- vor 22 Stunden
On 29 October 2018, Lion Air Flight 610 enters a nosedive and crashes into the Java Sea shortly after taking off from Soekarno–Hatta International Airport in Jakarta, Indonesia, on a flight to Pangkal Pinang. All 181 passengers and 8 crew members on board are killed in the crash.
Kategorie
📚
LernenTranskript
00:00Just minutes after takeoff from Jakarta, Indonesia...
00:08Line 610, I have no reliable altitude information. All instruments disagree.
00:13...pilots fight to control one of the world's newest airliners, the Boeing Max-8...
00:19They never really figured out what was going on.
00:22...and end up crashing into the Java Sea.
00:25This was a very serious accident.
00:28What does the tracking data show?
00:30Investigators follow an erratic flight path...
00:33They're off course. There are altitudes all over the place.
00:36...a history of maintenance issues...
00:37Did we have problems?
00:38I bet we did.
00:39...and learn about a treacherous piece of hidden software...
00:42Looks like the MCAS kicked in.
00:44What's that?
00:46...what they uncover shocks the world...
00:48...and grounds an entire fleet.
00:50The 737 MAX story will clearly be a watershed event in aviation history.
00:58Oh, fuck!
01:02...I mean, 1-0, we're having yards right here...
01:05...and you're on the left side.
01:06...and you're on the left side.
01:07...and you're on the left side.
01:08...and you're on the left side.
01:09It's just after 5 a.m. in Jakarta, Indonesia...
01:21...as 181 passengers settle in for a short domestic flight.
01:28In the cockpit, First Officer Harvino performs pre-flight procedures.
01:34Fuel pumps are on.
01:36The captain on this flight is Bhavya Sunezha...
01:40...who has more than 6,000 flying hours.
01:43The passengers are on board the latest version of the renowned Boeing 737...
01:50...known as the MAX 8.
01:52David Karbaugh is a former Boeing test pilot.
01:59The MAX is the fourth iteration of the 737...
02:06...one of the most successful airliners ever.
02:09And it was basically born out of a need to improve efficiency and performance.
02:28The MAX 8 has quickly become Boeing's fastest-selling airplane...
02:37...with more than 300 already in the skies...
02:40...and almost 5,000 in the order books.
02:43The one being used on today's flight was delivered to Lion Air two months ago.
02:49Line 610, you are cleared to runway 25L via Sierra Charlie 1.
02:56Contact tower when you are in position.
02:59Line 610, cleared to runway 25L via Sierra Charlie 1.
03:05All clear, no traffic. Let's run before takeoff.
03:09Flaps?
03:10Flaps 5.
03:12Fire indicated.
03:17Lion Air Flight 610 is a 90-minute journey from Jakarta...
03:21...over the Java Sea to Banker Island.
03:25The low-cost airline operates hundreds of these short flights every day.
03:31Indonesia is the fourth most populous country in the world.
03:36And with 17,000 islands, you've got to have an easy way...
03:40...to do short-range transportation to get to those places.
03:44And the MAX is the ideal airplane for that kind of operation.
03:50Line 610, cleared for takeoff. Runway 25, contact terminal East Wind Airborne.
03:55Line 610, cleared for takeoff.
03:57Line 610, cleared for takeoff.
03:58Line 610, cleared for takeoff.
04:02Line 610, cleared for takeoff.
04:15At 6.20...
04:16Rotate.
04:17...the MAX 8 lifts off the runway at Jakarta.
04:19at Jakarta but immediately there's trouble the captain's control yoke
04:28starts shaking a warning that the plane is about to stall take off config okay
04:36but what the pilots can't identify the source of the problem they have no
04:43choice but to continue climbing the passengers are unaware that the pilots
04:49are dealing with anything unusual
04:55line six one zero five heading two four eight that follows standard instrument
05:00departure why in there's extent the air traffic controller has no idea that
05:06there's an issue in the cockpit
05:13the pilots get a warning that their airspeed indicators do not agree
05:17airspeed disagree what's going on should we request a return to Jakarta
05:22landing gear up
05:28all right six one zero climb to flight level two seven zero still unaware of any
05:37trouble the controller instructs the crew to continue climbing to 27,000 feet
05:41altitude disagree the first officer now notices that the altimeters also show
05:51conflicting readings knowledge doctor to disagree by six one zero by six one zero
06:03your present altitude is the pilots are getting conflicting data about their
06:13altitude and their airspeed captain soon Asia expects his first officer to carry out
06:21the procedure for this situation can memory items their speed unreliable what
06:27altitude should I request yeah request proceed
06:33the situation is deteriorating quickly climbing above 1,000 feet the pilots are still unsure of their
06:45airspeed if they fly too slowly the plane could stall and fall from the sky
06:51request clearance to any holding point captain soon Asia wants to get the plane to a
06:56point where he can circle and solve the problem line six one zero request
07:01clearance to some holding point it's our current condition
07:04line six one zero what's the nature of your problem please
07:07we are experiencing a flight control problem line six one zero
07:14where's the airspeed airspeed there's no airspeed unreliable it's there
07:28got it autopilot of engaged disengaged not every failure is a major emergency and checklist are designed to grade or evaluate the severity of a system failure so pilots are trained to methodically go through each step by step
07:50but the checklist isn't helping okay okay now flying 5,000 feet above the sea captain
08:08soon Asia struggles to keep the planes nose up flight path vector may be unreliable
08:14line six one zero turn right heading zero seven zero to avoid traffic ahead
08:19set the pitch attitude roger heading zero seven zero
08:23line six one zero you're now descending we're having flight control problems and are flying manually
08:34six one zero maintain heading zero five zero
08:38the cabin would have realized that the airplane was not climbing as normal and
08:45that it had leveled off and there was probably some up and down sensations
08:50captain soon Asia has been fighting to keep the planes nose from pitching downwards
08:57please take control for a moment he now assigns that task to his first officer
09:03I have control so he can troubleshoot the problem himself
09:08oh it's very the first officer is also having difficulty keeping the aircraft level
09:16there was a wide variety of problems that they had to sort out and the first thing was what's common between all of these failures because that's how you start to sort through the problems
09:28flight 610 is flying erratically over the Java sea and becoming increasingly more difficult to control
09:35and becoming increasingly more difficult to control
09:39the lives of everyone on board now depend on the pilots figuring out the problem
09:44I don't know where we are and getting the plane to the ground safely
09:49line 610 have no reliable altitude information all instruments disagree
09:54Roger line 610 no restrictions
09:57when an aircraft declares an emergency the controller's number one job is to provide assistance to that airplane
10:04the controller allows flight 610 to fly at any altitude the pilots choose
10:09please clear 3,000 above and below of traffic
10:13okay will do what altitude would you like
10:16it's diving it's diving
10:20it's okay it's okay
10:21flight 610 is now speeding towards the sea
10:24and the pilots are out of options
10:27line 610 control
10:48line air 610 control
10:54city link 882 please hold on current position
10:59do you have visual on lion 610 a boeing 737 max 8
11:05negative no other planes in sight
11:1630 minutes after crashing into the Java sea the wreckage of lion air flight 610 is located
11:22there are no survivors
11:25relatives of the passengers are flown to Jakarta for trauma counseling
11:31while they wait for the recovery of the bodies of their loved ones
11:37investigators from Indonesia's accident investigation branch KNKT
11:42need to understand why one of the best-selling new aircrafts in the world
11:46fell from the sky
11:56okay what does the tracking data show
11:59working with data from air traffic control KNKT investigators focus on the flight path of lion air 610
12:05they're off course
12:08there are altitudes all over the place
12:12from this data we learned that this plane's altitude was fluctuating
12:18it kept going up and down
12:20we wanted to find out why the pilot couldn't keep the plane at a constant altitude
12:25investigators need to know if the controller can shed any light on the problems the crew was facing
12:33they reported that they were having a control issue
12:44line 610 what's the nature of your problem please
12:48we are experiencing a flight control problem
12:53line 610
12:55that's all he said a flight control problem
12:59soon after that they reported that their instruments were unreliable
13:04line 610 have no reliable altitude information all instruments disagree
13:09roger line 610 no restrictions
13:12that was about it
13:16bagaimana crew berkomunikasi dengan ATC pada hari
13:20from the information we received from the air traffic controller
13:23we didn't get the impression that the pilot was under pressure
13:26bagaimana mereka
13:28the pilots tone was normal
13:30it didn't seem that he was stressed
13:32it didn't seem that they don't know
13:34they can't remember
13:36since the pilots of flight 610 reported flight control problems
13:41and unreliable instruments
13:43investigators wonder if recent maintenance records
13:46could explain what brought down the Max 8
13:49only 11 minutes after take-off
13:51this flight had some problems with control
13:57at that point we needed to learn more about the plane's maintenance history
14:01the angle of attack sensor was replaced the day before
14:07there are two angle of attack sensors on the 737 Max 8
14:12the sensors calculate the angle between the plane's wing
14:15and the oncoming air
14:17their data helps determine if the plane's wings are providing sufficient lift
14:22it's a very important piece of information
14:25the pilots need to have some kind of warning that they are approaching stall
14:29and so the angle of attack sensor is what gives that
14:33for several days the left side sensor had been giving faulty readings
14:39it was finally replaced before the plane flew from Bali to Jakarta
14:43one day before the accident
14:45investigators interview the crew who flew the same plane just hours before the crash
14:53to determine if there were any problems with the replacement sensor
14:57did we have problems?
14:59you bet we did
15:01we conducted an interview with the crew of flight 043
15:07we learned from them that after take-off the crew was also having problems
15:11what investigators hear next is chilling
15:17the captain explains that when he lifted off from Bali
15:23there were simultaneous warnings that his air speed and altitude indicators had failed
15:29a few seconds later the Max 8 stick shaker activated indicating that a stall was imminent
15:39keep climbing
15:41all the modern airliners have three sets of independently powered essential flight instruments
15:49air speed and altitude and also the attitude of the airplane
15:53if there is a discrepancy you can determine which is providing inaccurate data
15:59their instruments are correct
16:01you have control
16:03the failure was on my side so I hand it off
16:07flaps up
16:11the captain adjusts his faulty instruments so they display data from the first officer's side
16:17we're diving pitch up keep trimming
16:19that's when the plane started diving over and over
16:23the captain reports that the plane began a series of uncommanded dives
16:27use your trim
16:29that's it
16:33in order to keep the plane climbing at a constant angle
16:37the pilots set the position of their horizontal stabilizer at take-off
16:41and make minor adjustments during the flight
16:43that's called trim
16:45trim can either be adjusted by the autopilot or manually by the crew
16:51but every time the first officer tries to trim the nose up
16:55the automated system pushes it back down
16:57the first officer is finding it almost impossible to keep the plane climbing
17:03the trim system on a modern jet has to be very powerful
17:07the trim in many cases is actually more powerful than the control column
17:15for some reason the Max 8 stabilizer continues to move independently
17:19pushing the plane's nose down despite the first officer's commands
17:25to see what's in the book
17:27when the automated system moves the stabilizer it also spins a large wheel that's located
17:33between the two pilots
17:35this tells them that the system is adjusting the trim on its own
17:39when the captain bent down to look at the checklist manual to solve the problem during this flight
17:47the third crew was the one notifying the pilot that the trim was moving abnormally
17:53yeah
17:55runaway stabilizer
17:57the switches to cut out
17:59the crew realizes the stabilizers automatic trim system is malfunctioning
18:04it's continually pushing the nose down
18:07disengaging the system resolves the issue
18:11when they cut out the trim switches the system stopped doing nose down trim
18:17moving the switch to cut out pretty much solved
18:19the investigators learned that the previous crew then did something astonishing
18:25so we kept going
18:29you kept going
18:33if they had decided to return and land in Denpasar
18:39it would have taken only five to ten minutes
18:41and they could have landed safely
18:43but they decided to continue flying to Jakarta
18:47Line Air 43
18:49we'll continue on to Jakarta
18:51following a near catastrophe
18:53with unreliable instruments
18:55and the stick shaker blaring
18:57the crew elected to continue the 90-minute flight to Jakarta
19:01it surprised all of us
19:05that they continued the flight
19:07the crew managed to make a safe landing
19:11at Jakarta and reported the problem
19:13to maintenance personnel
19:15I reported the issue
19:17and filled out the flight maintenance log
19:19if the airplane experience
19:21is an abnormal or an unusual system failure
19:25it goes into the maintenance log
19:27airspeed and altitude disagree
19:29but not a word about the stabilizer problem
19:35investigators are surprised to learn
19:37that the captain of the previous flight
19:39said nothing about the out of control stabilizer
19:41or the action he took to correct it
19:45runaway stabilizer
19:47moving switches to cut out
19:49the lives of the passengers
19:51and the crew that follows you
19:53is basically dependent on you
19:55filling out the paperwork correctly
19:59good morning
20:01good morning
20:03they're done loading
20:05so we should be able to get out of here on time today
20:07a few hours later
20:09the passengers and crew of flight 610
20:11boarded the aircraft
20:13with no knowledge or warning
20:15of the potential problems
20:17faced by the previous crew
20:19hours earlier
20:21fuel pumps
20:23on
20:25did a repeat of the problem on this aircraft
20:27result in the deaths of the 181 passengers
20:31and 8 crew
20:39it takes three days for search and rescue teams
20:41to lock on to the signal
20:43coming from the Max 8 flight data recorder
20:45divers recover it from a depth of 115 feet
20:51the recorder has preserved data from the accident flight
20:55and 18 previous flights
20:57covering almost 1800 different parameters
21:01master caution
21:03goes off as soon as they leave the ground
21:05probably because airspeed
21:07and altitude don't agree
21:11stick shaker
21:13activates here
21:15the data shows a repeat of the problem
21:17on the previous flight
21:19faulty readings caused by a discrepancy
21:21between the left and right
21:23angle of attack sensors
21:25from the FDR data we received
21:29we learned that this plane had faulty angle of attack readings
21:31that affected both flights similarly
21:33left and right angle of attack values
21:37are off by 21 degrees
21:39for the entire flight
21:41we suspected the new angle of attack sensor installed in Bali
21:51was either faulty
21:53or the installation process was done incorrectly
21:55the mechanic who replaced the sensor before the flight from Bali to Jakarta
21:59failed to ensure it was calibrated
22:01which resulted in faulty readings
22:03there's a procedure that would have shown it was erroneous and that it was bad
22:13they signed off that they did it
22:15they could not have done it
22:17on the max eight the angle of attack sensor doesn't just measure the airplane's angle
22:23altitude disagree
22:25it helps calculate precise airspeed and altitude
22:29that explains why airspeed and altitude disagreed throughout the whole flight
22:35the malfunctioning sensor on the captain's side resulted in a difference between the left and right side speed and altitude displays
22:45then there's this
22:47the data clearly shows that for every nose up trim input
22:51there was a corresponding automatic nose down trim input
22:55sounds like what the crew of flight 43 described
22:59the data shows investigators that for some reason the plane's automated trim system
23:03was repeatedly dropping the plane's nose while the pilots fought to lift it
23:0926 separate nose down commands
23:15this doesn't look like a runaway stabilizer to me
23:19runaway stabilizer is a common malfunction of the trim system
23:23usually resulting in one continuous uncommanded movement of the stabilizer
23:29the NTSB brought a representative from Boeing to help us in our investigation
23:37we asked them to explain why
23:39in both flight 610 and 043
23:41the same plane continued to pitch down
23:43we're trying to understand these automatic inputs
23:49looks like the MCAS kicked in
23:51what's that?
24:01Boeing points to an obscure automated system known as MCAS
24:05the maneuvering characteristics augmentation system
24:09that's when we first learned about the MCAS
24:13MCAS
24:15to understand what could have caused the crash of flight 610
24:19investigators need to go back seven years to 2011
24:23when Boeing first announced the development of the MAX 8
24:27the 737 MAX was basically born out of a need to improve the performance and sales of the 737
24:41in 2010
24:43Boeing's main competitor Airbus unveiled the A320neo
24:47a fuel efficient short haul airplane
24:49it was an immediate hit with airlines at a time of rising fuel costs
24:55Boeing was caught by surprise
24:58the A320neo was significantly more fuel efficient
25:03so all of a sudden they were faced with a dilemma
25:06do you design a new airplane?
25:08a four or five year project?
25:10or do you modify the existing 737?
25:13but there were problems with taking a plane that was designed in the 1960s
25:20and turning it into a fast and fuel efficient aircraft
25:24to improve the performance of the MAX they decided to install more fuel efficient larger engines
25:34the only way to make those larger engines fit was to slide them forward on the wings
25:41the design engineers had a problem that the ground clearance from the engines
25:45and on 737 you can't increase the size of the main landing gear
25:49because of the size of the wheel wells
25:51it has to fit there
25:53so the only thing they could do was to move the engines further forward and up
25:58that solved one problem but created another
26:02it caused the 737 to pitch up at low speeds
26:06particularly when it was already in a nose up position like during takeoffs
26:10so they created software that would recognize the airplane approaching stall
26:17and artificially force the nose down
26:20and logically they turned to the trim system to do that
26:25and that's the problem you solved with MCAS?
26:27yes it made the MAX handle like any other 737
26:31MCAS was designed for a very low probability event
26:38it's diving, it's diving, it's okay
26:41how were they trained to respond?
26:43well, they weren't, not specifically
26:46fly up, up, up
26:48could Boeing's high tech solution to a design problem
26:53have inadvertently put thousands of passengers around the world at risk?
26:58in order to eliminate the need for costly pilot training
27:05Boeing had to convince authorities that the MAX 8 handled the same way as all previous 737s
27:12different handling characteristics will automatically require time in the simulator and extra training
27:19Boeing argued that since MCAS operated in the background without the need for any pilot input
27:25it didn't affect the airplane's handling
27:28not a word about MCAS here
27:32Boeing never included mention of MCAS in the flight control manuals
27:37they argued that since the system was not under control of the crew
27:42it should not be included
27:44it's like the system doesn't even exist
27:48Boeing thinks that it's an automatic system for safety purposes
27:55and has nothing to do with pilot operation
27:58according to Boeing, the MCAS software would automatically move the plane's stabilizer
28:05to push the plane's nose down
28:07if it started to pitch up under very specific circumstances
28:11it only kicks in when these three conditions are met
28:18Boeing explains that MCAS only activates when it senses that the angle of attack is excessive
28:24when the autopilot is off
28:28and when the flaps are retracted
28:31an extremely rare combination
28:33professional pilots don't typically stall airplanes
28:38so the likelihood of an MCAS activation was thought to be extremely low
28:44this is the data of both flights
28:47tragically, the data shows that because of the faulty maintenance on the angle of attack sensor
28:53flight 610 ended up meeting all three conditions
28:57the series of problems occurred when the left angle of attack sensor was replaced in Bali
29:09investigators dig deeper into the data
29:12and discover the MCAS system had no fail-safe
29:16the MCAS installed in the plane relied on only one sensor
29:23MCAS only took data from one angle of attack sensor, not both
29:30most protection systems are designed with redundancies
29:35your instruments are correct, you have control
29:37so a single failure doesn't result in catastrophe
29:40flaps up
29:43what Boeing did not adequately do was assess all of the other failures that that single component would have
29:51the faulty angle of attack sensor
29:54wrongly showed the plane pitching up steeply
29:57the autopilot was disengaged for the entire flight
30:00and then right here
30:02they retract the flaps
30:04exactly the same
30:06as the previous flight
30:09that's when MCAS kicks in
30:13and starts pushing the nose down
30:18up to this point the crew only had a minor instrument problem
30:25by raising the flaps
30:27the pilots unknowingly triggered a much more serious problem
30:31we assume the pilots would know how to respond
30:37Boeing made the assumption that pilots would respond to the uncommanded MCAS inputs by disengaging the automatic trim
30:46the Boeing assumptions were that the pilots would instantly recognize the inadvertent MCAS activation
30:55and treat it within three seconds
30:59investigators examined the flight data of the previous Lion Air flight
31:03to see how that crew reacted to the MCAS activation
31:07the first MCAS input on flight 43 is here
31:11the captain pulls back on his control column and applies manual trim
31:17then fights against the MCAS for three minutes and forty seconds before hitting a cutout switch
31:22I think the assumption that they were going to recognize and act within three seconds
31:28was very optimistic if not unrealistic
31:32flying 610
31:35I have no reliable altitude information
31:37all instruments disagree
31:39unlike the previous crew
31:41the pilots of flight 610
31:43struggled with the problem for more than 10 minutes
31:46fly up
31:47up
31:48up
31:49and never made the connection to a runaway stabilizer
31:52investigators need to understand why two crews facing an identical problem reacted so differently
32:10investigators struggle to understand why the pilots of Lion Air flight 610 lost control of the aircraft
32:16after nearly three months of searching the ocean floor
32:20the cockpit voice recorder is finally recovered and taken for analysis
32:25the CVR was the key to our investigation
32:30together with the FDR data
32:32the CVR could reveal all the mystery in our investigation
32:35960 cleared for takeoff
32:42investigators hope the recording will help to explain why the crew of flight 610 couldn't identify the problem
32:49and take corrective action to fix it
32:52rotate
32:56takeoff or fake
32:58okay but what
33:00the faulty angle of attack sensor triggers a series of warnings as soon as the plane lifts off
33:09airspeed disagree what's going on
33:13should we request a return to Jakarta
33:16landing gear up
33:21after takeoff
33:23the MCAS system was activated
33:25and their plane started to pitch down
33:27the captain has noticed that the plane stabilizer is now automatically trimming the nose down
33:34and does what Boeing assumed he would
33:37he pulls back on the control column
33:39and uses manual trim to counteract the computerized inputs
33:44okay
33:46Boeing was right about that
33:48but the captain never mentions the trim problem
33:50he and his first officer are focused entirely on their faulty airspeed and altitude readings
33:58where's the airspeed airspeed
34:01there's no airspeed unreliable
34:03it's there
34:05got it
34:07this is where we found significant differences between flight 043 and 610
34:13it takes first officer Harvino nearly two minutes to locate the appropriate checklist for mismatched airspeed
34:21I think the first officer was pretty well task saturated
34:24and one of the things that task saturation does in humans
34:28it limits our ability to communicate
34:30we don't hear well and we don't verbalize things very well
34:32flaps up four degrees and seventy-five percent at one
34:36there it is
34:38when the automated trim system pushes the nose down
34:42the large wheel makes a characteristic sound
34:46when the trim wheel moves
34:49it makes a sound like a freight train
34:51it's meant to be noticeable
34:54following a reliable attitude
34:57and one
34:59ground speed
35:01check
35:03they still don't notice it
35:06wrong about that
35:08he didn't put it together that every time he trimmed up
35:11the MKS system was trimming it back down
35:1534 times
35:17he applies nose up trim 34 times
35:20and doesn't think to wonder why
35:21they did not recognize the problem and take the corrective action Boeing predicted they would
35:31in this particular case Boeing made assumptions about design and pilot experience and training
35:39that didn't add up
35:42please take control for a moment
35:45I have control
35:46investigators now hear another crucial difference between flight 610 and the previous flight
35:54that's it
35:55please take control
35:57not a word about the fact that he's had to make more than 30 trim inputs
36:02I think the captain was very frustrated with the first officer
36:09oh
36:11and I'm sure he didn't really want to hand it over to the first officer
36:14but he felt that he needed to in order to figure out what was going on with the checklist
36:20but because there's no mention of MKS in the manual
36:24there isn't a checklist for the crew to follow
36:27it's diving
36:29it's diving
36:31with no warning from the captain about the need for repeated nose up trim
36:34the first officer quickly becomes overwhelmed
36:37sadly this first officer was pretty well overwhelmed
36:40and as the system trimmed the nose down he was not nearly aggressive enough in responding to that
36:49in flight 610 the pilot didn't deactivate the automatic trim
36:55and the plane's nose kept coming down because of the MCAS
36:59and it didn't stop until the plane crashed
37:00one minute after taking control
37:05the first officer watches helplessly as the plane plunges towards the Java Sea
37:10fire up, up, up
37:13KNKT investigators discover that Boeing's assumptions of how pilots would recognize and overcome
37:18an uncommanded nose down trim on the MAX 8 were fatally flawed
37:28they sure didn't act the way Boeing said they would
37:34here it is
37:36without requiring exceptional skill or strength
37:40investigators soon learn why Boeing's assumptions about how pilots would react were so wrong
37:46to certify the MAX 8
37:50Boeing assured the FAA that an average flight crew would be able to override the MCAS system
37:56so were these guys average?
37:58Captain passed all his checks
38:02looks like a competent pilot
38:05this guy is a whole different story
38:11investigators are surprised by the first officer's background
38:14the first officer on Lion Air Flight 610 had had challenges in training
38:22he had trouble staying up with the airplane understanding the complexities
38:26his manual flying skills were not optimum and he required additional training
38:32it's diving, it's diving
38:34it's okay, it's okay
38:36Flight 610 proved that Boeing was wrong about how pilots would react to an MCAS failure
38:40fly up, up, up
38:43they never really figured it out
38:49and then the captain gave control to someone whose manual flying skills were not going to save the day
38:56as a result of the accident Boeing issues new guidelines for MAX 8 pilots
39:01informing them about MCAS and detailing the procedures to follow in the event it triggers an uncommanded nose down
39:09the bulletin advises pilots to apply manual trim and to move the stabilizer trim switches to cut out
39:17this was a reinforcement to the pilots that says there is a system on the airplane that can move the trim
39:23if it does so, treat it as a runaway stabilizer
39:28hey, is there any TV on?
39:38our breaking news, an Ethiopian Airlines has crashed shortly after takeoff from Addis Ababa
39:43the belief that Boeing's advisory would prevent another similar accident is shattered four months later when another MAX 8 crashes
39:53flight tracking data shows that Ethiopian Airlines Flight 302's altitude fluctuated throughout the flight
40:01there's immediate speculation that once again Boeing's MCAS software is to blame
40:09in both accidents the MCAS activated causing this nose down trim situation to occur repeatedly
40:17and in both cases the crews let the airplane accelerate far, far greater speed than it should have been
40:22put those two together and the controllability of the airplane was lost
40:27this time the pilots knew about MCAS and what to do in case it activated
40:33yet they still couldn't control the airplane
40:37Boeing realized well if this crew can't handle it then other crews won't
40:43in spite of the FAA's assurance that the MAX 8 is airworthy
40:47regulators around the world ground the global MAX 8 fleet until the problem with MCAS is fixed
40:55the main thing in our mind was we worried that all of the Boeing 737 MAX 8's that are currently flying all over the world
41:03might have the potential to suffer the same catastrophe
41:07the FAA eventually follows suit
41:10our concern isn't with the mistakes that were made
41:15a US congressional investigation determines that Boeing made faulty technical assumptions
41:20and errors in judgment which led to these accidents
41:23didn't know about this is unacceptable
41:26Boeing insists it's learned from these incidents
41:30and is determined to make the MAX 8 safe and regain public trust
41:34Boeing has committed to making it easier for pilots to override the MCAS system
41:40once that override is activated
41:45the system will not continue to re-engage
41:50and they're developing a training program to familiarize pilots with MCAS
41:57the 737 MAX story will change forever how airplanes are certified
42:08and the 737 MAX will clearly be a watershed event in aviation history
42:13you