Thursday, June 2, 2011

Human Factors Issues in the Air France Flight 447 Crashes

Almost two years after the Air France Flight 447(Airbus A330-200 jet)¬, a well-maintained modern airplane, crashed, the key components from the flight recorders and cockpit voice recorder were finally found. The plane was originally en route to Paris from Rio de Janeiro into the ocean, and unfortunately all passengers were killed.

According to The Wall Street Journal “The pilots of an Air France jet that crashed into the Atlantic Ocean two years ago apparently became distracted with faulty airspeed indicators and failed to properly deal with other vital systems, including adjusting engine thrust, according to people familiar with preliminary findings from the plane's recorders."
In another article Spiegel, citing the experts who have participated in the analysis of the Black Boxes data reports, stated that at the time the first alarm sounded, the pilot was not in the cockpit.

Following these revelations, and despite the fact that a formal investigative report is not yet published by Bureau of Investigations and Analyses, or B.E.A. , "Pilot Error " is vigorously condemned by the Syndicat de Pilotes d'Air France (SPAF).

According to New York Times "… the sequence of events captured on the recorders is expected to highlight that the jet slowed dangerously shortly after the autopilot disconnected. The pilots almost immediately faced the beginning of what became a series of automation failures or disconnects related to problems with the plane's airspeed sensors,…", "The crew methodically tried to respond to the warnings, according to people familiar with the probe, but apparently had difficulty sorting out the warning messages, chimes and other cues while also keeping close track of essential displays showing engine power and aircraft."

According to the NYT, “…pilots seemingly were confused by alarms they received from various automated flight-control systems as the plane passed through some turbulence typical on the route from Rio de Janeiro to Paris. They also faced unexpectedly heavy icing at 35,000 feet. Such icing is renowned for making airspeed-indicators and other external sensors unreliable."
All these notions hint at many human factors issues related to design, safety training, and hardware failure. A few questions that require a proper answer include:

• Why were the alarms confusing?
• Why were the warning messages difficult to sort out ?
• Why and how were the cues on the displays unclear?
Related Press Reports
"Crash du Rio-Paris : il n'y aurait pas eu d'erreur de pilotage, " LEMONDE.FR, May 19, 2011.

"Rio-Paris : les syndicats de pilote dénoncent les "fausses allégations, "LEMONDE.FR May 24, 2011.

“Air France Flight 447,” , May 16, 2011

Reports of Pilot Error in Air France Crash Are Condemned,", May 24, 2011.

“Absturz von Air-France-Flug 447,” Spiegel, May 22, 2011.,1518,764083,00.html  

“Report on Air France 447 crash deepens mystery,”, May 27, 2011.

The Applied Human Factors and Ergonomics International NEWS – June 2011- Number 26