曝光台 注意防骗
网曝天猫店富美金盛家居专营店坑蒙拐骗欺诈消费者
For “funereal” purposes
To put losses behind
To reassert trust and faith in the system
To resume normal activities
To fulfil political purposes
For improved system reliability
To learn about system vulnerability
To develop strategies for change
To prioritize investment of resources
A project supported by AIRBUS and the CAAC
A project supported by AIRBUS and the CAAC
June 2007
Investigation
The facts
An old generation four engine turboprop freighter flies
into severe icing conditions.
Engines 2 and 3 flameout as consequence of ice
accretion, and seven minutes later engine 4 fails.
The flight crew manages to re-start engine number 2.
Electrical load shedding is not possible, and the
electrical system reverts to battery power.
...
A project supported by AIRBUS and the CAAC
June 2007
... The facts
While attempting to conduct an emergency landing, all
electrical power is lost.
All that is left to the flight crew is the self-powered
standby gyro, a flashlight and the self-powered engine
instruments.
The flight crew is unable to maintain controlled flight,
and the aircraft crashes out of control.
Investigation
A project supported by AIRBUS and the CAAC
A project supported by AIRBUS and the CAAC
June 2007
Findings
Crew did not use the weather radar.
Crew did not consult the emergency check-list.
Demanding situation requiring decisive thinking and
clear action.
Conditions exceeded certification condition for the
engines.
Did not request diversion to a closer aerodrome.
...
Investigation
A project supported by AIRBUS and the CAAC
June 2007
... Findings
Crew did not use correct phraseology to declare
emergency.
Poor crew resource management (CRM).
Mismanagement of aircraft systems.
Emergency checklist – presentation and visual
information.
Flight operations internal quality assurance
procedures.
Investigation
A project supported by AIRBUS and the CAAC
A project supported by AIRBUS and the CAAC
June 2007
Causes
Multiple engine failures
Incomplete performance of emergency drills
Crew actions in securing and re-starting engines
Drag from unfeathered propellers
Weight of ice
Poor CRM
Lack of contingency plans
Loss of situational awareness
Investigation
A project supported by AIRBUS and the CAAC
June 2007
Safety recommendations
Authority should remind pilots to use correct
phraseology.
Authority should research into most effective form of
presentation of emergency reference material.
Investigation
A project supported by AIRBUS and the CAAC
A project supported by AIRBUS and the CAAC
June 2007
Investigation
The facts
An old generation two engine turboprop commuter
aircraft engaged in a regular passenger transport
operation is conducting a non-precision approach in
marginal weather conditions in an uncontrolled, nonradar,
remote airfield.
The flight crew conducts a straight-in approach, not
following the published approach procedure.
…
A project supported by AIRBUS and the CAAC
June 2007
... The facts
Upon reaching MDA, the flight crew does not acquire
visual references.
The flight crew abandons MDA without having
acquired visual references to pursue the landing.
The aircraft crashes into terrain short of the runway.
Investigation
A project supported by AIRBUS and the CAAC
A project supported by AIRBUS and the CAAC
June 2007
Findings
The crew made numerous mistakes.
But
Crew composition legal but unfavourable in view of
demanding flight conditions.
According to company practice, pilot made a direct
approach, which was against regulations.
…
Investigation
A project supported by AIRBUS and the CAAC
June 2007
… But
The company had consistently misinterpreted
regulations.
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AIRWORTHINESS AND FLIGHT STANDARDS(9)
