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Appendix
The Kegworth Air Accident (1989)
Introduction
The Kegworth air accident is used to illustrate several points in this topic. We
chose this particular accident because it is well known and has been widely
analyzed over the years (e.g., see Besnard et al.
2004
). The full accident report is
very comprehensive, and covers all aspects of the accident as well as the human
factors issues. It is available from the web site of the UK's Air Accidents
Investigation
(AAIB).
1
Branch
The
AAIB
are
responsible
for
investigating
accidents that occur within UK air space.
Description of the Accident
On 8 January 1989 a British Midland Airways (BMA) Boeing 737-400 plane
crashed into the embankment of the UK's M1 motorway close to the village of
Kegworth in the East Midlands, during a flight from London Heathrow to Belfast.
Of the 126 people on board, 47 lost their lives.
Both members of the flight crew were highly experienced. The Captain had
logged over 13,000 flying hours, whilst the First Officer had logged over 3,200.
Both pilots were rated for the B737-200, -300, and -400 series aircraft. They had a
combined experience of 76 flight hours in the Boeing 737-400 series aircraft.
Furthermore, they had not been trained on the new plane's controls, but had only
received a 1-day audio-visual conversion course on the B737-400, which has a
glass cockpit, i.e., the information is presented on digital displays rather than the
vast array of analogue instruments and electro-mechanical displays that appeared
in the cockpit of its predecessor, the B737-300. In addition, the B737-400 series
was fitted with a newer variant of an engine which could generate slightly more
thrust.
The
engine
had
been
certified
by
the
appropriate
authorities
after
undergoing testing.
During the flight, a fan blade broke off in the #1 engine. This resulted in an
increase in vibration above what is considered normal, and which was strong
1
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