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JOHN J. NANCE
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PDATES & ANALYSES


The Singapore Airlines 006 Accident - October 31, 2000

Singapore Airlines Runway Crash

Latest Update On The Crash Of Singapore 006:
As I'm sure you're aware, Singapore Flight 006 crashed on takeoff Tuesday night at Taipei's Chiang Kai-shek International Airport on Taiwan. A 1997 model Boeing 747-400, the flight carried only 179 passengers and 20 crewmembers, but could have held nearly 400 people. At least 79 people have lost their lives in this accident, and that is probably not the final figure. Of those who survived, some are grievously injured.

What We Know:
There was a Typhoon moving across the southern end of Taiwan at the time of the crash, creating winds reported at approximately 40 knots with gusts as high as 73 knots. (Taipei is at the northern end of the island). Heavy rain was reported on the airport at the same time.

Survivors of the flight say they felt the aircraft constantly buffeted and shaken by the heavy winds before and after they left the gate, a fact which - when coupled with the weather report - clearly raises the question of whether or not the conditions were too bad to meet the criteria used by Singapore pilots and dispatchers for departure. In other words, was the decision to attempt takeoff appropriate or not under the existing procedures and rules. We simply don't know the answer to this as yet, and I would caution everyone not to jump to any conclusions, because the information is still too sketchy. For instance, we do not yet know whether the winds were straight down the runway or whether there were heavy crosswinds (IE the wind blowing at an angle to the runway). Clearly the idea of taking off in the leading edge of a typhoon with wild winds seems violative of common sense, but we can't judge that without knowing the entire matrix of cockpit procedures, training, company regulations, and dispatcher information which formed the culture within which this crew was operating. Decisions aren't made in a vacuum, they result from practiced application of regulations, habits, and accepted assumptions, all of which are part of the specific operational culture of an airline. Therefore, a wrong decision is not just the mistake of a single pilot or crew, it is a mistake by the entire culture and/or team, and thus a system problem. Blaming a single individual for a systemic problem is at once simplistic and unproductive, and again, we're not sure here whether any part of the departure decision was incorrect.

Now, one additional point here: even if it turns out that the winds had no connection to the accident in causative terms, it is vital that the accident investigators thoroughly examine the takeoff decision, because if it was collectively flawed, the system will fail again in the future in some other situation and could directly create an entirely different sort of disaster.

It has been reported that the captain told the tower that he was trying to leap over (or get over or fly over or avoid) some object he saw in the runway ahead of him. If this is true, it raises two basic issues: 1) What did he see on the runway and how did it come to be there? [this could be an instance of "runway incursion," an unauthorized entrance of something or someone to a runway in use; and 2) What did he do to evade it?

This was a very heavy aircraft getting ready to fly for nearly 14 hours to Los Angeles. It was carrying upwards of 200,000 pounds of Jet A jet fuel, in addition to the weight of the aircraft, bags, cargo, and people, all of which may have totaled somewhere close to 800,000 gross weight. Thus, such a heavy 747-400 would need somewhere in the vicinity of 145 knots or greater to fly and sustain flight. If the captain tried to raise the nose and, in essence, "leap over" whatever object he saw, and if his airspeed was too low, the 747 might have momentarily become airborne in a close-to-the-runway phenomenon we call "ground effect" and then slammed back to the runway on its main gear. If that return impact was too great (and since this aircraft would almost certainly have been significantly over its maximum landing weight), that return to the runway might have triggered the collapse of a main landing gear assembly or strut, thus causing the aircraft to veer to one side and leave the runway at somewhere above a hundred knots.

Even if the aircraft did not get off the ground or return to the runway with enough vertical drop to break anything, it is highly possible that one of the main landing gear assemblies slammed into whatever the captain saw on the runway, creating great drag and skidding on that side, and veering the aircraft off the runway at above a hundred knots.

Now, however it happened, when a fully loaded 747-400 leaves a runway and enters soft ground, or impacts against the side of a runway structure under construction, the possibility of a massive and rapid progressive breakup of the aircraft is high. While it is certainly too soon to know the exact sequence here, the principle is this: The broken structure of the 747 as we saw it in the aftermath could potentially be explained by either scenario, a collapsed landing gear strut, or a damaged landing gear strut.

The last chapter is the presence of 200,000 plus of volatile fuel in disintegrating wings causing and feeding a massive fire, and the separation of the rear section of the aircraft (which saved most occupants from the fire that was consuming the forward section).

These are the parameters. We have a large aircraft that could not remain on the runway. Precisely why and how it left the runway will take time to discover, and in the meantime we simply must resist the temptation to ask or try to answer the question "who's wrong," and instead ask "what was wrong." Only by knowing all systemic causal factors can investigators appropriately reconstruct what happened, and when they do, you'll find a multitude of causes, not just one, and not just a singular pilot mistake.

One final note:
There is a report rattling around that because damaged construction equipment was found on an adjacent runway, perhaps the aircrew tried to takeoff on that closed, under-construction runway. True or not? I can't tell you yet, but I seriously doubt the report because in most cases internationally the closed runway would not be lighted with runway lights, and it is difficult to imagine a captain choosing to takeoff in a fully loaded 747-400 on an unlighted runway (it was night). Take such reports with great caution. Although it is a possibility (wrong runway takeoff), it's highly unlikely and would require a widespread failure of "systems" and training to explain.

More later.
John J. Nance

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