All language subtitles for Air.Disasters.S02E09.The.Final.Blow.1080p.PMTP.WEB-DL.DDP5.1.H.264-maldini_track3_[eng]

Just minutes
from Strasbourg Airport...

Merde!

...an Airbus A320
slams into a mountaintop.

Delta Alpha, your position?

There are survivors.

And I panicked,
because I am going to burn.

But they are
still in grave danger.

It's bitterly cold.

And what they don't realize

is that no one knows
where they are.

They could be
anywhere in there.

We can expect this in
the jungle or the rainforest,

but not in a highly
populated area.

Before investigators
can begin searching

for what caused the crash
of Air Inter Flight 148...

They must first find the plane.

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...

He's gonna crash!

January 20, 1992.

Air Inter Flight 148 has
departed from Lyon, France.

124.95, thank you.

Captain Christian Hecquet

and first officer Joel Cherubin
are experienced pilots

with over 12,000 hours of
flying time between them.

The flight is a short hop
between Lyon, in Central France

and the city of Strasbourg in
the mountainous Alsace region.

The french airline, Air Inter,

caters mostly to
business travelers

and prides itself
on being timely.

Crews are motivated
to avoid delays,

as former Air Inter pilot
Gerard Arnoux explains.

We were famous
for our very short turnaround.

And the faster we flew,
the better wages we got.

Have we been
flying for 35 minutes yet?

41 minutes.

The crew is
flying an Airbus A320,

one of the most technologically
advanced commercial airplanes

in the world.

Even before takeoff, the pilots
programmed the autopilot

to land on a specific runway
in Strasbourg.

The cockpit of the A320
is also very different

from other planes.

Instead of analog gauges,

the pilots look mostly
at digital displays.

Strasbourg,
good evening.

Runway in use, 05.

Transition level, 50.

Wind, 040 at 18 knots.

Visibility, 10 kilometers.

A recording from
Strasbourg Airport

informs the crew of
a change in plan.

Due to high winds and
poor winter weather,

they'll have to land
on an alternate runway.

05 in service.

Not the one
programmed into the autopilot.

05?

What sort of wind
are they giving us?

18 knots.

18 knots.

Captain Hecquet
doesn't like the idea

of changing runways.

No chance.

He was hoping
to use runway 23,

an approach that
provides the autopilot

with a precise navigational fix.

The new runway, runway 05,

is surrounded by
mountainous terrain

that can interrupt radio signals
sent to the autopilot.

You know, if we go with
the runway 05 procedure,

we--well, no.

Captain Hecquet
suggests a compromise.

I'm putting back
runway 23.

Otherwise, I couldn't make
the I.L.S. Interception.

He'll program
the autopilot

to fly towards runway 23.

But near the airport,

the captain will
take over the controls

and make a visual landing
on runway 05.

You're taking
23, then?

Yes!

Agreed.

Ladies and gentlemen,

we are commencing our descent.

We ask you to please
return to your seats...

Nicolas Skourias is
a university graduate student.

It was a quiet day.

I was expecting to go to see
my girlfriend in Strasbourg,

so I was very happy.

Roger, 854,
proceed to GTQ,

air level 140, contact Reims.

Delta Alpha, Strasbourg.

Yes, we intend
to proceed to do an I.L.S.

On runway 23,

then an indirect for
runway 05 after that.

The Strasbourg controller

considers the captain's plan.

Delta Alpha.

He warns that
there will likely be a delay

due to heavy traffic.

Given that we're
going to have three takeoffs

on 05, you risk waiting in
a stack at 5,000 feet.

We're not going
to mess about like that

descending at full speed.

If they had warned us
in advance! Cripes!

Delta Alpha, Strasbourg.

I hear you.

Aware of
the captain's frustration,

the controller
offers assistance.

If you want,
I can take you with the radar

to lead you to andlo at 5,000.

Andlo is
a navigational point

on the approach to runway 05.

It helps pilots align the plane
for landing.

Yeah, that's good.

Oh, yeah.

Ok, then, turn left to heading,
230 degrees.

148, turn left
to heading, 230 degrees.

There you are.
That will save you some time.

Since runway 05
doesn't allow

for a full autopilot approach,

the captain must calculate
the angle of descent on his own.

That makes 3.3 degrees.

3.3 degrees
is a normal flight angle

that provides a good slope
for landing.

Ladies and gentlemen,

we are continuing our descent.

The flight from Lyon
to Strasbourg was quite short,

I think 50 or 45 minutes,
nothing special.

It was very natural
and very ordinary.

Thank you.

Turn left, steer 90.

090 degrees, Delta Alpha.

The controller
talks flight 148

through the last turn to align
the plane with the runway,

now 15 and a half miles away.

Then, first officer Cherubin
notices

the plane is slightly
off course.

You are headed inside.

You're inside there.

You should have
started with 070.

Yeah.

At least that much.

The controller also notices

that the plane is off course.

Air Inter Delta Alpha.

It has missed
aligning itself

with ANDLO, the runway's
electronic guidepost.

Delta Alpha, you're
passing to the right of ANDLO.

Nevertheless,
he authorizes the landing.

Authorized for
final approach, 05.

Delta Alpha.

The captain initiates
the landing sequence.

Flaps towards two.

Flaps towards two.

Flaps at two.

Gear down.

Ladies and gentlemen,

we are going to land
in a few minutes.

Hecquet notices that
the plane is traveling too fast,

so he extends the speed brakes.

They disrupt airflow
over the wing,

which helps create more drag
to slow the plane.

We have to
watch our descent.

The approach axis...

The first officer
is more concerned

with their horizontal position
in relation to the runway.

It was 60, check it out.

But before the crew
can adjust their course...

Merde!

Delta Alpha, your position?

Air Inter Delta Alpha,
Strasbourg?

The crash is catastrophic.

The A320 has flown into
the side of a mountain.

Delta Alpha,
your position?

Flight 148
is no longer on radar,

nor responding to radio contact.

An emergency is declared
at Strasbourg Airport.

This is the last hit we got.

They were flying about
20 kilometers away

from the airport.

Officials need to
pinpoint the crash site.

But it's not as easy
as it might seem.

The airport's radar
is not recorded.

There has been no signal from
the plane's emergency beacon.

And surprisingly,

no one has reported
seeing a plane go down.

It could be anywhere in here.

The proposed search area

covers more than eight
square miles of dense forest,

just outside Strasbourg.

Nicolas Skourias survives the
crash of Air Inter Flight 148

with only minor injuries.

I realized that
I was alive, it was a crash.

I saw fire in front of me,
and I panicked,

because I say to myself,
I'm going to burn.

I went to the back of the plane,
what remained of the plane.

I found some other survivors.

Come on!

It's going to blow!

I was afraid of the explosion.

I was a panic.

With the smell of
leaking jet fuel in the air ,

the survivors move away
from the burning plane.

We stayed together,
waiting for the first aid.

But the wait will be
longer than anyone might expect.

Two and a half hours
after flight 148 disappeared

from radar near
Strasbourg Airport...

... the missing plane
has still not been located.

Amidst growing tension,
the French Aviation Bureau,

the B.E.A., sends in its lead
investigator, Jean Paries.

I immediately
called my two main investigators

and we organized the go team.

And we got prepared to
rush to the site

as soon as the site
was located somewhere.

The delay
feels like an eternity.

It was
surprisingly long.

We can expect this in the jungle
or the rainforest,

but not exactly in
a highly dense populated area

like the Strasbourg area.

With no help in sight,

Skourias returns to the wreckage
to look for more survivors.

I think that
some people that die,

could have survived if
the first aid come sooner.

Nearly 1,000 people
search for the missing plane.

But three hours after the crash,
there's still no sign of it.

Frustrated, Skourias goes
looking for help.

He stumbles into a TV crew
trying to find the crash.

But with no wreckage in sight,
they react with skepticism.

They didn't expect survivors

from an airplane crash.

Hey! Hey, you have to
believe me!

They didn't believe that
I was one of the survivors.

But believe me, I was,
because my face was black

due to the smoke,
the kerosene, and so on.

Come on!

The journalists follow him

back to the crash site,

where they discover
eight other survivors.

Finally,
the first rescuers arrive.

The crash site is located

near the top of
the 2,500-foot Mont Ste. Odile,

nearly 12 miles from the runway.

They found us after

four hours and 30 minutes.

So it was a mess.

A total of 87
passengers and crew have died,

including the pilot
and co-pilot.

The survivors begin
to tell their stories,

but no one reports anything

that might explain
why the plane crashed.

I don't know what happened.

We were landing,
I lost all consciousness.

We must have hit the trees.

Bob Macintosh,
an American NTSB investigator,

arrives at the crash site.

The B.E.A.
Of France recognized

the international attention
would be on this accident,

even though it was
a domestic accident.

He invited a group

of international
accident investigators

to come and participate.

Jean Paries.
Welcome to the team.

The first priority
for investigators

is to retrieve
the plane's black boxes.

We have not removed
the recorders yet.

With the boxes trapped

in the burning tail section,

any delay could prove costly.

We were very anxious

about the state of
the tape inside.

Will it be possible to use it?

Will we get the critical
information we need?

Puis-je m'approcher?

In France, aviation
accidents are also investigated

by the justice system.

Paries and his team are not
allowed access to the site

until judicial officials
secure the black boxes.

I had a visual picture

of the Gendarmes Aerienne,

the transport police,

standing around keeping us away
from the wreckage for a while,

and were very suspicious of
these international observers.

Maybe we should wait.

Even taking photographs,

which was somewhat
surprising to us.

In a previous crash,

the crash of Air France
flight 296 in 1988,

investigators waited 10 days

before returning the black boxes
over to police.

Rumors persisted that these
boxes had been tampered with.

This time, police are keeping
investigators at bay.

I can recall
seeing the glowing embers

and seeing the flight recorder
sitting there

and not being able to intervene

and say, "get that thing cooled
down as soon as you can."

After midnight,

the boxes are retrieved from
the plane and sent for analysis.

Investigators can only hope
it's not too late.

They were extremely hot.

They looked damaged,
they looked burned.

In the light of day,

investigators get
some of their first clues

from the crash site itself.

They discover why the plane's
emergency locator beacon

didn't send a signal.

It was actually
destroyed by the impact.

The beacon is located
inside the cockpit

and is designed to start working
after a crash.

Its failure suggests
an unusually forceful impact

with the ground.

We had this first feeling

the descent was
abnormally steep.

Investigators
examine the engines

to see if they may have stalled
before impact.

If you find
the blades curved

and a lot of wood sucked
inside the engines,

then you understand that the
engines were working properly.

And that's exactly
what they find.

The plane clearly had power,

yet it plowed steeply
into a mountainside,

without ever sending out
a distress signal.

Investigators are puzzled.

They hope that the box which
recorded the plane's flight data

will help them
solve the mystery.

Those particular recorders

had the best survival record
of any recorders.

They were top of the line as far
as survivability is concerned.

The black box
is designed

to survive temperatures up to
2,000 degrees Fahrenheit

for half an hour.

The tape recorder inside
is protected by a capsule

filled with water.

When the recorder heats
up, the water turns to steam,

absorbing the energy,
and actually vents out

through a little hole
in the crash enclosure.

But when the flight
data recorder is opened,

investigators make
a troubling discovery.

The FDR was
totally damaged,

impossible to read
anything from it.

It was subjected to
heat beyond the 30 minutes.

The recorder was just
never designed

to withstand that kind of
sustained heat.

And so we were
very disappointed.

There's now
only one hope

for recovering
the plane's flight data,

a device called a quick access
recorder, or QAR.

Maintenance workers use the QAR
to access the plane's computers.

But it also records
some flight data.

Unlike the black boxes, the QAR
is stored near the cockpit.

Investigators are encouraged
to discover

that in this case,
the QAR has survived.

But on closer examination, their
optimism turns to frustration.

The last 20 centimeters
of the tape

were burned and stretched,
and were damaged to the point

that we could not use them
into a machine.

We couldn't read it.

Investigators are
desperate to retrieve the data,

so they take a chance on
an experimental technique.

Known as the garnet technique,

a light is shone through
a mineral lens made of garnet.

You use a garnet stone
to visualize the magnetic pulses

that are actually
recorded on the tape.

The special lens helps

the technicians differentiate

between the positive and
negative magnetic pulses,

which translate as
binary digits, or bits.

There's 768
bits per second,

so that's a lot of
ones and zeroes.

You have to be very precise

in moving the tape under
the lens or the garnet

to make sure you
don't miss a bit

or read the same bit twice.

So it's difficult.

Analyzing the data
is even more painstaking.

It took about a day

to read a second of recording.

Any additional second recovered

could reveal something that
would make a difference.

The effort to
retrieve all the QAR data

could take a month or more.

In the meantime,
the focus of the investigation

shifts to the cockpit
voice recorder.

It was positioned just above
the other black box.

The cockpit voice recorder,

which was just inches away
but outside of the ashes

had air passing over it
and survived.

Runway 23...

The recording reveals
the captain's anxiety

early on in the flight.

You're
taking 23, then?

Yes!

Investigators know
that landing on runway 05

requires what's called
a non-precision approach.

That means pilots receive
electronic guidance

only on their horizontal
position--left and right.

They get no guidance
when it comes to altitude.

The non-precision approach

is significantly less accurate.

It's not really difficult,
but they are less comfortable.

05?

What sort of wind
are they giving us?

18 knots.

The non-precision approach

increases the demands on pilots.

Investigators can also hear
that the captain had concerns

about landing on runway 05.

48, Delta Alpha,

you are number one for
the VOR DME, runway 05.

Runway 05, 05.

10 nautical,
that won't work.

That's a lot of distress
over a non-precision approach.

Wondering what can
cause such distress,

investigators research
pilot training at Air Inter.

They find that most pilots did
not have extensive training

making non-precision landings
in the new A320.

I think we should
have had double the training

compared to an older plane.

Investigators ask the
airline for detailed records

on the pilot's history
of runway approaches.

They're intrigued
by what they discover.

Captain Hecquet had landed at
Strasbourg countless times,

but he had never landed
an A320 there

using a non-precision approach.

We're not going to
mess around like that

descending at full speed.

Clearly,
the captain was uneasy

about having to
execute a landing

he had never made before.

I think the captain
was worried about making it in

in a minimum amount of time,
in the minimum amount of delay.

Have we been flying
for 35 minutes yet?

And the co-pilot was worried

about not getting in trouble
by offending the captain.

At least that much.

More research into
the pilot's work history

offers yet another revelation.

While the two pilots had flown

more than 12,000 hours
between them,

they were both still
relatively new

to the highly advanced A320.

The aviation community
misunderstood the magnitude

of changes brought
by the new Airbus A320.

The captain had only
162 hours in the A320.

And the co-pilot, even less--

just 61 hours.

Behind this
accident scenario,

there is an issue of confidence

of the crew in themselves,

in the aircraft.

18 knots?

No chance.

They were not
prepared, really,

to fly in this
kind of condition.

If they had warned us
in advance, cripes!

Investigators conclude

that the crew's training
was insufficient.

But that alone does not
explain the crash.

Merde!

Investigators search
for other factors

in the crash of flight 148.

They review the conversations
between the crew

and air traffic controllers.

If you want,
I can give you radar headings

and take you to ANDLO at 5,000.

Yeah, that's good.

The radar vector
makes flying easier.

The captain was happy because
it was reducing his workload.

Turn left, steer 90.

With the controller's
assistance,

this landing should have been
very simple.

But when investigators
reconstruct

the plane's trajectory
using radar information

from various stations
around the airport,

they discover a shocking error.

The 090 heading
started here.

090 degrees, Delta Alpha.

But it won't
take them to ANDLO.

Last radar vector the controller
gave was incorrect.

It sent them...

Thank you.

...closer to the mountain.

They were off course because of
following the heading

they got from
the radar vectoring.

They found themself in this
undershoot situation.

You should have
started with 070.

Investigators
are also troubled

by the controller's
choice of words

when he warned the pilots
incorrectly

that they were headed
to the right.

Delta Alpha, you are
passing to the right of ANDLO.

From the pilots' perspective,

the plane was on the left side
of the runway, not the right.

It could only add
to their confusion.

It was very poor guidance,

because he didn't employ
the usual terminology.

Investigators recommend that

controllers use only compass
points when giving directions,

never the words
"right" and "left."

the controller's mistakes
clearly brought the plane

closer to the mountain.

Turn left.
Stay at 90.

090 degrees, Delta Alpha.

But once again,

investigators feel they don't
have the whole story.

It's not something
totally abnormal

to start a descent
from this situation.

Flaps towards two.

Flaps towards two.

It's not what you're
expected to do every day,

but it's not outside
the tolerance

of the concept of this approach.

Gear down.

When investigators study

the plane's reconstructed
flight path,

they discover something
more alarming

than the plane's
horizontal misdirection.

As it circled the mountain,

the plane inexplicably entered

a dangerously steep
and rapid descent.

Perhaps two and a half times

the normal rate of descent.

That's lethal
at that altitude.

Without the steep descent,

they would have
cleared the mountain.

If the vertical
trajectory had been correct,

they would have
no problem at all.

Finding the cause
of that sudden descent

is now key to understanding
why 87 people died

in one of the most advanced
passenger planes on earth.

Authorized for
final approach, 05.

The descent was
initiated at 18].00 hours,

19 minutes and 38 seconds.

That...

Delta Alpha.

...is the point
of no return.

By studying
flight 148's trajectory,

investigators determine
that the rapid descent

began 60 seconds
before the crash.

There is no indication on tape
that the descent was deliberate.

How it happened and why the crew
didn't notice is a mystery.

It should be a no-brainer
keeping track of the altitude.

The cockpit altimeter

gives pilots a constant readout
of their altitude.

The altimeter is
a very precise instrument,

they've become very reliable,

they are accurate to
within five or ten feet.

Ignoring it would be

a major error
in flying protocol.

Flaps towards two.

The recording reveals
just one single remark

from the crew
about their descent.

We have to
watch our descent.

It occurred
16 seconds before the crash.

We have to
watch our descent.

The captain had just
extended the speed brakes.

The aircraft was
accelerating abnormally.

The captain started to realize
there was something wrong

with the descent rate.

But the first officer
changed the subject.

The approach axis.

We're hitting the axis
a half point off.

There.

It was 60, check it out.

He refocused
the captain's attention

on the lateral situation rather
than the vertical situation,

which was the main problem,
of course.

And they both failed to
recognize the situation.

I think
they were planning,

they were going to
break out of the clouds

so they would be able
to see the runway.

And they wouldn't need to do
the full instrument approach.

It was 60,
check it out.

But the plane
never left the clouds.

There's an old adage
in aviation--

rocks have been known to
hide out in those clouds.

Merde!

It now seems clear

that the crew was not monitoring
their altitude closely enough.

But a bigger mystery remains.

We can only guess...

What caused that deadly descent?

After months of work,

investigators may finally
have the answer.

All the available flight data

from the damaged quick access
recorder has been recovered.

We were very anxious
to be able to read

as much as we could.

The data confirms
that just before the crash,

the plane was speeding
toward the ground

at an extremely high rate--
3,300 feet per minute.

It also confirms that
the angle of descent

was dangerously steep,

much greater than the 3.3
degrees selected by the captain.

3.3 degrees.

That's quite a difference.

Investigators now wonder,

did the autopilot malfunction?

Did it somehow fail to obey
the captain's safe descent angle

and send the plane into
a deadly nosedive?

But what state was it in
before the accident?

Unfortunately,
the flight control unit

which houses the autopilot
is too badly damaged

to provide any
definitive answers.

We could never demonstrate

that this FCU on this aircraft

during this flight

functioned properly or not.

But then, when he returns to

studying the flight data,

Paries discovers something
that may finally reveal

the cause of the crash.

He notices a similarity
between two key numbers--

the plane's vertical speed,
3,300 feet per minute,

and the intended flight path
angle, 3.3 degrees.

Coincidence?

Paries uses
a flight simulator

to test the new theory.

Can you show me a
descent of 3,300 feet

per minute?

He believes
that the similarity

is no mere coincidence.

On the autopilot,
there are two descent modes--

flight path angle

and vertical speed.

But they are both displayed
on the same window.

So 3,300 is abbreviated to 33.

Now, show me a flight
angle of minus 3.3 degrees.

The problem on this aircraft was

that the two values were visible

on the same window and
controlled by the same KNOB.

3.3 degrees.

Minus 3.3 degrees.

Paries strongly suspects that

the confusing display
tripped up captain Hecquet.

So it wouldn't be hard
to make that mistake, would it?

The confusion is quite easy
between the two modes,

if you don't do it carefully.

If the captain failed
to push the mode selector KNOB,

then entering a 33
would not have initiated

a safe 3.3 degree
angle of descent.

Instead, it would have
put the plane

into a deadly rate of descent
of 3,300 feet per minute.

Two months after the crash,
another Air Inter plane

enters a dangerously steep
descent for the same reason.

The crew only
discovered the problem

when they broke out
of the clouds.

Those pilots also confused

the plane's flight path angle

with its vertical speed.

They were lucky enough
to have a much higher cloud base

so they could
correct the problem.

Further research
reveals an industry-wide problem

with the A320.

Many people
confused these modes,

especially during training.

And many of them fell
in the trap

even after the training.

Eager to test his new theory,

Jean Paries programs a simulator

with all the known data
from flight 148.

He then inputs
the same rate of descent

he believes
the Air Inter pilots selected.

If Paries is correct,

the simulation will end with
the plane hitting the mountain.

But it doesn't.

We're missing something.

Strangely, this didn't
lead to a crash.

Every approach would
overfly this obstacle

by a significant margin.

Have we factored in the wind?

We started to work on other
alternate hypotheses.

Let's try again.

But initiate the turn sooner.

But nothing was really credible.

No matter how hard he tries,

Paries cannot
simulate the crash.

Unable to explain why,

he turns to the plane's
manufacturer for help.

Thanks for bringing this
to my attention.

After much research,

an Airbus designer comes to
Paries with an explanation

about a little-known element
of the autopilot's design.

In emergency situations

where the A320 needs to
change direction quickly,

the autopilot is programmed to
reverse the plane's direction

at twice the normal rate.

The reaction of the
autopilot would be much faster.

And these cases were typically
when you were descending

and asking the autopilot
to climb,

or climbing and asking
the autopilot to descend.

We immediately went back
to the data

at the very second

at which the descent was
commanded by the crew.

Gear down.

Paries discovers
a tragic coincidence.

Sadly, we found
at this very second

there was turbulence.

There was an ascent.

It's very slight,
but there it is.

The momentary turbulence

caused the plane
to climb slightly.

And this led to
a positive 600 feet per minute

vertical speed
for maybe half a second.

It was during
that same half second

that the crew commanded
the plane to descend.

The autopilot read this
as an emergency,

requiring a blazingly
fast descent.

That could be it.

Investigators now
contemplate a terrible thought--

could a random gust of wind,

hitting at exactly
the wrong split second

have been the difference
between life and death?

Here it comes.

And we got a crash.

Paries' theory
explains every aspect

of the crash.

The crew's confusion with
the autopilot display...

That's 3.3 degrees.

...caused the plane to descend

dangerously close
to the mountain.

Turbulence and an obscure safety
feature brought it even closer.

It was a fatal combination.

It's a fascinating lesson

about the random dimension
of accidents.

Half a second before,
half a second later,

they wouldn't have the accident.

The discovery of
a confusing cockpit display

has enormous implications
for the entire industry.

The flight
instrumentation of aircraft

like the DC10, MD11,
the 74S, and so on,

all the Boeing products and
all the commuter products

that were using
that avionics suite

had this vulnerability about it.

Investigators now
face a daunting question

affecting aircraft safety
around the world.

If the design of the autopilot
interface isn't changed,

how many more people could die?

There's mounting evidence

that the design of the autopilot
interface on the Airbus A320

led the Air Inter pilots
to accidentally dial in

a dangerous rate of descent.

3.3 degrees.

We felt a need to start
the industry to work on this.

The plane's
manufacturer, Airbus,

responds immediately.

The main change,
which was very quickly made,

was to change
the display window.

With the new design,

if a pilot selects
a vertical speed of 3,300,

the entire four-digit number
is displayed.

So the confusion between
an angle and the vertical speed

was no longer possible.

For investigators,
only one mystery remains.

All Airbus A320 jets are
designed to be equipped

with a safety device known as a
Ground Proximity Warning System,

or GPWS.

Which is a downward-looking

single purpose radar

that tells you how high
you are above the ground

directly beneath the airplane.

And if it gets to be too low,
it'll set off a warning.

Pull up, terrain. Pull up.

But captain Hecquet...

We have to
watch our descent.

...never received a warning

for one very simple reason--
his A320 didn't have that alarm.

Merde!

The first question,
of course,

was why the aircraft
was not equipped.

So it's not part of
the minimum equipment list?

The Air Inter
management had decided

they did not like the false
warnings that had been produced

by GPWS equipment.

Normally, most planes
fly slower than 250 knots

when under 10,000 feet.

But we flew at 350 knots
until the final approach.

So at those speeds, GPWS was
always giving off false alarms.

This decision, while legal,

prevented the pilots from having
one last line of defense

before crashing
into the mountain.

It's impossible to imagine

that the pilot wouldn't
have pulled up

if he'd heard the alarm.

We should have a GPWS
on commercial flights.

In any case, yes,
that's an obvious conclusion.

The report will
list these causes.

Flight deck ergonomics...

Investigators conclude

that there was no single cause

of the crash of flight 148.

The tragedy involved
an ill-fated combination

of many different weaknesses
in the airline industry.

We made 35 or so
recommendations,

including pilot training

about the ground proximity
warning system, and so on.

The recommendations
lead to sweeping changes.

Pilots must now have
more A320 training

before getting
behind the controls.

One of the two pilots

now need to have at least
300 hours on the plane.

They estimated that
300 hours were enough.

Another change--

the design of a more
heat-resistant black box.

The FAA did a test,

did some studies with
the thermal characteristics

of post-crash fires

where it came up with a value
of 260 degrees C

for 10 hours.

Delta Alpha, your position?

Air Inter Delta Alpha,
Strasbourg?

As a result
of the Strasbourg crash,

the A320 is now a safer plane.

You can only
get this change

if there is what people perceive
to be a good reason.

And sadly, a good reason
is still an accident.

But improved
aviation technology

is still no substitute

for well-trained,
well-prepared pilots.

There's an old axiom
in aviation

that you're taught early on

that, never let an airplane
take you somewhere

that your brain hasn't visited

at least five minutes
ahead of time.

This is an excellent example
of a flight crew

that didn't follow
that particular axiom.