Plane Crash Investigation

Fiction by John Barry Smith
1 Sep 1996


There was once a plane crash. It was terrible. Many children, boys, girls, men and women died terribly by being burnt, smashed, cut, and suffocated. Their families and friends cried when they found out. Everyone was sad and upset. It was a mystery why the plane crashed.
Everyone said, "Find out why the plane crashed."
So they did. Here's how they found out how the plane crashed.
The government established an agency composed of experts to investigate the circumstances and events leading to, during, and after the crash. The government agency, called the National Transportation Safety Board, or the NTSB, appointed a person to oversee the Board. He was called the Appointee. He believed that his Administration oversaw the safest aviation transportation system in the world. And he was right.
The Appointee went to the scene of the crash. It was a mess; bodies and pieces of plane were everywhere. The NTSB took charge and organized teams to recover the pieces of the bodies and the plane. The pieces of bodies went in one direction and the pieces of plane to another where it was put back together. The bodies were not put back together, or they were, I'm not sure about that.
The NTSB had an investigator, called the Investigator, but needed more help; like most government agencies they were underfunded and understaffed. No government agency ever has enough funds or staff, that's why they are called government agencies. The Investigator believed that he investigated aircraft accidents fairly and comprehensively. And he was right.
The NTSB Appointee asked the company who made the airplane if they would send someone over to help discover why his airplane crashed and killed all these people. The airplane maker said, sure, here he is, you can call him the manufacturer's representative; we can call him the Maker. The Maker went to the crash site to help the NTSB. He believed his airplane to be the strongest, safest airplane in the world. And he was right.
Everybody had ideas why the plane crashed. The most exciting ones were the most talked about, of course. What is the most exciting one you can think of? Boom? Yes! A bomb goes boom in a boom box is an exciting idea. But, it's been done before, so this time, bomb go boom in a boom box was not accepted right away. But maybe an exciting rocket powered missile could have hit the airplane? Maybe! So the Government agency involved with missile attacks by foreigners, the Federal Bureau of Bomb Investigation, was brought into the mystery. The FBBI assigned an agent, the Agent, who believed that he conducted investigations that were complete and based on fact. And he was right.
He initially wanted to find a bomb but if he couldn't get that, he would settle for a missile; so they started examining every piece of the airplane for explosive residue. Residue is something very small, invisible trace usually, which is found on something very small, a fragment actually. Explosive residue can be found around a child's cap gun or a nuclear explosion so if the residue is found, the conclusion can be very flexible and be made to fit whoever makes the discovery. So everyone worked very hard to find explosive residue. And they found some! But there was nothing around the residue that looked like an explosion had hit it so the residue stood alone waiting.
The NTSB Appointee, his Investigator, the Maker, and the FBBI Agent were all at the hangar where the pieces of the plane were being put back together one day. They stood around. They each had a cup of coffee in a cup with their agency logo on it which matched their windbreakers. They were sharp.
"How about them 'Niners," one of them said, "think they got a chance 'gainst Dallas this year?"
"No," the Agent replied.
"How's the investigation going?" asked the Investigator.
"Wait a minute, that's my question," said the Appointee.
"Well, I can ask that question, too," said the Agent.
"Yeah, me too," said the Maker.
"OK, OK, everybody can share and ask the question, how's the investigation going?" said the Appointee.
"What investigation," said the agent, and they all laughed. They got along awfully nice together.
"Well, the plane came apart in the air. The nose separated first and fell forming a debris trail. The rest of the airplane fell and exploded later forming its own debris trail," said the Maker.
"We haven't found any conclusive evidence of a bomb or missile or any hostile action against the plane," said the Agent.
"We reviewed the paper history of the plane and discovered it is an early model Boeing 747 and has over fifty thousand hours of flight time with several airlines flying all over the world in all types of conditions. There are also two Airworthiness Directives against the only item in front of the wing near where the destruction occurred on the right side which caused the nose to come off: the forward cargo door," said the Investigator.
An Airworthiness Directive is an order to the airline from the Federal Aviation Authority that a very dangerous condition exists and if the instructions in the Airworthiness Directive are not followed exactly, the aircraft is not permitted to fly. The forward cargo door had two Airworthiness Directives based upon previous events in which passengers were killed because of the door malfunctioning and opening in flight.
"The people are trusting us to find out what's wrong. They are continuing to fly in this type aircraft. I have consoled the victim's families. We will give daily press briefings and keep the public fully informed of all our discoveries regardless how trivial we think they may be now. I've asked for help from the public, has anyone received any help?" asked the Appointee.
"Yes, I have," said the Investigator.
"What was the help," asked the Appointee.
"An informed member of the public, who has vast experience in many aspects of aviation, suggested I visit his web site which has a hundred pages of documented evidence linking three crashes of similar type aircraft to this crash. The linking evidence is solid. He said to compare this crash to another which is similar and had a solution. The conclusion is that the inadvertent opening of the forward cargo door is tearing off leaving a big hole which causes the whole nose to come off. I reviewed the pages and they are legitimate extracts from government reports. The member of the public said he was granting our request for help and suggested we rule out the cargo door right away," the Investigator concluded.
"Well, that was very nice of the public," said the agent, "what a nice guy."
"That's very interesting," said the Maker, "let me check out that theory, where is the cargo door?"
"Over there," said the Agent who had previously checked it for explosive residue and found none even though a large explosion was suspected in the vicinity. The Maker walked over to the pieces of the door.
"What's the address of the web site," asked the Appointee, "I'd like to peruse the pages."
"http://www.corazon.com" said the Investigator, "and his email address is barry@corazon.com."
The Appointee went over to a nearby computer, went on the internet, booted up a web browser, put in URL address, and started reading the pages.
The Investigator asked the Agent, "Can you get us copies of the other accident reports although they belong to foreign countries."
"Can do easy, GI," said the agent and immediately picked out the small cellular phone from his coat and made a call. The logo of his agency was on the back of the phone and matched his coffee cup and windbreaker. He was sharp.
The Agent called some other agents who called some people who obtained the files and faxed them to the Agent in the hangar. "Yeah, getting confidential files from a foreign government quickly, piece of cake," the Agent mumbled under his breath.
"Hey this is great," said the Investigator, as the faxes came across. "Look at the evidence of voice recorder, radar information, destruction sequence, engine evidence, body pathology, and aircraft reconstruction, it all matches! And the one crash that we definitely know was a cargo door has matching evidence to the mostly mysterious ones."
"Who said the one sure cause was a cargo door?" asked the Agent.
"Me," said the Investigator, "I did that crash and it was the door opening in flight, we found the door, it was unlocked, all the evidence is correct."
"Hey this is great! This is very interesting," said the Appointee while reading the one hundred pages of the crash web site. "All the evidence matches. There is a link of cargo door opening to all these crashes. We should check this out."
Just then a loud shout went up over by the cargo door reconstruction area. The Appointee, the Agent, and the Investigator all looked over at the Maker who was jumping up and down shouting, "Come over here, come over here, I've found it, I've found it!"
Now, everybody reading this story, relax, don't panic, everything is going to be all right. This is just a story and not real life. We'll take a little break here to rest our brains.
Look around, you're still safe, you understand most of what your reading, and it's easy to just read words. To review: A terrible thing happened. The government is going to find out what happened so that it does not happen again. This is how they do it. Everything is organized before the terrible thing happens so that the truth will come out quickly and you can quit worrying. The four concerned parties were the Maker, the Investigator, the Agent, and the Appointee. The people who actually flew in the airplane and died in the airplane, the Pilot and the Passenger, were not concerned, not represented, and thus were not included. They would probably get too emotional, anyway.
"Over here, over here," shouted the Maker, "I've found it!"
The Appointee, the Agent, and the Investigator rushed over the to Maker who was kneeling next to the forward cargo door pieces.
"Look at this," said the Maker, pointing to the cam locks, the cam sectors, the locking pins, the door control wire bundle and the edges of the broken door. "Yes it's all here," said the Maker, "here is the locked lock sectors, the unlocked cam sectors, the worn metal cams and locking pins, the frayed wire bundle, and the broken pieces of door."
"What's it mean?" asked the Agent.
"It means that the door looked locked but wasn't fully latched. The metal is worn from constant use. The frayed wire bundle sent a erroneous signal to the door to open. The door opened up and outward into the slipstream and broke in half right here," said the Maker, pointing to the broken door halves.
"You know, I was right all along," continued the Maker, "my first airplane of this type did not have a door like this, only later was it added at the airlines insistence. And then later we changed the door so that it opens inward and upward so that if the door opens accidentally in flight the inside pressure will keep it closed and it will not tear off a large piece of nose skin which leads to the whole nose tearing off and crashing the airplane. See, we learn from our mistakes," finished the Maker, contentedly.
"Ah," said the Investigator, "this new crashed door matches the old crashed doors which match the known cause of door opening crash. It definitely is the door opening which caused the crash," finished the Investigator, contentedly.
"And look," said the Agent, "the floor beams are bent and fractured in the same way as a door opening event and not the opposite way as in an explosive event. It definitely was not a bomb but a door opening which caused this crash," said the Agent, contentedly.
They had found out the cause of their crash. They had done their job. They had earned their pay. They had fulfilled their years of education, striving, and experience. By teamwork, preparation and patience, they had unraveled a mystery. They all reached into their coat pockets for their cellular phones to make the calls to their bosses.
The Maker called his home office and spoke to the Chief Executive Officer. The Maker explained the door mechanical problem and how to fix it. The CEO told the Maker he would talk with the Board of Directors and get back to him. The Maker hung up satisfied with a job well done.
The Agent had called his Director and explained the discovery of the door problem. The Director had told the Agent he would talk with the Attorney General and get back to him. The Agent hung up satisfied with a job well done.
The Investigator called his family and told them of the door discovery. His family said they would talk with his buddies and would get back to him. The Investigator hung up satisfied with a job well done.
The Appointee called the Secretary and told him of the door problem discovery. The Secretary said he would talk to the President and get back to him. The Appointee hung up satisfied with a job well done.
"Well, what caused the door to open," asked the Appointee.
"Good question," said everybody.
"We'll get to that later," said the Maker, as they all waited for the phones to ring with the news from their bosses about congratulations, raises, promotions, assignments, and interviews.
The phone rang. It was for the Maker. He opened the cellular flap and listened to his boss.
The phone rang. It was for the Agent. He opened the cellular flap and listened to his boss.
The phone rang. It was for the Investigator. He opened the cellular flap and listened to his boss.
The phone rang. It was for the Appointee. He opened the cellular flap and listened to his boss.
After a few minutes of listening, the Maker, the Agent, the Investigator, and the Appointee folded the cellular flaps closed and put their phones back inside their jackets. They were silent. They went to a table and had a cup of coffee.
"How about them 'Niners, think they got a change against Dallas this year?" asked the Agent.
"No," said the Maker. "I think I may have been a bit hasty in my conclusion about the cause of the crash."
"I might have jumped the gun, too," said the Investigator.
"I may have rushed to a conclusion, also," said the Agent.
"I could have been brash," said the Appointee. "Let's reconsider."
"Yes, let's reconsider," they all agreed. And they did.
"I'll start," said the Maker, "my Chief Executive Officer reported from the Board of Directors who said that I may have been a bit hasty about the cause of the crash. Now that the cause of the crash might be determined to be a faulty forward cargo door, these events will take place as soon as it is official. Seven billion dollars of orders for this model aircraft will be cancelled, two billion dollars in liability claims will be paid by the company, new orders for our other aircraft will be slow in arriving, if ever; the repair costs for the faulty doors on all the aircraft will cost one billion dollars, our quality reputation will disappear, our stock price will disappear costing us billions in company value, and ten thousand employees will be laid off with no pension or health plan, including me. My boss asked me if I understood very clearly what he had told me, especially about the laid off with no pension part. I said I did," concluded the somber Maker. After a moment's reflection he added, "I definitely was a bit hasty about the cause of this accident. I'm reconsidering the accident cause right now."
"I'm next," said the Investigator. "My wife told me that I might have jumped the gun on the accident cause. When she called all my buddies and told them the cause of the accident was a door, they said that they were involved in the previous accidents which were said to be bombs but are now proven to be incorrect. Their reputations are shot, they have lost their credibility as accident investigators, they will not be able to get a job, their self esteem is gone, and they have said for me never to ever again contact them in any way. My wife is very concerned about my position now that I would be the enemy of all my coworkers. She fears for her security and for our daughter who may now not be able to afford dentistry and will have all the other kids laughing at her funny mouth. She might have to go to her parent's house with our daughter. She asked did I understand what she had said, especially the part about her going to her parent's house with our daughter. I said I did," concluded the somber Investigator. After a moment's reflection he added, "I definitely jumped the gun on the accident cause. I'm reconsidering right now."
"My turn," said the Agent. "My Director informed the Attorney General who said that I may have rushed to a conclusion on the accident cause. He said that now that the cause was a mechanical problem caused by us and not a bomb from foreign enemies the new request for additional funds for new agents will not be approved. Because our current agent staffing guide is based upon previous bombing incidents on airplanes that now appear not to have happened, our current staff will be reduced. Since we made errors in announcements of explosive finds, the public has lost confidence in our judgment and all our surreptitious activities such as monitoring mail and communications through court orders will be curtailed because of lack of court approval. With the general lessening of fear from foreign terrorists our recent inroads into overseas areas with local liaison offices, we will be told to leave and return to the United States and leave the overseas investigations to the locals or the CIA. Because we bungled this bombing investigation we will not be able to expand our investigative efforts into other areas, such as bankruptcies, and will be restricted to domestic crime. Since our budget will be slashed, our mission curtailed, and our employees laid off, I am to be assigned to a place I don't want to go to, for longer than I can stand, doing a job I hate. The Director asked me if I understood what he said, especially about the new assignment part. I said I did," concluded the somber Agent. After a moment's reflection he added, "I definitely rushed to a conclusion on the accident cause. I'm reconsidering right now."
"I guess I'm last," said the Appointee. "My Secretary called the President who said I could have been brash about the accident cause. The President said that now that the cause might be a mechanical problem which has gone on for years undetected instead of foreign terrorists, many changes will occur. When the manufacturer loses orders he lays off employees who are upset and vote against him. When the manufacturer lays off employees they don't pay their bills and go bankrupt and the entire economy of a large area of the country is adversely affected with people who will not vote for him. The billions of dollars coming into the country from overseas for airplanes will not be coming in and the national debt rises upsetting all the people who will not vote for him. The billions of dollars for airplanes will now go to a foreign country making them stronger. The cause being undetected for so long has allowed other planes to crash and kill people upsetting the victim's families and friends who will not vote for him. The reputation of the country resides in the quality of its products and the number one product of America has now shown to be defective, allowing the world to laugh at us. In addition, he will now have to apologize to a foreign leader for erroneously blaming him for bombing and destroying an aircraft resulting in sanctions against his country resulting in hardship for millions of his innocent citizens. The blame for the delay in detecting the cause, the blame for allowing the defective door to be certified as OK, the lack of oversight in enforcing the Airworthiness Directives, the revelations of sloppy paperwork and maintenance records will ensure that his administration will not be returned to power in the upcoming election. The President said that if he goes down everyone goes down. I will be replaced as Appointee and will never be appointed to anything higher than pre-school yard monitor for the rest of my life. The Secretary asked me if I understood everything he said, especially about the schoolyard monitor part. I said I did," concluded the somber Appointee. After a moment's reflection he added, "I definitely was brash on the accident cause. I'm reconsidering right now."
So they reconsidered. They did not consider their own well being; they were above selfish self interest. They thought about their company, about their friends, about their mission, and about their country. Their personal safety, the security of their families, their aspirations about their careers, and the respect of their fellows did not enter into their considerations one bit. They cared about a higher truth. They thought about loyalty to company, mission, friends, and country. They thought about right and wrong. They were not traitors. They were not thieves. They were not bad people. They realized they had to re-evaluate the cause of the crash. They needed to look closer at the evidence. They needed to consider some new conclusions based upon the closer look at the evidence. So they did.
They looked at the radar evidence of blips just before the two aircraft disintegrated. Hey, could be an anomaly, they all agreed.
They looked at the one half second loud sound then silence from the four aircraft. Hey, listening closer to this short sound makes it clear that this sound is different from all the rest of the short loud sounds. They are all different short loud sounds, they all agreed.
They looked at the FODDED engine number three of the three aircraft. Hey, this foreign object junk could be anything, including the lining of the intake. The FOD could be anything, they all agreed.
They looked at the missing bodies in the same seats in the three aircraft. Hey, could be sharks or wolves that made them disappear, they all agreed.
They looked at the sudden power cut on the four aircraft. Hey, power cuts off all the time; plug comes out, power station goes out, circuit breaker pops, could be anything. The sudden power cut could be anything, they all agreed.
They looked at the tearing off of the nose on the four aircraft. Hey, could be a bomb. That's right, they all agreed, it could be bombs which tore the nose off all the four aircraft.
They looked at the same type of early model, high flight time Boeing 747 of the four aircraft. Hey, coincidence, they all agreed.
They looked at the streak seen by eyewitnesses. Hey, drunk partygoers see all sorts of stuff, they all laughed, as they agreed to disregard eyewitness evidence.
They decided to ignore cargo door latch cams, lock sectors, pull in hooks, and frayed wire bundles, as well as bent and fractured floor beams, as being too complicated, too difficult to understand and prone to misinterpretation.
The Airworthiness Directives against the door were to be mentioned with no comment. The photographs of the reconstructed fuselage showing the destruction sequence were changed to drawings by an artist who closely followed instructions on what to represent.
They reviewed the evidence. They came to the conclusion that the previous conclusion was hasty, brash, and rushed. It could have looked like an inadvertent opening of the forward cargo door was the probable cause of the crash, but then again it could look like it wasn't. It all depended on how you looked at it. It was only natural to look at it from the company's best interest, the agency's best interest, the family's best interest, and the country's best interest, if they had a choice. And they did have a choice. They came to the sober, well thought out, conservatively reasoned explanation for the crash was unknown.
Their consciences were clear. They had closely examined the evidence and interpreted it in the best possible light for the best interests of their company, their friends, their mission, and their country. They were patriots.
They called their bosses on the phones with the new conclusion. They listened, they beamed, they hung up.
"Well," said the Maker, "orders for new planes are pouring in. Our company is more prosperous than ever now that the cause of the crash is not the company's fault. I've just been promoted, given a raise, and given a new assignment I've been wanting for years. My Chief Executive Officer wants to personally pat me on the back," the Maker concluded happily.
"Well," said the Investigator, "my friends have all invited me other to their house for football and a party. I don't have to bring any beer either. My wife said she got a baby sitter for our daughter and she's home right now waiting for me wearing her special outfit. She wants to personally pat me," the Investigator conclude happily.
"Well," said the Agent, "my director said that since the terrorist danger is still out there, all around, our mission of catching our enemies will proceed as planned, overseas and elsewhere. Also, budgets won't be cut and staff won't be reduced. He personally wants to shake my hand and wants me as his right hand man in the home office," the Agent concluded happily.
"Well," said the Appointee, "the President said he is getting much positive feedback from polls claiming the great confidence the people have in their leader who protects them from foreign enemies and domestic problems. The unemployment rate remains low, his campaign contributions continue to pour in, the society continues to travel and do business, confidence in his administration and its supervision of the regulatory agencies is high, his opponents have no issues to attack him with, he gets to be belligerent to non-nuclear countries and appear strong, and he just wants to see me personally and give me a great big hug. He also asked me to pick a job, any job, that my heart desires in the whole government, and it's mine, just like that," concluded the Appointee happily.
"How about them 'Niners," one of them said, "think they got a chance against Dallas this year?"
"Hell, yes," they all shouted, and went home, happy, guiltless, and content.
And that's how smart, honest, educated people can come to the wrong conclusion about an aircraft accident cause.
Comment: Best interest rules.
Contents
barry@corazon.com