All language subtitles for Mayday.S10E02.Whos.In.Control.1080p.AMZN.WEB-DL.DD+2.0.H.264-playWEB_track3_[eng]

Ladies and gentlemen,

we're beginning our descent towards

Amsterdam Schiphol Airport.

Thank you.

Turkish Airlines Flight 1951

is preparing to land in Amsterdam.

Amsterdam, Turkish 1951.

Descending to 7,000,
speed two, five, zero.

The crew is flying

a state-of-the-art Boeing 737.

Flaps, 15.

Localizer alive, localizer capture.

In the final
moments of the flight,

the landing turns into a catastrophe.

The plane falls like a rock.

The crash of Turkish Airlines Flight 1951

involves the most popular plane on Earth.

With nearly one and a
half million passengers

boarding 737s every day,
investigators need to figure out

if the problem was with the plane

or with the pilots flying it.

Mayday, Mayday.

On the morning
of February the 25th, 2009,

Turkish Airlines Flight
1951 becomes the first plane

to crash at Amsterdam's Schiphol Airport

in more than 10 years.

It smashed
into the ground really hard.

It made a tremendous noise.

The plane hits
the ground in a muddy field

just north of runway 18 Right.

Since the crash was so
close to the airport

rescue workers arrive quickly.

Most of the passengers have survived

but many are badly injured.

Survivors are taken
straight to local hospitals.

Images of the Amsterdam accident

quickly spread around the world.

This is the third crash of a passenger jet

in the past six weeks.

The sudden nature of this
accident adds to the mystery.

It doesn't take long for
the Dutch Safety Board

to arrive at the scene.

They will be investigating this accident

but they won't be alone.

The crash involved an American made plane

so the U.S. National
Transportation Safety Board

sends Joe Sedor.

One of its most experienced
investigators to Amsterdam.

When it's a non U.S. registered aircraft

that crashes overseas, such
as this Turkish Airlines,

we are the state of manufacturing

and design of the airframe.

And also in this case the engines.

Fuselage in three large pieces.

Engines forward of the main wreck site.

Flight 1951 was one

of the most advanced
aircraft in the skies.

The Boeing seven 37 800 series.

It's designed to travel longer
routes at higher altitudes.

The new generation 737 is still

the best airplane Boeing ever built.

We developed an airplane
that had an improved wing,

improved avionics, simpler systems

that required less maintenance.

Investigators
know this isn't just any plane.

The 737 is the world's best
selling commercial jet.

Finding out why this one
crashed is imperative.

There are more than 5,000
of them in the skies.

They carry about one and a
half million passengers a day.

Investigators must quickly
determine if there's a flaw

with the plane that could
cause another accident.

What they know so far is that Flight 1951

had been traveling from
Istanbul, Turkey to Amsterdam.

There were 128 passengers on
board the early morning flight

including four engineers from Boeing.

Ladies and gentlemen,

we're beginning our descent towards

Amsterdam Schiphol Airport.

Please raise your seat backs
to the upright position

and stow away your tray tables.

There was no mention on board

of any kind of trouble in the cockpit.

The crash has killed nine
people, including three members

of the Boeing team and
the pilots in the cockpit.

See if you can get me some
aerials of the crash site.

There are eerie similarities

to another recent accident
involving a Boeing aircraft.

British Airways Flight 38.

Approximately a year before this,

there had been a 777
short landing at Heathrow,

which had a dual engine flame up.

In that
accident, a Boeing 777 fell

to the ground short of the runway.

The British Airways pilots reported

that both their engines
stopped delivering power

just before landing.

At the time of the Turkish Airways crash

the cause of that accident
hasn't been found.

Like in that case,
investigators have plenty

of clues to work with.

The plane and its engines
are largely intact.

The flight data recorder
and cockpit voice recorder

are found in good condition.

There are also plenty of survivors

to describe what happened.

According to the passengers,
the landing had been routine,

but then suddenly the
plane simply dropped out

of the sky and hit the ground.

But perhaps the biggest clue

comes from the crash site itself.

The wreckage is not spread out.

It tells investigators that the plane

could not have been traveling
forward at high speed

when it hit the ground.

The way the aircraft
had crashed, it did appear

to be some sort of a landing accident

in which there was moderate
control of some sort.

The pattern of debris

and the passenger reports
point investigators

to an immediate suspect.

The engines.

The engines issue was a very big issue

in my thought process
at the time, initially.

There's no evidence
of fire on the fuselage.

In many crashes fuel in the
planes tanks ignites on impact.

The lack of fire raises
an obvious question.

Did the engine stop
running because Flight 1951

had simply run out of gas?

That was one of the
first thoughts that I had

was did this airplane have fuel aboard

because otherwise how does
a 737 literally fall out

of the sky on approach to an airport?

But the
location and condition

of the plane's engines suggest

that perhaps they didn't quit in flight.

Sure looks like it was running.

When we first looked at
where the engines ended up,

at the initial impression
was that they probably

were producing thrust that had impact,

given that they were so far
forward of the main wreckage.

That was just a very general conclusion.

Only the flight data recorder

can tell investigators
how much power the engines

were generating in the
seconds before the crash.

Lots of fuel.

Rules that out.

It doesn't
take long to discover

that there was plenty of
fuel in the planes tanks.

Flight 1951 definitely
did not run out of gas.

Passengers report that
in the final seconds

before the crash, the plane
hit what felt like turbulence.

It points investigators
to a well-known culprit.

A microburst.

A microburst is a powerful column of air

that shoots out of storm clouds.

It can literally slam a low
flying plane to the ground.

If an airplane flies into
that at approach speed,

you're not gonna be flying anymore,

you're gonna come out of the sky.

Certainly it was one of the things

that all of us took a
look at at the beginning,

was there a microburst.

In 1985,
a Delta Airlines flight

was caught in a microburst while landing

at Dallas Fort Worth Airport.

The plane hit the ground
short of the runway.

137 people were killed.

Investigators learned that
there were heavy clouds

above the airport at the
time of the accident.

A powerful gust of wind may
well have accompanied them.

The flight data recorder would
have recorded wind speeds

outside the plane.

Investigators will need
to analyze the flight data

to prove the microburst theory.

In the meantime, the rescue has
led to an unusual discovery.

There was three pilots in the cockpit.

Which is unusual, this
is a two crew cockpit.

So why was that third pilot there?

Since none
of the three pilots

survived the accident,
it's all the more urgent

for investigators to retrieve the data

from the cockpit voice recorder.

It records conversations in the cockpit.

They're in luck

Because of the way that the
aircraft crashed the access

to the recorders and the condition

of the recorders was excellent.

The reason
for the third pilot

is soon uncovered.

Flying standard arrival route.

Visibility 3,500 meters.

Expected to decrease to 2,500 meters.

For First
Officer Murat Sezer,

this had been a training flight of sorts.

He was new to the airline
and was being shown

the intricacies of landing
at Amsterdam's Airport.

In the Jeppesen charts
which is what all pilots use

to navigate to and from Schiphol,

there's 102 pages of
information on Schiphol alone.

So there's dozens of approaches.

Runway 18 Right has three
high-speed exits to the left.

The Captain, Hasan Arisan

was doing double duty.

He was training his first officer...

Make small corrections as
we get close to the runway.

And was in
command of Flight 1951.

It's because Captain Arisan was teaching

that there was the third
pilot in the cockpit.

Olgay Ozgur was a Safety Pilot.

He was there to keep an
eye on the flights progress

during this training mission.

The purpose of that second set of eyes

is to make sure that the
Captain and the First Officer

if they're in a situation
where it's a little bit

of a training portion of the flight,

that they don't miss something.

We got a clean recording.

The voice recorder reveals

that the three crew
members began preparations

for landing when still above 8,500 feet.

Amsterdam, Turkish 1951.

Descending to 7,000.

Speed, two, five, zero.

But the voice recorder

has picked up an unusual sound.

A warning that makes no sense
at this stage of the flight.

One of the investigators from Boeing

was an engineering pilot that came

and helped with the CVR.

And he's listening to see
are there any unusual sounds

that can be heard that
would not be normal.

Feet okay for ILS, 18 Right.

Descent to 4,000.

ILS 18 Right.

The alarm keeps sounding.

It's the landing gear
configuration warning horn.

Captain Arisan continually dismisses it.

Turkish 1951, descent
4,000 ILS 18 Right.

Landing gear.

Is that the landing gear warning?

They're 8,300 feet here.

The warning is a solid clue.

But investigators can't yet see

how it could possibly have caused a crash.

The crew of Turkish Airlines Flight 1951

got warnings to extend their landing gear

while still thousands of feet in the air.

On the initial listen, we
heard a gear warning horn

occur as the aircraft was
approaching when it was still up

and it was coming in
about 10,000 feet below.

Investigators now turn

to the flight data
recorder to help solve some

of the mystery surrounding this flight.

The analysis of wind speeds

outside the aircraft is completed.

It's clear none are drastic enough

to have brought down the plane.

No evidence of a microburst.

But the flight
data recorder does provide

some valuable insight into the cause

of the landing gear warning.

One of the instruments
that measures altitude

had the plane already on the ground.

When we looked and saw
the radio altimeter data,

on the recorder it said about 8,000 feet

and then immediately it went
down to about minus eight.

Minus eight feet is an
indication that the aircraft's

on the ground, but of course
it's still at 2,000 feet.

The Boeing 737 is equipped

with two separate altimeters.

One measures air pressure to determine

the planes height above sea level.

That reading is displayed
prominently in the cockpit

on both pilots flight display.

Sensor.

The plane is also equipped

with a radio altimeter.

It's made up of four antennas.

Two transmit signals to the ground

and two others read the
signal that bounces back

to determine the plane's height.

It's precise.

It's very, very precise.

Pressure altimeters can
sometime be not as accurate.

And radar altimeters are a 100% accurate.

If they're working properly.

One antenna feeds the reading

to the First Officer's display.

The other feeds the Captains instruments.

In the case of Flight 1951,
the Captain side was wrong

most of the flight.

Investigators go back over the CVR

and make a puzzling discovery.

Amsterdam, Turkish 1951.

Descending to 7,000.

Speed, two, five, zero.

Radio altimeter.

Captain
Arisan seems to have known

that the landing gear
warning was being caused

by a faulty radio altimeter.

The airplane thought that
it was low to the ground

and the gear was not down.

And the Captain recognized
that the problem

was really in the radio altimeter.

Showing him that they
should be on the ground

and he goes, "It's just
the radio altimeter."

Throughout
much of the approach,

the Captain's radio altimeter
had been displaying a reading

of minus eight feet.

Triggering the warning to lower the gear.

They treated it like it was a nuisance.

Turkish 1951, descent to 2,000.

2,000, 1951.

Investigators dig
for any other abnormalities.

They learn that with Flight
1951 still about 17 kilometers

from the airport controllers
directed the pilots

to begin their final turn
to line up with the runway.

Turkish 1951.

Left heading , two, one, zero.

Clear approach, one eight right.

Left, two, one, zero.

Clear ILS, Turkish 1951.

Two,
one, zero, set, sir.

This turn puts flight 1951

in line with runway 18 Right.

It's equipped with an
instrument landing system,

which sends out a signal
outlining the ideal descent path

to the foot of the runway.

The autopilot follows that
glide path until the plane

is a few hundred feet from the ground.

Then the pilot takes over.

It makes landing almost effortless.

The ILS is pretty easy to follow.

It's a video game.

My daughter has a flown in a simulator

and can land a 737 using the ILS.

The crew begins
configuring their plane

for landing unfazed by the warning horn

that's repeatedly triggered

by the malfunctioning radio altimeter.

Flaps 15.

10 kilometers
out, Flight 1951 picks up

the ILS signal that will
guide the plane to the runway.

Localizer alive.

Localizer capture.

The Safety
Pilot, Olgay Ozgur,

now reminds Captain Arisan
about the failed altimeter.

We have radio altimeter failure, sir.

Okay.

Turkish 1951.

Runway one, eight, right.

Cleared to land.

Cleared the land.

Thank you.

Investigators are stumped.

The crew knew about the malfunction

and continued their approach.

How had it then caused them to crash?

Clearly, there was more to this accident

than a faulty altimeter.

The whole premise of airline safety

and the way we build the airplanes,

the way we fly them is based on the idea

that we can have any number of failures

and we should still be
able to arrive safely.

The radio altimeter is
just one instrument.

There's no way in the world
that that one instrument

if it fails should be
a major cause of worry

that we're gonna have a crash.

Investigators
wonder if the crew

had been given proper
guidance for their approach.

They turned to exchanges
between the pilots

and the controller who guided them in.

They carefully review every instruction.

Turkish
1951, descend to 4,000.

Speed okay for ILS, one, eight, right.

Turkish 1951, descend to 2,000.

Turkish 1951, left
heading, two, one, zero.

Cleared approach, one, eight, right.

By following
the controller's instructions

the crew made their final turn
much too close to the runway.

For the intercept properly,
they should be here.

International
guidelines, call

for approaching planes
to intercept the signal

that guides them to the runway from below.

It's so pilots don't
have to make any drastic

last minute course
corrections to get to it.

To intercept here, they had to descend.

But Flight
1951 was given instructions

that brought it to the
threshold of the glide slope

while still way above it.

It's a common practice at Schiphol

because it gets planes
to the runway faster.

Because they were so close, they had

to capture the glide slope from above.

Although it is an unusual situation,

it is one that can be
handled by a flight crew

if it is managed properly.

Approaching
a glide slope from above

is more difficult mostly
because the crew has

to suddenly slow the
plane and descend rapidly

to intercept the signal.

We also call this a slam dunk approach.

And some pilots like
it, some pilots don't.

It's a little bit harder
and things happen quicker

when you're above the glide path, trying

to intercept from above.

And it's just a challenge
for a lot of pilots.

The approach from above

increased the crew's workload
but it's standard practice

at Schiphol Airport.

I've flown into Schiphol
dozens of times and I expect it.

If the
controller's instructions

had somehow overtaxed this crew,

their conversations would indicate it.

They're just five
kilometers from the runway.

- Thousand.
- Check.

Flaps 40.

Speed brake.

Speed brake armed.

Green light.

One thing at a time.

Landing gear.

Gear down.

Three green.

- Flaps?
- Flaps, 40.

Greenlight.

- 500.
- All lights on.

Please warn the cabin crew.

Okay.

Cabin crew.

Take your seats.

Then real trouble.

A stall warning.

- Speed, sir.
- I have control.

100 knots of speed.

Arisan
forced to save his plane.

But just 400 feet above the ground,

and only one and a half
kilometers from the runway,

the Boeing 737 suddenly
fell straight down.

It only took a few seconds
for it to hit the ground.

Turkish 1951.

The recording sheds light

on the final minutes of the flight.

The crew was configuring
their plane for landing

well after it should have been done.

- Flaps?
- Flaps 40, green light.

Most
airlines have regulations

that call for a flight to be stabilized

to have all checklists completed

by the time the plane hits 1,000 feet.

In instrument conditions,
you required at a 1,000 feet

to have basically everything done.

The airplane is configured.

You have slowed.

You have runned your before landing check

and you have received
your landing clearance

and from a 1,000 feet on in,

you just monitor the instruments

and we're looking for the runway.

Please warn the cabin crew.

Yeah.

Cabin crew.

In fact, this
crew was still running

their checklist up to the
moment the crisis hit,

460 feet above the ground.

This approach was not stabilized.

Because of the aircraft was unstable

the flight crew was in a very
high workload environment

in the last 1,000 feet of flight.

The radio
altimeter was malfunctioning.

The aircraft was giving off warnings.

The crew was assigned
a challenging approach

and they were executing a checklist late.

But none of this explains
why Flight 1951 crashed.

In these types of accidents,
you can never get inside

the head of the pilots.

And that's a very
frustrating type of accident.

But the flight data recorder

does provide another intriguing clue.

Moments before Flight 1951 hit the ground

the planes engines were at idle,

hardly providing any power.

Perhaps this accident is a
repeat of the Heathrow incident.

The engines, it was interesting to note

were at idle approximately
the last two minutes

of the flight until the very end

when the thrust was increased again.

That was a big red flag right there.

The question is, is why was that the case?

But then they spot something

that's very different from
the accident at Heathrow.

Retard Flare Mode.

For some reason,

while still more than a
1,000 feet above the ground

the planes computer began
preparing to touch down.

In Retard Flare Mode,
engine power is reduced

to idle by the flight computer.

And the planes nose
automatically pitches up

to the flare position.

Planes should only be
in this configuration

just before they touch the ground.

The autopilot raises the
nose to break the descent.

The auto throttles brings the
power back to flight idle.

And you touched down with the power

either all the way in idle
or just about to be an idol.

But Flight 1951 went

into a slow nose up position
well before touchdown.

Causing the plane to fly slower

and slower throughout its descent.

So why was Flight 1951 in landing mode?

And why hadn't any of
the three crew members

noticed how slowly they were flying?

So what else was going on
when the engines went to idle?

The troubles seems to start

with a malfunctioning altimeter.

We have to look at the system as a whole

and to see how that minus eight

affected the other
systems on the aircraft.

And that was a very big
portion of this investigation.

We had to say, how did the
autopilot use that data?

More importantly, how did the
auto throttle use that data?

The computer
that flies the plane consists

of two main systems, the auto
pilot and the auto throttle.

The auto throttle
determines how much power

to ask the engines for
while the autopilot controls

the planes altitude and direction.

The two systems work
independently of each other.

And only one of the radio altimeters

provides information to the auto throttle.

In this case, I had to
learn everything there

was about radio altimeters
and auto throttle systems,

which I didn't know before.

The pieces of the
puzzle begin coming together

when they find the connection

between the faulty radio altimeter

and engine power.

The radio altimeter provides information

to the auto throttle
from the Captains side.

The only
altimeter feeding information

to the auto throttle was the
captains and it was wrong.

It showed minus eight feet throughout most

of Flight 1951s approach.

It's beginning to look like
the faulty radio altimeter

triggered the events
that led to the crash.

Investigators need to know
what went wrong with it.

On a 737, the transmitting
and receiving antennas

for both radio altimeters are lined up

underneath the cockpit.

Three of the antennas were all
but destroyed in the crash.

They can't be tested.

But one antenna from the
captain side is undamaged.

Investigators consider two possibilities.

A failure of one of the components

or some sort of interference

that caused the faulty reading.

The only component that
survived the crash checks out.

The computers that control
the system also work.

But investigators do make a
curious discovery about them.

They aren't the same ones that
were installed on the plane

when it was delivered to Turkish
Airlines seven years ago.

This find changes the
focus of the investigation.

The maintenance aspect
of this accident aircraft

was one that we looked
at as deeply as we could.

When the plane's
maintenance log is studied,

investigators find that the
radio altimeter on this plane

had a problematic history.

We got additional data
from Turkish Airlines

and that data showed
that on this one aircraft

of the past, I believe
over a 1,000 flights

there was about 150 flights

that had faulty radio altimeter systems.

The documents
show that a little more

than a year before the crash,
both computers were replaced

because of complaints, they
were causing faulty readings.

One of the incidents involved
a radio altimeter reading

of minus eight feet.

So that was telling us
that there was an issue

that had been there.

The issue did not just
occur on this flight.

The faulty
readings persisted.

Mechanics repeatedly swapped the computers

and replaced the antennas
to try to solve the problem.

It's determined that Turkish
Airlines tried several ways

to fix the altimeter.

But they couldn't find
a repair that worked.

At the time of the accident,
Turkish Airlines had a fleet

of 52 Boeing 737 800 series airplanes.

It's on page 93.

When we reviewed the maintenance data,

we found that radio altimeter problems

had been written up several times

on both the accident
airplane and the fleet.

Investigators discover

that in the year before the crash

Turkish Airlines dealt
with 235 system faults

with the radio altimeters on their 737s.

Fixes ranged from replacing
and exchanging antennas,

cleaning of the systems, exchanging

and replacing the computers

and installing gaskets
to shield the system

from possible water damage.

It's not like they weren't
doing anything about it.

The Turkish Airlines
maintenance personnel knew

that the radio altimeter problem was one

of their highest issues
with regard to maintenance.

16 of those
altimeter repairs were made

to the plane that crashed
in February, 2009.

If the problem was so
widespread, investigators wonder

why it hadn't caused serious
problems before this accident.

They don't have to dig too far back

to find out that in fact it had,

on this very same plane.

On two recent flights, they
had the exact same problem.

Twice in
the 48 hours leading up

to the accident, the radio altimeter

showed a negative reading,

putting the plane into Retard Flare Mode.

Both times the crew noticed the problem.

Disengage the also throttles

and brought the plane
in for a safe landing.

You just disconnect
them and fly the airplane.

In the months after the crash,

other operators come forward
with similar stories.

In Australia, in the
Netherlands, in Canada

in Austria pilots report their 737s

going into Retard Flare Mode
when the left radio altimeter

showed a faulty reading.

Each of those crews reacted the same way.

They disengage the auto throttle

and push the power back up manually.

They all landed safely.

Things are gonna break on an airplane

and usually you're able to identify that

and make it so that it's not
a threat for the landing.

In 2008, Boeing
received a whopping 2,569

reports of faulty radio
altimeters on their latest 737s.

But very few of those cases involved

the plane going into Retard Flare Mode.

Hardly any reports at all.

Boeing also
tried, but couldn't find

the cause of the failures.

They concluded that the
radio altimeter problem

was not a threat to safety because

the 737 gives off enough warnings

so that crews can
intervene and land safely.

In fact, in every instance

where the radio altimeter failed

crews were able to recover.

Turkish Airlines Flight 1951 seems

to be the one exception.

Investigators still don't know why.

It really got us
wondering of what happened.

And that's when we started
to look really closely

at the actions of the flight crews

while it was on that final approach

in less than a 1,000 feet.

Finally, as
investigators again revisit

the last minutes of Flight 1951,

the circumstances of the
tragedy become clear.

They see a remarkable sequence of events

that transpire to bring down this plane.

So what was happening when

the plane went into Retard Flare Mode?

They discover that the plane

went into landing mode
and pulled back power

at the worst possible moment.

Exactly as the crew was descending
to meet the glide slope.

It masked what was actually happening.

As the crew
configured their plane

to drop down to meet the glide slope,

they expected the plane to slow down

as part of that maneuver.

But the plane was actually slowing down

because the computer was in landing mode.

That's why none of the
three pilots said anything

about the throttles moving to idle.

It was insidious.

Were it first captured in the Retard Mode,

it didn't hurt them at all
because they were actually high

and they were a little bit fast.

And the pilots actually
wanted the power back anyway,

in fact the throttles may have already

been in the flight idle
mode as they were trying

to get down and slow down.

Right the trouble
starts here at 8,300 feet,

13 miles out from the airport,
minutes before the crash.

Amsterdam,
Turkish 1951 descending 7,000.

Speed, two, five, zero.

Turkish 1951.

Descend to 4,000.

Speed okay

for ILS, one, eight, right.

Radio altimeter.

But would the crew have known

that because of that radio altimeter

they would've gone to a Retard Flare Mode

in their throttles?

No.

It's a common problem at the airline

that the crew couldn't see
the risk it posed this flight.

We have an airplane
that was malfunctioning

in a very minor way, but in a way

that if not caught could
and did metastasize

into something much more virulent.

Turkish 1951.

Descend to 2,000.

2,000.

1951.

Turkish 1951.

Left heading two, one, zero.

Clear approach, one, eight, right.

Left two, one, zero.

Clear ILS.

Turkish 1951.

Left at 210 degrees,

maintaining 2,000 feet.

Brings the flight in right here.

Five point five miles out.

We now have to intercept the
the glide slope from above.

At 2,000 feet
with the glide slope below them

the pilots have to reduce their speed

while descending steeply.

Speed, one, four, zero.

They believe
the throttles are moving back

for the descent to the glide slope.

In fact, the auto throttle
is slowing the plane down

because it's gone into landing mode.

It will continue to slow
the plane until it stalls.

What we found is that
when the flight crew

was doing their before landing
checklist, each one of them

was doing something
while they should've been

monitoring their airspeed.

For the next 100 seconds,

no one notices what's happening.

Until it's too late.

Established
altitude set, 1,000.

Check.

- Flaps, 40.
- Speed, set.

The experienced pilot recognize

that the First Officer's
probably a little bit behind

on the approach so he calls for flaps 40

and moves the lever,
informing the First Officer

that he has done so.

He's trying to help the
First Officer catch up

to the position of the aircraft.

- Speed brake.
- Speed brake, armed.

Green light.
- One thing at the time.

Landing gear.

The plane is
now 700 feet from the ground.

- Gear down, three green.
- Flaps.

Flaps, 40, green light.

In their haste
to complete their checklist,

none of the three crew
members notice the warnings

that their speed is dropping dangerously.

First, a red bar appeared
on their flight display.

Then when the air speed continued to drop

a flashing box appeared
around their actual air speed

to draw the pilot's attention to it.

At this point, no one sees either.

Cabin report confirmed.

The aircraft is
now 600 feet from landing.

When things start changing colors,

it's a warning to you,
it's a caution to you

that you're approaching
the limits of the aircraft.

Missed approach.

Altitude set 500.

So all of these indications
the crew has in front

of them saying that the
aircraft is slowing down.

During that time they were still
completing their checklist.

Of course the aircraft

is getting closer to the ground.

In fact,
it's less than 500 feet

from touch down.

And right before the
stick shaker started

the captain told the Safety Pilot...

Please warn the cabin crew.

Cabin
crew, take your seats.

Speed, sir.
- I have control.

By the time they
advanced their throttles

to full power, it was unrecoverable.

They were too low for
the engines to catch up.

And that's it.

It's now too late to save this plane.

They all knew about the altimeter problem

but knowing didn't help.

Boeing also didn't foresee

the potentially deadly
effect of a faulty altimeter.

But on February the 25th, 2009,

it triggered an unusual sequence of events

that brought down a jetliner
and killed nine people.

The official report into the accident

blames it on a convergence
of circumstances.

There is never ever just one
cause to an airline accident.

It simply doesn't exist.

Maybe someday God will
swap one out of the sky

but until then, there's never one cause.

The Dutch
report also points out

that Boeing could have
realized the problem

with the radio altimeter system

could have had an impact on safety.

Given that no one foresaw how

that failure might cause a crash.

The Turkish Airlines accident
raises a big question.

Are airplanes becoming too complex?

Investigators have determined

that Turkish Airlines
Flight 1951 crashed mainly

because the pilots didn't
recognize the consequences

of the warnings they were getting.

Turkish
1951, descend to 4,000.

This is not the first plane

to crash because the
crew didn't understand

what their plane was telling them.

Our problem is not the automation,

our problem is the depth of the training

and the ability of the human beings

to recover from mistakes
made in interfacing

with the automation.

Mica Endsley
studies the relationship

between pilots and technology.

We haven't really
designed the automation

to take best advantage
of what people do well

and take away the parts
that people don't do well.

In 1996, the crew
of an Aeroperu 757 crashed

when the pilots couldn't
decipher contradictory warnings

about their altitude and airspeed.

The plane flew into the Pacific Ocean.

61 passengers and nine
crew members were killed.

In 1995, the flight management
system on a Boeing 757

could and should have stared
the plane to a safe landing

in Cali, Colombia.

But a last minute change
to the flight plan meant

the crew had to reprogram their computer.

They mistaken the entered a course

that took them headlong
into a 9,000 foot mountain.

159 people died in the crash.

The cautionary tale here is

that we can get this equipment.

We can get these silicon-based units,

if you will, so sophisticated

that we can't talk to them effectively.

And when they go berserk
or they have a problem

or we misprogram them, we
end up putting ourselves

and our passengers in
danger while we're trying

to figure it out.

NASA is working on something

called the Integrated
Intelligent Flight Deck.

It's a project aimed at
helping humans better use

the technology that surrounds
them in the cockpit.

They're looking at automated
flight manual systems,

voice recognition systems.

They've developed new kinds of microphones

that are bone conducting chips.

They're developing new
displays for understanding

the ground environment
for being able to detect

where other aircraft
are in the environment.

What some
researchers are finding

is that the best technology
shouldn't replace pilots

but work with them.

Really integrating people
with technology more effectively

has to do with designing the displays so

that you can really
understand what it's doing

and you can make it
simpler to understand how

to make it do what it
is you want it to do.

You shouldn't have to push 16
buttons through eight levels

of menus to figure out what's
going on with the system.

It should be integrated
and presented effectively.

It should be as easy to communicate

with as the person next to you.

Boeing and Airbus,

the two largest manufacturers
of passenger planes

take very different
approaches to the relationship

between humans and technology.

Airbus gives the flight computer much

of the decision-making
power in the cockpit.

In their view, this is
a way to prevent a lot

of human errors by my
making sure the airplane

doesn't do something
that's gonna cause a crash,

even if the humans want them to.

But Boeing
has a different view.

Its philosophy is to provide information

to pilots and have them make decisions.

Having more information
is better for the pilot,

having the pilot in the
loop, in the equation,

so to speak, I kind of liked that.

Airbus will argue vociferously
and in continuous fashion

that that view is archaic and incorrect.

I think the jury is still out.

The final report

into the Turkish Airlines
tragedy blames the crash

of Flight 1951, partly on
a failure of technology.

The erroneous radio
altimeter data caused

the auto throttle to go to a improper mode

that is of course not a good situation.

The cause of
the radio altimeter failure

was never uncovered.

The Dutch investigation asks Boeing

to improve the reliability of the system.

We learned a lot about
the radio altimeter system

and how it affects the
auto throttle system.

Boeing is currently working
on system improvements

to prevent this type
of auto throttle event

from occurring again.

But the
report also faults the crew

for not noticing that their speed

was dropping dangerously low.

In spite of the fact that there
were three pilots on board.

Forget that you got an auto throttle,

you look at the airspeed and
you look at the altitude.

You look out the damn
window if you want to.

But air speed is crucial component

of staying alive in an airplane.

And you always need to
know what your speed is.

But to Mica
Endsley, the crew's failure

to monitor instruments is
entirely understandable

and maybe more the fault of
the instruments than the crew.

It's actually very difficult for people

to be monitors of automation.

One of the things that
people don't do a good job

of actually is monitoring.

We're very good on-the-spot
decision makers.

We're very good at coming
up with creative solutions

to problems, but repetitive monitoring

is a kind of thing that actually people

aren't very good at at all.

So what we have to do is design automation

to work with people in a way
that keeps them more actively,

cognitively involved and in the loop

and not just monitoring
a piece of automation

to say is it doing what
it's supposed to be doing?

Who's the ultimate computer?

The pilot.

The individual who should be able to say,

I don't know what this
thing is doing to me

but I'm punching it off
and flying the airplane.

Fly the jet.

Probably the smartest
thing we ever learned

to say in our training in the airlines,

fly the jet do that first
or nothing else counts.

That's what they forgot to do.