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Boeing, We Have a Problem

  • Jan Kulísek
  • 3/24/2019, 14:38:17

These thoughts about the Boeing MAX plane crashes in Indonesia and Ethiopia are in Politics section, because of very poor coverage in the mainstream media.

What do we know so far?

The Ethiopian Airlines crash on March 10, 2019 was very similar to the crash of Lion Air five months prior on October 29, 2018. On the previous Lion Air flight an off duty pilot intervened and saved the day. The pilots made a write up in the logbook. After their landing the ground crew checked the fault involving angle of attack sensors and wrote it off as "could not duplicate". The plane crashed the following day.



Then the first extremely critical question is the duty of the crew to read previous logbook write ups before preparing for departure. The crew that crashed the Lion Air flight had to be aware of the logbook write up and how the previous crew solved the MCAS failure. They probably didn't read the write up, which would be a criminal negligence that resulted in 189 deaths (FAA Policy regarding pre-flight procedures).

In the Ethiopian Airlines crash one of the most significant piece of evidence is the fact that the horizontal stabilizer was in the full nose down position as per the Washington Post Investigators find 2nd ... As per other sources it was the case of Lion Air crash as well. Here is more info on how the horizontal stabilizer works in Boeing 737 aircraft:



In order to make anyone accountable we have to be aware of key additional facts. Pilots qualified on the previous version of Boeing 737 had as one of the memory items horizontal stabilizer runaway malfunction. It is called a "memory item" since the pilots have to memorize it as a remedy for a potentially deadly situation during which there is no time to check the Quick Reference Book. The following video Mentour Pilot demonstrates this situation:



The Ethiopian Air pilots had six minutes of flight to deal with their emergency and the aircraft didn't reach over 2,500 feet above ground as per Ethiopian Airlines Crash: New Boeing Jet ...

Based on all of the above we may already have enough info to assign the blame. The media entirely blame Boeing and FAA while giving pilots and airlines free pass. That is wrong for sure.

However, the existence of MCAS should have been properly highlighted in Quick Reference Book and maintenance manuals, which most likely was not at least prior to Lion Air crash. Boeing and FAA should be held accountable for this omission. Furthermore, it looks like software programming and testing of MCAS included allowing single point of error regarding AoA (Angle of Attack) sensors. Supposedly, during the flight MCAS reads data from both AoA sensors one at a time and wrong data may then be included resulting in potential failure of the entire MCAS system. I find this hard to believe and I would wait for preliminary results.

Then what we have here next is the pilots and their training. As per Boeing and FAA the pilots' training for Boeing 737-800NG aircraft should have been sufficient to fly the MAX version provided that the pilots are signed off on a short iPad additional training specific to MAX, to which are still essential questions unanswered. One of them is how the updated Quick Reference Book addressed the runaway stabilizer memory item in the presence of MCAS.

Who is responsible for two Boeing 737 MAX crashes then? Boeing, FAA, airlines or the pilots? In my opinion, all of them. The pilots should not be sitting in the cockpit without clear understanding how to deal with one of the emergencies that must be handled on the top of their head. Then the airlines must make sure that their pilots are properly trained. Did that happen in the case of Ethiopian Airlines and Lion Air? I highly doubt it. In addition, we must not forget the logbook write up. In my view, it has a major and essential role. And as far as FAA goes, it should not approve single point of failure of MCAS. In short, everyone involved is accountable in one way or the other.

As for the conclusion, watch here at minute 20:20:



In other words, since November 7th, 2018 the pilots were in the case of MCAS failure instructed by FAA to use Runaway Stabilizer Trim Procedure and given a little further information how it may look like in the cockpit as shown in the video by Mentour Pilot above. As of before the release of the first preliminary report on April 4th, 2019, the above would clearly put the ball in the airline's and pilots' court. But that no longer appears to be the case since the pilots attempted the procedure and failed. On the other hand, there are still more unanswered essential questions, one of them is why the throttles were set to 94% the entire flight.

Then let's wait and see how this will turn out. Anyone for bets?

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Update 03/26/2019

I just ran across the most qualified analysis of the Boeing MAX mishap on the Czech web portal iDnes in an interview with the Czech Republic's best civil aviation expert and long term pilot of Being 737 Ladislav Keller. The video is 39 minutes long, but unfortunately in Czech. You can find it here: Havárie boeingů: chyba je spíše na straně pilotů, situace měla řešení

The video is a confirmation of my article above minus mentioning of the logbook write up. The interview differs from the other sources only by mr. Keller going further in the area of putting the full blame on the pilots and is very animate about how fake news media informs, or better put it, misinforms the public. In addition, according to him, grounding of Boeing MAX planes is politically correct overreaction. I share his view especially when we include the logbook write up. Was it mentioned anywhere in the mainstream media? I did not notice.

Ladislav Keller published five books and co-authored one more. Here is his biography: Databaseknih.cz: Ladislav Keller

Preliminary report on Lion Air crash in October 2018: PRELIMINARY KNKT.18.10.35.04

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Update 04/04/2019

Today there was a press conference and preliminary findings presented by Ethiopian Air. As expected, Ethiopians are pushing all the blame on Boeing and FAA. However, we didn't learn too much of game changing information here, in my opinion. Juan Brown summarized today's info on YouTube below:



Preliminary report published on 04/04/2019 is here: Aircraft Accident Investigation Bureau Preliminary Report March, 2019. I predict a long legal battle to come.

Don't forget to follow Boeing ..., Part 2