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Old Jul 20, 2019, 7:49 pm

737-Max 8 safety concerns

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Old Mar 16, 2019, 11:19 am
  #106  
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Originally Posted by LarryJ
As you said, we didn't know the cause for a couple of years. The airplane continued to fly with no resolution to the accident.
There was only 1 accident. In the case of the MAX you have more than that, so you have a pattern.
Apples to oranges.
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Old Mar 17, 2019, 12:35 am
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Originally Posted by Betterthanyou
There was only 1 accident. In the case of the MAX you have more than that, so you have a pattern.
Apples to oranges.
Turns out there were a few parallels.

The AF447 pilots were in a stall but the stall was so deep that the computer disregarded the angle-of-attack (AoA) sensors judging the data to be invalid and shut off the stall warning alerts. Several times during the descent the AF pilots made the correct move to aggressively lower the aircraft nose (reduce pitch) but, when they did, the AoA signal fell back into a more normal range and the stall warning alerts sounded. This led the pilots to believe that lowering the pitch was making the problem worse (i.e. a high-speed or mach stall) and they pulled up again.
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Old Mar 17, 2019, 3:07 pm
  #108  
 
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Seems a little early to be stating some of these things but I will leave the article here.

https://www.seattletimes.com/busines...ion-air-crash/
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Old Mar 17, 2019, 3:36 pm
  #109  
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Wow.... just wow...

The engineers who wrote the MCAS software have major blinders if the software worked as noted by the SeattleTimes reporter.

In enterprise IT software, it's expected that tuning/automation features should have a repetition-limit. If the same event was triggered multiple times in a short period of time.. stop the automated-corrections and send an alert to the operator (i.e. pilot) instead. Looks like MCAS didn't have that basic concept and it would simply keep doing its thing without any kind of break or notification.

Also this part made me quite angry

MCAS was classified as a “hazardous failure,” meaning that it could cause serious or fatal injuries to a small number of passengers. That’s still one level below a “catastrophic failure,” which represents the loss of the plane with multiple fatalities.

...

But when the consequences are assessed to be more severe, with a “hazardous failure” requirement demanding a more stringent probability of one in 10 million, then a system typically must have at least two separate input channels in case one goes wrong.

Boeing’s System Safety Analysis assessment that the MCAS failure would be “hazardous” troubles former flight controls engineer Lemme because the system is triggered by the reading from a single angle-of-attack sensor.

“A hazardous failure mode depending on a single sensor, I don’t think passes muster,” said Lemme.

....

According to a detailed FAA briefing to legislators, Boeing will change the MCAS software to give the system input from both angle-of-attack sensors.

It will also limit how much MCAS can move the horizontal tail in response to an erroneous signal. And when activated, the system will kick in only for one cycle, rather than multiple times.
If the software can (without warning) make dramatic changes to the operation of the aircraft - it should NOT be allowed to do so on a single-point-of-failure (1 sensor) and do so without explicit warning to the operator/pilot.

Yet Boeing's software engineer deliberately designed it this way. I can't even being to understand how the software engineers designed this single-data-source design for such a critical system. Do they seriously never considered what happens if the sensor goes bad?!?!



It's beginning to feel like a deliberate effort to hide the operational reality of the MCAS software so that Boeing could shove the aircraft out the door ASAP and to promise no pilot re-training.


via Airlines.net


Economic problem. Boeing sells an option package that includes an extra AoA vane, and an AoA disagree light, which lets pilots know that this problem was happening. Both 737MAXes that crashed were delivered without this option.
This seems to me that Boeing was aware of the risk posed by its MCAS software... but decided to sell a cheaper-but-more-dangerous model.
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Last edited by Plato90s; Mar 17, 2019 at 4:01 pm
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Old Mar 17, 2019, 4:47 pm
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It is going to take some time to play out but if these allegations turn out to be true (big if in our fake news culture) the problems compounded in a way that it is possible no one foresaw this outcome. They should have but I work in IT systems too and I know how these situations get away from you. Then again, I am not in a sector where human lives hang in the balance. If the above is true the entire system broke down from design, testing, regulation, and training. This article makes it sound intentional but that is a bridge too far right now. I do not believe anyone involved would have allowed a system into public transportation that was known to have flaws that could lead to loss of life. It sounds like the nature of the system was categorized incorrectly allowing it to operate without redundancy, the parameters it could correct by were increased dramatically from spec, and the system was certified without pilots understanding what it did and without training them on its operation and corrective actions. That is going to be a bombshell IF it turns out to be true. We have to keep in mind this is just one reporter's conjecture on what happened though.
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Old Mar 17, 2019, 5:35 pm
  #111  
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Was it inadequate pilot training and experience?

In The New York Times:
After 2 Crashes of New Boeing Jet, Pilot Training Now a Focus

Representative Peter A. DeFazio, Democrat of Oregon and the chairman of the House transportation committee, said he asked F.A.A. officials after the Lion Air crash why more substantial training was not required. “I said, ‘This is essentially a different airplane, and how is it that it was certified without requiring pilot retraining?’” Mr. DeFazio recalled. He said the F.A.A. defended what had been decided as the work of pilots and others who “came to a consensus decision.”

The F.A.A. bases its rules for training around the typical experience of a pilot in the United States, explaining that “the average caliber, skill and training of U.S. pilots is extensive, with countless hours of flight time and training both on the flight deck and in simulators.” But other countries tend to follow the lead of the United States in terms of training, leaving less experienced pilots potentially vulnerable.

“Overseas, pilots in some cases have a tiny fraction of the training that our pilots have,” Mr. DeFazio said. “Our pilots may all be good enough to recover with an MCAS problem with a bad sensor.”
And Captain Sully Sullenberger in a Facebook post:
We do not yet know what caused the tragic crash of Ethiopian 302 that sadly claimed the lives of all passengers and crew, though there are many similarities between this flight and Lion Air 610, in which the design of the Boeing 737 MAX 8 is a factor. It has been obvious since the Lion Air crash that a redesign of the 737 MAX 8 has been urgently needed, yet has still not been done, and the announced proposed fixes do not go far enough. I feel sure that the Ethiopian crew would have tried to do everything they were able to do to avoid the accident. It has been reported that the first officer on that flight had only 200 hours of flight experience, a small fraction of the minimum in the U.S., and an absurdly low amount for someone in the cockpit of a jet airliner. We do not yet know what challenges the pilots faced or what they were able to do, but everyone who is entrusted with the lives of passengers and crew by being in a pilot seat of an airliner must be armed with the knowledge, skill, experience, and judgment to be able to handle the unexpected and be the absolute master of the aircraft and all its systems, and of the situation. A cockpit crew must be a team of experts, not a captain and an apprentice. In extreme emergencies, when there is not time for discussion or for the captain to direct every action of the first officer, pilots must be able to intuitively know what to do to work together. They must be able to collaborate wordlessly. Someone with only 200 hours would not know how to do that or even to do that. Someone with that low amount of time would have only flown in a closely supervised, sterile training environment, not the challenging and often ambiguous real world of operational flying, would likely never have experienced a serious aircraft malfunction, would have seen only one cycle of the seasons of the year as a pilot, one spring with gusty crosswinds, one summer of thunderstorms. If they had learned to fly in a fair-weather clime, they might not even have flown in a cloud. Airlines have a corporate obligation not to put pilots in that position of great responsibility before they are able to be fully ready. While we don’t know what role, if any, pilot experience played in this most recent tragedy, it should always remain a top priority at every airline. Everyone who flies depends upon it.
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Old Mar 17, 2019, 6:55 pm
  #112  
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Originally Posted by NWAlaskaFlyer
I do not believe anyone involved would have allowed a system into public transportation that was known to have flaws that could lead to loss of life. It sounds like the nature of the system was categorized incorrectly allowing it to operate without redundancy, the parameters it could correct by were increased dramatically from spec, and the system was certified without pilots understanding what it did and without training them on its operation and corrective actions.
(bolding mine)

We have already seen Boeing's defense. It was presented after the LionAir crash. Boeing claimed that the pilots should have recognized the problems and recovered by themselves.


Do I believe that a Boeing software program manager used that exact rationale to justify non-disclosure of MCAS? I do.

I think Boeing was determined to make sure that they don't have to re-certify the 737-Max from scratch with the FAA and don't want to admit to airlines that pilots need to be re-trained for the different performance profile for the 737-Max. The people involved most likely justified it to themselves that pilots with thousands of hours of experience in the 737 could correct things even if MCAS screwed up massively.



I do agree that pilot training is an issue, because Boeing's excuse has a kernel of truth in it. The pilots could have corrected the issue once MCAS started screwing up. Better training by the human element of commercial aviation could have saved the passengers from Boeing's engineering mistake.

But at worst, I'd say that's a contributing cause. If the basic premises laid out in the article are true, the primary cause for both crashes is Boeing's behavior.
Originally Posted by NWAlaskaFlyer
That is going to be a bombshell IF it turns out to be true. We have to keep in mind this is just one reporter's conjecture on what happened though.
A very persuasive point, IMO, is the reporter specifically mentions that he reached out to both Boeing and the FAA for comments before the Ethiopian Air crash.

That's a bombshell of a statement, and if Boeing had any substantive reply.... their PR office should be out there right now screaming bloody murder.

The story is now being cited by the Reuters, Bloomberg, etc... yet there's no angry denial from Boeing.

Silence speaks for itself in this case.
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Last edited by Plato90s; Mar 17, 2019 at 9:14 pm
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Old Mar 18, 2019, 12:26 am
  #113  
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Originally Posted by NWAlaskaFlyer
Seems a little early to be stating some of these things but I will leave the article here.

https://www.seattletimes.com/busines...ion-air-crash/
If true, this makes the US look even less credible in the eyes of the rest of the world. No wonder Ethiopian Air decided to send their data recorders to Europe for analysis.

Honestly, I'm not even sure how the FAA could come back that, regardless of how Boeing does as a company in the future. (On that note, this might very well also cause airlines to gravitate towards Airbus and other non-US aircraft manufacturers long-term.)
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Old Mar 18, 2019, 9:44 am
  #114  
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Originally Posted by LarryJ
Turns out there were a few parallels.

The AF447 pilots were in a stall but the stall was so deep that the computer disregarded the angle-of-attack (AoA) sensors judging the data to be invalid and shut off the stall warning alerts. Several times during the descent the AF pilots made the correct move to aggressively lower the aircraft nose (reduce pitch) but, when they did, the AoA signal fell back into a more normal range and the stall warning alerts sounded. This led the pilots to believe that lowering the pitch was making the problem worse (i.e. a high-speed or mach stall) and they pulled up again.
Nevertheless, the fleet of planes was not pulled out of service. Again..ONE accident, not a pattern of accidents.
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Old Mar 18, 2019, 3:44 pm
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Originally Posted by Betterthanyou
Nevertheless, the fleet of planes was not pulled out of service. Again..ONE accident, not a pattern of accidents.
Many countries grounded the MAX before a pattern was established. Just as the A330 was never grounded because a pattern, or design flaw, had not been discovered.

We still don't have confirmation that the Ethiopian flight had an MCAS activation. The correlation that resulted in the FAA grounding was that the stabilizer jackscrew was found in a far nose-down position (haven't seen if it was fully nose-down). MCAS is one of several systems that has the potential to drive the stab trim towards nose-down. We won't know why the Ethiopian trim was so far nose-down until the DFDR data is released.

The decision should be data-driven, not emotional.
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Old Mar 18, 2019, 9:11 pm
  #116  
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Originally Posted by LarryJ
... The decision should be data-driven, not emotional.
I spent three years at Boeing Flight Test as an Analysis engineer and a Test Director, and most of the the other 18 with the company in Systems Engineering and Test Program Planning for various military aircraft

regrettably, the internet-driven high cycle rate of media coverage isn’t really compatible with the rigorous and logical processes of obtaining myriad quantities of data, conducting myriad analyses to distill the data into usable information, and making decisions based on the knowledge that the information conveys
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Old Mar 19, 2019, 8:49 am
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Originally Posted by jrl767
regrettably, the internet-driven high cycle rate of media coverage isn’t really compatible with the rigorous and logical processes of obtaining myriad quantities of data, conducting myriad analyses to distill the data into usable information, and making decisions based on the knowledge that the information conveys
You aren't kidding!
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Old Mar 19, 2019, 9:52 am
  #118  
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Originally Posted by LarryJ
Many countries grounded the MAX before a pattern was established. Just as the A330 was never grounded because a pattern, or design flaw, had not been discovered.

We still don't have confirmation that the Ethiopian flight had an MCAS activation. The correlation that resulted in the FAA grounding was that the stabilizer jackscrew was found in a far nose-down position (haven't seen if it was fully nose-down). MCAS is one of several systems that has the potential to drive the stab trim towards nose-down. We won't know why the Ethiopian trim was so far nose-down until the DFDR data is released.

The decision should be data-driven, not emotional.
I am talking about the Airbus in the AF accident, and why it was not pulled.
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Old Mar 19, 2019, 12:22 pm
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Originally Posted by Betterthanyou
I am talking about the Airbus in the AF accident, and why it was not pulled.
Yes, as an example of how such decisions are made.

While the Ethiopian accident initially looked similar to the Lion Air accident, the similarities were superficial with no definitive links. Many countries grounded the airplane, anyway. Canada and the US grounded the airplane when the Ethiopian jackscrew was found to have been in a nose-down stab trim position. That was a strong enough link between the two accidents to warrant grounding while the investigation continued.

The unanswered question is why was the stab trim in such a nose-down position on the Ethiopian airplane? We know, with a good degree of certainty, that the same situation was created on the Lion Air plane due to the inappropriate activation of the MCAS system due to a faulty AoA sensor/sender and the crew's subsequent failure to accomplish the runway stabilizer procedure prior to losing control of the aircraft.

Several systems can move the stabilizer trim. MCAS, Speed Trim System, Electric stab trim, and the autopilot. Only MCAS is unique to the MAX. Additionally, the stab trim could have been mis-set prior to takeoff (this has caused a number of accidents over the years).

The initial data from Flightstats suggests that the Ethiopian flight never reached an altitude at which the flaps would be fully retracted. MCAS is disabled when the flaps are not fully retracted. That suggests the possibilities that the Flightstats data is wrong, the flaps were retracted early, the flaps were not extended for the takeoff (they are required for t/o), or something other than MCAS caused the excessive nose-down stab trim. We need the DFDR data to determine what actually happened.

Prior to the AF447 incident, the flaw in the pilot tubes had been uncovered and a fix was in the process of being installed throughout the fleet. The accident airplane had not had the fix installed. At the time, however, there wasn't any data to indicate that a faulty pitot tube initiated the accident sequence. That wasn't confirmed until the DFDR was recovered many months later. If that had been known, the unmodified A330 fleet might very well have been grounded pending the installation of the fix. They didn't have that correlation so the fleet was not grounded just like the MAX was not grounded until evidence of the correlation was found.
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Old Mar 20, 2019, 3:22 am
  #120  
 
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I put major part of the blame on Boeing successfully lobbying against retraining 737 pilots for 737MAX.
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