EK521 preliminary report issued by GCAA

ek521
The UAE GCAA today released its preliminary report into the crash of EK521.

Credit where due – ICAO rules allow the investigating authority to keep the preliminary report confidential. The GCAA have made the report public.

The preliminary report is a factual report of the events. It does not seek to comment on why the crash occurred. Nor does it seek to make any judgement on the actions of the crew that day.

There are no great surprises in the detail of the crash itself. Weather was a factor but was not untypical of the middle of a summer day in Dubai.

Here is the basic timeline:

8.37.07 start flare IAS 159kts
8.37.17 right hand main gear touches down IAS 162
8.37.19 aural message – long landing, long landing
8.37.20 left hand main gear touches down
8.37.23 aircraft airborne/go-around
8.37.28 ATC clearance – straight ahead – climb to 4,000.
8.37.29 flaps from 30deg to 20deg
8.37.31 landing gear lever – UP
8.37.35 thrust levers from idle to full thrust IAS 134
8.37.38 aft fuselage impacts runway – rate of descent 900ft/minute IAS 125
8.38.10 aircraft comes to a rest
8.39.36 two fire tenders commence streaming foam

Approx 8.47 centre wing fuel tank explodes:

“As the ARFFS crew were fighting the fire, an explosion occurred approximately nine minutes after the Aircraft had come to rest.

After fuel tank explodes Commander and Purser evacuate the airplane.” (9 minutes after airplane comes to a stop).

“The Commander and senior cabin crewmember were the last to exit the Aircraft. They stated that they were still searching the cabin for any remaining passengers. When the center fuel tank exploded, causing intense smoke to fill the cabin, they attempted to evacuate from the cockpit emergency windows. However, as the cockpit was filled with smoke, they were unable to locate the evacuation ropes. Consequently, both evacuated by jumping from the L1 door onto the slide laying on the ground.”

There is some alarming detail in Section 1.15.2 and the discussion of the evacuation. Only five exits could be used – and each of those had problems – wind, water, smoke, slide deflation.

It is also unclear how long it took to complete the evacuation from the time that the airliner slid to a halt.

The report really does emphasise what an outstanding job the cabin crew did to get everyone out of the airliner.

Have a read of the GCAA’s report: Runway Impact during attempted go-around

Here is flightglobal on the chaotic evacuation:

“Investigators have detailed the extraordinary evacuation of the crashed Emirates Boeing 777-300 at Dubai, disclosing that cabin crew had to cope with problems at all 10 exits.

The General Civil Aviation Authority has also revealed that passengers were already unbuckling seat-belts and leaving their seats as the aircraft was still sliding along the runway.

Investigators have determined that the 777 came down on its engines and fuselage, with its undercarriage retracted, after failing to climb away during a go-around on 3 August.

The aircraft shed its right-hand engine at it came to a halt, resulting in an intense fuel-fed fire.

While the aircraft had five exits on each side, the evacuation slides for those on the left were badly affected by the wind.

The inquiry also notes that cabin crew assigned to the two forward left-hand doors were initially unable to open them – possibly because the aircraft was listing to the right – and required assistance.

Four of the left-hand doors were ultimately opened – the central door was left shut owing to smoke outside – but their slides were either blown up against the aircraft or, in one case, detached before it could be used.

Passengers could only evacuate from the rearmost left-hand exit before the wind made its slide unusable.

Four of the right-hand exits – on the side facing the fire – were opened. The forward slide was initially wind-blown and subsequently deflated after some occupants had escaped, while the second exit was temporarily barred from use due to smoke.

Passengers evacuating down one of the slides on the aft right-hand doors “became stuck”, says the inquiry, because it filled with water during the firefighting effort. Cabin crew redirected passengers to the rearmost right-hand door slide, which had to be held down by firefighters owing to the wind.

While cabin crew had instructed passengers to leave belongings behind, the inquiry states that “several passengers” evacuated the aircraft carrying their baggage.

The aircraft’s captain and senior flight attendant were the last to leave the aircraft. They were forced to jump from the forward left-hand door – the slide for which had detached – because the aircraft had filled with smoke as a fuel tank exploded, and they could not locate the cockpit evacuation ropes.

Flight EK521 had been transporting 282 passengers, of which 269 had been seated in the economy-class cabin and the other 13 in business-class. None was in the first-class section.

Despite the chaotic situation, all the passengers, as well as the 18 crew members, survived the accident, although a firefighter attending the crash was fatally injured during a wing tank explosion about 9min after the jet had come to rest.”

Meanwhile this one post on PPRUNE says all you need to know about the issues faced by pilots around the world:

“There are some basic skills that you need to master in order to be called a professional pilot, for example, being able to take off and or carry out an RTO within the confines of the runway, also you need to be able to land an aircraft and or carry out simple missed approach.

What is being missed by all of the posts seemingly blaming the unnecessary auto call out for a GA, is simply this; regardless of whether or not the GA was done or not, the basic skill of being able to carry out a bog standard missed approach was for some reason beyond this crew. This is a very basic skill that should be in every pilots toolbox. To put it another way, if the crew had of ignored the call out to do a GA, and instead continued with the landing, the gap in their skill set would not have been exposed this time but would still have existed.

This loss of basic skills seems to be becoming a common theme as more and more crew have not had any experience on anything other than modern late generation airliners. By way of recent examples, AF447, Asiana @ SFO, Air Asia X off Sumatra, and the ATR72 in Taiwan.

There is a very strong emphasis in our company for crew to use automatics in all phases of flight to the maximum extent, and manual flying is actively discouraged. This, I believe is a very flawed approach to both training and normal operations. The net result is, I believe, a very substantial eroding of basic hand flying skills in our company, and it would appear from recent industry accident history, that this insidious global reduction in basic skills is a very extensive problem.

Unfortunately the blame for this accident will be sheeted home to the crew, and the real culprits, the middle management of airlines around the world responsible for running training departments, and setting SOP’s will come out unscathed.”

Precisely.

New on 25 September – David Learmount of Flight Global on Lessons from Dubai

, ,

Leave a Reply