ASN Wikibase Occurrence # 207806
This information is added by users of ASN. Neither ASN nor the Flight Safety Foundation are responsible for the completeness or correctness of this information.
If you feel this information is incomplete or incorrect, you can submit corrected information.
| Date: | Saturday 3 March 2018 |
| Time: | 18:28 UTC |
| Type: |  Boeing 737-75B (WL) |
| Owner/operator: | Germania |
| Registration: | D-AGEU |
| MSN: | 28104/39 |
| Year of manufacture: | 1998 |
| Fatalities: | Fatalities: 0 / Occupants: 128 |
| Aircraft damage: | None |
| Category: | Incident |
| Location: | Canary Islands airspace -
 Spain
|
| Phase: | En route |
| Nature: | Passenger - Scheduled |
| Departure airport: | Puerto del Rosario Airport, Canary Islands/Fuerteventura Island (FUE/GCFV) |
| Berlin Schönefeld Airport (SXF) | |
| Investigating agency: | CIAIAC |
| Confidence Rating: |  Accident investigation report completed and information captured |
Germania flight ST1433 was en route at FL380 when the flight crew experienced intense pressure changes. After observing the Cabin Rate of Climb Indicator, they noticed that there was a problem with the pressurization of the cabin. Moments later, the visual and auditory cabin altitude warning activated. The crew put on oxygen masks.
The pilot monitoring noted that the FLT ALT and LAND ALT indicators showed dashes, so they concluded that a double failure of the cabin pressure controller had occurred.
Meanwhile, the altitude of the cabin reached 15,000 feet in an uncontrolled manner. The oxygen masks of the passengers were deployed automatically when the cabin altitude reached 14,000 feet.
The crew declared the emergency situation (MAYDAY) to the air traffic control service, communicating their intentions to carry out an emergency descent.
During the descent, the crew manually regained control of cabin pressurization, after which they decided to cancel the emergency declaration.
The crew decided to divert and land at the Malaga Airport, where they landed normally.
CAUSES:
The investigation was unable to realiably determine the cause of this incident.
1. According to the studies conducted during the investigation into this incident, it may have been caused by two possible faults.
Initially. the #2 cabin pressure controller (CPC2) commanded the outflow valve (OM to open completely. The upset that opened the OFV was caused by corrupted data in the CPC. The source of that corrupted data was either a SEU or the result of failing solder joints.
Later, due to the stiffness of the OFV, the # 1 cabin pressure controller (CPC1) was unable to return it to its closed position and thus stabilize the cabin pressure. This may have bee n a factor contributing to the severity of the depressurization. It was possible to identify what caused the stiffness of the OFV.
2. After the incident, suspecting that both cabin pressure controllers had failed simultaneously, they were replaced; however, various anomalies continued to occur involving the loss of cabin pressure.
3. The aircraft operator did not provide information on what caused the loss of cabin pressure after the cabin pressure controllers were replaced.
Moreover, it is not known if these subsequent incidents were analyzed in detail by the operator.
On 3 March 2018, before the incident, two other incidents involving cabin pressure were re ported. It is thought that the lack of a detailed analysis of these prior incidents by the operator's maintenance technicians could have been a contributing factor in this incident.
Accident investigation:
 |
|
Sources:
http://www.fomento.gob.es/MFOM/LANG_CASTELLANO/ORGANOS_COLEGIADOS/CIAIAC/INVESTIGACION/2018/IN-008-2018.htm
History of this aircraft
Other occurrences involving this aircraft
| 23 May 2012 | D-AGEU | Air Berlin | 0 | Düsseldorf |  |
non |
Revision history:
| Date/time | Contributor | Updates |
|---|---|---|
| 18-Mar-2018 10:23 | harro | Added |
| 05-Jun-2019 10:24 | harro | Updated [Destination airport, Narrative, Accident report, ] |
| 05-Jun-2019 10:25 | harro | Updated [Departure airport, Destination airport] |
| 27-May-2022 00:33 | Ron Averes | Updated [Location, Departure airport] |
Corrections or additions? ... Edit this accident description
The Aviation Safety Network is an exclusive service provided by:
Quick Links:
| ASN Home | Send Correction / Feedback |
| FSF Home | Disclaimer | Copyright |
| Contact Us | Privacy Policy |
| Press / Media |
CONNECT WITH US:
©2024 Flight Safety Foundation