British Airways Flight 5390

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British Airways Flight 5390

Summary
Date	June 10, 1990
Type	Window failure
Site	Didcot, Oxfordshire
Passengers	81
Crew	6
Injuries	2
Fatalities	0
Survivors	87 (all)
Aircraft type	BAC One-Eleven
Operator	British Airways
Tail number	G-BJRT
Flight origin	Birmingham International Airport (United Kingdom)
Destination	Málaga Airport

British Airways Flight 5390 was a British Airways flight between Birmingham International Airport in England and Málaga, Spain. On June 10, 1990 an improperly installed pane of the windscreen failed, blowing the plane's captain halfway out of the aircraft, with his body firmly pressed against the window frame. The flight crew managed to perform an emergency landing in Southampton with no loss of life.

Contents 1 The incident 2 Injuries 3 Investigation 4 Safety recommendations 4.1 British Airways 4.2 Civil Aviation Authority 5 Modern media 6 See also 7 References

[edit] The incident

The aircraft, captained by Tim Lancaster and co-piloted by Alastair Atchison, was BAC One-Eleven Series 528FL G-BJRT. It took off at 7.20 am local time, with 81 passengers, four cabin crew and two flight crew. Co-pilot Atchison handled a routine take-off, and relinquished control to Lancaster as the plane established itself in its climb. Both pilots subsequently released their shoulder harnesses, while Lancaster loosened his lap belt as well.

At 7.33 am, the cabin crew had begun to prepare for meal service. The plane had climbed to 17,300 feet over Didcot, Oxfordshire. Suddenly, there was a loud bang, and the fuselage quickly filled with condensation. The left windscreen, on the captain's side of the cockpit, had suffered a catastrophic failure. Lancaster was jerked out of his seat by the rushing air and forced head first out of the cockpit; his knees snagging onto the flight controls. This left him with his whole upper torso out of the aircraft, and only his legs inside. The door to the flight deck was blown out onto the radio and navigation console, blocking the throttle control which caused the plane to continue gaining speed as they descended, while papers and other debris in the passenger cabin began blowing towards the cockpit. On the flight deck at the time, flight attendant Nigel Ogden quickly latched his hands onto the captain's belt. Susan Price and another flight attendant began to reassure passengers, secure loose objects, and take up emergency positions. Meanwhile, Lancaster was being battered and frozen in the 500mph slipstream, and was losing consciousness due to the thin air.

Atchison began an emergency descent, re-engaged the temporarily disabled autopilot, and broadcast a distress call. Due to rushing air on the flight deck, he was unable to hear the response from air traffic control. The difficulty in establishing two-way communication led to a delay in British Airways being informed of the emergency and consequently delayed the implementation of the British Airways Emergency Procedure Information Centre plan.

Ogden, still latched onto Lancaster, had begun to suffer from frostbite, bruising and exhaustion. He was relieved by the remaining two flight attendants. By this time Lancaster had already shifted an additional six to eight inches out the window. From the flight deck, the flight and cabin crew were able to view his head and torso through the left direct vision window.

Atchison eventually received clearance from air traffic control to land at Southampton, while the flight attendants managed to free and hold onto Lancaster's ankles for the remainder of the flight. By 7.55 am the aircraft had landed safely on Runway 02 at Southampton. Passengers immediately disembarked from the front and rear stairs, and emergency crews retrieved Lancaster.

[edit] Injuries

Lancaster was taken to Southampton General Hospital, where he was found to be suffering from frostbite, bruising and shock, and fractures to his right arm, left thumb and right wrist. The flight attendant who held Lancaster to prevent him from flying out of the plane received minor cuts and bruises to his arm. Everyone else left the airplane unhurt.^[1]

Less than six months after the accident Lancaster was working again. He later left British Airways when he reached the company's mandatory retirement age. Currently he is flying for EasyJet.

[edit] Investigation

Accident investigators found that a replacement windscreen had been installed 27 hours before the flight, and that the procedure had been approved by the Shift Maintenance Manager. However, 84 of the 90 windscreen retention bolts were 0.026 inches (0.66 mm) too small in diameter, while the remaining six were 0.1 inches (2.5 mm) too short. The investigation revealed that the previous windscreen had been fitted with incorrect bolts, which had been replaced on a "like for like" basis by the Shift Maintenance Manager without reference to the maintenance documentation.^[2] The air pressure difference between the cabin and the outside during the flight proved to be too much, leading to the failure of the windscreen. The incident also brought to attention a design flaw in the aircraft of the windscreen being secured from the outside of the aircraft, putting a greater pressure on the bolts than if they were secured from the inside.

Investigators blamed the British Airways Birmingham Airport Shift Maintenance Manager for installing the incorrect bolts during the windscreen replacement and for failing to follow official British Airways policies. They also found fault with British Airways' policies, which should have required testing or verification by another individual for this critical task. Finally, investigators blamed the local Birmingham Airport management for not directly monitoring the Shift Maintenance Manager's working practices.

[edit] Safety recommendations

Investigators made eight safety recommendations in the final accident report:

[edit] British Airways

• Review their quality assurance system and encourage engineers to provide feedback.
• Review the need to introduce job descriptions and terms of reference for engineering grades Shift Maintenance Manager and above.
• Review their product sample procedure to achieve independent assessment of standards and to conduct an in-depth audit into the work practices at Birmingham Airport.

[edit] Civil Aviation Authority

• Examine the continued viability of self-certification with regards to safety critical tasks on aircraft.
• Review the purpose and scope of the FOI 7 Supervisory Visit.
• Consider the need for the periodic training and testing of engineers.
• Recognise the need for the use of corrective glasses, if prescribed, in association with aircraft engineering tasks.
• Ensure that, prior to the issue of an air traffic control rating, a candidate shall undergo an approved course including training in both the theoretical and practical handling of emergency situations.

[edit] Modern media

This incident was featured on the Discovery Channel Canada programme Mayday (National Geographic Air Crash Investigation in other parts of the world), called "Blow Out".

[edit] See also

• Civil Aviation Authority
• Lists of accidents and incidents on commercial airliners

[edit] References

Notes

Bibliography