Wednesday, January 30, 2013

An Aircraft Incident - Good CRM



On 25 Oct 2005, Capt. L Marcelo (Brazilian pilot with 8400 hours) and F/O Thomas Abraham (Indian with 939 hours) were scheduled to operate flight BD 201 from Kolkata to Chennai. The crew arrived at flight operations about 0:50 mts before scheduled departure. After a detailed briefing by the FDO, the crew proceeded to the aircraft and spoke with the engineer at the aircraft regarding the snags reported by the previous crew. F/O Abraham was the PF for the first sector from Kolkata to Delhi. There was a slight delay on the part of ground operations and this time was utilized by the crew to discuss various operational aspects connected with the flight. Departure was from R/W 01R. During the take off roll, all callouts were made by Capt. Marcelo. All parameters were normal during the ground roll. After unstick, on selecting gear up, at around 400’ agl a loud bang was heard. This was followed by a yaw to the right, and high vibrations. Capt Marcelo took over control of the aircraft, made a quick scan of the engine parameters and found that there was a rapid rise in the No. 2 engine EGT, which was going beyond limits. Capt Marcelo partially retarded the No. 2 engine thrust lever in order to contain the EGT, while at the same time climbed to the security altitude of 800’. F/O Abraham made a PAN call to the ATC. At security altitude, Capt Marcelo asked for MCT on live engine, engine failure shutdown checklist and after take off checklist, in this order. Both crew members concurred that the No 2 engine was malfunctioning, and the checklist was called out by F/O Abraham. The flaps were left at flap 1 position, as the crew operating the previous flight on this aircraft had reported difficulty/ vibration while deploying flaps. Also, the Capt was not sure if the flap assembly had sustained any damage during this emergency. Capt Marcelo had the field in sight and elected to do a visual circuit to minimise the time in air. On D/W, the one engine inoperative descent approach checklist was carried out by F/O Abraham, followed by the one engine inop landing checklist. An overweight, flap 15 landing was carried out at a Vref of 150 kts. The landing was normal with manual braking, and No. 1 engine reverser deployed. Taxi in and shutdown was as per SOP. The tyres of the right main landing gear deflated on reaching the bay. The cause of the incident has been attributed to internal object damage caused due to fatigue failure of 3 blades of the HP Turbine. The engine sustained extensive damage to the HP and LP turbine section and downstream of the turbine.

Capt Marcelo and F/O Abraham had arrived in Kolkata on 23 Oct 2005 after operating BD 102 from Chennai to Kolkata. This was their first flight together as a crew. The crew utilized the extended stay in the hotel at Kolkata to get acquainted with each other, personally and professionally. During this process, one of the situations put forward by Capt Marcelo was a condition of an engine failure after take off. They discussed the actions in such a situation and agreed that priority should be given to flight path control, followed by the appropriate checklists and a landing back at Kolkata. Overweight landing was discussed, and Capt. Marcelo opined that single aisle aircraft undercarriages were designed to perform overweight landings as the difference in their MTOW and MLW was not very large. Also, that it was preferable to carry out an overweight landing in such a case, as the cause of engine failure would not be known to the crew, and thus such an eventuality should be treated with the same priority as an engine fire.



Crew Resource Management highlights

  1. There was a large difference in the flying experience of the crew. In addition to this, there were cultural differences too considering the nationalities of the crew. This was also the crew’s first time together. Capt. Marcelo understood the importance of CRM and thus took advantage of the time available during the extended stay at Kolkata to get to know F/O Abraham better, both personally and professionally.
  2. During this interaction, situational emergencies were discussed, including an emergency of engine failure after take-off at Kolkata.
  3. The Captain immediately took over controls on encountering the emergency, with the F/O taking over the duties of PNF (PM). The F/O alerted the ATC with a PAN call, and carried out checklists as per the directions of the Captain.
  4. The previous discussion of a similar situation helped the decision making process in this case, in terms of overweight landing and the other actions pertaining to the emergency situation.
  5. Open cockpit communications helped optimize performance of both crew members.
  6. Both crew members concurred on the engine malfunction before taking action.


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