C.F.I.T. © Global Air Training Limited 2010

“How did that goat get into this cloud?” © Global Air Training Limited 2010

CFIT Definition A CFIT accident is “one in which an otherwise serviceable aircraft under the control of the crew is flown unintentionally into terrain, obstacles or water, with no prior awareness on the part of the crew of the impending collision” © Global Air Training Limited 2010

We are all average. No-one is GOD. -We are human we make mistakes when operating systems/interfacing with technology/CRM & Automation -Is it our human failing cos we are stupid? -Is it the design of the equipment; small buttons, small screen? -Is it the interface; poor labelling, poor schematics? -Is it logic; Otto not doing something in the order/way a human would? EXP: FMS vs home computer. Q Screen size Q Windows vs mode buttons and submenus Q Qwerty vs alphabetic keyboard Q Vertical vs horizontal location of screen Q Use of Colour © Global Air Training Limited 2010

Causes of CFIT CFIT occurs in IMC or at night or both Lack of Horizontal position awareness 33% Lack of Vertical position awareness 66% © Global Air Training Limited 2010

CFIT Accidents Chart © Global Air Training Limited 2010

Risk Factors Altimeter settings Safe Altitudes ATC Errors Incorrect units used (inHg/hPa/mbars) Incorrect values transcribed from radio communications Confusion of QNH/QFE settings Extreme atmospheric conditions Safe Altitudes ATC Errors Be prepared to question Flight Crew Complacency Familiarity leads to complacency Non Precision Approaches No SOP for GPWS pull up warning © Global Air Training Limited 2010

CFIT Is it a new type of accident? March 1931 the Southern Cloud (Tri-motor Fokker) crashed 200mls NE Melbourne. Since then over 30,000 pax & crew have lost their lives in CFIT accidents Half of all early piston engine commercial aircraft accidents were due to CFIT It can happen at any stage of the flight Virtually all CFIT accidents involve either: Error in Navigation Ineffective monitoring Failure to follow S.O.P.s © Global Air Training Limited 2010

Equipment to reduce CFIT risk Radio Alt - introduced in late 1960’s GPWS SAS Electronics Engineer started concept in Europe 1971 Voluntarily installed by a number of airlines 1973 Boeing offered it as a recommended safety device 1974 Basic part of all Boeing aircraft manufactured 1975 FAA enacted a rule requiring all large transport aircraft to be fitted This followed a TWA 727 accident in USA, during a VOR/DME approach, 90 Fatalities FAA Mandatory Requirement rushed through & UK CAA Follows MSAW – 1975 software package for ATC detects a/c flying below MSA and enables the controller to warn the crew. Developed for use with ARTS (automatic radar terminal systems) radar capabilities VASI, PAPI, ILS, VOR, DME, © Global Air Training Limited 2010

Early GPWS Doubts Prior to the introduction the FAA expressed doubts Would crew become complacent? If crew followed procedures wasn’t that a sufficient safeguard against CFIT? In a survey conducted soon after the GPWS installation requirement, 83% of the pilots surveyed expressed concerns about false or nuisance alerts. Concerns included: having a midair collision while performing a mandatory pull-up losing control of the airplane while distracted ignoring a valid warning because of system credibility problems ignoring a valid warning through a misunderstanding of the cause of the warning. © Global Air Training Limited 2010

Frequency of pull-up warnings GPWS Improvements Frequency of pull-up warnings Mark 1 = 1 per 750 sectors Now = 1 per 5,000-7,000 sectors © Global Air Training Limited 2010

CFIT KL © Global Air Training Limited 2010