Red Arrows ejector seat accident

[newshound]

2011. This took a long time to get to court. Good example of two independent faults leading to the tragedy.

[Me]

I don't quite see why the seat manufacturers were to blame. The over-tightened nut was down to the RAF ground crew apparently and I would have thought the ejector seat handle would be part of the pre-flight checks.

[Roger Hayter]

It should either be impossible to over-tighten the shackle or there should be a big fixed label prompting a valid test of tightness.

It should not be possible to place the locking pin when the release handle is not in a safe position to be locked.

It *is* actually rocket engineering, which is why they should be a bit careful. It is bad enough working all day sitting on a rocket powered seat without its safety being totally reliant on no-one ever being careless or forgetting something, with no obvious visual indication of the error

[Nightjar]

This was a known issue that the manufacturers had warned many users about. However, they did not warn the MoD, so the groud crew didn't know it was critical.

The checks would probably only call for the safety pin to be in place, which it was. The design was faulty, as it was possible to insert the safety pin when the handle was not in the safe position. Again, the MoD were not made aware of this.

[Me]

I do see your reasoning, but the ground crews and the pilots have a duty of care, especially with a critical safety item such as an ejector seat. Do they not have a torque wrench? Do they not check on the staus of something that might save their life? Manufacturers can only do so much.

[newshound]

Two points, the safety pin could be mis-located so that it looked OK but was actually doing nothing. That's a design fault. I have the impression that MB knew about the risk of overtightening, but had not made that clear enough to the RAF.

[Brian Gaff]

Yes there was, for a change a good simple explanation on bbc radio news yesterday. brian

[Roger Hayter]

Human beings are imperfect creatures. As are the machines they make. In order to get to the level of safety we have reached in air transport (which is enormously safer than a few decades ago), absolutely everything has to have several layers of checks and secure design. It must be possible to make several mistakes and still not crash (obviously depening on the exact mistake!). "We'll be alright if everyone always does their job properly" simply isn't good enough. Look at all the rigmarole to avoid operating on the wrong side of the patient in hospital, and it still happens. Each manufacturer is held to the same standard as the rest of the system.

[GB]

That seems very odd. There must be a procedure for issuing notices?

[Nightjar]

What is particularly odd is that they did issue notices to other countries, but not to the UK. I suspect a serious administrative error.