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Accident Description: [ Ссылка ]=
𝗦𝗽𝗮𝗻𝗮𝗶𝗿 𝗙𝗹𝗶𝗴𝗵𝘁 𝟱𝟬𝟮𝟮 was a scheduled domestic passenger flight from Barcelona to Gran Canaria with a stopover in Madrid. The flight was operated by a McDonnell Douglas MD-82 (Reg. EC-HFP) on 𝗔𝘂𝗴𝘂𝘀𝘁 𝟮𝟬, 𝟮𝟬𝟬𝟴.
The flight was cleared for takeoff on Barcelona's runway 36L at 14:23:14. This was the flight's second attempted take-off: 59 minutes earlier, the pilots had abandoned a departure because of excessive temperatures in the ram air temperature (RAT) probe. The plane was taken to a parking area where maintenance workers de-activated the RAT probe's heater. At 14:23:19, the crew released the brakes for takeoff. At 14:24:06 the crew called out "V1", at which time the DFDR recorded a speed of 147 knots, and "rotate" at 14:24:08, at a speed of 154 knots.
Once airborne, the plane rose to a maximum altitude of 40 feet above the ground. The stall warning stick shaker was activated at 14:24:14 and on 3 occasions the stall horn and synthetic voice sounded in the cockpit: "[horn] stall, [horn] stall, [horn] stall". Impact with the ground took place at 14:24:23. The wings separated from the plane and the fuselage broke into 2 main parts. The wings and the rear two-thirds of the fuselage were engulfed by fire.
𝗖𝗮𝘂𝘀𝗲𝘀:
The crew lost control of the airplane as a consequence of entering a stall immediately after takeoff due to an improper airplane configuration involving the non-deployment of the slats/flaps following a series of mistakes and omissions, along with the absence of the improper takeoff configuration warning.
The crew did not identify the stall warnings and did not correct said situation after takeoff. They momentarily retarded the engine throttles, increased the pitch angle and did not correct the bank angle, leading to a deterioration of the stall condition.
The crew did not detect the configuration error because they did not properly use the checklists, which contain items to select and verify the position of the flaps/slats, when preparing the flight. Specifically:
- They did not carry out the action to select the flaps/slats with the associated control lever (in the "After Start" checklist);
- They did not cross check the position of the lever or the status of the flap and slat indicating lights when executing the" After Start" checklist;
- They omitted the check of the flaps and slats during the "Takeoff briefing" item on the "Taxi" checklist;
- The visual check done when executing the "Final items" on the "Takeoff imminent" checklist was not a real check of the position of the flaps and slats, as displayed on the instruments in the cockpit.
The CIAIAC has identified the following contributing factors:
- The absence of an improper takeoff configuration warning resulting from the failure of the TOWS to operate, which thus did not warn the crew that the airplane's takeoff configuration was not appropriate. The reason for the failure of the TOWS to function could not be reliably established.
- Improper crew resource management (CRM), which did not prevent the deviation from procedures in the presence of unscheduled interruptions to flight preparations.
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