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Alaska Airlines flight 1282 NTSB preliminary report [pdf]

ntsb.gov

221–230 of 285 posts

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#221

Earlier quoted context omitted.

> Given how cheap flash is these days How cheap is flash that will survive a sudden stop from 400mph to 0 mph in no seconds flat, will survive a post-crash fire, and/or submersion for years in salt water? Flash data retention at high temps is TERRIBLE (and gets worse for MLC/TLC/etc), see any flash datasheet. It is NOT nearly as simple a problem as you might think. Yes, it is a solvable problem, but please do not dis…

I often wonder why we still rely so heavily on local storage when in-flight Internet exists. Flight data could be streamed in real time to the cloud for redundancy.

https://www.youtube.com/watch?v=qMWZCuTQpds

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#222
post #196

Earlier quoted context omitted.

I doubt this was intentional? It sounds more like mistakenly applying the procedure for opening a normal door, which requires no followup, to opening a door plug , which does.

lol of course it was intentional. what the Spirit mechanics had to do was a RMV, they knew this, because the Boeing eng rep told them so, but they didn’t like this, so they marked it in the system as an OPEN but performed the work of a RMV, to avoid the additional quality checks a RMV would require. And then they fucked up the RMV but didn’t know and no one else did because it was marked as an OPEN so no one checked…

Are Spirit employees allowed to file records in CMES?!

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#223
post #168
post #14

Earlier quoted context omitted.

> How did this pass Boeing QA? https://www.airlinepilotforums.com/safety/146074-boeing-inte...

It's crazy their supplier is delivering so many must-fix defects they have to have a warranty team on site to help fix them. Crazier that Boeing just let that get more and more out of hand instead of making Spirit get their shit together on their end. https://www.youtube.com/watch?v=xIAfCupuZ3w Edit: Also that entire culture and dynamic between Boeing and Spirit on the production floor seems very toxic and driven by…

When you gut a part of your company to spin it out as separate company that isn't going to have same union contracts and can be then squeezed as hard as possible...

First you create the reverse monopoly then ensure the toxicity, all in chasing supposed "value add" of final assembly and coordination (to paraphrase the Boeing CEO who made the strategy, who wasn't from McDonnell but was a Boeing lifer)

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#224
post #211

>[evidences] indicate that the four bolts that prevent upward movement of the MED plug were missing before the MED plug moved upward off the stop pads. Ok >Photos from the interior repair that show the lack of bolts Huh. Well that's conclusive.

Photos may not have been after conclusion of repair so technically not conclusive. However it certainly lines up.

Not the photos but the fact that the bolts are missing and there are are no witness marks indicating they were present when the door ejected.

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#225

Earlier quoted context omitted.

Can someone explain to me why this door plug wasn't actually a plug that physically stays sealed from cabin pressure? That seems like a sensible failsafe?

Probably because it reuses parts of the design of the emergency door so it can be swung out of the way for maintenance. The emergency door uses this complex designs of stop pads and guide rails etc to have “plug” characteristics (which did hold out for 3 months without being properly secured) because a true plug door would have to swing inwards, which isn’t an ideal property for an emergency escape, and I’d guess it…

It's also done this way so a real emergency exit can be installed instead of the plug if the airline (or another airline that buys the plane) decides to increase seating capacity. It would be really inconvenient (not to mention mechanically questionable) if you would have to weld additional stuff onto the fuselage to accomplish this, so the parts that are connected to the door frame are already there...

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#226

> The flight crew reported that the cockpit door had opened during the depressurization event. In a revision to the Flight Crew Operations Manual, issued on January 15, 2024, Boeing confirmed that the door functioned as designed. Interesting for terrorists. Cause a rapid decompression, and get easy access to the cockpit.

They may go then and blow the whole thing up good insted of such half measures. Sufficiently rapid decompressions may not that reliable and predictable to carry out so I can control the plane afterward easy kind of feats.

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#227

A very thorough preliminary report. I've worked for a long time in quality systems, and this is a perfect example of a systemic failure. They've got work being handed off between Boeing employees and 3rd party contractors with insufficient controls in place to verify that very basic tasks are being performed. I'd be curious to know how many non-conformances they typically see during assembly of a plane and whether ma…

I was speaking with some friends at a Christmas party who work for the Navy - they’ve taken deliveries of planes from Boeing with the same sort of issues that start in the factory. They even went as far as to say the whole lot of planes should’ve been rejected but weren’t. Multiple things not built to spec.

The planes they worked on did not share an assembly line with the 737 but another Boeing model…

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#228
post #168

Earlier quoted context omitted.

It's crazy their supplier is delivering so many must-fix defects they have to have a warranty team on site to help fix them. Crazier that Boeing just let that get more and more out of hand instead of making Spirit get their shit together on their end. https://www.youtube.com/watch?v=xIAfCupuZ3w Edit: Also that entire culture and dynamic between Boeing and Spirit on the production floor seems very toxic and driven by…

Spirit has no competition. How do you threaten the supplier who owns your production when you have no other options?

Considering we're talking about Boeing, who actually do the work Spirit does for them for the 737 for other airframes (making the fuselages), and used to do it in house for the 737 before too (in that same Wichita factory complex where Spirit is now, Spirit being the result of Boeing's monumentally stupid decision to divest), I think it's fair to say that Boeing can bring production back in house.

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#229
post #218
post #160

Earlier quoted context omitted.

>In a lot of software organizations with rapidly changing and undocumented requirements, there's a good chance defects will go unnoticed until they're no longer relevant, so spending a lot to find them before they're shipped is a waste. It's really a shame that a good percentage of these applications full of bugs and "rapidly changing and undocumented requirements" don't get scrapped and stay many decades afloat unti…

I really find it disingenuous to imply that we can’t build moon rockets because we’re not good enough at engineering projects - I can think of a few engineering projects that took off last year, to say the least. And nasa doesn’t deserve the shade IMO. The kids of the people who built the Apollo program aren’t working at boeing or fighting for one of the few underpaid nasa positions - they’re building reusable rocket…

If we're fine at engineering, why are doors falling off planes?

I don't think you can say "We're fine at engineering but we're often terrible at management."

They're not separate things.

Engineering culture is about inventiveness, pride, craftsmanship, and getting the job done well. Bean counter culture is the opposite of all those. If that's the culture engineers work under not only do none of them happen, but they become less and less possible over time.

Re: Alaska Airlines flight 1282 NTSB preliminary report [pdf]

#230
post #25

The report seems to mesh with and confirm many details of the anonymous insider account at https://leehamnews.com/2024/01/15/unplanned-removal-installa... . The bolts were not reinstalled following work on the plug rivets/seal. The official system doesn't record that work was done requiring the bolts to be removed.

Can someone explain to me why this door plug wasn't actually a plug that physically stays sealed from cabin pressure? That seems like a sensible failsafe?

Good point. Boeing (737) has the door open to the outside. The Airbus (320) the door opens to the inside.

I can remember when I was small my Mom mentioned that doors of buildings in the US are mandatory to open to the outside, a rule that does not exist in Europe AFAIK. So there you have it, you have a significant higher chance of crashing in a Boeing, but when it happens, your can leave the plane 2 seconds faster.

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