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Title: | Crash after takeoff, Report of the Public Inquiry into the causes and circumstances of the accident near Staines on 18 June 1972 |
Micro summary: | This Trident crashed shortly after takeoff. |
Event Time: | 1972-06-18 at 1611 UTC |
File Name: | 1972-06-18-UK.pdf |
Publishing Agency: | Aircraft Accident Investigation Board (AAIB) |
Publishing Country: | United Kingdom |
Report number: | 4/73 |
Pages: | 54 |
Site of event: | A field near Staines |
Departure: | London Heathrow Airport, London, England, United Kingdom |
Destination: | National Airport, Brussels, Belgium |
Airplane Type(s): | Trident I |
Flight Phase: | Takeoff |
Registration(s): | G-ARPI |
Operator(s): | British European Airways |
Type of flight: | Revenue |
Occupants: | 118 |
Fatalities: | 118 |
Serious Injuries: | 0 |
Minor/Non-Injured: | 0 |
Other Injuries: | 0 |
Executive Summary: | Trident G-ARPI (called throughout this report by its call-sign'Papa India'), owned by British European Airways (BEA) and operated by them under a valid air operator's certificate, crashed in afield near Staines at 1611 hours on Sunday, 18 June 1972, shortly after taking-off from London [...] The immediate causes of the accident were these: (1) A failure by Captain Key to achieve and maintain adequate speed after noise-abatement procedures. (2) Retraction of the droops at some 60 knots below the proper speed causing the aircraft to enter the stall regime and the stick-shaker and pusher to operate. (3) Failure by the crew to monitor the speed errors and to observe the movement of the droop lever. (4) Failure by the crew to diagnose the reason for the stick-pusher operation and the concomitant warnings. (5) The dumping by the crew of the stall recovery system. The underlying causes were these: (1) The abnormal heart condition of Captain Key leading to lack of concentration and impaired judgement sufficient to account for his toleration of the speed errors and to his retraction of, or order to retract, the droops in mistake for the flaps. (2) Some distraction, the nature of which is uncertain, possibly due to the presence of Captain Collins as a passenger on the flightdeck, which caused S/O Ticehurst's attention to wander from his monitoring duties. (3) Lack of training directed at the possibility of 'subtle' pilot incapacitation. (4) Lack of experience in S/O Keighley. (5) Lack of knowledge in the crew of the possibility or implications of a change of configuration stall. (6) Lack of knowledge on the part of the crew that a stick-shake and push might be experienced almost simultaneously and of the probable cause of such an event. (7) Lack of any mechanism to prevent retraction of the droops at too low a speed after flapretraction. |
Learning Keywords: | Operations - Crew Resource Management |
Operations - Pilot Experience - Pairing | |
Operations - Training Deficiency | |
Operations - Uncontrolled Flight into Terrain | |
Consequence - Hull Loss |
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