reducing "Crew-caused"
approach and landing
accidents 

Pilot-in-charge Monitored Approach

2012 A319 GPWS G_A Tunis Tunisia

Brief account : 

After a late briefing followed by a change of runway, which shortened the approach significantly, the A319 crew's approach was very unstable. The descent rate was 4,400 fpm, 1000ft high and at 240 kts at 5 miles on final.  A go-around was initiated following a GPWS "Pull Up" warning at 800ft RA, 2500 fpm, and 220kt, with a minimum height of 398ft.  

Crew-related factors : 

This event showed a classic example of "in-charge" factor as well as plan continuation bias, among other factors. 

The Captain (PF) had been occupied with a number of other issues and a late cockpit visit, resulting a late briefing and descent initiation for landing on R/W 29. The aircraft was already high when the runway was changed to R/W 19, shortening the available track by about 20 miles. 

The Captain then became focused on activity to get the aircraft down as he could clearly see the runway.  In his words in the report "He stated that during the descent, the cockpit was self-centred, .....[he] was absorbed by his workload, had not informed the copilot of his plan of action and did not listen to the latter’s comments".  ("Plan continuation")

The F/O (PM) meanwhile was well aware that the situation was very unsatisfactory, but "having been a Captain himself, he did not insist as he did not want to e ncroach too much on his colleague’s decisions. He then no longer informed the Captain of the instrument displays" .("In-charge" factor)  

If PicMA had been the SOP, the following factors would have been affected. 

The F/O might have tried to initiated the briefing prior to Top-of-Descent as he would have been about to take control and become PF.

When the runway change was given by ATC, the Captain would have been better able to consider the effect of the shortened track on the aircraft's total energy state, and requested an extension of some sort.

As the Captain would have been in personal communication with ATC the subsequent confusion might have been avoided

The Captain would have been inhibited about demanding action to correct the situation if the approach continued to be high and fast.  

In short, the Captain would have been in proper command and not focused on his short term objective which were by his own admission actually unachievable.  

 

Type: 
A319
Where: 
Tunis
Expected weather: 
Visual
Pilot in charge: 
Capt
Early transition: 
No
Go-around : 
At or above DH/A
Damage: 
Minor or none
PicMA potential: 
Major
Year: 
2012
Time: 
Day
Deterioration: 
No
Vert Guidance: 
G/S
Both Head Up: 
No
LoC: 
No
Operator: 
Air France
Fully prepared: 
No
Actual Weather: 
None relevant
Autopilot : 
Y
CCAG: 
Low
Source material: