Captain John Cox Chief Executive Officer of Safety Operating Systems

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Pilot Error Cause of Smolensk Disaster

Pilot error cause of Smolensk disaster - expertJohn Cox praises Russian professionalism in the Smolensk follow-up

Download audio file  03-26-2012

Interview with Capitan John Cox, Chief Executive Officer of Safety Operating Systems in Washington D.C. and a world renowned aviation expert.

My first question was regarding the Polish report. Since the crash report is supposed to be complete about the country’s authorities, where the crash takes place, how much weight can we give the Polish report and what were the reasons for them coming up with it?

It is unusual for a country to produce a second report outside of the state of occurrence, where the accident occurred. I think that Polish authorities dealt as though some of the Russian report needed some amplification and they elected to produce a second report. It’s not unprecedented but it’s very unusual.

Do you see politics playing a role in this process at all?

Anytime there is the loss of a government airplane like this – and it has so much visibility – I hesitate to speculate on politics. The Russian report was very well-written. I found it in my experience the Russian investigators have always been very good. They are very thorough. The reasoning behind the Polish report could have some political overtones but I’d hesitate to speculate on it.

I’ve recently read an article about the late President Kachinsky – I don’t know if you can speculate on it either – that he often ordered his pilots to land in very dangerous conditions. Have you heard anything about that?

There was concern in all the reports that the pilots felt pressure to continue approach. There is a comment on the voice recorder makes reference to if they miss the approach they are concerned that one or more of the passengers will be upset. I think the pilots felt some pressure. To what degree that played in the accident it’s a bit harder to tell. But clearly there was pressure.

The Polish report stated the pilots were not prepared. What can you say on this after reading the report?

I found that an interesting comment. The pilots were clearly prepared. They’d flown the airplane before, they were properly trained, they knew the type of approach that they would be executing in the bad weather, they had talked to the facility, to another Polish airplane, a JAK, that had landed previously. They knew the weather. So, I would have counted them as being prepared for the approach. To say otherwise, I don’t understand the reasoning behind it.

They came in rather low. Were there any reasons for that since it was not an instrument approach?

The last segments of the approach are really the core issues for the investigators in the cause to the accident. When the weather is very bad pilots can never get their instruments to a specific altitude. And you know what that altitude is in advance. This airplane descended below that altitude when they still didn’t have adequate visibility to safely land. That’s the core issue, and it’s acknowledged by the Russian report ad also the Polish report. Thad’s the core issue.

In the Polish report, did they go to why pilots ignored the TAW system? Can you remind our listeners what that is?

The Terrain Awareness and Warning System (TAWS) is a very good bit of technology that helps pilots not have the airplane strike the ground unintentionally, which has been a problem in aviation for decades. This very good technology shows where that potential conflict might be and gives the pilot time to avoid the pending accident. So, in this case, the TAWS did activate and the pilot ignored it.

What were the main differences between the Polish report and the Russian report? Did you see any glaring differences?

Actually, the two reports are reasonably close. The Russian report centered more on the actions of the crew as being the primary cause and they were very specific about that. The Polish report attempted to spread the cause out, including the Russian air traffic control system, the type of autopilot, the type of aircraft, the training of the pilots. They diversified the cause out much more broadly.

Whose fault was the disaster?

As an accident investigator, it’s not my job to ascertain fault. The primary causal factor was the descent of the airplane below the proper attitude without adequate visibility to land. Therein is the primary cause. Beyond that there are some contributing causes. Therein is the probable cause of the accident.

Are you satisfied with both of the reports? Was that question answered at all as to why they came down so low?

I am very satisfied with both reports, particularly the Russian one, which I think was actually very well done. There was some discussion of the pressure the pilots felt as to continue the descent. They knew the weather was bad and the visibility was very restricted. And that is the decision that pilots have to make on a frequent basis. And it’s not always an easy one. But, in this case, they continued, and, unfortunately, they were a bit short of the runway, and the left wing struck a very large tree, causing significant damage and loss of control of the airplane.

What questions did you see brought up from the Polish report? Are there any unanswered questions that need to be answered or that we can bring closer to this tragedy?

I think we have reached the point where closure to this tragedy is the next step. There have been some training changes. The Polish government has reassigned VIP government travel, reconstituting that specific squadron of the air force. That’s probably a positive step. And I think in the future the Russian air traffic control system will also learn something from this tragedy to be extra vigilant and to assist pilots to the maximum degree they can in terms of bad weather. Out of all the accidents comes the learning process and we try very hard to make the aviation safer. This very high-profile accident will do that also.

What lessons could be learnt from this?

I think the training for the pilots that fly VIP airplanes will be improved. I think the types of technology available to those crews will be improved.  And they’ll recognize that they may want to move into new generation aircraft. The Tupolev-154 is a workhorse, it’s been in the fleet for many, many years. But there are some new technology airplanes out there. I think that’s a possibility for VIP government travel as well. So, there are a number of lessons that the industry will learn

Praise for Russian Professionalism in the Smolensk Crash Investigation

12-20-2010  

Download audio file

Interview with Captain John Cox, the chief executive officer of Safety Operating Systems in Washington DC and a world renowned aviation expert, on the Katyn air disaster draft report and the reaction by Polish authorities.

John Robles: Mr. Cox, last time we spoke you had said that your experience with Russian investigators had been very good and that they were professional and regarded their reputations quite highly. Do you still stick to those words?

John Cox: Absolutely. I believe that the Russian investigators are very high-quality investigators. I think that they will look into all aspects of the accident and work in cooperation with the Polish authorities to understand the ramifications.

John Robles: In your opinion, is it common for a politician, even one as high up as a Prime Minister, to comment on an aircraft disaster report?

John Cox: It is unusual to see a senior politician to take such a strong position on a technical document. And I am a little uncomfortable until we know all the details that are contained in this draft report. It is still in its formulative stage. It's been brought to the Polish authorities for input. So, I think it is a bit premature on the part of the Prime Minister. He may express displeasure, but I think it is part of the normal ICAO process. 

John Robles: The Interstate Aviation Committee (IAC) is responsible for civilian airspace and operations in the CIS. Do you have any experience working with them?

John Cox: I have no personal experience with them, but I know they enjoy a good reputation as far as being a quality organization.

John Robles: Anyway, Edmund Klich had said that there were 12 factors leading to the plane crash. What do you think those may have been?

John Cox: It is most important to say that there are probably well more than twelve. In over 30 years of accident investigation I have never seen an aircraft accident be down to one or two causes. There are usually many causal factors and there are even more contributory factors. So, to fully understand what happened, you must look at contributory as well as the causal factors. I believe that it is highly likely that  these 12 additional factors that were brought in; some maybe causal, some maybe contributory. In all my years of accident investigation have I ever seen it an accident be caused by just one or two things.

John Robles: Some have made an issue whether the airport was military or civilian. Apparently, as I understand it, under Polish law, or rules, if it was civilian the crew was 100 percent responsible. If it was military, then the military should have given them an order not to land. And there have been reports that they had over a dozen orders to pull up and they did not. Can you shed some light on that? Who is in charge, who is in control of the landing process?

John Cox: In the end, the pilot flying the airplane has the final authority to land or not to land and that is true throughout civilian aviation. So, that final decision process rests with the captain. That being said, information from the ground can be very critical and we don’t know, to my knowledge, exactly what the crew saw or did not see. And that would play very heavily into the decision made by the flight crew. As far as military airport versus civilian, the rules may be different. I know that in some of the eastern European countries there can be a prohibition against lining up with a runway in, iclement or, bad weather, but this final decision still rests with the captain.

John Robles: What would you say about reports that the president himself and the head of Polish military aviation were in the cockpit during the landing process? Can you comment on that at all?

John Cox: I have heard reports that there were people in and out of the flight deck. On a VIP flight the flight deck door is permitted to be open in most operations. So, having them in and out of the flight deck during the course of the flight may be a very usual thing. As far as during the instrument approach itself, I don’t have information to say if there was pressure applied to the crew or not and who those people were. Normally, that close to landing, everyone is in their seats with their seatbelts fastened. It would be unusual to have a non-crewmember in the flight deck during that phase of flight.

John Robles: Can I ask you a personal question as a pilot yourself? If you were in a similar situation, say, and you had the president of the United States standing behind you telling that you had to land the plane right now, and you knew that it was a very dangerous thing to do, what would you do in that situation?

John Cox: I think it would solely depend on whether I could see or not, the safety of the airplane would supersede anyone’s comment to me, as to whether we had to land or not; that decision rests exclusively with the captain.

John Robles: Mr. Klich said the head of the Polish military aviation had attempted to intimidate him into blaming Russia for the air disaster. Can you comment on that at all?

John Cox: It's heresay, I have no way to determine the accuracy of a statement like that or not. There's no way to know,

John Robles: Is it possible, I mean, to fully blame the people on the ground for this? It sounds kind of odd to me.

John Cox: It is never one thing. If there are  issues with the ground they should be included in the report, if there's issues with the flight crew and if there's issues with the aircraft. All aspects should be evaluated and a good report will be inclusive of all the causal and contributory factors.

John Robles: Here is some technical information I have, and this should be right up your alley. This is a quote from Vladimir Gerasimov, a Hero of Russia and a pilot: “The conventional rate of descent is 3.5 meters per second, and theirs was more than 9 meters. With such high vertical speed, I quote, the “descent” of the Tu-154 reaches 50 meters on the second round. In other words, after descending lower than 60 meters, the airplane fell into a trap, that's what they said.” Basically, once they had started descending, there was nothing else they could do. I mean they couldn’t pull up.

John Cox: Jet aircraft are high-performance vehicles, and as such, they are capable of arresting descent very quickly. The Tu-154 is a well-known and well-tested airplane. Those were highly experienced pilots and if they did have an excessive rate of descent, which I have not seen proof of yet, then it would make it more difficult for them to arrest that rate of descent if they were close to the ground. That assumes that this excessive rate of descent actually existed.

John Robles: Can you recover from a nine-meter rate of descent in the Tupolev Tu-154?

John Cox: Yes.

John Robles: What would you say to all the people on the Internet and a lot of people in the press, who want to make a big conspiracy out of this and say that there were something planned behind it?

John Cox: The are allegations that are made in virtually every aircraft accident I’ve ever been around, they are usually without foundation. My experience has been that if the agencies investigating the accident are cooperating and they are all directed to get the best and most complete answer possible, they will bring forward a full and complete report. And I believe that will happen in this case.

John Robles: Is there anything you would like to add in conclusion?

John Cox: I think the important thing to realize is that this is still not a finalized report. And so, before saying that conclusions can be drawn, I think we need to wait in fact, for that final report.There are still, obviously, discussions going on between the Russian investigators and the Polish investigators. I think once those discussions are concluded and the final report is released, then and only then can we see all the issues that contributed to this tragic accident.

John Robles: Can you comment on the condition of the aircraft?

John Cox: That airplane had received very high-quality maintenance. It was a presidential airplane and it was therefore kept to high standards. The Tu-154 is an older design, but that does not in any way imply that it is less safe. If properly maintained, aircraft of its age and older can certainly be flown safely for many-many years or decades.

John Robles: Thank you so very much for speaking with me.

John Cox: My pleasure.

John Robles: That was Captain John Cox, the chief executive officer of Safety Operating systems in Washington D.C. We were talking about the draft report on the investigation into President Lech Kaczynski’s airplane crash in April this year.

Klich said the head of the Polish military aviation had attempted to intimidate him into blaming Russia for the air disaster. Can you comment on that at all?

John Cox: It's heresay, I have no way to determine the accuracy of a statement like that or not. There's no way to know,

John Robles: Is it possible, I mean, to fully blame the people on the ground for this? It sounds kind of odd to me.

John Cox: It is never one thing. If there are  issues with the ground they should be included in the report, if there's issues with the flight crew and if there's issues with the aircraft. All aspects should be evaluated and a good report will be inclusive of all the causal and contributory factors.

John Robles: Here is some technical information I have, and this should be right up your alley. This is a quote from Vladimir Gerasimov, a Hero of Russia and a pilot: “The conventional rate of descent is 3.5 meters per second, and theirs was more than 9 meters. With such high vertical speed, I quote, the “descent” of the Tu-154 reaches 50 meters on the second round. In other words, after descending lower than 60 meters, the airplane fell into a trap, that's what they said.” Basically, once they had started descending, there was nothing else they could do. I mean they couldn’t pull up.

John Cox: Jet aircraft are high-performance vehicles, and as such, they are capable of arresting descent very quickly. The Tu-154 is a well-known and well-tested airplane. Those were highly experienced pilots and if they did have an excessive rate of descent, which I have not seen proof of yet, then it would make it more difficult for them to arrest that rate of descent if they were close to the ground. That assumes that this excessive rate of descent actually existed.

John Robles: Can you recover from a nine-meter rate of descent in the Tupolev Tu-154?

John Cox: Yes.

John Robles: What would you say to all the people on the Internet and a lot of people in the press, who want to make a big conspiracy out of this and say that there were something planned behind it?

John Cox: The are allegations that are made in virtually every aircraft accident I’ve ever been around, they are usually without foundation. My experience has been that if the agencies investigating the accident are cooperating and they are all directed to get the best and most complete answer possible, they will bring forward a full and complete report. And I believe that will happen in this case.

John Robles: Is there anything you would like to add in conclusion?

John Cox: I think the important thing to realize is that this is still not a finalized report. And so, before saying that conclusions can be drawn, I think we need to wait in fact, for that final report.There are still, obviously, discussions going on between the Russian investigators and the Polish investigators. I think once those discussions are concluded and the final report is released, then and only then can we see all the issues that contributed to this tragic accident.

John Robles: Can you comment on the condition of the aircraft?

John Cox: That airplane had received very high-quality maintenance. It was a presidential airplane and it was therefore kept to high standards. The Tu-154 is an older design, but that does not in any way imply that it is less safe. If properly maintained, aircraft of its age and older can certainly be flown safely for many-many years or decades.

John Robles: Thank you so very much for speaking with me.

John Cox: My pleasure.

John Robles: That was Captain John Cox, the chief executive officer of Safety Operating systems in Washington D.C. We were talking about the draft report on the investigation into President Lech Kaczynski’s airplane crash in April this year.

 

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