Forget delays and lost luggage

Forget delays and lost luggage

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It's a familiar refrain in the post-COVID era: flying is just not what it used to be.

Between cancellations, delays, lost luggage and booking errors, travellers are fed up, with a growing number even resorting to private charters to avoid the chaos.

As airlines around the world struggle to get things back on track amid rising costs, staff shortages and strikes and increased demand, passengers certainly haven't been shy about sharing their "travel nightmares":

On the Sunday morning of June 10, 81 passengers boarded a British Airways flight from Birmingham International Airport bound for the coastal resort town of Malaga. 

With wheels up right on schedule at 7:20am and the aircraft steadily approaching its cruising altitude, captain Tim Lancaster and co-pilot Alastair Atchison released their shoulder harnesses and settled in for the three-hour flight.

The cabin crew got to work preparing their trolleys for meal and drinks service as passengers flipped through their travel guides and switched into holiday mode.

Four men in pilot and stewards' uniforms huddle together, one kneeling and one standing while the others lean in

Most of the crew had worked together many times before, though co-pilot Alastair Atchison (centre, kneeling), was new to the team.(PA Images via Getty Images: Adam Butler)

But just 13 minutes after take-off, at 17,300 feet, a loud bang came from the cockpit as the internal door burst off its hinges.

The cabin suddenly filled with condensation mist. The crew knew at once that something had gone horribly wrong: 'explosive decompression'

Flight attendant Nigel Ogden, who had just offered the pilots a cup of tea, was the first to see the catastrophe unfolding inside the cockpit.

Captain Tim Lancaster had been sucked through a gaping hole where the windscreen should have been.

His torso was pinned to the outside of the aircraft by the force of the oncoming winds, while his legs were jammed firmly inside the cockpit.

With the control column pushed forwards, presumably as the captain was jerked out of his seat, the plane dipped and rolled towards the right.

Ogden immediately grabbed Lancaster by the waist while chief steward John Heward rushed in to haul the debris of the cockpit door off the navigation panel, and shoved it out of the way into a toilet cubicle.

Co-pilot Atchison had managed to stay in his seat, immediately taking back the controls of the plane.

Descending at 4,600 feet per minute through some of the world's busiest airspace, the first officer was desperate to avoid a mid-air collision and stabilise the air pressure to bring oxygen back into the cabin.

Within 148 seconds, Atchison managed to bring the plane back level at 11,000 feet.

Meanwhile, Simon Rogers and Sue Gibbins, who made up the rest of the cabin crew, tried to calm the passengers, urging everyone to re-fasten their seatbelts and take the emergency brace positions.

The inside of an airplane cabin on display in a museum shows rows of three seats on one side, an aisle, then two

The aircraft was one of the 500 series, the largest version of the BAC 1-11, capable of carrying up to 119 passengers and cruising at 21,000 feet.(WIkimedia Commons/Ad Meskens via Creative Commons 3.0)

The cabin had descended into a silent panic. Passengers wept and prayed, convinced the plane was going to crash.

"An air hostess standing near us at the back of the plane started to cry. I thought we were going to crash," a passenger later told reporters

''Then one of the men on the flight deck came onto the loudspeaker announcement radio and said the windscreen had blown out and warned us to prepare for an emergency landing.''

'Er ... the captain ... I believe he is dead'

As the air pressure equalised, wind rushed back into the cockpit, creating a mini-tornado of papers and debris. An oxygen bottle that had been bolted down just missed Ogden's head.

Atchison had made a distress call to nearby airports, but could barely make out the response over the roar of 630-kilometre-per-hour winds.

Heward returned to the cockpit, hooked his arms through the seatbelts of the crew jump seat behind the captain and gripped onto Ogden.

The two men tried with all their might to pull Lancaster back through the hole, but the slipstream was immense.

 

With -17C winds lashing Lancaster's body and violently flinging him against the side of the plane, the crew feared the worst: there was no chance the captain was still alive.

By now his body had slipped further out the window and around to the side.

They could see his head, bleeding profusely and with his eyes wide open, banging against the side windscreen. 

But they held strong, fearful that if they let go, he could be sucked into one of the plane's engines. 

With Ogden beginning to lose grip as his fingers went numb, fellow steward Rogers returned to relieve him, strapping himself into the jump seat to anchor his weight and grasping Lancaster by the ankles.

An exhausted Ogden returned to the cabin, where he put an arm around his colleague and told her he feared the worst.

Finally, Atchison found a safe, vacant runway and set the course for nearby Southampton Airport.

Air traffic control: "5390 we've been advised it's pressurisation failure. Is that the only problem?" 

Co-pilot: "Er negative sir, the er, captain is half sucked out of the aeroplane. I understand, I believe he is dead."

Air traffic control: "Roger, that is copied."

Co-pilot: "Er, flight attendant's holding onto him but, er, requesting emergency facilities for the captain. I, I, I think he's dead."

Atchison brought the plane safely to the ground in a textbook landing.

Flight BA5390 touched down at 7:55am, less than 200 kilometres from its origin. 

A miraculous tale of survival

Almost as soon as the aircraft came to a stop, Ogden and Gibbins instructed the passengers to disembark as usual off the forward and rear stairs. 

Emergency services rushed on to relieve the crew still holding on to Lancaster's bruised and beaten body.

To their astonishment, he was still alive.

The captain was suffering from frostbite, a fractured elbow, wrist and thumb, and severe shock. 

Four men and a woman in airline uniforms stand around a hospital bed where a shirtless man is sitting up

Captain Tim Lancaster was treated for frostbite and other injuries, while the rest of the crew came out of the flight relatively unscathed.(PA Images via Getty Images)

Ogden had dislocated his shoulder and sustained minor frostbite as well as a few cuts and bruises. All crew members were taken to hospital, and four passengers were also treated for shock. 

Having survived about 20 minutes exposed to sub-freezing temperatures and hurricane-force winds, Lancaster had lost consciousness. 

But as paramedics assessed him on a stretcher inside the cockpit, he awoke, telling them: "I want to eat." 

Years later, Lancaster recounted in a documentary how he had purposefully twisted his torso around to face the inside of the plane so that he would be able to breathe. 

"I couldn't breathe because I was facing into the airflow. And I turned my body round and I was looking back along the top of the aircraft," he said.

The crew were lauded for their heroic efforts in saving their captain's life and bringing all 81 passengers back to the ground. 

The co-pilot and four stewards were each awarded the Queen's Commendation for Valuable Service in the Air, with Atchison also receiving the Polaris award for his airmanship.

"It was like something from a disaster movie. I still find it hard to believe I was at the centre of it all," Ogden wrote in 2005

The minuscule error that allowed a windscreen to break

It was up to the UK's Air Accidents Investigation Branch to get to the bottom of the incident: what could have caused the pilot's windscreen to suddenly fall off, mid flight? 

Most aircraft windscreens are fitted from the inside out, relying on something called the plug principle, where pressure inside the cabin helps to hold it in place. 

But on this particular plane, a BAC 1-11 series 528FL, the windscreens were designed to be fitted from the outside, fixed with 90 individual countersunk bolts.

The battered windscreen was found in a field near Chosley in Oxfordshire, along with the corner post and some of the bolts that had been securing it. 

Just 11 bolts were still attached to the windscreen, while 18 were found loose nearby. One was still secured to the aircraft window frame.

Investigators quickly realised the bolts didn't match the manufacturers' guidelines. 

Some were the right diameter, but slightly too short, while most were the right length, but 0.66mm off in diameter. None were the right-sized bolt. 

In reviewing the plane's maintenance record, investigators found that the pilot's windscreen had been replaced just 27 hours before the fateful departure. 

Late on Friday, June 8, the maintenance manager in charge at Birmingham International Airport had decided to tackle the job during his overnight shift so that the aircraft would be ready for a wash on the Saturday morning.

But he made a series of errors and lapses in judgement that would prove disastrous. 

Shortcuts, mixed up bolts and human error

Working with a crew that was down two engineers, the manager opted to carry out the windscreen change himself. 

As a licensed aircraft engineer with decades of experience, he had regularly serviced the BAC-11, though it had been about two years since he'd last tackled a windscreen change. 

After a quick glance at the maintenance manual to jog his memory, he surmised it was a straightforward job with no obvious difficulties, and went about his work.

Feeling it would take too long to look up the correct parts for the job in the catalogue, he brought one of the bolts he’d removed down to the store room.

The bolt heads were too small to carry any markers identifying their part number, but after sifting through the trays to compare, he deduced it was an A211-7D.

The store room supervisor, who had been in the job for about 16 years, noted that usually, a slightly longer bolt — the A211-8D — would be used to fit that windscreen, but the manager decided that as A211-7D bolts had come out, he would put the same ones back in.

The store room only had about five of the bolts he wanted rolling around in the drawer, so the maintenance manager went to another warehouse to find more. 

Rather than relying on the part numbers on faded old drawer labels to locate them, he took out a few and measured them side by side with the old bolt before settling on the ones he needed.

But these turned out to be a third type of bolt: the A211-8C. 

 

Assuming the outboard corner posts would require longer bolts to get all the way through, he also grabbed six of the next size up. 

Back in the hangar with an assortment of the wrong bolts, he hurriedly set up a safety raiser to access the windscreen and finish the job. 

The combination of the platform's position and issues with his tools meant the maintenance manager had to reach across the nose of the plane with both hands to fix the bolts in place, but couldn't properly see or feel the thread slipping. 

When he got to the corner posts, he realised the longer bolts weren't quite right, so retrieved six of the old bolts he had earlier removed and used those. 

Despite working alongside the still-in-tact right windscreen, he failed to notice that the bolts he was installing were sitting lower in the countersink. 

A close-up on three labelled bolts shows the left and right fill the hole entirely while one in the centre leaves space

The report concluded the heads of the bolts on the right hand window filled the countersinks, while those the maintenance manager installed did not.(Supplied: UK Air Accidents Investigation Branch)

After finally wrapping up the job, the maintenance manager moved on to his next task, and as the most senior engineer on shift, nobody else checked his work.

One last chance to avoid catastrophe

In their final report, the Air Accidents Investigation Branch concluded that "a series of poor work practices, poor judgements and perceptual errors ... eroded the factors of safety" and led to BA5390's incident.

The original windscreen had been primarily attached by bolts that were 2.54mm shorter than those specified. Just two were the correct size.

But the shift maintenance manager had taken shortcuts and missed several cues that should have alerted him to the initial problem and his own subsequent errors: 

  • He chose to physically match bolts instead of referring to a parts catalogue and pressed on with the wrong ones despite the store manager's warning;
  • He used incorrect tools and poor techniques to attach the windscreen;
  • Working in poor light in the hangar and the warehouse, he did not wear the mild corrective lenses he relied on for reading small print;
  • He was likely affected by sleep deprivation, given the job was carried out between 3am and 5am, towards the end of his first night shift in five weeks;
  • And there was no final inspection to check his work and correct the errors.

There was still one last chance to catch the mistakes.

The following night, just hours before BA5390's disastrous journey, the same maintenance manager carried out a windscreen change on another BAC 1-11. 

This time, the job was set up for him, with all the parts he needed. 

He noticed the bolts were A211-8Ds — the correct size — and recalled that he had used shorter bolts the night before, but didn't think much of it. 

And so, BA5390 set off the following morning with a shoddy windscreen — the only critical component that could have failed in such a dramatic way. 

"Had it been any other item, the selection of the wrong bolts may have been unmistakably apparent during the fitting process, or the subsequent failure may not have been so obvious or traumatic."

Investigators recommended sweeping reviews to quality assurance and training.

Though it was one engineer who fixed the wrong bolts to the plane, the report suggested his actions were merely a symptom of a culture that prioritised sticking to the schedule.

As for the captain who got sucked out of the aircraft? Just five months after his near-death experience, Tim Lancaster returned to flying. 

A black and white image shows a pilot sitting inside the cockpit of a plane

 

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