Investigation finds Marathon pilots at fault for 2024 Air Serbia accident

The plane, registered OY-GDC, was scheduled to function flight JU324 to Dusseldorf with 111 folks on board, together with 5 crew members from the Greek provider. The incident unfolded throughout takeoff and, regardless of vital plane and floor infrastructure injury, resulted in no accidents.

The chain of occasions started when the crew was cleared to line up on Runway 30L through intersection D6, which supplied a takeoff run of two.349 meters. Nevertheless, the plane mistakenly entered the runway at intersection D5, leaving just one.273 meters accessible, far lower than the required distance for the plane’s precise takeoff weight of over 45 tonnes. Air site visitors management instantly observed the error and warned the pilots that the accessible takeoff distance was inadequate. They recommended the crew vacate the runway and taxi again to D6. Regardless of this, the captain insisted that they had sufficient runway and carried out a fast recalculation utilizing the mistaken intersection/runway mixture (entered as 12R/D5 as a substitute of 30L/D5), with discrepancies famous between the captain’s and first officer’s information entries. This gave a deceptive sense of security margins. The report highlights that the captain exerted stress on the primary officer, who deferred as a substitute of difficult the choice.

Deliberate taxi and takeoff path (blue), precise taxi and takeoff path (pink)

Through the takeoff roll, thrust was not superior to most (TOGA) till very late, additional lowering efficiency. Because the plane accelerated, the crew shortly realised the tip of the runway was approaching. The primary officer rotated on the calculated Vr, leading to a tail strike and the plane making contact with airport lighting installations and the localiser antenna for Runway 12R. Particles from the broken buildings was later discovered scattered past the airport perimeter. The affect induced structural injury to the left wing, fuselage, stabiliser and local weather management methods, in addition to gasoline leakage from the left tank. Floor services additionally sustained appreciable injury, together with a number of strategy lights and the far-field monitor antenna, rendering the ILS downgraded from CAT III to CAT I functionality.

Second the plane hits the localiser antenna

After departure, the crew reported irregular vibrations, uncommon noises, in addition to flap issues, and declared an emergency. Air site visitors management coordinated with emergency companies, arranging for a low cross so the touchdown gear may very well be visually inspected. The plane then landed safely again on Runway 30L at 18:36 native time, escorted by fireplace and rescue automobiles. The evacuation was carried out through jet bridge at a parking stand, whereas firefighting groups labored to include leaking gasoline. The flight crew was unable to detect the injury whereas taxiing after touchdown, a conclusion reached throughout the investigation by simulating the crew’s subject of view from the plane towards the broken space.

The investigation additionally famous that the crew didn’t correctly conduct a regular departure briefing, and this was recognized as a contributing issue to the accident. Particularly, the report states that in flight preparation there have been vital discrepancies within the efficiency information entered into the calculation purposes. As a result of the crew skipped or didn’t comply with a correct departure briefing, these errors went unnoticed. The absence of the briefing meant that incorrect parameters had been entered into the Flight Administration and Steerage System, and there was no cross-check to catch them.

The investigation revealed a number of procedural lapses and human issue points. The crew failed to stick to straightforward departure briefings and operational cross-checks, resulting in incorrect inputs in efficiency calculations. The captain exerted stress on the primary officer, who didn’t problem the choice to depart from the shorter intersection. Compounding the issue, the plane was not configured optimally for the shortened takeoff distance, and the lowered thrust setting (FLEX 33°C) was used as a substitute of most energy from the outset.

Upon touchdown again in Belgrade, fireplace crews adopted the plane throughout taxi to the gate and took motion to include gasoline leaking from the left wing. Foam was utilized to forestall fireplace threat, and passengers disembarked through a jet bridge safely. Nevertheless, the investigation factors out that the plane was initially parked at gate C2, on the passenger terminal, regardless of the gasoline leak and structural injury. Solely later, after a preliminary inspection, was it towed to a distant stand (B3). The airport’s Emergency Plan has since been revised, requiring such an plane to be directed to an remoted parking place instantly, away from terminal operations. Shortly after the accident Air Serbia severed all ties with Marathon Airways.

Each the 58-year-old captain and the 44-year-old first officer underwent alcohol testing, with outcomes returning damaging. Through the investigation, the Flight Information Recorder (FDR) and Cockpit Voice Recorder (CVR) had been faraway from the plane and despatched for readout and evaluation in cooperation with the plane producer. The Serbian Civil Aviation accident investigation company emphasised that the occasion underscored the necessity for stricter adherence to efficiency calculations, intersection takeoff procedures and CRM coaching. The in depth structural injury to the plane and floor tools, mixed with the close to lack of management throughout takeoff, mark this as one of the vital critical latest incidents at Belgrade Airport.