Chinook Helicopter Crash

1
Chinook Helicopter Crash

• RAF has maintained 30
• Chinooks since 1980.
• Used during the Gulf
• War.
• Mainly for transportation
• of equipment or Troops.

2

• Thursday 2nd June 1994
• Chinook Helicopter departs from RAF base in
• Aldergrove(Northern Ireland). Due for Fort
  George,
• Inverness (Scotland).
• Helicopter never arrives at destination.
• Chinook Helicopter crashes in to the Mull of
• Kintyre (Scotland).

3

• All 29 people onboard had died.
• 25 were senior anti terrorism experts
• (list shredded).
• 4 RAF crew
• 2 of which were pilots
• -Jonathan Tapper and Rick Cook

4

• PILOT F/LT JONATHAN P.TAPPER. (Left)PILOT
  F/LT RICHARD D.COOK. (Right)
• LOADMASTER M/SGT GRAHAM W.FORBES.LOADMASTER
  SGT KEVIN A.HARDIE.

5
Asst Chief Constable BRIAN FITZSIMONS. Det
Chief Superintendant DESMOND CONROY.Det Chief
Superintendant MAURICE REILLY.Det
Superintendant PHILLIP DAVIDSON.Det
Superintendant ROBERT FOSTER.Det
Superintendant BILLY GWILLIAM.Det
Superintendant IAN PHOENIX.Det Chief Inspector
DENIS BUNTING.Det Inspector STEPHEN
DAVIDSON.Det Inspector KEVIN MAGEE.Home Office
CB-57 JOHN DEVERILL.COLONEL CHRISTOPHER BILES.
OBE.
LT COLONEL JOHN TOBIAS.LT COLONEL GEORGE
WILLIAMS.MAJOR CHRISTOPHER J.DOCHERTY.MAJOR
ANTHONY HORNBY.MAJOR GARY SPARKS.MAJOR
RICHARD ALLEN.MAJOR ROY PUGH.ANNE
JAMES.MARTIN DALTON.JOHN HAYNES.MICHAEL
MALTBY.STEPHEN RICKARD. LT CLNL RICHARD
GREGORY-SMITH.
6
FADEC

• Full Authority Digital Electronic Control
• 2 parts (Chinooks fitted with FADEC AKA MK2)
• DECU- Digital Electronic Control Unit
• Monitors electric signals. Outputs warnings if
  necessary.
• Hydro mechanical Unit
• Receives signals from DECU so can pump correct
  fuel to engines

7
What It Does

• Controls the helicopters engine.
• Provides the correct fuel, air and ignition
  ratios.
• Less work for the pilots. No longer need to
  adjust engine at different altitudes.
• Senses the engines vital functions, and adjusts
  when required.

8
Investigation Into Crash

• Pilots were charged guilty of gross negligence
• deceased aircrew could be found negligent
• only where there was absolutely no doubt
• whatsoever
• - House of Lords

The pilots were grossly negligent in that the
pilots continued to fly the aircraft directly
towards the Mull at high speed, at low level and
in deteriorating visibility. - House Of Lords,
Session 2001-2 Paper 25
9

• At this time certain information was not
• Received by the investigators, for example-
• MOD suing FADECs manufacture at time of crash
• MOD asks manufacture of FADEC to help with the
• investigation of crash
• The engine was replaced six weeks before crash

10

• This and more came into light when media got
• Involved. Computer Weekly had compiled and
• published a detailed Report in 1999.
• House of Lords committee report found that there
  is
• Doubt about the cause of the crash because of the
• possibility of a Technical malfunction
• Pilots finally cleared of charges on Wednesday
  6th
• February 2002

11
FADEC Problems

• Chinook recently refitted from MK1 to MK2
• i.e. updated to the FADEC system
• Cheaper to run maintenance better fuel
  consumption
• The 2 pilots were reluctant to fly requested
  MK1
• - Request denied (Lack of availability)
• Number of errors experienced by testing pilots

12

• EDS- a multinational computer company ran through
• FADEC Code.
• Found 485 anomalies 20 through the code
• 56 which may have been considered serious
• MOD software specialists (AAEE )
• Aeroplane and Armament Experimental Establishment
• Also felt that the software had not met the
  standards

13

• A report by the Assistant Director of
  Helicopter Projects six weeks before the crash.
• Expressed a concern for the lack of testing.
• Also the FADEC software should be revised.
• Inquiry was not informed of this report.

14
Companies Involved

• Boeing Chinooks
  manufacture
• Textron Lycoming
• - software company
• Chandler Evans- helped designbuild parts of
  FADEC
• Hawker Siddle- wrote majority of software

15

• Concerns from EDS and AAEE were directed at
• Lycoming reply was that the issues raised were
  not
• safety critical at that time.
• As Chinook DECU system ran on two engines
• Even if both engines failed Chinook could still
  land
• As two engines were operational very unlikely
  event
• of criticality

16

• Despite of the problems raised by EDS, AAEE
• and Assistant Director Helicopter Projects the
  MK2 was cleared for flight by
• Assistant Director Helicopter Projects
• Assuming no safety critical problems had occurred
• US FADEC flight tests (not the same system as the
  RAF)

17

• New MK2 were receiving errors when testing
• Day before the crash Airworthy Assessors
• suspended flights on newly modified Chinooks
  fitted
• with FADEC.
• This was due to no satisfactory answers from the
• Contractors
• Flight trials started again in November 1994

18
Conclusion

• Comments from EDS and AAEE should
• have been looked into before release
• Number of pilots had reported errors
• Learn from past mistakes another Chinook
• crash in 1989

19

• AAEE were late in the project
• More testing could have caused delays.
• Not to rely on some ones else's flight testing
• e.g. the US
• Bad news may get filtered and therefore not
• Be passed up the chain of command.

20

• Lack of communication between parties
• involved
• MOD
• RAF
• Boeing
• Textron Lycoming
• EDS
• AAEE

21
. Allow 3rd party investigation teams for
incidents.
. Sufficient time allowed for testing methods.
. Acknowledge all possibilities in
requirements . Not to ignore other experts
opinions. - Be able to accept criticism or
judgement
. The easiest conclusion is not always the
correct one