Flight Safety Information - May 20, 2024 No. 100 In This Issue : Incident: Lufthansa CRJ9 at Zurich on May 19th 2024, rejected takeoff due to hot brakes indication : Incident: Scoot A20N near Penang on May 17th 2024, avionics smoke indication : Incident: United B763 over Atlantic on May 19th 2024, laptop wedges : Incident: AirAsia India A320 at Bangalore on May 18th 2024, engine fire : Incident: India A321 at Delhi on May 17th 2024, suspected fire in APU : Incident: THY A333 at Milan on May 17th 2024, engine trouble : With safety in the spotlight, FAA reauthorization includes long-awaited safety rules, plus full NTSB funding : Secondary Cockpit Barriers Finally Become Mandatory On Commercial Aircraft More Than 20 Years After 9/11 : Never Say Never? How Open Is Southwest Airlines To Another Merger? : UK Aviation Authority raises safety violation concern over Air Peace : Saudia Group agrees largest ever Saudi jet deal with Airbus : Flying Blind—Embracing Aviation-Style Safety and Training Measures in Health Care : Call for Nominations For 2024 Laura Taber Barbour Air Safety Award : CALENDAR OF EVENTS Incident: Lufthansa CRJ9 at Zurich on May 19th 2024, rejected takeoff due to hot brakes indication A Lufthansa Canadair CRJ-900, registration D-ACNQ performing flight LH-2367 from Zurich (Switzerland) to Munich (Germany), was accelerating for takeoff from runway 28 when the crew rejected takeoff at high speed (about 110 knots over ground) requesting emergency services to check their brakes and asking tower whether any smoke was visible from the brakes. Tower reported no smoke was visible, the crew suspected a wrong sensor at the inboard brakes of the right main gear. Following checks by emergency services the aircraft taxied back to the apron about 10 minutes after rejecting takeoff. The aircraft is still on the ground in Zurich about 10 hours after the rejected takeoff. The flight was cancelled. https://avherald.com/h?article=518d37d4&opt=0 Incident: Scoot A20N near Penang on May 17th 2024, avionics smoke indication A Scoot Airbus A320-200N, registration 9V-TNF performing flight TR-478 from Singapore (Singapore) to Langkawi (Malaysia), was enroute at FL340 near Penang (Malaysia) when the crew declared Mayday reporting smoke in the avionics bay. The crew decided to divert to Penang for a safe landing on runway 04 about 20 minutes later. The aircraft remained on the ground in Penang for about 31 hours, then positioned back to Singapore but has not yet returned to service about 63 hours after landing in Penang. A listener on frequency reported the aircraft was in contact with Penang ATC when the crew declared Mayday due to avionics smoke and diverted to Penang. https://avherald.com/h?article=518d3670&opt=0 Incident: United B763 over Atlantic on May 19th 2024, laptop wedges A United Boeing 767-300, registration N663UA performing flight UA-12 from Zurich (Switzerland) to Chicago O'Hare,IL (USA), was enroute at FL340 about 500nm northwest of Shannon (Ireland) when the crew decided to turn around and divert to Shannon reporting a passenger's laptop had become stuck in the seat. The aircraft descended to FL330 and landed safely on Shannon's runway 06 about 90 minutes after the decision to turn around. The airline reported the aircraft diverted to Shannon to address a potential safety problem caused by a laptop being stuck in an inaccessible location. The aircraft is still on the ground in Shannon due to crew duty time limitations. The passengers were taken to hotels. https://avherald.com/h?article=518d34ba&opt=0 Incident: AirAsia India A320 at Bangalore on May 18th 2024, engine fire An AirAsia India Airbus A320-200 on behalf of Air India Express, registration VT-ATF performing flight IX-1132 from Bangalore to Kochi (India) with 173 passengers and 6 crew on board, was climbing out of Bangalore's runway 27R when the right hand engine (CFM56) caught fire. The crew stopped the climb at 6000 feet, worked the related checklists including shutting the engine down and discharging the fire extinguishers while returning to Bangalore but was unable to extinguish the fire. The aircraft landed back on Bangalore's runway 27L about 12 minutes after departure, vacated the runway with flames out of the right hand engine throughout and stopped clear of the runway. An emergency evacuation was initiated while fire fighters put the fire of the right hand engine out. There were no injuries. The airport reported the crew reported an engine fire, the aircraft returned to Bangalore, ground services saw still flames, hence all 179 passengers and 6 crew were safely evacuated. https://avherald.com/h?article=518d113c&opt=0 Incident: India A321 at Delhi on May 17th 2024, suspected fire in APU An Air India Airbus A321-200, registration VT-PPT performing flight AI-807 from Delhi to Bangalore (India) with 175 people on board, was climbing out of Delhi's runway 29R when the crew stopped the climb at FL070 reporting a suspected fire on board, possibly in the air conditioning system. Soon after the aircraft entered a hold before returning to Delhi for a safe landing on runway 29L about 70 minutes after departure. A replacement A321-200 registration VT-PPV reached Bangalore with a delay of about 5.5 hours. The occurrence aircraft is still on the ground in Delhi about 14 hours after landing back. The airline later reported the crew received a fire warning for the APU. https://avherald.com/h?article=518c2bb0&opt=0 Incident: THY A333 at Milan on May 17th 2024, engine trouble A THY Turkish Airlines Airbus A330-300, registration TC-JOK performing flight TK-1876 from Milan Malpensa (Italy) to Istanbul (Turkey), was climbing out of Malpensa's runway 35L when smoke was observed from one of the engines (CF6). The crew stopped the climb at 6000 feet and returned to Malpensa for a safe landing on runway 35R about 30 minutes after departure. The flight was cancelled. The occurrence aircraft is still on the ground in Milan about 24 hours after landing back. https://avherald.com/h?article=518c95cd&opt=0 With safety in the spotlight, FAA reauthorization includes long-awaited safety rules, plus full NTSB funding President Joe Biden signed the 2024 FAA Reauthorization Act into law on Thursday. The law provides funding for the Federal Aviation Administration for the next five years and addresses various aspects of air travel related to consumer protections, investments in air traffic control staffing and much more. Notably, the act also expands funds for another agency: the National Transportation Safety Board. This is the independent federal body tasked with investigating major accidents involving all forms of transportation and making recommendations based on the findings. The legislation allocates $738 million to the NTSB through fiscal year 2028, along with the $105 billion in funding for the FAA. Beyond funding, however, the reauthorization act implements numerous reforms and practices that the NTSB has pushed for, in some cases for years. While the NTSB has the authority to investigate incidents, the recommendations it issues are not binding. Most prominently, the act requires airlines to outfit all new and existing aircraft with cockpit voice recorders that can save 25 hours of audio before overwriting existing recordings. Airlines are currently required to carry CVRs that record just two hours of audio. In theory, the two-hour requirement was meant to ensure that the final events leading up to an accident were recorded and preserved for investigators. In practice, however, when an accident occurs but the pilots are able to land safely, the time it takes to land and fully shut the plane down — thus deactivating the recorder — has meant that the relevant recordings are often gone by the time investigators begin to examine the plane. Recordings from 14 incidents that the NTSB has investigated since 2018 were missing because they had been overwritten, the agency said. The NTSB first recommended that the FAA extend the minimum recording time in 2017; this came after a close call in which Air Canada flight 759 was within just a few seconds of inadvertently landing on a taxiway at San Francisco International Airport (SFO) rather than the runway. Four other aircraft were on the taxiway at the time and would have been in the path of the Air Canada flight. By the time the episode was reported and an investigation was launched, the CVR had been overwritten. The legislation also enacts several other NTSB recommendations. One such rule would require planes that fly over oceans to have equipment that can broadcast CVR and flight data recorder data remotely in the event of an accident and broadcast the location of the wreckage. That requirement follows recommendations that the NTSB issued following the loss of Malaysian Airlines Flight 370 in 2014. Additionally, the law requires the FAA to review and implement various NTSB recommendations linked to safety surrounding turbulence and others pertaining to overseeing airline operations. "I'm deeply grateful to Congress for including the NTSB in the FAA reauthorization bill, which authorizes funding increases for our agency over the next five years — much-needed resources that will allow us to continue as the world's preeminent safety agency for years to come," NTSB chair Jennifer Homendy said in a statement following the bill's passage. "Additionally, we appreciate Congress' safety leadership in mandating the FAA to implement many of our most critical recommendations, which, once acted upon, will further strengthen our nation's 'gold standard' of aviation safety," Homendy added. The NTSB has been increasingly prominent over the past few years as safety in air travel has come under the spotlight. Safety concerns arose following a handful of runway incursions and other near misses in late 2022 and 2023 and then again after a door plug fell from a newly delivered Boeing 737 MAX 9 during an Alaska Airlines flight on Jan. 5 of this year. The latter caused the cabin to decompress and left a gaping hole in the side of the aircraft. No one was seriously injured in any of the incidents. Homendy has led the investigation into the Boeing incident, which has included reviewing safety procedures and processes at Boeing; the plane-maker has become embroiled in scandals over quality control lapses and other problematic manufacturing processes. Along with holding nightly media briefings in the days following the episode, Homendy testified in front of Congress in March. The impact of the new legislation was immediately apparent in the context of the past few years' investigations. According to the NTSB, the CVRs were overwritten in seven of the 2023 runway incursions, as well as on the Alaska Airlines flight this year, stymieing investigators. https://thepointsguy.com/news/faa-reauthorization-ntsb-safety/ Secondary Cockpit Barriers Finally Become Mandatory On Commercial Aircraft More Than 20 Years After 9/11 Retrofitting current aircraft could take between five and six years. SUMMARY • The new law mandates a secondary cockpit barrier on all commercial aircraft to prevent 9/11-style attacks. • Implementation may take up to six years, leaving the US vulnerable until retrofitting is complete. • Legislation will require all new aircraft to have secondary barriers to enhance pilot and crew safety. President Joe Biden has 'fixed' one of the most tragic flaws that led to the darkest day in American aviation, 9/11. This week, the president signed into law the “FAA Reauthorization Act of 2024,” which now requires a secondary cockpit barrier to be installed on all commercial aircraft. The US House 387-26 adopted the rule and placed it before the president. It will remain law until 2028, when the National Transportation Safety Board is reauthorized to keep it going. The requirement that all aircraft be installed with a secondary cockpit barrier will take time and could take five to six years to implement. Until retrofitting is completed, a retired FAA investigator told the Boston Herald that the United States could "be vulnerable to a 9/11-style attack." Advocates for a secondary barrier have reiterated that these are key to preventing the future hijacking of aircraft and should deter terrorists from being able to access the cockpit. Installing a secondary barrier is the final 9/11 Commission recommendation that has yet to be implemented. Acting FAA Associate Administrator for Safety, David Boulter, reiterated the concern, noting: “No pilot should have to worry about an intrusion on the flight deck.” https://simpleflying.com/secondary-cockpit-barriers-finally-become-mandatory-on-commercial-aircraft-more-than-20-years-after-911/ Never Say Never? How Open Is Southwest Airlines To Another Merger? The carrier's leadership team recently shared its point of view. SUMMARY • Southwest is not planning mergers now, but future acquisitions could be possible. • Industry consolidation pressures smaller carriers to consider mergers for survival. • Carefully planned timing and execution are crucial for successful mergers. During a shareholder meeting on May 15th, Southwest Airlines' leadership team was quick to express its opinions on the carrier's immediate position regarding mergers and acquisitions. While the carrier indicated that it had no plans to merge with or purchase another airline in the near future, it did indicate that it would "never say never" to the possibility of yet another such expansion. With the airline industry so heavily consolidated, Southwest Airlines is currently just one of four major airlines in the United States to command more than 15% of the market. For carriers like Alaska Airlines, which are struggling to control 7% of the market, acquisitions like the company's recent purchase of Hawaiian Airlines could prove a necessary survival tactic. Southwest is no stranger to airline mergers. It rose to market dominance in 2011 when it acquired and gradually integrated into its network the former Orlando-based low-cost carrier AirTran Airways. Nonetheless, amid staff concerns and a lack of competitive pressure on Southwest within the market, the airline's management team did not rule out the possibility of acquiring yet another airline at some point in the future. A neutral attitude Mergers and acquisitions can be excellent opportunities for airlines to expand their operational capabilities and extend service to new destinations. However, purchasing the wrong carrier or failing to correctly execute a merger can lead to bankruptcy for an airline. In an industry with such razor-thin margins, carriers often encounter financial difficulties and, as a result, may come up for sale. According to Southwest Airlines' management team, knowing exactly when and how to execute a merger is crucial, with CEO Bob Jordan sharing the following words: "We’ve done acquisitions over our history here at Southwest—I participated in AirTran—you never say never to those kinds of things, but we’re focused on, right now, running our business, improving our returns, managing the impact of the Boeing shortages." This cautious approach speaks to the challenging nature of mergers and acquisitions. As a seasoned executive, Jordan quickly identifies that just because a merger may be in the cards does not mean it is the right move for Southwest. Severe limitations Rumors about Southwest's supposed interest in mergers arose in mid-March when the union representing the airline's pilots, SWAPA, retained multiple major law firms in the event that the carrier sought out a merger. According to Aviation Week, the organization had no knowledge of the airline's intent to acquire another carrier and chose to retain counsel as a strategic, risk-mitigating measure. The company is also currently facing capacity constraints. Boeing struggles to meet delivery timelines for its 737 MAX 8 jets and has yet to achieve certification for the 737 MAX 7, a key piece of the airline's fleet modernization plan. Southwest operates eight non-Hawaii routes over 2,100 miles (plus return flights) across North America. Jordan was also quick to discuss the extensive impact of the airline's challenges and how they are forcing the airline's management team to narrow their focus at the moment. At least for now, it appears that mergers are out of the question—but not forever. https://simpleflying.com/southwest-airlines-merger-stance-analysis/ UK Aviation Authority raises safety violation concern over Air PeacePublished on May 20, 2024 The United Kingdom Civil Aviation Authority has raised safety violation concerns over Nigerian carrier, Air Peace. This is as the UK civil aviation authority wrote to Nigeria’s Civil Aviation Authority, stating that Air Peace has reportedly violated some aviation safety regulations. The development came barely three months after the Nigerian carrier commenced the Lagos-London route, which led to a price cut war among air carriers. Accordingly, two mandatory incident reports on Air Peace had been reportedly sent to the United Kingdom Civil Aviation Authority. The UK CAA, in turn, forwarded the complaints to the NCAA. The CAA’s letter of complaint forwarded to NCAA was entitled; ”United Kingdom SAFA Ramp Inspection Report with reference number: CAA-UK, -2024-0217” and ”NATS Management System Safety Report.” The NCAA has also written to Air Peace to clarify the issues. The letter, with reference number: NCAA/DOLTS/APL/Vol.11/03624, was titled, “United Kingdom SAFA Ramp Inspection Report. It was dated May 14, 2024, and signed by the NCAA General Manager of Operations, Capt. O.O. Lawani. In the letter, the NCAA said the UK CAA had called its attention to the lack of operational approval of Electronic Flight Bag functions affecting the safe operation of the aircraft. The captain of the flight admitted that an Electronic Flight Bag was being used for navigational purposes. NCAA further noted that the CAA stated in its letter that there was “no mounting device for the use of EFB, no charging points or battery for backup.” Meanwhile, the firm has yet to react to the development when filing this report. On April 25, Air Peace commenced operations at London Gatwick from the Murtala Muhammed International Airport, Lagos, under Nigeria’s Bilateral Air Services Agreement with the UK. https://dailypost.ng/2024/05/20/uk-aviation-authority-raises-safety-violation-concern-over-air-peace/ Saudia Group agrees largest ever Saudi jet deal with Airbus RIYADH (Reuters) -Saudia Group, owner of the Saudia airline and budget carrier flyadeal, on Monday announced an order for 105 Airbus narrow-body aircraft in what the company’s director general described as the largest ever order from a Saudi airline. The order consists of 12 A320neo and 93 A321neo single aisle aircraft. State-owned Saudia Group said that Saudia would be receiving 54 of the A321neo jets, while flyadeal would acquire 12 A320neos and the remaining 39 A321neo aircraft. Neither Saudia Group nor Airbus disclosed the value of the deal, however, the Future Aviation Forum where the order was announced said the record Saudi order was worth $19 billion. Planemakers typically offer discounts on large orders. Saudia Group Director General Ibrahim Al Omar said the planes would start being delivered from the first quarter of 2026. Saudia Group said the last would be delivered in 2032. Saudia Group’s backlog of Airbus jets now stands at 144 of the A320neo family aircraft, Airbus said in a statement. State-owned Saudia plans to expand rapidly over the next seven years as part of Crown Prince Mohammed Bin Salman’s Vision 2030 programme to wean the kingdom off its oil dependence. Tourism is a key pillar of the economic diversification strategy. In November, Saudia said it was close to an agreement on an order for 100 narrow-body jets but wanted the manufacturer to agree to supply an additional 50-plus jets. It did not specify the manufacturer at the time. https://wmbdradio.com/2024/05/20/saudia-group-agrees-largest-ever-saudi-jet-deal-with-airbus/ Flying Blind—Embracing Aviation-Style Safety and Training Measures in Health Care When disaster strikes in the skies, the world takes notice. The recent incident of a door panel detaching mid-flight garnered widespread attention, sparking urgent investigations and calls for preventative measures. Yet, amid the clamor for aviation safety, a more devastating crisis persists in our health care system, claiming the lives of over 250,000 patients annually due to preventable medical errors. These tragedies often go unnoticed, accepted as part of the grim reality of American health care. But what if they didn't have to be? What if we refused to accept such losses as routine? Rather than acceptance, we need to apply the same level of urgency and pursue the same level of innovation to safety in health care as we do to safety in other industries like aviation, where this level of risk would be completely unacceptable. From fundamental nursing to ongoing reinforcement of safety and on-the-job education and training, there is an opportunity for change to better support our nurses. Let's think about the perspective of a new nurse—they went through years of rigorous studies (mostly in the classroom), passed a major exam, were elated and ready for practice but were then thrust into the chaos of a hospital environment. Multiple patients, interruptions, and administrative duties make a recipe for quick burnout and error. Unsurprisingly, nearly 18 percent of these dedicated professionals leave the profession within their first year, overwhelmed by the demands at the bedside after finding it doesn't match up with what they expected in clinical practice. It's time to reimagine the journey of new nurses—given recent events, why not consider the lens of aviation safety protocols? Just as pilots undergo rigorous and continuous simulation training and participate in extensive on-the-job training and shadowing before they are cleared for independent "practice," so too should nurses. Simulation technology offers a safe environment in which new nurses can hone their skills, make mistakes, watch others make mistakes, and learn without the dire consequences of real-life chaos. Additionally, nurse residency programs need to be built out more across the country, as an additional level of support for new nurses, providing invaluable mentorship and structure to ease the transition from academia to clinical practice. By no means should these thoughts be misconstrued as blaming new nurses—I was once a new nurse. As an industry, we need to come together to address systemic flaws that fail to adequately prepare nurses for the challenges they will face. We should not be trying to implement change the same way we did when I was that new nurse, 25 years ago. Nursing educators, state boards, health care systems, and technology vendors must come together to provide the resources and support necessary for success. By beginning this shift and improving the system that readies new nurses for clinical practice, we can hope to improve the outcomes at the bedside—reflected in better patient safety, medication error rates, and burnout of new nurses. The founder of modern nursing, Florence Nightingale, stated, "The very first requirement in a hospital is that it should do the sick no harm." By looking at other high-risk industries such as aviation and the safety measures put in place to protect the public, we can transform and hopefully improve the safety of our health care system with the power to save lives and prevent countless tragedies. We owe it to our patients, our nurses, and ourselves to refuse to accept the status quo. Let's channel the same level of urgency and innovation that we apply to air travel safety into our health care system. When it comes to patient safety, there's no room for complacency. Tim Bristol, PhD, RN, CNE, FAAN, FAADN, is a faculty development, NCLEX, and curriculum design specialist who has taught at all levels of nursing and is an expert in bringing the evidence base of nursing, health care, and education to students and faculty. He currently serves as director of strategic planning, NurseThink, at Wolters Kluwer Health and is a fellow in the American Academy of Nursing. https://www.newsweek.com/flying-blindembracing-aviation-style-safety-training-measures-health-care-opinion-1901620 Call for Nominations For 2024 Laura Taber Barbour Air Safety Award ALEXANDRIA, Va. -- The Laura Taber Barbour Air Safety Foundation is now accepting nominations for the 2024 Laura Taber Barbour Air Safety Award, honoring a leader in global aviation safety. The Award will be presented during the 77th Annual International Air Safety Summit, taking place November 5 – 7 in Rio de Janeiro, Brazil Presented annually since 1956, the Laura Taber Barbour Air Safety Award recognizes notable achievement in the field of civil or military aviation safety in method, design, invention, study, or other improvement. The Award's recipient is selected for a "significant individual or group effort contributing to improving aviation safety, with emphasis on original contributions," and a "significant individual or group effort performed above and beyond normal responsibilities." Mechanics, engineers, and others outside of top administrative or research positions should be especially considered. The contribution need not be recent, especially if the nominee has not received adequate recognition. Nominations that were not selected as past winners may be resubmitted for consideration in subsequent years. Please note that self-nominations will not be considered. The Award Committee, composed of leaders in the field of aviation, meets each year to conduct a final review of nominees and selection of the current year's recipient. Please help us identify and honor this year's most deserving recipient. Nominations, including a 1-to-2-page narrative, can be submitted via the Laura Taber Barbour Foundation website at http://ltbaward.org/the-award/nomination-form/. Nominations will be accepted through June 2, 2024. For more information, including a complete history of Award recipients, see www.ltbaward.org. About the Laura Taber Barbour Air Safety Foundation and Award The Laura Taber Barbour Air Safety Award's story dates back almost 80 years. On April 14, 1945, after visiting family in Pittsburgh, Laura Taber Barbour was aboard a Pennsylvania Central Airlines DC-3 when it crashed into the rugged terrain of Cheat Mountain near Morgantown, West Virginia. All passengers and crew were killed. In 1956 her husband, Dr. Clifford E. Barbour and son, Clifford E. Barbour, Jr., in close association with The Flight Safety Foundation, established the Laura Taber Barbour Air Safety Award in her honor. For the past 68 years, this distinguished award recognizing outstanding achievements in aviation safety worldwide has been presented at Flight Safety Foundation’s International Aviation Safety Summit. In 2013, The Laura Taber Barbour Air Safety Foundation was formed as an independent non-profit charitable organization composed of members of the Award Board, the aviation community, and the Barbour family. In addition to the annual presentation of the award, in 2019 the Foundation initiated a scholarship program that supports worthy students pursuing professional aviation studies. As the Foundation broadens its scope, the Laura Taber Barbour Air Safety Award will continue to recognize those who significantly contributed to aviation safety. For more information on the Foundation, the award, and past winners, visit http://LTBAward.org CALENDAR OF EVENTS • Blazetech - Aircraft Fire Hazards, Protection, and Investigation Course June 4 - 7, 2024 • (APTSC) Asia and Pacific Turboprop Safety Conference - June 26 - 27, 2024 Kuala Lumpur, Malaysia • Airborne Public Safety Association, Inc. (APSCON 2024) - July 29 - August 3; Houston TX • Asia Pacific Summit for Aviation Safety (AP-SAS 2024), Aug. 13-15, Beijing, China. • Asia Pacific Airline Training Symposium - APATS 2024, 0-11 September, 2024, Singapore • Aircraft Cabin Air International Conference - 17 & 18 September - London • 2024 Ground Handling Safety Symposium (GHSS) - September 17-18, 2024 - Fort Worth, TX • 2024 ISASI - Lisbon, Portugal - September 30 to October 4, 2024 • International Congress of Aerospace Medicine ICAM 2024 in Lisbon, Portugal, 3 - 5 October 2024 • Aviation Health Conference back on Monday 7th and Tuesday 8th October 2024 • 2024 NBAA Business Aviation Convention & Exhibition - Oct. 22-24 (Vegas) • Sixth Edition of International Accident Investigation Forum, 21 to 23 May 2025, Singapore Curt Lewis