Emirates A388 near Salt Lake City on Feb 1st 2020, turbulence injures passenger

Last Update: October 1, 2020 / 19:09:33 GMT/Zulu time

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Photo of Emirates Airlines A6-EON, Airbus A380-800 — Emirates Airlines A6-EON, Airbus A380-800 (Photo credit: Mike Burdett / Flickr / License: CC by-sa)

Incident Facts

Date of incident
Feb 1, 2020

Classification
Report

Cause
Turbulence

Airline
Emirates Airlines

Departure
Los Angeles, United States

Destination
Dubai, United Arab Emirates

Aircraft Registration
A6-EON

Aircraft Type
Airbus A380-800

ICAO Type Designator
A388

An Emirates Airlines Airbus A380-800, registration A6-EON performing flihgt EK-216 from Los Angeles,CA (USA) to Dubai (United Arab Emirates) with 333 passsenger and 28 crew, was enroute over Wyoming, Salt Lake City FIR (USA) just leaving FL330 to step climb to FL350 when the aircraft encountered severe turbulence about 270nm northeast of Salt Lake City,UT (USA), that lasted for 114 seconds. The crew immediately turned the fasten seat belt signs on upon onset of the turbulence, the aircraft's airspeed increased but did not exceed MMo, autopilot and autothrust remained engaged throughout the encounter, the vertical speed (climb rate) varied between 540 and 1400 fpm with vertical accelerations between 0.44 and 1.63G. As result of the turbulence one passenger received a serious injury (fracture of the left leg's ankle), when she was thrown up into the air and twisted when hitting the floor again. The aircraft continued to Dubai for a safe landing about 13.5 hours later.

On Oct 1st 2020 the UAE GCAA released their final report concluding the probable cause of the accident was:

The Air Accident Investigation Sector determines that the cause of the Accident was the acceleration forces imposed on the Aircraft as it flew through an area of clear air turbulence, which resulted in an unsecured passenger forcefully impacting cabin furnishings in the lavatory.

Contributing Factors

Lack of placarded instructions and inaccessibility of the handholds within the lavatory for use in case of turbulence.

The GCAA analysed:

Upon hearing that other Aircraft were reporting to air traffic control (ATC) that there was light turbulence below FL290, the flight crew were aware that the OFP indicated insignificant shear rates of either ‘zero’ or ‘one’ for any turbulence between FL330 and FL350 over the Rocky Mountains, Wyoming. In addition, ATC had not communicated to UAE216 any pilot reports or turbulence beyond FL290. Thus, the flight crew did not believe that there was any threat to the Aircraft as it followed the planned route.

The Investigation concludes that the turbulence encounter was not associated with wake vortices as there was no other aircraft close to the flight level of UAE216. Because there was no active weather system over the ridges of the Absaroka Range, it is possible that the unanticipated clear air turbulence encountered by the Aircraft was related to the formation of mountain waves.

Within a few seconds of the onset of the turbulence, the flight crew reacted appropriately by immediately turning the seatbelt sign ON and directing the cabin crew to be seated. The Operator’s standard operating procedures for a turbulence encounter were followed, including reporting the turbulence to ATC and communicating with the Operator’s medical support team to determine whether to continue the flight to OMDB, taking into consideration the passenger injury.

Cabin Safety

In case of unanticipated turbulence, for a person occupying a lavatory, except for lavatories specifically equipped for use by people of determination, there was no standardization of handholds in terms of number and orientation. Some lavatories had one handhold and others had two with the handholds oriented either horizontally or vertically. For a person standing and facing the sink, there was no handhold within easy reach in case of turbulence.

Similar to the turbulence occurrence of 19 July 2019 (AIFN/0009/2019), the injury was sustained by a passenger in the aft cabin. Thus, without placarded instructions and sufficient handholds or other means for occupants to secure themselves during unanticipated significant turbulence, injuries will most likely reoccur.

The Investigation could not determine whether the deficiencies related to the lavatory handholds contributed to this Accident as it was not possible to interview the injured passenger.

However, the description by the passenger of being “forced up in the air” during the turbulence indicates that, most likely, the passenger was unable to make use of the single handhold in the lavatory to secure themselves.

Handholds should be located such that in case of unanticipated turbulence, they are easily accessible when the person is seated or standing and when using the lavatory sink. The Investigation believes that the repeated injuries to persons occupying the lavatory may suggest that the placement of the handhold are insufficient and not easily reachable.

The Investigation recommends that the Operator standardize and improve the
accessibility of the lavatory handholds, having regard to optimum ergonomic design requirements, and also include simple placarded instructions on the use of the handholds in case of turbulence.