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It's horribly unpopular to pick on the dead pilots, particularly when it looks like you're sticking up for a big evil corporation, but sadly you're very likely correct. In both cases, the pilots didn't strictly follow procedure. In the Lion Air case, they forgot about the stab trim completely for some reason. This had happened on the previous flight too; it was only saved because a 3rd (non-Lion Air) pilot happened to be in the cockpit and told them what to do. In the Ethiopian Air example, they remembered, shut off the stab trim, but then increased thrust too high to adjust the trim manually, and then turned the electric trim system back on. It's possible they could have saved the plane at that point, adjusting the electric trim by hand then turning it back off (to defeat MCAS), but they didn't.

It remains crazy how much this procedure would have required the pilots to do. It's utterly senseless how bad cockpit automation remains in 2019. If Boeing was going to add a bunch of code to the cockpit, they should have made flying the plane in an emergency easier, not harder.



> In both cases, the pilots didn't strictly follow procedure

But would "the procedure" actually have saved the plane? I don't believe so. WalterBright is arguing that the pilots should have known better than "the procedure" and done something different from what the checklists and memory items proscribed. I can't comment on doing so — as I'm not an airline pilot — but to put blame on pilots in this sort of situation without acknowledging Boeing's actions is beyond tasteless.

IMHO Boeing is 100% responsible for the deaths.


I specifically wrote "There's plenty of failure that needs to be dealt with all around with those accidents." That means Boeing, the airline, the FAA, and the pilots. To say that any one action is 100% of the cause is incorrect. Every point of failure needs to be corrected in the chain of events leading to the crash.

> tasteless

When you're trying to make airplanes safe, matters of taste, politics, emotions and legal culpability have nothing to do with it. The NTSB has a very good track record of dispassionately sticking to the facts, and I am looking forward to reading their report.


I completely agree.

Here's the deal, though: this wasn't just one crash. It was two. The failure mode of the second was indeed different than the first: it was a failure of Boeing and the aviation authorities to appropriately respond to the first disaster.

To propose that pilots should have willy-nilly flipped MCAS on and off based on your reading of the news is just staggering. What if there was another bug where turning on MCAS when there was an AoA disagree led to an instant plunge, regardless of etrim inputs? I'd bet you'd be critiquing those dead pilots for not following the checklist — and keeping MCAS off — in such a case.


Turning it back on is indeed what the EA pilots did after being unable to use the manual trim, if I read the account correctly, the MCAS re-engaged and caused the final plunge. That wasn't on the checklist. But if they'd also engaged the manual trim switches, it would have corrected the nose down.

It's not willy-nilly nor staggering. The EAD (referenced in another post here) indeed talks about using the electric trim to fix the nose down problem, and then cutting off power to the system.


I think one piece of information you’re missing is that they also had cockpit warnings that the sensors were malfunctioning, and the pilot side controls were stuck on stick-shake the whole ride.

So add in the part where you can’t actually trust what your instruments are telling you, and the plane is flying like a demon has possessed it.

In the moment you are wondering, is the plane stalling? Is my airspeed actually what is being displayed? Why is trim not responding? My heart is beating 200bpm. Is that whooshing the blood in my ears or the wind?

The answers to these questions is obvious in hindsight. In that moment the flight had entered mortal peril. The question is not why didn’t the pilots recover from mortal peril with perfect hindsight. The question is how did this flight get into mortal peril in the first place?


Yes, indeed. It doesn't talk about turning STAB TRIM back on, though, nor does it talk about turning STAB TRIM on with etrim inputs already applied — that's what I was calling your homegrown protocol.

My point is that it's easy to armchair quarterback the pilots whether they followed the checklist or went off checklist to do something better or worse. The problem started long before they got in the cockpit, though, and had been made evident once before at the cost of 189 lives. To continue to focus on pilots' actions at this point is missing the elephant for the flea.


> It doesn't talk about turning STAB TRIM back on, though, nor does it talk about turning STAB TRIM on with etrim inputs already applied — that's what I was calling your homegrown protocol.

The EA pilots already had gone off the checklist when they turned the stab trim back on.


Responsibility is a tricky thing in tragedies like this. In hindsight, yeah, Boeing undoubtedly should have made more noise about this possible failure condition, and/or tested the system better, and/or designed the stall-prevention system to deal with sensor failures more gracefully, and/or redesigned the wing, and/or spent more time on their simulators, and/or designed a whole new plane. But none of those options are risk-free in terms of safety. Making MCAS more complicated might have made it riskier and harder to test. A new airplane could have come with new problems (like the 787, which has nearly exploded in flight due to battery problems).

I said "pick on" the pilots, not "blame" them. There were a lot of bad things that added up. In the case of the Lion Air flight, the maintenance staff signed off on the plane even though they were aware the angle-of-attack sensors were completely broken, which had nearly caused a crash on the previous flight. The previous flights' pilots also either didn't report this incident, or their report was disregarded. Then when the emergency occurred, the pilots didn't know what to do. There are many reasons that that any plane's trim system could have malfunctioned, and the black box data suggests the pilots would have been unable to manage any of them. So the plane was taking off in an non-airworthy state with pilots who didn't know how to deal with a common system failure and weren't told that a system had just malfunctioned hours previously on this exact aircraft. The MCAS failure was a match thrown into a kindling box of bad circumstances.


Ok, sure, but you're picking on the pilots for not following Boeing's procedure exactly. And at the same time, WalterBright is picking on them for attempting to follow the procedure. And at the same time, I'm arguing that it's unclear if Boeing's procedure would have saved them at all.

The LionAir crash was a tragedy. The Ethiopian Airlines crash was not just a tragedy; it was a complete systemic failure to appropriately react.




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