical pilot said (pdf, p. 27 of 48) Boeing would go "face to face" with any regulator that tried to make simulator training a requirement for the Max: "Boeing will not allow that to happen." Earlier this week Boeing said it would recommend simulator training for pilots when the 737 Max is again certified to fly. On announcing the latest release of emails, which come after an earlier batch of damning communications made public in December, the plane maker, said "these communications do not reflect the company we are and need to be, and they are completely unacceptable." Some employees also expressed scathing opinions about the Max development team, and Boeing management culture more generally. One email described the Max as "designed by clowns, who are in turn supervised by monkeys," an apparent reference to the FAA. Another wrote in 2018, "Would you put your family on a MAX simulator trained aircraft? I wouldn't." The exchanges reflect a safety culture that appears to have deteriorated sharply in the wake of Boeing's 1997 acquisition of aircraft manufacturer McDonnell Douglas. The purchase removed a competitor, but also changed Boeing in fundamental ways that contributed to the 737 Max crash, by shifting its priorities from design and engineering to costs. Those concerned about the company's approach to safety appeared to feel ignored. A line in one of the released emails now stands out as darkly prescient: "I don't know how to fix these things. It's systemic. It's culture... Sometimes you have to let things fail big so that everyone can identify a problem." https://qz.com/1782894/boeing-quashed-stupid-requests-for-737-max-simulator- training/ Back to Top Nationwide pilot shortage allowing for younger pilots to fly commercial planes COUNCIL BLUFFS, Iowa (WOWT)-- A pilot shortage in the nation has airliners scrambling. Experts say almost half of pilots flying for major airlines in our country right now will be retiring in the next 10 years. This makes it a little sweeter for young pilots graduating from flight school here in the metro. These students at the age of just 20 or 21-years -old are almost ready to graduate. And right out the gate, they'll go from flying small planes to flying airliners with dozens of passengers. "Almost every day in class they taught us that the pilot shortage is real," said the student. Leighton Kaluza and Damon Miler are pilots at advanced air in Council Bluffs. They're two of thousands of students ready to fly commercial airliners once they graduate. "The first time you fly an airliner there's paying people in the back and they don't know," said Miler. "We are really fortunate, it's a great time in aviation." Authorities are now forcing airline pilots to retire at the age of 65. "What's happening is that the pilots are aging and retiring out of the system, and as they retire out there's nothing in the pipeline to fill them back up," said Kelly Deed, Advanced Air Inc. Deeds says their flight school has grown over the last 5 years as more people gain interest in becoming a commercial pilot. They currently have students from all over the world - from South America and as far as Japan. The school is a direct feeder for airlines such as Southwest, Envoy, and Skywest Kahlua will finish flight school in May and already has a job lined up with Republic Airlines. "In the past it was we were fighting to get hired and get a job somewhere and now the tables have totally turned," said Kahlua. The students say because of the high demand for pilots- airliners are now offering higher pay and bigger bonuses to sign on. https://www.wowt.com/content/news/Nationwide-pilot-shortage-allowing-for-younger- pilots-to-fly-commercial-planes-566858961.html Back to Top Back to Top Back to Top Najeeb E. Halaby Graduate Student Fellowship The Najeeb E. Halaby Graduate Student Fellowship was established by the National Center for Atmospheric Research (NCAR) to shape the next generation of aviation researchers, honoring the late Najeeb Elias Halaby, an eminent aviator and administrator, for his vision and more than five decades of extraordinary contributions to aviation (https://ral.ucar.edu/opportunity/halaby-fellowship). The Fellowship The recipient of a Najeeb E. Halaby Graduate Student Fellowship will spend three months (in 2020 or early 2021) in residence with NCAR's Aviation Weather Research Program, which Mr. Halaby was instrumental in establishing in the 1980s. As the nation's leader in addressing aviation weather research, NCAR plays a unique role in meeting user needs by transferring research results to operations through its Research Application Laboratory (http://www.ral.ucar.edu/). The Fellow will conduct research broadly aimed at mitigation of weather sensitivities (e.g., weather impact avoidance) on aviation. We particularly encourage applicants interested in weather impacts on emerging modes of transportation, like unmanned aerial system operations and urban air mobility. The Fellowship will provide: * a monthly stipend for three months, including temporary living expenses * round-trip travel expenses to and from Boulder, CO * travel to a conference to present results * page charges (if necessary) for one publication of key results Eligibility and Application The Halaby Fellowship targets graduate students (late Masters or early PhD level) enrolled in an aviation-relevant department or program of a domestic or international university. Interested candidates should have advanced research skills, far-reaching vision, and dedication to get things accomplished. Consideration for this Fellowship will be given to candidates based on the following submitted material: * Curriculum vitae * Proposal (maximum five pages) presenting the research to be conducted at NCAR, the anticipated outcome of that, and how the proposed effort ties into the candidate's ongoing graduate research project(s) * Contact information for three references (one of which should be the student's primary advisor) NCAR will accept applications for the Halaby Fellowship each year. Email Applications by February 28, 2020 to halabyfellowship@ucar.edu Back to Top RESEARCH SURVEY SMS for small operators: does it make sense? As part of an independent research project at Lund University, we'd like to hear from small business/private aviation operators about their experience with Safety Management Systems (SMS). Does your organisation have an SMS, and a workforce of 20 or less? Does the SMS generate value? Do you think there might be a disconnect between the SMS requirements and t he capabilities of your organisation? Considering the current lack of scientific research and peer-reviewed literature for this particular sector of aviation, this is a rather unique opportunity to share feedback in complete anonymity and to help identify any issue requiring focused attention. Please take a few minutes to complete the survey now, but also to share the link: https://www.surveymonkey.com/r/RYDPYYT Any assistance to advance the industry's understanding of the strengths and weaknesses of the SMS framework will be greatly appreciated! For any question or comment, please do not hesitate to contact st1830de- s@student.lu.se. Many thanks, and best wishes for 2020! Stéphane De Wolf MSc student, Human Factors & System Safety Lund University Curt Lewis