Case Studies

Aloha Airlines Flight 243 (1988) When inspection systems assume continuity in a structure that no longer has it

  The Event On 28 April 1988, Aloha Airlines Flight 243, a Boeing 737, was cruising between Hawaiian islands. At altitude, a large section of the fuselage roof suddenly separated from the aircraft. An explosive decompression occurred instantly. Despite extreme structural damage, the aircraft remained partially controllable and performed an emergency landing. One flight attendant […]

Überlingen Mid-Air Collision (2002) When two systems trusted the same idea of separation

  The Event On 1 July 2002, two aircraft were flying in controlled European airspace: Bashkirian Airlines Flight 2937 (Tupolev Tu-154) DHL Flight 611 (Boeing 757 cargo aircraft) They collided mid-air over southern Germany near Überlingen. All passengers and crew on both aircraft were killed.   What Happened (Surface Explanation) The aircraft were under the

Eastern Air Lines Flight 401 When attention became the system’s weakest component

  The Event On 29 December 1972, Eastern Air Lines Flight 401, a Lockheed L-1011 TriStar, was on approach into Miami. The landing gear indicator light failed to illuminate. What began as a minor technical anomaly escalated into a fatal loss of situational awareness. The aircraft eventually descended into the Florida Everglades.   What Happened

Helios Airways Flight 522 When the system never knew it was already dying

  The Event On 14 August 2005, Helios Airways Flight 522 departed Cyprus bound for Prague with a scheduled stop in Athens. It never reached Athens. The aircraft entered a holding pattern, continued on autopilot, and eventually crashed into mountainous terrain near Grammatiko, Greece. There was no explosion.No structural failure.No external impact. The aircraft simply

Air Inter Flight 148 When the interface made two different actions look the same

  The Event On 20 January 1992, an Airbus A320 operated by Air Inter was descending toward Strasbourg during a night approach. The aircraft deviated from its intended path and impacted terrain in the Vosges mountains. There was no loss of control.No structural failure.No external threat. The aircraft flew a controlled path—into the ground.