In December 22, 1999, a Korean Airlines B757 Flight 8509 left Stansted Airport, London bound to Milan. It crashed on final approach, killing 4 of its 4 crew members. I would like to provide an insight of the accident, focusing on the human factors and crew resource elements which may have contributed to the disastrous incident.
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The aircraft experienced a loss of control shortly after its takeoff resulting from inadequacy in airmanship and maintenance combined. The captain’s ADI was faulty even before its last flight. The crew, uninformed of the faulty ADI, wasn’t able to trace the roots of the problem, which consequently led to their inability to address it at the time of the crash. The 57-year old captain moreover felt frustrated with the delays that had happened, especially that of contacting the ATC on the incorrect frequency.
This may have caused intimidation to the flight engineers on board. One of the engineers even took no action at the first sound of the comparator alarm, while another officer either wasn’t able to alert the captain to the extreme unsafe attitude that developed, or simply didn’t monitor the aircraft during its climbing turn. Misdirection of the maintenance activity at the airport is also a part of the chain of errors that occurred. Lastly, the doubtfulness of the agreement for local engineering support was a considerable factor for the accident.
This accident was fully preventable. If only basic flying skills in partial-panel situations, crew resource management, and maintenance troubleshooting were keenly observed and effectively practiced by the crew, lives could’ve been spared. This accident serves as a lesson for other crews as well. It should remind us that having two pilots operate an aircraft poses the possibilities of failure even if they are experienced, well-trained and knowledgeable. Our ability to diplomatically assume command in times of crisis, especially when the commander is unable to perform, should be a human principle guided by the virtue of shared leadership.
Pilot Error Cited in KAL Cargo Jet Crash at Stansted (2003) from http://www.aviationtoday.com/regions/mideast/2843.html
Review of Root Causes of Accidents Due to Design from
Korean Air Incidents and Accidents from
http://www.nationmaster.com/encyclopedia/Korean-Air-incidents-and-accidents=See More on Korean, Old