Page: 1 Transcript Station: CANBERRA CONFERENCE Date: 03/12/2010 UNIT Program: PRESS CONFERENCE Time: 10:30 AM Compere: 0 Summary ID: C00041634633 Item: MARTIN DOLAN FROM AUSTRALIAN TRANSPORT SAFETY BUREAU RELEASES THE PRELIMINARY REPORT INTO THE QANTAS FLIGHT EMERGENCY LAST MONTH OVER SINGAPORE. INTERVIEWEES: MARTIN DOLAN, AIR TRANSPORT SAFETY BUREAU Audience: Male 16+ Female 16+ All people N/A N/A N/A COMPERE: And as you can see we are standing by to take you live to ATSB, that's the Australian Transport Safety Bureau [indistinct] into the Qantas A380 drama. And we'll keep an eye on that one. [Unrelated item: weather] And we are standing by to go to Canberra for an Australian Transport Safety Bureau media briefing. It will accompany the release of its preliminary factual investigation report into last month's engine failure on board the Qantas flight QF32 over Indonesia. The ATSB chief commissioner Mr Martin Dolan will present the facts gathered from the investigation to date, and will also take us through the key safety actions that the relevant parties have taken to prevent a recurrence. Page: 2 Of course Qantas grounded its fleet for three weeks and recently just got back off the ground. We'll go live to this news conference now. MARTIN DOLAN: Good morning everyone. Martin Dolan, the chief commissioner of the Australian Transport Safety Bureau. I'm here to introduce the release of our preliminary factual report into an in-flight uncontained engine failure over Batam Island in Indonesia of an Airbus 380 aircraft operating as Qantas flight 32. This has been a fast-moving investigation with a range of actions already taken in response to what we've found. The report we're releasing describes the facts as we currently understand them of the occurrence and the sequence of events. It also sets out what we understand to be the most likely mechanism of engine failure, and outlines safety action that has already been taken in response to that. In essence the report outlines that the aircraft took off from Singapore, and in the course of climbing from Singapore, the crew heard two loud bangs in the engine, received indications of a failure in the number two engine, undertook a lengthy series of actions to establish the extent of damage and their capacity to control and direct the aircraft, and then planned and executed a safe landing back in Singapore with no injury to passengers or crew. Page: 3 The report indicates that the occurrence was essentially the result of an uncontained engine failure. Elements of an intermediate pressure turbine disk, segments of that disk were liberated through the engine damaging the left wing and the fairing between the left wing of the aircraft and the fuselage of the aircraft. There was considerable damage an… to the aircraft, and effects of a number of the aircraft systems. The report goes into some detail as to the crew's response to that action, and I'll get back to that in a moment. The investigation is ongoing. These investigations are complex and involve a range of international organisations and agencies. The initial assessment was that the most likely cause of the engine failure was problems with release of oil into a particular part of the engine, leading to an oil fire and the consequences finally in the liberation of the disk elements. That was initially responded to be ensuring that there were regular inspections for any oil leakages in the relevant elements of the Trent 900 series engine, and the Airbus 380, and on that basis, with caution, continued operations of the aircraft were seen as acceptable. Page: 4 In the course of investigation in the last 48 hours, we, working with Rolls Royce and others, determine that there was a particular problem that had to that stage not been identified. And we therefore yesterday issued a safety recommendation in relation to that issue which was essentially a manufacturing defect, or potential manufacturing defect in oil pipes in a number of Trent 900 series engines which had the potential to lead to fatigue cracking - the liberation of oil - and the sorts of things that happened with the engine in the incident over Batam Island. Since then, Rolls Royce has issued a procedure for checking all the relevant engines to determine whether or not the problem that we have identified does exist in any of those engines, and if the problem is detected in any of the engines, those engines will be taken out of service. Additionally, the European Aviation Safety Agency has issued an authorisation of an upgrade of the engine controlled software for the Trent 900 series engines which is designed as a defence against possible turbine disk overspeeds in the future. It will essentially detect the precursors to that - and will enable the engine to be shut down if those precursors to a potential overspeed are seen in the engine. The report goes on to outline the details of the actions taken by the crew in response to what you'll understand was a very challenging situation, their Page: 5 methodical assessments of a range of error reports, the status of the aircraft, their professional and focused handling of the situation, and their safe landing in Singapore. The investigation is continuing. The report outlines a range of further lines of inquiry. We are not yet at the stage where we can definitively say that the fatigue problem, potential fatigue problem with the oil pipe that has been detected is the cause of what happened over Batam Island, but we think it is significant enough as a safety issue in any event that needed to be identified - and it has been safely dealt with. This investigation we think has been a very positive example of international cooperation amongst safety agencies and with manufacturers of aircraft and operators of aircraft, and manufacturers of engines. In getting to the point where we have, we were particularly reliant on very effective operation with Rolls Royce. And we think the investigation to date - and we hope will continue to be - a very effective example of cooperation in the interests of identifying problems and maintaining aviation safety. That's essentially it. The report has some more details. But I'm happy to take questions on any elements of that. Page: 6 QUESTION: Given the flaw you found in these oil pipes, was the two flights Qantas had - the A380s in recent weeks, were they safe flights? MARTIN DOLAN: The problem has been identified at this stage as far as I'm aware only in the oil pipe of the engine that was on the aircraft who's in… where the uncontained disk liberation happened. MARTIN DOLAN: There's an inspection regime in place to determine whether or not that problem exists in any other engine. QUESTION: But you said that was a manufacturing flaw, so it could potentially exist in other engines. MARTIN DOLAN: Indeed, it could potentially exist in other engines which is why the inspection regime is in place. QUESTION: How long until we get the results of that? MARTIN DOLAN: We understand that there's urgent inspections going on. We haven't been given the details from individual airlines as to exactly what they're doing but they're aware that the risk exists and they will obviously inspect for it because they operate the aircraft with engines. QUESTION: Should this flaw be - would it have been possible to do - to detect this visually by inspecting it? Page: 7 MARTIN DOLAN: Its - its oil pipes leading into an internal bearing arrangement within the engine and so inspection in fact was a very difficult thing and it has - has had to be a very highly specialised inspection procedure and equipment put in place to actually test for the potential problem. QUESTION: So maintenance could not have spotted this - spotted the problem? MARTIN DOLAN: It was given that no one was aware that the potential problem existed. It's highly unlikely that any maintenance would have been able to establish this potential problem. QUESTION: Is there anything from the investigation so far to suggest that there's any problem other than the engine, like with the Airbus, the A380 at all other than the engines or with Qantas and the way Qantas has been handling its maintenance and… MARTIN DOLAN: We have seen no maintenance related issues in relation to this event. We are currently still examining the extent of the damage as a result of liberation of the engine parts and so it is obvious that there was considerable damage to the aircraft but that's not as we - we can't at this stage say much more than that. I think the thing we should all reflect on is that despite considerable damage the aircraft was controlled and was safely landed in Singapore. Page: 8 QUESTION: So an A380 aircraft should not fly until these safety inspections are complete? MARTIN DOLAN: There's a potential problem with engines. So those engines should be inspected before flights occur, correct. QUESTION: Are they - have they been grounded world wide? Do you know what the situation is? MARTIN DOLAN: We don't have all the details of the situation. The procedure was only promulgated by Rolls-Royce overnight. What we are aware of is that for Qantas there was an immediate response to our safety recommendation which was to do inspections of their operating aircraft in advance of their projected future operation. So that's something that's currently being completed by Qantas. QUESTION: How long before all the - all the Trent 500 engines have the software upgrade you mentioned? MARTIN DOLAN: We've only just see the announcement from IASA as to the approval of the software upgrade and we don't have information at this point as to how long that will take. I understand informally that it can be done quite quickly. QUESTION: When did you make the safety recommendation to Qantas? Page: 9 MARTIN DOLAN: We made the safety recommendation - I'm just trying to remember the sequence of events, it's been a rather busy 48 hours. The evening of the - what's today? The third. The evening of 1 December. QUESTION: Have they seen the report? MARTIN DOLAN: Yes they got an advanced copy of our report as an interested party in our investigation. QUESTION: The two [indistinct] you discovered in the last 48 hours, is that linked at all to the leaks in the three other Qantas engines that they found oil leaks in and the smears in the Singapore Airline Trent engine as well? Are they directly related? MARTIN DOLAN: We don't have enough information at this stage to rule in or rule out that sort of relationship. Our best assessment at this point is that there's two potential causes of oil leakage; (1) that relates to a fitment of an oil tube and whether that's reliable in terms of the oil and the second is this potential fatigue cracking in a particular oil pipe. We're still working through the various elements of this and so at this stage we're not saying anything definitively about that other than oil and oil fire is the highly probable cause of what happened over Batam Island. QUESTION: [Inaudible]… MARTIN DOLAN: We are satisfied that with the inspection regime that's in place in the borescope of - to detect Page: 10 whether there is a problem leading to a potential fatigue and in the quick implementation of the software upgrade, that all the necessary safety action has been taken. QUESTION: [Inaudible]… MARTIN DOLAN: We at this stage don't have full information to make a firm assessment of that and so you should take our comments at this stage as relating to the Trent 900 series engine generally. QUESTION: You touched on the professional and focused conduct of the crew on board the aircraft. How crucial was that to the safe arrival of the aircraft in Singapore? MARTIN DOLAN: The aircraft would not have arrived safely in Singapore without the focus and effective action of the flight crew. QUESTION: You said that the leaky oil pipe is a significant finding. You haven't established exactly what happened here but do you feel that you have solved - you've worked out what's happened in this case? MARTIN DOLAN: What we know is that we have identified a significant safety issue that's directly relevant to what happened over Batam Island. Our investigation will still have some way to go before we can say that that is the cause. We will continue to look just to make sure we haven't missed Page: 11 something else. So at this stage we're saying we've identified a significant safety issue and have not identified any others. But our investigation continues. QUESTION: [Indistinct]…that could be a sole cause? That could be the sole cause? MARTIN DOLAN: It could be but that's - I'm not going any further than saying it's a possibility at this stage. Our investigation continues. QUESTION: How much has this investigation cost so far? MARTIN DOLAN: That's not actually something that I have available but a significant amount of money. We can get some information to you on that if you want to give me your details later. QUESTION: Are there any A380s flying into Australia at the moment? MARTIN DOLAN: That's not - not something that I actually have current information on and it's probably more a matter you should raise with the civil aviation safety authorities, the regulator of aviation safety in Australia. QUESTION: You've obviously had discussion with Qantas, have you spoken to Singapore Airlines and Lufthansa, who also use the Trent 900 and are they Page: 12 implementing the same measures as far as you know? MARTIN DOLAN: We have spoken to our counterparts in Singapore and to the Singapore regulator and put it in their hands to talk to Singapore Airlines and similarly we've been dealing with the European Aviation Safety Agency in relation to their safety regulatory responsibilities for Lufthansa. So we see this, we've identified the problem, made it know to the operators and to the safety regulators and we are seeing the safety action being taken by the regulators and the operators in response. QUESTION: We recently had the oxygen bottle, that freaky oxygen bottle that blew up and it's unlikely to be any other problem like it. Could this oil - leaky oil be a similar situation? MARTIN DOLAN: It's possible that this is a one off, but the results of inspection will tell us whether or not that's the case. QUESTION: Was there - do you have any information about how was it manufactured that would suggest that may be wider spread? MARTIN DOLAN: We don't at this stage have the detailed information that would enable us to make a call one way or another. What we know is it's a possibility which is why the inspection regime is in place. Page: 13 QUESTION: [Indistinct] shut down number one engine. What have you found about the circumstances about that? MARTIN DOLAN: We're still looking at the details of that but our best assessment at this point is that it was a direct consequence of some of the damage to the wing of the aircraft which as you'll see in our report severed some wiring, and that had some consequences in relation to the number one engine which led to that problem with shut down. QUESTION: How close did this come to being a disaster given the extent of the damage? MARTIN DOLAN: I - that's, I think, with respect, an impossible question to answer, and the only thing we can say is that in a situation like this where you have considerable pieces of engine turbine disk released from an engine then the consequences are very serious. QUESTION: Do you know what the most serious damage was done, the… MARTIN DOLAN: The most serious damage in terms of scale was the result of one significant part of the turbine disk going directly through the wing of the aircraft. Another piece came to the fairing that is in front of the joining of the wing and the fuselage and that's where the damage to the wiring principally occurred. Page: 14 So they're the two things that probably in our view at this stage most significant. We'll continue to look at all the details of the damage that occurred and the consequences. QUESTION: That's [indistinct] talk about the significant in - detrimental to the plane's ability to fly. MARTIN DOLAN: Well we list in the report a range of systems and capabilities of the aircraft that were affected by the damage. These include such things as the slats of the aircraft were unable to be deployed for landing. There were some limitations at least, it would appear, from the signals the crews were getting with [indistinct] steering, there's a whole range that we've listed in the report. And rather than go through them I just say so there was a whole sequence of consequences about the operation of the aircraft that we list in our report. QUESTION: And has Rolls Royce agreed with your findings, are they accepting them or [indistinct] question? MARTIN DOLAN: Well probably the best way of answering that is to say we made a safety recommendation, and in response Rolls Royce has issued a procedure for detecting the problem and said that it needs to be done very urgently, as in with two cycles of operation with the engine. QUESTION: Sorry, [indistinct], just before that, you - was it - that you said you didn't have any data on how many Page: 15 potential engines currently in operation around the world would be [indistinct]. MARTIN DOLAN: That's - we don't have an answer to the number at this stage, so what we're saying is - what we do know is that there are three operators who have Airbus 380 aircraft with the Trent 900 series engines, but at the moment I don't have the numbers that go to the number of engines that are affected. QUESTION: And, sorry, those operators are Qantas, Singapore, and… MARTIN DOLAN: Lufthansa. QUESTION: Is the manufacturer of this plane also involved in making any other pieces of the aircraft? MARTIN DOLAN: My understanding is that Rolls Royce has essentially focused on the engines of the aircraft, but I'm - I suppose I would have to admit that my understanding is a little limited there, so our focus has been on the engines, and on the manufacture of the engines. QUESTION: Just again on Rolls Royce… MARTIN DOLAN: Yeah. QUESTION: You talk about the cooperative working relationship you have with them. Is there any disagreement Page: 16 about what the conclusions you're drawing as you go through the investigation. MARTIN DOLAN: No, this has been a very cooperative process. Obviously the sorts of discoveries that are being made in the course of the investigation need to be worked out very hard to determine what's the best safety action to be taken in response. And so this is a very high-pressure arrangement, but the relationship has been very effective, and as you can see from the speed with which there was a safety response once the problem had been identified, we think it's working very well. QUESTION: How many Australians were involved in the investigation? MARTIN DOLAN: Has anyone got the numbers at the moment on how many people were deployed? I would say we've had at least 25 of our staff involved one way or another in this investigation so far. Just as a ballpark figure, guys, is that about the territory? Ian? MALE SPEAKER: Yeah, it's been variable, but at least 12 investigators. MARTIN DOLAN: Directly involved - plus a range of others providing support of various sorts. Page: 17 If there are no further questions, thank you very much for your attendance and look forward to talking to you at some other time. Thank you. * * END * * TRANSCRIPT PRODUCED BY M EDIA M ONITORS target-monitor-analyse CLIENT SERVICE CENTRE 1300 880 082 AGENCY REPORT For private research and not to be disseminated. Every effort made to ensure accuracy for the benefit of our clients but no legal responsibility is taken for errors or omissions. (*) - Indicates unknown spelling or phonetic spelling. Metro TV demographics are supplied by OzTAM, Radio and Non-Metro TV demographics are supplied by Nielsen Media Research. 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