Lion Air Crash Due to Malfunctioning MCAS

...or lethality of not reading the (new) instructions...or translations there of.

The Boeing risk assessment team thought that the chances of this happening were so small that there was no need to inform the pilots....

..."A January 2018 report of the new Boeing’s created by the Brazilian ANACbriefly mentions the MCAS, but offers no specific guidelines on its operation. Whether the Lion Air 610 crew had any knowledge of the MCAS’s existence prior to their October 29 takeoff is unknown. Sources said Boeing risk assessment team felt the chances of the MCAS going off in flight were so remote, they felt an explanation of the system was unnecessary"..

https://www.flyingmag.com/lion-air-investigation-takes-an-unexpected-turn

There's lots of CYA action going on here!

I can't see anything that says what the correct procedure would be, or even if there was a procedure...
So if they'd read it they'd have been none the wiser... they'd just have known that they were going to die because some idiot had made an unnecessary change...
"Improved to the point of lethality"
If it ain't bust don't fix it....
Del

All changes are not Progress!!

Yeah I can't wait until some coder with a couple of towhooks in his eyebrows is in charge of driving my car.

jhammond

What the Lion Air Pilots May Have Needed to Do to Avoid a Crash

If the anti-stall system indeed ran away with the stabilizer control, only a fast sequence of steps by the pilot and first officer could have saved the aircraft, instructions later issued by Boeing show.

On the outside of the yoke in front of both the pilot and the first officer, there is a switch for electrically controlling the trim – the angle of the stabilizers. If the pilot understood what was happening, he could have used that switch for a few seconds at a time to counteract what the M.C.A.S. was doing to the stabilizers. But that would have been only a temporary solution: the pilot has to release the switch or the nose could go too high. But if he releases the switch, the anti-stall system would reactivate a few seconds later, according to a bulletin issued by Boeing.

The crucial step, according to the Boeing bulletin, would be to reach across to the central console to a pair of switches (sometimes protected with covers that must be opened), and flip the switches off. Those switches disable electric control of the motor that moves the stabilizers up and down, preventing the anti-stall system from exerting control over their position.

The final step would complete the process for giving the pilots physical control. Cables for manually operating the stabilizers run over a wheel – actually two wheels, one on either side of the console next to the ankles of the pilot and first officer. One of the pilots must rotate the wheel to pull the stabilizer back into the correct position.

I doubt that any of this was on the check-list.

They were doomed before they ever left the gate!

The change in engine design was at the heart of the change in control for trim...

..."It’s unique to the MAX because the 737 MAX no longer has the docile pitch characteristics of the 737NG at high Angles Of Attack (AOA). This is caused by the larger engine nacelles covering the higher bypass LEAP-1B engines.

The nacelles for the MAX are larger and placed higher and further forward of the wing, Figure 1."...

Figure 1. Boeing 737NG (left) and MAX (right) nacelles compared. Source: Boeing 737 MAX brochure.

By placing the nacelle further forward of the wing, it could be placed higher. Combined with a higher nose landing gear, which raises the nacelle further, the same ground clearance could be achieved for the nacelle as for the 737NG.

The drawback of a larger nacelle, placed further forward, is it destabilizes the aircraft in pitch. All objects on an aircraft placed ahead of the Center of Gravity (the line in Figure 2, around which the aircraft moves in pitch) will contribute to destabilize the aircraft in pitch.

https://leehamnews.com/2018/11/14/boeings-automatic-trim-for-the-737-max-was-not-disclosed-to-the-pilots/

Links:

https://www.theatlantic.com/notes/2019/03/heres-what-was-on-the-record-about-problems-with-the-737-max/584791/

https://www.aviationcv.com/aviation-blog/2019/shocking-facts-boeing-737max-crash

Analysis seems to indicate again that the automation was over riding pilot control input and the pilots were unable or unaware of how to go to full manual control. The Pilot account which mentions " jury rigging " is very telling. Also the competition with Airbus and time tables with respect to $$. Remember everything has been monetized and this means everything is also weaponzed.

From AV Web Flash:

At a follow-up press conference in Indonesia Thursday, accident investigators said they did not claim that a Lion Air 737 MAX 8 was unairworthy before it crashed into the Java Sea on Oct. 29.

Read more

I've watched lots of "airplane disaster" shows and most crashes are due to human error, often because an item in the checklist was missed. How hard would it be for the airplane to make sure all systems were ready for takeoff? Like a submarine, where a board of lights that monitor the hatches must all be green before they dive.

Not knowing anything about this plane or the service routines,,

I know when a part is changed in my car, a diagnosis and system check is required to determine if the repair is completed and correctly done. ( flow chart )

Does not Boeing have a similar procedure in place when service or repairs are performed ?

I have a bad feeling that it is up to the airline to fix and check their fleet. And some of those small foreign airlines are lax and poorly trained.

"DALLAS (AP) — American Airlines pilots are seeking more training on an automated anti-stall system on certain new Boeing jets. The system is under scrutiny after a deadly crash in Indonesia.

Southwest Airlines says its pilots are getting more instruction on recovering from stalls, but a spokeswoman says that training was approved before the Lion Air accident and is not limited to the new model of Boeing 737 that was involved in the Oct. 29 Indonesian crash.

The developments came Thursday after Boeing technical experts met separately with pilots from both airlines.

Indonesian investigators are probing whether pilots on an Oct. 29 Lion Air flight were overwhelmed when incorrect sensor readings activated the anti-stall system and automatically pushed the nose of their plane down. The Boeing 737 MAX plunged into the Java Sea, killing 189 people.

The anti-stall system differs from those in previous Boeing 737 models. Pilots at American and Southwest say Boeing didn’t explain the changes in the new plane’s operating manual.

Boeing says the MAX is safe and that there is a procedure for stopping the nose-down command. The Chicago-based company, however, is considering whether software changes in the anti-stall system are needed.

Modern planes use sensors outside the fuselage to measure airspeed and the pitch of the plane’s nose. The sensors can malfunction, however, and safety experts have suggested that Boeing will have to change the automated anti-stall system of the 737 MAX — which entered service last year — to prevent it from responding to a single erroneous reading.

Southwest Airlines said all of its pilots are getting additional classroom and simulator training by the end of the year. Airline spokeswoman Brandy King said the training covers all its Boeing 737 jets, not just the new MAX model, and includes recognizing and reacting to situations in which the nose might be pointed too high, and unreliable sensor readings. She said the training was approved before the Lion Air crash.

Boeing representatives met Sunday with leaders of the pilots union at Southwest. The union declined to comment on the meeting.

Dennis Tajer, an American Airlines pilot and spokesman for the Allied Pilots Association, said several members of his union met with Boeing’s lead engineer and chief test pilot for the 737 MAX on Tuesday in Fort Worth, Texas. He said they quizzed the Boeing experts on how erroneous readings from a single sensor could trigger the nose-down command.

American Airlines pilots who were already familiar with the 737 got 56 minutes of training on a tablet computer when learning to fly the MAX, and “it seemed to suffice,” said Tajer, who is a pilot himself, “but clearly there is more to this aircraft.”

A Boeing spokesman said the company always examines aircraft design and operation after any accident or incident.

“Boeing continues to evaluate the need for software or other changes as we learn more from the ongoing investigation,” said the spokesman, Charles Bickers.

A spokesman for American declined to say whether the airline had agreed to the union’s request for more training, saying only that the airline was working with the union.

United spokeswoman Megan McCarthy said, “We have the proper training in place for our pilots.”

At the end of October, Southwest had 26 Boeing 737 MAX jets, American had 16, and United Airlines had seven, according to Boeing figures."

___

David Koenig can be reached at http://twitter.com/airlinewriter

https://www.apnews.com/8c3f52e92d0f45628ef0a175b5763bbd

Boeing should have stuck to their guns and never implemented the French MACS systems. The Boeing systems were tried and true, but some how were sold a bill of goods, because of "competition" . At least they kept the unified yolk system, which is (in my mind) superior to the "side stick". New pilots beware.

Low altitude emergency is 'terrorizing', especially when two pilots are confused, AND, fighting the aircraft. The 'jump seat' pilots have, over the years, saved lives. I am in favor of making it mandatory that on take off and landing the jump seat is occupied by a qualified pilot. The wide body American Airlines pilots are all in the cockpit during take off and landing (and weather) for a reason.(not sure of other airlines) LET THE PILOTS FLY