Aci 315 08 Pdf 42
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Aci 315 08 Pdf 42
On 7 October 2008, Qantas Flight 72 was scheduled to fly from Singapore Changi Airport (SIN) to Perth Airport (PER). The aircraft, VH-QPA, was delivered new to Qantas on 26 November 2003, initially as an A330-301. In November 2004, it had a change in the type of engines fitted, and was redesignated as an Airbus A330-303.
The crew was led by Captain Kevin Sullivan (53), a former US Navy (1977-1986) pilot. The first officer was Peter Lipsett, and the second officer was Ross Hales. In addition to the three flight-deck crew members, with nine cabin crew members and 303 passengers, a total of 315 people were on board. Captain Sullivan had 13,592 flight hours, including 2,453 hours on the Airbus A330. First Officer Lipsett had 11,650 flight hours, with 1,870 of them on the Airbus A330. Second Officer Hales had 2,070 flight hours, with 480 of them on the Airbus A330.
On 7 October 2008 at 09:32 SST, Qantas Flight 72, with 315 people on board, departed Singapore on a scheduled flight to Perth, Western Australia. By 10:01, the aircraft had reached its cruising altitude of around 37,000 feet (11,000 m) and was maintaining a cruising speed of Mach 0.82.
The incident started at 12:40:26 WST, when one of the aircraft's three air data inertial reference units (ADIRUs) started providing incorrect data to the flight computer. In response to the anomalous data, the autopilot disengaged automatically. A few seconds later, the pilots received electronic messages on the aircraft's electronic centralised aircraft monitor, warning them of an irregularity with the autopilot and inertial reference systems, and contradictory audible stall and overspeed warnings. During this time, the captain began to control the aircraft manually. The autopilot was then re-engaged and the aircraft started to return to the prior selected flight level. The autopilot was disengaged by the crew after about 15 seconds and remained disengaged for the remainder of the flight.
The Australian Transport Safety Bureau (ATSB) investigation was supported by the Australian Civil Aviation Safety Authority, Qantas, the French Bureau of Enquiry and Analysis for Civil Aviation Safety (BEA) and Airbus. Copies of data from the aircraft's flight data recorder and cockpit voice recorder were sent to the BEA and Airbus.
The aircraft was equipped with an air data inertial reference unit (ADIRU) manufactured by Northrop Grumman; investigators sent the unit to Northrop Grumman in the United States for further testing.On 15 January 2009, the European Aviation Safety Agency (EASA) issued an emergency airworthiness directive to address the problem of A330 and A340 aircraft, equipped with the Northrop-Grumman ADIRUs, incorrectly responding to a defective inertial reference.
In a preliminary report, the ATSB identified a fault occurring within the number-one ADIRU as the "likely origin of the event"; the ADIRU, one of three such devices on the aircraft, began to supply incorrect data to the other aircraft systems.
About two minutes later, ADIRU no. 1, which was providing data to the captain's primary flight display, provided very high (and false) indications for the aircraft's angle of attack (AOA), leading to:
As with other safety-critical systems, the development of the A330/A340 flight-control system during 1991 and 1992 had many elements to minimise the risk of a design error, including peer reviews, a system safety assessment (SSA), and testing and simulations to verify and validate the system requirements. None of these activities identified the design limitation in the FCPC's AOA algorithm.
The ADIRU failure mode had not been previously encountered, or identified by the ADIRU manufacturer in its SSA activities. Overall, the design, verification and validation processes used by the aircraft manufacturer did not fully consider the potential effects of frequent spikes in data from an ADIRU.
Airbus stated that it was not aware of