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| Mrshed
July 14, 2025, 19:41:00 GMT permalink Post: 11922448 |
If you think everything is said...
Breaking News: On Jul 14th 2025 India's DGCA instructed airlines to check the fuel switches on the Boeing 787 and Boeing 737 aircraft as used by Air India Group, Indigo and Spicejet for possible disengagement of the fuel control switch locking feature according to the SAIB released by the FAA on Dec 17th 2018. The checks have to be completed by Jul 21st 2025. Source: Avherald.com FWIW I don't think everything is said, and further elements may be uncovered - I just think the investigators have laid out pretty clearly areas they think are (and are not) likely causes when you read between the lines. Incidentally the above smacks of optics to me following it being shared that air India had not performed these checks, and the associated speculation of cause, but that's just a theory 😉 Subjects (links are to this post in the relevant subject page so that this post can be seen in context): DGCA FAA Fuel (All) Fuel Cutoff Switches Special Airworthiness Information Bulletin |
| Mrshed
July 15, 2025, 08:48:00 GMT permalink Post: 11922748 |
The odds of this being a mistake are incredibly low.
However, while on observation this makes a deliberate act appear more likely, that ignores the odds of a suicidal pilot ready to act in this way being in the cockpit also are incredibly low. Can't work out the whole Bayesian side on this obviously but subjectively, both options are very low likelihood (perhaps equally low likelihood) and so on the facts we have today it's very premature to conclude deliberate act. Incidentally, two things can be concurrently true: 1. Deliberate act is likely enough, given what we know, to be worthy of discussion and tabling as an option. 2. Deliberate act cannot be concluded definitively, nor can the possibility of a mistake be ruled out, given what we know. A little too binary in viewpoint on these two considerations from a few here I think (both ways). Subjects: None |
| Mrshed
July 15, 2025, 14:53:00 GMT permalink Post: 11923004 |
I think there's a number of reasons this could have been delayed. - Overloaded pilot distracted between the two switches being moved up - Initial view that key focus was to get at least one engine back, then changed mind (realised how low they were? realised single engine startup would take too long to relevant thrust?) I think the additional time to start something up *and trying to ensure a good operational state and outcome* vs someone just basically "pulling the plug" is understandable. Subjects: None |
| Mrshed
July 15, 2025, 21:32:00 GMT permalink Post: 11923282 |
There is likely also extensive testing to be conducted to exclude even the most remote possibilities that have been discussed here.
Maybe the real reason for his early retirement was less noble.
It is fairly common in the US airline industry to offer a pilot the option to resign prior to being fired. Subjects: None |
| Mrshed
July 15, 2025, 21:34:00 GMT permalink Post: 11923283 |
Subjects (links are to this post in the relevant subject page so that this post can be seen in context): Fuel (All) Fuel Cutoff Switches RUN/CUTOFF |
| Mrshed
July 15, 2025, 21:38:00 GMT permalink Post: 11923288 |
So why did they give so much space to a discussion of SAIB NM-18-33? It's obvious that the switches were not faulty, or they'd have said. If they couldn't tell if the switches were faulty, they'd have said. They do tell us that the throttle control module was swapped out and there's been no problem with the switches. So they don't need to mention it. It doesn't read to me as a logical part of the preliminary report, but as something they were under pressure to include to imply that there may have been a technical problem rather than pilot malfunction.
Simplest answer is often the best - they included it to show they had considered it? Imagine this forum if they hadn't included a nod to the SAIB - 90% of posts would be about the SAIB. can't really win on this one in the court of public opinion. Included or not, they made no recommendations for even proactive reminding of the SAIB to operators. This is more telling for me.
They are as aware as anyone on this forum of previous SAIB relating to these switches, and explicitly reference them in the report, and haven't even taken the incredibly easy step of "re-suggesting" this. This is telling and should be very carefully considered before further suggestions in this direction.
Subjects (links are to this post in the relevant subject page so that this post can be seen in context): Fuel (All) Fuel Cutoff Switches Preliminary Report SAIB NM-18-33 Special Airworthiness Information Bulletin |
| Mrshed
July 15, 2025, 21:57:00 GMT permalink Post: 11923299 |
Other than the report stating (by implication of IAS etc) no issue with thrust until the switches were moved, as well as the CVR exchange shared makes basically no sense in that scenario.
Subjects (links are to this post in the relevant subject page so that this post can be seen in context): CVR Memory Items Preliminary Report |
| Mrshed
July 16, 2025, 05:42:00 GMT permalink Post: 11923437 |
The timestamps most certainly are not synced so the blue boxes on my image almost certainly need to move a little left or right, but actually when I looked at them before I think it's pretty close. What is it that makes you think they are out (genuine question!). Subjects (links are to this post in the relevant subject page so that this post can be seen in context): ADSB |
| Mrshed
July 16, 2025, 06:00:00 GMT permalink Post: 11923444 |
- mental health issues are grossly underestimated in all areas, particularly by those who haven't experienced them but also even by those that have. Period. - they are further under recognised in males compared to females, and so would still today disproportionately affect this sector - they are less likely to be called out by individuals in organisations/sectors that have a more explicit sense of hierarchy - they are less likely to be called out by individuals who have potential consequences to livelihood in doing so - pilots are humans too Pilots, possibly, have a set of personal traits that led to them becoming pilots in the first place, that likely make them less predisposed to mental health issues (on average) - for example, they are less likely to have a neurodivergence which has a very strong comorbidity with mental health concerns. However, they also possibly have a higher level of environmental factors that can contribute to mental health issues such as the sheer chronic level of accountability held and the stress that this could cause. They certainly work in an environment which has fundamental reasons that would discourage sharing of mental health concerns, and even reduce self recognition of these issues. A few examples only, certainly not exhaustive. But TL;DR - I'd posit that the rate of truly experienced mental health issues experienced in pilots is higher than whatever rate almost anyone is thinking. Around 12% of people globally have a mental health issue at any given time - even being incredibly conservative, the rate in pilots is clearly going to be at least in single whole figure percentages (which is far from rare). Obviously the majority of these issues are not going to be those with severe outcomes, but some will. And almost all mental health issues tend to affect cognitive ability to at least some level. Slowness in action and fatigue are diagnostic criteria for many of the most common mental health conditions for example. Subjects (links are to this post in the relevant subject page so that this post can be seen in context): Mental Health |
| Mrshed
July 16, 2025, 06:03:00 GMT permalink Post: 11923446 |
It was your suggestion that the pilot here potentially had been allowed to retire rather than being sacked that I think is a little far in speculation given no evidence behind it. Subjects (links are to this post in the relevant subject page so that this post can be seen in context): Muscle Memory |
| Mrshed
July 16, 2025, 07:50:00 GMT permalink Post: 11923495 |
Thank you @Mrshed. Outstanding post.
As a critical care physician (with AVMED background), these last few years we seeing unprecedented rates of self-reported stress, anxiety, depression, and deliberate self-harm. This is being experienced in most western countries (perhaps globally, but I have less direct knowledge of non-western countries). It is absolutely off the scale. In my 35 year career, I have never seen anything like the last 4 years. Sadly, I am confident this phenomenon will result in more incidents like Germanwings, MH370 and this. I have no good solution to this problem in any industry but in pilots in particular. The only good way is to create a culture where these issues can be shared genuinely without fear of judgement or consequence. But this is a social issue, and also not without it's own challenges, and as such is likely impossible. However, awareness is a good starting point and pilots being aware that even very conservatively, in a room with 6-10 colleagues the chances are that at least 1 has a mental health challenge (regardless of the emotionally held view to the contrary) can at least start to help. Subjects (links are to this post in the relevant subject page so that this post can be seen in context): Mental Health |
| Mrshed
July 16, 2025, 14:20:00 GMT permalink Post: 11923758 |
As I've previously posted, there is the fact that the ADS-B data (in your diagram) continues long after electrical power from the engines would have been lost. Someone recently posted that the engines don't even need to run down for this to happen, saying that operation of the FCS to cutoff would shut down the engine VFSG's.
As an aside, I have no knowledge of the software used by Flight Aware reporters, but I would be surprised if, at the very least, the computer involved was not set up with NTP (Internet Network Time Protocol) to synchronize its clock. This would set the computer's clock to within a small fraction of a second of correct time. For even greater accuracy, an inexpensive GPS device could be interfaced with the computer. So in the diagram (can't modify right now but I will), the blue bar starts at 5 and ends at 13, max altitude marker at 8. That would tie in with loss of power. It would put, interestingly, engine cutoffs right at the earliest opportunity within the window available with sampling etc. (Incidentally an apology to Musician who I incorrectly told earlier that such a movement would be inconsistent with max altitude record, I can see clearly now this isn't the case!). Subjects (links are to this post in the relevant subject page so that this post can be seen in context): ADSB Fuel (All) Fuel Cutoff Switches |
| Mrshed
July 16, 2025, 15:00:00 GMT permalink Post: 11923788 |
What I would say is that mental health issues are complex and while there are some ways that these pan out more often on average, the causes, drivers, and effects are very unique to the individual. At least some people will be at a point where they do not care about the consequences on others (or indeed become completely oblivious to them). There's also cases we may not typically think of as "suicide", such as terrorist attacks or "spree" killers, that are nevertheless in many cases suicide (minimally in so much that the individual knows there's a high risk of death for them in such circumstances, yet proceeds anyway). So I can comment on it but not robustly, other than it certainly happens. Thankfully very rarely. There are also of course other types of death due to mental health other than intentional suicide - for example paranoia/schizophrenia causing such actions. Subjects (links are to this post in the relevant subject page so that this post can be seen in context): Mental Health |
| Mrshed
July 17, 2025, 07:51:00 GMT permalink Post: 11924197 |
I think the rest of that article adds nothing ("experts believe" etc), but that specific element on CVR, if true (which I suspect it is) would confirm which pilot said what (which in fairness is what has been broadly assumed for some time here anyway). I don't think it actually confirms anything else at this stage, perhaps other than the reported "panic" of the PF. The calmness of the PM could be attributed to a number of things - yes, perhaps intention and knowledge, but equally perhaps just experience. It all starts to contribute to a picture admittedly but no smoking gun here I don't think. It's the rest of the CVR outside of this conversation that would start to more definitively build the picture at this stage. Subjects (links are to this post in the relevant subject page so that this post can be seen in context): CVR |
| Mrshed
July 17, 2025, 08:07:00 GMT permalink Post: 11924206 |
This is a topic of actual research:
https://www.pmhc.org/research
Currently 12.6% of pilots meet the medical threshold for depression, with a slight but below average difference between males (12.8%) and females (11.4%), with 4.1% of all pilots experiencing recent suicidal thoughts. https://ehjournal.biomedcentral.com/...940-016-0200-6 It should be noted that the utilized test (PHQ-9) is considered insufficient to assess suicide risk. Depending on scoring these values could be about average, or significantly below average. Based on their wording I would expect the latter, because their methodology does not specify severity.*1 Results of 0-4 points suggest no intervention necessary, 5-9 (classified as mild) simply suggest retaking the test after a few weeks. Research shows that for the general public Major Depressive Episodes have a prevalence of ~5-10%, with the prevalence of minor depression being less studied but significantly higher than major depression. There is also significant symptomatic overlap of mild depression with stress related conditions such as "Burnout" (if you know, please don't, this conversation is already complex enough without bringing that in). Considering the prevalence of stress in the industry I am actually surprised the numbers here are not higher. The lesser delta between males and females could be indicative of just such an issue, meaning that based on the data available the number of pilots actually suffering from depression could be less than even the comparably low number reported here. The actual suicide risk is usually orders of magnitude below even that but not easily covered in this data context due to the test used. Cognitive impact is highly variable depending on the individual, actual symptoms and severity. It would be wrong to assess that 12.6% of pilots are a risk factor from this data. Quite the opposite, in fact. After the Germanwings crash the topic was discussed and has reached the awareness threshold for many. Mild cases usually require little to no intervention beyond raising awareness and helping the brain fix its chemistry through positive reinforcement. This can be as simple as taking PTO, reducing work hours, or focusing on social or physical activities. In the past 10 years these kinds of low impact measures have been made more readily available, most notably during the Covid-19 pandemic and the resulting turmoil. Further political activity has lead to some positive action as well. I already mentioned the recent success of the Pilot Mental Health Campaign getting legislation through Congress for improvements of the outdated FAA guidelines on mental health in an earlier post. Similar efforts are underway globally, be that internal review within regulatory bodies, or political movements. I won't comment more on this thread I dont think about general trends and MH in pilots as it probably demands its own thread, but really interesting and thanks again. Subjects (links are to this post in the relevant subject page so that this post can be seen in context): FAA Mental Health |
| Mrshed
July 18, 2025, 05:07:00 GMT permalink Post: 11924844 |
Apologies for the delay in responding to your posts. I see that you and others have stepped in, thanks.
I think for various reasons the ADSB data's absolute values are offset by some amount, for possibly all of the parameters. But there should be consistency in the deltas for the timestamp (by receiving station), the raw baro altitude, the Flightradar24 AGL values, and the airspeed. Flightradar24 themselves note that for altitude " ... the data is not above ground level, but it is consistent to itself." 08:08:46.55 ... 575ft ... 21ft ... 184kt 08:08:48.14 ... 600ft ... 46ft ... 179kt 08:08:48.61 ... 600ft ... 46ft ... 177kt 08:08:49.01 ... 600ft ... 46ft ... 177kt 08:08:49.46 ... 625ft ... 71ft ... 177kt 08:08:49.92 ... 625ft ... 71ft ... 174kt 08:08:50.39 ... 625ft ... 71ft ... 174kt 08:08:50.87 ... 625ft ... 71ft ... 172kt From the Preliminary Report's airport cctv picture, the RAT was seen deployed at, by my estimate here , 150ft baro altitude, between 4-7 seconds after rotation. So the ADSB readings have to be prior to that. What's interesting is that the ADSB data covers: - 4-5 seconds of time (let's approximate 4 seconds from 46.55 to 50.55, ignoring the 0.32s for the moment) - 50ft of altitude gain - Declining airspeed from the 1st reading to the last in this final segment from the runway. Big questions in my mind: 1. If the loss of ADSB corresponds to the E1/E2Fuel Cutoff switches being moved from RUN -> CUTOFF, why is the airspeed declining for the prior 4 seconds? 2. In 4 seconds, why is there only 50ft of altitude gain? that seems odd. 3. To account for only 50ft of alt gain, if we assume the 1st reading is on the runway just before rotation, the intermediate +25ft alt gain is at rotation (Nose up but MLG still on the runway), and the last 4 readings are in the air (nose up an additional 25ft), that means that 1 second or less after lift-off, ADSB was lost - this is before E1/E2 FCO RUN-> CUTOFF. It's just weird . Subjects (links are to this post in the relevant subject page so that this post can be seen in context): ADSB FlightRadar24 Fuel (All) Fuel Cutoff Switches Parameters RAT (All) RAT (Deployment) RUN/CUTOFF |