f-sc000725a, Ostatni lot Concorde, Raport w sprawie katastrofy Concorde
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Accident
on 25 July 2000
at La Patte d’Oie
in Gonesse (95)
to the Concorde
registered F-BTSC
operated by Air France
REPORT translation
f-sc000725a
FOREWORD
This report presents the technical conclusions reached by the BEA on the circumstances
and causes of this accident.
In accordance with Annex 13 of the Convention on International Civil Aviation, with
EC directive 94/56 and with Law No 99-243 of 29 March 1999, the analysis of the accident
and the conclusions and safety recommendations contained in this report are intended
neither to apportion blame, nor to assess individual or collective responsibility. The sole
objective is to draw lessons from this occurrence which may help to prevent future
accidents or incidents.
In accordance with Law No 78-753 of 17 July 1978, this document is released subject to
literary and artistic copyright. Copying, distribution or the use of this document for
commercial purposes is forbidden.
SPECIAL FOREWORD TO ENGLISH EDITION
This report has been translated and published by the Bureau Enquêtes-Accidents to make
its reading easier for English-speaking people. As accurate as the translation may be, the
original text in French is the work of reference.
F-BTSC - 25 july 2000
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Table of contents
FOREWORD__________________________________________________________________ 2
LIST OF ILLUSTRATIONS_______________________________________________________ 9
GLOSSARY _________________________________________________________________ 11
SYNOPSIS __________________________________________________________________ 14
ORGANISATION OF THE INVESTIGATION ________________________________________ 15
1 - FACTUAL INFORMATION ___________________________________________________ 17
1.1 History of the Flight _______________________________________________________ 17
1.2 Injuries to Persons ________________________________________________________ 18
1.3 Damage to Aircraft ________________________________________________________ 18
1.4 Other Damage ____________________________________________________________ 18
1.5 Personnel Information _____________________________________________________ 18
1.5.1 Flight Crew ____________________________________________________________ 18
1.5.1.1 Captain ___________________________________________________________ 18
1.5.1.2 First Officer ________________________________________________________ 19
1.5.1.3 Flight Engineer _____________________________________________________ 20
1.5.2 Cabin Crew ___________________________________________________________ 20
1.5.2.1 Cabin Services Director_______________________________________________ 20
1.5.2.2 Flight Attendants ____________________________________________________ 20
1.6 Aircraft Information________________________________________________________ 21
1.6.1 Airframe ______________________________________________________________ 21
1.6.1.1 Information ________________________________________________________ 21
1.6.1.2 Maintenance _______________________________________________________ 21
1.6.2 Landing Gear __________________________________________________________ 22
1.6.2.1 General ___________________________________________________________ 22
1.6.2.2 Landing Gear Retraction ______________________________________________ 22
1.6.2.3 Braking ___________________________________________________________ 25
1.6.2.4 Deflectors _________________________________________________________ 25
1.6.2.5 Wheels and Tyres ___________________________________________________ 26
1.6.3 Fuel _________________________________________________________________ 27
1.6.4 Engines ______________________________________________________________ 28
1.6.4.1 General ___________________________________________________________ 28
1.6.4.2 CONTINGENCY Mode _______________________________________________ 29
1.6.4.3 Reheat Cutout ______________________________________________________ 29
1.6.4.4 Fire Protection ______________________________________________________ 29
1.6.4.5 Engine Maintenance _________________________________________________ 30
1.6.5 Weight and balance _____________________________________________________ 31
1.6.5.1 Weight ____________________________________________________________ 31
F-BTSC - 25 july 2000
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1.6.5.2 CG_______________________________________________________________ 32
1.6.5.2.1 CG Determined during Flight Preparation _____________________________ 32
1.6.5.2.2 CG Determined from Investigation Data ______________________________ 32
1.6.6 Takeoff Performance ____________________________________________________ 33
1.6.7 Aircraft systems ________________________________________________________ 34
1.6.7.1 Flight Controls ______________________________________________________ 34
1.6.7.2 Air Conditioning_____________________________________________________ 35
1.6.7.3 Le GPWS _________________________________________________________ 35
1.7 Meteorological Conditions __________________________________________________ 36
1.7.1 General Situation at 12 h 00 ______________________________________________ 36
1.7.1.1 At Altitude _________________________________________________________ 36
1.7.1.2 On the Ground _____________________________________________________ 36
1.7.2 Situation at the Aerodrome _______________________________________________ 36
1.7.3 Documents Supplied to the Crew___________________________________________ 37
1.8 Aids to Navigation_________________________________________________________ 37
1.9 Telecommunications ______________________________________________________ 37
1.9.1 Radar Track ___________________________________________________________ 37
1.9.2 Telecommunications ____________________________________________________ 38
1.9.2.1 ATIS _____________________________________________________________ 38
1.9.2.2 Flight Data Frequency ________________________________________________ 38
1.9.2.3 Ground Frequency __________________________________________________ 39
1.9.2.4 Loc South Frequency ________________________________________________ 39
1.10 Aerodrome Information ___________________________________________________ 39
1.10.1 General _____________________________________________________________ 39
1.10.2 Runway Inspections ____________________________________________________ 40
1.10.2.1 Regulations _______________________________________________________ 40
1.10.2.2 The inspections on 25 July 2000_______________________________________ 42
1.11 Flight Recorders _________________________________________________________ 42
1.11.1 Recorder Types and Readout ____________________________________________ 42
1.11.1.1 Cockpit Voice Recorder (CVR) ________________________________________ 42
1.11.1.2 Flight Data Recorder (FDR) __________________________________________ 43
1.11.1.3 QAR ____________________________________________________________ 43
1.11.2 Cockpit Voice Recorder _________________________________________________ 44
1.11.2.1 CVR Readout _____________________________________________________ 44
1.11.2.1.1 Time-base ____________________________________________________ 44
1.11.2.1.2 Software Used _________________________________________________ 45
1.11.2.2 Transcript of the Recording ___________________________________________ 47
1.11.2.3 Identification of the Alarms and Noises __________________________________ 50
1.11.2.3 1 Procedure_____________________________________________________ 50
1.11.2.3.2 Supplementary Research_________________________________________ 52
1.11.2.3.2.1 Recordings in flight __________________________________________ 52
1.11.2.3.2.2 400 Hz demodulation ________________________________________ 53
1.11.2.3.3 Research Results _______________________________________________ 54
1.11.3 FDR Readout _________________________________________________________ 54
1.11.3.1 The Flight ________________________________________________________ 54
1.11.3.1.1 Analysis of Parameters __________________________________________ 54
1.11.3.1.2 Values of Parameters____________________________________________ 56
1.11.3.2 Track (end of report) ________________________________________________ 60
1.12 Wreckage and Impact Information __________________________________________ 60
1.12.1 The Runway __________________________________________________________ 60
1.12.1.1 Water Deflector ____________________________________________________ 60
1.12.1.2 Pieces of Tyre _____________________________________________________ 61
1.12.1.3 Piece of Metal _____________________________________________________ 62
1.12.1.4 Structural Element__________________________________________________ 62
F-BTSC - 25 july 2000
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1.12.1.5 Brake Servo Valve Cover ____________________________________________ 63
1.12.1.6 Piece of Concrete and Signs of Explosion _______________________________ 63
1.12.1.7 Lighting __________________________________________________________ 63
1.12.1.8 Tyre tracks _______________________________________________________ 63
1.12.1.9 Soot Deposits on Runway ____________________________________________ 65
1.12.2 Between Runway 26 Right and the Accident Site _____________________________ 67
1.12.3 The Accident Site ______________________________________________________ 68
1.12.3.1 Description of Site and Plan __________________________________________ 68
1.12.3.2 Instrument Indications _______________________________________________ 72
1.12.3.3 Examination of Engines______________________________________________ 78
1.12.3.3.1 Secondary exhaust nozzles _______________________________________ 78
1.12.3.3.2 Primary exhaust nozzles _________________________________________ 78
1.12.3.3.3 General findings ________________________________________________ 78
1.12.3.4 Examination of Wheels and Tyres______________________________________ 80
1.12.3.4.1 Wheel No 1____________________________________________________ 80
1.12.3.4.2 Wheel No 2____________________________________________________ 80
1.12.3.4.3 Wheel No 5____________________________________________________ 80
1.12.3.4.4 Wheel No 6____________________________________________________ 80
1.12.4 Work on the Wreckage__________________________________________________ 81
1.12.4.1 Reconstruction of the Wing and Examination of the Debris __________________ 81
1.12.4.1.1 Upper Wing ___________________________________________________ 82
1.12.4.1.2 Lower Wing ___________________________________________________ 83
1.12.4.2 Aft part of Fuselage _________________________________________________ 84
1.12.4.3 Examination of the Seats ____________________________________________ 84
1.12.4.4 Examination of the Landing Gear ______________________________________ 84
1.12.4.5 Examination of the Dry Bays __________________________________________ 86
1.12.4.5.1 Description ____________________________________________________ 86
1.12.4.5.2 Examination ___________________________________________________ 87
1.12.4.5.2.1 Forward Part _______________________________________________ 87
1.12.4.5.2.2 Aft Part ___________________________________________________ 87
1.12.4.6 Structural Resistance to Fire __________________________________________ 88
1.13 Medical and Pathological Information________________________________________ 88
1.14 Fire ____________________________________________________________________ 88
1.15 Survival Aspects _________________________________________________________ 89
1.16 Tests and Research ______________________________________________________ 89
1.16.1 Flight Preparation for AFR 4590___________________________________________ 89
1.16.1.1 Flight Preparation at Air France _______________________________________ 89
1.16.1.1.1 Flight Planning _________________________________________________ 89
1.16.1.1.2 Flight Departure ________________________________________________ 89
1.16.1.1.3 Ramp ________________________________________________________ 90
1.16.1.1.4 Traffic ________________________________________________________ 90
1.16.1.2 Preparation of Flight AFR 4590________________________________________ 90
1.16.1.2.1 Flight Planning _________________________________________________ 90
1.16.1.2.2 Flight Departure ________________________________________________ 91
1.16.1.2.3 Ramp ________________________________________________________ 91
1.16.1.2.4 Traffic ________________________________________________________ 92
1.16.2 Aircraft Loading _______________________________________________________ 92
1.16.3 Observation and Pictures of the Event______________________________________ 93
1.16.4 Previous Events _______________________________________________________ 94
1.16.4.1 Nature of Events ___________________________________________________ 94
1.16.4.2 Events which caused Structural Damage to Tanks _________________________ 95
1.16.4.2.1 Event on 14 June 1979 at Washington ______________________________ 96
1.16.4.2.2 Other Events __________________________________________________ 98
1.16.5 Tyre destruction Mechanism _____________________________________________ 98
1.16.5.1 Experimental Tests _________________________________________________ 98
1.16.5.2. Theoretical Study of Metallic Strip Cutting Tyre __________________________ 101
F-BTSC - 25 july 2000
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