Air Canada 797 Essay
Air Canada 797
On June 2, 1983, a passenger plane Air Canada 797, a McDonnell Douglas DC-9-32, was scheduled to depart at Dallas Fort-Worth International Airport at Dallas, Texas. The flight was a regularly scheduled international one, carrying 46 occupants—41of which were passengers and 5 were crew members headed by Captain Donald Cameron and First officer Claude Ouimet. (National Transportation Safety Board, 2002) (NationMaster. com) Flight 797 was scheduled to fly from Dallas, Texas to Montreal, Quebec, Canada, and finally to Toronto, Ontario, Canada.
There were supposedly two stopovers—the Toronto International Airport and Montreal-Dorval International Airport. (Assalamualaikum, 2009) The plane caught fire in the left aft lavatory. The crew members attempted to extinguish the fire and contacted the air traffic control (ATC) but failed. The captain and first officer then made an emergency landing on Greater Cincinnati Airport, Convington Kentucky. Despite the fact that the plane landed safely, the plane still suffered from fire and half of the passengers didn’t manage to get out of the plane before it was destroyed. Because of this, 23 passengers died, 16 had major injuries.
(NationMaster. com) All service crews, including the captain and the first officer were uninjured from the incident. Accident Details There are several reports regarding the Air Canada 797 incident, but the thorough details on the incident turn out to be only a few. According to National Transport Safety Board, it was even the pilot who noticed something wrong almost right after when the plane took off. He said that, about 30 minutes after the plane departed, a 30-inch long by g-inch wide louvered panel below the cockpit door was accidentally kicked from its foundation and fell on the floor.
He noticed that nothing went wrong on the plane so the flight still continued and progressed without incident until the plane reached Indianapolis Air Route Traffic Control Center’s (ARTCC) airspace. According to Civil Aviation Disasters, there were three succeeding snaps that the pilot heard when they were at Louisville, Kentucky. The first officer came to find out that these snaps were caused by the circuit breakers which popped out—the DC bus, the left toilet and the left toilet flushing motor. The captain tried to reset the breakers twice but failed.
There was also a passenger who grabbed the attention of the flight attendant saying that he smelled something different from the left lavatory. The flight attendant in charge saw smoke seeping under the door of the lavatory. Because of this, the flight attendant then tried to eliminate the smoke or fire using fire extinguisher but failed due to the heavy smoke. (Civil Aviation Disasters) The lavatory was already filled with smoke from floor to ceiling. Passengers were also instructed to move away from the smoke.
The flight attendant who was in charge of the CO2 extinguisher saw no flames but only thick curls of black smoke flooding through the walls of the lavatory. One flight attendant informed the captain and the first officer about the grave situation. The captain, putting on a face mask, then ordered the first officer to see what was happening. He didn’t put any face mask or portable oxygen bottle, since the plane was neither equipped with such breathing devices nor required to possess them. The first officer failed to look at the situation since the thick smoke quickly spread on the last three to four rows of seats.
None of the flight attendants and even the first officer saw fire. Their perception that the smoke coming from the trash bin was also proven to be false. When the first officer returned to the cockpit, he informed the captain that it will be better for them to go down, not telling the captain that the trash bin was not the cause of the smoke. One flight attendant, on the other hand, assured that the passengers have been moved away from the smoke and that they didn’t have to worry. The first officer went back to the lavatory wearing the captain’s smoke goggles since his goggles was not at reach during the time that he was urgently needed.
When the first officer went out of the cockpit, one officer told the captain that the smoke was clearing out. Little they did know that just after a few moments that the smoke was clearing out, it will return rapidly. The first officer on the other hand, decided to check for the second time the lavatory. When he touched the lavatory door, it was too hot so he didn’t get to open it, which indicates that the situation was getting graver. One flight attendant signalled him to immediately go back to the cockpit, so instead he just instructed the flight attendant to leave the lavatory door closed to limit the smoke overwhelming the plane.
The first officer then went back to the cockpit, telling the captain that they should really go down soon since he didn’t like what was happening. The captain already had a clue on what was happening due to the warning lights indicated on the control. During the time that the first officer was inspecting, the airplane had indicated a series of malfunctions—left a. c. and d. c. electrical systems lost its power. Because of this, the captain contacted the Indianapolis Center requesting them to standby since the plane is experiencing electrical problems.
“After 30 to 45 seconds later, the Louisville high radar sector controller working Flight 797 lost the flight’s radar beacon target. The controller then detected the computer to track all the primary targets. Flight 797’s position was then depicted on the scope by a plus sign and associated data block. ” When the first officer returned to the cockpit, the emergency warning light flashed meaning that “the ac and dc electrical buses lost its power, so the attitude directional indicators also tumbled” (National Transportation Safety Board, 2002).
The first officer activated the emergency light switch, as ordered by the captain. (National Transportation Safety Board, 2002) The first officer announced that they soon will have an emergency landing and also made a mayday call to Indianapolis. Civil Aviation Disasters stated, “As the descent began, there was a noise from the aft of the aircraft and black smoke began to billow forward. Indianapolis instructed 797 to descend to 5000ft for vectors to Cincinnati. Due to the loss of electrical power, 797’s transponder was not functioning so the controllers had no indication of the aircraft on radar.
” “Smoke filled the cabin—passengers were instructed to put wet towels on their faces (some used only the clothes that they were wearing for cover their noses) and the first officer and the captain donned oxygen masks” (National Transportation Safety Board, 2002). When the emergency landing was made, the plane already has no power to even operate the breaks. The four wheels of the plane popped. When the plane reached its stop, the first officer and the captain exited immediately. The emergency doors also opened, giving way to the passengers to reach their exit.
However, due to the thick smoke of the plane, not all found their way through the doors before the fire took over the plane. (Civil Aviation Disasters) What went wrong? There was a report made by Aviation Knowledge that 4 years before the incident happened, Flight 797 had an explosive decompression in the rear bulkhead which requires rebuilding of the tail section and replacing or splicing of hydraulic lines and most of the wiring in the aft section of the fuselage. Because of this damage, the investigators cannot identify the exact location where the fire started after the incident happened.
They added that during the initial parts of the accident, the fire wasn’t life threatening yet. Although 90 seconds after the evacuation, the oxygen contained in the plane became sufficient for it to have a flashover. Aviation Knowledge added that, “The flashover was made worse because the toxic and noxious fumes provided additional accelerants to the air mixture. “Oxygen is a highly reactant with many noxious fumes produced by chemical reactions” (Aviation Knowledge, 2009). “Given the nature and location of the fire there was nothing that the flight crew could do to stop the chemical reaction from happening.
” (Aviation Knowledge, 2009) Civil Aviation Disasters reported that “the toilet flush motor wasn’t the real cause of the accident, as perceived by the crew members of Flight 797” (Aviation Knowledge, 2009). “Tests showed that, even if it had overheated, the magnitude of the heat would not be sufficient to ignite adjacent materials. Analysis of the motor wiring showed that it had been damaged by an already existing fire which caused the circuit breakers to trip. Study of the aircraft showed that the fire had begun behind the toilet’s back wall, burning through the walls and allowing smoke to enter the toilet.
This was the reason no fire was seen when the flight attendant emptied the fire extinguisher in the toilet. As the fire burned down below the toilet, the heat was blow onto the generator cables and the circuits opened, taking them offline. The fire then continued to burn in the space between the toilet wall and the aircraft’s outer skin, allowing the fire to move forward above the ceiling panels and enter through the ceiling and sidewall panels. Unfortunately, as soon as the aircraft stopped and the doors were opened, fresh oxygen was available to feed the fire and the aircraft was quickly consumed.
The precise origin of the fire has never been determined. ” (Civil Aviation Disasters) It is also evident that on the reports that the flight attendant used a fire extinguisher and it failed since there was no fire that was in sight, only smoke. CO2 extinguishers should, because of its purpose of fighting fire, should be applied directly on the base of the fire. (Cox, 2009) Cox also added that there were some changes that were made because of the incident, proving that these things didn’t exist when the incident happened.
First of which is the lavatory fire detection. From the aforementioned story on how the smoke was detected, it is clear that the passenger who really saw the smoke first on the left lavatory of the plane. Second are full face masks/ portable crew oxygen. From the incident, it was only the captain and the first officer who had oxygen masks. Also, they were only able to access one of the oxygen masks since the other wasn’t accessible during that time the emergency was happening. The flight attendants also did not have smoke goggles.
From this incident, it is a proof that every plane needs oxygen masks for every passenger and crew member. Third is protective breathing equipment. The passengers during the incident didn’t have any protection besides the wet towels that were given to them by the flight attendants. These, certainly, were not enough given the thick smoke of the plane. Next is that the plane could have used fire blocking seats. Fabric can aggravate fire, and given the situation, or perhaps when other planes catch fire, fire blocking seats would be a great help to not intensify the situation.
The fourth one that the plane lacks is the Halon Fire Extinguisher, which killed the fire when it landed in Kentucky. What Flight 797 had during that time was CO2 fire extinguishers, which did nothing because there wasn’t any fire that was in sight before it landed. Lastly, the plane and the crew members should undergo through AC 25-9 or Smoke Testing so that when situations like this flare up, even if there’s only smoke that is in sight, the crew will immediately know what to do.
(Cox, 2009) According to Noland, the plane could also use floor lights, since it became a problem for most of the passengers to hear the instructions of the flight attendants, perhaps because they too were having a hard time talking, what more shouting, for instructions, due to the thick smoke. Most of them also, during the time of landing, could not stand and had to bend down just so they could ease their breathing process. Floor lights would be a helpful tool for them to find emergency exit doors especially during emergency incidents like this.
In the summary administered by Honorable Jane F. Garvey, she stated that the Safety Board determined 3 probable cause of the Flight 797 incident. First is that the fire had an undetermined origin. Given the situation, it must have been hard to kill the smoke given that there is not fire that is in sight. Second is the crew members underestimated the fire severity. From the narrated story, the flight attendant, shortly after they attempted to extinguish the fire, said to the captain that the situation was handled, when in fact, about a few moments later, the smoke became worse.
It was clear that despite the warning signs from the very beginning—the snaps, the circuit breakers, the smoke, the a. c. and d. c. electrical systems losing its power—all these events that went wrong would have been a clue that the plane was in dire need of an emergency landing immediately. Lastly, the Safety Board blames the conflicting fire progress information provided to the captain. Garvey also stated that one of the reasons that made the incident worsen was the slow decision making process of the crew members on doing an emergency landing.
(Garvey, 2002)It is not only during this situation, but on any situation, where a series of flare ups show, it is always a must to think of the safety of the passengers above all else—in this case, having an earlier safety landing would have saved more lives. Emergency Response Before the plane landed, there were no flames in sight—only smokes. But after the plane landed and the passengers exited, the passengers, right after they stepped out, stated that they saw fire through the left and right wing emergency exits.
This statement was also supported by the fire fighters, stating that they saw flames in the cabin. During the time that the airplane landed, the crew members and the passengers also made their way out of the plane while the fire fighters (7 airport crash-fire-rescue vehicles with 13 airport fire fighters came) initiated an exterior attack on the fire. There were still some passengers making their way out when the scene commander ordered an interior attack on the fire—for rescue purposes and extinguishing the fire.
The left aft window was targeted during the interior attack since the scene commander believed that most passengers would make their way out using the left forward cabin door and it would be difficult for the fire fighters to enter with their protective equipment and hoses with the escape chute deployed. The fire fighters attempted to enter the plane wearing self-contained breathing apparatus, not proximity suits’ protective hoods since the hoods didn’t fit the breathing apparatus.
After the foam was applied on the cabin, the fire fighters still attempted to get in the plane but didn’t make through because it was too hot, although there’s no fire seen but only thick smokes. “About 2 to 3 minutes after the attempt to enter the cabin from the wing failed, the tail cone was jettisoned, and these two fire fighters, using a ladder, entered the aft fuselage with a 1. 5-inch hand line. The rear pressure bulkhead door was opened; however, the fire fighters were driven back by the intense heat.
The fire fighters attempted to re-enter the left overwing exit and then the forward left cabin door; both attempts were unsuccessful. ” The scene commander called for fire fighting and ambulance mutual aid assistance but the only thing that was the ambulance. Despite this, 2 fire trucks and an ambulance came on its way for additional help. “Before the fire was extinguished, 12 pieces of fire fighting equipment and 53 fire fighters had responded in mutual aid from neighbouring towns. According to the on-scene commander, the firemen “had the fire pretty well under control.
. . ” when water and extinguishing agent additive were almost exhausted. According to the commander, supplies began to run out about 10 minutes after fire fighting efforts were begun, and at 1952, the on-scene crash-fire-rescue units depleted their water supplies. The units were replenished through supply lines laid by airport and mutual aid personnel to a hydrant located about 600 feet from the airplane. At 2017, 56 minutes after the fire fighting began, the fire was extinguished. ” (National Transportation Safety Board, 2002) The Crew Members and Safety procedures
Before the incident, the crew members were briefed on how to respond in case a fire flares up in the airplane—the nearest fire extinguisher, immediately attacking the fire, and a continuous communication with the captain. In the procedure, it is also said that there is an axe, which they can use if necessary, in order to rapid access to the fire through the destruction of some panels. The flight attendant said that he knows the function of the axe when they were trained, but the exact panels to destroy during fire weren’t said.
“The flight attendant in charge also testified that it was obvious that the fire was contained behind the lavatory panelling, but that he did not consider using the crash axe because he would have had to destroy the whole area of panelling in the lavatory to “get to it”” (National Transportation Safety Board, 2002). Flight attendants of Air Canada know about the CO2 extinguisher, on how to use it, and that the passengers should be moved once fumes or sever smoke invaded the plane. The flight attendants also instructed the passengers about the emergency exit doors.
When the plane was about to land, the captain instructed the flight attendants to instruct the passengers to sit until the plane lands. When the emergency doors opened, the flight attendant instructs the passengers to “come this way” heading to the emergency exit doors. Some heard the instruction, but some didn’t due to the grave situation. One passenger also said that it was impossible during that time to even gather breath and shout an instruction. It is the duty of flight attendants to do everything for the passengers to escape although they are not obliged to risk their own lives.
All of the flight attendants testified that they did everything that they can, given the situation, in order to help the passengers evacuate. None of the passengers saw if the emergency light illuminated since they had to bend down just to breath due to the thick smoke overwhelming the plane. (National Transportation Safety Board, 2002) Conclusion Based from the analysis of the accident, it can be concluded that there were actions, from the crew members, most especially, for Air Canada 797 not reach its grave end.
On a lighter note, the situation brought changes to aviation. Equipments like smoke detectors and automatic fire extinguishers were realized as something that is needed by every single airplane. Beacuase of the accident also, airplanes install fire-blocking seat cushions and floor lightings. Moreover, planes that are built 5 years after the incident were made sure to have flame-resistant interior materials. (Noland) Bibliography Assalamualaikum. (2009, March 18). Air Canada Flight 797. Retrieved May 2, 2010, from WordPress. com: http://ummulqurasaudi.
wordpress. com/2009/03/18/air-canada-flight-797/ Aviation Knowledge. (2009, October 6). Air Canada Flight 797-Fire Fight. Retrieved May 2, 2010, from Aviation Knowledge: http://aviationknowledge. wikidot. com/asi:air-canada-flight-797-fire-fight Civil Aviation Disasters. (n. d. ). Air Canada 797. Retrieved May 1, 2010, from Pilot Friend: http://www. pilotfriend. com/disasters/crash/aircanada797. htm#r Cox, J. (2009). Reducing the Risk of Smoke and Fire in Transport Airplanes: Past History, Current Risk, and Recommended Mitigations.
Retrieved March 3, 2010, from In Flight Warning Systems: http://www. inflightwarningsystems. com/docs/CoxJMitigationsPresNoVid. pdf Flight Stimulation Systems. (2006). Event Details. Retrieved May 1, 2010, from Flight Simulation Systems, LLC: http://www. fss. aero/accident-reports/look. php? report_key=202 Garvey, J. (2002, January 4). National Transportation Safety Board. Retrieved March 3, 2010, from National Transportation Safety Board: http://www. ntsb. gov/recs/letters/2001/A01_83_87. pdf
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