Sunday, December 11, 2016

Repeat after me: "Declaring an Emergency, Proceeding Direct"

LaMia Flight 2933 (LMI2933) was a charter flight of an Avro RJ85, operated by LaMia, that crashed near Medellin, Colombia shortly after 22:00 local time on November 28, 2016, killing 71 of the 77 people on board. The flight had run out of fuel.

While it was supposed to be flight planned to fly to its destination of Medellin, then its alternate Bogota, and then for an additional 30 minutes, upon arrival in the Medellin area it was only minutes from total fuel exhaustion.
Avro RJ 85

The aircraft had been flight planned to (or beyond) its maximum range. According to the Wikipedia article, this operator had repeatedly flown to or beyond the legal limits of the airplane. In all likelihood, the PIC was blatantly reckless. Arrests have been made and government officials suspended, but that's not the point of this entry.

Approaching its destination of Medellin, the flight was issued holding instructions due to another aircraft that had, ironically, a fuel situation. That would later be determined to be caused by a malfunctioning fuel gauge. That flight was making a precautionary landing and had been given priority. LMI2933 was third in line for landing and had been issued a holding pattern. At the point they entered the holding pattern, they had six minutes of fuel on board.
this doesn't mean that you wait to declare an emergency until you have less than 30 minutes of fuel on board, but as soon as it looks like you'll land with less than that

LMI2933 mentioned to ATC an “issue with fuel”, but that is a long way from declaring an emergency, which they eventually did, but not before they had apparently already run out of fuel, saying "Lamia 933 is experiencing a total failure, total electrical failure, out of fuel." The electrical failure, was of course due to the fact that the engines had stopped working due to fuel starvation. The airplane was already in a descent due to engine failure at the time they asked for radar vectors to the airport.

ICAO (International Civil Aviation Organization) requires "If the PIC calculates that the flight will arrive with less than reserve fuel (30 minutes minimum), then it is required to declare a Mayday-fuel." Note that this doesn't mean that you wait to declare an emergency until you have less than 30 minutes of fuel on board, but as soon as it looks like you'll land with less than that on board, even though you may have much more on board at the time.

It should have been clear to this crew that this had been the situation for a while. Other than proper flight planning and landing at an airport short of the stretched limit of Medellin, the crew should have declared and emergency due to fuel as soon as they contacted the Medellin controller (as well as with each previous controller).

When told of "an issue with fuel" the controller was apparently preparing to bring them in next, which was kind of the controller—but not required. When issued the holding instructions the crew accepted them and took two turns in the holding pattern.

The captain, who as also an owner of the airline, may not have  wanted to admit that his planning was that bad, and he had gotten them into a terrible situation. Had he landed "safely" he may well have had legal action taken against him for violating multiple safety regulations, instead they did not admit their situation and not only the pilots, but most of the passengers paid the ultimate price.

There are many lessons in this accident. No doubt among them will be safety culture, fuel planning, and CRM. More will probably be revealed when the final accident report is issued. But clearly one clear lesson to put into play when all of the unexpected events pile up and you're short on fuel is that saying "an issue with fuel", "minimum fuel" or other similar terms does not get you the immediate priority handling that you need. The words "mayday" or "emergency" must be used. If still, you do not get what you need to land safely, then you must violate any clearance or other regulation to maintain the safety of the flight. In this you are not only allowed, you are required!
Repeat after me "Declaring an emergency, Proceeding Direct...."

Other reading on the subject

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