Flight Safety Information - December 30, 2024 No. 259 In This Issue : Crash: Jeju B738 at Muan on Dec 29th 2024, gear up landing and overrun : Azerbaijan Airlines flight J28243 : Accident: PAL DH8D at Halifax on Dec 28th 2024, main gear collapse on landing : Incident: PAL Express DH8D at Bacolod City on Dec 27th 2024, runway excursion on landing : Incident: KLM B738 at Oslo on Dec 28th 2024, hydraulic problems, runway excursion : INGENIO Aerospace Heli-Mount Tablet EFB contributes to operational safety : Incident: Cem CRJ1 near George on Mar 26th 2024, shattered windshield : ietnam Airlines Makes Emergency Landing at Taoyuan Airport to Save Critically Ill Passenger, Demonstrating Excellence in Aviation Safety and Passenger Care : Accident: JAL A359 at Tokyo on Jan 2nd 2024, collided with Coast Guard DH8C on runway and burst into flames : Safety II White Paper: Assessing Resilience and Human Variability Within Aviation Safety : Accident: Sunstate DH8D at Broken Hill on Dec 26th 2024, hard landing : Akasa Air Executives Suspended Over Training Lapses : Incident: Sunstate DH8D at Broken Hill on Dec 23rd 2024, gear problem Crash: Jeju B738 at Muan on Dec 29th 2024, gear up landing and overrun By Simon Hradecky, created Sunday, Dec 29th 2024 05:43Z, last updated Sunday, Dec 29th 2024 22:11Z Note: Ground Observer Video of the bird strike and additional photos in the original article. A Jeju Boeing 737-800, registration HL8088 performing flight 7C-2216 from Bangkok (Thailand) to Muan (South Korea) with 175 passengers and 6 crew, landed on Muan's runway 19 at about 09:03L (00:03Z) with all gear up, overran the runway sliding on fuselage and engines, impacted a concrete fence about 300 meters (1000 feet) past the runway end and burst into a fireball. Two people have been rescued alive, 120 bodies have been recovered, there are no hopes for more survivors. Muan's Fire Fighters reported the malfunction of the landing gear, likely caused by a bird strike, prompted a go around. The aircraft then attempted another landing in adverse weather conditions. However, the exact cause needs to be determined by a following joint investigation. Authorities reported two survivors, a male and female, both cabin crew, were rescued alive with mid to serious injuries from the tail of the aircraft. South Korea's Ministry of Transport reported there were several issues including bird strike and landing gear malfunctions, they will thoroughly investigate to find out the causes. The ministry later added, a bird strike warning had been issued at 08:57L about 6 minutes prior to the crash, about one minute after the bird strike warning the crew declared Mayday at 08:58L while on final approach to runway 01, tower cleared the aircraft to land on opposite runway (19), the aircraft crashed 5 minutes after declaring Mayday. The flight data recorder has been recovered, the cockpit voice recorder is yet to be recovered. A ground observer reported that the aircraft flew through a flock of birds, two or three pop-sounds were heard as if the birds were ingested into engines, flames were seen from the right hand engine. The aircraft climbed a little but seemed to be unable to climb further and landed opposite direction. When the aircraft overflew the observer, it had the landing gear down. The hospital reported one of the flight attendants suffered a fractured shoulder and head injuries, but was conscious and was able to walk. ADS-B data received from the airplane ceased at 900 feet at 08:58L (23:58Z Dec 28th) while on approach to runway 01 - previous flights were received until the transponder was switched off at the apron. The videos show the aircraft was skidding on runway 19 before impacting the concrete fence. South Korea's EAIP states about bird concentration in the vincinity of the airport: The seashore and wetland are situated near Muan International Airport, and the seashore and wetland provide good nesting habitat for both resident birds such as Black-billed Magpie, Ring-necked Pheasant, Rufous Turtle Dove, Tree Sparrow, Mew Gull and migratory birds such as Mallard, Gray Heron, Egret, House Swallow. Mallards inhabit around the airport during winter season, normally October to March. Mallards are active during the morning time and evening time, and they are flying at high altitude. Gray Heron and Egret inhabit during summer season, normally August to September, and they are active during the daytime. Most of resident birds are active during the daytime and fly at low altitude. Muan International Airport strives to prevent bird strikes by implementing both non-lethal techniques, gas cannons and playback of distress calls, and lethal techniques, live ammunition shooting, during airport operating hours. Metars: RKJB 290200Z 27006KT 230V310 9999 FEW045 07/M04 Q1028 NOSIG= RKJB 290100Z 21002KT 9999 FEW045 06/M02 Q1028 NOSIG= RKJB 290000Z 11002KT 9000 FEW045 02/M00 Q1028 NOSIG= RKJB 282300Z 10004KT 9000 FEW045 M00/M01 Q1027 NOSIG= RKJB 282200Z 31002KT 9999 SCT045 02/M02 Q1027 NOSIG= RKJB 282100Z 29004KT 260V330 9999 BKN045 04/M02 Q1026 NOSIG= RKJB 282000Z 32004KT 9999 BKN045 04/M02 Q1026 NOSIG= RKJB 281900Z 31008KT 270V340 9999 BKN040 04/M02 Q1026 NOSIG= Azerbaijan Airlines flight J28243 Date:Wednesday 25 December 2024Time:06:28 UTCType: Embraer ERJ-190AR Owner/operator:Azerbaijan Airlines Registration:4K-AZ65 MSN:19000630Year of manufacture:2013 Engine model:General Electric CF34-10E Fatalities:Fatalities: 38 / Occupants: 67 Other fatalities:0 Aircraft damage: Destroyed, written off Category:Accident Location:5 km NW of Aktau Airport (SCO/UATE) - Kazakhstan Phase:Approach Nature:Passenger - Scheduled Departure airport:Baku-Heydar Aliyev International Airport (GYD/UBBB) Destination airport:Grozny Airport (GRV/URMG) Confidence Rating: Information is only available from news, social media or unofficial sources Narrative: Azerbaijan Airlines flight J28243, an Embraer ERJ-190AR, crashed near Aktau Airport, Kazakhstan, after having declared an emergency. Flightradar24 data shows the aircraft having fluctuating altitude and speed data. There are conflicting figures as to the number of people on board. According to the airline, there were five crew and 62 passengers onboard. According to information from the Ministry of Emergencies, 29 survivors were taken to the hospital. Eleven are in serious condition. Flight 8243 took off from Baku International Airport (GYD) in Azerbaijan at 03:55 UTC on a flight to Grozny Airport (GRV), Russia, that usually takes about one hour. The Russian Federal Agency for Air Transport (Rosaviatsiya) stated that during that morning the situation in the area of Grozny airport was 'very difficult'. At that time, Ukrainian military drones were reported to be carrying out attacks in the cities of Grozny and Vladikavkaz. Rosaviatsiya states that the airspace was closed as a result, without stating the timeframe of the closure in relation to flight 8243. In addition, there was 'dense fog' in the area of Grozny Airport, according to Rosaviatsiya. Metar data from 05:02 UTC show that there was an overcast cloud deck at 800 feet with a visibility in fog of 3500 m. Rosaviatsiya goes on to state that the aircraft made two attempts to land at Grozny, which were unsuccessful. The flight was then offered other airports for diversion and the flight crew decided to proceed to Aktau Airport. Flightradar24 ADS-B data stopped at 04:25 UTC reappeared at 06:07 UTC when the flight showed up over the Caspian Sea, squawking 7700 (emergency). Altitude and speed data are available from 05:14 UTC, showing fluctuating altitude and speed as the aircraft heads to Aktau Airport. According to local media, Kazaeronavigatsiya stated that the flight crew had reported problems controlling the aircraft. Videos show that the aircraft collided with terrain in a right wing low, nose down altitude. The aircraft broke up and a fire erupted. Post accident photos show that the main cabin area was consumed by the ensuing crash fire. The tail section came to rest upside down away from the main wreckage and was free of fire damage. Multiple videos, purportedly of flight J28243, are being shared on social media. They show the oxygen masks had dropped in the cabin at some point before the accident. Also, a passenger was supposedly interviewed after surviving the accident. He stated having heard an explosion during the descent or approach. He also reported observing that shrapnel had perforated his life vest. Another in-flight video shows a hole in a flap track fairing on the left-hand wing. Additionally, post accident video footage of the tail section shows multiple small holes in the tailfin as well as horizontal stabilizer. On December 27, Azerbaijan Airlines released a statement, reporting that it was suspending flights to several additional Russian airports after flights to Grozny and Makhachkala had already been suspended on December 25. This decision was made in accordance with the Azerbaijan State Civil Aviation Authority, and was based on the preliminary results of the investigation, "due to physical and technical external interference" and considering "potential risks to flight safety". METAR: UATE 250600Z 03005MPS 9999 BKN036 04/M01 Q1025 NOSIG RMK QFE767/1023 UATE 250630Z 04006MPS 9999 BKN036 04/M01 Q1025 NOSIG RMK QFE767/1023 Accident: PAL DH8D at Halifax on Dec 28th 2024, main gear collapse on landing By Simon Hradecky, created Sunday, Dec 29th 2024 10:30Z, last updated Sunday, Dec 29th 2024 10:30Z A PAL Airlines de Havilland Dash 8-400 on behalf of Air Canada, registration C-GPNA performing flight AC-2259 from St. John's,NL to Halifax,NS (Canada) with 77 people on board, had landed on Halifax's runway 23 at 21:13L (01:13Z Dec 29th) when the crew declared Mayday, Mayday after the left main gear had collapsed, the left wing contacted ground, sparks and fire were briefly visible, also mentioned by tower. The aircraft was evacuated. Metars: CYHZ 290300Z 22005KT 15SM FEW240 M02/M02 A3023 RMK CI2 SLP247= CYHZ 290200Z 21006KT 12SM MIFG FEW220 M02/M02 A3023 RMK CI1 SLP246= CYHZ 290121Z 21006KT 15SM SKC M02/M02 A3023 RMK ACCIDENT REPORT SLP247= CYHZ 290100Z 21006KT 15SM SKC M01/M01 A3023 RMK SLP249= CYHZ 290000Z 20005KT 15SM SKC M02/M04 A3024 RMK SLP252= CYHZ 282300Z 00000KT 15SM SCT220 01/M02 A3023 RMK CI3 SLP246= CYHZ 282200Z 29004KT 15SM BKN160 BKN250 01/M02 A3025 RMK AC4CI2 SLP252= CYHZ 282100Z 27004KT 15SM BKN190 02/M02 A3024 RMK AC7 SLP251= Incident: PAL Express DH8D at Bacolod City on Dec 27th 2024, runway excursion on landing By Simon Hradecky, created Saturday, Dec 28th 2024 21:57Z, last updated Saturday, Dec 28th 2024 21:57Z A PAL Express de Havilland Dash 8-400, registration RP-C5911 performing flight PR-2285 from Cebu to Bacolod City (Philippines) with 69 people on board, landed on Bacolod's runway 03 but could not stop before the end of the runway resulting in an overrun. The airline reported that the brakes could not handle the slippery portion of Runway 03 during heavy rain, the aircraft failed to stop within the intended runway length, resulting in an overshoot into the taxiway. Philippines CAA (CAAP) reported there were no injuries in the minor runway excursion. No weather data are available for Bacolod. Incident: KLM B738 at Oslo on Dec 28th 2024, hydraulic problems, runway excursion By Simon Hradecky, created Saturday, Dec 28th 2024 21:25Z, last updated Saturday, Dec 28th 2024 21:37Z Note: See photos of the aircraft seen partly off the runway in the original article. A KLM Boeing 737-800, registration PH-BXM performing flight KL-1204 from Oslo (Norway) to Amsterdam (Netherlands) with 176 passengers and 6 crew, was climbing out of Oslo's runway 19L when the crew reported hydraulic problems and stopped the climb at 5000 feet. The crew subsequently decided to divert to Oslo Torp Sandefjord Airport, where the aircraft touched down on runway 18 about 50 minutes after the departure at 19:05L (18:05Z). During roll out the aircraft veered to the right and went off the runway coming to a stop with nose and right main gear off the runway. There are no reports of injuries. Norwegian Police reported the aircraft performed an emergency landing due to a hydraulic failure. The airport is currently closed. The airline reported: "During takeoff of flight KL1204 from Oslo with destination Amsterdam this evening (28-12) a loud noise was heard. It was decided to divert to the airport of Sandefjord. After landing, the Boeing 737 veered off the runway into the grass at low speed. All 176 passengers and 6 crew members are unharmed and are being taken care of. The circumstances of the incident are being investigated." Metars Sandefjord Airport: ENTO 282020Z 22013KT 9999 OVC006 07/07 Q1015 NOSIG= ENTO 281950Z 22012KT 9999 OVC006 07/07 Q1015= ENTO 281850Z 22012KT 9999 OVC005 07/07 Q1016 NOSIG= ENTO 281820Z 21013KT 9999 OVC005 07/07 Q1017 NOSIG= ENTO 281750Z 22011KT 9999 OVC006 06/06 Q1017 NOSIG= ENTO 281720Z 21010KT 9999 OVC005 06/06 Q1017 NOSIG= ENTO 281650Z 21011KT 9999 OVC005 06/06 Q1018= ENTO 281620Z 21012KT 9999 OVC004 06/06 Q1018 NOSIG= ENTO 281550Z 21011KT 9999 OVC004 05/05 Q1018 NOSIG= ENTO 281520Z 22008KT 9999 OVC004 05/05 Q1019 TEMPO SCT006= Metars Gardermoen International Airport: ENGM 282020Z 19009KT 9999 OVC003 02/02 Q1013 TEMPO BKN005= ENGM 281950Z 14004KT 090V170 9999 SCT002 OVC005 02/02 Q1013 TEMPO BKN004= ENGM 281920Z 19008KT 3600 0750SE R19R/1400U R01R/1600D R19L/P2000N R01L/P2000N -DZ BR SCT002 OVC004 02/02 Q1014 BECMG 8000 NSW= ENGM 281850Z 19008KT 2400 0600E R19R/P2000N R01R/0800N R19L/0700U R01L/P2000N -DZ BR SCT002 OVC004 02/02 Q1014 TEMPO 0700 FG= ENGM 281820Z 19009KT 0900 0600E R19R/1800U R01R/1600U R19L/0700U R01L/0900U -RA FG VV002 02/02 Q1014 TEMPO 2000 BR= ENGM 281750Z 23003KT 200V260 0650 0500SW R19R/0900D R01R/0900D R19L/0800N R01L/0600N FG VV002 02/02 Q1015 NOSIG= ENGM 281720Z VRB01KT 0650 0550SE R19R/0900U R01R/0650N R19L/0750D R01L/0750N FG VV002 02/02 Q1015 NOSIG= ENGM 281650Z 15003KT 110V170 0700 0600NW R19R/0800N R01R/1200U R19L/0800U R01L/0800N FG VV002 02/02 Q1016= ENGM 281620Z 15003KT 100V200 0650 0500SE R19R/0900N R01R/0600N R19L/0700N R01L/0800N FG VV002 02/01 Q1016 TEMPO 0500 FG= ENGM 281550Z 21003KT 170V240 0750 0550SE R19R/1100D R01R/0650N R19L/0700D R01L/0900N FG VV002 02/01 Q1016 TEMPO 0500 FG= ENGM 281520Z 21004KT 1000 0700SE R19R/1200D R01R/0750N R19L/1100D R01L/1200U FG VV002 01/01 Q1017 TEMPO 0500 FG= INGENIO Aerospace Heli-Mount Tablet EFB contributes to operational safety INGENIO Aerospace Press Release | December 10, 2024 Estimated reading time 4 minutes, 30 seconds. Note: See photos in the original article. INGENIO Aerospace (INGENIO), a provider of innovative product design and manufacturing for business, commercial and military aviation, commented on the benefits of its Heli-Mount Tablet electronic flight bag (EFB), which helps mitigate risk in the demanding environment of rotorcraft operations. This ruggedized aircraft-type-agnostic product is a critical safety measure that addresses power requirements and operational reliability. The secure and robust mounting system improves ergonomics and facilitates pilot access to electronic tablets (i.e., Apple and Android devices). It withstands vibrations and shocks and has been successfully tested in the most demanding operating conditions. A CH-146 Griffon helicopter lands in Yellowknife, Northwest Territories. AB Erica Seymour, 4 Wing Imaging Photo One hundred and thirty shipsets have been delivered to the Royal Canadian Air Force (RCAF) for fleet upgrades – 96 units for CH-146 Griffon helicopters (the Canadian military variant of the Bell 412) and 34 for CH-148 Cyclone helicopters (the Canadian military variant of the Sikorsky S-92). Improperly secured tablets pose significant safety risks as tragically demonstrated by the 2022 crash of a CH-47D Chinook helicopter in Idaho, where National Transportation Safety Board (NTSB) investigators demonstrated that an Apple iPad likely jammed against the co-pilot’s left pedal contributing to the fatal accident. The Chinook had been engaged in firefighting operations at the time of the tragedy. Since then, the NTSB has highlighted the importance of securing electronic devices in the cockpit to prevent interference with flight controls. Exclusively designed to perform in rugged conditions, INGENIO’s Heli-Mount Tablet EFB enhances safety, utility and functionality. It may be implemented on virtually any helicopter in service today. INGENIO Aerospace Photo In addition to offering a direct interface with other avionics systems, the Heli-Mount Tablet EFB provides unrestricted USB 2.0 data passthrough and USB type-C charging connectivity. Most tablets require 15W USB power delivery for fast charge. The Heli-Mount Tablet EFB delivers charging capacity up to 60W – a significant margin for growth designed to future-proof recharging requirements. “We are proud of the safety benefits that our Heli-Mount Tablet EFB delivers,” said James Bell, president and CEO, INGENIO. “This innovative product is being installed on RCAF Griffon and Cyclone fleets, where it has performed impeccably under very challenging operational conditions. Our objective is to enhance EFB safety across private, commercial and military rotorcraft operations. Given that it is completely type-agnostic, the potential worldwide market is enormous.” “Tablet EFB’s are remarkably effective at increasing situational awareness in the cockpit. But like any loose objects, they can create hazards. The importance of robustly securing tablets is critical. The Chinook crash in Idaho makes this point with tragic clarity. Our Heli-Mount Tablet EFB contributes to superior ergonomics, operational efficiencies and – most importantly – crew and passenger safety,” concluded James Bell. Incident: Cem CRJ1 near George on Mar 26th 2024, shattered windshield By Simon Hradecky, created Thursday, May 9th 2024 19:13Z, last updated Friday, Dec 27th 2024 20:31Z A CemAir Canadair CRJ-100, registration ZS-CMK performing flight 5Z-404 from Johannesburg to George (South Africa), was enroute at FL300 about 10 minutes prior to reaching top of descent when the first officer's windshield shattered. The crew donned their oxygen masks and performed an emergency descent to FL090. The aircraft landed safely on George's runway 11. South Africa's CAA opened an investigation into the occurrence. The aircraft remained on the ground for about 48 hours before returning to service. In December 2024 South Africa's CAA released their final report concluding the probable causes of the incident were: Electrical arcing in the heating element, evidenced by the discoloured polymer interlayer, was a significant factor which caused the crack on the windshield. The arcing caused localised high temperatures and electrical stress. Extensive delamination between the outer glass layer and the interlayer on the heating element interface compromised the heating element’s effectiveness. The temperature gradient and stress of the malfunctioning heating element likely caused the delamination. The stress which exceeded the tempered glass layer’s limits led to the fracture and further delamination. The CAA summarized the sequence of events: The aircraft departed from FAOR to FAGG at 0810Z, operated under instruments flight rules [IFR]. Around 0930Z whilst cruising at FL300 and about 10 minutes before the top of descent, the starboard (right-side) cockpit windshield cracked. The first officer (FO) who was the pilot flying (PF) promptly donned the oxygen mask and declared an emergency to Cape Town (FACT) air traffic control (ATC). The ATC officer cleared the aircraft to descend to FL090. The aircraft descended safely and, later, executed an uneventful landing on Runway (RWY) 11 at FAGG. The damage was confined to the starboard cockpit windshield; all occupants were not injured. Upon inspection of the starboard windshield assembly, significant fractures were found on the outer glass layer; moreover, extensive delamination was found between the outer and intermediate layers on the heating element interface. This delamination caused the temperature gradient which increased stress on the glass. The primary cause of the failure was localised arcing where delamination had occurred; this was likely due to moisture ingress between the glass layers. The arcing increased localised stress which led to the windshield’s crack. Vietnam Airlines Makes Emergency Landing at Taoyuan Airport to Save Critically Ill Passenger, Demonstrating Excellence in Aviation Safety and Passenger Care Friday, December 27, 2024 Vietnam Airlines flight VN307, en route from Taipei to Ho Chi Minh City (HCMC), made an emergency landing at Taoyuan Airport on Wednesday to assist a critically ill passenger. The swift actions of the flight crew and the timely intervention of a medical professional on board were instrumental in saving the passenger’s life. About two hours into the flight, a 32-year-old Vietnamese male passenger seated in 24G began exhibiting alarming health symptoms, including low blood pressure and cold extremities. The flight crew promptly called for assistance, and a nurse on board assessed the passenger’s condition. The nurse determined that immediate medical intervention was crucial. After consulting with Vietnam Airlines’ operations center, the flight crew made the decision to divert the aircraft to Taoyuan Airport. The aircraft landed at 1:27 p.m., where the Vietnam Airlines office in Taiwan had already arranged for an ambulance to transport the passenger to a nearby hospital. The passenger, who was initially in critical condition, is now conscious and undergoing medical tests and monitoring at the hospital. This quick response underscores Vietnam Airlines’ commitment to prioritizing passenger health and safety, even when it incurs additional operational costs. Flight VN307 resumed its journey to HCMC after a delay of approximately three hours and ten minutes. Despite the disruption, the airline’s handling of the emergency situation received commendation from passengers and aviation professionals alike. Vietnam Airlines has established a commendable reputation for its proactive approach to passenger health emergencies. Over the years, the airline has consistently prioritized safety, making emergency landings when necessary to ensure that passengers receive timely medical attention. While such diversions entail significant costs for additional fuel and ground services, the airline remains unwavering in its commitment to passenger welfare. This incident highlights the importance of having trained medical personnel among passengers and the readiness of flight crews to handle emergencies. Vietnam Airlines’ actions not only saved a life but also reinforced the trust and confidence of travelers in their service. As air travel continues to grow, incidents like these emphasize the critical role of safety protocols and emergency preparedness in the aviation industry. Vietnam Airlines’ exemplary response serves as a model for other carriers to follow, showcasing the airline’s dedication to passenger care and operational excellence. Accident: JAL A359 at Tokyo on Jan 2nd 2024, collided with Coast Guard DH8C on runway and burst into flames By Simon Hradecky, created Tuesday, Jan 2nd 2024 10:07Z, last updated Friday, Dec 27th 2024 18:08Z A JAL Japan Airlines Airbus A350-900, registration JA13XJ performing flight JL-516 from Sapporo to Tokyo Haneda (Japan) with 367 passengers and 12 crew, landed on Haneda's runway 34R at 17:47L (08:47Z) in night time conditions but collided with a Japanese Coast Guard Dash 8-300 registration JA722A (Coast Guard code MA722) on the runway shortly after touchdown and burst into flames. The A350 came to a stop off the right hand edge of the runway about 1680 meters/5510 feet down the runway and was evacuated. All occupants were able to evacuate. The other aircraft carrying 6 people also burst into flames, 5 of the six occupants are confirmed dead. Both aircraft burned down. 15 passengers of the A359 received injuries, the captain of the Dash 8 received serious injuries. The aircraft fires were extinguished about 8 hours after the collision. The airline reported their A350 was carrying 367 passengers (including 8 children) and 12 crew, all of them evacuated from the aircraft. In a second press release the airline reported there had been no anomaly with the aircraft prior to departure. The crew had received and read back landing clearance. After the collision and coming to a stand still three emergency slides were used to evacuate the occupants of the aircraft. The details of the accident are under investigation by the JTSB. Japan's Coast Guard reported their Dash 8-300 registration JA722A (Code MA722) was carrying 6 people, the captain was able to evacuate, the other 5 are currently missing. The aircraft was carrying supplies to their Niigata base where the New Year's Earthquake struck. Tokyo's Metropolitan Police reported 5 of the occupants of the Dash 8 are confirmed dead. Tokyo's fire department reported, the captain of the DH8C received serious injuries, 17 occupants of the A359 received injuries. Later the Fire Department corrected the number to 14 injuries amongst the occupants of the A359. Passengers of the A359 reported the landing appeared normal at first, after touchdown there was a thud and the outside lit up in orange. A first announcement was made "please calm down" followed by "do not take your luggage and do not stand up". There was no clear announcement to evacuate, however, when other passengers stood up they also stood up and thus escaped. Japan's Ministry of Transport stated Haneda Airport was closed, the flights cancelled, there is no prediction when the airport will open again. In a press conference the Ministry of Transport stated that it is under investigation whether JL-516 had been cleared to land. There was a Coast Guard aircraft on the runway causing a collision, the details of the collision are under investigation. In a graphics the Ministry showed the approximate positions of both aircraft (see below). In the afternoon of Jan 2nd 2024 (European Time) the French BEA reported they have dispatched 4 investigators and 5 technical advisors to Tokyo to join Japan's JTSB, who are investigating the accident. The team is expected to be on site by Jan 3rd 2024. A number of arriving flights are being diverted to Narita Airport where the flights are being accepted one by one. According to ATC recordings the A359 as well as a number of other aircraft departing runway 34R were handed off to Tower Frequency 118.725MHz, however, the Coast Guard DH8C was handed off to tower at 124.350MHz. JL-516, upon being handed off to tower by approach, was told by tower to "continue approach", about 90 seconds later tower cleared the aircraft to land. Haneda Airport resumed operations on their runways 16R/34L, 04/22 and 05/23 at about 21:30L (12:30Z) about 3:45 hours after the accident while runway 16L/34R remains closed. On Jan 3rd 2024 Japan's Ministry of Transport said, that the DH8C had received instructions to proceed as far as he could, the coast guard captain by his own testimony however understood this instruction as takeoff clearance, lined up runway 34R instead leading to the collision. The JTSB is investigating the occurrence. In the evening of Jan 3rd 2024 Japan's Ministry of Transport released a transcript of the ATC communication (see below, the Ministry also released a version that translates the communication to Japanese) that states, that JL516 was cleared to land on runway 34R, winds 310 at 8. About 10 seconds later and about 2:16 minutes prior to collision the DH8C reported on tower and was cleared to taxi to holding point C5 (Runway 34R), which was correctly read back by the crew. There is no record of any further clearance to the DH8C (other than the captain of the DH8C stated that he had takeoff clearance). On Jan 3rd 2024 the JTSB reported one of the black boxes of the DH8C have already been recovered, the blackboxes of the A359 are yet to be recovered. On Jan 3rd 2024 Tokyo's Metropolitan Police reported they too have opened an investigation for professional negligence into the accident. On Jan 3rd 2024 the airline reported the aircraft skidded for about 1000 meters after the collision. The last person got off the A359 at 18:05L, 18 minutes after the collision. In the evening of Jan 3rd 2024 the British AAIB announced they also have sent a team of investigators to Japan to assist the JTSB in their investigation. On Jan 4th 2024 the JAL reported that actually 15 passengers needed medical attention. There were three pilots in the cockpit, none of them was able to see the DH8C, therefore a go around was never considered. After the aircraft came to a stop the cockpit crew was not aware of any fire, however, flight attendants reported fire from the aircraft. The purser went to the cockpit and reported the fire and received instruction to evacuate. Evacuation thus began with the two front exits (left and right) closest to the cockpit. Of the other 6 emergency exits 5 were already in fire, only the left aft exit was still usable. The Intercom malfunctioned, communication from the aft aircraft with the cockpit was thus impossible. As result the aft flight attendants gave up receiving instructions from the cockpit and opened the emergency exit on their own initiative. On Jan 4th 2024 Japan's Ministry of Transport stated that it appears the tower controller was not aware of the Coast Guard DH8C on the runway. The pilots of the A359 did not see the DH8C and are currently being interviewed by the JTSB. On Jan 4th 2024 Tokyo's Metropolitan Police reported in an interview with them the captain of the DH8C stated that suddenly a fire started in the back of or behind the aircraft. The Police is investigating whether the captain was aware there had been a collision with the passenger aircraft. On Jan 5th 2024 works to clear the runway are under way. The flight data recorder of the A359 was recovered, the CVR has not yet been found. On Jan 5th 2024 the Ministry of Transport reported that the tower controller in charge stated in an interview, that after giving the taxi instructions to the DH8C he turned his attention towards other aircraft and did not notice the DH8C had taxied onto the runway. The runway monitoring system has been working properly. The DH8C stopped on the runway for about 40 seconds, it is possible that the controller missed the alert display, there is no rule requiring the controller to stare onto the screen all times, the screen would turn red and runway be flashing yellow (operative on all runways since 2011). Runway 34R is estimated to return to service on Jan 8th 2024. According to a Japanese Media report by a reporter on board of the A359 as passenger the evacuation was mainly completed about 7 minutes after the collision, the captain subsequently walked through the aircraft and found a number of passengers who had not yet evacuated and prompted them to leave the aircraft. The captain was the last to leave the aircraft 18 minutes after coming to a stop. In the evening of Jan 5th 2024 the Ministry added, that the aircraft had been evacuated within 7 minutes after the collision, however, it took another 11 minutes until the captain managed to convince several petrified passengers still in the cabin to leave the aircraft. On Jan 6th 2024 Japans Ministry of Transport said, that so far there had been no rule requiring air traffic control to permanently monitor the positions of aircraft to prevent incorrect approaches to the runways. Starting Jan 6th 2024 a new position in the ATC center was created to permanently monitor the monitors showing aircraft positions in order to prevent aircraft incorrectly entering the runways. The number of ATC staff will not be increased, however. The Cockpit Voice Recorder of the A359 was recovered on Jan 6th and is being analysed. Interviews with the air traffic controllers in charge of runway 34R are to be conducted. On Jan 7th 2024 (UTC) runway 34R was returned to service at midnight Jan 8th 2024 Japan Time, after the wreckages of both aircraft had been removed and the runway had been repaired. More than 1200 (domestic) flights had to be cancelled during the closure of the runway due to the non-availability of the runway. On Jan 9th 2024 Japan's Ministry of Transport stated that the departure sequencing is no longer to be told to the flight crews, "number one" etc. is abandoned for departures. There is a possibility that the flight crew of the DH8C mistook that information as clearance for takeoff. In a press conference on Jan 23rd 2024 the JTSB reported that the data have been successfully downloaded from the flight data recorders and voice recorders of both aircraft and are now being analysed. On Dec 25th 2024 the JTSB released their preliminary report in Japanese only (166 pages) summarizing the events on board of the DH8C. The DH8C had been cleared to taxi via taxiways H and C to holding point C5. Tower giving priority to the aircraft indicated that the aircraft would be number 1 for takeoff, the crew read this information back correctly while taxiing towards C5, the crew verified they had sufficient takeoff distance available. The captain thought they had received clearance to line up runway 34R, the crew turned the anticollision lights on and worked the before takeoff checklist. In a partially overlapping radio communication the crew heard "Runway 34R, cleared for takeoff". The aircraft lined up and stopped. In that moment the collision between the aircraft occurred. Related NOTAMs: J0019/24 NOTAMN Q) RJJJ/QMRLC/IV/NBO/A/000/999/3533N13947E005 A) RJTT B) 2401021538 C) 2401031500 EST E) RWY 16L/34R-CLSD DUE TO DISABLED ACFT E5877/23 NOTAMN Q) RJJJ/QMXLC/IV/M/A/000/999/3533N13947E005 A) RJTT B) 2401021530 C) 2401302130 D) 02 05 09 12 16 19 23 26 30 1530/2130 E) TWY C1 THRU C14-CLSD DUE TO MAINT E0023/24 NOTAMN Q) RJJJ/QMXLC/IV/M/A/000/999/3533N13947E005 A) RJTT B) 2401020930 C) 2401021500 EST E) TWY C1 THRU C14-CLSD DUE TO TRBL J0011/24 NOTAMR J0010/24 Q) RJJJ/QMRLC/IV/NBO/A/000/999/3533N13947E005 A) RJTT B) 2401021136 C) 2401021300 EST E) ALL RWY-CLSD DUE TO DISABLED ACFT E0025/24 NOTAMN Q) RJJJ/QMXLC/IV/M/A/000/999/3533N13947E005 A) RJTT B) 2401021144 C) 2401021300 EST E) TWY C(FM C1 TO C14)-CLSD DUE TO TRBL E0026/24 NOTAMR E0024/24 Q) RJJJ/QMXLC/IV/M/A/000/999/3533N13947E005 A) RJTT B) 2401021154 C) 2401031200 E) TWY G(BTN C AND H2),G(INT OF H2)-CLSD DUE TO RESCUE OPR E0024/24 NOTAMN Q) RJJJ/QMXLC/IV/M/A/000/999/3533N13947E005 A) RJTT B) 2401020953 C) 2401021200 E) TWY G(BTN C AND H2),G(INT OF H2)-CLSD DUE TO RESCUE OPR J2253/23 NOTAMN Q) RJJJ/QLRAS/IV/NBO/A/000/999/3533N13947E005 A) RJTT B) 2312271500 C) 2402211500 E) REF AIP SUP 225/23 ITEM TWY:2,3,4,5,6,7,10,11,12,13,33,38,44,54 TWY-CL-LGT FOR M1,R1,W11(BTN W AND R1)-U/S TWY-CL-LGT FOR E10(BEHIND SPOT 53)-PARTLY U/S TWY-CL-LGT FOR D5-U/S TWY-CL-LGT FOR A(BTN W AND A2),A(INT OF W1),A1,A2(INT OF A),W1 -PARTLY U/S TWY-CL-LGT FOR A16-U/S TWY-CL-LGT FOR K(BTN SPOT 304 AND C),R(INT OF K)-U/S TWY-CL-LGT FOR R(BTN K AND Y),R(INT OF Y)-PARTLY U/S STOP-BAR-LGT FOR C1 THRU C14-U/S TWY-CL-LGT FOR T12,T14,Q,Q1,Q2-U/S TAXIING-GUIDANCE-SIGN FOR T12,T14,Q,Q1,Q2-U/S TWY-CL-LGT FOR C(INT OF C3),C(INT OF C5)-PARTLY U/S TWY-CL-LGT FOR T(BTN T2 AND SPOT 909),T(INT OF T4),T(INT OF T6) -PARTLY U/S TWY-CL-LGT FOR C3(INT OF RWY 16L/34R)-PARTLY U/S RAPID EXIT TWY INDICATOR LGT FOR D5-U/S Metars: RJTT 021000Z 32003KT 9999 R34L/P2000N R22/P2000N R34R/P2000N R05/P2000N FU BKN015 08/04 Q1016 NOSIG RMK 7SC015 A3002 1000E FU ON RWYC-MID= RJTT 020930Z 31007KT 9999 R34L/P2000N R22/P2000N R34R/0900VP2000U R05/P2000N FU BKN015 08/04 Q1016 NOSIG= RJTT 020900Z 33008KT 9999 FEW020 07/04 Q1016 NOSIG= RJTT 020830Z VRB03KT 9999 FEW020 SCT090 08/04 Q1016 BECMG TL0900 30006KT= RJTT 020800Z 13003KT 090V150 9999 FEW020 BKN090 09/05 Q1016 BECMG TL0930 30006KT RMK 1CU020 6AC090 A3000= RJTT 020730Z 16007KT 130V190 9999 FEW020 BKN100 08/05 Q1016 NOSIG= RJTT 020700Z 12007KT 9999 FEW030 BKN100 09/04 Q1016 NOSIG= RJTT 020630Z 13010KT 9999 -RA FEW030 BKN070 09/04 Q1016 NOSIG= RJTT 020600Z 14005KT 120V180 9999 -RA FEW030 SCT060 BKN080 08/03 Q1017 NOSIG= RJTT 020530Z 12005KT 9999 -RA FEW025 SCT060 BKN080 08/02 Q1017 NOSIG= RJTT 020500Z 09003KT 050V120 9999 -RA FEW040 BKN060 08/02 Q1017 NOSIG= RJTT 020430Z VRB01KT 9999 -RA FEW030 BKN050 09/01 Q1018 NOSIG= RJTT 020400Z 01003KT 310V060 9999 -RA FEW030 BKN045 09/00 Q1018 NOSIG= CCTV Video of line up of Coast Guard (at 2:40 mins), landing of A359 (coming into sight at 3:20 mins) and collision at 3:47 mins (Video: Single Preference): Safety II White Paper: Assessing Resilience and Human Variability Within Aviation Safety Nov 11, 2024 By Gareth Coville , Dharm Guruswamy , Brian Hilburn, Ph.D. , Chuck Huber , Houda Kerkoub , Gene Lin, Ph.D. , David McKenney , Greg Sizemore Transportation New, complementary approaches are needed to improve upon existing FAA safety accomplishments. As the nation's aerospace system becomes ever more complex, traditional data-driven safety approaches of addressing precursors to accidents are becoming more challenging. Safety II offers a complementary approach to the FAA's traditional safety management approaches. Safety II acknowledges that humans bring variability to complex sociotechnical systems, and as a result, precursors will always exist. Our nation's aerospace system is an example of a complex sociotechnical system that consists of both the daily operations of the National Airspace System (NAS), and the processes employed to design, build, certify, and maintain aerospace products. The FAA and other aviation stakeholders can continually improve the safety of the aerospace system by learning from all operations (i.e., asking what is working well in addition to focusing on what went wrong) and understanding how human variability is contributing to safety. Download White Paper • Safety II White Paper: Assessing Resilience and Human Variability Within Aviation Safety Accident: Sunstate DH8D at Broken Hill on Dec 26th 2024, hard landing By Simon Hradecky, created Friday, Dec 27th 2024 17:23Z, last updated Friday, Dec 27th 2024 17:23Z A Sunstate Airlines de Havilland Dash 8-400, registration VH-QOD performing flight QF-2017 from Sydney,NS to Broken Hill,NS (Australia), landed on Broken Hill's runway 06 but touched down hard in gale force winds. The aircraft went around and entered a hold for about 75 minutes while working checklists due to resulting gear problems and waiting for weather improvement. The aircraft subsequently landed on runway 06 with emergency services waiting for the aircraft and became disabled on the runway. The runway was closed for a number of hours. The aircraft is still on the ground in Broken Hill about 38 hours after landing. Broken Hill's City Council advised that the airport was closed for the remainder of the day. The airline reported the crew elected to do a go around after identifying a a gear problem, that could be unsettling for the passengers. No weather data are available for Broken Hill. Akasa Air Executives Suspended Over Training Lapses The DGCA, India's aviation safety regulator, has suspended Akasa Air's Director of Operations and Director of Training for six months due to lapses in pilots' training. The suspension follows unsatisfactory responses to previous show-cause notices. Akasa Air has pledged compliance, emphasizing its commitment to safety. Devdiscourse News Desk | Mumbai | Updated: 27-12-2024 21:14 IST | Created: 27-12-2024 21:14 IST The Directorate General of Civil Aviation (DGCA) has taken decisive action against two senior officials at Akasa Air, suspending their roles due to alleged failures in pilot training standards. This six-month suspension targets the Director of Operations and Director of Training. The aviation regulator's orders, issued on December 27, came after a regulatory audit highlighted that Required Navigation Performance (RNP) training was conducted on unqualified simulators. This violation, among others, prompted the DGCA to act after unsatisfactory explanations from the executives in response to show-cause notices earlier this year. In response, Akasa Air has issued a statement asserting compliance with the DGCA's order and reaffirming their commitment to maintaining high safety standards. The DGCA has advised the airline to appoint suitable replacements for the suspended positions. Incident: Sunstate DH8D at Broken Hill on Dec 23rd 2024, gear problem By Simon Hradecky, created Friday, Dec 27th 2024 17:00Z, last updated Friday, Dec 27th 2024 17:00Z A Sunstate Airlines de Havilland Dash 8-400 on behalf of Qantas, registration VH-QOI performing flight QF-2017 from Sydney,NS to Broken Hill,NS (Australia), had been enroute at FL220 and was in the initial descent towards Broken Hill when the crew stopped the descent at FL180 and decided to return to Sydney due to a gear problem. The aircraft landed safely back in Sydney about 3:20 hours after departure. A replacement DH8D registration VH-QOY reached Broken Hill with a delay of about 5 hours. The occurrence aircraft returned to service about 20 hours after landing back. Curt Lewis