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TransAsia Airways is the carrier, which was founded in 1951. This airline operates flights to such countries as China, Japan, Thailand, Macau, and others. Also, it serves domestic flights. At the time of the accident of Flight 235, the carrier owned 23 aircraft vehicles. Some of them were A320, ATR-72, and A330. The company had several large-scale catastrophes since its establishment. For instance, in 2002, the company’s plane crashed because it was in severe icing conditions and the crew failed to take the appropriate actions to prevent possible automation.
Also, in 2003, one of TransAsia’s aircraft machines collided with a truck that was crossing the runway (Joy 2015). Fortunately, no one was hurt in the accident; nevertheless, this plane was scrapped because of the damage received. The purpose of this paper is to review the Flight 235 accident, as well as to analyze the causes of its origin and the importance of the human factor, which made a critical contribution to the outcome of the occurrence.
On the morning of February 4, 2015, the aircraft ATR 72-600, which served the flight GE235 crashed in the vicinity of Taipei. It fell into the river a few minutes after takeoff. During the fall, the plane hit the overpass, and the taxi passing it with the wing (Accident description 2015). During the flight, the plane was carrying 58 passengers including children and members of the crew. Most of the passengers were tourists from mainland China.
It is worth noting that one of the aircraft’s engines broke down almost immediately after the beginning of the flight, and in just a few minutes after it, the plane crashed (Hume 2015). According to the information provided by the media, the data from the black boxes showed that the left engine began to work improperly when the aircraft was at an altitude of 400 meters. Thus, after takeoff, the left engine stopped after 37 seconds of flight.
The team filed an alarm and shut down the right engine, and after that, they were unable to restart it (Accident description 2015). Almost 35 seconds after the left engine broke down and the pilots gave the distress signal, the black box stopped recording. The plane was aviated by 42-year-old Liao Chien-Tsung. The first pilot strived for diverting the plane from colliding with the buildings. During the crash, the liner lowered one wing almost vertically down, fitted in between the apartment buildings, and fell into the water. As a result of the disaster, 48 people including the two pilots died.
Human Factors Leading to the Accident
According to the official data and the investigation, the plane crash and the death of passengers occurred due to the pilot error. Therefore, the main cause of the crash was related to the human factor. After the pilot was cleared for takeoff, he leveled the plane on the runway to the centerline, released the brakes, and gained the speed of 215 km/ h. It is crucial to emphasize that the moment of separation of the aircraft from the ground is one of the most complex aspects of the flight, and it requires the particular attention of the crew, a profound training, and stress resistance (Foresman, Fosl & Watson 2016).
This is because, during this period, the plane is at a low height, it has a low speed, and carries a large amount of fuel (Accident description 2015). During this moment, the pilot has to monitor the dashboard, keep track of the speed and acceleration, listen to the frequency, and to refer the takeoff to the center of the runway. All these actions should be performed simultaneously requiring the pilot to be as concentrated as possible.
When the plane flew out of the runway and retracted, the first pilot turned the plane to the right; thus, heading for the city center (Accident description 2015). At this point, one of the engines broke down causing severe stress to the pilot. However, it should be noted that this occurrence was not critical because the aircraft ATR-72-600 was designed in such a way to be able to keep on flying with only one functioning engine. Accordingly, the failure of one engine could not have served as a major cause of the crash (Aviation occurrence report TransAsia Airways flight GE235 2015).
Moreover, the pilots were to be thoroughly trained for handling such stressful situations and trained in the proper tactics for maintaining the aircraft in this case. To be more precise, the pilot must stall the fuel supply to stop the broken engine and avoid the occurrence of ignition (Hume 2015). In this approach, the vessel could be deployed and landed as soon as possible. However, Liao stopped the fuel supply to the engine that was functioning properly and the plane was in the sky with no functioning engines. Respectively, the intelligent overvoltage of the first pilot in such a stressful situation led to his erroneous actions and made the aircraft uncontrollable (Foresman, Fosl & Watson 2016).
Apart from the fact that the pilot did not realize that he turned down the working engine, he tried to raise the nose of the plane, which also was a critical error. As a result, the plane lost the speed, hovered at an altitude of 411 meters, and started to fall because it was deprived of the lifting power (Hradecky 2015). The pilot turned the plane to the left even though the plane lost the speed and had a low altitude, and while the aircraft nose was turned up (Hradecky 2015).
During the attempt to restart the engine and turn toward the river, the pilot also tried to gain altitude and avoid a collision with the overpass. Thus, pulling the wheel in a curve, the pilot deprived the left half of the wing of the lifting power. The aircraft rolled 90 degrees, hit the overpass, and fell into the river.
It should be noted that in such situations, the skillfulness of an individual is of great importance. If the actions of the pilot have been worked out to automaticity, he would automatically perform the actions that he has learned rather than instantly analyzing a variety of options to choose the one way of behavior (Foresman, Fosl & Watson 2016). In the same way, this accident is an example of the direct importance of the human factor, which was the pilot error.
Before the official investigation and the release of the official data, various reasons for the tragedy were put forward. One version was the icing of the aircraft; however, the investigation revealed that this could not have happened in those conditions, in which the plane was operating. According to the official report, there was slight cloudiness in 1,300 feet and broken clouds at 2800 feet. Moreover, during such a short period in which the aircraft was flying, the aircraft could not have iced up (Aviation occurrence report TransAsia Airways flight GE235 2015).
The dew point and temperature difference also could not lead to icing. Accordingly, it could not affect the plane crash. Thus, the weather and visibility were generally normal. The Commission for investigation of the GE235 disaster stated that №2 engine failure happened during the takeoff, while the crew mistakenly shut down the running engine №1. The flight data recorder indicated that the plane turned into a glider and the pilots could no longer control it.
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Based on the data of the report, GE235 remained in the air for 2 minutes and 40 seconds, but within 45 seconds after takeoff at an altitude of approximately 1,200 feet, the temperature of the gas turbine engine №2 fell (Aviation occurrence report TransAsia Airways flight GE235 2015). Therefore, an automatic feathering of the left engine took place. The crew documented an emergency on the board, yet they did not give particular information about engine failure.
The engine №1 was gaining the height of 1650 feet. The engine lever of control №2 remained stable (Aviation occurrence report TransAsia Airways flight GE235 2015). A throttle lever №1 gradually moved downwards. When the right engine parameters were shifted close to zero, the supply of fuel to the left engine was turned off, respectively, it can be concluded that the pilots thought that the faulty engine was functioning properly.
The plane began losing the height, and after 1 minute 15 seconds, it fell into the river. According to the voice recorder, the crew talked about the engine restart procedure 27 seconds before the fall (Aviation occurrence report TransAsia Airways flight GE235 2015). In addition to the incorrect manipulations made by the first pilot in a stressful situation, this aircraft was previously identified with the failure of the left engine. It was replaced by serviceable Pratt & Whitney PW100-127M.
It is crucial to mention that several issues contribute to questioning the reliability of the first pilot and his skills (Hume 2015). According to the investigation, he was unable to pass the simulator training less than a year before the accident (Aviation occurrence report TransAsia Airways flight GE235 2015). The pilot did not have sufficient expertise in reacting to engine flameout and takeoff. Moreover, in 2014, the pilot did not pass the test for correct responding to the abnormal engine start section (Hume 2015). However, he was retrained and qualified as captain later on.
Among the aspects of the human factor, the official documentation revealed that the flight crew did not document properly the uncommanded feather of the engine. Thus, they were confused with actual malfunctioning. Also, the pilots did not comply with the corresponding policy in terms of operating procedures during the engine ignition (Aviation occurrence report TransAsia Airways flight GE235 2015). The crew did not respond correctly to the warnings regarding the loss of engine power.
Therefore, the plane stalled after an attempt to restart the engine. Further on, the attempt to do so was performed at an altitude at which it would be no longer possible to gain control of the height and speed (Aviation occurrence report TransAsia Airways flight GE235 2015). The erroneous management and insufficient communication between the team members and the support resulted in inappropriate responding and wrongful piloting decisions.
In response to the consequences of the accident, TransAsia has held major activities to retrain the pilots. The aviation industry has also been subjected to changes. After the tragedy, the Aviation Administration of Taiwan conducted testing of the pilots with the help of a special simulator, which checks the preparedness of pilots to act in emergencies. Because the testing of pilots took quite a lot of time, many flights were canceled, and Airbus A320 was launched to solve the problem of reducing the number of flights (Joy 2015).
Moreover, TransAsia introduced and conducted a special program in collaboration with the United States and Europe to enhance the safety management system. To avoid possible incidents in the future, the airline conducted a mass retraining of its pilots. To ensure that the airplane arsenal was functioning properly, the airline brought manufacturers to check the vehicles.
It is crucial to emphasize that before this accident, the company has successfully passed the audit of safety. This situation has revealed that such large companies as TransAsia might have entrusted the conduct of the audit to firms that were not competent for a critical evaluation of the safety of carriers and the skills of the crew. In this regard, many experts have become skeptical about the credibility of the audit (Joy 2015). Moreover, the audit of other airlines was highly questioned as well.
Importantly, some carriers that had credibility also had plane catastrophes. For instance, Air Algérie, Ethiopian Airlines, and some other major airlines. Such firms as IATA IOSA, Utair have carried out the auditing services for them. Accordingly, the inconsistency of airlines with the essential safety requirements was evident, as well as the competency of the firms conducting the auditing.
Starting from 2015, EASA has carried out major work on aviation security enhancement. The activities of the agency were aimed at changing and transforming aviation legislation. For example, a recommendation has been introduced that during the flight, at least two crew members should be present in the cockpit. Moreover, it was proposed to change the security rules of the PBN navigation program. The objective of this program is to keep operational performance (Joy 2015).
In particular, instead of obtaining operating permits, the new rules should ensure better training and testing of pilots, as well as provide increased attention to the operational rules based on pilots’ work performance. Also, the agency offered a more functional use of drones and developed legal regulations for their use in the industry. Most importantly, it was proposed to develop new guidelines and pilot training requirements. It was required to provide effective training of the crew for situations when they can lose control of the aircraft during the flight (Joy 2015). Also, the new culture was approved, according to which the leading operators and other industry representatives will be punished for severe negligence, intentional foul, and destructive actions.
Accident description. 2015. Web.
Aviation occurrence report TransAsia Airways flight GE235. 2015. Web.
Foresman, G, Fosl, P & Watson, J 2016, The critical thinking toolkit, John Wiley & Sons, New York.
Hradecky, S 2015, Crash: Transasia AT72 at Taipei on Feb 4th 2015, right engine failed, left engine shut down, aircraft rolled sharply and lost height shortly after takeoff. Web.
Joy, M 2015, Upon a trailing edge, Troubador Publishing Ltd, London.