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Thread: Bad take-off computation.

  1. #21
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    Quote Originally Posted by TeeVee View Post
    like i suspected, blue wall stuff. you do realize that this helps no one? and further, the names were omitted to "protect" the not so innocent. and of course, i'm being sarcastic here, as it's not about innocence or guilt. this was very very likely pilots' error. as an alleged pilot yourself, you should be grateful for the lesson learned.

    i'm not advocating anyone getting canned over this, since i'm not in the position to judge whether this was the kind of mistake that absolutely should never have been made. and i rarely, if ever, rejoice in anyone losing their job. but you've gotta think of it this way: being in charge of an enormously dangerous instrumentality carries with it an enormous burden not to eff up, and if you do, you're gone.

    I know Atlas, NO ONE is going to loose their job over this. There will be a come to Jesus meeting at the training center in MIA, and more than likely a sim ride or two.

  2. #22
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    Quote Originally Posted by Schwartz View Post
    In your experience, how many times in 100 would the verification step catch an error?
    Human beings have an inherent flaw, they make mistakes. This is one of the reasons for the verification process. Is it perfect? Nothing ever is!

  3. #23
    Senior Member 3WE's Avatar
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    Quote Originally Posted by Evan View Post
    TOPMSFMSNOTAMTCASOBWBSFMSTOPMS
    Indeed.
    Les règles de l'aviation de base découragent de longues périodes de dur tirer vers le haut.

  4. #24
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    Quote Originally Posted by BoeingBobby View Post
    Human beings have an inherent flaw, they make mistakes. This is one of the reasons for the verification process. Is it perfect? Nothing ever is!
    Any value in an electronic system sort of monitoring/overseeing any of this stuff...speaking broadly?
    Les règles de l'aviation de base découragent de longues périodes de dur tirer vers le haut.

  5. #25
    Senior Member 3WE's Avatar
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    Ya know...ANOTHER reason for the 'line of scilence' is that blabbing can open the employer up to 'defamation' lawsuits from the ALLEDGED stupid pilots (suits aided by someone's coworkers.) I know I'm a dumbass at times, but y'all continue to say the funniest things.
    Les règles de l'aviation de base découragent de longues périodes de dur tirer vers le haut.

  6. #26
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    Quote Originally Posted by BoeingBobby View Post
    Human beings have an inherent flaw, they make mistakes. This is one of the reasons for the verification process. Is it perfect? Nothing ever is!
    For sure, I know that is absolutely true. The reason I ask is it is very easy to have a false sense of feeling secure bypassing the normal procedure of double checking if the number of mistakes was very low. If let's say, an error was made and caught 3 times in 100, then the odds of getting away with skipping the double check procedure this mistake is 97%. I imagine a good pilot who makes the odd exception of bypassing the double check would never likely have an incident like this in their career even if they skipped procedure once a year.

    It's also really easy for 2 pilots in the same environment to make the same mistake at the same time (see recent Air Canada incident).

  7. #27
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    Quote Originally Posted by 3WE View Post
    Indeed.
    LOL

  8. #28
    Senior Member Evan's Avatar
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    Quote Originally Posted by Schwartz View Post
    ...would never likely have an incident...
    Aviation accidents mostly involve the unlikely. Thus, the unlikeliness of an event is no excuse for not doing something to prevent it.

    The more important word is 'foreseeable".

  9. #29
    Senior Member Gabriel's Avatar
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    To Schwartz and TeeVee and Evan's point... I made this exercise before and was not taken seriously because, they said, it is not realistic. it is not, and it is not meant to be. It is an oversimplified reality to make a point. Reality is much more complex (and worse).

    Say that all pilots are alike, they have exactly the same training, same skills, same strength and weakness regardless of their experience (they all have enough experience to have their ATP license and that's enough, additional experience doesn't make them any different).

    Now, that doesn't mean that there is no randomness. You can have identical dice and they will not yield identical values every time. But, ON AVERAGE, even if they are biased (but in the same way) they WILL produce the same fraction of 1, 2, 3, etc... among them.

    In the same way, these pilots don't touch down always with the same vertical speed, but the average vertical speed and the distribution of vertical speeds around that average is the same for all of them. (just used the touchdown vertical speed as an example, but it can be anything).

    Now say that there is a mistake (like wrong take-off computation) that this universe of pilots make, as a combined crew, at a rate of once per million flights. And say that this mistake ends up being an accident one out of 100 times that it is made. Since these pilots fly, on average, 10,000 flights along all their career. The vast majority of these pilots are never involved in such a mistake. Only 1 in 100. And only 1 in 10,000 have an accident as a result of this mistake. Yet, with 40 million flights per year, we have on average 40 such incidents per year and an accident every 2.5 years.

    When this accident happens it is very tempting to say "pilot error, they were irresponsible, they didn't do their job, after all most of the pilots never make this error in their whole career". And yet, that's not the case. With the current system and process, this accident is bound to happen every 2.5 years on average. And blaming, disciplining and firing the pilots who make it will not help an inch to improve the situation. Not only it can happen to any pilot, but it can happen to any pilot with the same probability. It is something that WILL happen to some of them, any of them, at any time, every once and then.

    Now, full disclosure is something that can lead to improve the situation. It can make the pilots more aware. It can help make the pilots realize that that can happen to them too. The poor unlucky pilots that made the mistake can explain how this mistake happens, what factors were involved, and this information can be used to take actions reduce the likelihood of occurrence.

    And yes, I realize that these pilots, in the Atlas case, didn't follow the procedure. Every time there is a PILOT ERROR there is something that was not done correctly. But, even then, there is a fine and fuzzy line (but there IS a line) between a real mistake and reckless negligence.

    Giving any kind of disciplinary action to this crew makes no sense to me. Giving THEM remedial training either. These pilots will not make the same mistake with or without remedial training. They learnt the lesson the hard way. Improving procedures, improving the training program, adding software aids, adding TOMPS, maybe adding or changing regulations, etc works much better. I mean, can work at all.

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  10. #30
    Senior Member Evan's Avatar
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    Quote Originally Posted by Gabriel View Post
    And yes, I realize that these pilots, in the Atlas case, didn't follow the procedure. Every time there is a PILOT ERROR there is something that was not done correctly. But, even then, there is a fine and fuzzy line (but there IS a line) between a real mistake and reckless negligence.
    Gabriel, this is what I've been saying all along, about everything from Turkish 1951 to this incident. In most of these cases, there is a fuzziness between negligence and mistake, but we have to allow pilots to make occasional mistakes. That's what redundancy is there for. And we have to allow both pilots to make the mistakes on rare occasions. That's what protective systems are there for.

    The only obvious negligence I see here is the continued resistance by both the industry and its pilots to making TOPMS a standard requirement. Since it is a relatively simply, relatively cheap, relatively maintenance-free and relatively harmless addition to the cockpit, I see no excuse for this.

  11. #31
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    Quote Originally Posted by Evan View Post
    The only obvious negligence I see here is the continued resistance by both the industry and its pilots to making TOPMS a standard requirement. Since it is a relatively simply, relatively cheap, relatively maintenance-free and relatively harmless addition to the cockpit, I see no excuse for this.
    No excuse?

    Please, tell me what IS TOPMS?

    As best as I can tell it is:

    -An acronym (thus you have a woody about it)
    -A interesting concept that could be turned into any number of smartphone apps.
    -A great idea that Gabriel laid out in detail in a textbook ass-hat parlour-. talk post
    -A great idea that 3BS laid out in detail in a textbook ass-hat- parlour-talk post (in fewer words than Gabriel) (My idea did differ from his, but no one cares because I'm not an aeroengineer). (My idea was passive and involved green, yellow and red colors and categories of fat dumb and happy, somewhat off from where it should be, and not-good, better check V-3BS figures...and something you might do at 'the 80 knots' check for green/yellow or red category, well BEFORE V-2.)
    -A potential distraction with potential unintended plane-bending-and-people-killing consequences (according to a 40,000 hour 747 pilot)

    Is there A system...

    ...an FAA-approved system?
    ...pilot-approved system?
    ...manufacturer approved system?
    ...a legal-approved system?
    ...something crazy-thoroughly vetted for ease of use and hopefully minimized risk of unintended negative consequences.

    Bottom line- A genuine, approved, tested, ready-to-go system, that truly is being 'resisted with no excuse'???

    Does it truly exist in 'a final form', or are we still mostly playing with it?
    Les règles de l'aviation de base découragent de longues périodes de dur tirer vers le haut.

  12. #32
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    Quote Originally Posted by 3WE View Post
    A potential distraction with potential unintended plane-bending-and-people-killing consequences (according to a 40,000 hour 747 pilot)

    Where do you come up with 40,000 hours?

  13. #33
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    Quote Originally Posted by BoeingBobby View Post
    Where do you come up with 40,000 hours?
    While I believe that my listening ability and memory is better than yours, I do tend to gloss over largely useless details in favor of the big picture.

    Shall we discuss how much lift a high-lift wing produces versus a low lift wing in a steady descent and my official flight time which is _______________.
    Les règles de l'aviation de base découragent de longues périodes de dur tirer vers le haut.

  14. #34
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    Quote Originally Posted by BoeingBobby View Post
    Where do you come up with 40,000 hours?
    He is adding up all your 4 limbs.

    --- Judge what is said by the merits of what is said, not by the credentials of who said it. ---
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  15. #35
    Senior Member Evan's Avatar
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    Quote Originally Posted by 3WE View Post
    No excuse?

    Please, tell me what IS TOPMS?
    - A proposed system to prevent runway excursions and tree-mowing, antenna-bending takeoffs. AFAIK there are systems in an advanced stage of development. Honeywell had a system in the works almost ten years ago and the patent dates back to the 90's.

    - A no-brainer.

    - Google is your friend.

    As best as I can tell it is:

    -A potential distraction with potential unintended plane-bending-and-people-killing consequences (according to a 40,000 hour 747 pilot)
    We've been over this before. You have a system that is able to detect performance issues and power-setting errors in the early, low speed part of the takeoff roll. I see no reason why it can't be inhibited (to prevent false warnings) above 80kts. So once again, please explain to me how this could be a plane-bending-and-people-killing system. It would almost certainly be a people-preserving system.

  16. #36
    Senior Member 3WE's Avatar
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    Quote Originally Posted by Evan View Post
    Blah Blah Blah.
    In other words, there is no such system ready to go. A prototype from pre GPS/LCD days is a long way from ready. Apparently Gabe and 3BS's parlour proposals aren't 'too late'.

    And for some reason, the modest, extra 'iPhone' code is not there in the flat screen TV.

    Should I enroll in an iPHone app-writing class at the local community college? I know BASIC and FORTRAN (pre Windows) (Ooooo, acronyms).
    Les règles de l'aviation de base découragent de longues périodes de dur tirer vers le haut.

  17. #37
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    Quote Originally Posted by 3WE View Post
    While I believe that my listening ability and memory is better than yours, I do tend to gloss over largely useless details in favor of the big picture.

    Shall we discuss how much lift a high-lift wing produces versus a low lift wing in a steady descent and my official flight time which is _______________.

    Why do I bother?

  18. #38
    Senior Member Evan's Avatar
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    Quote Originally Posted by 3WE View Post
    In other words, there is no such system ready to go. A prototype from pre GPS/LCD days is a long way from ready. Apparently Gabe and 3BS's parlour proposals aren't 'too late'.

    And for some reason, the modest, extra 'iPhone' code is not there in the flat screen TV.

    Should I enroll in an iPHone app-writing class at the local community college? I know BASIC and FORTRAN (pre Windows) (Ooooo, acronyms).

    In other words, the will is not there. Like the Boeing autothrust issue and the Airbus pitot failure issue, it's all wait-til-it-happens 'won't happen again' mentality these days when dealing with very foreseeable accident scenarios.

    Honeywell showed off a working prototype back in 2014. It is a software enhancement to their existing SmartRunway system.

    https://www.aopa.org/news-and-media/...akeoff-monitor

    And it's not a new idea. Here is an abstract from a 1987 proposal: https://arc.aiaa.org/doi/abs/10.2514...urnalCode=jgcd

    At least when it does happen, maybe it won't have to happen again.

  19. #39
    Senior Member Gabriel's Avatar
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    Quote Originally Posted by Evan View Post
    At least when it does happen, maybe it won't have to happen again.
    But it did happen. Of course, because the 747 was cargo and only crew died, and the 737 was a small plane killing a limited number of passengers (plus singe digit on the ground), and the A340 was just a near miss where luck was the main factor in not having 350 bodies, these were minor incidents and not total air disasters, so nothing happened here, keep moving, and wait until it happens again, this time preferably with a A380 in high density config. Tick, tock, tick, tock.....

    --- Judge what is said by the merits of what is said, not by the credentials of who said it. ---
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  20. #40
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    Quote Originally Posted by Gabriel View Post
    But it did happen. Of course, because the 747 was cargo and only crew died, and the 737 was a small plane killing a limited number of passengers (plus singe digit on the ground), and the A340 was just a near miss where luck was the main factor in not having 350 bodies, these were minor incidents and not total air disasters, so nothing happened here, keep moving, and wait until it happens again, this time preferably with a A380 in high density config. Tick, tock, tick, tock.....
    The reason there is no cognitive dissonance here is that when it happens, it will clearly be the "Pilots' fault". That myth can persist because of the infrequent nature of the problem. Such a system won't help them sell more planes. It will only cost money, and since the actual accident rate is so low, they won't see the ROI because it's a pilot problem.

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