Ignoring The One Man That Can Save You | The Crash Of Alitalia Flight 404
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- เผยแพร่เมื่อ 28 ก.ย. 2024
- Disclaimer: All videos are used for representational purposes only and the content of the narration do not in any way reflect on any entities shown in the video.
Donations are appreciated but never expected: miniaircrashinvestigation@gmail.com (Paypal) Don Van Valkenburg: / steinfiller
This is the story of Alitalia flight 404. On the 14th of november 1990 Flight 404 was a flight from Linate airport in Milan to Zurich. They were flying a DC-9 and they had 40 passengers and 6 crew members on board. At 6:36 pm alitalia flight 404 took off from runway 36R from linate bound for Zurich with the first officer at the controls. The Dc 9 left Italy behind and climbed to its cruising altitude of 20000 feet. As they reached their cruising altitude they listened to the automated weather broadcasts from Zurich.
The surface wind at Zurich was at 240 degrees and 8 knots. The pilots discussed among themselves about the best possible runway for a landing. The first officer is of the opinion that a landing on runway 28 would be best given the current wind conditions but the active runway right now is runway 14. But they still discuss a left hand circling approach to land on runway 28.
As they descended they talked about the approach procedure for runway 14, they also talked about what they should do in the event of a communications failure or a go around. The crew were given radar vectors to perform an ILS approach onto runway 14. At 7 pm the copilot says “We perform a CAT II(approach)". As all of this happened they descended through 9000 feet and passed abeam of the zurich airport they were to the south west of the airport. The captain noted, "We are by KLOTEN, FL 90. He is bringing us in high", From the radar plots in the report that puts them approximately here.
So lets see the approach that they were trying to execute. From the point that they were at they'd fly to EKRON or near it and then turn right to a heading of 070 degrees.theyd maintain 070 degrees till they reached D-10, then they'd turn right to the runway heading all the while maintaining 4000 feet till they intercepted the glideslope at DME 8. From then its just a matter of following the ILS glideslope to the foot of the runway and then landing on runway 14. Now that we know what they were planning to do lets get back to the cockpit to see how they executed this approach.
After the captain commented that they were abeam of zurich airport they were cleared to descend to 6000 feet and they were asked to fly 325 degrees. With a heading of 325 they'd arrive at or near ekron. Once near EKRON they set the heading to 068 which took the plane in a right turn and they were following the approach chart correctly up to this point. At 7:05 pm they identified ILS runway 14. At 7:06 pm they got the approach clearance to the ILS runway 14. As we talked about before now they had to maintain 4000 feet and intercept the extended centerline of the runway. To do this they were given a heading of 110 and 4000 feet. This took the plane in another right turn. But the captain read the heading back as 120 degrees this caused a bit of confusion for the first officer. Should he fly 110 or 120? The first officer selected 110 degrees and They flew on.
Soon afterward the copilot said “Radio approach”. They were about to intercept the localizer and they were about to make their final course correction to line up with the runway. The copilot set radio1 as the receiver for this landing. At this point they had made their final turn to line up with the runway but they were slightly east of the localizer. That's the little curve that you see here on
As soon as anyone calls for a go around, you need to take that seriously and go around. You can ask questions or challenge the call later; all you've lost is time. 1,000 ft. over the ground is not the time to figure out who's flight instruments are correct.
Agreed. If someone is calling a go around there’s usually very little time to discuss.
A go round is a go round. Once it's called max thrust and climb, gear up. You can argue about it later. This was a cluster fuck. PIC called a go round but fell to Captains Disease: #1 Captain is always right. #See rule #1. Many years ago I had declared a go round and as I was pouring in the coal Captain said No and reached for the throttles. Backhanded him with everything I had. He was unemployed when the Board came in.
@@itsjohndell That was a good call you made.
@@itsjohndell that’s awesome! Good job staying with your better judgement. I like how you handled it. I bet he took you seriously from then on. This is the whole basis of CRM, RIGHT? Sounds like he wasn’t willing to step up to the times.
@@itsjohndell Never argue about a go around. Just do it!
Few weeks ago I watched the TV show Air crash investigation about this exact crash. If only the captain would have left the first officer alone when he wanted to go around, they would have all survived. I watched few episodes on Air crash investigation where the first officer tells the captain to go around but stubborn captains don't listen and fly into the ground. Sometimes pilots with more experience are more dangerous then the new pilots because new pilots always want to do everything by the book and experienced pilots sometimes think that they're so good that they don't need to do everything by the book, complacency has killed a lot of very experienced pilots.
Wait this is an ACI episode? An ACI episode I haven’t watched? Time to go find it!
@@MiniAirCrashInvestigation
Here is also a clip on TH-cam from the episode, but if you want the full episode click the previous link I posted in a comment above:
th-cam.com/video/wrDq5V3DZAU/w-d-xo.html
Great thanks! Will check it out :)
You know what they say: "pride always comes before a fall". This is a prime example. 🤥
I liked this video. You talking and explaining things is easier to understand than trying to read huge paragraphs of important info in the 3 seconds they give you on these other crash sites.
I look forward to more videos from you!! This is the first time I've watched your channel and I like it!
Thank you!
I think first officers probably are more cautious. And captains usually have egos that they think they're always right.
Massimo was my friend. I will never forget that night watching the breaking news about the flight crash. I was sitting in my friend's living room in Milan and when I saw the flight number, I looked at them and could only utter: that's Massimo's flight. He was supposed to come back to Milan that night ......... instead he met his destiny!
“If it don’t look right... go around! It’s better you should have to tell someone why you did it, than for someone to have to find out why you didn’t.”
"You can always go around, if it don't look right coming down, don't wait until your sideways sliding on the ground, you can always go around. I know that when I learnt to fly, my instructor was yellin' in my ear, power in, carb heat cold, climb-out pitch, flaps to go, take it 'round the patch one more time again. But I know now, that he was showing me, that just because the nose is pointing down, if it doesn't look right, give it one more try, you can always, go around. You can always go around, if it don't look right coming down, don't wait until your sideways sliding on the ground, you can always go around. You're comin' in, you see you're high and fast, but your mind somehow set on getting down, the runway leads into grass, which leads into trees, little beads of sweat drippin' from your brow. You still have time, simply change your mind, would sure be nice to fly this plane again, with the wings still strait, this ain't no place to hesitate, pitch and power, gear and flaps, HEY GO AROUND! You can always go around, if it don't look right coming down, don't wait until your sideways sliding on the ground, you can always, you can always go around, if it don't look right coming down, don't wait until your sideways sliding on the ground, you can always go around.
(yes I just typed out the entire lyrics of the "you can always go around" song)
The pilots were arguing about where the plane was positioned, so that's an unstable approach even without the hill.
Very true! As Mentour Pilot would say "this is when you know something's seriously wrong".
Saw a video where it only said the pilot was to blame for this due to his "anger management" issues. He seems to have physically disciplined one of his colleagues in his career and failed at numerous tests than one could in the program. I think your video is alot more elaborate and true to the point though. Nice!
You are referring to flight 5719. The Alitalia captain was never observed hitting a subordinate (apparently).
@@TheBoeingE i see
Very beautiful footage of DC-9 production, roll-out and test flying. A DC-9 air refueling? A DC-9 with a parachute? And finally a DC-9 with a Hud!
Hey, I only just recently discovered your channel and wanted to say thanks for your work. My father is originally from the area and my family had often told me about the accident and how it was apparently well audible from their home. Although constantly seeing aircraft pass overhead was a factor that led to me studying Aerospace Engineering now, I had never looked up specific information on that accident. As I was just browsing the internet to find more I noticed that even in German there isn't a lot of information to go on, which makes your research all the more impressive. Best wishes and keep up the good work!
Too many pilots have caused crashes because they wanted to avoid doing a go-around in order to 'save face' and to save themselves from lots of paperwork and 'splainin'. For that one moment in time, these particular pilots forgot that they have the lives of so many innocent people in their hands.
It certainly saved them for doing paperwork
@@SomeTH-camGuy CUZ THEY DEAD NOW N I G G A
And this is why practically every airline implemented no-questions-asked go-arounds, meaning no explanations needed. I honestly doubt that pride was ever a primary driver behind avoiding go-arounds.
@@tookitogo Makes you wonder what exactly goes through their heads when this happens that keeps them from doing what they know is the right and the smart thing.
@@hehhehhuhhuh7014 Absolutely!!! I can’t imagine it, either.
Unacceptable! Being cognizant of the unique terrain, not to mention the glide slope marker inconsistencies, was more than enough to preclude such a foolish mistake.
You would think.
Hey just as a recommendation, you're quite good at the voice over, but I can't help but think it's held back a bit by your equipment. You probably could get a better cleaner sounding mic for less than $100
Excellent video! I just started to inform myself about this particular crash because my father told me an anecdote about it today. He was a military police soldier on active duty when it happened. Right after it happened his unit was sent to secure the crash site from trophy hunters and the press while the firefighters were trying to put out the fire. The way he described the scene was literally hell; darkness, rain, fire, debris and mangled corpses everywhere accompanied by a wicked smell consisting of kerosene and burnt flesh. He didn't eat grilled meat and fly airliners for over a year after this.
4:01 Damn that's one scary tail drag.
I like the speakers narration of the tragic circumstances while at the same time,watching random planes land on some of his videos
For the ILS transmitter, there are actually 3 "beams". The intended beam, the actualy glide slope, and a ghost beams one above and one below.
The pilot needs to make sure they aren't one one of the ghost signals by knowing how far out they are, and their altitude.
Without knowing their actual altitude, they had no way to tell they were on a ghost signal.
You did a nice job, hope you're successful
Thank you so much for your support pat!
The hubris of the captain doomed them all
Such a beautyful vintage shots on background :)
Speaking as a retired Captain [29.5 year Airline Pilot, 26.5 years as Captain]: Captains are raked over the coals by many managements for their 'on time' performance. This leads some Captains to have a 'complete the mission' mindset rather than a 'do it as safely as possible' mindset in day to day line ops! With this mindset and the other equipment issues you outlined, the Captain was more likely to rationalize the conflicting information and override the FO's impulse to go around so as to be 'on time'. This is just my OPINION, BUT I have seen this kind of setup cause at the very least damage and some near fatal incidents many times in the 34 years that I was a Pro Pilot.
Greg, I don’t doubt your experience as I know corporate cultures are different, but I’ve been at my airline for 30 years now and have never once been questioned about being late or executing a go around. Hopefully that reflects more and more companies today.
I do agree that the “target fixation” to get on the ground and make everything work out has always been and still is a threat. Best regards.
Loving the DC-9 Footage, by the way. Great visual inclusion.
Thank don valkenburg he got this footage from his dad and he digitized it and uploaded it to TH-cam
Very good use of video, as well as your excellent analysis. Well done!
Captain and FO should always concur on matters when safety is involved, always giving benefit of a doubt to whichever is less comfortable with a situation. No captain should ever overrule his FO when such doubts arise until a matter is thoroughly reviewed and discussed in the cockpit. An FO serves as insurance in the form of a second opinion and that opinion will always be respected by a responsible captain.
Love this channel. Please keep it coming!!
Great video. Very detailed. You've got me a new subscriber. Keep up the good work.
can you do Aeroflot 7425 as a bonus episode? there is almost no information that I can find on it.
The pilots should have known about the hill near the airport , the pilot thought he could level off ! The danger near the outer mark should have been emphasised that . The pilot had skimmed the ground to reach airports many times before ... the levels are just for reducing noise annoyances and reducing chance of collision with emergency helicopters or harrison ford. He didnt know it was absolutely vital to not go below "minimum" altitudes..
How much (in%) have engineers improved in emissions and efficiency since then?
I remember early 1970"s we wouldn't have white laundry drying outside when runway 27 was in use on EHAM 😅.
Quite a lot is the answer
The per seat fuel burn of the 737 family has decreased by about one third
@@gamma_dablam ⅓ less so ⅔ remaining?
Sounds great, but over 50 years actually not that much in comparison with cars, which reduces by 50% or more.
With larger bypass engines, more efficient wing profile including larger variance with slats & flaps, winglets, lightweight composite materials etc I'd expect more like ⅔ reduction.
Great video bro!
Glad you liked it!
"Broken instruments, a misread altimeter, and a captain who just did not see the danger in front of him....." Exactly why I will not fly.
do you drive? do you walk? do you climb on ladders?
Wonder why he didn't go through his flight plan as he surely would of realized the terrain and the need to be on alert especially with pre landing check list being done before entering the circuit. Sad that people died in this! Preventable loss!
Great work man
keep up the good work bro!
Watching this again after the Air France incident at JFK yesterday where Alitalia took off and flew to Rome after a minor collision with AF on the ground.
Controlled flight into terrain gives me fits, see?
Even though your videos from a year ago are good. Your latest videos have really come along way with the simulations. Great job and Thank You!
Have you thought about redoing some of these older vids for us newer subscribers? I'm finding quickly i'ts way easier to get the mental picture when you show it so accurately now
I forgot how smoky the DC9s were!
all engines of that generations were smokers. The worst were the aft-fan types used on the CV-990A
404: NOT FOUND
Literally the first thing I thought of when I saw the thumbnail.
So very sad for the victims families. This plane crashes into a mountain, after the crash, “let’s put lights on the mountain.”
Aaaaaand... adding the lights is bad _how?_
OOops! Made the comment below, went back to vid just in time to catch the bit about the drum altimeter! What a bodge it was! Wonder how many planes got flown into terrain b4
they changed?
whoahh do you have any more information about what's going on in the footage at 4:05? is that like a test or some thing?
As far as I could see, all clips shows some form of tests. E.g tail strike, build up of ice to distort aerodynamics on the surfaces and how (maybe) the deicing makes the ice behave mid flight, ingestion of water / ice or slush of the engines during take off and landing as well as sharp roll, yaw and rudder inputs to name a few.
It's the MD-87 on that particular one, and I can't find much about it other than this clip th-cam.com/video/X7daNgAVtzc/w-d-xo.html
00 is not hard to mistake and the needle was on the opposite side. No excuse for misreading it.
Not to sound morbid, but I genuinely hope there's an afterlife just so the FO could look at the captain and say I told you so. Infuriating when people die because of one man's ego. Once someone says go around, you go around and talk about it later, bid avoid (in most airlines, you can ask to not fly with someone again, not guaranteed but if there's a lot of pilots you probably won't see them again) the FO if you think he's that stupid, but go around and figure it out later.
Have anybody out there ever been on jet and have an engine blow out-i was on a Airbus 300 continental airlines in 1993 taking off in Houston tx-and the right engine blew out-two loud thumps-we had one engine left-we had just pulled up from the runway-we had a very good captain-he kept the jet straight till we leveled out-and then started turning around too go back to the terninal-took about 15 minutes-the fire trucks and all the rescue personal we're waiting for us on the right side of the runway-thats the most Erie 15 minutes I've ever experienced in my life-you start thinking about what it's gonna be like to hit the ground and burn up-if you will feel anything or not-they say you die in your head in a situation like that
I fly for one of the US majors and I also conduct training and checking sessions in the simulator. We practice situations like you went through every year so the guys and gals out there know what to do. Granted that out there flying day in and day out they never know if they’re going to have an engine fail on them(they do know in the sim), but we drill this into them to the point that they should recognize and be able to react correctly if they ever encounter that. On the ground it’s easier to deal with, but if this had happened in flight, I guarantee that you would have had a successful outcome.
That altimeter is idiotic. Who thought that was a good idea?
Oh No!!(My reaction, soon as I heard -for the-second-time!!- that ".. the pilots did not know..."!!
Well-researched and narrated, but the visuals are just a collection of stock footage largely unrelated to the story
The tail planes are huge
So sad knowing completing the go around fully would have saved them
Just go around, the gamble isn't worth it.
8:57 What is that?? Honestly it looks like something (or someone!!) got squashed in the wheel well as the gear retracted.......
"Captain?"
"Yeah?"
"Are you sure we're high enough?"
"Yeah, why?"
"Well, I may be dumb, but it doesn't seem like there should be goats in the clouds."
So they tried to catch the glide slope but they cought a mountain.
What video did you use here?! I'd really like to watch it with sound.
Brilliant again Sir. But dont get bigheaded.
All these 404 comments.... the Internet error page 404 didn't exist in 1990
Nice one !👍
Pilots don't have to report go-rounds to the company. There is no paperwork.
Currently, but the standards were probably different back then.
It's the cold equations fallacy. The cold equations was a Sci-Fi story about a shuttlecraft delivering vaccines to a planet with an almost zero margin of error, when a stowaway is discovered, and the captain of the spacecraft shoots the stowaway because the stowaway will cause the spacecraft to run out of air and fuel and crash.
The fallacy is creating a space shuttle that operates on a near zero margin of error under any circumstances.
In this case, it was the paperwork required to explain a go-around to penny pinching bureaucratic idiots who don't consider that the fail state of an airplane that doesn't go around is a crash and death.
Which is why the standard is now no reporting or paperwork for go-arounds.
What's the connection between the story and the images? 👀
Of course, it’s a McDonnell Douglas again.
You pronounce altitude interesting, alltitude, here in Washington state natives say Al-titude like a guy named Al, I am assuming this is true for the rest of the west. But you say Altimeter like that.
In the rest of the west, as well as in 49 other states and the District of Columbia.
I’ve wondered where this guy is from, because his English is very good, but not 100% native. Every once in a while he mispronounces things. (Tellingly, it’s mispronouncing common words, not obscure jargon.)
There are *bold* pilots.
There are *old* pilots.
Are there any *bold old pilots* ?
i like this captain. He hates bureaucracy and paperwork, and now, he will eternally avoid it
4:05 THAT'S A FUCKING MASSIVE TAILSTRIKE WTF
Liked. You read the accident report of SUST, fine! I live 700 Meters from the crash site away. The last words are so sad...
19:10:55 Cap: che non me torna... - it makes no sense
19:10:55 F/O: no neanche a me - no, me neither
19:10:57 Cap: tira su, tira su, tira su, tira su! - pull up, pull up, pull up, pull up!
CLACK (disconnecting AP)
19:10:59 F/O: go around
19:11:00 Cap: no, no, no, no. Fattidi il glide - no no no no, do the glide
19:11:11 Cap: ce la fai a reggerlo? - can you hold it?
19:11:13 F/O: Si - Yes
19:11:14 RADIO ALT MIN WARNING: PIP-PIP-PIP-PIP-PIP-PIP-PIP-PIP
19:11:16 Cap: Aspetta proviamo a rim... - wait, let's try to st... (maybe "stay")
19:11.18 CRASH
---- END OF CVR ---
Are there still pieces of wreckage on the hill?
@@MiniAirCrashInvestigation you won't find anything at this place anymore i think. 2 years ago a farmer found a small piece of the dc9 on a tree, for more than 25 years it was hanging up there. according to the police, the piece is no longer needed, as the investigations are been completet since years. the piece was given to the local museum of the village "weiach".
the crash site is very clean, you can see young trees everywhere where crash lane was. And a memorial stone with crosses.
@@creist11 Good to know!
Awesome translation. This is really scary, poor passengers and crew
This is difficult to follow and the video doesn’t match most of the narrative.
There are a lot less videos of the actual planes and incidents available from that time. In fact, there is still not much video of most plane accidents. Even fewer of them for ones hat happen at night. So instead of a blank screen he fills it in with videos and images. In this case, footage showing the legendary plane that is no longer in the air that operated this flight. Even some shots of ground conditions.
These guys are doomed! They just don't know it yet! Very sad!!
And once more, the day could have been saved by a simple go-round. It almost sounds like pilots hate go-rounds, doesn't it? Wrong. We simply only hear about those who didn't do theirs in these videos.
only runway 28 has ILS and 15 has VOR which does not help the crew determine if they are at the correct altitude. Also affecting decision making is the flight before them said they only gained visual at 1.3 miles.. So the Captain was willing to wait to see the runway based on that information. You do a disservice here to the pilots. You also fail to mention the reason they could not land at the preferred runway was due to Germans not wanting the noise after 10pm... Thus the noise abatement law in Germany forced them into an unsafe approach. The primary mistake here was that the captain thought he was 2 miles out thus past the hill.. Fact is he was 4.3 miles out and since he is dead no one will ever know why he made that mistake.
I do not think that the German rules, as absurd as they are, were contributing to the accident. BTW, at that time, only 14 and 16 had ILS, and 28 did not (it does today), so it was pretty safe to start the ILS approach and then jump over to a visual 28 landing. They did it all the time.
I really want to like this channel. But the narration with no visual aids is hard to follow. Yeah there’s random pics and video of random planes but that almost makes it more confusing.
I like the flight channel with their msfs video but I really wish they had narration.
Combine the two!
Give the people what they want!
There is always some sort of error in the system, and they always try to cover it up putting a blame on the pilots.
Very interesting but the irrelevant video footage is distracting potentially confusing.
When will people learn...
trickle-down, anything, never works...
INdeed. Its sort of like... "Didnt you read the notice?2 or "Look I was told to keep a watch out for ..."
1:32 WTF is this guy on?!?
9:53 why would you use it then!!?
Build a good one for f sake!
it's 2021. and still we can't remove dangers like mountains and birds close to airports?
humans are so good at destroying otherwise.
Letting those trading ads run to get you paid
Your images had no sense with the video, its distracting…
OK I like and subscribe
if the pilots were alive, i am sure the co pilot will be like : I TOLD YOU & YOU STOPPED ME DOWN
& the pilot would be like : uhhh .... I am sorry ?
I told you & you slapped me down. no such phrase as stopped me down.
@@penzanceparade lol true
404 seems like a very bad flight number in the digital age.
Too much goboldygook!
the flight no was 404 so i think the pilot was err 404 in head
worst video ever. He uses stock footage the whole time that has nothing to do with what he's talking about. way to "call it in" dude. Put some effort into your videos at least!
you need a microphone dude. sounds like you're using a laptop mic. even a 20$ mic from amazon will sound better. i say this as a hearing impaired person
i truly cant understand most of your words and not every video has auto captions, which is based on your audio anyway and can mess them up
Hey rainy yes at the time I was using a really cheap mic. But now upgraded to an actual mic. Also for my newer videos subtitles are available in the settings. So that should make following the video easier :)
😧😢
8:12. Omg! Is that proof of chemtrails?? 😂😂😂
whaaaat?
@@PeterNGloor
It's a joke!
know accident. mather of bad trained pilots, no CRM and an overconfidnet capt.
this flight was doomed to fail. Why 404? Thats a webpage code for "Error - Not found"!
404: Airplane Not Found!
Flight 404
safety not found
*404 - Plane not found*
Why would one want to fly on flight 404 :)
Airplane 404, runway not found...
@@Trainboy1EJR that’s hilarious lol
Error 404 landing not found.
no its Error 404, Runway Not Found
ERROR: 404
PLANE NOT FOUND
404: Runway not found.
Alitalia 404 - glideslope Not found
Error 404: plane not found
404 plane not found
This is lame.
So basically airplane altitude measuring hardware/sensors were inaccurate, right?