Virgin Australia pilot avoiding ‘overspeed’ led to crew member breaking leg, ATSB report finds


Virgin Australia pilot avoiding 'overspeed' led to crew member breaking leg, ATSB report finds

An airline pilot’s rush to avoid going above the aeroplane’s maximum safe speed resulted in one crew member badly breaking their leg, a safety report released today has found.

Another crew member was also injured in the September 2017 incident on board the Virgin Australia flight coming into Adelaide from Melbourne, according to the Australian Transport Safety Bureau (ATSB).

The ATSB report found the crew, comprising a captain and first officer, had been instructed to perform a high-speed descent by air traffic control, but changes in windspeed resulted in the Boeing 737 “rapidly” accelerating.

With the plane reaching and then exceeding its maximum recommended speed of 630 kilometres per hour, the captain “abruptly” pulled back on the control column, causing the aircraft to pitch up with its nose in the air as the autopilot switched off.

“Even though the autopilot was operating correctly, when the aircraft was approaching and exceeding the maximum operating speed, the captain’s perception was that the autopilot was not controlling the aircraft and that urgent intervention was necessary,” the report stated.

“However, the captain did not follow the normal procedure for taking over control of pilot flying duties.”

One of the crew members in the back of the plan suffered a broken leg because of the jolt and was unable to return to their seat for landing, instead sitting on the floor.

A slide sheet had to be used to remove the person from the plane.

“Cabin crew members recalled an abrupt upset in the cabin, which they perceived as sudden and without warning,” the report stated.

Another crew member on their first day working without a “buddy” hit their jaw on the galley bench and suffered other minor injuries to their body and face.

Captain concerned about ‘overspeed’

The ATSB found the increased airspeed — the speed relative to the air through which an aircraft is travelling — was a result of a sudden decrease in tailwind as the plane descended into Adelaide Airport.

The plane’s flightpath into Adelaide.(Supplied: ATSB)

It also found the captain was “highly concerned” about avoiding an “overspeed”, which is when an aeroplane goes over its maximum safe speed.

“This was partly because of a perception that Virgin Australia were also concerned about overspeed and wanted to avoid overspeed events, and partly because of a perception that minor overspeeds had significant implications for the safety of the aircraft,” the report found.

“These factors contributed to how the captain responded to the sudden increase in airspeed towards the maximum operating speed.”

In a statement, Virgin Australia Group spokesman Kris Taute said the company “issued an information bulletin to pilots acknowledging the company’s position around minor overspeed events, and provided training and improved techniques to prevent and recover from them”.

“This included highlighting that disengaging or overriding the autopilot could lead to a change in aircraft pitch,” he said.

Both crew members continued working at Virgin Australia after the incident.

A line graph with a blue and brown line jerking suddenly up about halfway across
A graph showing the plane’s vertical acceleration and angle before and after the autopilot disengaged.(Supplied: ATSB)

Flight crew knew about problem

The ATSB found the “magnitude of the captain’s control input was probably greater than intended”.

“This was influenced by a perception that the autopilot was not controlling the aircraft so an urgent intervention was required. The magnitude of the control input caused sudden pitch changes, resulting in the injuries to the cabin crew,” the report concluded.

“This reduced the likelihood of the crew effectively responding to the unexpected increase in airspeed.”

The report said pilots could ignore air traffic control instructions if they thought they could not safely comply with them.

“Wherever possible, pilots should take the opportunity provided in an earlier stage in flight to identify risks and take steps to reduce the likelihood of a critical situation developing,” it said.

The 737 involved was not the same model — the 737 MAX 8 — as those in which pilots have reported nosediving once autopilot was engaged.

Those planes were grounded after crashes in Indonesia and Ethiopia.


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