Swift AT72 at Palma Mallorca and Madrid on Feb 19th 2021, tyre damage on departure
Last Update: June 13, 2022 / 20:09:08 GMT/Zulu time
Incident Facts
Date of incident
Feb 19, 2021
Classification
Incident
Airline
Swiftair
Departure
Palma Mallorca, Spain
Destination
Madrid, Spain
Aircraft Registration
EC-LYJ
Aircraft Type
ATR ATR-72-200
ICAO Type Designator
AT72
On Mar 25th 2021 Spain's CIAIAC reported upon arrival maintenance discovered the tread of the #2 tyre was missing and informed the crew, who indicated they had not noticed any event.
The CIAIAC continued an aircraft departing Palma Mallorca the following morning at 08:07L (07:07Z) reported the presence of tyre debris on runway 24R. The tyre debris was subsequently cleared from the runway.
The CIAIAC reported the aircraft received minor damage and opened an investigation into the occurrence.
On Jun 13th 2022 the CIAIAC released their final report concluding the probable cause was:
The probable cause of the incident is considered to be the perforation of tyre number 2 on the left main gear by an external object (FOD), which caused the tread to detach.
The CIAIAC analysed:
On Friday, 19 February 2021, at 23:30 H, the ATR-72-212A aircraft landed at Madrid - Adolfo Suárez Airport having lost the tread on the No. 2 tyre of its main landing gear.
After the operator reported the incident to the Madrid Airport Management Centre at 00:19 h on 20 February, an inspection was carried out along the route taken by the aircraft but did not find any debris from the tyre.
At the aircraft’s departure airport, Palma de Mallorca, the crew of a flight taking off reported the possible presence of tyre debris on the runway on Saturday, 20 February at 8:07 h.
A runway inspection was subsequently carried out, confirming the presence of tyre debris and triggering the process to remove it.
Our review of the aircraft’s maintenance history did not identify any problems or abnormalities. With specific regard to the review of the retreading, no defects that could have weakened the tyre’s internal structure were observed.
Of the meteorological conditions
No conditions, such as crosswinds or high temperatures that could have affected the geometry of the tyre rubber while taxiing, were recorded.
Of the operation.
According to the crew, the aircraft taxied normally, without the need for excessively sharp turns or manoeuvres that could have affected the wheel’s structure.
According to the documentation provided by the operator, neither the weight and balance nor the inflation pressure records for the incident flight show anything to suggest excessive load on the landing gear.
Furthermore, there was no record of any previous issues that might have affected the proper functioning of the landing gear.
Of the wreckage
Between 30% and 40% of the detached tread was recovered during the additional unscheduled runway inspection. A detailed analysis of the fragments revealed the presence of a cut whose origin is compatible with the tyre having rolled over a foreign object, initially puncturing the tread in sector 4 and subsequently causing it to detach completely.
The fact that no foreign object was found on the runway does not rule out the possibility that this may have caused the incident. In some instances, tyres may not fail immediately after puncture due to the circumstances involved in the event (impact energy, depth of the perforation) and the characteristics of the FOD (profile), which dictate the internal damage sustained and how long the tyre can resist. Therefore, an event of this type can occur several landings and take-offs after the tyre is punctured.
Of the management of the situation.
In terms of the chronological development of the events, the following aspects stand out:
The crew did not notice the tyre tread detachment at any point.
The operator’s maintenance staff detected the incident after the aircraft arrived at Madrid Airport, reporting it to the Madrid Airport Management Centre at 00:19 h. At 00:48 h, the operator’s personnel were informed that no debris had been found, and it was agreed that they would report the event to the flight’s origin airport, Palma de Mallorca.
Palma de Mallorca Airport, however, did not receive any notification in this regard until 08:07 h, when an aircraft that was taking off from runway 24R of said airport alerted them to the possible presence of tyre debris on the runway. It was only then that an unscheduled runway inspection was carried out, and the tyre debris was found.
Therefore, the runway remained contaminated for almost eight hours after the incident was first detected.
Although company procedure was initially followed and the appropriate notification made, it was not monitored until its definitive closure. We are, therefore, addressing a security recommendation to the operator, SWIFTAIR, proposing it establish the appropriate measures to ensure notifications are monitored until their definitive closure.
In a separate issue, two scheduled runway inspections, one between 23:00 h and 23:15 h and another between 07:27 h and 07:35 h, were carried out in the period between the incident flight taking off from Palma’s runway 24R at 22:00 h and the take-off at 08:07 h, from the same runway, of the flight that reported the debris. Both were carried out by highly experienced personnel and in line with the airport’s regulations on runway inspections, the first by one technician and the second by two. Neither found debris on the runway.
In this regard, irrespective of whether Palma Airport’s runway inspection procedures are well-defined and comprehensive in terms of the means to be used and the criteria to apply, the capacity to detect an object using visual inspection methods remains low. The problem stems from the fact that the inspections are visual and performed by one person, from a moving car that can travel up to 40 km/h and covers areas up to 30 m wide. In this case, the inspections were also carried out at night, and the objects to be located were the same colour as the asphalt of the runway itself. Obviously, the smaller the objects to be located, the more limiting these conditions are.
Palma Airport carried out runway inspection tests to check the capacity of personnel to find various objects, but despite knowing for sure the objects were there, they failed to locate all of them. It is clear that visual inspection methods are subject to limitations inherent to the human condition, making it impossible to guarantee that small objects will be detected.
Furthermore, studies on FOD indicate that small metallic objects are the most likely to be hazardous. However, the studies also show that they only account for a small percentage of all the FOD found on runways and that, in 80% of cases, they do not imply any consequences for aircraft operations, which explains why visual detection is still the primary method used at most airports, including Palma de Mallorca.
The new fixed and mobile FOD detection methods being developed are extremely expensive. Moreover, the fixed methods imply installing additional elements in the manoeuvring area, which could potentially compromise operational safety, and the mobile methods still need to be improved in terms of their execution times and ability to avoid false alarms.
Taking all these factors into account, we have decided not to issue any recommendations in regard to implementing new detection methods, but we are issuing a security recommendation to propose that Palma de Mallorca Airport study the possibility of improving the current inspection procedure.
Incident Facts
Date of incident
Feb 19, 2021
Classification
Incident
Airline
Swiftair
Departure
Palma Mallorca, Spain
Destination
Madrid, Spain
Aircraft Registration
EC-LYJ
Aircraft Type
ATR ATR-72-200
ICAO Type Designator
AT72
This article is published under license from Avherald.com. © of text by Avherald.com.
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