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Report on Cork Metroliner EC-ITP crash

here

244 pages.

Administrator
Shoreham EGKA, United Kingdom

I wonder why you need 224 pages when this says it all:

The immediate cause of the accident was a loss of control of the aircraft at a low height, from which recovery was not possible. The approach was continued despite not having the required minima and the aircraft descended below the decision height without adequate visual reference. Loss of control was initiated by the retardation of the power levers below Flight Idle, a manoeuvre prohibited in flight as such a manoeuvre may result in excessive airspeed deceleration and may induce an uncontrollable roll rate due to asymmetric thrust and drag.

Chimps in the cockpit one could say.

Chimps in the cockpit one could say.

Yes and no. These boys were put under enormous pressure and as consequence made a lot of mistakes, for which they paid the ultimate price. They shouldn’t have flown for that company (any of the companies involved in this complicated plot) in the first place, but tell that to someone who just got himself the one and only job available in Spain all year.
The guy in the LHS should not have been made captain the way it went and he should not have flown with a complete newbie on one of his first flights in command. And so on.

EDDS - Stuttgart

The tone of the report sounds like a bit of what we see in penal court. Instead of taking responsibility, it’s the circumstances, the bad childhood, etc. Every cock up by the crew is due to insufficient training, oversight, procedures, etc. When an employee cuts himself a finger off, it’s the employer’s fault because the last training on how to wear gloves was over a year ago, etc. A sexual harasser in the workplace sues the employer because he has not received proper training saying that asking a girl three times is already harassment (2x in 6 months was OK at the last big company I worked for). People are treated as a wobbly mass that is formed by employers/society and whatever they do is on those that put them there.

“The approach was continued despite not having the required minima and the aircraft descended below the decision height without adequate visual reference.” What else is to say and what excuse is there for going below the DH? None as far as I’m concerned.

Last Edited by achimha at 31 Jan 14:42

“The approach was continued despite not having the required minima and the aircraft descended below the decision height without adequate visual reference.” What else is to say and what excuse is there for going below the DH? None as far as I’m concerned.

Perhaps, but if we don’t explore what may be the root causes, and just dismiss every accident as whatever the final (often human induced) cockup was, we never learn anything and never learn how to prevent things getting into that state in the first place. Aircraft accidents always have a chain of events, and breaking the chain early may prevent the opportunity to have a sudden loss of judgement from ever presenting itself, and the Irish investigators would not be doing a good service if they had merely made a one page report that just stated the obvious.

The crew of that flight didn’t exist in a vacuum. There are many contributory reasons leading up to why they put themselves in that position and to just dismiss it with a two-liner about the crew doing what they shouldn’t just dooms us to repeat history over and over again.

Last Edited by alioth at 31 Jan 16:30
Andreas IOM

Instead of taking responsibility, it’s the circumstances, the bad childhood, etc.

Yes, but that’s really the case here. The captain of this flight had “grown up” (so to say, as an aviator) in an environment with very poor standards. In his years in the right hand seat, he has probably seen more violations of rules than rules being respected. Obviously, going around and diverting was not an option for this company. Also, delaying a flight for an hour for the weather (which was below minimum at destination and alternates) to improve was not an option. So what does a fresh captain on one of his first assignments do? Be the first one in years who diverts? A guy with Spanish ego? When everybody before him would have landed somehow? It’s easy to say: How stupid to fly three illegal approaches and bust the minimum on each occasion. But very difficult not to do in the situation these guys found themselves in. How do I know? Don’t ask. And yes, I have also flown a Metroliner for an always-near-bankrupt company at some time during my aviation life.

EDDS - Stuttgart

…in an environment with very poor standards. In his years in the right hand seat, he has probably seen more violations of rules than rules being respected

There was a term for this I saw a while back in the Space Shuttle Challenger accident report – “normalizing deviancy”. Basically, you let minor infractions pass until they become normal practice, and sometimes (as it did with NASA, Morton Thiokol and the Challenger) it results in disaster. The two words “normalizing deviancy” sum up the practise very well, I think.

Andreas IOM
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