Flight Safety Information [November 23, 2018] [No. 238]

 Flight Safety Information
Top Flight Safety Information November 23, 2018  –  No. 238
In This Issue
Incident: Easyjet Europe A320 at Barcelona on Nov 6th 2018, rejected takeoff due to engine malfunction
Incident: Swiss A320 at Zurich on Nov 14th 2018, engine shut down in flight
Incident: Montenegro F100 enroute on Nov 11th 2018, engine combustion chamber damage
Accident: Peruvian B735 at La Paz on Nov 22nd 2018, both main gear struts collapse on landing
LIBIK Fire Suppression Kits for the Cabin and Flight Deck
Indonesia wraps up Lion Air crash victim identification
Lion Air Crash Report Due Next Week, Boeing 737 Max in Focus
Indonesian lawmakers tell authorities to get tough on Lion Air, following fatal crash
Emirates refuses to use air bridges in Pakistan, Senate committee told
Cambodia Prepares for First Pilot Training School
Researchers test carbon nanotube aircraft de-icing system
International Accident Investigation Forum 2019 – Singaore – 10 – 12 April 2019
Position Available: Business Aviation Audit Programs Manager

Incident: Easyjet Europe A320 at Barcelona on Nov 6th 2018, rejected takeoff due to engine malfunction
An Easyjet Europe Airbus A320-200, registration OE-IZV performing flight U2-2760 from Barcelona,SP (Spain) to Milan Malpensa (Italy), was accelerating for takeoff from Barcelona’s runway 07R when the crew rejected takeoff at high speed (about 90 knots over ground) due to an engine (CFM56) malfunction. The aircraft slowed safely and returned to the apron.

A replacement A320-200 registration G-EZOA reached Milan with a delay of about 2 hours.

The occurrence aircraft remained on the ground for 24 hours and departed to Milan for flight U2-2760 the following day.


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Incident: Swiss A320 at Zurich on Nov 14th 2018, engine shut down in flight

A Swiss International Airlines Airbus A320-200, registration HB-IJS performing flight LX-729 from Amsterdam (Netherlands) to Zurich (Switzerland), was descending towards Zurich when the crew reported they needed to shut the right hand engine (CFM56) down. The crew advised they wanted emergency services on stand by but expected a normal landing, they would vacate the runway and stop off the runway for an inspection. The aircraft continued for a safe landing on Zurich’s runway 14.

The occurrence aircraft remained on the ground for about 39 hours before continuing service.


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Incident: Montenegro F100 enroute on Nov 11th 2018, engine combustion chamber damage

A Montenegro Airlines Fokker 100, registration 4O-AOP performing flight YM-181 from Ljubljana (Slovenia) to Podgorica (Montenegro), was enroute when the crew noticed a slight increase of RPMs on the right hand engine (Tay 650), all indications remained within the operating range however. The flight continued to Podgorica for a safe landing.

A post flight inspection revealed severe engine damage. A hole was burned into the combustion chamber’s wall leaking hot air into the bypass duct causing discolouration also on the outside of the engine cowl. The engine is being replaced.

The occurrence aircraft is still on the ground 11 days later.

The airline reported the engine had recently been returned from overhaul and had since run a few hundreds hours of the 6500 hours service interval. The aircraft manufacturer, engine manufacturer, Montenegro’s Civil Aviation Authority and accident investigation board have been notified, an investigation has been opened.


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Accident: Peruvian B735 at La Paz on Nov 22nd 2018, both main gear struts collapse on landing
A Peruvian Boeing 737-500, registration OB-2041-P performing flight P9-331 from Cuzco (Peru) to La Paz (Bolivia) with 122 passengers and 5 crew, suffered the collapse of both main gear struts while landing on La Paz’s Airport El Alto (Bolivia) runway 10 at about 10:22L (14:22Z). The aircraft came to a stop on the center line of the runway resting on nose gear, both engines and the aft belly of the fuselage. The passengers disembarked onto the runway via mobile stairs. There were no injuries, the aircraft sustained substantial damage.

The airport estimates the mishap of the Peruvian Airlines Aircraft will close the airport until 15:00L (19:00Z).

Bolivia’s DGAC confirmed Peruvian Airlines’ Boeing 737-500 OB-2041-P suffered an accident while landing on La Paz’s runway 10 at 10:22L. There were no injuries. The aircraft suffered a problem with the main landing gear.

Accident: Peruvian B735 at La Paz on Nov 22nd 2018, both main gear struts collapse on landing
Accident: Peruvian B735 at La Paz on Nov 22nd 2018, both main gear struts collapse on landing


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Indonesia wraps up Lion Air crash victim identification

Rescue teams in Indonesia recovered human remains that filled some 200 body bags (AFP Photo/ADEK BERRY)

Indonesia on Friday wrapped up the grim task of identifying Lion Air jet crash victims from recovered body parts, with a preliminary report on the cause of the accident that killed 189 people due next week.

The Boeing 737 Max jet — one of the world’s newest and most advanced commercial planes — plunged into the Java Sea on October 29 shortly after taking off from capital Jakarta to Pangkal Pinang city, killing all on board.

Since then, investigators have been doing DNA testing on recovered body parts. As of Friday, 125 people have been identified after testing on human remains that filled some 200 body bags, said Arthur Tampi, head of the national police medical centre.

“We have identified 89 men and 36 women, including two foreigners, namely an Italian and an Indian national” who was the flight’s captain, Tampi told reporters in Jakarta.

The identification was being called off because all the recovered remains have been tested, he added.

Budget carrier Lion Air has said it is paying a little over $100,000 in compensation to the families of each crash victim.

The smashed jet’s flight data recorder was recovered but divers are still looking for the cockpit voice recorder.

A formal preliminary report on what might have caused the crash is due Wednesday.

So far, investigators have said the doomed plane had problems with its air-speed indicator and angle of attack (AOA) sensors prompting Boeing to issue a special bulletin directing operators what to do when they face the same situation.

An AOA sensor provides data about the angle at which wind is passing over the wings and tells pilots how much lift a plane is getting. The information can be critical in preventing the plane from stalling.

Last week, a US airline pilots union, the APA, said that companies and pilots had not been informed by Boeing of certain changes in the aircraft control system.

While Boeing has come under fire for possible glitches in its newest 737 model — released just last year — the accident has also resurrected concerns about Indonesia’s poor air safety record, which until recently saw its carriers facing years-long bans from entering European Union and US airspace.


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Lion Air Crash Report Due Next Week, Boeing 737 Max in Focus

  • Investigators set to submit preliminary findings on Nov. 28
  • Lion Air jet plunged into Java Sea Oct. 29, killing 189 people

A flight data recorder from flight JT610. Photographer: Malekiano/AFP via Getty Images

With the cockpit voice recorder of the crashed Lion Air jet still elusive almost a month after the disaster, Indonesian investigators are set to rely on the flight data recorder, interviews of technicians and pilots for a preliminary report due next week.

Indonesia’s National Transportation Safety Committee’s early findings may be released on Nov. 28, Chairman Soerjanto Tjahjono told lawmakers in Jakarta on Thursday. The report will contain possible causes of the fatal dive by the Boeing Co. 737 Max jet into the Java Sea off Jakarta with 189 people on board.

Indonesian investigators have indicated that a faulty system may have caused the nation’s worst aviation disaster in two decades, prompting Boeing to reinforce its pilot manual to airlines operating the latest generation of its best-selling model. Airlines with Max planes in their fleets and outstanding orders have been eager for information about the little-known anti-stall feature of the Max that has emerged as an area of focus.

The report will detail facts and description of what investigators have learned from the flight data. One missing piece from the investigation has been the cockpit voice recorder which contains the conversation between the pilots and the air traffic controller. Lion Air Flight JT610 crashed within minutes after take off into the shallow waters of the sea.

Investigators inspect the wreckage from flight JT610 on Nov. 4.Photographer: Ulet Ifansasti/Getty Images

In the past week, Boeing has stepped up its response by pushing back on suggestions that the company could have better alerted its customers to the jet’s new anti-stall feature. The three largest U.S. pilot unions and Lion Air’s Operations Director Zwingly Silalahi have voiced concern over what they said was a lack of information about the Maneuvering Characteristics Augmentation System on the Max, which would in limited circumstances, lower the jet’s nose without any input from pilots.

U.S. airline manuals for new 737 models offer inconsistent or confusing details of another automated anti-stall feature linked to the control yoke, called the elevator feel shift, the Wall Street Journal reported.

Boeing has said it is confident in the safety of the 737 Max and is taking every measure to “fully understand all aspects of this incident, working closely with the investigation team and all regulatory authorities involved.”

Lion Air and Boeing executives are set to meet on Nov. 30 to discuss delivery schedule of the pending Max jets the carrier has ordered,” Daniel Putut, a director at the Indonesian airline,, told reporters in Jakarta on Thursday. The delivery schedule hasn’t been affected by the crash, he said. The airline has ordered a total of 272 Max jets, of which 11 have been delivered, he said.

Indonesian safety committee’s Tjahjono said the agency was still trying to locate the so-called angle of attack sensor, while the search for the cockpit voice recorder is on. An undersea oil pipeline passing through near the crash site and lack of equipment to sweep the seabed were making the search for the black box difficult, he said.


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Indonesian lawmakers tell authorities to get tough on Lion Air, following fatal crash

Lion Air investigators examine part of the landing gear of the ill-fated Lion Air flight JT 610 at the port in northern Jakarta on Nov 5, 2018.

JAKARTA (THE JAKARTA POST/ASIA NEWS NETWORK) – Lawmakers on the House of Representatives Commission V overseeing transportation and infrastructure have called on the government to act firmly against private airline Lion Air Group following last month’s deadly crash.

The Commission held a hearing on Thursday (Nov 22) on the crash, scrutinising relevant parties and the ongoing investigation process.

Lawmaker Bambang Haryo Soekartono of the Gerindra Party called on the government to revoke Lion Air Group’s licence, citing its “proven poor safety track record”.

“Lion (Air) has shown its poor commitment (to safety standards) and that could tarnish the image of our Transportation Ministry,” Mr Bambang said.

Indonesian Democratic Party of Struggle (PDI-P) lawmaker Rendy Lamadjido also encouraged the ministry to impose stricter sanctions on the company, pointing out that the government had been lenient in monitoring pilots.

He also suggested that the ministry establish a council tasked with auditing and producing recommendations for all pilots in all airlines operating in the country.

“There are a lot of pilots who need to be evaluated. I suggest that we establish a council for pilots. When an incident occurs, the council should examine the pilots. This is for the sake of our safety,” Mr Rendy said.

The hearing was attended by officials from the Transportation Ministry, National Search and Rescue Agency (Basarnas), the Meteorology, Climatology and Geophysics Agency (BMKG) and the National Transportation Safety Committee (KNKT).

A staff member of Indonesia’s National Transportation Safety Board examining debris from Flight JT610 at Tanjung Priok port in Jakarta on Thursday. While flying is becoming safer, there are still areas of concern, said the International Air Transport

A representative of the KNKT revealed that the Boeing 737 MAX 8 aircraft that was used on flight JT610 from Jakarta to Pangkalpinang, Bangka-Belitung Islands, which crashed into the Java Sea on Oct 29 killing all 189 people on board, had experienced recurring problems during its last few flights.

A preliminary investigation revealed that the plane had produced faulty airspeed readings during its last four flights.

The aircraft in question had only been in service with Lion Air since August.

“But the pilot who flew the airplane from Denpasar managed to handle it and was able to change to an anti-stall system,” KNKT head Soerjanto Tjahjono said during the hearing.

“The pilot on the crashed plane might have failed to understand the problem. Each individual has different (reactions),” Mr Soerjanto said after the hearing.

The KNKT has also stated that Boeing failed to alert airlines and pilots about the system to prevent the aircraft from stalling.

Only after the crash did Boeing issue an operational manual bulletin that directs all airlines operating the Boeing 737 MAX to follow existing flight crew procedures to address circumstances where there is erroneous input from an angle of attack sensor.

The KNKT has also analysed the flight data recorder (FDR), which records variables like airspeed, altitude, heading and vertical acceleration, and found that from when the airplane began to stall until it crashed, the pilot attempted to trim it up, but he failed to reach the standard height.

The committee will announce the details of the analysis results next week, a month after the accident took place.

Transportation Minister Budi Karya Sumadi said his ministry had been conducting special and comprehensive examinations of a number of Lion Air aircraft.

To date, the authorities have yet to find the downed plane’s cockpit voice recorder (CVR). The CVR records verbal communication between crew members within an aircraft’s cockpit.

KNKT investigator Ony Soeryo Wibowo said the lack of advanced equipment had hampered the search team’s efforts to cope with the thick mud under the surface.

“Sophisticated vessels (needed in the search efforts) are very expensive. We need a vessel that can remain stationary without anchoring. The existing equipment is not that advanced.”


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Emirates refuses to use air bridges in Pakistan, Senate committee told

ISLAMABAD: A parliamentary committee was told that Emirates airline has refused to use passenger boarding bridges at airports in Pakistan after an air bridge collapsed at the new Islamabad International airport last month.

The Chief Executive Officer (CEO) of the Pakistan International Airlines (PIA), Air Marshal Arshad Malik, told the Senate Standing Committee on Aviation that Emirates had announced its decision, citing safety standards as the reason. The committee met for a briefing on how the air bridge collapsed with complete details of its make, model and purchase, among other things.

On Oct 9, the air bridge, purchased from the Spanish company Adelte, collapsed, leaving two staff members injured. Director General of the Civil Aviation Authority (CAA) Hassan Baig said the matter was under investigation. “We are looking into several possible reasons such as design faults, human error, maintenance problems as well as communication errors. It can be all four. But, so far it seems to be a design flaw,” said Mr Baig.

He explained to the committee that similar faults had been detected with air bridges at Karachi airport and Bacha Khan International Airport in Peshawar.

According to the official, a thorough report is due on Dec 7; however, the fault seemed to be in the design of the bridge – apparently, a loose pin. “Similar design problems were detected at both the airports in Karachi and Peshawar,” said Mr Baig, adding that the remaining payments to Adelte had been suspended. According to the contract, the CAA is in a position to ask Adelte to extend the warranty period of the air bridge. The Pakistan Tehreek-i-Insaf’s Senator, Nauman Wazir, however, said that human error must not be ignored.

The chairman of the committee, the Pakistan Muslim League-Nawaz’s Senator Mushahidullah Khan urged Air Marshal Malik to take the matter seriously.”Today Emirates has declined to use the air bridges, tomorrow other airlines may follow. The PIA can lose a lot of revenue,” said Mr Khan.

The committee also discussed newspaper reports highlighting the involvement of PIA officers in smuggling and money laundering. Air Marshal Malik responded by saying that the matter was indeed sensitive, and would be taken seriously. “Some staff has already been placed under scrutiny and disciplinary action has been taken against two staff members. Their actions bring disgrace not just to the PIA, the Airport Security Force (ASF) and other associated organisations but also to the entire nation,” said the CEO.

According to a senior official of the ASF, the various departments must coordinate more efficiently to prevent such cases. “We still lack coordination while checking catering vehicles, for instance,” said the official.


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Cambodia Prepares for First Pilot Training School

Cambodia Angkor Air, Cambodia’s national carrier, is one of the country’s growing airlines. ( Photo: Jennifer Meszaros)

Training provider Alpha Aviation Group (AAG) has inked a memorandum of understanding with Cambodian holding company Negocia Ventures to explore the development of Cambodia’s first modern pilot training school. The announcement comes at a time when Boeing projects demand for pilots in the region to triple over the next decade.

Negocia Ventures chairman and CEO Thierry Tea, who is also the founder and managing director of the PhilJets Group, told AIN that strong market demand coupled with a proliferation of new airlines in Cambodia prompted the decision to explore a variety of pilot-training solutions, including a flight simulator, to address human resource shortages.

“We have been observing Cambodia for some time and recognize that education is really important, especially as new airlines enter the market. As air travel grows, we believe that the local workforce must be ready to meet the demand,” he said.

Renowned for its Buddhist temples, including the Unesco heritage site Angkor Wat, Cambodia has witnessed a surge in air travel, which has attracted a number of foreign investors to set up new airlines. The country is now served by eight domestic carriers: Cambodia Angkor Air, Sky Angkor Airlines, Cambodia Bayon Airlines, Lanmei Airlines, JC International Airlines, Small Planet Airlines, Cambodia Airways, and KC International Airlines. A ninth carrier-Bassaka Airlines-suspended scheduled service in early October and currently operates a charter flight to Hangzhou, China.

Meanwhile, two new airlines-Cambodian MJ Airlines and Air Siem Reap-are expected to enter Cambodia’s increasingly competitive airspace in 2019. MJ Airlines told AIN that the company is in the final stages of receiving an air operator’s certificate and expects it to be issued on January 29. The Chinese-backed carrier will initially operate a fleet of three A320s to service destinations in North and Southeast Asia. Air Siem Reap, a joint venture between Bangkok Airways and Cambodian investors, has plans to initially operate routes between Thailand and Cambodia.

Tea said that Negocia Ventures and AAG will explore the possibility of developing an ab-initio pilot training program. “We are looking at all options, including a ground and flight school as well as bringing in a flight simulator. We will also examine financing options for students” he said.

Headquartered in the UK, AAG has steadily increased its geographical presence in both the Middle East and Southeast Asia and offers a diverse portfolio of training solutions including ab-initio pilot training, “fly now pay later” schemes, and type ratings to tackle the rising shortage of qualified pilots in the region.

AAG’s UAE unit, managed by Air Arabia, offers a multi-crew pilot license program, the largest in the region with more than 330 graduates. Its Philippines training center offers pilot training and a variety of trainers including an EASA-certified level-D Airbus A320 full flight simulator (FFS), an A330/A340 FFS, and an A320 fixed-base simulator.


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Researchers test carbon nanotube aircraft de-icing system 

Multi-walled carbon nanotube

Researchers from Queen’s University Belfast have developed a new system to prevent ice from building up on aircraft.

Conventional anti-icing systems on most passenger aircraft are based on hot air which is bled from the engines and piped to the inner surface of the wing. The heat is then transferred to the outer surface by thermal conduction to stops ice from building up.

This method adds weight, requires maintenance and uses large amounts of energy, particularly on the new generation of composite aircraft.

Researchers from Queen’s have developed an ultra-light weight heater from webs of carbon nanotubes (CNT) for de-icing aircraft surfaces.

Professor Brian Falzon, from the School of Mechanical and Aerospace Engineering, who led the research team said, “We started by creating a CNT web, where individual CNTs are aligned in the draw direction, and horizontally stacking 10-40 layers of the webs, at different orientations, to achieve the desired heating characteristics.

“Each layer of CNT web can be as thin as 1/2000 the thickness of a human hair and the weight of a web large enough to cover a football field would be less than 30 sheets of A4 photocopy paper.

“These CNT webs were cured within a thin glass fibre laminate to provide structural support, and connected to a power supply. When we carried out testing, we discovered that the newly developed CNT heaters achieved rapid heating which shows they could quickly de-ice aircraft and provide effective ice protection in flight.”

The nanotube anti-icing system is still in the early stages of development – TRL 3. Moving this from the lab to a product will require further investment from an interested industrial partner.

Falzon said, The webs could be attached on the inner surface of a wing leading edge, nacelle lipskin or could also be incorporated within a composite material.

“Incorporating such systems in a wing leading edge or nacelle lipskin will require developing a means of introducing electrical power into the system and optimisation of the CNT-web for the desired thermal performance – using the webs themselves as sensors to activate device.”

Dr Xudan Yao, a researcher on the project said, “Compared with the heating systems currently used on aircraft, the CNT heater that we have created is lighter, provides rapid and more uniform heating and is more energy efficient. It is also more flexible in terms of fitting the shape and performance of any surface or power requirement to achieve rapid anti-icing and de-icing.


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ARGUS International, Inc. is Growing
Business Aviation Audit Programs Manager Position Available
ARGUS PROS, A division of ARGUS International,is your one-stop source for creating a superior operation within your air transportation business. We are an experienced quality and safety assurance provider and are accredited by IATA as an IOSA Audit and Training Organization. Ours is a flexible organization, committed to true team auditing for multiple standards at the domestic, regional, and international levels, as well as tailoring all the other resources and services we offer to your specific needs.
ARGUS PROS is currently seeking a Full Time BA Audit Programs Manager to join our team. This position will work at our Denver, CO location. ARGUS is an established company with an unparalleled client list and reputation. The perfect candidate will have the proven ability to work with the listed technologies in a team setting.
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  • Monitors Flight Safety Foundation, International Business Aviation Council (IBAC), Air Charter Safety Foundation for audit program related changes.
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Please register to submit your cover letter and resume at:

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Phone: (231)720-0930 (9-6 EST) 

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