Original subtitles

Beatours 28, you are clear for takeoff.

80 knots.

Stop!

Don't hammer the brakes. Don't hammer the brakes.

137 people

are on board this British Airtours flight.

Within minutes, nearly half of them will be dead.

This should not really have happened.

Evacuate, evacuate!

The aircraft didn't even get airborne.

It didn't run off the runway.

And yet, still 55 people were killed.

For investigators, it's a familiar routine--

reconstructing the final moments inside the cabin,

analyzing the wreckage and the flight data recorders.

In the end, they turn to a psychologist

to help them figure out how a survivable emergency

turned into one of British aviation's

most horrific disasters.

Ladies and gentlemen,

we are starting our approach.

We lost both engines!

Put the mask over your nose.

Emergency descent.

Mayday, mayday.

Brace for impact!

I think I lost one.

Investigation starting...

Man: He's gonna crash!

Just before six in the morning

on August the 22nd, 1985,

Manchester's Airport is coming to life.

The first flights of the day are being prepped for departure.

British Airtours Flight 28 is scheduled to take 131 passengers

from Manchester to the Greek island of Corfu.

British Airtours is a division of British Airways,

specializing in low cost flights to vacation destinations.

It's a chilly morning.

A slight breeze is blowing.

Ideal flying weather.

Most of the passengers on this early morning flight

are traveling on vacation.

Lindsay Davies is heading to Greece

with her boyfriend Charlie Thickson.

All right, let's go.

We'd been going out with each other for a year,

and that's one of the reasons we were so excited about it.

You know, it was our first holiday together.

Captain Peter Terrington

is in command.

I was the senior training captain

on the fleet.

First officer Brian Love

is being trained by Terrington.

He was going to perform a takeoff and landing,

as part of his training.

All right, captain?

Yep.

Ah, briefing, then, Brian.

Airfield emergencies.

You handling the aircraft.

What are the four things you're going to stop for?

Fire, failure, configuration warning,

or you shouting stop.

Okay. So you bring the thing to a stop

and I'll take over the aircraft

and leave you to deal with the emergency.

I'll deal with the ATC.

Okay?

If you've talked about the possibility of emergency

and talked over what you would do,

then if it actually happens,

it's easier to recall those items.

Okay, Brian, start two.

Starting two.

Oil pressure rising.

Okay, go one.

24, 25, 26, 27, 28, 29.

129 plus 2 on board, captain.

All strapped in, doors are closed and automatic.

Thank you, Arthur.

The crew is flying a Boeing 737.

It takes just four minutes

for the plane to reach the foot of the runway.

Beatours 28, you are clear for takeoff.

The 737 has 3,300 yards

to get to take-off speed.

The engines are pushed to high power.

I was sitting by the window,

looking out of the window.

Everything was normal.

The plane was going quite fast.

80 knots.

Check.

We heard a dull thud,

which sounded as if it came from outside.

I was really keen to see what was going on outside

but couldn't see anything.

Captain Terrington needs to act fast.

Stop!

And the immediate reaction was to stop.

We were quite a few knots below our decision speed,

so I very quickly closed the throttles

and applied reverse thrust.

We could feel the aircraft slowing down,

and I thought we'd blown a tire,

and I didn't know, so we just waited to hear.

Don't hammer the brakes.

Don't hammer the brakes!

I thought the tire might have gone

and would cause damage to the undercarriage

if we braked too strongly.

Probably nothing.

I wouldn't worry.

I just assumed that maybe a tire had burst,

so I wasn't really alarmed at that point.

My thought at that time was, oh, okay,

we're going to get off this plane

and probably have to move all the luggage

onto another plane and take off.

Soon, passengers on the left side of the plane

see the real problem.

I could see orange flames

inside the back of the engine.

And at that point, I thought it's obviously not a burst tire.

That wouldn't cause that,

and this is perhaps something a bit more serious.

Let me by. I'm not staying there.

But at that point I knew that I wanted to get off the plane,

and I wasn't happy at all.

I knew that there was a fire,

and I just wanted to get away from the fire.

Smoke is seeping into the cabin.

Please sit down!

My nearest exit was at the back.

I didn't want to go to the back

because the smoke was coming in there.

So I decided in my mind

that I was going to go through the front.

I said to Charlie...

Come on, we're going.

And that's when I started going towards the front of the plane.

Stopping. 28 mike, we're abandoning takeoff.

Looks like we've got a fire on number one.

Looks like there's a lot of fire.

Thank you.

Plane on fire, runway 24.

From where he's sitting,

captain Terrington can't see how bad the fire is.

He needs advice from the tower.

Do we have to get the passengers off?

I would do, by the starboard side.

Terrington decides to pull off the runway.

Evacuate to the starboard side, please.

Fire drill, engine number one.

Shutting down two.

Evacuate, evacuate!

Please stay calm!

Before the flight crew leaves the cockpit,

they must complete a 15-step checklist.

Parking brake.

Set.

Speed brake lever.

Down.

But time is running out.

We had an evacuation checklist,

but it was four pages long,

and the last item was to get the passengers off.

Engine and APU fire warning switches.

This didn't cover my problem at all.

On the 737, there are four cabin doors.

The two in the back are covered in flames and smoke,

leaving only two for 137 people.

Then, a mechanical problem eliminates one of those.

Well, Arthur was opening one right.

And, um, he was really banging, he was really trying to open it,

and it was really hard to open.

The back of the cabin is filling with smoke.

It's making breathing difficult.

Passengers rush forward.

It just seemed to go on forever

before they, they started evacuating.

And that's when I thought I'm not going to get off.

It's going to blow up with all of us on it.

Engine and APU fire warning switches.

Now, all 137 people on board are alive.

But with every second,

their odds of surviving are decreasing.

Flight 28 is becoming a death trap.

The jammed door on the right side of the 737

leaves the crew no choice.

They must get the passengers out

from the side of the plane that's burning.

As soon as we opened the door,

the fire service were already around,

shooting foam up the slide

and it came into the galley floor.

We wanted to start evacuating passengers,

but there was a bit of a bottleneck

and nobody was coming forward.

The aisle is quite narrow where the galley is,

and they were pushing forward.

And I could see this boy

that was really sort of pushed against the wall.

He couldn't get out so I pulled him by his T-shirt,

had the yellow T-shirt, and he, he sort of tumbled forward,

and after that everybody sort of just tumbled in behind him.

And we just directed them down the slide.

Jump.

Jump. Jump.

In training they tell you to bring people to the door

and you tell them to jump.

Jump.

Desperate to get people off the plane quickly,

the purser returns to the jammed door.

After several attempts, he manages to force it open.

The only time I turned around

was to make sure that Charlie was following me.

See you out there.

One thing I did see when I looked back

was people going to the front,

towards the front of the plane where the seats are,

and pushing the seats forward,

folding them down as they went along.

So people were trying to rush forward from the back.

The chute was open and people were just jumping out

straight onto the chute.

As I got to the bottom,

I didn't look back at all, was just wanting to get off.

Dozens of passengers have made it off the plane.

But there are still many more inside.

It was smoldering and it was black, thick black smoke.

And Charlie had said that after you'd gone,

this black smoke came down, he said,

and everybody was screaming and panicking.

He said people are going to die in there.

Standby power switch.

Captain Peter Terrington

and his first officer Brian Love

are still aboard the burning airplane.

And they still haven't completed the steps required to evacuate.

There was four tons of fuel

coming out of that aircraft.

Wing tank.

Ready to go, Brian? Go, Brian.

I could see quite a lot of flames.

Completing the checklist

would put their lives at risk.

We did as many items as we could.

And then we both went out of the flight deck window.

There are no more passengers at the exits.

So Joanna Toff decides to see

if anyone else is left in the cabin.

And the smoke was, you could touch it,

it was so thick.

And you could taste, it was awful, really.

Go!

There was a young girl

just a bit further down in the cabin.

But she was really disorientated;

I mean, I suppose we all were, really.

We just didn't have any idea what was going on.

I just brought her down to the slide.

She was taken off then.

The fireman was telling me to come on out.

And I'm thinking well, I'm not finished, you know,

we've not finished yet.

When Toff re-enters the cabin,

the thick smoke makes it as hard to see as it is to breathe.

It was really dark and quiet,

I've never seen anything like it.

And I could see the light from the door anyway by then,

so I knew where the door was.

The smoke forces Toff to abandon her search.

Just minutes after pulling off the runway,

British Airtours Flight 28 has been consumed by fire.

We got out of the flight deck,

which was relatively intact.

And when we turned round on the ground

we saw a complete wreck of an aircraft.

And it had happened in a matter of seconds.

It was, uh, dreadful.

54 people are dead.

One more person would later die in the hospital.

There was nothing wrong, really, with us.

We thought nothing physical wrong with us.

But our lives changed, you know,

just in those, in those few hours.

I couldn't breathe.

I was virtually out the door and I couldn't breathe then.

The smoke was coming in

and everybody just stood up and ran out.

It was just a mad panic getting out.

When the smoke came,

you just couldn't see anything at all.

You couldn't see anybody.

It takes 125 firefighters

more than two hours to put out the fire.

News of the disaster soon spreads around the world.

British Prime Minister Margaret Thatcher

flies to Manchester to visit the scene.

When we get a terrible air crash of this kind,

everyone is appalled and shocked.

Every single aspect of this accident

will be thoroughly investigated.

It has to be.

This is the fourth major commercial air disaster

of the year.

In June of 1985,

an air India jet exploded over the Atlantic Ocean.

329 people were killed.

Weeks later, 137 people died when a Delta Airlines flight

crashed at Dallas-Forth Worth Airport.

And just ten days before the Manchester crash,

the deadliest single-aircraft accident in history.

Japan Airlines flight 123, a fully loaded 747,

slammed into a mountain, killing 520 people.

British Airtours Flight 28 adds 55 new victims

to the list of air casualties.

1985 is now the deadliest year

in the history of commercial aviation.

The flying public is getting nervous.

Britain's Air Accidents Investigation Branch

sends a team to Manchester

to unravel the events that led to the catastrophe.

Among them, Stephen Moss.

He'll be inspecting the plane's engines.

This should not really have happened.

The aircraft didn't even get airborne.

It didn't run off the runway,

and yet still 55 people were killed.

Chris Protheroe is also on the team.

His focus is on the fire.

We were aware from initial reports

that the fire had entered the aircraft very rapidly

as the aircraft came to a halt.

And that was a focus for me.

It doesn't take too long for Stephen Moss

to figure out where the trouble started.

He sees damage to the plane that was not caused by the fire.

The first thing we noticed clearly

was the hole in the underside of the wing.

And right next to it was a gaping hole

in the side of the engine.

Seems that one had led to the other.

To lift a passenger jet

off the ground,

massive thrust is needed.

That power is created when air travels

through the front of the engine to a series of compressor fans.

It's then ignited,

and the exhaust pushes the plane forward.

Something had clearly gone very wrong

with Flight 28's left engine.

Investigators look for clues on the runway and in the cabin,

hoping to discover why so many people died.

Entering the cabin for the first time,

there was a, as with all aircraft fires,

there's an overwhelming pungent smell...

Burning plastic, burnt fuel.

Burning material had dropped down onto seats,

and so the aisles were filled up

with the remains of overhead lockers.

A scene of devastation.

The damage in the cabin is revealing.

It's almost completely charred up high,

but is relatively intact down low.

It was clear that there had not been a flashover

in this particular case.

A flashover occurs

when the gases in an enclosed space

become so hot that they ignite,

incinerating everything around them.

The way Flight 28's cabin is charred

tells Protheroe about the nature of the fire.

Many of the seat squab cushions,

even things like the emergency evacuation cards,

which are just plastic laminated cards,

were pretty much undamaged.

You could have wiped them off and put them on another aircraft

and nobody would have known they'd been in this accident.

Whereas at the upper levels in the fuselage

there was a great deal of heat damage,

and this is not a characteristic of a flashover.

The fire in the cabin had been severe,

but should not have been catastrophic.

This leaves investigators with two questions:

Why did so many people die, and what caused the fire?

The answer to the question

may be outside the plane, lying on the runway.

Investigators find a large piece of dome-shaped metal

along the plane's path.

Stephen Moss can see it's from a piece of the engine

called a combustor can.

It looked like there'd been a separation of the can

from the front end, from the back end.

The combustion chamber

of the 737's jet engines

contain nine combustor cans.

It's where fuel and air are mixed and ignited.

So each can needs to withstand intense heat.

Moss suspects the fractured can

somehow blew apart and destroyed the plane's left engine.

It had struck

an under-wing fuel tank access panel

and put a sizable hole in that,

which directly led to the release

of a vast quantity of fuel.

Proving the piece of the combustion can

penetrated the wing is easy.

It fits neatly into the hole in the wing.

This was clearly the, if you like,

the root cause of the accident.

The engine on the plane

is a Pratt & Whitney JT-8D.

For Moss, that's of grave concern.

At the time, it was probably

the most widely used jet engine on commercial air transport

in the world.

And it was obviously pretty urgent

that we try and find the cause of this one

in order to prevent other aircraft

having the same problem.

There are tens of thousands of combustor cans

in service around the world.

One of them erupted in Manchester.

Stephen Moss needs to find out why it failed, and fast.

Investigators looking into the deadly fire

on board British Airtours Flight 28

study the plane's maintenance log.

They discover the combustor can that ruptured

had previously been damaged.

We needed to look at that repair

and how effective it was.

During a routine inspection

a year and a half earlier,

mechanics had found small cracks in some of the combustor cans.

It was certainly not uncommon

to find fatigue cracks in the cans.

They're operating in a high temperature environment.

The manuals give various schemes for repairing these cracks.

Investigators find mechanics repaired the cracks

according to a procedure laid out

in the engine repair manual.

They welded them closed.

But the crack on can number nine was unusually long.

The overhaul manual did not give any limit

on the length of crack that could be repaired,

and it was a longer crack than had been experienced before.

It was still repaired.

After the repaired cans

were put back in the engine,

mechanics had no way of knowing

the weld didn't effectively seal the crack.

That's because the cans can't be inspected

while the engine is on the plane.

Since the repair there were eleven reports

of slow acceleration

from the engine that exploded in Manchester.

A damaged combustor can

could have been a reason for the problem.

But troubleshooting guides

available to mechanics in Manchester

didn't list that as a potential cause.

Instead Pratt & Whitney offered other ways

to fix the acceleration problem.

So mechanics in Manchester made minor adjustments

to fix the plane's idle speed and kept the plane in operation.

Cockpit voice recordings reveal that the crew of Flight 28

was aware there was a problem with slow acceleration.

Slow acceleration on the number one engine

day before yesterday.

I was on the flight, yes, sir.

And they signed off on it.

But the log entry led captain Terrington to believe

that the problem had been fixed.

A comment in the tech log

for the flight before the last one,

that the engine was slow in accelerating.

It wasn't apparent as a serious problem.

Because the engineers had done some work

and the aircraft had been flying the previous day

with no problems.

The idle speed adjustments

didn't fix the real problem--

the cracked combustor can.

And it reached the breaking point on Flight 28.

Stopping. 28 mike, we are abandoning takeoff.

Evacuate, evacuate!

Please stay calm and don't panic.

If the airline had inspected the cans,

I think there is no doubt

that they would have seen the problem.

Investigators now know the origins

of the Manchester disaster.

The welded crack in combustor can number nine

gave way as Flight 28 sped down the runway.

The front of the can was ejected from the engine

and put a hole in the underside of the left wing.

That led to a huge fuel leak onto the damaged engine,

which caused the fire.

Engine fires are not uncommon.

The body of a 737 is insulated with fire-retardant material

to protect the cabin.

Investigators still don't understand

how a fire outside the plane spread into the cabin

as quickly as it did.

It was clear from these photographs

that there was a very dynamic phase to the fire

whilst the aircraft was at speed on the runway,

which produced this energetic, turbulent sort

of blow torching type of fire, visually, anyway,

trailing behind the aircraft.

A press photo from the day of the crash

leads fire inspector Chris Protheroe to a new theory.

The photographs of the aircraft

that appeared in the press

showed the left thrust reverser deployed.

The general impression

that one got visually from that photograph

was that the thrust reversers

had effectively blow torched fire

against the side of the fuselage,

and that that, if you like, was the explanation

as to why the fire had penetrated so quickly.

That photograph and the implications of it,

actually, therefore, loomed quite large.

Stop!

There are several ways

to bring a speeding jet liner to a halt.

One is with the brakes.

Don't hammer the brakes.

Another is with the engine's thrust reversers.

Thrust reversers redirect the exhaust

from the jet engine forwards.

This helps slow the plane down.

It looked as though the thrust reversers

had simply blown this big fire on the left of the aircraft

against, directly onto the side of the aircraft,

directly onto the rear fuselage.

That would explain why the fire

destroyed the cabin so quickly.

It now seems possible that captain Terrington

made the fire worse by trying to slow his plane down.

We have to get the passengers off.

But Protheroe has two good reasons

to doubt his theory.

One is the location where charring

from the burning exhaust gas, or efflux, was found.

The efflux impinges on the fuselage further up,

closer to the roof, the crown skins of the aircraft.

So actually the penetration that we had low down

did not fit with that.

And the other reason is

by the time the thrust reversers were deployed,

the left engine had already exploded.

But to act as a blowtorch

the engine would have needed considerable exhaust.

We did calculations to confirm

that the residual thrust from that engine

would not have had the energy to have this effect.

Clearly, something other than the thrusters

had caused the fire to spread so quickly.

Protheroe looks more closely at the data.

After examining weather reports from the day of the accident,

he finds the answer.

The wind was the main factor

that determined the severity of the fire

in terms of its attack on the outside of the aircraft,

how rapidly it penetrated the aircraft,

and it also affected the conditions inside the cabin.

Believing he had blown a tire,

captain Terrington made a fateful decision.

Stopping. 28 mike, we are abandoning takeoff.

Well, when we heard the thud, then we closed the throttles.

It was my assumption

that we were going to turn off the runway,

clear the runway,

ask air traffic for an engineer to come out and check the tires.

Like a highway,

an airport runway has a series of exits.

Captain Terrington chose one called Link Delta.

We got a fire on number one.

Captain Terrington turned his plane to the right

and brought it to a stop.

He couldn't have realized that doing so

would make the problem far worse.

There was a crosswind,

a slight crosswind from the left side of the aircraft

that was carrying the fire that was burning

from the fuel that was pooled underneath the left wing.

It carried that fire aft, rearwards

and to over and under the rear fuselage,

in between the wing and the tail plane.

The wind wrapped the fire

around the back of the plane...

And into the cabin.

If there had been no wind at all,

I think the situation would have been very much more benign.

Investigators have discovered how the fire started

and the conditions that caused it to penetrate the cabin.

Now investigator Ed Trimble must solve the biggest mystery

surrounding the Manchester accident.

Here we had an aircraft

which had aborted the takeoff for good reason,

had taxied off and stopped in a taxiway,

in an expeditious manner,

and yet 55 people had lost their lives.

So there was a big question

as to precisely why that had occurred.

Investigators learn that most of the dead

were not found in the worst burned parts of the plane.

Autopsies will point to the real killer on Flight 28.

Of the 54 people who died in the cabin,

only six had suffered serious burns.

All the rest died from smoke inhalation.

It seems the smoke in the cabin was particularly lethal.

Survivors tell investigators that the smoke was unbearable.

The smoke was really black and, and it was,

it was almost touching you, it was, it was, really weird.

And they said that the effect of that was shocking.

That immediately you took one breath of the smoke,

you began to feel debilitated

and you knew that if you took another breath or two,

you weren't going to make it.

At the time of the Manchester accident,

the effects of fire on an airplane

had been well studied and understood.

But the effects of smoke were not.

To figure out what made the smoke so toxic,

Trimble decides to recreate the fire that burned on Flight 28.

We were trying to model

not only the gases which were produced,

but also the kind of threat levels which were produced.

The smoke that filled the plane

was from materials burning inside the cabin.

The foam in the seats, the wool in the carpets,

and the plastic overhead bins all release poisonous fumes.

Those conditions are recreated by burning the same materials.

Trimble discovers the passengers on Flight 28 inhaled smoke

that contained a deadly blend of poisonous gases,

including high levels

of carbon monoxide and hydrogen cyanide.

Now he desperately needs to find out

if there's any way to protect airline passengers

from that kind of smoke.

It would seem to me pretty clear

that unless we could protect people's respiratory systems

from the assault from such combustion gases,

there was little that we could do

to improve survival chances from aircraft fires.

Over the course of five weeks,

investigators run dozens of tests,

experimenting with different filters.

They burn nearly a quarter ton of material

to create the necessary smoke.

Their dramatic conclusion:

it may have been possible to save passengers' lives.

There was not the slightest doubt in my mind

that in these situations, in an aircraft cabin,

if it is being assaulted by combustion gases,

your chances of survival are vastly improved

if you have smoke hood protection.

British Airtours Flight 28

had only enough smoke hoods for the crew.

They were never used.

Trimble's research indicates

that smoke hoods for passengers could have saved lives.

There were hoods available,

both of the filter type and the breathable gas type,

which can provide a very high level of protection to people

in these circumstances.

Many of the passengers on Flight 28

would have survived with a few more minutes

of breathing time.

A full Boeing 737

is designed to be evacuated in less than two minutes.

So even without additional time,

more of the passengers on Flight 28

should have been able to get off.

To discover why so many people never made it off the plane,

investigators turn to an unlikely source for the answer.

By law, airplane manufacturers

must prove their planes can be evacuated quickly and safely.

When the 737 was introduced in the UK,

Boeing demonstrated that 130 people

could get off the plane in just 75 seconds.

All public transport aircraft

are certificated to the same criteria,

and that is that the total complement of passengers

must be capable of evacuating from the aircraft

using half the exits in the aircraft--

it's generally one side or the other--

within a maximum of 90 seconds.

But 90 seconds after Flight 28 came to a stop,

most of the passengers were still on board.

The reason why the evacuation at Manchester

wasn't achieved in 90 seconds

is because the conditions in a real fire evacuation

are completely different from the certification conditions.

The certification evacuation is conducted

in clear conditions,

with no smoke that reduces vision

and overwhelms passengers.

Within minutes of coming to a stop,

Flight 28 filled with a thick black smoke.

A soon as the smoke began

to spill into the rear cabin

and then flow forwards,

essentially that induced immediate panic

in those who were so affected by the smoke.

Because the respiration, I mean, the typical comment

was I took one breath of the smoke

and I felt as though my lungs were solidifying.

You can imagine under these conditions

that people have got to get away from the smoke.

And the people did this

by basically clambering over the seats

and other people in front of them.

In less than five minutes,

what should have been a survivable accident

turned deadly.

To prevent future tragedies,

Britain's civil aviation authority

decides to learn more about people.

Helen Muir is a psychologist and a leading expert

on how airplane design can influence survival.

She's asked to study

the behavior of passengers on Flight 28

to figure out why so many died.

What we had to learn to do

was to design the aircraft interior

so even if we had what we might say

was dysfunctional behavior in totality,

we could accommodate the needs of individuals

in their desperate rush to get out.

Muir configures a cabin to duplicate Flight 28

and fills it with volunteers.

Then, to have them act as though the plane's on fire,

she offers money to the first ones off.

And that produced behavior that was quite unbelievable.

People went over seats, they went round past each other,

all sorts of things.

And indeed, when survivors from the actual Manchester accident

came and saw the videos,

they said yeah, this is, that's how it was.

The evacuation of Flight 28 was slowed

by the fact that passengers became jammed

in the bulkhead opening

separating the main cabin from the galley.

Alright, folks, the door's open,

jump down the slide.

Investigators discover the logjam was created

by the design of the Boeing 737.

The bulkhead opening was 22 1/2 inches wide,

just enough for one person to fit through.

Muir's tests showed the narrow bulkhead opening

created bottlenecks

that flight attendants had to constantly clear.

Increasing the width to 30 inches

greatly improves the movement of passengers.

What we showed, through repeat testing,

that if you changed the minimum gap from 20 to 30 inches,

you would dramatically improve

the speed at which people could get out

and you'd reduce the likelihood

of people falling and slipping and so on.

As a result of Helen Muir's work,

a recommendation was made to increase the space

between the bulkhead walls to 30 inches

and introduce strip lighting to help guide passengers to exits

even when they are blinded by smoke.

Muir also found a way to improve cabin safety

without redesigning the cabin.

Please sit down.

She conducted research

on the behavior of the cabin crew in emergencies

and found that passengers get off a plane much faster

with a highly assertive crew.

It's because we don't want people

really making their own decisions.

We want people to do

exactly what the cabin crew or the procedures state.

And we don't want people hesitating,

particularly at the door.

Helen Muir's research prompted manufacturers

to redesign cabins to make them safer.

But one safety feature remains controversial: smoke hoods.

Ed Trimble believes they should be mandatory

on all commercial flights.

Without a doubt. Without a doubt.

Helen Muir is less convinced.

She's studied how smoke hoods affect passenger behavior

and is worried they would slow down

the orderly evacuation of an airplane.

We know you've only got

literally one and a half to two minutes

for everybody to get out.

What we don't want to have

is something which is difficult to put on

and so it slows people getting down.

The most important lesson

of British Airtours Flight 28

is that seconds matter.

It's now universally accepted that it takes 90 seconds

from the first sign of fire before it becomes unsurvivable.

The passengers on Flight 28 lost valuable time

when the starboard side door jammed.

The investigators determined that the slide mechanism

deployed too early, preventing the door from opening.

There was a flaw that led the slide container's lid to jam

if the door is opened too quickly.

After the Manchester accident,

Boeing quickly redesigned the system

so that couldn't happen.

But the recommendations made by the AAIB

weren't adopted quickly enough to save lives six years later.

In 1991, a Boeing 737 slammed into another plane

on the runway in Los Angeles and caught fire.

Many of the 22 people who died

were overcome by smoke before they could get out.

But in 2005, the crash of an Air France jet in Toronto

showed how much has changed since the Manchester accident.

All 309 people got off that plane in just 90 seconds.

No one died.

Some major changes to commercial airliners...

Alright, the door's open.

...came about because of a flight

that never left the ground.

That's the only way I can resolve it

with the death of 55 of my passengers.

The fact that flying is now safer.

I can't imagine anybody, you know, doesn't wish

that it hadn't happened.

You know, despite what's been learned

and despite maybe the subsequent lives that have been changed,

you know, you'd give anything for it not to have happened.