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Air France tells its pilots like it is regarding AF447 - Unusual Attitude
Source: flightglobal.com (link)

 
Comments upon the Air France October 2009 Pronouncement (below - at #7)
1 Air France Flight Ops management had to say something profound and timely after AF447 - and this is it. It's typical of a major airline which has had its major unexpected accident.... and is short on explanations and understandably defensive. We heard something similar from Swissair, Air New Zealand after Mt Erebus and no doubt QANTAS would project similar defensive platitudes....once their day comes. There's no credibility in, or foundation for, the Brazilian communist insurgency plot blather in the comments at the foot of that page. That's just typical South American internal political blarney. It'd be noteworthy more for its absence, if nobody had made such an ambit claim.
2 The wholus bolus fleet and type-wide across-the-board replacement of Thales AA tubes by Goodrich and type BA Thales tubes demonstrates the AF mgmt's willingness to apply tourniquets wherever and whenever - but it's also a tacit admission that they'd completely overlooked the potential for disaster in the long known deficiency of the existing pitots. Airbus is of course equally guilty there - as is Thales. What they collectively fear now is any clear and logical explanation of how that Swiss-cheese hole alignment scenario was frozen in place by their inaction. And well they might. Because of the prior 32 incidents, there was ample scope for safety experts worldwide to look further into the potential for calamitous developments resulting from pitot freeze-ups at high altitude in weather. Nobody did, the inevitable accident occurred and so there's now a huge blotch of blameworthiness that's looking for ownership and inviting litigation. The only chance for avoiding damaging PR and expensive settlements is to promote a generalized obfuscation. To do this they've had to conduct a low-likelihood "search in vain" for the recorders, introduce fixes that include new procedures for weather avoidance, impute some blame upon the co-pilots at the AF447 helm and just incidentally, change the pitots (quote: Created training materials "Ice Crystals" and "Reminders for the use of radar,"). It's a scattergun approach to an incident that's, notwithstanding all camouflage, still obviously rooted in the known pitot flaws. "Modified the content of sessions divisions 4S Boeing to introduce a presentation of the elements of the AF 447 and strengthen our defenses against the dangers caused by the storms." An interesting way of saying that: "crews are now being indoctrinated in the suspected train of possible events in their simulator sessions".
3 The overhaul of the Air France safety culture via a 3rd party is reminiscent of what Korean Airlines was forced into after a series of accidents. KAL got a Delta safety expert in to give them a physical. Indisputably there was a turnaround result in that case. Hubris was the root source of Korean's ills and I think we'd all agree that financial hubris at management level was instrumental in Swissair's downfall. Air New Zealand had resisted throughout the Erebus investigation and ultimately came a humiliating cropper when Justice Peter Mahon exposed an "orchestrated litany of lies" and cover-up as underlying their whole stance of blaming the captain. As we now know, it was actually one of automation's first identifiable failures. The Airline's chief NAV officer had inadvertently programmed the aircraft's navigation system with a well disguised error of around 15nm. It was unchecked and non-verified and sufficient to mislead the crew into the slopes of Mt Erebus in white-out conditions. Airlines world-wide quickly learnt the lesson of not adopting any haughty and blameless posture once their house of cards was toppled. A humble PR renovation and safety facade overhaul is now par for the course. Compare this with the QANTAS "closed shop" approach to their rebuilding of the 747-400 that overran at Bangkok. It was an insurance write-off, but with no injuries. So behind the scenes, QANTAS bought the wreckage back from their insurers and had it rebuilt, just to avoid the rancour of a write-off and to retain their flimsy denial facade of inbuilt infallibility. It fooled nobody. Commercial imperatives have now forced QANTAS to rebadge all manner of sundry offshoots with their flying Kangaroo emblem. It's such a diverse airline that it's now only a matter of time until one of their fledgling low-cost offshoots blots the escutcheon for the QANTAS name. The Australian flag-carrier has had criticisms over a number of maintenance incidents and most recently a QANTAS Jetstar pilot has been grounded for allowing an SMS texting distraction to cause a gear not down overshoot from low finals. Hubris comes in many different forms. QANTAS has become a symbol that's almost onomatopoeic with safety, but pride always comes before a fall. The Air France experience with the disappearance of AF447 is a sobering lesson in not allowing known flaws to ultimately prove their lethality.
4 Quote: "Launching the re-engineering of the preparation and monitoring of flights". This could be interpreted as Air France being now supportive of inflight data reporting via satellite - or at least adopting a measure to ensure post-crash recovery of flight recorders.
5. Some denial of the pitot tube circumstantial evidence is apparent [See yellow and blue highlit section in the translation below].
6. "Truth requires that you know that the probability of encountering such a scenario is extremely low, since it requires that the three probes frost up at the same time"

In the light of the AF447 aftermath, it's a little hard to swallow this bland statement. "None but the blind", I guess. "Unusual attitude" is an apt title for the Flight Global piece.

Summary

Overall, the document below isn't out of character for an airline that's suffered a major catastrophe that remains unsatisfactorily unexplained. However there are elements of denial and attributions of blame towards its flightcrew that really shouldn't be in a public document. The delivery amounts to a potpourri protestation of innocence and befuddlement. It should be seen against a long-lasting background of union unrest within the AF pilot ranks. Yet against the backdrop of this jigsawed and convoluted expression of regrets, veiled accusations, promised rectifications and avowals of "turning over a new leaf", you cannot disregard the revelational background of the Air France Concorde disaster. A shifting of the blame onto the Continental DC-10's shedding of a titanium spacer took the spotlight off that supersonic airframe's brake-build defects and a history of tire failures. It became everyman's disaster and not just an AF-branded one. Now that the AF447 flight recorders will never be found and definitive analysis will be impossible, standby for a further Airbus and BEA endorsed document from Air France that will tend to scatter the possible causes further afield - into the realms of stormy weather, unlawful interference, radar malfunction and even flight control failure (ref the recent failure of two spoiler brackets). The prior pitot failures will become just another straw in the wind of vague possibilities.

7.

Air France Memo To Pilots Google Translation - Document Transcript

Security Directorate Directorate of Air Operations Roissy, October 20, 2009 ENOUGH OF POLE - FALSE AND DISCUSSION ON THE SAFETY OF FLIGHT!

For the safety of flights in an airline is primarily: - A continuous work on elements that guarantee security, - A return to fundamental business driver. As you will see, form, tone and content of such communication, addressed to all company pilots are unusual. They are because the situation we are living since June 1 and is also the challenge for us is nothing other than ensuring the security of our air operations. With the disappearance of flight AF447 in the Atlantic, Air France has experienced the worst disaster in its history, and more than four months later we still do not have elements that allow us to identify the factors that led to the loss of the aircraft. Therefore we are implementing measures on a wider scope. This lack of findings leaves the field open to speculations of all self-proclaimed experts "Sc flight safety" that continue to spread in the media and in the lockers NTP to give their explanation of the accident, while the elements on which they rely are partial, inadequate or totally erroneous. They throw and disorder in the public mind and give an unprofessional image of being a pilot, it would not matter if they do not cast also disturb the minds of some Air France pilots by making them doubt the correctness of our doctrine, our procedures and those of the manufacturer. Worse still, they doubt the pilots themselves of their own skills. Purporting to act in the interests of flight safety, they do, in fact, contribute to the decline. Far from controversial, this letter is to invite each driver to provide the right answers to the main question to an airline: how to improve flight safety. We offer to share some answers in the following lines. No false controversies and debates on issues of flight safety Since 1 July, your boxes are flooded with leaflets and information of all kinds, whose tone and content do not invite serious reflection. We are sorry. Some media will seize any statement or any pseudo-rapport into their field day, since it is an Air France pilot who speaks, and this even in the absence of any new information duly executed. In contrast, management has deliberately chosen the opposite course, some of it makes the criticism in saying it wants to hide the truth. While we certainly have not sufficiently communicated, but we must remember:

a. it is the Board of Inquiry and Analysis is responsible for technical investigation and therefore it is his duty to communicate the facts, that's what he did in the first progress report published last July

b. Findings that are thin, since they come from ACARS messages sent by the aircraft itself and initial analysis of some debris that was recovered. We have, at present, no registration and no path;

c. at this stage, the BEA has not issued recommendations intended for the company. Despite this lack of physical evidence to guide our action, we are not left without anything and it is worth recalling what was done for 4 months: continued work on the elements that ensure flight safety. In the absence of clearly defined cases, the guiding principle is this: we have chosen to strengthen our defenses on all matters on which we interviewed following the occurrence of AF 447. Work in time on the fundamentals of security is the only option that can bring us more in terms of flight safety. In this perspective and beyond the immediate actions following the accident, we have already: - Replaced the pitot tubes AA Thales Thales tubes by BA, on the whole fleet Airbus 330/340 and then in early August on the manufacturer's recommendation and EASA, we installed tubes in positions Goodrich CdB and Stand By; - Launched a campaign of systematic inspection of pitot tubes A320 - Created a mock specific IAS questionable Airbus more than half of NTPs have followed so far and believe it is appropriate and useful, - A procedure is in place to remove any doubt, to strengthen monitoring of the positions of our aircraft by SC CCO, without waiting for the amendment of agreements, - Created training materials "Ice Crystals" and "Reminders for the use of radar," - Modified the content of sessions divisions 4S Boeing to introduce a presentation of the elements of the AF 447 and strengthen our defenses against the dangers caused by the storms. We do not stop there and we will continue this process by: - Calling for a mission outside experts, composed of individuals recognized internationally, to make a systemic study of flight safety, - Carrying on A320, replacement probes Thales BA in positions CDB and Stand By, by Goodrich probes, identical to the 330/340, - Launching the re-engineering of the preparation and monitoring of flights; - The launch meeting was held October 19 and was attended by specialists of air operations, service lines (NI), the flight preparation of the dispatch, and Security Directorate; - Creating groups of instructors referents, whose function will be to harmonize the educational messages, - Pursuing the establishment of system safety management, particularly on aspects "safety culture" and "just culture" in the deployment of system security management.

This list is not exhaustive and we will complete whenever we deem useful. Know that we are determined to continue along this path, that of continually improving our processes, although we are currently experiencing difficulties in the deployment of some ambitious projects like OMPNT (link). Other companies have faced the same challenges before us and were able to overcome them. Therefore, these difficulties should not lead us to reject it in all our projects. We are ready to open discussions with trade unions and 100% dedicated to finding ways that will ensure that these discussions will be conducted with serenity, with the expertise and all the seriousness it deserves for flight safety. A return to fundamentals of being a pilot. Recently, some union publications have pointed to the difficulties of control A320 simulators when icing simultaneous three pitot tubes takeoff. They criticized the fact that this exercise was originally chosen as subsequently amended (by inventing a pressure Airbus to make, of course, history even more attractive and therefore credible). Truth requires that you know that the probability of encountering such a scenario is extremely low, since it requires that the three probes frosting at the same time, while the aircraft is climbing and later, icing results in a durable sealing total and absolute for these probes. For it to grow, it is necessary that all conditions are maintained and appear simultaneously. Furthermore, Airbus has indicated that this failure to the simulator does not accurately simulate the chain of consequences in the real world. Furthermore, no such event has been identified on Airbus, and no similar event has been identified in the analysis of RAS on incidents of pitot tubes Air France has known since 2001. We have removed this year because he was teaching-cons and some advocated to solve this problem, a deviation from this doctrine. Because you must be convinced of an essential element that you do not remember often enough: our key risks - in terms of likelihood and severity - are elsewhere. We did not find them in extreme cases, in the most unlikely situations, but in the daily operation in our most mundane activities. And most surprisingly, when conducting the analysis of factors contributing to these incidents is that: - The application of simple procedures could have prevented the event; - There is no procedure to correct or create new procedure. In other words, simply to apply our doctrine, our procedures, in the calm and serenity. We offer a few examples: - An overshoot does not accelerate the pace by taking the risk of forgetting an ad or disrupt the normal work, although the altitude of RDG is low on the contrary, it requires actions consistent, sequenced and verified by the PNF, keeping in mind that before stabilizing at altitude, we must begin by taking over a little, showing the trim and push off the PNF should check everything before . The passenger comfort, in this case, secondary. - An alarm "config" is a "no go, even if we think being able to identify the cause, and verify that the flaps are extended. Nothing we can say that they will not return during the takeoff roll or there is not another hidden fault. This alarm is a "forbidden". We should not have to deal with this type of incident feedback, because it should not exist. Time pressure can not be an excuse, or the execution of the mission a sufficient reason to override. - Inserts speeds V1, VR, V2 in the MCDU must be the subject of two double-checks: firstly by the one that inserts the data under the "control action", the second under a "cross-check. "Even if the other crew member was shown a straight face during the pre-flight or during the previous flight. - A takeoff path must be scrupulously respected when it is the path of failure (EGPWS?) and that the restriction is a restriction barrier. By choosing a different course, a pilot only increases the risk even if the impression of moving away from the most significant obstacles, because in case of failure, besides the fact that the crew did not know necessarily the constraint on the inclination (climb gardient?) it would have to maintain during its trajectory will consume the slope, which has a basic need. We could show you other examples of equivalents (for this you really need to read or reread the latest publications of "Overview"). We have chosen these because they illustrate the factors that have led some of us to make those deviations that have generated risk and can be summarized in a few sentences: - Commitment to "too" well done - conduct an RDG flexible compliance schedule, improve margins over obstacles, etc.. - The Overconfidence:, - Feel good about his aircraft and its environment, to the point of granting deviations due to coarse thinking hazard control, - The feeling of extreme security, thinking that despite redundancy in systems, procedures and alarms, we are immune to the consequences. Each of us can draw on personal experience and identify precursors of such situations or equivalent events . We thought we could control these "basic" risks  thanks to our professionalism, our procedures, our training and that we would not see more such incidents. We thought the situation would encourage everyone to be extra vigilant. It is clear that this is not the case and recent events have proved otherwise.

Conclusion:  Like you, we feel great difficulty to the fact of not knowing what happened and did not understand the causes of this accident. The reality is so and it is not unlikely that we remain in ignorance. The temptation is great for some to call into question the entire foundation and in particular the doctrine, procedures and practices essential to our business that we have taken so long to formalize cooperation with all industry airline. We ask you not to yield to the temptation to express yourselves with extreme excesses. Flight safety requires a methodical long-term approach. We are committed to continuing and identifying any particular lines of simplification. In everyday life, we must ensure the safety of our operations and for this we ask:

1. that you focus on the fundamentals of being a pilot during the duration of the mission. It's your daily contribution to simplification;

2. to apply rigorous procedures that are robust and shared by all. That way you get involved in daily safety;

3. to assume fully the role assigned to you within the crew. That's how you give meaning to your action.

      Pierre-Etienne Marie Gautron Lichtenberger

      Director of Flight Operations Director of Security Security Directorate management of air operations

*see also  this Air France Pilots Assn link