Navigational error brings flight to Melburne instead of Kuala Lumpur
This might be the costliest navigational error in history. (www.theguardian.com) Más...Sort type: [Top] [Newest]
People have paid with their lives.
Still an important reminder to perform cross checks.
1: Incorrect position entered into the IRS during Alignment. - Wonder why they don't use the GPS position instead of manually typing it in? Was the primary GPS 1 system offline? (it usually takes a couple of minutes after power is established to get the fix, but is generally accurate to within metres)
2: When the flightplan is entered, (via ACARS request? Co-Route? Manually!) the fact that "YSSY" is a few thousand miles from E015° there will be a position mismatch error that is independently displayed on both MCDU screens and has to be cleared on each. No pilot should be pressing buttons on "the other" pilot's CDU.
3: When taxying around, and lining up to the runway, the runway and green course line shouldn't be available. Distance to runway would be hundreds/thousands of miles away instead of, you know... less than 1.
4: After takeoff, the flight director wanted a left turn (probably from 16R) Correctly they noticed this and corrected the turn to a left turn. Not clear if this was using the side-stick or FCU heading mode.
5: They "Did something" which "Made things worse" so that they degraded the aircraft to only being able to accept a visual approach. Which probably means they switched all 3 ADIRS switches from NAV to ATT. This causes the attitude indicators to go black (all the blue/brown is gone) and the autopilot drops out and cannot be engaged - they are 100% flying with the sidestick now.
6: Sydney Tower says the airport's visibility/ceiling is below visual approach minima, and suggests they better head to Melbourne where the weather is better/above visual approach minima.
7: After a certain amount of time flying straight/level with the side-stick, the ADIRS will align 'enough' to provide attitude indication (and vertical speed info) but not enough to give navigation tracking information (this has to be done on the ground, stopped, and takes around 10 minutes).
8: With the ADIRS in ATT mode, the Autopilot can once again be engaged to maintain headings and altitudes and vertical speeds, but will not engage in complex navigation modes like lateral navigation.
9: Didn't say in the article, but I'm wondering if they were radar vectored all the way to Melbourne? Given the navaid rationalization project decommissioned many navigation aids (VOR's and NDB's etc) early this year (AIRAC 1606), and there is no more VOR at Sydney (Now RNAV waypoint TESAT) and many of the VOR's and NDB's between Sydney and Melbourne are gone now, I'm guessing 'traditional' navigation methods are not available in this configuration?
Not familiar enough with the airbus to remember if ATT mode is able to run the autopilot on an ILS approach? But you'd have thought a raw data handflown ILS is still available at Sydney? I know for a fact the ILS data is able to be viewed on the standby instrument that isn't effected by the ADIRS being in ATT mode one bit!
Yes, the big main "navigation screen" is displaying either nothing, or worse still... the wrong information (Hi You might actually be just south of Sydney right now, but the INS says you are near Port Moresby. :D ), but guess what: ILS systems are not driven by the INS or GPS. Use the raw data and turn off the flight director, and get the nav screen out of NAV and into displaying raw data ILS: problem solved(ish). The erronious "Terrain terrain, pull up" stuff might be annoying... which is probably a good enough reason to go somewhere you can see the ground you're flying over.
Remember, the plane thinks it is somewhere it isn't. It doesn't think it's nowhere. So trucking around at 1000ft on the ILS Centreline and glideslope, and the EGPWS thinks it's inside a mountain somewhere.